April 28, 2010
Volume 12, Issue 9
Midwifery Today E-News
“Postpartum Care”
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Midwifery Today Conferences

Birth Is a Human Rights Issue

The right to have the most joyous and healthy pregnancy, birth and postpartum possible should be a human right for both mother and baby. Learn how you can help. Come to our conference in Strasbourg, France, September 29 – October 3, 2010. Classes will include Mothers' Birth Rights, Babies' Birth Rights, and Maternal Mortality Is a Pressing Human Rights Concern.

The complete program for the Strasbourg, France, conference this fall is now online! You may view it online or download a PDF. Sign up for your first choice of classes before they fill up! Go here.

Come to a Midwifery Today Conference in Russia!

We're teaming up with Domashniy Rebenok (Home Child magazine) for the “Birthing in Love: Everyone’s Right” conference this June in Moscow. You'll be able to learn from teachers such as Eneyda Spradlin-Ramos, Michel Odent, Katerina Perkhova, Gail Hart and Marina Dadasheva. This is a great opportunity to learn from Russian midwives and share our knowledge with them, so plan now to attend!

Learn more about the Russia conference and view complete program.

In This Week’s Issue:

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Quote of the Week

“Postpartum women are a gentle and essential force of nature. They are full of love, and there can never be too much love.”

Robin Lim

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The Art of Midwifery

Treating Postpartum Depression

We’ve had a lot of success in our practice using breastfeeding itself as an antidepressant, with supporting herbs and very good nutrition to help manage fatigue/blues. We have used sedating teas: catnip, skullcap, licorice. We have used mood and hormone stabilizers in tincture form as needed: motherwort, Dong quai, lemon balm. We have used Bach Flower Remedies as needed: olive and Rescue Remedy. Many mothers who previously used psych meds are skilled at determining when the herbs are not enough for them.

S. Condon, CNM, New York
Excerpted from Midwifery Today’s Birth Wisdom, Tricks of the Trade,, Volume III
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Jan’s Corner

“Dry up pills” and breast cancer

I have been doing Midwifery Today for almost 25 years now, so many, many articles, ideas and pieces of research have come across my desk. But there was one piece of research that I just couldn’t find, no matter how hard I searched. My great research editors couldn’t help me find it. It seemed to be hidden, even on the Web.

The research I was searching for is related to the “dry up pill,” which is given in the hospital to women who are not breastfeeding to dry up their milk supply, and its possible link to breast cancer. After maybe 50 years of using this pill, it finally fell out of favor with the medical establishment.

The escalating incidences of breast cancer really made me want to find the source. I figured it had been hidden so that the pharmaceutical company wouldn’t get sued. (Yes, I know I am a bit paranoid about the motives of the medical field, but most of you know why.)

Then, one of my Facebook friends came into the office for a visit. I mentioned it to her and—voilá—she found it when she went home. Here is what she said:

“After we talked about the ‘dry up’ pills and cancer, it occurred to me that Robert Mendelsohn, author of Confessions of a Medical Heretic and Male Practice: How Doctors Manipulate Women, might have mentioned something about the dry up pills and cancer. He does. He mentions three ‘dry up’ drugs [linked to breast cancer] in Male Practice: DES; Parlodel and Chlorotrianisene (Tace).”

In a newspaper article printed in the Spokane Daily Chronicle on Dec. 26, 1978, Dr. Mendelsohn tells a woman whose doctor prescribed DES after her birth for lactation suppression, “…you should be concerned about yourself, since DES, the most common medication used to inhibit lactation, has been linked to cancer of the breast. If you were treated the way millions of women were treated (from July 1976 to June 1977, 21,000 prescriptions were written for DES for breast engorgement or lactation suppression) during the past few decades, you were probably not even told the nature of this hormonal medication.”

Mendelsohn goes on to say that DES has also been linked to vaginal cancer in the female babies born to women who took the drug, as well as genital defects in their male children.

