|June 10, 2009|
Volume 11, Issue 12
|Midwifery Today E-News|
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When you watch Harriette Hartigan's "More than Food" DVD slide show you'll be reminded that a breastfed child is, indeed, receiving more than food. If you are a childbirth educator, lactation consultant or educator, doula, midwife or nurse, you will find this beautiful DVD a useful tool to share with your clients.
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In This Week’s Issue:
Quote of the Week
"There are three reasons for breastfeeding: the milk is always at the right temperature; it comes in attractive containers; and the cat can't get it."
— Irena Chalmers
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The Art of Midwifery
Breastfeeding newborns, like the evolutionary process of vaginal birth, is about bacteria. The breast milk of a human mother, like other mammalian mothers, is species-specific, having been adapted over eons to deliver specific and sufficient nutrition to guarantee proper growth, health, and immunity development. Researchers have long known that breastfed babies possess an intestinal flora that is measurably different than formula-fed infants. Of specific interest is a group of bacteria known as bifidobacterium. Some of you may immediately recognize the name, as they are often added to dairy-based foods such as yogurt, often advertised as "live cultures" on the packaging. These are probiotics.
Studies have shown that at one month of age, both breastfed and formula-fed infants possess bifidobacterium, but population densities in bottle-fed infants is one-tenth that of breastfed infants. The presence of a healthy and robust population of bifidobacterium throughout the first year or two of life contributes significantly to the child's resistance to infection and overall development of defense systems—not to mention the physical development of the intestinal system in general. Aside from the substances secreted by these specific bacteria that are known to inhibit the growth of pathogenic bacteria, they also work to make the intestinal environment of the infant more acidic, creating an additional barrier against invading pathogens. In short, breastfed babies are sick less, are less fussy, have fewer and shorter duration of bouts of diarrhea, and have more frequent—and softer—bowel movements.
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 email@example.com.
Send submissions, inquiries, and responses to newsletter items to: firstname.lastname@example.org.
A comparison of 227 babies who were breastfed for their first 13 weeks or more with 267 who were formula-fed (from birth) found that the breastfed babies had fewer hospital admissions, significantly less gastrointestinal illness, and a smaller reduction in respiratory illness. This result was the same even when supplements were introduced before 13 weeks, and lasted beyond the time of breastfeeding. Breastfeeding for less than 13 weeks resulted in a rate of gastrointestinal illness similar to that found in bottle-fed infants.
— BMJ 300: 11-16, 1990
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Impact of Cesareans on Breastfeeding
One of the earliest family relationships we see strained by a cesarean is that of the mother and baby.
Jennifer Block says, "The most common reason why babies are not put to the breast within the first hour is the cesarean section; and cesarean babies are more likely to be given milk substitutes in the nursery while the mother is recovering."
Mothers who have cesareans are less likely to breastfeed, for many reasons. Often mother and baby are separated, which means a delay in getting baby to breast. The mom is dealing with pain, fatigue, possibly stress, and even trauma. The incision itself causes the mom difficulty in finding a comfortable position in which to nurse. The baby may have respiratory issues.
Let's look beyond that to see how this disruption of the breastfeeding relationship may affect the family. The State of the World's Mothers report asserts that "Immediate breastfeeding is one of the most effective interventions for newborn survival." I submit that, rather than an intervention, breastfeeding is the normal biological extension of pregnancy and childbirth. It also provides many advantages to mom and baby.
Breastfeeding provides the baby with good immune system protection, gut protection, protection against obesity and short- and long-term disease protection. Breastfeeding also helps the mom. Her uterus returns to normal size more quickly after birth if she breastfeeds. She is less likely to experience postpartum depression. She is less likely to have brittle bones later in life.
Studies indicate that women need two years (over a lifetime) of breastfeeding to lower their risk of ovarian cancer. Every six months of breastfeeding cuts down a woman's breast cancer risk. She also is more likely to space her children in a physically healthy way. Without the norm of breastfeeding, the mother is clearly at long- and short-term risk.
