September 10, 2008
Volume 10, Issue 19
Midwifery Today E-News
“Sudden Infant Death Syndrome”
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Order this issue of Midwifery Today and read what Marsden Wagner has to say about misoprostol induction of labor. You'll also find an overview of drugs in labor by Sarah J. Buckley. Other articles include HIV and Pregnancy, Compassionate C-section, and Placental Rituals, Placental Medicine.
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When you attend the full-day Breech Birth: Many Approaches class you'll learn how to turn breech babies, what to do if they won't turn and how to work with breeches in waterbirth. The class will cover palpation skills, estimating fetal weight, amniotic fluid, and communication with baby by touch and words. You'll learn about frank, footling and complete breech, and how to stay calm. Part of our conference in Bad Wildbad, Germany, October 2008.

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What do you want to learn about birth and midwifery?

When you attend our conference in Eugene, Oregon, in March 2009 you'll be able to choose from a wide array of important subjects. Planned classes include

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In This Week’s Issue:

Quote of the Week

"What makes pain intolerable to women is fear. What takes the fear away is knowledge, relaxation and focus. Yes, when these things are incorporated, there will still be pain but it will not be intolerable. Remember, you are hearing this from a certified wimp."

Gloria Lemay

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The Art of Midwifery

Anytime you can get your name and message in front of your target market, you have the chance of getting a new client. Blogging allows you to educate your potential clients and convinces those women that you know what you are talking about. It is one of the quickest, easiest ways to get out the information that people need to know about you and about the services you provide. Generally most people have little or no idea that a business like yours exists and they certainly don't realize just how beneficial it will be for them. Because not many midwives use it yet, blogging will put you ahead of your competition and allow you to attract more clients. It's better than a basic Web page, because it catapults you into the search engine, therefore getting your and your business noticed more expeditiously.

Sheri Menelli and Anne McManus
Excerpted from "Blogging to Boost Your Birthing Business," Midwifery Today, Issue 85
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A study of Sudden Infant Death Syndrome (SIDS) deaths in the UK from 1984 to 2003 showed significant changes in the factors leading to death. Two notable changes have been an increase in the percentage of SIDS deaths that occur when one of the parents sleeps with the baby on a couch, and a higher proportion of SIDS deaths now occurring in economically disadvantaged families. While further studies are needed, parents are advised to avoid sleeping with their babies when possible, particularly outside of the bedroom.

Lancet 367(9507): 314–19, 2006

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Sleep Position and SIDS

When my daughter was born in 1978, I was told that she should never sleep on her back; she might choke, be unable to turn over and die. Instead, the nurse practitioners recommended putting her on alternate sides, with a pillow behind her back to prevent her from rolling over. They told me that placing her on her stomach might cause her head to flatten on one side, so alternating sides was the best approach.

I was horrified when I found that my daughter's cousin, born a month after her, was sleeping on her back so I told her mother how dangerous it was. Fourteen years later, in 1992, the American Academy of Pediatrics (AAP) recommended that babies not sleep only on their stomachs, because researchers had shown a correlation between stomach sleeping and Sudden Infant Death Syndrome (SIDS).

Only a few years later, the National Institute of Child Health and Human Development, the Maternal and Child Health Bureau, the American Academy of Pediatrics (AAP), the SIDS Alliance and the Association of SIDS and Infant Mortality Programs implemented their Back to Sleep public education campaign [named for its recommendation to place healthy babies on their backs to sleep] with federal funding. Considered a huge success, this educational campaign also advised parents to provide a firm mattress and not to put pillows in with babies or smoke around them. The SIDS rate declined from 12 deaths per 10,000 babies to 5.7 deaths per 10,000 babies—a decrease of about 53%.

One thing not mentioned in this campaign was the SIDS risk caused by fungus and chemicals found in babies' mattresses. From 1988–1989 Barry Richardson, a British chemist, tested the mattresses of 200 babies that had died of SIDS and found all of them infected with S. brevicaulis fungus and spores and phosphorus, arsenic or antimony; and when brought to body temperature, each generated toxic gas from these chemicals. Ninety-five percent of the mattresses had been used previously by another infant, as well. This information, while published in Midwifery Today (Issue 61, Spring 2002,, was never made widely available in the US.

In 2005, the AAP advised parents not to place babies on their stomachs or on their sides to sleep. It seems that several studies had shown in increased risk of SIDS in relation to side- or back-sleeping, particularly when the baby has symptoms of infection. And the wheel goes round.

