June 24, 2009
Volume 11, Issue 13
Midwifery Today E-News
“Placenta Medicine”
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Placenta rituals, remedies and recipes…

…are what you'll find in Placenta: The Gift of Life. Read this book to discover the various ways placentas have been used by people around the world and throughout the ages. You'll also find 15 recipes that will show you how to use the placenta in ointments, essences and other remedies for a variety of ailments. Placenta: The Gift of Life is a book from Motherbaby Press, an imprint of Midwifery Today.
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In This Week’s Issue:

Quote of the Week

"What if every woman had her placenta encapsulated instead being prescribed a bottle of pills? I think depression would decline, breastfeeding rates would increase and greedy pharmaceutical and formula companies would be out the massive profit they make off our ignorance."

Tiffany Rosenbrock

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The Art of Midwifery

After a woman has a baby, many changes quickly begin to occur in her body. Hormones revert to pre-pregnancy levels, organs shift and blood levels decrease—just to name a few. This transition can sometimes be difficult. Placentas contain hormones which, when given in the postpartum period, can make the change easier. Ingesting the placenta also can help to prevent postpartum depression. I have seen quite a few women who had postpartum depression with previous pregnancies take placenta medicine after a current pregnancy and feel completely different.

Placenta medicine also has nutritional benefits. It is a high source of iron and protein. Because the placenta is the bridge between mother and baby, it contains all of the same vitamins and nutrients that mother has passed across to baby. This may be especially important if a woman experiences postpartum hemorrhage.

Kelly Graff
Excerpted from "The Bridge of Life: Options for Placenta," Midwifery Today, Issue 84
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Scientists in Russia and Belarus are adding lactoferrin, a protein in human milk, to goat milk through genetic modification. The intent is to enable mothers who cannot breastfeed their children to give them milk that is almost as good.

Ninety doe kids from genetically modified bucks are being raised on a farm outside of Moscow in the hope they will produce milk with the same—or higher—amount of lactoferrin [that] is found naturally in human breast milk.

Similar projects are being carried out in the Netherlands and China. Dutch scientists have created a transgenic cow producing the protein, but in small quantities. Goats were chosen over cows for the Russian-Belarusian study because they produce more milk in proportion to their weight and are less dependent than cows on external factors such as temperature.

Daily Telegraph, 2009

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Drying the Placenta

The most practical method of processing the placenta is to dry it. This method has been and still is being used all over the world. Depending on the culture, the placenta is dried in the oven or in the sun. When the placenta is finally mummified after many hours, it will still need to be protected from bacteria and insects.

Traditionally the dried placenta is wrapped in a piece of cloth and hung in a cool, dry place to be cured like bacon. In a modern household, a preferable method is to grind it into a powder and keep it in a well-sealed jar in the refrigerator. The powder can then be used to produce various remedies.

The placenta must be completely mummified before being pulverized. The average placenta is 25 mm thick, has a diameter of 22 cm and weighs about 500 g. Depending on the size and thickness of the organ, an average of three days and three nights is required for it to dry enough to be broken into chunks.

The exposure to heat during the drying process should be as gentle on the healing substances as possible. Afterwards, the placenta will only be half its original size and will have turned hard and black. It needs to be brittle enough to be crushed into pieces with a heavy object.

First, grate the dry chunks of placenta, then grind with a coffee mill or with a mortar and pestle. Keep removing the powder and grinding the bigger pieces. If the powder is still not fine enough, add a carrier substance such as sugar, silica or mineral earth. The crystals of the carrier substance will make the powder even finer.

The completed placenta powder keeps best in a cool, dry place. The container should be marked with the date the powder was made, the dilution and the origin of the raw material. Experience shows that the powder can be stored for up to three years. If bacteria, spores or parasites are not destroyed, the powder will develop a bad smell. If this happens, do not use the powder anymore.

Cornelia Enning
Excerpted from Placenta: The Gift of Life, Motherbaby Press 2007

To read more about the placenta or find recipes using the dried placenta, Placenta: The Gift of Life can be purchased here.

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Question of the Week

Q: I have a friend who has been trying to get pregnant for at least two years now, probably three, without success. She is a powerful, healthy, active, spiritual woman. Her husband is a wonderful African dancer and has an individual providing spiritual guidance from Africa who has promised them that the baby will come someday. I am an RN and know the medical definition of infertility. I try to have hope for them but it is hard for me. My friend has had all the infertility tests run and has been told all is okay with her. I do not know about her husband. They cannot afford in vitro fertilization.

