|July 22, 2009|
Volume 11, Issue 15
|Midwifery Today E-News|
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Ina May Gaskin ~ Michel Odent ~ Elizabeth Davis
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Quote of the Week
"Natural childbirth allows the hormones that have been working for women for thousands of years to fulfill their functions. This is more important than just helping a woman through labor and delivery. Birth-related hormones also affect well-being much later in life."
— Janet Schwegel, Adventures in Natural Childbirth
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In This Week’s Issue:
The Art of Midwifery
How can we avoid disturbing the process of birth and align our practices with our evolutionary blueprint? This can seem difficult in a culture where birth has been disturbed, one way or another, for many generations. Yet it is really very simple—if we were to provide conditions of privacy and a sense of safety for birthing women, as close as possible to the conditions necessary for sexual activity, most women would experience a spontaneous, ecstatic and relatively easy birth.
These are some suggestions for mothers and midwives on how to undisturb birth:
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.
Dr. Michel Odent is the founder of the Primal Health Research Centre in London, UK. Primal Health Research is a developing branch of epidemiology. It includes all studies exploring correlations between what happened during the "primal period" (fetal life, perinatal period, year following birth) and what will happen later on in life in terms of health, behavior and personality traits. To access the Primal Health Research database, go to www.birthworks.org/primalhealth/. The following is excerpted from an interview with Dr. Odent, by Jan Tritten of Midwifery Today.
Among the recent large and authoritative studies of autism from a Primal Health Research perspective, the Australian one will convince anyone that the main risk factors occur in the perinatal period (Glasson, E.J., et al. 2004. Perinatal factors and the development of autism: a population study. Arch Gen Psychiatry 61(6): 618-27). The birth records of 465 subjects born in Western Australia between 1980 and 1995 and diagnosed with an autism spectrum disorder by 1999 were compared with those of 481 siblings and of 1313 controls. No differences in gestational age at birth (including the proportion of premature infants), weight for gestational age, head circumference or length were observed between cases and control subjects. Pre-eclampsia did not appear as a risk factor. These negative findings lend more importance to perinatal factors. Compared with their siblings, individuals with autism were more likely to have had induced births, to have experienced fetal distress and to have been born with low Apgar scores. Compared with control subjects, they were more likely to have been born after induction and by elective or emergency c-section.
The largest study ever published about the perinatal risk factors for autism was published in July 2002 (Hultman, C., P. Sparen and S. Cnattingius. 2002. Perinatal risk factors for infantile autism. Epidemiology 13: 417-23). The researchers had at their disposal the recorded data from the Swedish nationwide Birth Register regarding all Swedish children born during a period of 20 years (from 1974 until 1993). They also had at their disposal data regarding 408 children (321 boys and 87 girls) diagnosed as autistic after being discharged from a hospital from 1987 through 1994 (diagnosis according to ICD-9 code 299A). Five matched controls were selected for each case, resulting in a control sample of 2040 infants. The risk of autism was significantly associated with caesarean delivery and a 5-minute Apgar score below 7. Unfortunately the variable "labour induction" could not be taken into account, because it did not appear in the National Birth Register until 1991 (personal correspondence with one of the authors).
A recent report from Israel also found no prenatal differences between autistic children and controls, but the rates of birth complications were higher among the autistic population. In addition, we must consider data indicating that perinatal factors may play a lesser role in autism in "high-functioning" individuals compared with studies of autism associated with severe retardation, as well as data suggesting that anesthesia during labour is a risk factor for the development of dyskinesia among autistic children. Although the risk factors for autism seem to occur mostly in the perinatal period, we must keep in mind the association of autism with fetal valproate syndrome (a rare congenital disorder caused by exposure of the fetus to valproic acid during the first three months of pregnancy), thalidomide embryopathy (a syndrome related to in utero exposure to thalidomide) and Mobius sequence (disorder linked to first-trimester exposure to misoprostol).
— Michel Odent
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A Link Between Prenatal Ultrasound and Autism?
