August 5, 2009
Volume 11, Issue 16
Midwifery Today E-News
“Having a Healthy Pregnancy”
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What has driven hospitals and insurance companies to turn birth into a commercial, assembly line process?

MT online store Find out when you watch Pregnant in America, a documentary that examines our current childbirth system and the direction U.S. obstetrics might be headed. You'll learn about the dramatic rise in cesareans, misconceptions regarding pain and the use of numerous interventions to speed the process of birth. This DVD will give women and their families a different view of birth than is available through the mainstream media.
It includes interviews with well-known childbirth experts, including Marsden Wagner, Ina May Gaskin, Barbara Harper and Robbie Davis-Floyd.
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In This Week’s Issue:


Quote of the Week

"My own prescription for health is less paperwork and more running barefoot through the grass."

Leslie Grimutter


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The Art of Midwifery

Many studies have found that women with morning sickness improve dramatically after taking daily B6 supplements. The logical connection is fairly easy to track down; it all has to do with how vitamin B6 is involved in maintaining normal blood glucose levels.

First of all, B6 is essential for the utilization of carbohydrates (converted during metabolism into glucose, the body's primary source of energy). When the diet provides too little B6, one of the amino acids is converted into a harmful substance which binds to insulin (involved in the body's normal utilization of blood glucose), rendering it useless and impairing the body's use of glucose. As well, B6 is necessary in the release of glycogen (the stored form of glucose found in the liver and muscles). A person deficient in B6 has trouble using the glucose in the blood after meals; between meals, this person's system also has difficulty releasing glycogen to maintain their blood glucose level in a healthy range.

And low blood sugar levels cause nausea. This is because the body is forced to burn proteins and fats as fuel. When fat is burned without the help of carbohydrates (a process called ketosis), there is a leftover byproduct, ketobodies. A build-up of ketobodies causes nausea (as well as brain damage to the unborn child). If the person then avoids eating because of the nausea, or eats and vomits the food, their blood glucose and vitamin B6 levels continue to fall, creating a vicious circle.

In such a case, supplements may be difficult to manage; if the woman is vomiting too frequently to keep an oral supplement down, B6 injections have been found to be effective. Once the vomiting has subsided, the woman can switch to an oral supplement. From the beginning of pregnancy, by eating frequent small meals (including plenty of complex carbohydrates from fresh vegetables and whole grains), as well as including in the diet other natural sources of vitamin B6, women can usually avoid morning sickness altogether.

Althea Seaver
Excerpted from "Feel Fine: Avoiding Some Common Discomforts in Pregnancy," Midwifery Today, Issue 21
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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 mtensubmit@midwiferytoday.com.

Research

After monitoring 262 pregnant women for factors such as fruit and vegetable intake, physical activity and smoking levels, University of Queensland researchers have concluded that "[t]here is a clear need to develop and evaluate effective pregnancy behaviour interventions to improve primary prevention in maternal and infant health."

Of the women surveyed, only 2.7% met the recommendations for vegetable intake, 9.2% met the guidelines for fruit intake and only 32.8% (about one-third of the women) received adequate levels of physical activity. Almost more surprising is the finding that approximately one-quarter of the women continued to smoke during their pregnancy.

Australian and New Zealand Journal of Public Health 33(3): 228–33
The full text of the study can be read online at: http://www3.interscience.wiley.com/cgi-bin/fulltext/122423650/HTMLSTART


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Preventing Complications with Nutrition

Nutrition in pregnancy—a no-brainer, right? Who would think it was so controversial? Disagreement over a healthy diet during pregnancy continues to rage, with one side saying that what a woman eats will have no effect on her pregnancy and the other saying it has an enormous impact. So what's a woman to eat?

The fact is that research has been done on this subject, but with the exception of folic acid, it stopped somewhere around the 1980s when the focus shifted to drugs as the answer to curing all ills. The research that was done was not widely accepted due to the fact that it could not include clinically controlled studies. It would not show common sense or ethics to starve a group of pregnant women in order to supply a control group. The researchers did the logical thing and used the women's previous diet and circumstances as the control. The results were amazing. Dr. Tom Brewer totally eradicated preeclampsia in specific populations where the former rates were upwards of 40 percent. He had the women eat a healthy, varied, well-balanced diet that included high quality foods, adequate protein and complex carbohydrates. He also had them drink water to thirst, salt to taste and avoid drugs. Unfortunately, the National Institute of Health refused to publish the results because he couldn't do a clinically controlled study.

So what's the problem with pregnancy nutrition? The standard medical community does not believe that women need to eat this way. Doctors keep saying that they don't know the cause of preeclampsia, but they are madly searching for a "magic pill" or single cause to shed some light on the mystery.