My friend has great faith and has, incredibly, not lost hope but I wish I had some information to give her besides the normal medical research on things that could help her get pregnant. I know this is a struggle so many other women deal with too. Any ideas?

— Maira

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: 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?

— Michelle

A: During my first pregnancy, I had preterm labor and delivered at 37 weeks. After the birth of my first son, my cervical dysplasia (discovered during pregnancy) did not resolve, but continued to worsen. I had laser ablation of the cervix 5-1/2 months postpartum (a laser is used to burn the outer portion of the cervix and get rid of the abnormal cells).

I became pregnant 14 months after the first birth, and had no issues with preterm labor. In fact, he was born at 41 weeks. This labor was not typical, in that my contractions were not painful, but I was making cervical change throughout the day. I arrived at the hospital at 9 am, and he was born at 4:30 pm. The only intervention I had was an AROM at my request at 9 cm.

I also have a friend who had cryo for her dysplasia (with the same obstetrician/gynecologist I used), and had no trouble becoming pregnant, carrying to term and delivering just fine.

I can't speak to midwives risking out women from personal experience, other than I talked about my own situation with a midwife friend, who had no concerns about my ability to homebirth if I ever became pregnant again.

— Meredith

A: LEEPs are so common I wasn't going to respond to the above question thinking that other midwives would have had many women with a similar history. I have not seen any women have preterm labor, [though this] does not mean that other midwives or practitioners have not had the exact opposite experience from me. HPV is an infection and generally transmitted to the vaginal and cervical tissues by sexual intercourse. It can lead to cancer and therefore LEEP is recommended. What I have seen most often is the scarring of the cervix that initially slows dilation. For example, opening past a finger tip in labor can be prolonged. During a cervical exam massage of the cervix has relieved the scar tissue and dilation then proceeds as normal on women who have not taken DHA or other essential fatty acids during pregnancy.

DHA administration is now becoming commonplace supplementation in mainstream obstetrical care for baby's brain growth and development during the last trimester of pregnancy. Something midwives have been doing forever—evening primrose oil—is similar in terms of properties, is excellent for fetal brain growth and development and softens the cervix preparing it for dilation. Most midwives prefer that a client wait until she is 36 weeks to begin evening primrose oil. Start with 500 mg the first week, 1000 mg the second week, 1500 the third week, until a total of 3000 mg a day is ingested. Evening primrose oil has undergone clinical trials and is considered non-toxic to infants up to 8000 mg/daily dose.

For general overall cervical health—folic acid. Even 400 mcg per day of folic acid can have major improvements on cervical health and I have read research that has uncovered reversal of dysplasia in some women once they started ingesting folic acid supplements over a period of time. In addition, should one become pregnant while taking folic acid supplementation, she is already preventing the possibility of dietary/hereditary spinal cord anomalies with the folic acid-B12 deficiency syndrome. What is good for baby is definitely good for mom!

— Sandra Tallbear, CNM

A: I'm a midwife in New Zealand providing continuity of care for women over their childbirth experience. I have cared for a number of women with the procedure you are querying—called a LLETZ procedure in NZ. Both LLETZ and cone biopsy have the potential to cause scarring of the cervical tissue, resulting in cervical dilatation dystocia (lack of dilatation) or an incompetent cervix (a cervix that dilates prematurely). However, I am yet to see this—all the mothers I have cared for who have undergone this treatment have labored either at term or post-term without cervical problems.

It does not preclude women from midwife care—here in NZ women have a consultation with an obstetrician during the pregnancy to discuss the possible risks, but remain under midwifery care. Hope this helps.

— Kelly Manninen, Midwife

A: I have not seen any significant incidence of either cervical incompetence or preterm labor resulting from LEEPs although these are potential risks. Scar tissue causing difficulty dilating is another possible complication of LEEP, however, I have not seen any significant incidence of that either. Fortunately, most LEEPS, if done well, should not have a major impact on childbirth, and having it done well is essential to prevent loss of elastic tissue or scarring.

— Eden Gabrielle Fromberg, DO, FACOOG, DABHM
Holistic Gynecology & Integrative Fertility

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

A: I would recommend acupuncture for endometriosis. Years ago my roommate had endometriosis and her best relief from symptoms and eventual healing came from acupuncture treatments.

— Danette Condon

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

OSU Study Reveals Conflict between Doctors, Midwives over Homebirth

CORVALLIS, Ore. Two Oregon State University researchers have uncovered a pattern of distrust—and sometimes outright antagonism—among physicians at hospitals and midwives who are transporting their homebirth clients to the hospital because of complications.