There is more at stake here than what the baby has to eat today or how she gets it. Whether a mom breastfeeds her baby—or not—can affect the lifelong health of both.
Midwives can inform moms and work with local hospitals to encourage them to become baby-friendly establishments that encourage and actively work to get baby to breast within the first hour of life, regardless of what mode of delivery is used.
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Question of the Week
Q: How much time must elapse after the birth of a baby without delivery of the placenta for you to consider it retained?
— Midwifery Today Staff
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: My 21-year-old daughter has been advised to have a LEEP (loop electrosurgical excision procedure) for moderate dysplasia due to HPV. I know this may leave scarring on the cervix or possibly pose a small risk of preterm labor when she becomes pregnant. My midwife said she would be put on a preterm labor protocol. What experiences have midwives had with this situation?
Have you seen cervical scarring or preterm labor after a LEEP? Does scarring lead to slower dilation or "stalls" in dilation? Does she have any alternatives for treatment other than the LEEP? What is your advice regarding pregnancy? Would this preclude her from using a midwife?
A: After my first daughter was born in 1999 I was diagnosed (about 2000 or 2001) with extreme cervical dysplasia. My GP got me in to see a gynecologist very quickly, who recommended that the LEEP be performed as promptly as possible. I chose to not go that route right away despite pressure from both doctors. I chose to be treated by a traditional Chinese doctor with acupuncture and herbs. One of the first questions she asked me in regard to my condition was if I had ever experienced sexual abuse. Well, um, err, actually, yes, but had never mentioned it to anyone before this particular appointment.
I can't remember exactly why but I chose to switch to a different traditional Chinese doctor who, in turn, asked me the same question. I then recalled a completely different and separate abusive scenario. Somewhere along this healing path I also recalled a third, again separate (involving a different person), scenario. I also connected with a very progressive cancer clinic in Vancouver.
My medical doctor there recommended, based on my history, that I get a second opinion from a female oncologist/gynecologist. Getting in to see her took much less time than my GP led me to believe it would. My GP had also suggested holotropic breath work in regards to other things going on in my life at the time. It was about one or two years after my first visit to the gynecologist who recommended the LEEP when I finally met with the female gyno for a second opinion. In that time I had made some shifts in my diet, did holotropic breath work, had many TCM visits, worked with my homeopath, made some changes in my career path and cried a lot. Oh, yeah! …and worked and was mom to my pre-schooler. The second opinion was that a LEEP was far too extreme a treatment for what she could see. She recommended laser treatment. I went with that. I had the laser treatment in December 2002 or 2003—can't quite remember! It was a very brief procedure. My PAP tests since then continue to come back [normal]. In December 2006 I gave birth at home, in the water, to my second daughter. If anything, she arrived a week or so later than I thought she would although the quick 2.5 hours barely gave my husband and midwife enough time to set up and fill the pool before she was born. It was a beautiful, perfect, and loving family experience.
I was about 37 yrs old when first diagnosed. I am now getting very close to 46. There is no one recipe for healing. Your daughter must follow her heart courageously and listen to and observe her body without fear. Everybody's journey is different.
I am not a midwife. I have done some doula training but really my passion and livelihood is movement. Movement through dance, yoga, Pilates, hand-drumming, craniosacral rhythms. I have had the honour of witnessing in so many ways the amazing healing powers that we all possess.
May your journey and your daughter's journey be filled with joy!
A: Regarding the options of treatment for HPV, the surgeon should have offered a conservative watch-and-wait approach as well as the LEEP. Your daughter could get more frequent pap smears and/or colposcopies to watch for worsening cervical diagnosis. She should, of course, optimize her diet, exercise, QUIT SMOKING and take multivitamins. Many times if the immune system is enhanced, the body can fight off the virus without losing a big piece of cervix!