The cause of autism has been pinned on everything from "emotionally remote" mothers (since discredited) to vaccines, genetics, immunological disorders, environmental toxins and maternal infections. Today most researchers theorize that autism is caused by a complex interplay of genetics and environmental triggers. A far simpler possibility worthy of investigation is the pervasive use of prenatal ultrasound, which can cause potentially dangerous thermal effects.
Health practitioners involved in prenatal care have reason to be concerned about the use of ultrasound. Although proponents point out that ultrasound has been used in obstetrics for 50 years and early studies indicated it was safe for both mother and child, enough research has implicated it in neurodevelopmental disorders to warrant serious attention.
At a 1982 World Health Organization (WHO) meeting sponsored by the International Radiation Protection Association (IRPA) and other organizations, an international group of experts reported that "[t]here are several frequently quoted studies that claim to show that exposure to ultrasound in utero does not cause any significant abnormalities in the offspring. … However, these studies can be criticized on several grounds, including the lack of a control population and/or inadequate sample size, and exposure after the period of major organogenesis; this invalidates their conclusions…."
Early studies showed that subtle effects of neurological damage linked to ultrasound were implicated by an increased incidence in left-handedness in boys (a marker for brain problems when not hereditary) and speech delays. Then in August 2006, Pasko Rakic, chair of Yale School of Medicine's Department of Neurobiology, announced the results of a study in which pregnant mice underwent various durations of ultrasound. The brains of the offspring showed damage consistent with that found in the brains of people with autism. The research, funded by the National Institute of Neurological Disorders and Stroke, also implicated ultrasound in neurodevelopmental problems in children, such as dyslexia, epilepsy, mental retardation and schizophrenia, and showed that damage to brain cells increased with longer exposures.
Dr. Rakic's study, which expanded on prior research with similar results in 2004, is just one of many animal experiments and human studies conducted over the years indicating that prenatal ultrasound can be harmful to babies. While some questions remain unanswered, based on available information, health practitioners must seriously consider the possible consequences of both routine and diagnostic use of ultrasound, as well as electronic fetal heart monitors, which may be neither non-invasive nor safe. If pregnant women knew all the facts, would they choose to expose their unborn children to a technology that—despite its increasingly entrenched position in modern obstetrics—has little or no proven benefit?
— Caroline Rodgers
Web Site Update
Read this article excerpt from the most recent issue of Midwifery Today newly posted to our Web site:
My heart broke. I instinctually wanted to gather her up like a little child into my arms, rock her fear away and caress her with reassuring words, "It's okay, honey. Don't be afraid. You're okay." But I knew that approach wouldn't reach through her panic and into her inner world. Feeling almost unkind I took charge, looking her straight in the eyes and, using my firm voice, guided her through each contraction, working to keep her grounded in the present and reminding her that she was now safe and protected. This was birth. It was strong, but she was okay.
Read this review from Midwifery Today newly posted to our Web site:
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Question of the Week
Q: What are your theories on the causes of autism? Do you see a prenatal or perinatal link? We want to hear your thoughts and experiences.
— 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: 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 an 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?
A: I was in a similar situation. I'd been trying to get pregnant for over 2.5 years, all the tests showed that I was well and my husband was too. We couldn't afford IVF. After all that time I accepted the fact that I probably wouldn't get pregnant and decided to give up. Amazingly after all that time I was able to just accept that it wasn't happening and stop thinking about it all the time. Surprise, surprise—6 months later I was pregnant for the first time at the age of 30.
Not sure that that is really any help, but maybe it's hopeful still for your friend.
A: The Webster Technique done by a certified Chiropractor can align and relax the uterus making it more receptive to fertilization. To find a provider go here.
— Ursula Sabia Sukinik
A: This woman with infertility issues should check out the fabulous science of NaPro Technology, developed by Dr. Hilgers at Pope Paul VI Institute in Omaha, Nebraska. It is a morally sound way of addressing these issues without involving the loss or cryopreservation of conceived embryos through IVF. Their diagnostic techniques are phenomenal.
