|February 16, 2011|
Volume 13, Issue 4
|Midwifery Today E-News|
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Attend one or both days of the two-day Traditional Midwifery Skills pre-conference class at our conference in Bad Wildbad, Germany, this October. You’ll learn from teachers such as Elizabeth Davis, Carol Gautschi, Ina May Gaskin and Gail Hart. Topics covered include Essentials for a Normal Birth, Preventing Complications with Prenatal Care, Labor and Birth Complications, Holistic Complete Exam, Helping the Slow-starting Baby and Suturing Overview.
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In This Week’s Issue:
Quote of the Week
Motherhood has a very humanizing effect. Everything gets reduced to essentials.
— Meryl Streep
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The Art of Midwifery
I’ve found humor at birth to be safe and effective. A good giggle can change the energy for the better and bring perspective to a situation that is getting stale. A couple’s tolerance for and enjoyment of different types of humor should be assessed prenatally. Inside jokes can help people feel seen and heard. I look for opportunities to develop this connection during prenatal contact. Inside jokes often take the form of teasing and exaggerating issues. This type of humor isn’t without risk, so careful assessment and accurate dosing must be considered.
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.
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Valentine’s Day Twins
We were expecting quite a large baby from our measurements. It was a lovely, if complicated birth: a first-time mother, a four-hour second stage and a hemorrhage. Her husband was a studying to become a doctor! What’s interesting, looking back, is that while she was laboring my midwife partner, Mony, and I were in the other room talking about undiagnosed twins! They were an especially fun couple who lived in student housing. When a little person appeared in my hands I was momentarily confused by the small size but we were working on stopping her bleeding and helping the baby. The 5 lb 6 oz girl was a little slow to start. I gently placed my hand on the mother’s still large uterus. “Mony,” I said, “this is more than a placenta. There is another baby here. Will you check the heartbeat?” The parents were surprised, and then very excited to be having two babies. Off we headed to the hospital. We had excellent doctor back up.
It was a rather exciting ride‚ filled with our anticipation. The transport and birth went smoothly. The doctor on call was not our favorite‚ but this was before the cesarean epidemic and he just set up for the birth. The mother’s contractions started back up and in about 20 minutes there was another little baby girl. The babies were both more than five pounds, a bit small but healthy, and both went home the next day. The intense testing that is done now was not done in 1979. It really was a happy‚ loving Valentine’s Day.
The postpartum visits were a joy. There were no breastfeeding problems and the family got on with life. When we looked at the chart to scrutinize what we may have missed‚ we had indeed missed a growth spurt that might have had us check more closely into things. What we all decided‚ midwives and parents‚ is that it was just the way it was supposed to be. If we had known about both babies it would have been a very different outcome. I do not‚ however‚ recommend you work that way. Check all details of your care—charts‚ palpation‚ dates—carefully. Outcomes are not always that good.
— 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 on Twitter: twitter.com/jantritten
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Diet Linked to Twinning Rate
The incidence of twinning in humans is linked to elevated insulin-growth factor (IGF). The twinning rate of women who do not eat any dairy is one-fifth the rate of vegetarians and omnivores. Elevated IGF levels related to a woman’s diet, including the consumption of milk that contains growth hormones, appears to enhance the chances of a multiple pregnancy.
— Steinman, Gary. 2006. “Effect of diet and heredity on the human twinning rate.” J Reprod Med 51: 405–10.
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Twins: A Very Special Occurrence
Something about the word “twin” seems to inspire an immediate anxiety attack in all concerned: mother, father, grandmother, midwife and especially obstetrician. Medical literature abounds with information on multiple gestation and the inherent risks to the mother and her babies. Twins are generally viewed as pathology and very little is written about the possibilities of achieving an optimum outcome. I do not consider “twinning” to be an anomaly, but a very special occurrence which deserves careful management to ensure safety for both mother and babies. Indeed, there is no reason that a mother of twins cannot expect to deliver healthy full-term infants when she is properly educated, has a high level of responsibility and receives excellent prenatal care.
It is not my intent to either advocate or oppose the idea that the management of multiple pregnancies is beyond the scope of midwifery practice, or that out-of-hospital delivery of multiples should be considered. It is, however, my opinion that if one undertakes the practice of midwifery one should be knowledgeable about all possible “variations of normal” which may—and are likely to—occur.
In fact, the first twins’ birth I attended caught me my surprise. The mother, new to my area, came to me in the second trimester. As I recorded her fundal height and found it to be above dates, I referred to her previous records and found she had equal measurements for dates with her first baby. Her son had weighed 10 lb at birth, so I accepted the disparity as normal for her. At term, her fundus measured 44 cm. If I had been looking for twins, I probably would have discovered them, but because I assumed she was going to have another “whopper,” I simply missed the signs. Her labor progressed smoothly and rapidly to second stage, when she pushed once and delivered a beautiful, small, baby girl into my hands, I immediately listened for another heartbeat and discovered a second baby, ready to be born.
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Question of the Week
Q: How do you facilitate good midwife-doula relationships?
— Jan Tritten
SEND YOUR RESPONSE to firstname.lastname@example.org 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 are your favorite natural remedies for labor and birth?
— E-News editorial staff
A: As much gentle encouragement as needed, and trying to stay in touch with whatever will make mom feel the most safe and loved at any given moment.
— Kristine Silveri
A: Arnica, both topical and oral, helps mom to heal. Peppermint extract is good for mom to smell if she needs energy or feels queasy.
— Diane Klingbile Peplin
A: I had a few prolonged third stages with my beginning practice and I was amazed at how quickly the placenta came with homeopathic pulsatilla—within five minutes! I wish I could use that if I ever practice in the hospital.
— Kathy Mercer
A: I like to focus on prenatal nutrition and emotional preparation. If you do the work prenatally, the birth is usually smoother. Labor is usually hard work and many women are not prepared to be pushed beyond their limits physically or emotionally. Getting outdoors and around nature, watching the cycles of weather, learning what animals need and do, these are all helpful.
— Helena Wu
A: Placenta-globules, if needed, in combination with Caulophyllum and Cimicifuga.
— Cornelia Enning
Responses to any Question of the Week may be sent to E-News at any time. Write to email@example.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.
Think about It
It is commonly thought that to choose to birth twins at home is to take an unacceptable risk. As a midwife, I need to ensure that parents who make such a decision are adequately informed, as I see it is their, and not my, decision to make. My role is to provide information showing the perceived risks vs. the benefits.
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