September 3, 1999
Volume 1, Issue 36
Midwifery Today E-News
“Herpes”
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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Keep Baby Safe
5) Treatment for Herpes
6) Genital Herpes: Natural Remedies
7) Route of Infection
8) Question of the Week
9) Question of the Week Responses
10) Switchboard
11) Coming E-News Themes

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1) Quote of the Week:

"Every exit is an entry somewhere else."

- Tom Stoppard

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2) The Art of Midwifery

When discussing with another midwife the long perineum that always seemed to tear, she suggested that the mom get into the hands and knees position. Last time I had one, I tried it and the mom didn't tear. I think this position takes some of the stress off the perineum and positions the baby higher in the introitus.

- Gail Hart

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3) News Flashes

Researchers at Temple University School of Medicine examined records from 6,550 women born at 37 to 44 weeks' gestation in 1974 and who had babies of their own in 1995 or 1996. Those who at birth had been in the bottom tenth percentile of standard weight charts for their gestational age were three to four times more likely to have gestational diabetes when pregnant themselves. The head of the research team theorized that if a woman is born small, it may have been caused by insufficient nutrition, and it compromised her internal organs. Perhaps as a result the pancreas doesn't have enough of the cells that produce insulin.

- Obstetrics & Gynecology, reported in American Baby, April 1999

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4) Keep Baby Safe

Herpesvirus can have a devastating effect on the baby's central nervous system. If initial outbreak occurs during the first trimester, consult with backup. If there are active lesions when labor commences, vaginal delivery is generally prohibited unless sores have closed and can be kept from contact with the baby. Do cultures on both the sores and cervix in the event of any outbreak during pregnancy. Weekly cultures are no longer deemed necessary in the last trimester--a visual inspection of the cervix at the onset of labor is considered sufficient to rule out current infection. But if membranes rupture prior to the onset of labor, screen the cervix within two hours, as the baby may be rapidly affected by herpesvirus without the barrier of intact membranes.

- Elizabeth Davis, Heart & Hands, 3rd ed., 1997

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5) Treatment for Herpes

Treatment of herpes genitalis includes prevention or treatment of secondary infection. Acyclovir 200 mg five times daily for 5-7 days following a first dose of 400 mg can reduce the duration of the primary attack. Recurrent infections may require acyclovir suppressive therapy. Neonatal screening should be undertaken following delivery and acyclovir treatment given if necessary. Annual cervical cytology is recommend for all women with this condition.

- Betty Sweet, ed., Mayes Midwifery, 12th ed. 1997

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6) Genital Herpes: Natural Remedies

Vitamin C enhances immunity by acting as an antioxidant, antihistamine, antiviral and antifungal. It may also enhance white blood cell activity and promote production of interferon-specific immunoactive proteins released by blood cells in response to viral infections.

Zinc has been shown in several clinical trials to reduce the frequency and severity of herpes outbreaks. It may inhibit the ability of the herpes virus to reproduce itself, particularly when applied topically to lesions (zinc sulfate ointment). Zinc supplementation in the form of 60-90 mg daily (taken in divided doses of 15-30 mg at a time with food to prevent nausea from developing) appears to enhance cell mediated immunity and help the immune system identify and fight the virus. This large dose may be continued for a month or two, then reduced to 30 mg daily as immune function improves and outbreaks decline.

Lysine has been shown to be important in the prevention and treatment of herpes outbreaks. Some researchers believe a diet high in arginine and low in lysine may activate the herpes virus and promote outbreaks. HSV replication requires arginine, so a diet high in lysine may block arginine and prevent it from activating the virus. Most high protein foods contain many amino acids, including both arginine and lysine. Chocolate, nuts and grains are high in arginine while relatively low in lysine. Legumes have a high lysine content and are lower in arginine.

No amino acid should be taken exclusively for more than one month. Favoring one amino acid can lead to deficiencies in other amino acids. Lysine is best used as part of a comprehensive program that includes diet, herbs and immune support.

Aloe vera, an excellent antiulcer and vulnerary, can be applied topically to lesions and also taken internally for its antiviral effect. Recent research has identifed several immune stimulating compounds in aloe gel. Take 1-2 oz. aloe juice mixed with fruit juice daily for chronic viral infections. The amount can be increased up to a pint or more a day.

Lemon balm (Melissa officinalis) has been shown in research too have antiviral effects against the herpes virus. Applying strong lemon balm extracts to initial herpes outbreaks can prevent recurrence, or can speed healing. Creams prepared from highly concentrated melissa extracts and melissa essential oil are now available.

