December 6, 2006
Volume 8, Issue 25
Midwifery Today E-News
“Pain Relief in Pregnancy”
Print Page

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Attend the full-day class with Barbara Harper and discover the unique psychological and physical properties of water that make it so beneficial to birthing women. You'll learn that breech births, OP births and twin births can all benefit from waterbirth. Barbara will also discuss the concerns about and potential risks of water labor and waterbirth. She will report on clinical findings, current research and models from various places around the world, as well as share her hands-on experience. Part of our March 2007 conference in Eugene, Oregon. Go here for info.

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In This Week’s Issue:

Quote of the Week

"My involvement with midwifery has been the very best life I could have. I feel I have been living on sacred ground."

Jan Tritten

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The Art of Midwifery

Grind comfrey root using a mortar and pestle or grinder and mix it with hot water to make a paste. New mothers can apply it to their perineum after birth to help heal tissue.

April, Midwifery Today Forums

ALL BIRTH PRACTITIONERS: The techniques you've perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to

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Passionate Midwifery Education

Elizabeth Davis, Part II
More from Elizabeth Davis' Education Workshop in Germany

Elizabeth Davis asks "What is it about conventional education that didn't work for me?"

We were not allowed to show our intuitive side. Women want context. They are aware of what is going on in the room. Women want to know why they need to know something. Give them context; they need to know who, what, where and why.

We are taught in a male model that is a brick building model, piece by piece. We are not supposed to ask why. They will tell you at the end.

Female thinking is spiral, circular. We spiral around looking at the same material from different aspects. As we climb the spiral we are seeing different views. Imagine making a spiral pot from rolled clay. Many of us did it in grade school.

A woman will ask for the opinion of every friend she knows, even though she will likely receive opposing views. After considering everything, she will make her decision. We are like a cauldron sharing half-baked ideas, stirring them up in a brainstorm.

Men are the opposite. In infancy boys are into tangible objects. Girls are more interested in the human face. Women can multitask—they are comfortable with many ideas and tasks coming at the same time. These distinctions in style make a huge difference in your educational program. If the program you choose is designed on the male model, the fit might not work for you. Doing midwifery requires that you learn to tap into your feminine side, because the women we are with will be best served by this side of you. This is especially so since they are going through an event that is ultimately female.

This editorial is adapted from Elizabeth's wise words. To inquire about her school, e-mail her at:

love, Jan
Jan Tritten, Mother of Midwifery Today

To read all installments of our column on midwifery education, go to our Better Birth and Babies Blog.

Editor's Note: We received this letter in response to the Passionate Midwifery Education column.

RE: education opportunities [E-News Issue 8:22]: Might I suggest that aspiring midwives who decide to acquire licensure in California, check first with the Medical Board of California (Licensing Operations) to determine whether the midwifery school advertised has been approved by the Board and is accredited through either MEAC, ACNM or their state department of health and education. Not doing the research might delay the prospective midwife in acquiring the approved training and education and most definitely delaying licensure in California.

This could also apply to those who reside in Florida and Washington State, as California has reciprocity with those states. This consideration will most probably save time, money, and a lot of frustration.

Herman W. Hill, Jr.
MBC-Licensing Operations

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Pain Relief in Pregnancy

Back pain affects as many as 80% of pregnant women. During pregnancy, joints throughout the body become more mobile. The spine can be more easily sprained or pulled into suboptimal alignment, causing muscle spasm, inflammation, pain and a decrease in functional and recreational activities.

Weight gain, the majority of which is distributed at the abdomen and breasts, shifts the woman's center of gravity forward and upward, resulting in posture changes. These changes place stress on the muscles and ligaments surrounding the spine, which can also lead to pain and functional limitations.

Several safe, effective treatments can help women manage their pain and optimize their well-being throughout pregnancy and into the postpartum period. Among them are physical therapy and chiropractic treatment.

Physical Therapy

After evaluating the woman's posture, spinal and pelvic alignment, joint mobility, muscle flexibility, strength and tone, a physical therapist (PT) can perform safe, gentle techniques to realign joints, improve joint motion and reduce muscle spasm. In addition, a PT can design an exercise program specific to the client's needs in terms of muscle strength and flexibility, and teach her how to move, position herself during sleep and optimize her posture during daily activities. Moist heat or cold packs may be used to help reduce pain and spasm.


  1. Postural retraining will help during pregnancy and throughout motherhood to decrease stress to the spine, thereby decreasing risk of injury.
  2. The pregnant woman can stop seeing the PT and continue independently with her individually designed exercise program when she is ready.
  3. Most health insurance covers the cost of physical therapy.


  1. Depending on the facility, patients may not receive one-on-one treatment.
  2. Not all therapists are experienced in treating pregnant women.

Chiropractic Treatment

A chiropractor experienced in treating pregnant women will assess posture, alignment, muscle tone and mobility for regions of restricted movement or malalignment that may contribute to swelling, pain and muscle spasm. S/he will then use various techniques to adjust, manipulate or realign the joints. Some chiropractors will also recommend appropriate stretching and strengthening exercises to help maintain the corrections in alignment.