Oregon State University assistant professor Melissa Cheyney and doctoral student Courtney Everson said their work revealed an ongoing conflict between physicians and midwives, similar to that found in other studies of the dynamics between the two groups across the country.

The pair recently examined birth records in Oregon's Jackson County from 1998 through 2003, a period when that county saw higher-than-expected rates of prematurity and low birth weight in some populations. The researchers wanted to assess whether those rates were linked to midwife-attended homebirths.

The findings revealed that assisted homebirths did not appear to be contributing to the lower-than-average health outcomes and, in fact, that the homebirths documented all had successful outcomes. But even more importantly to Cheyney, discussions with doctors and midwives uncovered a deep mistrust between the two groups of birthing providers, with doctors expressing the firm belief that only hospital births are safe, while midwives felt marginalized, mocked and put on the defensive when in contact with physicians.

"We've been getting insight into their world view, and it's been quite illuminating," Cheyney said.

Cheyney, who is a practicing midwife in addition to being an assistant professor of medical anthropology and reproductive biology, said she was surprised that physicians, when presented with scientifically conducted research that indicates homebirths do not increase infant mortality rates, still refuse to believe that births outside of the hospital are safe.

"Medicine is a social construct, and it's heavily politicized," she said.

She is working with Lane County obstetrician Dr. Paul Qualtere-Burcher to draft guidelines that would help midwives and their clients decide when they need to seek medical help, based in large part on Cheyney's research, and another that would ask physicians to recognize midwives as legitimate caregivers.

Qualtere-Burcher said creating an open channel of communication isn't easy.

"I do get some pushback from physician friends who say that I'm too open and too supportive," he said. "My answer, to quote (President) Obama, is that dialogue is always a good idea."

Qualtere-Burcher said he believes that if midwives felt more comfortable contacting physicians with medical questions or concerns, there would be a greater chance that women would get medical help when they needed it.

"Treat (midwives) with respect, as colleagues, and they'll not be afraid to call," he said.

While Qualtere-Burcher believes it would be wonderful, but Utopian, for all midwives to agree to seek medical assistance under the guidelines they're proposing, and for all physicians to learn to deal more collegially with midwives, he hopes that if a small group on each side agrees to the plan, it will provide more evidence that a stronger relationship between physicians and midwives will lead to better outcomes for mothers and infants.

Last year the American Medical Association passed Resolution 205, which states: "the safest setting for labor, delivery and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex" The resolution was passed in direct response to media attention on home births, the AMA stated.

What is interesting, Cheyney points out, is that 99 percent of American births occur in the hospital, but the United States has one of the highest infant mortality rates of any developed country, with 6.3 deaths per 1,000 babies born. Meanwhile, the Netherlands, where a third of deliveries occur in the home with the assistance of midwives, has a lower rate of 4.73 deaths per 1,000.

One of the biggest problems Cheyney sees is that physicians only come into contact with midwives when something has gone wrong with the homebirth, and the patient has been transported to the hospital for care. There are a number of reasons why this interaction often is tension-filled and unpleasant for both sides, she says.

First is the assumption that homebirth must be dangerous, because the patient they're seeing has had to be transported to the hospital. Secondly, the physician is now taking on the risk of caring for a patient who is unknown to them, and who has a medical chart provided by a midwife which may not include the kind of information the physician is used to receiving.

And because the midwife is often feeling defensive and upset, Cheyney said, the contact between her and the physician can often be tense and unproductive. Meanwhile, the patient, whose intention was not to have a hospital birth, is already feeling upset at the change in birth plan, and is now watching her care provider come into conflict with the stranger who is about to deliver her baby.

"It's an extremely tension-fraught encounter," Cheyney said, "and something needs to be done to address it." As homebirths increase in popularity, she added, these encounters are bound to increase and a plan needs to be in place so that doctors and midwives know what protocol to follow.

"We're having a meeting in early May to propose a draft for a model of collaborative care that might be the first of its kind," in the United States, Cheyney said.

Cheyney is also pushing to get hospitals and the state records division to better track homebirths. The department of vital records had no way to indicate whether a birth occurred at home until 2008, and without being able to pull data, Cheyney said it's hard to explore the nature of home birth in Oregon.

She's also working on education programs for midwives in rural areas, including a cultural competency piece as demographics in Oregon continue to change.

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Re: E-News 11:7 about Uterine Didelphys

Some time ago I had a colleague, a young doctor with uterus didelphys. She had two normal pregnancies and two normal deliveries in our small community hospital without problems. I think that a key is good pregnancy and labor control, without unnecessary interventions.

G. Colic, MD, Ob/Gyn specialist
Belgrade, Serbia

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