— Lynn Grandon
A: It doesn't always work, but I have seen it work many times…natural progesterone cream. This is especially true if synthetic hormones were ever used such as the pill or patch or depo injections.
We also get a lot of xenoestrogens from pesticides and plastics off-gassing. The natural progesterone is reported to knock the synthetic from the receptor sites so they can receive the natural.
I have a friend pregnant now who was infertile for 15 years following the birth of her first child. She used the progesterone cream for over a year and conceived and continued to use it into her 2nd trimester. It is the cheapest and most harmless thing to try. If you develop uncomfortable symptoms from its use, stop using it. Make sure that it is truly a standardized dose of natural progesterone cream with instructions for its use, and not just wild yam cream.
The one I have used and recommend is available at: www.homefirst.com
— Heather Russell, RN and former Registered Midwife
A: I would suggest acupuncture for your friend. I was unable to get pregnant, even with IVF, and when I added acupuncture, it worked immediately. Recent studies in infertility support this.
A: I would suggest that this couple find a "fertility awareness" teacher. Very often difficulties getting pregnant can be turned around with simple lifestyle changes and improved timing based on the woman's unique cycles (not on the so-called "average" cycle).
— Natalya Lukin, LM, CPM
A: I would suggest that your friend read the book "The Art of Natural Family Planning." It has lots and lots of good (and mostly non-medical) information that could be of help.
Also suggest both of them go through a cleanse, perhaps supervised by an ND. I have found often women will get pregnant with ease after a cleanse, but the body is wise enough to know that it might be overload of her body before the cleanse is done to handle a pregnancy. Also his health is a key factor for fertility and for baby so this is often helpful to him as well.
Hope some of this helps, if it is encouraging I have a friend who became pregnant for the first time after making changes to cleanse and improve her diet. (She was 52 years old at the time and her husband was a few years older than she was. She had given up on having her own child, doctors had told her she was in complete menopause, but she had decided that a child in some way would become an important part of her life.)
— Anna Matsunaga
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: My own personal experience is that yes, with my first there were stalls in dilation and a very long labor (34 hours). However, much less with the second. And by my third labor (only 4 hours), I must say I don't think that the surgery had any effect on length. I don't know if that is helpful. Seemed to be more an issue in the first labor … and I wish the doctor had been more aware of the effect of the surgery 7 years previous to have mentioned it to me.
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
A new study has found that physicians do not always report abnormal test results to their patients. The Archives of Internal Medicine report states that "[i]n this study, failures to inform patients of clinically significant abnormal test results or to document that they have been informed appear to be relatively common, occurring in 1 of every 14 tests." Read the full report here.
I am a childbirth educator who very much enjoys the online version of your magazine.
I would not have picked the answer chosen for the questions about whether a 21-year-old woman, who from the question I assume has never had a baby, should have LEEP for dysplasia resulting from HPV. [Editor's note: The answer referenced above appeared in "Question of the Week Responses," Midwifery Today E-News, Volume 11, Issue 12.]
The answer is a subjective expression of another woman's experience which hardly relates at all to that of the woman in question. Odette had already had a baby, she suggests that her condition was somehow caused by sexual abuse (even if it is, perhaps that is not the case with the other), and she finally chooses laser treatment a year, or two, she can't remember, after her diagnosis. I don't know much about dysplasia but it sounds like laser treatment is the heavier, more expensive option. I'm sure laser treatments do work quite well, but, knowing the medical establishment, it's not covered by insurance companies for cases that are less than extreme. Her conclusion that she later had a beautiful water birth that went quickly does not reassure me at all that the 21-year-old will have a easy time during her first birth, after work is done on her cervix. Odette didn't even have LEEP, and the specific questions—like whether a midwife would generally accept a woman who had had this procedure—are not addressed.
I hope the woman who wrote in finds some comfort in Odette's story, but I do not. Apples to apples is a basic scientific principle, and if we are to compete with doctors and scientists we must at least attempt some sort of logic!
— Ginger Bisharat
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