  1. An effective way to correct alignment problems.
  2. Effective if done in conjunction with appropriate stretching and stabilization exercises.


  1. Can be costly, depending on insurance.
  2. Manipulating joints that are already more mobile may result in pain and injury if done incorrectly.
  3. If done without incorporating exercise, relief may be temporary.

Alicia Silva, excerpted from "Treatment Options for Back Pain in Pregnancy," The Birthkit Issue 48

Want the whole story? Order your copy of The Birthkit Issue 48.

Midwives and chiropractors have many similarities in approaches to health care. Both groups share an acknowledgment of, and trust in, the body's inner wisdom. Chiropractors call this wisdom "innate intelligence." When allowed to perform without interference, innate intelligence coordinates the responses to the body's needs at any given moment, thus maintaining the body's optimal health.

In chiropractic, we recognize that this inborn wisdom uses the nervous system as its conduit to transmit electric-like impulses of intelligence to all systems and functions of the body, thus maintaining a state of homeostasis and balance. Mechanical stress to the nervous system by the bones of the cranium and spine may interfere with this normal transmission of intelligence and result in a state of dis-ease. Chiropractors call this nerve stress "vertebral subluxation." Specific chiropractic adjustment reduces the pressure from the nervous system, restoring the pathways of transmission, thereby allowing for better overall function of the body.

Since discovery of the Webster Technique, its protocol has been revised to include women of all stages of pregnancy. Doctors of chiropractic reported a greater than 85% success rate in the technique's ability to balance pelvic structures and remove constraint to the woman's uterus, thereby allowing the baby to turn into the vertex position. The Webster Technique is becoming an important part of prenatal care for all women looking to optimize their potential for more natural deliveries.

Jeanne Ohm, excerpted from "Midwifery and Chiropractic: Bonding for Life," Midwifery Today Issue 69

Want the whole story? You can read more about midwifery and chiropractic care in Midwifery Today Issue 69. Make sure you always get the whole story. Subscribe to Midwifery Today magazine, a 72-page quarterly print publication.

The buoyancy of water benefits pregnant women by allowing them to tone their muscles with minimum stress. I discovered also that isolation exercises from Middle Eastern dance combined with the hydrostatic pressure of water promotes increased flexibility of joints throughout the body, reduces swelling and improves circulation.

Conscious breathing while isolating different parts of the body leads to greater awareness of the body and thus a deeper connection with ourselves and our healing potential. The focus is on breathing deeply, staying in the moment, relaxing, and releasing muscle tension and body discomforts with each breath. Letting go with the breath means breathing discomfort out.

AquaNatal encourages women to discover how specific areas in their bodies respond to breathing and moving. Women have interesting realizations as they learn how to isolate and observe movements. Each woman discovers which parts of her body have greater agility, which have less, which have not been used except in connection with another part, where she is holding tension, and how to release body or emotional tension with her breath.

Marina Alzugaray, excerpted from "American AquaNatal," Midwifery Today Issue 59

Want the whole story? You can read more about AquaNatal in Midwifery Today Issue 59. Make sure you always get the whole story. Subscribe to Midwifery Today magazine, a 72-page quarterly print publication.

You Grew in My Heart Pendant

Give Birth Jewelry this Holiday Season
The "You Grew in My Heart" Pendant is perfect for your mother or grandmother. Also available as a slightly smaller charm.

News Flash

Records of 3 million Canadian hospital births between 1991 and 2002 were reviewed to assess whether a connection exists between medical induction of labor and incidence of amniotic-fluid embolism (AFE). Researchers found that AFE occurred nearly twice as often in women who had medical induction of labor than in women who did not. Fatal cases occurred 3.5 times more often. AFE, which is considered a rare and sometimes fatal maternal complication of delivery, is an obstetric emergency in which amniotic fluid, fetal cells, hair, or other debris enter the maternal circulation, causing cardiorespiratory collapse. The population-based study was funded by the Canadian Institutes of Health Research Institute of Human Development, Child and Youth Health.

The Lancet, October 21, 2006.

Products for Birth Professionals

Looking for a good appointment book for the new year?

MT tote bag You need With Woman—a 15-month appointment book and resource guide for midwives, doulas, childbirth educators and lactation specialists. You'll appreciate the reference guides and resources, the space for listing appointments and client information, and the handy pocket for your business cards or gestational wheel. Order one now!

Rediscover the hidden wisdom of birth.

Let Birth Be Born Again

Read Let Birth Be Born Again for information that will help you restore birth to its rightful place as a safe, simple and exciting family event. Author Jean Sutton says, "Most women, mothers and midwives have deep inside them the 'women's wisdom' of generations gone before. It tells us that what is happening is not right, and makes us uncomfortable as we carry out the protocols laid down for us." This book helps us rediscover this hidden wisdom. Click here.