Licorice is an antivral known to reduce inflammation and heal ulcers. It contains a steroid-like saponin called glycyrrhizin which can alleviate pain and speed healing of herpes lesions. It should be applied topically and taken internally for best results. Prepare tea by boiling one teaspoon shredded root per cup of water for five to 10 minutes. Drink four to five cups of licorice tea per day at the onset. A cloth soaked in the tea and applied to ulcers may speed healing. Salves containing glycyrrhizinic acid, one of the antiulcer compounds in licorice, are available.

- Jill E. Stansbury, ND, author of Herbs for Health and Healing, Publications International, 1997

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7) Route of Infection

Sixty to 80% of all infants who develop neonatal [herpes] are born to infected women who are completely asymptomatic during pregnancy as well as at the time of birth. These women have no past history and their current partner is free of genital lesions. Only 27% of infected women whose babies become ill have a history of recurrent lesions during the current pregnancy. Transplacental communication or infection which ascends from the lower genital tract are both possible options for intrauterine infection, which can occur with both primary and recurrent infection. Infection via virus crossing the placenta or membranes is rare. The most common route of infection occurs during labor and birth when the baby has direct contact with infected maternal secretions. After birth, the baby can acquire herpes via contact with lesions on the breasts or lips of an infected person; babies born to seronegative mothers are most at risk from such exposures.

In the absence of internal examination or other invasive procedures, there is no evidence that external perineal lesions result in ascending infection in the presence of ruptured membranes, although such infection is probably more likely when the cervix is colonized.

- Anne Frye, Understanding Diagnostic Tests in the Childbearing Year, 6th ed, Labrys Press, 1997

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8) Question of the Week (repeated): Here in Mexico it is big business to be able to turn a breech baby anywhere between 3-6 months. I wonder about the risks involved and if anyone out there finds this a successful procedure?

- Evette, aspiring midwife

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9) Question of the Week Responses

Q: In regards to treatment of genital herpes during pregnancy, are there any herbs or other preparations that you know of to prevent an active infection "flare-up"? A woman in one of my childbirth classes desperately wants to have a vaginal birth. I would appreciate any information that could help her.

- D. Windover

I have genital herpes, and while I very rarely experience a flare-up, when I do, it is usually at a time of extreme stress in my life. You might make your client aware of the many benefits of staying calm and relaxed, especially in the last few weeks of her pregnancy, as herpes outbreaks are definitely linked with stress.

If your client does experience an outbreak close to her due date, if she takes the following actions as soon as she detects the first signs (tingling, soreness), she can shorten the length of the outbreak: Remove all restrictive clothing (underwear, panty-hose, pants, etc.) so that air can circulate freely to the developing lesion. After peeing, wash and blow-dry the area gently. The goal is to get the wet lesion to crust over, after which it will heal quickly and no longer be a risk to the baby.

- Trudy Noort

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Herpes outbreaks occur, as I understand it, when there is a deficiency of lysine. To treat outbreaks, a woman may take L-Lysine 1000 mg three times a day for 5 days. It is more effective if taken at the first sign of outbreak (tingling or pain). She may then follow with L-Lysine 500 mg four times a day for the rest of the pregnancy for suppression therapy. In our practice, we encourage pregnant women to take lysine as described above for the entire pregnancy. It seems to be very effective and is an inexpensive supplement. Women should also emphasize foods which are high in lysine in their diets.

- Liza McKinney, CNM

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Lysine, which is a dietary supplement, helps reduce herpes outbreaks quite well. Lysine is not produced in the body and is ingested normally in vegetables. Another way is lemon balm. It is well known by herpes sufferers to reduce outbreaks and quickly get rid of an outbreak. It can be found in health food stores. Just apply an amount that covers the area 2-3 times a day during an outbreak, or in accordance with the product label if given.

- Lucia Brazier, outbreakjinei@hotmail.com

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I suggest that immune-stimulating supplements be taken throughout pregnancy, particularly vitamin C in the mineral ascorbate form (not just ascorbic acid), plus bioflavonoids and rutin. Also try a garlic supplement. I have had great success with 5 Mushroom Extract, which is anti-viral. It contains the Japanese mushrooms Tremella fuciform, Cordyseps sinensis, Ganoderma lucidium, Lentinus edodes, Grifola frondosa. Take 10-20 drops in water 3 times a day. A client of mine developed an outbreak of herpes a week before her due date; after using the extract, everything resolved in about 3 days.

In Australia, 5 Mushroom Extract is marketed by Health World Limited, and their product range is called Metagenics. They are primarily practitioner only products, but can also be purchased through pharmacies here in Australia. Email them at hworld@healthworld.com.au to see if there is an American agent.

