September 24, 2008
Volume 10, Issue 20
Midwifery Today E-News
“Alcohol and Pregnancy”
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Survivor Moms: Women's Stories of Birthing, Mothering and Healing after Sexual Abuse
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Placenta: The Gift of Life
The role of the placenta in different cultures, and how to prepare and use it as medicine.



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In This Week’s Issue:


Quote of the Week

"Bacchus [the god of wine] has drowned more men than Neptune."

Giuseppe Garibaldi


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The Art of Midwifery

My experience has been that if labour is allowed to progress normally, outcomes for mother and babies are better. This does not mean that existing complications of pregnancy or potential problems in pregnancy are not assessed and dealt with expeditiously.

I feel that all too often the introduction of prostins and oxytoxic preparations, stretching of the cervix and early rupture of the membranes are deployed for varying reasons.

Manual manipulation of the cervix to force it to full dilation often ends with cervical incompetence, cervical tears, arrested labour and retained placenta.

My theory relative to retention of the placenta is that because all the normal processes have occurred prematurely, the readiness of the placenta to be detached is delayed. I refer to this as placental embarassment, commonly called retained placentas.

Movena Bowe-Clarke
Nassau, Bahamas
Excerpted from "Cards and Letters," Midwifery Today, Issue 74
View table of contents / Order the back issue


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 mtensubmit@midwiferytoday.com.


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Research

A recent study found that binge-drinking during early pregnancy did not cause spontaneous abortion, but having three or more episodes of binge-drinking, or consuming three or more drinks per week and having two binge-drinking episodes doubled the risk for stillbirth during the pregnancy. Binge-drinking was defined as having five or more drinks on one occasion. Of the nearly 87,000 Danish women studied, almost 24% reported at least one binge-drinking episode during the first 16 weeks of pregnancy, usually in the first 6 weeks.

While women are still wise not to drink during pregnancy, this study may help to assure those women who had a binge-drinking episode before learning that they were pregnant.

Obstet Gynecol 111: 602–09, March 2008

On the other hand, a study published in the American Journal of Epidemiology showed double the risk of cleft lip, palate or both in the babies of women who binged in the first trimester. The risk was tripled among women who had binged three or more times in the first trimester.

Am Journal Epidemiol 168(6): 638–46, 2008


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Reverse the Trend of Intervention

Birth, like the rest of life, has many unknown factors. Yet we all seem to have gotten here.

Creating more intensity around birth seems to have become the normal trend. Breech birth, twin birth and prolonged labor, along with postdates, have all become major reasons for surgical birth. Technology has replaced Mother Nature.

A new role in midwifery has evolved. We now must counteract all the medical sensationalism around birth and bring birth back to its simple and rightful place as a normal, natural passage.

How odd to have people who are not on the front lines of birth setting the standards. Policies and trends have become politically-based. Surgical deliveries are necessitated by statistics that have been misconstrued. By this I mean that statistics are not always interpreted accurately. A perfect example of this is the "term breech trial," in which the authors concluded that vaginal deliveries are not safe for breech babies. This added to problem of "cause-and-effect" for doctors, who are afraid of the normal birth process and believe they must perform major surgery to protect them from liability. In January 2006 an article in The American Journal of Obstetrics and Gynecology concluded that "the original term breech trial recommendation should be withdrawn" due to inaccurate accountability of information. The trouble is, as a result of this particular study 23 countries have since 2000 adopted policies mandating cesareans for all breech babies—a hard thing to reverse!

Henci Goer quotes a Colorado doctor in her book, Obstetric Myths Versus Research Realities, who believes that cesarean births are much too prevalent. He states; "It's hard to 'section' everyone, even if you want to, but I'm impressed at how well doctors are doing when they try!" This quip becomes a deep statement of what birth has actually become. "If it doesn't fall out, cut it out!" How have we gotten so far from the norm?