Fill 2007 with Photos of New Life!

Into Being 2007Put Harriette Hartigan's 2007 Into Being calendar on your wall and fill your year with heart-warming black and white photos of pregnant moms and newborns. What a lovely gift for your midwife or doula, your pregnant friend or relative, your mother, your grandmother or anyone who loves babies.Click here.

Show your clients that a good birth is possible.

The Birth as We Know It DVD features 11 natural births, including the home waterbirth of twins, a breech delivery and a birth in the Black Sea. It also includes interviews and footage on related topics such as the sexuality of childbirth, circumcision, limbic imprint and c-section. Order the DVD.

Birth as We Know It

Love and Life

Give the Love and Life print to someone you know who loves birth.
This fetus with a heart, printed in eye-pleasing swirls of blue, purple and pink, is perfect for a midwife's office or a baby's room.

Midwifery Today Magazine Issue 68Give the gift of information! You'll save $5 per subscription when you order two one-year Midwifery Today subscriptions at the same time. And one of these can be your own renewal or new subscription!

Web Site Update

The complete program and registration form for our Costa Rica 2007 Conference are now online. Check out the amazing class offerings and expert teachers at this conference.

Advertising Opportunities

Eugene, Oregon, Conference 2007

Join Midwifery Today at our next conference, "Midwifery Leading the Way," to be held in our home town of Eugene, Oregon, March 14–18, 2007. We expect a great turnout, so start planning to be a part of this exciting conference. Whether you exhibit, put an ad in the program or send inserts, you don't want to miss this opportunity!

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Give Birth Jewelry this Holiday Season
Baby EarringsAnyone who loves babies will love wearing the Baby Earrings. Just $13 a pair, these lovely sterling silver earrings make great stocking stuffers. Order the earrings.

Forum Talk

I hear so many stories of women's milk drying up during pregnancy. I don't want to do anything to compromise my nursing relationship with my daughter when I conceive again. I wonder if there is a foolproof way to make sure you have plenty of milk during pregnancy. Or does it depend on genetics and you just don't know what to expect until it's too late?

Charlotte, North Carolina

Go to our forums to share your thoughts and experience.

Question of the Week

Q: What do you recommend for pregnant moms who are dealing with mild depression, mood swings and blues?

— Anon.

SEND YOUR RESPONSE to with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.

Womb with a View

Give Birth Jewelry this Holiday Season.

The Womb with a View Pendant is the perfect gift for your midwife or doula. Show her how much her care means to you! Also available as earrings.

Question of the Week Responses

Q: I am a new midwife from Victoria, Australia. The midwifery-led unit I work in is being pushed into providing an obstetric model of care (by the obstetricians) rather than the current woman-centred model of care. This has resulted in the introduction of a protocol requiring that a vaginal assessment be carried out within 1–4 hours of arrival at the unit and 4–6 hourly until babe is born.

This current protocol will remain unchanged unless we can produce some evidence/research supporting nonintrusive methods of assessment. The majority of the midwives, including the unit manager, do not want to see this become policy, and a focus group has been formed to address this issue. Can readers point me in the direction of research that addresses the impact that invasive interventions such as vaginal exams can have on a woman and her childbirthing experience, and any alternate methods of assessment?

— Amy Corlass

A: Seward, et al., Excess Digital Exams Raise Risk of Chorioamnionitis, OBGYN News, August 1997. "The risks of chorioamnionitis increase with the number of vaginal digital exams performed during labor and with the length of active labor."

— Amy Haas

A: Is it possible for the obstetricians to provide proof that their suggested methods cause a positive impact, or do not cause negative impact? I didn't think so. They want to change it. Make them prove it.


Responses to any Question of the Week may be sent to E-News at any time. Write to Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.

Think about It

The hardest part of learning midwifery is being included in the birth setting itself. There are many ways to study the scientific and obstetrical arts of midwifery. There are schools, study groups, conferences, Internet classes and intensive hands-on programs.

These types of learning offer an essential insight into the world of midwifery, but they are not the real midwifery we lovers of birth struggle for. We desire the intimate relationships prenatal, birth and postpartum care offer. We want to serve our mentors and our women and really learn the secrets only a practiced midwife can share. The desire is to learn the way our grandmothers and their grandmothers did, by being taken under the wing of a respected, beloved midwife of the village.

Practicing midwives, seasoned midwives, please open yourselves up to those who desire knowledge. Tell your birth stories, reveal your intuitions, welcome an apprentice. It is in sharing life lessons that a midwife is born, not by reading a book, or by knowing how babies grow and come out. Midwifery is born by attending laboring women.

Amanda Moore, excerpted from "Birth of a Midwife," Midwifery Today Issue 61

MIDWIFERY TODAY Back Issues are available online. Issue 61

Classified Advertising

Use theatre for social change! BOLD is a global movement to make birth mother-friendly. Join our online book club or organize a BOLD performance in September 2007. Visit:

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