July 7, 2010
Volume 12, Issue 14
Midwifery Today E-News
“Prenatal Care”
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Learn about breech birth with Ina May Gaskin, Michel Odent and Cornelia Enning

In the morning, Ina May and Michel will help you develop a variety of breech skills, including palpation and assessing fetal weight. You’ll also learn about frank, footling and complete breech, as well complications that can occur. In the afternoon, Cornelia will discuss the special circumstances of breech waterbirth. Did you know that breech birth in water improves fetal oxygenation by increasing uterine blood supply during immersion? Attend this class to find out more!

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In This Week’s Issue:


News Flash

Midwifery Today Responds to Study Questioning Homebirth Safety

The American Journal of Obstetrics and Gynecology will soon publish a report that questions the safety of planned homebirths. This report may fuel an attack on all types of midwives, everywhere. The authors state that babies born at home have a mortality rate three times higher than babies born in hospital. Their conclusion is controversial because many large and rigorous studies have concluded that homebirth and hospital birth have essentially the same safety for mother and baby.

Read Midwifery Today’s response.


Quote of the Week

“The family’s trust in the midwife and the midwife’s trust in the competence of the family members are the basis of caring that has the power of magic.”

Mary C. Howell


The Art of Midwifery

Estimating Fetal Weight

Russian midwives estimate fetal weight by using this trick: multiply the girth of the pregnant mom’s belly by her fundal height, using centimeters. The estimated fetal weight will be in kilograms. Girth x fundal height = fetal weight.

Jill Cohen
Excerpted from Midwifery Today’s Wisdom of the Midwives, Tricks of the Trade, Vol. II
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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.


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Jan’s Corner

Prenatal Care

For mothers: Prenatal care is what you do between your visits to your midwife or doctor. No one can do this for you. Each day, eat 80–100 grams of protein with lots of fruits and vegetables, salt your food to taste, and drink 8–12 glasses of water. And don’t believe all of the medical myths. Remember: everything done to you, your belly and your baby has consequences. Protect your baby from ultrasound, including Doppler, unless there is a really clear reason to use this technology. We just do not know the problems caused by what we are doing. As Carla Hartley says, “Birth is safe, interference is risky.”

For practitioners: My friend Verena, a midwife from Italy, says, “If you really prepare a woman for birth in the prenatal period, most of your work is done. She will do well.” It is interesting that a midwife needs to be a counselor to help women in their prenatal course. Think of all the garbage most women have picked up about birth from her culture. Most women’s birth stories are horror stories. Many are stories of outright abuse at the hands and mouths of medical professionals. Rare and refreshing is the woman who grows up unscathed in this strange (birth) culture. Those abused women tell their stories to others, and because there are so few good stories—maybe 1–2%—the cycle continues. Television shows such as TLC’s A Baby Story, along with other hyped-up media messages, mess with their minds even more. The battle really is in the mind. Couple this with one out of three or four women suffering from sexual abuse, and midwives, doulas and childbirth educators have their hands full.

Yes, all who love, nurture and help pregnant mothers need counseling skills to help turn the tide of birth. You are our hope. From your practices will emanate good, amazing and joyful birth stories. Let’s break the cycle in our lifetime— or at least in the younger ones’ lifetimes. Each one, teach one (or many) about how truly glorious birth was designed to be.

Jan Tritten, mother of Midwifery Today

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
Midwifery Today on Facebook: facebook.com/midwiferytoday
International Alliance of Midwives on Facebook: facebook.com/IAMbirth


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www.pathwaystofamilywellness.org



Research

Maternal Vitamin A Deficiency May Adversely Affect Offspring’s Lungs

Researchers say a woman’s vitamin A intake during pregnancy may be crucial to the healthy development of her baby’s lungs.

In a study published in the May 13, 2010, issue of the New England Journal of Medicine, researchers examined a group of children between the ages of 9 and 13 from a vitamin A-deficient population in rural Nepal, whose mothers were the subjects of a vitamin A study during their pregnancies. The children whose mothers had received vitamin A supplements during pregnancy had better lung function than the children whose mothers were in the placebo group.

The study concluded that, “vitamin A deficiency in a mother during pregnancy could have lasting adverse affects on the lung health of her offspring.” However, the researchers said the study did not support vitamin A supplementation for women “in either safe motherhood or child survival strategies.”

— Checkley, W., et al. 2010. Maternal Vitamin A Supplementation and Lung Function in Offspring. N Eng J Med 362:1784–94.


