July 16, 1999
Volume 1, Issue 29
Midwifery Today E-News
“Homebirth”
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Broaden your education in the United Kingdom and Jamaica!

Make plans now to attend one or both these conferences:

London, England, September 9-13, 1999
Evidence Based Midwifery

Ocho Rios, Jamaica, December 2-6, 1999
Birth Without Borders--Weaving a Global Future
Sponsored by:

Mothering magazine www.mothering.com
Cascade Health Care www.1cascade.com

Important Conference Notes:

  • For reduced conference registration prices, postmark your Jamaica conference registration by August 1 or fax it no later than August 1.
  • Students receive price reductions of 25% for Jamaica, 30% for London.
  • Group discounts are available.
  • Subscribe to Midwifery Today magazine and receive a reduced conference price.
  • CEUs for Jamaica are in progress.

For your copy of the printed programs send your full name and postal address to inquiries@midwiferytoday.com. Please mention code 940.

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This issue of Midwifery Today E-News is brought to you by:

- Breech Video
- Waterbirth Website

Look for their ads below!

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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Homebirth
5) Question of the Week
6) Switchboard
7) My Story
8) Midwifery Today Conference in Philadelphia
9) Coming E-News Themes

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1) Quote of the Week:

"Dr. DeLee, who introduced forceps and episiotomy around the turn of the century, stated just before he died that if he had his whole life to live over he would do home births and nothing else, realizing that the majority of his work was probably going to do bad instead of good."

- Mayer Eisenstein, MD in Safe Alternatives in Childbirth

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2) The Art of Midwifery

Comfrey's anti-inflammatory properties reduce swelling and allow bones to reunite effectively. Apply a tepid moist poultice around the entire injured area as soon as possible, and allow it to stay in place as long as possible. Repeat several times a day. The prickly quality of comfrey leaves can be an irritant to inflamed and swollen tissue so keep the plant materials encased in the poultice cloth. If the fractured body part can be immersed in a warm infusion prepared in a bucket, this can be effective as well. Comfrey is especially indicated for a broken tailbone or a separated symphysis pubis.

- Linda Lieberman, The Birthkit Issue 1, a Midwifery Today publication

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To subscribe to The Birthkit, Midwifery Today's between-issues quarterly newsletter, call 800-743-0974 or email inquiries@midwiferytoday.com. Save $3 if you subscribe to both The Birthkit and Midwifery Today magazine. Please mention Code 940.

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3) News Flashes

A study has been completed concerning 1,148 planned births out of hospital in Hessen, Germany during an eighteen month period. Thirty-five midwives in freestanding birth centers and fifty homebirth midwives were attendants at the births. Skill level assessment and screening methods for at-risk pregnancies were emphasized; complications were referred to the hospital. The study concluded that homebirth is significantly less subject to medical interventions and the costs are lower, confirming already published data from other countries. This study was unusual in that the Ministry of Health and the principal health insurance organization in Germany helped fund the study.

- Elisabeth Geisel, ENCA European coordinator

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4) Homebirth

Tew M. Place of birth and perinatal mortality. J R coll Gen Pract 1985; 35(277): 390-394.
Using the raw perinatal mortality rates (PMR) from a 1970 British national survey, the hospital PMR was 27.8 per 1000 births versus 5.4 per 1000 for homebirths/general practitioner units (GPU). This was not because hospitals handled more high-risk births. When PMRs were standardized based on age, parity, hypertension/toxemia, prenatal risk prediction score, method of delivery and birth weight, adjusted hospital PMRs for each category ranged from 22.7 per 1000 to 27.8 per 1000 while homebirth/GPU rates ranged from 5.4 per 1000 to 10.5 per 1000.

