|February 4, 2009|
Volume 11, Issue 3
|Midwifery Today E-News|
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In This Week’s Issue:
Quote of the Week
"The most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing we ever give each other is our attention.... A loving silence often has far more power to heal and to connect than the most well-intentioned words."
— Rachel Naomi Remen
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The Art of Midwifery
If midwives can ensure that they communicate effectively with each pregnant woman, and can negotiate with her an acceptable and realistic plan of management for her pregnancy, then it will be much easier to deal with any complications that arise.
— Tingle, J., J. Wilson and A. Symon
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 firstname.lastname@example.org.
Send submissions, inquiries, and responses to newsletter items to: email@example.com.
A small study of women's encounters with a midwife during childbirth, with data collected by tape-recorded interviews two to four days after delivery, found that "presence" by the midwife was the most important factor in a good experience. This included the need to be seen as an individual, a trusting relationship—obtained by good communication and proficient behavior, and supporting the women on their own terms by providing a sense of control.
— Midwifery 12(1): 11–15, 1996
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Whether you are a midwife, doula or childbirth educator, it is essential that you stay in touch with current clients, past clients and prospects. An electronic newsletter is often a fast, inexpensive, and effective way to do this. The benefits of your own newsletter are not to be understated. It allows you to:
This last point, about using electronic communication to help convert prospects to clients, can make or break your business. Prospect e-mail addresses are some of your most important business assets. When prospects call you about your services, you must get their e-mail address. They are very interested in your service. They really want to get a chance to know you. They want to make sure that you have the abilities to help them. They want to know your personality. They want to know how you can help them. Twice a week, send them articles that will help in pregnancy, labor, or after the birth.
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Question of the Week
Q: Why do some women develop swollen feet and hands in the first trimester of pregnancy?
SEND YOUR RESPONSE to email@example.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.
Question of the Week Responses
Q: I am a Lamaze Certified Childbirth Educator and had learned many years ago that pain in childbirth is caused by the muscular contractions of the uterus. The theory: When the uterus contracts, a percentage of oxygen is cut off. When this is accompanied by fear, tension and holding one's breath, there is less oxygen for the uterus. I was told that a hard-working uterus needs all the oxygen it can get to help minimize pain.
However, I recently read a brief article in Fit Pregnancy (Oct/Nov 2008) that states: "Labor pain evidently comes mainly from the cervix, not the uterus, a Swedish researcher says. In non-pregnant women, the uterus contains pain-sensitive fibers, but for reasons unknown, those fibers disappear almost completely during pregnancy. Experts' best guess is that this is an evolutionary adaptation; if the nerve fibers remained, birth would be too painful—as would pregnancy. The findings could lead to more effective labor pain treatment." ~ From S.R. Karolinska Institute
I'd appreciate any input you might have on this subject and, if possible, referral to another possible source.
— Elly Rakowitz, LCCE
A: I don't have any other sources for you but I do have some input. Labour is a spiritual experience, it's physical and emotional as we know and the best way to help women birth their babies is to help them embrace all of that. They need to know they can do it, believe their body knows what it is doing, trust, breath, relax, open, and welcome it and the power of being the centre of the universe.
Too much naming stops the flow. I don't think knowing exactly where the most pain is coming from matters...are you looking for a labour pain treatment, some certain way to make all women comfortable with scientific knowledge of just where exactly their discomfort originates? Tell them they are amazing, whisper "open" in their ears, help them visualize where the baby is in their bodies, and the breath is certainly key, those babies do love their oxygen... Every birth is as different as every person you know and I can't help but believe that we all feel it in our own way, our own rhythm. It's got to be an ever changing, ever flowing and deeply personal passage with totally different "nerve fibres" coming into play at any time. I think it is impossible to focus on one set of nerves, one place that is the source.
— Donna Harnett
A: Hi Elly, In response to your question regarding the source of pain in childbirth, I would like to refer you to Grantly Dick-Read's book Childbirth without Fear. It is an incredible insight into the causes for pain in birth, and points out that pain is likely caused by fear during birth. It is referred to as the "Fear-Tension-Pain Syndrome." He references several women whom he witnessed give birth and were obviously without pain and each of these women had in common the lack of fear of childbirth. He also cites physiological reasons why our bodies are not capable of inflicting pain on us during childbirth. He actually states that it is the fear that causes blood to leave the uterus, and thus the uterus was without oxygen (blood goes to other parts of the body necessary for fight or flight responses) and thus women feel pain. So by his theory it is not the work of the uterus itself that causes pain, but extraneous (namely psychological) factors. It is quite an insightful and eye-opening book. I personally have experienced a virtually pain-free birth, and the only time I felt pain was for a short time (15 minutes) when I also felt afraid. Later I went on to read his book and it shed a light on what I personally experienced.
— Martha Basham
A: I believe Grantly Dick-Read in Childbirth without Fear addresses this question and perhaps provides an explanation.
From Chapter 4, Anatomy and Physiology: The muscle layers of the uterus and nerves of the uterus:
The uterus is composed of three types of muscles.
The muscles in the outer layer are mainly longitudinal, are expulsive, and are controlled by the parasympathetic nervous system or the mammalian brain.
The muscles in the middle layer run in all directions, including in figure eights, are constrictive, and are controlled by the sympathetic nervous system or neocortex.
The muscles in the inner layer are mainly circular, are concentrated in the lower half of the uterus and near the neck, are constrictive, and are controlled by the sympathetic nervous system or neocortex. They are sphincter muscles, in effect.
From Chapter 5, The Pain of Labor
The uterus does not contain pain receivers or nociceptors for many types of pain. It "can be burned, cauterized, handled and moved without sensation of discomfort to the patient." It does contain nociceptors, however, for "excessive tension or laceration."
In other words, if fear (via neocortical stimulation) causes the circular muscles to constrict, while the longitudinal muscles continue to expel, the uterus will experience excessive tension that will be perceived as pain.
— Susan Planck
Responses to any Question of the Week may be sent to E-News at any time. Write to firstname.lastname@example.org. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.
Think about It
How to avoid e-mail communication problems
Write clearly and briefly. Proofread, wait, proofread again and then send it. If you are having trouble communicating with a person by e-mail, call them on the telephone or meet them face-to-face rather than continuing the e-mail discussion.
Re: Monitoring FHR in presence of meconium (E-News 11:2, Feedback)
I would like to dispute the recommendations by Sandra Ebanks regarding monitoring the FHR in the presence of meconium. Monitoring per the NICE guidelines, which she states are to monitor FHR in low-risk pregnancies for one minute following a contraction and not during or before. I would like to know how a person monitoring only after a contraction can accurately determine the FHR baseline. There may be a late deceleration or prolonged deceleration that lasts for more than the one minute timeframe. You cannot determine the baseline via this method, therefore you cannot accurately determine if there is a late deceleration or if you are monitoring a baseline change or prolonged deceleration. You have nothing to compare it to. ACOG's guideline is to listen to the FHR for 30 seconds prior to, during, and after a contraction in order to determine baseline and if decelerations or accelerations may be occurring. [One] needs to know baseline in order to make such determination.
— Tanya Jennison, RN
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