The issue of VBAC has now become a fight for survival. Historically we went from "once a c-section, always a c-section" to a safe trial of labor. We now are back to always a c-section. Why? Once again, inaccurate statistical information has led doctors to doubt the natural variations that birth presents. Instead, they choose to put women through major surgery and then leave them alone to care for their new babies and themselves. Has anyone noticed that the increase in use of uterine stimulants for labor induction or augmentation creates a higher rupture rate? Or that c-section, in general, follows a cascade of often unnecessary interventions? I really question the validity of the belief that all breech babies need to be surgically removed or that a trial of labor is not safer than surgery.

Unless we question and re-question some of these issues, the rates of surgical deliveries will continue to rise and become the norm. This could easily relegate natural birth to the status of novelty rather than choice. Stripping women of their birth experience through interventions and surgical deliveries interrupts Mother Nature's process—a process that empowers women through the intensity of birth, giving them the confidence to truly mother their children.

Jill Cohen, excerpted from "Reverse the Trend of Intervention," The Birthkit, Issue 50


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In 2002 and 2003, 4.3% of pregnant women ages 15 to 44 years old reported using illicit drugs during the prior month and 4.1% reported binge alcohol use. Pregnant women ages 15 to 25 years old were more likely to use illicit drugs than pregnant women who were between the ages of 26 and 44, but had similar binge alcohol use.

— Substance Abuse and Mental Health Services Administration (SAMHSA), US Department of Health and Human Services, http://www.oas.samhsa.gov/2k5/pregnancy/pregnancy.cfm


Web Site Update

Read reviews online of Motherbaby Press's newest book, Survivor Moms: Women's Stories of Birthing, Mothering and Healing after Sexual Abuse.

The three reviews include a review by the Sidran Institute for Traumatic Stress Education & Advocacy, one by Shari Maser for Midwest Book Review, and one by Amanda Topping, CPM, for The Birth Project newsletter.


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Question of the Week

Q: How do you bill for your work in the laboring process prior to passing the patient off to an MD for a c-section?

— Elizabeth Wilson


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


ed page graphicYou want to be a midwife but where do you start?

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Think about It

According to the Centers for Disease Control and Prevention, there are five things a woman should know about drinking alcohol during pregnancy:

  1. Drinking alcohol during pregnancy can cause a baby to be born with birth defects and have disabilities. These conditions, called fetal alcohol spectrum disorders, or FASDs, are among the top preventable birth defects and developmental disabilities. FASDs can cause problems in how a person grows, learns, looks, and acts. FASDs can also cause birth defects of the heart, brain, and other major organs. These problems last a lifetime.
  2. There is no known amount of alcohol that is safe to drink while pregnant. All drinks with alcohol can hurt an unborn baby. A 12-ounce can of beer has as much alcohol as a 5-ounce glass of wine or a 1-ounce shot of liquor.
  3. There is no safe time to drink during pregnancy. Alcohol can harm a baby at any time during pregnancy. It can cause problems in the early weeks of pregnancy, before a woman even knows she is pregnant.
  4. Too many women think drinking alcohol during pregnancy won't hurt their unborn baby. About 1 in 12 pregnant women in the United States reports alcohol use. And about 1 in 30 pregnant women in the United States reports binge drinking (having five or more drinks at one time)*.
  5. Fetal Alcohol Spectrum Disorders are 100% preventable. Fetal alcohol spectrum disorders are 100% preventable—if a woman does not drink alcohol while she is pregnant.

*In these findings, binge drinking was defined as having five or more drinks at one time. More recently, the definition of binge drinking for women has been changed to four or more drinks at one time.


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Feedback

I'm not sure if there has been any ongoing response to the letter sent to Midwifery Today E-News by Zora (E-News, Issue 2:52). I appreciate the response that Sandra Stine, CNM, submitted and considering the state of midwifery almost eight years later [it] still remains succinct.

This year I attended the CAM annual conference and was made aware of the 2% goal—2% homebirth goal.

Thank you for your ongoing efforts on behalf of midwives, mothers and babies!

Shelagh Carrick, LM


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


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