In 1994, the pharmaceutical company Sandoz halted the sale of Parlodel for lactation suppression after a lawsuit charged that the drug was killing women and the US Food and Drug Administration was ignoring the drug’s fatal effects.

Although most women are now advised that the best way to dry up their milk supply is to let the body do it on its own by not expressing the milk, there are still some lactation suppression medications (mainly Clomiphene medications such as Serophene or Clomid) being prescribed to postpartum women.

Once again, the natural way is the best way. Even in postpartum care we must be careful. God knew what He was doing when creating this lovely process of birthing and mothering and midwives to help us.

Want more information about breast cancer? This article from The Free Library is rich with preventative information and resources.

Jan Tritten, mother of Midwifery Today magazine

Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.

Jan's blog: community.midwiferytoday.com/blogs/jan/default.aspx
Jan on Twitter: twitter.com/jantritten
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A study published in the March 2010 issue of the medical journal Obstetrics & Gynecology, found that acupuncture may help alleviate the symptoms of depression in pregnant women.

The study, conducted by Stanford University researchers, examined the effects of 12 acupuncture treatments given over the course of eight weeks on 150 pregnant women diagnosed as having major depression.

Women in this study who received the acupuncture treatments were more likely to experience at least a 50% reduction in the severity of their depression symptoms.

— Manber, R., et al. 2010. Acupuncture for depression during pregnancy: A randomized controlled trial. Obstet Gynecol 115: 511.

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The Fourth Trimester

How can we best help women in the postpartum period? We must first treat each woman individually. Part of good prenatal care is the ability to get to know women and their needs. Investing the time early on can be valuable toward postpartum solutions. Many women experience postpartum “blues.” This is caused from normal hormonal changes combined with all the emotional changes that occur. I tend to worry if I do not see some irrational moods or a bout of tears during this time. It is perfectly normal to experience this and may be a good outlet, enabling the mother to process through and release her emotions. This too shall pass within a short period of time.

Some first-time mothers become totally overwhelmed with their newborns. This new mom may have not been taught by the women in her family about how to care for a child. The basic maternal instinct is present but she has no idea how to go about care. Do not assume all women know how to care for a baby. I have had to tuck more than one first-time mom under my wing and “show and tell.” Left unattended these new mothers can become confused, frustrated and depressed after birth. I have seen moms do just great for the first few weeks and then suddenly they crash and burn into a deep depression.

This does not happen to many women, but it is important to identify postpartum depression. This condition is often a combination of hormonal, chemical and emotional imbalances. It can be a very tender process to re-establish the balance. I recommend collaborating on care when it goes out of your realm.

A homeopathic, naturopathic or allopathic care provider can help with nutritional, herbal, homeopathic and/or allopathic remedies, all of which can help to re-establish balance. Teamwork is key—it will heal the imbalance and create a dynamic that helps you to help moms without exhausting yourself. This is important! If you become frustrated and burned out, you are of little use to the mom and her family.

There is also a lot of information that is vital to the new mom’s partner. During pregnancy I try to establish the role the partner envisions he/she will play during the immediate postpartum period. I find it extremely helpful to have the partner read The Birth Partner, by Penny Simkin. This book covers in detail everything a partner should consider. When will the partner need to return to work? What expectations of care are important as regards establishing in-home care from others? These questions lead to dialogue between the two partners and a plan gets set in motion. This can be very reassuring to the couple. I remind them that I am there for them 24/7 and can always be consulted. Building confidence and trust with the partner is just as important as building it with the mom. The bond they form after birth sets the pace for their parenting.

Jill Cohen
Excerpted from "The Fourth Trimester," Midwifery Today, Issue 61
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What is optimal fetal positioning?

How Will I Be Born?