- Marianne Idle

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10) Switchboard

I was taught to do bimanual compression, which means to grab and hold the uterus firmly. At that point you would also administer herbs or drugs so it is a matter of minutes before postpartum hemorrhage should slow. I believe that if you cause the mother great pain it can cause more problems such as shock. Also getting her adrenalin going can cause her to bleed more. In Russia they used ice packs on the uterus to contract it and stop the blood. It worked!

- Jill Cohen

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I have had great success helping women deliver full term using aloe vera. I know aloe vera has been used as a laxative, but it is also very useful, in capsule form, for ridding the body of excess fluid. The mother will not lose more amniotic fluid than necessary. (She will not experience a dry birth. And, yes, there is such a thing. I have seen it only once, though.)

During my fourth pregnancy I experienced polyhydramnios. Twins were suspected when I was at 20 weeks. My fundal height had increased 10 cm in 4 weeks. An ultrasound revealed a single baby. No one ever told me what polyhydramnios was, or that I had it. It was quite uncomfortable. Although it was my shortest birth--5 hours from start to finish (my usual time is about 20 hours)--he was not my largest baby--9 lbs.6 oz. compared to my third baby, a 10-pounder.

I knew I had polyhydramnios because when my membranes were ruptured, lots and lots of amniotic fluid poured out, and after my baby was born there was still copious amounts of amniotic fluid. It squirted out, literally soaking my midwife and my husband. Although I'm grateful for the quick and relatively easy birth I had, I wish my CNM had explained what polyhydramnios was and offered some relief.

- Alison

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Are any midwives' clients using goat's milk as a supplement for the newborn when the mother chooses to work and needs a supplementation source? How is it working out? Is it a viable alternative to formula?

- Sandra

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I have a friend who is 42 and pregnant with her fourth child. It has been seven years since her last pregnancy and she is overweight. She is always very sick during her entire pregnancy, unable to keep food and liquids down. She becomes weak and unable to get out of bed. This pregnancy seems the same. She is a very picky eater. She hates tea but is willing to try a pregnancy tea, maybe mixed with juice. Her last pregnancy she had to be hospitalized for dehydration. She is not necessarily interested in a holistic only approach, so all suggestions would be helpful. I am studying to be a midwife and she is looking to me for some answers, but it seems like every suggestion I give her she has already tried. I would love some suggestions from others that I could pass on to her.

- Kelli

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I am interested in learning about the effects of marijuana use by nursing mothers.

- Sherry

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I was happy to read the letter from the nurse talking about her hospital's practice of providing a homelike atmosphere for laboring woman [Issue 33]. In our hospital too we encourage ambulation and, since we have no whirlpool, showers. However most nurses are unaware of the enormous impact they have on a woman's experience. When a mom begins to waver and give up and ask for an epidural, many nurses will go right ahead with it without trying other things. We need to have alternatives to suggest, especially if she came in stating she did not want one. I receive so many fliers for external fetal monitoring workshops. What L&D nurses need are more workshops on non-pharmacological comfort measures.

- Susan Vaughen RNC susanv@n-jcenter.com

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I am a community midwife who provides whole care for home and 'natural' hospital births. Whilst hospital can try to mimic the 'naturalness' of home, it invariably fails. It takes more than wallpaper and pretty curtains, intermittent monitoring and ambulation to change an entire philosophy, one that cries out to women that they *need* the safety of a hospital because their bodies are really unable to cope with childbirth, that pain is to be doctor controlled and expected to be terrible.

Women in my care have free choice regardless their past history. In four years I have used pethidine once at a homebirth and gas and air twice. This isn't because the women can't have pain relief, they don't ask for it!

I don't have to be 'laid back' in my care for the women; they direct and I observe. These women are never 'patients' so they do not adopt the 'sick role.' When women are empowered their babies are rarely compromised. We build a relationship of trust and total control for the woman. I realise that this style of care does not exist much in America, but it is up to us as women and midwives to support the best and least patriarchal care that we can.

- Astrid Osbourne, midwife, West Midlands, England

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I am currently researching midwifery schools around the country. I am planning to attend one sometime in the next two years. Are there scholarships or grants that are available to midwifery students? I have found that it is expensive to go to any school, but especially one that is not a traditional university or college. Please help.

- Jesse Hewitt Jesse@kagi.com

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Thinking about becoming a midwife? Paths to Becoming a Midwife: Getting an Education is the book for you! Learn about the different ways to become a midwife, then choose your school or program from the listings at the end. The new edition has many new articles and all new schools listings.

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To order or for more information, email inquiries@midwiferytoday.com, or call: 541-344-7438,1-800-743-0974 (USA only) FAX 541-344-1422

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

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11) 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:

- Circumcision (Sept. 10)
- Preeclampsia (Sept. 17)
- Breastfeeding (Sept. 24)
- Vitamin K (Oct. 1)

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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