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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.


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Overcoming Disparity: Midwives Collaborating for Equality in Birth Outcomes

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MANA Region 4 Presents: Overcoming Disparity: Midwives Collaborating for Equality in Birth Outcomes. Madison, Wisconsin July 16-18 Meet national & local experts/practitioners sharing maternal & infant care models that work. CEUs and Pre-conference workshops available! Speakers include: Robbie Davis-Floyd, PhD, Jennie Joseph, LM, CPM, Sandra Steingraber, PhD. Information/Registration at www.mana4madison.org .



Supporting Pregnancy with Massage Therapy

In recent years, thousands of massage therapists have trained to become pre- and perinatal massage therapy specialists. Not that nurturing touch during pregnancy, labor, and the postpartum period is a new concept. Although not massage therapists, midwives have been valued for centuries for their highly developed hands-on skills. Massage and movement during the childbearing experience was and continues to be a prominent part of many cultures’ maternity care.(1) Most of the world’s more peaceful cultures use touch prominently during pregnancy and early childhood.(2)

Profound local and systemic changes in a woman’s physiology occur as a result of conception and the process of labor. Changes during pregnancy span the psychological, physiological, spiritual and social realms. A typical session performed by a therapist specializing in pre- and perinatal massage therapy can address pregnancy’s various physical challenges: edema, postural changes, and pain in the lower back, pelvis or hips. The stress-reducing effect of massage not only can relax mom, but it will also improve uterine blood supply and fetal and maternal outcomes.(3)

Swedish massage may facilitate gestation by supporting cardiac function, placental and mammary development, and increasing cellular respiration. It also reduces edema and contributes to sympathetic nervous system sedation.(4) Deep tissue, trigger point and both active and passive movements alleviate stress on weight-bearing joints and myofascial structures, especially the sacroiliac and lumbosacral joints, lumbar spine, hips and pelvic musculature.(5) Structural balancing and postural re-education reduce neck and back pain caused by improper posture and strain to the uterine ligaments. Prenatal massage therapists find that they also can facilitate ease of labor by preparing selected musculature and joints for release and support during childbirth.

Beyond these physical effects, an effective prenatal massage therapy session provides emotional support. In the safe care of a focused, nurturing therapist, many women unburden their worries, fears and other anxieties about childbearing. Therapeutic massage and bodywork can help the mother-to-be develop the sensory awareness necessary to birth more comfortably and actively. If laboring women whose partners learned and provided basic massage strokes to their backs and legs had shorter, less complicated labors, imagine the benefits generated by the skilled hands and compassionate heart of a trained touch specialist!

References:

  1. Goldsmith, Judith. 1984. Childbirth Wisdom. New York: Congdon and Weed.
  2. Prescott, James. 1995. The Origins of Human Love and Violence. http://www.violence.de/prescott/pppj/article.html Accessed 7 Jul 2008.
  3. Gorsuch, R., and M. Key. 1974. Abnormalities of pregnancy as a function of anxiety and life stress. Psychosomatic Medicine 36: 353.
  4. Zanolla, R., et al. 1984. Evaluations of the results of three different methods of post-mastectomy lymphedema treatment. J Surg Oncol 26(3): 210–13.
  5. Quebec Task Force on Spinal Disorders. 1987. Scientific approach to the assessment and management of activity-related spinal disorders. Spine 12: Suppl 1.

Carole Osborne
Excerpted from "Supporting Pregnancy with Massage Therapy," Midwifery Today, Issue 87
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Web Site Update

Read this article excerpt from the brand-new issue of Midwifery Today, Summer 2010:

  • A Hidden Tragedy: Birth as a Human Rights Issue in Developing Countries—by Vicki Penwell
    “The five direct causes of nearly two-thirds of maternal deaths worldwide are all things we have learned to prevent, treat or correct, making it all the more unjust that woman are dying of these childbirth complications. They are: Hemorrhage, Sepsis, Obstructed Labor, Eclampsia, and Complications of Abortions”

Read these reviews from Midwifery Today newly posted to our Web site:

  • MotherTouch: Nurturing Touch for Birth (video)—produced and directed by Leslie Piper and Leslie Stager
    Calling on the birth practices of women throughout human history, this beautiful half-hour film documents the use of touch and massage in four different births.
  • MotherTouch: Touch Techniques for Birth (video)—produced and directed by Leslie Piper and Leslie Stager
    “Touch is a language that arises before words and is understood beyond words…. It is a nourishment so necessary that it can actually supersede a newborn's need for food.”

