October 8, 2008
Volume 10, Issue 21
Midwifery Today E-News
“Stretch Marks”
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Quote of the Week

"Ultimately, risk, like beauty, is in the eye of the beholder."

Dr. M.F. Green

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The Art of Midwifery

As midwives, we know that every woman has different tissue and skin integrity. This is evidenced by the color of our skin and the amount of stretch marks we find on our bodies. Supplements like Vitamin C and omega fatty acids will help strengthen this integrity, but it's unknown if it makes a measurable difference. We've all heard the theories about genetics, smoking, proper nutrition, etc., in regards to tissue integrity and pliability.

During a normal, spontaneous labor free of judgment and negative observation, vaginal tissues respond to hormones by increasing secretions, blood flow and sensation. As the baby moves down, the vagina is more relaxed and open. If a woman feels inhibited or pressured, it creates interference in these hormones and increases the risk of perineal trauma.

Hydration in labor is vitally important, as we are all aware. However, over-hydration, i.e., IV fluids, can swell the tissues to a point where there is very little give or elasticity.

Pamela Hines-Powell
Excerpted from "Honoring Body Wisdom," Midwifery Today, Issue 74
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"In a double-blind study published in the 1991 International Journal of Cosmetic Science, 34 percent of pregnant women who massaged a cream containing gotu kola extract (Centella asiatica), alpha tocopherol (a form of vitamin E) and collagen-elastin hydrolysates (enzymes) into their skin developed stretch marks, compared with 56 percent who used a placebo."

New York Times, 29 May 2008

Home Remedies for Stretch Marks

The last weeks of pregnancy can be a growth-filled time on many levels. The baby is bulking up on fats, putting on weight to sustain herself during that period between the birth and the time when breast milk comes in. A mother's growing belly at this stage is amazing—it may seem as if there won't be enough skin to grow with it. Some women report gaining a pound or two per week as the harvest time draws near. Good attention to this inevitable reality in the earlier part of pregnancy is the best way to nourish the skin and prevent stretch marks. Keeping the skin supple and hydrated with certain herbs can be beneficial.

Photo of comfrey by Jennifer RosenbergThe ideal herbs for use in this instance are classified as emollients and vulneraries. Emollients are cooling in nature and moisturizing, and they give elasticity to tissues and membranes. These types of herbs are specific for skin issues and allow deep penetrating action and healing. Vulneraries promote healthy growth and repair on a cellular level and are suited for use both internally and topically. These herbs work very well in a natural oil base applied externally right where they are needed. They all share nutritive tonic qualities and are perfectly safe for use directly on the skin for extended periods of time. The following herbs carry all of these qualities: comfrey (Symphytum officinale), chickweed (Stellaria media) and violet (Viola odorata).

Herbal Oils and Butters

Herbal oils are a type of extract similar to an alcohol- or water-based extract. The process is very much the same. An herb infuses a selected oil for a period of time, and the oil is then strained and bottled for use. Any type of quality vegetable oil will do, and some good choices include olive, almond, apricot kernel or coconut oil. These are especially wonderful for use on the skin because they are easily absorbed and carry moisturizing qualities of their own. Oils of this nature are naturally abundant in vitamin E and preserve well.

When preparing an herbal oil, dried herbs must be used. Fresh herbs tend to leak moisture from the plant into the oil, causing spoilage. Fresh wilted plants can be used in oil; the important point to consider is whether the plant material is sufficiently free of internal water. Fill a clean, dry glass jar about a third full with dry plant material and pour in the oil of your choice, covering the herb completely and filling the jar to its brim. Cap tightly and let it sit, out of any direct light or heat, for two to four weeks. When the allotted steeping time is complete, strain the oil through a cloth-lined sieve and store in a clean glass bottle. Herbal oils can be applied freely to the stretching belly as often as the mother likes.

To save time, there is a stove-top method of preparation. This is best done in a double boiler, with the water in the lower pan brought to a gentle boil and the oil and herbs in the upper pan being sufficiently warmed but not boiled. Boiling oil immediately spoils it. Simmer the oil and herbs for 20 minutes. Strain and bottle as usual.