The 1970 survey assigned a prenatal risk score to predict the likelihood of problems during labor. When PMRs for hospital versus home/GPU for the same level of risk (very low, low, moderate, high, very high) are compared, the hospital PMR was lower only at the very highest risk level. All differences, except in the "very high risk" category, were significant. The PMR for high-risk births in home/GPUs (15.5/1000) was slightly lower than that for low-risk births in the hospital (17.9/1000). Moreover, the PMRs in home/GPUs for very low, low, and moderate risk births were all similar, but hospital PMRs increased twofold between categories, which suggests that hospital labor management actually intensified risks.

The percentage of infants born with breathing difficulties (9.3% versus 3.3%), the death rate associated with breathing difficulties (0.94% versus 0.19%), and the transfer rate to neonatal intensive care units for infants with breathing problems who survived six hours (62.0% versus 26.2%) were all higher in the hospital (all p<0.001), further evidence that hospital interventions do not avert poor outcomes.

Although no national study has been undertaken since, smaller studies confirm that increasing use of hospital confinement is not the reason for the overall drop in PMR since 1970. In fact, those years when the proportional increase in hospital births was greatest were the years when the PMR declined least and vice versa.

- Henci Goer, Obstetric Myths Versus Research Realities, A Guide to the Medical Literature, Bergin & Garvey, 1995

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Tew reported 1985 British data that confirmed the older data. At a lower level of risk, PMR was seven times higher in hospital. At a higher level of risk the perinatal death rate was four and a half times higher in hospital. Out of the hospital, "birth was very much safer to mothers in both the lower and higher risk groups." She examined 1986 birth data from the Netherlands, where one-third of births are at home. The country as a whole has excellent maternity care and outcomes. However, PMR for hospital births was six times higher than for homebirths. The Dutch data also allowed birth attendant comparisons. Looking at pregnancies of normal length, PMR was ten times higher for obstetricians than for midwives. For obstetricians "the average risk status [of women] at delivery was not much higher than that of midwives' deliveries. It could not possibly account for a PMR ten times as high for obstetricians as for midwives," decided Tew.

"The British and American experience, now powerfully supported by the Dutch results, tells us convincingly that homebirth and midwives are indeed 'safer than we thought.' Together they offer the safest option. The danger of home as a place of birth does not lie in its threat to the healthy survival of mothers and babies, but in its threat to the healthy survival of obstetricians and obstetric practice."

- Diana Korte & Roberta Scaer, A Good Birth, a Safe Birth, Harvard Common Press, 1995

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Traditionally, birth has been a very private affair in which only the most intimate of a woman's relations would attend the laboring woman. Grandmothers, aunts and wise women of the village whom the woman most trusted were the ones to be called. In today's society, however, women have been taught to place their trust in the medical model of childbirth and in medical professionals rather than in persons with whom they are most familiar. They are taught to accept the place of birth that the medical professional chooses (because it is the medical professional's "safe place"?).

For many women this is a difficult and sometimes impossible transition, one which so impacts the sense of the familiar that patterns of labor are changed and the sensation of birth pain intensified. Outcome is made less predictable, and birth comes to be regarded as a difficult and painful ordeal, fraught with danger. Moreover if the woman is confronted with an unfamiliar and therefore "not safe place," a survival mechanism will kick in. She will protect her baby by preventing it from being born by ceasing to contract, keeping her cervix closed and in general "failing to progress."

If we could ask babies where they would like to be born, I wonder how many would answer, "Oh, in a hospital, of course! I want to be sure that I will be born amidst all modern technology has to offer in the even that an emergency should occur." Or, might they answer, "I want to be born in an environment of peace, security and joy and be received into the loving arms of my mother."

- Valeria El Halta, "Not Among Strangers," Midwifery Today Issue 50

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For a limited time, purchase Midwifery Today Issue No. 50 on Homebirth and save! Regular price is $12.50; purchase this remarkable issue for just $10 (plus shipping). Offer ends July 30, so place your order quickly! Mention code 940.

"I'm reading through Issue 50 and I've never been so moved by any magazine in my life."

- Leilah McCracken

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5) Question of the Week (repeated):

I would like more information about TENS (Transcutaneous Electrical Nerve Stimulation) for use in labor. The instructions on the units say "PREGNANCY: The safety of [TENS] for use during pregnancy or delivery has not been established. But I know it has been used for this purpose. Is there evidence that TENS works and is it safe?