Advertising Opportunities

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Question of the Week

Q: Because of my deep interest in all things birth I tend to get in many conversations with new mums about their birth stories and these often lead to tales of interventions and women’s hurt at the traumatic processes. It seems 9 out of 10 stories include mum being hooked up to a foetal monitor and soon being told that it is picking up [decelerations of the] baby’s heart rate during contractions and, therefore, that some form of intervention is needed.

Is baby’s heart rate dropping normal during contractions or is it cause to intervene? If so, what are the guidelines for interventions such as caesareans, induction, etc.?

— Josie Vendramini, Australia
http://www.positivebirthstories.com


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: What alternatives to suturing have you used (e.g., Super Glue, seaweed) in your practice?

— Jan’s Corner, E-News 12:10

A: I have used alternatives to suturing (especially Super Glue) but these are for surface tears, or small hanging pieces. I think it’s important to remember that with a second-, third- or, God forbid, a fourth-degree tear that muscle is torn.

When muscle tears, it retracts. Each side of the muscle pulls back into the mucosa. This is why, when the anal sphincter is torn, it may require grabbing the ends of the sphincter muscle and holding them with clamps to suture the ends together. If muscle tissue is not pulled together by sutures, I have been taught that the mucosa will heal together, the skin will probably heal together, but the underlying muscle layers will not, and the integrity of the mother’s perineal floor will be compromised.

Mary (guest writer Mary Cooper, CPM) has done many more births than I have, and I don’t know if she sutures, but I know that many midwives do not. I believe that if the midwife isn’t able to provide that service for her clients, and needs to transfer in for it, the client is more likely to decline and tears that really should be sutured don’t get properly repaired.

— Edie Wells, CPM, LM
Blessed Beginnings, Inc.


Q: What was the longest second stage you’ve experienced, and how well did mother and baby pull through?

— Midwifery Today staff

A: I had a mom once who was an RN. She risked out for a homebirth here in South Carolina, as she went into labor at 36 weeks. I transported her to a small hospital where we met the CNM back-up that had seen her for the two visits required by law. She did first stage in a normal amount of time then she pushed for 12 hours! She slept on and off during that time. In fact, we all slept some on and off. It was kind of weird sleeping during her pushing, but we needed to take shifts. Her CNM was fine as long as mom/baby looked good. (They did). I still laugh about the OB who stuck his head in the room after about 10 hours and said, “Do you all need any help in here?” We said no, and he left. A vacuum was used a little bit at the end and a small baby was delivered with good Apgars. Since then we have had a few moms push 2–3 hours at home then another 2 hours in-hospital and they have had good, vaginal births there in the end, but nothing has topped that first one!

— Lisa Aman, LM


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.


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Letters

Dear Midwifery Today,

The Nursing and Midwifery Council is the nursing and midwifery regulator for England, Wales, Scotland, Northern Ireland and the Islands. We exist to safeguard the health and well-being of the public. We recently launched a survey about proposals to amend some of the rules related to midwifery practice and supervision.

One of the questions we are asking is about the postnatal period. The rules define the postnatal period as: “the period after the end of labor during which the attendance of a midwife upon a woman and baby is required, being not less than 10 days and for such longer period as the midwife considers necessary.” We are asking whether it is appropriate for the rules to specify how long a midwife should attend a woman and baby in the postnatal period. Does this stipulation enhance the safety of women and babies? We believe that removing the stipulation of 10 days would still facilitate midwives to provide care that centers on the individual needs of women and babies.

To take part in the survey or to find out more please visit the consultation page of our Web site http://www.nmc-uk.org/. If you have any questions about this work please call, or e-mail our midwifery team at midwives.rules@nmc-uk.org. This is your chance to let us know your thoughts on midwifery practice, the function of the local supervising authorities, and the roles and responsibilities of supervisors of midwives.

As well as hearing from organizations, we are also keen to hear from parents themselves. This phase of the consultation closes on July 23, 2010. The next phase, early next year, will look at the standards and guidance related to the rules. There will also be an opportunity to comment on relevant proposals. It is expected that any changes to the rules and standards will take effect from the end of 2011.

We want as many people as possible to respond to this survey as possible, so please pass this information to anyone who may be interested.

Angeline Burke


Only letters sent to the E-News official e-mail address, mtensubmit@midwiferytoday.com, will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will not be considered.


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