"Since such a common and lethal disease must have rational, scientific etiology or cause, theories other than maternal malnutrition in late pregnancy have proliferated, as private drug firms have stampeded in a frenzy to find the 'magic bullet" to cure or treat blindly the signs and symptoms of this still 'mysterious,' enigmatic, cryptic 'disease of antiquity.' So far all of these non-nutritional, drug-focused efforts have failed."
—Dr. Tom Brewer, The New Genetics in Global Maternal-Fetal Medicine/Perinatology, 2003

This attitude means that the majority of women receive no education on nutrition in pregnancy. Desperate treatments of preeclampsia, such as diuretics, elimination of salt intake and calorie and weight gain restriction, only exacerbate the problem by further reducing and restricting much-needed blood volume (called hypovolemia) and reducing the blood supply to the placenta and fetus. Women call Dr. Brewer daily with horror stories of eclampsia, premature babies, placental abruption and fetal growth restriction.

He has spent a lifetime doing research and education on preeclampsia prevention, the cause of which is widely thought to be unknown. But not to Dr. Brewer. He found in his obstetrical practice over the years that asking women what they ate and having them eat a well-balanced, adequate protein and salt, high complex carbohydrate (whole grains, beans, vegetables, etc.) varied diet all but eliminated the incidence of preeclampsia in the populations with which he was working. Another plus was the lower incidence or elimination of premature labor and births, placental abruption, fetal growth restriction and hypovolemia.

Preeclampsia, toxemia and eclampsia are all symptomatic degrees of the same disease that Dr. Brewer calls "metabolic toxemia of late pregnancy." They are evidenced by symptoms of high blood pressure, edema (swelling), sudden weight gain, proteinuria (protein in the urine), spots before the eyes, headaches, elevated liver enzymes and, in the most severe cases, eclamptic seizures. It is a dangerous disease of pregnancy that can kill both mother and baby. Any one of the symptoms alone is not necessarily an indication of preeclampsia. For instance, some swelling is normal during pregnancy; and it is not uncommon for a healthy, well-nourished woman to have a month where she gains 5–10 pounds due to a normal, healthy, expanding blood volume (usually in the seventh to eighth month).

The anatomy of eclampsia is complicated, but the basis of Dr. Brewer's research is simple: Eat good food and avoid drugs. Working with a poor, malnourished population, he looked at what the women were eating and the high rate of eclampsia and other serious maternal/fetal health problems. Rather than throwing complicated, expensive technology and drugs at the problem, he did something logical—he fed them. He asked what they were eating and recommended they eat whatever health[ful], whole foods were available to them. Apparently their diets were especially deficient in protein, so he recommended they eat eggs and drink milk because these were not only nourishing, but also inexpensive and easy to come by. Meat was expensive and scarce, but if the women could afford to obtain some, he recommended they add it to their diets, too. Contrary to the popular beliefs at the time, he told women to salt their food to taste. This supports an expanding blood volume necessary to support pregnancy and grow a baby. He reduced the rates of eclampsia from 40 percent to almost nothing.

Amy V. Haas
Excerpted from "Preventing Complications with Nutrition," Midwifery Today, Issue 67
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Midwifery Today Magazine Issue 68

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Question of the Week (Repeated)

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 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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You want to be a midwife, but where do you start?

Are you an aspiring midwife who's looking for the right school? Or maybe you're trying to decide if midwifery is the path for you. Visit our Better Birth Education Opportunities page to discover ways to start or continue your education.



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?

— Maira

A: I would suggest that your friend learn about the sympto-thermal method. There is a very informative book written by Toni Weschler, MPH called "Taking Charge of Your Fertility." It explains how a woman can learn about her cycle, therefore helping her achieve (or avoid) pregnancy. It does cover problem situations, such as low fertility. Especially if your friend has an irregular cycle, this book could be truly helpful in helping her achieve a pregnancy. It's a great thing to know your body no matter what you're trying to do.

— J

A: Try suggesting to the couple that looking after babies, the earlier the better, will help the appropriate hormones kick in. Ideally both of them do this. Weekends there are many young, single mothers who would appreciate some baby sitting. Or even give the mother a break by walking with her when she exercises. Both of them could hold and snuggle with the infant. Important to include the male as well as the problem may well lie with him.

I would suggest that the couple are upfront with their goals as many mothers are rightly suspicious these days, particularly if they are feeling vulnerable without a mate. A long-lasting friendship could easily develop along with a happy event. I had a lot of success with suggesting this to my clients when I was a Rolfer. Lost count of the number who conceived.

— Rayner

A: I would highly suggest getting in for chiropractic care, having her nutrition checked and find out if she is vegan. Is she consuming soy which contains estrogen? Are her cycles short or long? Does she need natural progesterone after ovulation?