- Jeanne Batacan, CMA, ICCE, CLE

Send your responses or submit a Question of the Week to mtensubmit@midwiferytoday.com

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6) Switchboard

It is my understanding that goldenseal can cause uterine contractions. What is the incidence of preterm labor in women who use oral goldenseal for the treatment of Group B Strep? [See Issue 28 for herbal treatment of GBS.]

- A. Casagrande, CNM DCasajr@aol.com

Response: I have never had a problem with goldenseal causing uterine contractions. One woman complained of a yeast infection after douching with goldenseal, and a sensation of burning. My sense is that her vaginal mucosa was probably already inflammed from a yeast infection that was about to show itself. Goldenseal can irritate already inflammed tissue.

I typically have women who are GBS positive begin with oral and vaginal douching with goldenseal at 36 weeks for 1 week, then every 3 days. Contractions at 37 weeks or beyond are fine, so there is no danger there. Joy Gardner in her book "Healing Yourself During Pregnancy" states that you shouldn't take more than 1/4 teaspoon or one "00" capsule per day. However, I believe this applies primarily in the first trimester and for women with a history of premature labor. I agree that goldenseal is a strong herb and should be used with precaution. I strongly recommend supplementation with acidophilus orally and vaginally because goldenseal also destroys beneficial bacteria and could bring on a yeast infection in the woman taking it and thrush in her newborn.

Anyone else have experience with the use of goldenseal?

- Betty Idarius

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My son David was born by emergency cesarean following labor induced with Prostin, a type of prostaglandin gel. I have since found out from Upjohn, the pharmaceutical company that manufactures this drug, that it is not FDA approved for induction of full-term labor. It is FDA approved for abortions only.

The dose I was given was eight times the dosage recommended by Upjohn and ACOG for Prepidil, another kind of prostaglandin gel which is FDA approved for induction of full-term labor. In the course of the labor my baby went into fetal distress and the emergency cesarean was performed under general anesthesia. I developed many complications after the surgery and had to be readmitted to the hospital twice, first with a diagnosis of endometritis and psuedomembranouscolitis (which I developed from the toxic antibiotics given me, one of which was Clindimiacin), and secondly with a diagnosis of enterocolitis, also from the antibiotics. It was a horrendous experience and I received no support from the midwives or their backup doctors.

In addition, my legal right to informed consent was violated. It is my right to know that a drug I am being given can cause fetal distress which can lead to fetal death. I also should have been informed that this drug is not FDA approved and that the dose I was given was eight times that of a comparable drug that is FDA approved. I would never have consented to this induction if I had known this. Whatever happened to ethical, competent care, not to mention compassion? I would love to hear if anyone else has had a similar experience with Prostin. -Joy, mother of David, born 1/97 JBao@aol.com

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I'm 38 and have had 12 pregnancies. I have 2 sons, 17 months apart. The other 10 pregnancies ended in miscarriage. All were girls, including one set of twins. I'm desperately searching for any info on a link between gender and recurrent miscarriage. Do I have to deliberately avoid conceiving girls in order to have a family? Is there something I can do to be able to carry girls?

- Terry Y.

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A midwife colleague who works in Sydney, Australia will be visiting family in the USA from 10 August till first week of September and is looking for workshops/conferences on midwifery (anywhere in US is feasible) or birth centres to visit.

And does anyone know of workshops/meetings in London UK, 2-9 August? Please
respond to Jan Cornfoot capers@gil.com.au

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Shore your responses to Switchboard letters with E-News readers! Send them to mtensubmit@midwiferytoday.com

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7) My Story: How I Survived a Homebirth Assisted by an MD by Jody VanNess

When I was expecting my fourth baby, I wanted to have a home delivery as I had done for my other children. I believe for mothers and babies considered low risk at the start of labor, home is the safest place. To all those who say "You are so *brave* to have your babies at home--I could never do that," I can only respond, "you are so *brave* to have your babies in a hospital. Between the supine position for the benefit of the fetal monitor, the curling up in a ball on your side for an hour for the benefit of the cranky anesthesiologist, the Pitocin you will almost certainly be given, you will be lucky to get out of there without dangerous dips in the baby's heart rate and a C-section."