Why is it important and how can you help your clients achieve it? You’ll learn this and more when you read Understanding and Teaching Optimal Foetal Positioning by Jean Sutton and Pauline Scott. Succinct and thorough, this manual includes brief descriptions of the various ways a fetus can present, information on how a fetus can be encouraged to rotate into the optimal position during later pregnancy and postures the mother should use or avoid during actual labor. Optimal Foetal Positioning features numerous black and white line drawings that illustrate and illuminate the information in the text and is a must-own for anyone who works with pregnant women. Click here.

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As a home or birth center midwife, you may rarely encounter emergencies, but when they do happen, you need to know what to do. Birth Emergency Skills Training: Manual for Out-of-Hospital Midwives gives you the information you need. It takes you from the initial steps of intervention though definitive care, balancing a friendly tone and visual appeal with authoritative and clinically useful information. This book belongs on the shelf of every practicing midwife. To Order

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Web Site Update

Visit the Midwifery Today YouTube Channel

Please check out this YouTube video, part of our Birth Essentials series:
Shoulder Dystocia-Tricks of the Trade
In this video, attendees at Midwifery Today’s Denmark conference share tricks of the trade about shoulder dystocia.

Click below to view, or you may wish to go here to download video and view without streaming interruption.


Read this article from Midwifery Today, Issue 90, recently-posted to our Web site:

  • Solace for Mothers—by Sharon Storton
    “…Eventually, the symptoms of Tanya’s trauma will probably be diagnosed as ‘postpartum depression.’ If not, she may suffer alone her isolated cocoon, separated from her world by slashing self-criticism, judgment and the effort it takes to avoid the anguish of flashbacks. It was for mothers like Tanya that Solace for Mothers was formed. Solace for Mothers is an organization designed for the sole purpose of creating and providing support for women who have experienced childbirth as traumatic. Solace for Mothers provides support for mothers, as well as education and support for their family, friends and care team.”

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Question of the Week

Q: Midwifery Today is in the midst of updating our book, Paths to Becoming a Midwife: Getting an Education, and would like to hear from midwives about the role of the apprentice. What do you look for in an apprentice? What makes you decide to take an apprentice into your practice? In which roles are apprentices most helpful to you? Who should not try to become an apprentice?

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: With the efficacy and safety of prenatal ultrasound in question, we’ve been wondering how many midwives stick to the traditional fetoscope for prenatal exams and how many have switched over to using a hand-held Doppler. We want midwives to weigh in on this debate. Fetoscope or Doppler for prenatal exams? Which do you prefer and why?

— Midwifery Today staff

A: I was trained using a Doppler, but in my own practice use a fetoscope. I have used the Doppler in early pregnancy so that my moms can hear their baby’s heartbeat before it can be detected with the fetoscope, per their request. I prefer the fetoscope because I’m not convinced the Doppler is safe for the unborn baby and there’s something distinctly different and special about hearing the heartbeat with a fetoscope as opposed to the Doppler.

— Andrea Pratt, CPM

A: I always use a fetoscope, whenever possible. I’m still not convinced it is harmless, [so] I refuse to use a Doppler before 20 weeks, unless something drastic is going on. Even after 20 weeks I use it very judiciously. (Doris Haire, forgive me!) In labor I will use it when necessary, to catch heart tones when mama is in some position other than on her back (which I hope she is!) unless the mama wants me to use the fetoscope, then I will, but most of the time I think not interfering with her “labor land” psyche by making her lie down on her back so that I can get FHTs with the fetoscope, is more important than the brief ultrasound exposure baby would get from the Doppler. I do like to show Doris Haire’s DVD about the dangers of ultrasound, (or have them read Ultrasound Unsound? if they are “Plain” [Amish]) before I would use the Doppler on them, but in the end, it is their choice, as long as it’s an informed choice!

— Marlene Waechter, CPM

A: I was pregnant with my seventh child in 1982 when I went in for my first appointment and the nurse pulled out this “newfangled” gadget to listen to the baby even though I was only 11 weeks along. I asked what it was and as she explained it, I had a check in my spirit that made me refuse to let her use it. She was a little miffed, but put it away.