A: My daughter had the same situation as your daughter—she had a LEEP followed by three deliveries. The first was 12 hours and the next two were much faster. I had scarring on my cervix from a cervical procedure years ago. Later I had a 24-hour labor followed by a much faster one. I don't think you'll know until your daughter has delivered how it will affect labor, but it seems it was a necessary procedure. I'd focus instead on the fact that she and her partner are well prepared for their birth and are practicing the techniques they were taught.
— Linda B. Jenkins, RN
A: I have seen at least one occasion in which a mom had trouble with stalls in dilation after a LEEP. She stalled twice, which she had not done in previous births. After hours at the same dilation, I did a little gentle manual dilation during a pelvic exam. Then she continued to dilate until she stalled a second time. Effacement was complete each time. For some reason it was different than normal stalls in labor, although she was able to deliver at home.
— Judy, CPM
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
CDC Breastfeeding Advice regarding H1N1 Influenza (Swine Flu)
Infants who are not breastfeeding are particularly vulnerable to infection and hospitalization for severe respiratory illness. Women who deliver should be encouraged to initiate breastfeeding early and feed frequently. Ideally, babies should receive most of their nutrition from breast milk. Eliminate unnecessary formula supplementation, so the infant can receive as much maternal antibodies as possible.
If a woman is ill, she should continue breastfeeding and increase feeding frequency. If maternal illness prevents safe feeding at the breast, but she can still pump, encourage her to do so. The risk for novel influenza A (H1N1) transmission through breast milk is unknown. However, reports of viremia with seasonal influenza infection are rare.
Expressed milk should be used for infants too ill to feed at the breast. In certain situations, infants may be able to use donor human milk from a HMBANA-certified milk bank [see http://www.hmbana.org/].
Antiviral medication treatment or prophylaxis is not a contraindication for breastfeeding.
Giving Birth is a powerful life event; for survivors of sexual and other abuse it can be an opportunity for healing and transformation. If you are a survivor, please consider submitting your birth story; how it offered healing, transformation, ecstasy, etc.; and the way you prepared or planned for your birth. Your story will be considered for our upcoming book and for our Web site to help others prepare by reading positive birth stories. Please visit http://tinyurl.com/okgzz4 to submit your story. (Book by Elizabeth Davis and Debra Pascali-Bonaro coming from Rodale in 2010.)
You will be asked to choose how you would like to be credited; full name, first name only, fictional name or anonymous. We appreciate your help, because we believe that birth stories are a powerful way to pass on knowledge and help women prepare for their own journey with birth.
— Elizabeth Davis and Debra Pascali-Bonaro
Dear Friends: We are in a very difficult moment in Brazil. Our Rio de Janeiro Birth Center (Casa de Parto David Capistrano Filho) was closed down today. The authorities found a state law that prohibits a health institution from existing without doctors! We know it's political: new persons in the government and big pressure for our local doctors. We have the support of the Brazilian government but we know that in this case we will never know what might happen.
We are pretty sure that it's time to call for the help of our friends outside Brazil. We need e-mails against this attitude. We need to show the power of our movement to make birth a physiological process in a c-section country.
We are organizing to go to the streets and tell them that we want our Birth Center back!
If you want more details about this wonderful birth center go to: www.casadeparto.kit.net
Please send e-mails to support the Casa de Parto David Capistrano Filho, RJ, to: email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, with a copy to email@example.com.
Thank you so much. We are sure that if we work hard and well, in the end we will be stronger than we are now.
— Heloisa Lessa,
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ALACE Labor Assistant Training Workshop www.alace.org Advocate/Support pregnant/birthing women! July: NYC; August: Boulder; September: Mississippi; October: Seattle/Chicago; November: Albuquerque. Contact Thérèse 804-320-0607 or email@example.com
Morning Star Woman's Health and Birth Center is expanding and looking for full-time CPM or CNM. Both urban and rural locations available. Salary/benefits negotiable. Out-of-hospital experience required. Send resume/cover letter: Paula@morningstarbirth.com
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