Herbal Belly Butter

Belly butter is a thick, rich emollient preparation that takes an herbal oil a step further. Use an herbal oil as a base and warm it on the stove. Remember: The oil must not boil. Add 1 tsp of grated beeswax to 1 oz of the warm oil. Melt and blend well, and add additional drops of oils, such as jojoba, wheat germ, cocoa butter or vitamin E. These are highly concentrated and emollient in effect. They will add to the overall richness of the butter.

To test the butter, while it is still hot place a small amount on the tip of a teaspoon and remove this spoon to the refrigerator. Allow the spoon to sit in the fridge for a few minutes, and then check it. The butter will have solidified to its final consistency, and at this point you can adjust it as needed. Adding more oil will make a softer butter and adding more beeswax will create a firmer one. When you have the desired consistency and it is all well blended, remove to a small shallow jar and let it cool without the cap. When the butter has completely solidified, cap it and store in a cool, dry place. Apply liberally as needed.

Susan Perri
Excerpted from "Home Remedies for Stretch Marks," The Birthkit, Issue 32

Products for Birth Professionals

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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.

Learn "About Physiology in Pregnancy and Childbirth"

A compilation of eight articles by Verena Schmid, an independent midwife from Italy, this book will give you a unique view of pregnancy, birth and related processes. Verena applies her nearly 30 years of midwifing homebirths to providing you with a deeper understanding of the complex biological processes that make up the perinatal period. This book is must reading for informed midwives and mothers-to-be. Click here.

About Physiology in Pregnancy and Childbirth

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Web Site Update

Erratum: Our apology to Amy V. Haas for our editing error in the article "Homebirth after Cesarean: The Myth and the Reality" in Issue 86 of Midwifery Today. The incorrect paragraph has been corrected online to this:

"There is a cultural myth in this country that cesareans are just as safe as, if not safer than, normal vaginal birth. However, a study by MacDorman et al., published in 2006, specifically looked at infant and neonatal mortality rates and found that the overall neonatal death rate for babies born by c-section is 2.9 times as high as that for babies born via vaginal birth, and 6.7 times as high if the cause of death was intrauterine hypoxia and birth asphyxia.(4) Additionally, maternal mortality is three times as high for women who have c-sections.(5)"

Read these article excerpts from the most recent issue (Autumn 2008) of Midwifery Today newly posted to our Web site:

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Question of the Week

Q: I wonder if anyone knows of a scientific study, research or has anecdotal information or theories on the physiology behind women who live in close quarters or are close to one another menstruating together. We all know of times we have had our menses arrive early or late, to find that it was influenced by another woman's cycle. A friend asked me if two women were sleeping on either side of a wall (e.g., in an apartment complex) and didn't know each other, would their menstrual cycles synchronize? So, part of the question is, is it entirely hormonal or do the women need to have a close bond, personally on an emotional, social or spiritual level? I look forward to hearing some input.

— Molly

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.

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Question of the Week Responses

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 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

A: Yes, I too experienced something similar (though not quite so drastic) during my 2nd pregnancy. I had been doing quite fine, using a high quality prenatal supplement prior to attempting to conceive, and I continued on that after I was pregnant. I was doing great. Went to the midwife for my first prenatal visit, and she told me that I HAD to take the prenatal vitamins from a certain company—she wouldn't take women as patients who didn't use that particular brand because she thought it was so good.

Meekly, I complied. I stopped what I was on and started on her required brand. I became so nauseated throughout the night that I couldn't sleep, and by morning would feel slighly better, only to feel horrible again for several hours after breakfast and into the afternoon.

After a few weeks of losing sleep, and spending most of the day in misery, I started realizing that ALL of this had started right after I started on my midwife's brand of prenatals. I also realized that the misery began within an hour or so of when I took my vitamins each morning and evening! I stopped those vitamins and went back on my previous prenatals, and had no more trouble!