I told my husband about it later, and since he was on sabbatical leave from the university and working with a doctor at a medical school, he had access to the medical library and said he would see what he could find on the subject. He came across an article that essentially said there was significant evidence that showed the vibrations and heat produced by the Doppler could be harmful to the baby’s rapidly dividing and differentiating cell structure, especially in early pregnancy.

Needless to say, I never allowed the use of the Doppler and have only rarely used it (only briefly exposing the baby), usually to relieve the anxiety of a mom who’s had a miscarriage and wants to just hear a couple of beats to know the baby is okay.

I feel that using the fetoscope allows me to more precisely locate FHTs which help me find the position of the baby, especially when the baby is in an odd position and hard to palpate. Also, I know I’m not intruding into the baby’s space and disturbing it unnecessarily.

Thanks for bringing up this subject. It’s one I’ve spoken out about for years.

— Judy Roberts

A: Fetoscope only. There is no reason to expose the growing baby to any effects of Doppler ultrasound. Further, one can really gauge/confirm position using the fetoscope with palpation.

— Tammi McKinley, CPM
Arlington, Virginia

A: I offer clients both the use of Doppler and fetoscope during prenatal exams. I have a personal preference for using the fetoscope as I know there are no negative side effects. I also love that using the fetoscope helps to confirm the position of the baby. I use the Doppler if the client wants me to pick up heart tones in early pregnancy or if they have difficulty hearing through the fetoscope.

— Erika Urban, CPM
Saint Peter, Minnesota

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.

Midwifery Today Short Video Contest Announcement

video cameraHelp spread the word about good birth!

Enter our short video contest on the theme “Birth Is a Human Rights Issue” and you could win a free five-day conference registration! Entry fee is US$10 per video and you can enter as many times as you want in the three categories: Short Documentary, Make ’em Laugh, and Advertise Optimal Birth. The winning videos will be shown at our conference in Strasbourg, France.

Entry Deadline is August 10, 2010, so get your creative gears spinning! Go here for more information and instructions.

Think about It

Calling current US breastfeeding rates “suboptimal,” researchers recently concluded that if 90% of US families breastfed exclusively for six months, the country would save $13 billon and prevent more than 900 infant deaths each year.

— Bartick, M., and A. Reinhold. 2010. The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis. Pediatrics Apr; doi:10.1542/peds.2009-1616.

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Blessings friends,

Shanti Uganda is looking for an amazing midwife volunteer in Uganda to help our project coordinator get our newly constructed birth house up and running. With the birth house built, we will now be taking the next two months to prepare for our expected opening in June 2010.

This position is open to existing midwives who are willing to help with our staff orientation, assist in establishing our prenatal education program and work with our project coordinator on our birth house guidelines and needed supplies.

For more information, please contact Kristen, our project coordinator, at kristen@shantiuganda.org.

The Shanti Uganda Society

Baby! International Film Festival, May 1–2, 2010, Kampala, Uganda

Rejoice Uganda, founded in 2008, is a children’s charity based in Wakiso Namusera. It is our priority to provide help to neglected and forgotten orphans, children suffering from the impact of HIV/AIDS, war, child abuse, domestic violence, and poor parenting. We are proud to be hosting this baby film festival in association with Baby! International Film Festival Team and our US sponsors, The Parent TV Network and The Santa Barbara Graduate Institute.

The festival, the first of its kind in Uganda, will bring together a diverse array of powerful films, leading experts, and dynamic panel-participants to explore pregnancy, birth and bonding, breastfeeding, and key issues that concern our community families and children.

You may find out more about Rejoice Uganda at www.rejoiceuganda.org and the Baby! International Film Festival in Uganda at http://babyff.com/web/festivals/rejoice-uganda.

Do not hesitate to contact our festival team at 0777027803 or 0782442626 if you have any questions or need more information.

In Him,
Marvin Nyansio

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