May 27, 2009
Volume 11, Issue 11
Midwifery Today E-News
“Cerebral Palsy”
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In This Week’s Issue:


Quote of the Week

"The risk of cerebral palsy was nearly doubled with exposure to certain herpes viruses, including the chickenpox virus."

Catherine Gibson, Researcher


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The Art of Midwifery

One very effective trick (in hospitals that insist that mothers labor on "clear liquids only") is to have the mother take along a zippy bag of "labor cubes" to the hospital, storing them in her room fridge. "Labor Cubes" are ice cubes made out of very strong raspberry leaf tea (perhaps one cup herb to one quart water, simmered down to half and strained) that is heavily sweetened with honey. If the laboring mother begins to fade, energy petering out or contractions waning due to lack of nutrition, she can chomp on these satisfying slushy cubes, which usually will perk her up and kick in some great contractions in a matter of minutes.

Beth Barbeau
Excerpted from "Tricks of the Trade: Liquids Only," Midwifery Today, Issue 81
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

Magnesium sulphate given to women at risk of preterm birth helps to protect the baby's brain and improve long-term outcomes.

Babies born too early (preterm) have a higher risk of dying in the first weeks of life than babies born at term, and those who survive often have damage in the form of cerebral palsy, blindness, deafness or physical disabilities. This can cause huge distress for parents. Magnesium is an important element essential for normal body functions. Magnesium sulphate may help to reduce damage to a preterm baby's brain. However, it has adverse effects in the mother of flushing, sweating, nausea, vomiting, headaches and a rapid heartbeat (palpitations). This review identified five studies involving 6145 infants and shows that magnesium sulphate therapy protects the preterm baby's brain from cerebral palsy.

Cochrane Database of Systematic Reviews 3: CD004661, 2007


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How Cerebral Palsy Affected My Births

I was born with a mild disability—I have cerebral palsy. This did not affect my two pregnancies very much, although I had more muscle cramps than usual. Like many women, my labors were quite different from each other. My first labor lasted 32 hours, even with medical intervention. My second labor lasted only two hours. However, even though they were so diverse, I did experience the same disability side effect, clonus, during both labors.

My doctor offered me morphine during my long, early first labor. Instead of relieving my pain, it made me ill and I was given another drug. In addition, the clonus, or series of rapid rhythmic muscle contractions, made it impossible for me to use the stirrups. My husband quickly improvised and braced my legs to help control the jerking. This helped me feel better about my labor, although that feeling changed to dismay when my doctor said that I was pushing ineffectively. I was exhausted and so was my uterus.

When I became pregnant with my second child, I was determined to push "successfully." I thought that a birthing chair would help, but the clonus made it difficult to move into the chair. In addition, with the short and intense labor of a precipitate delivery, all I could do during the second stage was scream. Yet my son crowned without any pushing on my part. I came to a startling realization that is not talked about much: We may not have a great deal of control over pushing.

After talking with women who have had spinal cord injuries, I found that some were able to deliver without the help of forceps or suction, despite being physically unable to push due to muscle paralysis. These conversations seemed to give credence to my idea that if the uterus is not too tired, often it can do the work of pushing the child out without any extra help from the mother.

Several years after my son's birth, while working at the Center for Independent Living in Berkeley, California, I received a call from a woman with a spinal cord injury who wanted information about pregnancy, labor and delivery. She said that she couldn't find anything written for women with disabilities, which made me think about my pregnancies. I, too, wished that I had had information available.

Judith G. Rogers
Excerpted from "How Cerebral Palsy Affected My Births," Midwifery Today, Issue 27
View table of contents / Order the back issue

Editor's Note: After her experiences, Judith G. Rogers wrote Mother to Be: A Guide to Pregnancy and Birth for Women with Disabilities, with Molleen Matsumara. The book is now in its second edition and is available at Amazon.com.


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Question of the Week

Q: We use Eldon cards for blood typing and were told by a doctor that the Eldon cards are only 80% correct for newborns. In the minimal time I have had to research this I have not found that to be true. What are midwives out there using at home?