I asked a female MD who works in an emergency room to attend my homebirth--the midwife who was supposed to have attended my third birth missed it because she lives three hours away. This would be the doctor's first homebirth and her first time to give prenatal care. She was pretty laid back during our prenatal visits at her home, although I didn't agree with the long glucose tolerance test she insisted on. But I went along, "passed" the test, and we made it to the big day.

My previous "miss" in mind, I decided to call her when I was pretty sure I was in labor and not wait until I was absolutely positive. She arrived in the middle of the night with her husband (he didn't want her traveling at 1 a.m. over back roads alone) and her apprentice daughter in tow. When she checked me at 2 a.m. and found me only 2 centimeters dilated, I was offended that she acted like I had called her too soon. She knew my history and she knew my plan to call when I was only "pretty sure" I was in labor. She said, "Well, if you are in labor, it is very early, and it will be a long time." My husband told her he had seen me in labor enough times to know when I was, and this was it.

I went outdoors with my friend. We walked for two blocks including up a hill, returned home, then repeated the trip three more times. At 4 a.m. the doctor checked me and I was 4 cm. I walked my route five more times, and an hour later I was 7 cm. The walking had done the trick. I had an urge to push soon after, and the doctor said it would be OK if I did it gently. She said the pushes didn't have the right sound (maybe I was holding my breath) and to pant through them.

I got into a hot shower, partly to control the pain and the urge to push, but after about 20 minutes, to push without her knowing. When I came out at 6 a.m. she pronounced me fully dilated and I was allowed to push. She was patient, gentle and encouraging during the second stage, which took 30 minutes. (Baby number one had a second stage of five hours, baby number two had a second stage of five minutes, and baby three had a second stage of about one minute.) My beautiful baby boy was born at 6:30 a.m.

The moral of the story is that although she was there for me and I felt safe having my homebirth, she knew little about normal labor and nothing about labor support. Happily for me, I had already delivered three babies at home and given labor support to my friend on three occasions, so I knew what to do. I got a lot of support from my husband and from my friend, who had had natural, midwife attended births. I believe if it had been my first baby, I would have had a terrible experience with this care provider. My family is complete, so I don't have to worry about finding a midwife in the future, but I hope for a day when women everywhere will be able to choose a midwife attended homebirth.

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8) Midwifery Today Conference Planned for Philadelphia!

Philadelphia, PA, USA: March 23-27, 2000

Classes are still being developed, but will include a preconference Education Day, an intensive study day designed for existing and would-be midwifery educators and those with an interest in this area.

Several other education related classes are planned. They include Midwifery Education, Tricks of the Trade, The Apprenticeship Model of Midwifery Education, Inquiry-based Learning and Mentorship, and Supporting Students.

Post-conference includes Evidence-Based Midwifery, a day-long workshop that will explore many of the emerging issues in this field.

To receive a printed copy of the program when it's ready, send your name and postal address to inquiries@midwiferytoday.com. Please mention code 940.

Details may change as planning progresses.

If you have questions about the conference, contact mailto:inquiries@midwiferytoday.com

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9) Coming E-News Themes

Coming issues of Midwifery Today E-News will carry the following themes. You are enthusiastically invited to write articles, make comments, tell stories, send techniques, ask questions, write letters or news items related to these themes:

- Cutting the cord (July 23)
- Ultrasound (July 30)
- Premature labor (Aug. 6)
- International Midwifery (Aug. 13)

We look forward to hearing from you very soon! Send your submissions to mtensubmit@midwiferytoday.com. Some themes will be duplicated over time, so your submission may be filed for later use.


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