Despite these well-publicized recommendations, according to an article in The New York Times (18 Oct 2005), increasing numbers of parents are letting their babies sleep on their stomachs. The article quoted an unscientific internet poll which showed that virtually equal numbers of parents put their babies to sleep on their stomachs (42%) as on their backs (43%). This is quite an increase from the 2002 statistic given by the National Center for Health Statistics (NCHS) of 11.3% of parents whose babies slept on their stomachs, but not anywhere near the 70% of babies that slept on their stomachs in the mid-1990s. So why are parents taking this risk with their babies' lives?

Parents who admit to putting their babies to sleep on the stomachs are clear on why they do so: the babies sleep better and are more likely to sleep through the night sooner. Even the Academy admits this.

Another reason that parents may be averse to always placing babies on their backs to sleep is positional plagiocephaly, or malformation of the head. According to the AAP, this issue still needs more study to determine whether a correlation exists. It is something that parents should be aware of if their baby is back-sleeping.

Interestingly, even medical professionals don't feel obligated to follow these guidelines in many cases. According to the AAP position paper, hospital personnel often place preterm babies on their sides or stomachs during hospitalization, modeling such management to parents and perhaps accustoming the babies to this position.

An interesting study from California showed that infants who were not used to sleeping on their stomachs were at greater risk when sleeping that way than those who were used to sleeping on their stomachs.

Cheryl K. Smith
Excerpted from "Go to Sleep, Little Baby," The Birthkit, Issue 50
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  Midwifery Today Issue 85

Learn how sexual abuse affects women during pregnancy and childbirth and what you can do to help.

Survivor Moms

Survivor Moms: Women's Stories of Birthing, Mothering and Healing after Sexual Abuse was written to help break down the isolation pregnant women and their caregivers often feel—as though they were the only ones having to cope with these challenges. You'll be able to read excerpts from 81 women's stories of birthing, mothering and healing after childhood sexual abuse. The book also includes some complete narratives, discussion of implications of women's experiences for their care, suggestions for working together during maternity care and beyond, resources to consult, and information from current research.

Suitable for both caregivers and pregnant survivors, Survivor Moms will help anyone whose life has been touched by sexual abuse. Published by Motherbaby Press, an imprint of Midwifery Today. Get the book.

SIDS rates declined significantly from 1989–1991 to 1995–1998, while deaths reported as cause unknown/unspecified and other sudden, unexpected infant deaths, such as accidental suffocation and strangulation in bed (ASSB), remained stable.

According to a study published in 2006, from 1999–2001 the decrease in SIDS rates was offset by an increased rate of deaths classified as "cause unknown/unspecified" and "ASSB." The researchers concluded that "most of the decline in SIDS rates since 1999 is likely due to increased reporting of cause unknown/unspecified and ASSB."

American Journal of Epidemiology 163(8): 762–69, 2006

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Web Site Update

Reviews of the Motherbaby Press book "Survivor Moms: Women's Stories of Birthing, Mothering and Healing after Sexual Abuse" have been posted online with links from the Motherbaby Press pressroom.

Read this excerpt of the article "Homebirth after Cesarean: The Myth and the Reality" by Amy V. Haas from Issue 86 of Midwifery Today newly posted online.

"'Homebirth after cesarean' is a phrase that garners mixed reactions—most of them negative. 'Why?' or 'Are you insane?' they ask. The people who make these comments, however, usually have no idea about the realities of birth in the US.
"My phone rang one afternoon. It was a woman looking for a care provider to attend the birth of her next child at home. I offered to send her the midwives list.
"'I won't go back to a hospital unless I am unconscious,' she told me."

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Question of the Week

Q: When my daughter's pregnancy was first confirmed she was happy, eating well and putting on a pound a week. She was given pre-natal vitamin supplements and a week after she started taking them she began to get violently ill. She couldn't tolerate even the smell of toast, had vomiting and diarrhea and was living on baby food, as that was all she could keep down.

She had to be taken to emergency as she was so weak and dehydrated, even though she had tried very hard to drink plenty of water. She had to be put on a drip for fluids and couldn't even walk as she was so malnourished. She initially had put on 10 pounds, which she lost in a couple of weeks. Because she is a very petite girl she couldn't afford to lose much more. I really thought she was going to die. She lives in [the] US, so I could talk to her through Skype and I felt useless to help her.