I do not like offering to take blood to the lab at the hospital for RH negative moms due to the cost, and parents are opting to just receive the RhoGAM instead of paying for the blood typing of the infant. I trust the opinion of experienced midwives, can you help me?

— Donna Reicks


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: I have a friend who has endometriosis in her lungs. She has bled during her period for many years, (spit blood) from her lungs, and now after her second baby she finally did testing and discovered that it is endometriosis.

I hope to find her some solutions, hopefully alternative—a way to help her without filling her with drugs and hormones. We are from southern Chile, in South America. I would really appreciate some tips, or even better, the name of someone who knows how to heal or treat naturally (successfully) this ailment.

Thank you very much.

— Aiyana Gregori
ayunklo3@surnet.cl

A: I am sorry to read about your friend's endometriosis. What an interesting question, because I had never heard of endometriosis in the lungs before. I highly recommend that she checks out Our Bodies, Ourselves, The Boston Women's Health Book Collective, and their Web site/blog http://www.ourbodiesourselves.org/. I have found them really helpful. At the same time I recommend that she does additional learning and research besides the books and Web site. I hope my recommendations help her. Good luck to her.

— Jessica A Bruno

A: I have heard of Mayan Abdominal Massage helping with endometriosis of all sorts, or getting hormones in balance. Sometimes having too much estrogen can cause endometriosis. Plastics, pesticides, herbicides, soy and non-organic animal products can convert to estrogen in the body. So having a saliva test done by a skilled practitioner, to check for hormones, and then possibly starting progesterone topical cream can often help! Good luck!

— Blue Bradley, CNM
Twisp, Washington


Q: I am a 28-year-old woman and I've just been told that I have uterine didelphys—with two of everything (cervix, uterus and vaginal canal). According to the gynecologist I saw, I can become pregnant but she said there is a higher risk of premature birth and of a caesarean. Other than this I am perfectly healthy and have had no illnesses or anything.

While I am not planning to get pregnant in the next two years, I would really like to think about my options, to prepare myself when the time is right. I have always planned on having a homebirth with a midwife to assist. I really want the opinion of someone who is not solely from the medical side of things. I know the doctors tell me what they think is the right thing to do but I have always felt that birth is a more natural occurrence than what the majority of the medical society seems to believe.

— Deborah

A: I cared for a woman with uterine didelphys last year, and was excited to do so because a good friend of mine also has this condition. The birthing woman was having her third child, the first two having been born without any difficulties. She had a lovely waterbirth with a CNM in our hospital, free from complications. It is remarkable how well our bodies work, even in the presence of variations from the norm. May Deborah have the birth she is dreaming of when the time is right.

— Molly Brom, RN


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

In the US, data from the prospective National Collaborative Perinatal Project study summarised in the 2003 Task Force on Neonatal Encephalopathy and Cerebral Palsy have shown that approximately nine percent of cases of cerebral palsy are due to possible birth asphyxia. A consensus statement, endorsed by the American College of Obstetricians and Gynecologists (ACOG) among others and published in the British Medical Journal in 1999, comments: "Epidemiological studies suggest that in about 90 percent of cases intrapartum hypoxia could not be the cause of cerebral palsy and that in the remaining 10 percent intrapartum signs compatible with damaging hypoxia may have had antenatal or intrapartum origins."

Because birth trauma is so rarely the cause of cerebral palsy, even the most extreme rates of caesarean section would not prevent it.

Sarah J. Buckley
Excerpted from "Networking: More on Cesareans," Midwifery Today, Issue 69
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Feedback

Re: E-News 11:9 Feedback regarding whether there is a genetic propensity for Down syndrome, for one cause, translocated chromosome, genetics are implicated:

"Maternal age is not linked to the chance of having a baby with translocation. Most cases are sporadic, chance events, but in about one third of translocation cases, one parent is a carrier of a translocated chromosome." National Down Syndrome Society, www.ndss.org/index.php?option=com_content&view=article&id=60&Itemid=77

Anonymous


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