March 18, 2009
Volume 11, Issue 6
Midwifery Today E-News
“Blood Loss and Hemorrhage”
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Hemorrhage HandbookBe Prepared for Hemorrhage

The Hemorrhage Handbook is filled with great stories told by expert midwives that give you superb insight into bleeding problems that may occur during the prenatal period, the birth or postpartum. Topics include the importance of good nutrition, how the bloodstream works, herbs to use, the RhoGAM controversy and Chinese remedies.
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Midwifery Today Conferences

Learn about the Traditions and Techniques of Mexican Midwifery

When you attend this class with Naolí Vinaver, you'll discover simple techniques that promote healthy pregnancy and birth—techniques that go back thousands of years. You will also learn how to use a rebozo, a very useful tool in all parts of the childbearing cycle. Time for hands-on practice will be provided. Part of our conference in Copenhagen, Denmark, May 2009.

Learn more about the Denmark conference and get a complete program.

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In This Week’s Issue:

Quote of the Week

"…in feeding babies, two substantial mammary glands are more useful than the two hemispheres of a professor's brain."

Oliver Wendell Holmes

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The Art of Midwifery

The guideline for bleeding is that the mother should seek medical help if the blood is being measured by the cup, rather than spoonful. I always ask women, "How many tablespoons of blood is it?" This way, they can tell me, "Oh, not even two teaspoons" or "I'd say 3/4 of a cup"—but let them do the talking for an accurate view. Learn to listen.

Gloria Lemay
Excerpted from "Tricks of the Trade: Bleeding in Pregnancy," Midwifery Today, Issue 82
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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

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A comparison was done between early and late cord clamping in 230 singleton deliveries. Late cord clamping was that done after birth of the placenta. Preterm infants, those with low birth weight or respiratory distress and infants of Rh negative mothers were excluded. This small study showed a statistically significant decrease in the time for delivery of the placenta and amount of postpartum blood loss when the cord was clamped after delivery of the placenta. The authors also noted that late cord clamping also has the advantage of increased placental transfusion to the baby.

— 25th International Congress of the Medical Women's International Association 2001,

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advertiserJoin us for "Committing to a Dignified Birth"

We invite you to the Mexican Caribbean to take part in our International Conference "Committing to a Dignified Birth" from the 21st-24th May 2009. Get to know the traditional mayan midwives and connect with the Mayan fertility goddess Ixchel on the white sandy beaches of Tulum. Check our Web site for more information:

Yunnan Paiyao

Yunnan Paiyao (also know as Yunnan Baiyao) is a secret formula of Chinese herbs containing mostly Pseudonginseng and Angelica. Because it is contraindicated during pregnancy, midwives often don't include this valuable patent Chinese remedy in their medicine bags. It is easily available in Chinese Medicinal pharmacies all over the world. It also is relatively inexpensive and is packaged to give it a long shelf life.

The immediate function of Yunnan Paiyao is to arrest hemorrhage, cure wounds, activate blood circulation dispersing blood clots, eliminate inflammation and swelling, as well as expel pus and counteract toxins.

Doctors of Traditional Chinese Medicine (TCM) will often give Yunnan Paiyao as a first defense against a traumatic hemorrhage (even a deep cut or a gunshot wound), both orally and directly applied to the wound. It comes as a powder, either in capsules or in a small bottle. Included with each package is one small red "safety pill" which should only be administered in the case of serious injury and is best if taken with wine. At Bumi Sehat we give the "safety pill" for deep puncture wounds.

Other indications include arresting internal and external bleeding from trauma and localized bruising. It alleviates pain from trauma to ligaments and tendons. It is an excellent treatment for hemorrhage of gastric and duodenal ulcers and hemorrhoids, as well as hemoptysis due to tracheitis, pneumonia, bronchiectasis, pulmonitis and sore throat. It is also a treatment for pyogenic infections of skin, i.e., red swollen abscess, carbuncle and furuncle.

Specifically for women, this medicine can be used to treat painful dysmenorrhea, menostasis, irregular menstruation, hypermenorrhea, metrorrhagia, leukorrhea and excessive menstrual bleeding. It may be used postoperatively to reduce keloid scarring (i.e., after cesarean birth) and to promote healing.

Roberta Aqua and Robin Lim
Excerpted from "Yunnan Paiyao: Postpartum Friend," Midwifery Today, Issue 82
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Question of the Week

Q: What do people think about using something like Emergen-C Bone Health for a prenatal supplement? I find it easy to take as a powder added to water, and generally well-balanced, without the excessive vitamin C that the other versions have. I have even had women use it during labor instead of sports drinks, because of the balance of minerals and B-vitamins. Opinions? Experiences?

— Amy V. Haas, BCCE

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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Are you an aspiring midwife who's looking for the right school? Are you a practicing midwife who would like learn more? Visit our Education Opportunities page to discover ways to start or continue your education.

Question of the Week Responses

Q: I am pregnant with my fourth 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 four 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

A: As it turned out, I discussed the situation with my OB, and advocated my position, namely, that the question of 38 week delivery was in actuality a scheduling problem rather than a medical problem, and that if my due date had fallen on another (more convenient) day of the week, we wouldn't have been discussing this issue. My obstetrician couldn't exactly argue otherwise and in the end agreed to do the c-section on the day I reached my 39th week. So all turned out well, and my daughter, Elisabeth, is a beautiful baby, was delivered without incident and without lung problems!

— Brigid

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

Discomfort and swollen tissues can be caused by wearing commercial pads with "extra absorbency" chemicals. After three or four days, the postpartum woman is well-advised to stop wearing store-bought pads and switch to cotton reusable pads, cloth diapers or folded face cloths for the remaining days of lochia.

Gloria Lemay

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Free CPR Course for Parents

Seattle-based CPR training firm HeartSaving Solutions,, believes all parents should have the right to learn how to save their children's lives in the event of an emergency. To that end, the company has made its online infant and child CPR course completely free of charge.

Available to parents, grandparents, older siblings and anyone else who would like to learn infant and child CPR from the comfort of their own homes, Online Baby CPR used to cost $13.95 per person. HeartSaving Solutions founder Keith Weaver, however, decided to provide the infant and child CPR training for free when he realized that in spite of its importance, many parents just can't afford to take any CPR course right now.

The Online Baby CPR course is designed for parents and is a complete CPR training class. Proceeding through the course on their own time, participants will learn child and infant CPR, choking and drowning prevention, automated external defibrillator (AED) use, and how to help a child or baby who is already choking. There is no software required and nothing to download. Although parents will thoroughly learn the basics of CPR, the free course does not offer a CPR certification, making it for personal use only.

Those wondering whether they can really learn CPR online needn't worry. Online Baby CPR uses industry best practices to teach the lifesaving concepts of CPR through video, images, audio, text and quizzes; students can ask questions at the forums, where certified CPR trainers are on hand to provide answers.

To learn more about HeartSaving Solutions, visit the company at More information about the Online Baby CPR course is available at

Keith Weaver
HeartSaving Solutions

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