Also, my third pregnancy ended in a transport and an emergency c-section. I lost so much blood that the doctor initially thought a transfusion would be necessary. Thankfully it wasn't, but he wanted me on prenatal vitamins for the iron and the nurses began giving me his prescription. Within 24 hours or so, I began to get dry heaves and feel very ill. By day two, I was even worse. I finally refused to take their vitamins anymore and began to feel better. The nurses weren't happy with me, but I told them I would take only my trusted brand. DH brought them in, and after they took them down to the pharmacist for approval I was allowed to take them. That was the end of my problem again! The hospital personnel said they had "never heard of such a thing" but after I got home and carefully read the drug insert information from their brand of vitamins, which they'd thrown in with all my stuff, I found that it stated clearly that it COULD cause nausea in some people!

— Hope Anne D.

A: I have definitely had clients (and myself) be sensitive to vitamin supplements, though not to the degree your daughter is. Supplements can contain fillers, binders, etc., that make you nauseous. Supplements are used as a sort of nutritional "insurance" but are not always absorbed well by the body as you point out with the iron. Taking these supplements forces the body to deal with these lab-created substances. There are some brands available at health food stores or food co-ops that are made with real foods. With real food, your body takes what it needs. It is made for digesting and using the nutrients in whole foods.

If a pregnant mom is not taking vitamins she needs to be very attentive to her nutrition. Pregnancy does make more demands on the body and certain nutrients, such as folic acid, are needed in greater amounts. Eating whole, unprocessed, preferably organic foods is best.

A good way to obtain very easily assimilated vitamins and minerals is by drinking herbal infusions (like tea but steeped longer—2 hours at least for leafy herbs, to get the constituents into the water) like red raspberry, nettles, alfalfa, red clover, oatstraw and milky tops. Drink 1–3 cups every day.

There also are a number of good herbal books with a focus on pregnancy out there.

— Helena

A: I suffered from Hyperemesis Gravidarium throughout the first few months of each of my three pregnancies. I was never able to keep prenatal vitamins down—even when I tried the "natural" brand found at the health food store. What worked best for me was to eat a healthy diet rich in protein, and to be sure I was taking in vegetables and fruits in a wide variety of colors (things like mango, avocado, dark leafy greens, etc.). I chose to supplement with a liquid called "Floradix vitamins + herbs" in the last few months of pregnancy. I did this because it offered a digestible form of iron that didn't make me feel sick, and I needed an iron supplement because of slight anemia.

Once in the eighth month of my last pregnancy, when my morning sickness had been long gone, on a whim I took a multi-vitamin that I had gotten as a free sample. I vomited within 30 minutes and vowed never to take another multi-vitamin again.

There are many alternatives to prenatal vitamin supplements, and I hope that all pregnant women can get access to accurate nutrition information, especially when they find they are sensitive to traditional multi-vitamins. It is shame when a mother feels compelled to take daily multi-vitamins even if they make her sick, simply because she is concerned for her baby's well-being. She should be assured that diet alone can be sufficient to grow a healthy baby, if she is willing to pay attention to eating well.

I should add that all three of my babies were over 9 lb at birth and are in perfect health (at ages 9, 5 and 1.)

— Shay Pokress
Arlington, Massachusetts

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: In response to Sue Miller's question about snoring and bothering her husband's sleep, I could sure relate. My midwife told me that some folks get stuffy during pregnancy, and some don't. I did with my first and third children, but not the others. My husband bought a pack of Breathe Right strips that I would stick on the outside of my nose. They opened up my nasal passages just far enough that I could breathe—quietly—and my husband and I could both sleep—in the same bed.

— Carrie Greisen

Responses to any Question of the Week may be sent to E-News at any time. Write to mtensubmit@midwiferytoday.com. 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 the American Pregnancy Association, it is estimated that up to 90% of women are prone to developing stretch marks in pregnancy.

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I wanted to comment on the article "Sleep Position and SIDS" by Cheryl K. Smith (Midwifery Today E-News 10:19).

I feel that the story left out important details and advice for families. Why not consider purchasing a non-toxic crib mattress so that your child is not in contact with such chemicals? I understand that not everyone can afford a new mattress, therefore I think it important to write to our government officials concerning laws for mattress manufacturing requirements and push them to stop the use of toxic chemicals in all mattresses.

In general a healthy infant sleeping in a healthy home with healthy parents is just fine to sleep in the same room with the parents on his/her stomach. If people feel uncertain about this they can choose to do back or side-lying until an infant is able to roll over, thus making the decision for themselves.

Callie Acuff

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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