|Febuary 18, 2009|
Volume 11, Issue 4
|Midwifery Today E-News|
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In This Week’s Issue:
Quote of the Week
"Healthy people are those who live in healthy homes on a healthy diet; in an environment equally fit for birth, growth work, healing, and dying…. Healthy people need no bureaucratic interference to mate, give birth, share the human condition and die."
— Ivan Illich
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The Art of Midwifery
Sometimes a baby comes shooting out like a bullet with no tearing at all. Other babies ease out nice and slow, and a tear occurs anyway. To some degree, it is necessary to move beyond the issue of tearing and onto the larger picture of the birth experience as a whole. We must resist becoming too set in our ways. We must try to see each woman's unique needs and experiences. One of the many beautiful things about the midwifery model is the degree to which the midwife and client get to know one another. Ideally, the midwife will know what importance the client places on the possibility of tearing, which will help the midwife know how to proceed during the birth. Hopefully, the client will trust the midwife and be willing to do some type of prenatal preparation.
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.
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Aspirin May Prevent Preeclampsia
Retrospective research, using the data on 32,000 women, suggests that if low-dose aspirin were taken more widely that preeclampsia caused by placental defect could be reduced by 10%. In addition, it was shown to decrease premature delivery as well as poor pregnancy outcomes in general.
The researchers noted that while taking aspirin increases the risk of bleeding, the potential benefits may outweigh the risks in women who have an increased risk of developing preeclampsia. This includes women who are overweight, older or have a previous or family history of the condition. However, they also cautioned against pregnant women self-medicating with aspirin, noting that only one case of preeclampsia is expected for every 50 pregnant women.
— http://news.bbc.co.uk/2/hi/health/6662321.stm. Accessed 17 May 2007.
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Can Humanity Survive the Safe Cesarean?
Human beings react differently from other mammals to interference with the birth process. When delivery of non-human mammals is disturbed, the effects are immediate and easily detected. For example, when animals give birth by c-section or with an epidural, the general rule is that the mother is not interested in the baby. Among humans, on the other hand, we need extensive statistics to detect what are mere tendencies and risk factors. These are much more complex in our species: We speak and we create cultural milieux. In certain situations, particularly in the perinatal period, human behavior is less directly under the effects of the hormonal balance than the effects of the cultural milieu. For example, a human mother knows when she is pregnant and can anticipate maternal behavior, while other mammals must wait until the birth when they release a flow of love hormones to kindle their attachment to their newborns.
Today, we understand that to have a baby, a woman—like any other mammal—has been programmed to release a cocktail of love hormones. Today the number of women who actually "give birth" to babies and placentas thanks to this hormonal release is ever-decreasing. First, because many women give by birth by cesarean. Second, most of those who give birth vaginally receive pharmacological interventions. Unfortunately substitutes block the release of the natural hormones and do not create the same behavioural benefits. We have to wonder what will happen, in terms of civilization, if this trend continues in future generations. Can humanity survive the safe cesarean?
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Question of the Week
Q: I am pregnant with my 4th child; the second child was a compound presentation and I had a T incision. During the c-section for my third child, the vertical extension of the T opened up after the baby was delivered, so my T has been stitched twice. I believe it is double-stitched; I know it was after the first c-section, and I'm assuming it was again with the second. Additionally, my vaginal delivery was at 41 weeks, and my second child also went 41 weeks gestation. I never went into spontaneous labor with either child, even after waters broke. I had pitocin (no epidural) with the first, and no drug interference with the second prior to discovery of the baby's hand in the birth canal (the doctor had manipulated my uterus to expel waters and try to facilitate labor). Add to all this that I was diagnosed with gestational diabetes (GD) in December. So far my blood sugars are okay with diet. This baby will arrive almost two years to the date from my last cesarean.
Here's my problem: The recommended time for my cesarean is 39 weeks gestation, which falls on a Friday. The hospital doesn't usually do "elective" surgery on Friday, Saturday or Sunday, and my surgeon isn't available again until the following Tuesday, making me 4 days past my 39 week mark. The perinatologist is worried about rupture and suggests cesarean before 39 weeks, but then the hospital requires an amniocentesis to determine lung development. I do not like the idea of an amniocentesis, and if lung development is immature, I'd have to wait anyway.
My question is what to do? I feel an exception should be made to give me surgery at 39 weeks, rather than incurring risk to the baby from amniocentesis and respiratory problems, but I'm not sure they'll do this. What can you tell me, either about getting an exception to surgery dates and/or risk of rupture, or would you recommend doing the amnio and delivering before 39 weeks? I really do not want to deliver early, especially for the doctor/hospital scheduling policies. Any help you can give me is appreciated!
— Brigid Luzarraga
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I am a pre-nursing student at New Mexico State University-Grants. My goal is to obtain a BSN in the next four years and then go on to a CNM program after that. My ultimate goal is to have a midwifery clinic of my own by about 2020. I'm hoping that some E-News subscribers could direct me to some good scholarship or grant programs.
For the two years I've already been taking pre-nursing courses, I've taken out approximately $32,000 in student loans. I work about 3/4 time at my local school district as a teacher's aide. Since I'm looking at two more years of pre-nursing courses and two years of full time nursing study, I'm looking for a way to fund my education without more loans.
I will also be looking for a midwifery apprentice program after completing the CNM. I would like to practice somewhat traditionally at my own clinic. I welcome any and all information.
— Pam Burns
Re: Breastfeeding guidelines regarding use of nipple shells (E-News 11:2, Feedback)
I'd like to know what "current research" as Ingrid Tilstra, IBCLC, LLLL states, does not support the use of breast shells during pregnancy for flat nipples. The use of breast shells (not shields) during pregnancy to create subtle pressure on the nipple to draw it out more is widely used at the hospital where I'm an L&D nurse. This seems advantageous to our patient population. Could she provide her references in this current research?
Thank you kindly.
— Tanya M. Jennison, RN
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Morning Star Women's Health & Birth Center seeking a full-time CPM or CNM for birth center and homebirth practice. Supportive medical collaboration. Salary/benefits negotiable. Beautiful rural area 1 hr. drive from Mpls/St. Paul. Send resume and cover letter: Paula@MorningStarBirth.com
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