They told her that she had a condition—hyperemesis gravidarum (HG)—that affects some pregnant women and causes this type of thing. I suggested maybe she shouldn't take the supplements, as I had heard that certain things like iron that aren't slow release can make you sick. At first she was worried about stopping them, as she thought that her baby was going to suffer. She was so desperate she thought she would try it, and within a few days she was back to her old self again. Even though she was very small she had always been a good healthy eater.

When she finally got an appointment with a doctor, she was given three other samples to try and each time she took one she was very sick. I've spoken to many doctors and they think it is a coincidence. I think not! She has stopped taking them all together and has regained her weight and is fine. I have researched about supplements and they all can cause problems and all the professionals say that you don't need these if you eat a healthy diet which she always has done.

Have other women out there been sensitive to these supplements? I hope that this information may help someone out there who encounters a similar problem.

— Teresa

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.

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Question of the Week Responses

Q: I am in my third trimester of pregnancy and my husband is complaining that I am snoring—sometimes so loud that he has to sleep in another room. Is this related to the pregnancy? Will it stop once I have the baby? Is there anything I can do in the meantime to minimize or stop it?

— Sue Miller

A: I'm sure that everyone who read your question had the same first reaction that I had: you are snoring because you are sleeping on your back, no? Most of the time? You could sleep on your side with lots of pillows supporting your belly but after a while it's just not that comfortable (what is?!). And do you really care that he goes into another room? Sounds like a perfect solution to me—more room for you! Anyway it won't be long before you're all snuggled in bed together and you won't be snoring…of course there is that crying baby thing…breathe deeply.

— Donna

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

According to a study of 13,000 children at Brunel University in the UK, women who use a lot of household cleaning products during pregnancy or shortly after birth increase baby's risk of developing asthma. They found a 41% increase in the child's chance of developing asthma by age seven, even taking into consideration family history and other variables.

So it's better to spend time playing with baby than cleaning the house in those first years—since children who are exposed to bacteria and dust have healthier immune systems than those who live in pristine homes.

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ALERT: Dr. Phil asking for only horror stories about midwives

I would like to bring your attention to the link below and would ask you to write to Dr. Phil with your story. They appear to be asking for midwife horror stories. I want to swamp him with stories about great experiences and for the midwives to write and tell their stories. I think it would really help for them to see how people really feel.

I am very annoyed that he has specifically asked for the bad stories. I'd really like them to hear about the bad hospital births! But it is Doctor Phil after all!

Please send your story in. It may not do any good, but we can only try. To be silent will help no one.

Midwives, please send this link to all your clients and ask them to send their story in. Please forward to your clients and friends.

[Sent to Midwifery Today E-News by Judy Ritchie]

After seeing the movie The Business of Being Born and talking to some people, I thought about how great it would be if Oprah did a show about birthing in the US—the increasing c-section rate, birthing in other countries, homebirths, the increase in interventions and the Business of Being Born (perhaps interviewing the director and Ricki Lake). She has such a large audience that she could potentially inform and educate millions of women. So I went to her site and e-mailed the show my idea. Then I posted my message on the "birthing naturally" board of and this is one response I received:

"I was at a Q&A with Abby Epstein & Ricki Lake back when BOBB was just being premiered and they said at that time that Oprah (or at least her producers) had declined doing a show on it because it didn't have 'mass appeal.' Maybe if enough people let her know they do want it, she will."

So, here is the link in the hope that they will realize this topic does have "mass appeal." Please e-mail [the show via this contact page]:

Danielle J. Garcia

Joy Jones is collecting names of caregivers who would like to be included on her Web site,, as supporters of the use of the Brewer Diet—so that people around the country will be able [to find] such caregivers in their area. Send contact information for obstetricians, midwives and other pregnancy caregivers to Joy at

The homebirth midwives in Israel have to deal with the Ministry of Health and Israel Midwives Assoc. now about the issue of some homebirth midwives doing VBACs. The debate is after a home-VBAC transfer for adhered placenta and hemorrhage (not in the scar). I need to know in what other countries (where homebirth is a recognized birthing option by the medical establishment), is VBAC considered an option at home. I am wondering about Holland, Germany, Canada, Australia, New Zealand, England, and various states of the US.

Thank you,
Ilana Shemesh
Midwifery Today Country Contact for Israel

Only letters sent to the E-News official e-mail address,, will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will not be considered.

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