There is a lot that is not known about this person. But after 2 years of not getting pregnant, her nutrition may be off, his sperm may be low or malformed…it could be several things. I would be seeking further answers in various routes ASAP.

— Heather

A: I would recommend that your friend look into the HypnoBirthing HypnoFertility program to help her get pregnant. I have worked with women who have been struggling with infertility for years, trying everything without success, and with only a few sessions of hypnosis, they are able to get pregnant. You can tell her to check out www.hypnofertility.com and look for a practitioner in her area. There are also numerous studies done showing the benefits of hypnosis for fertility that she can read on the site.

I'm happy to answer any questions if I can.

— Kathryn Beck, CH, HBCE, HBFS, RMT
Certified Hypnotist, HypnoBirthing Childbirth Educator, HypnoBirthing HypnoFertility
Specialist, Reiki Master Teacher
kat@imaginehealthandwellness.com

A: There are many things that can be tried to improve this couple's fertility on all levels—body, mind and spirit.

At the body level there are many great fertility diets and supplementation suggestions out there. I recommend the Acubalance Fertility Diet, reading "The Natural Way to Better Babies" by Francesca Naish and having a look at the work of the Foresight Foundation.

On a mind and spirit level I recommend having a look at The Work of Byron Katie and maybe finding a HypnoFertility practitioner or Kinesiologist who can help uncover any subconscious blocks.

Chinese Medicine has a long history of successful treatment of fertility issues so your friend may be interested in finding an Acupuncturist and Herbalist that specialises in fertility. Randine Lewis's site: The Fertile Soul www.thefertilesoul.com has practitioner referrals with clinics all over the US.

I hope that helps.

— Heather


Q: [From E-News 7:6] I was blessed with a wonderful homebirth under the watchful eyes and in the warm hands of two local midwives in the state of Illinois. This was my fourth homebirth and sixth pregnancy. The birth of my 8 lb 4 oz baby went beautifully. It was not until I got out of the birthing pool and onto the birthing stool to release our placenta that my uterus prolapsed. My midwives did their best and gave me all the information they knew about uterine prolapse. I am reaching out to the bigger midwife community for additional advice about how to treat a prolapsed uterus and maintain uterine health through the rest of my life. I am only 24, and who knows what is in the future. If we choose to have another baby, what will likely happen? Your support, knowledge, and resources would be greatly appreciated.

— Jahmanna

A: My name is Natasha Althouse and I am certified Mayan Abdominal Massage Practitioner. This work is based on ancient techniques from the Mayan tradition of Belize along with the lifelong study of medicine and massage of Dr. Rosita Arvigo. This treatment combines massage, herbs, prayer, fajas, and self massage to help realign (and lift) the uterus as well as cleanse the digestive system and create homeostasis within the individual. It is amazing work and there are practitioners all over the globe. I had a client last year with a prolapsed uterus and after she had 5–6 treatments along with regular chiro care…it lifted and has stayed lifted. She acknowledged that she had to keep up with her own "self-care" in order for everything to stay balanced…but that is the true nature of health…it's not all in someone else's hands right?

The Web site to learn more about this work is www.arvigomassage.com and if you click on "practitioners"…you will find someone in your area!

Best of luck and happy, healthy uterus to you!

— Natasha Lynn Althouse


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

What about the ways we use our bodies? Can we really birth instinctively if we cannot use our bodies freely? If we cannot squat, if our back muscles are weak from too much sitting and if our babies are not optimally positioned because of our lifestyle and the ways we habitually misuse our bodies? Physical preparation—through Janet Balaskas' Active Birth exercises, optimal fetal positioning, The Pink Kit and/or prenatal yoga, for example is a very important facet of preparing for instinctive birth, helping us to open to the "specified reactions" of our instincts through, for example, different postures and positions.

Sarah J. Buckley
Excerpted from "A Vision of Birth," Midwifery Today, Issue 68
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Letters

Thank you to all of you who have been calling [your senators]. These calls have been very successful and I've just learned that [Senator] Boxer may actually introduce our bill (HR2358) in the Senate! There are actually two bills that are very important to birth centers. One is HR2358—Medicaid Reimbursement for Birth Center Facility Fees, and the other is HR1101—Equitable Reimbursement for Midwives under Medicare (currently midwives are paid 35% less than physicians). [Ed Note: This bill is now called Midwifery Care Access and Reimbursement Equity Act of 2009.]

Again, thank you for your persistent phone calls. They are making a difference!

Karen H. Roslie, Exec. Admin.
Best Start Birth Center
www.beststartbirthcenter.com

Editor's note: For more information on these bills, visit the ACNM's Issues and Legislation page at: http://capwiz.com/acnm/issues/


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