September 24, 1999
Volume 1, Issue 39
Midwifery Today E-News
“Breastfeeding”
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Broaden your education in Jamaica and Philadelphia, Pennsylvania!

Make plans now to attend one or both these conferences:

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

Get your program online at Midwifery Today's new website: www.midwiferytoday.com

Look for the link on the homepage.

Sponsored by:

- Mothering magazine: Mothering is in its 24th year of providing inspiration for attachment parenting. Mothering guides, nurtures, and supports while providing the latest on controversial parenting topics.

- Cascade Health Care: Cascade HealthCare Products, Inc. began business in 1979 with the primary goal to provide supplies and equipment for the emerging profession of midwifery. We have developed a complete product line that not only serves midwives, but nurse midwives, childbirth educators, lactation consultants, visiting nurses, birth centers, WIC programs, nurse practitioners, doulas, and professionals dealing with expectant parents, families and women's healthcare.

* Philadelphia, Pennsylvania, March 23-27, 2000
Mainstreaming the Midwifery Model

Program is now available. 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 sponsored by:

- Keeper
- Professional Breastfeeding Resources

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) La Leche League Leader in Mexico
5) Tongue-Tie
6) Nature's Vaccine
7) From the Garden
8) Breast Yeast
9) Switchboard
10) Improving Your Practice
11) Classified Advertising
12) Coming E-News Themes

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1) Quote of the Week:

" Work is love made visible."

- Kahlil Gibran

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2) The Art of Midwifery

Few families readily perceive the full extent of a woman's vulnerability once labor has ceased. Many times, the intense focus and concentration that friends and family members directed toward the mother are abruptly withdrawn and transferred to the infant or elsewhere. Some women who are strongly dependent on this psychological/emotional support sense the loss acutely. This may contribute to postpartum depression.

- Judy Edmunds in "The Grand Finale to Birth," Midwifery Today Issue No. 34

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3) News Flashes

A study conducted at Johns Hopkins School of Hygiene and Public Health in Baltimore, Maryland looked at records of more than 7,000 infants and determined that part-time breastfeeding does not offer babies protection from common infections. Babies who were breastfed exclusively had significantly less diarrhea, wheezing, vomiting and doctor visits for illness than did other infants. Those who received more than half their nutrients from breastmilk saw some benefits, but babies whose diets were less than half breastmilk were no healthier than formula fed babies.

- Fit Pregnancy, Summer 1999

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We also sell Marie Biancuzzo's book, Breastfeeding the Newborn (464 pages, 1999) and low-cost continuing education materials.

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4) La Leche League Leader in Mexico

In Mexico I met a wonderful La Leche League leader named Maura Sessin who lived in a very small village. Her specialty was getting babies back on the breast after they had been fed almost exclusively with formula and other substitutes. Desperate mothers came to her with babies who were doing very poorly on the milk substitute they were being fed. Because many families could not afford formula, unpasteurized milk, water of questionable quality and various other "food" powders were mixed to feed the hungry baby while the mother struggled more and more to establish an almost non-existent milk supply.

Maura had an incredible success rate with her mothers. She talked to the parents and explained that the effort would take their full cooperation. In addition, both parents had to agree that breastfeeding the baby would be their No. 1 priority. Maura asked them to pretend that the baby had just been born, and they were going back in time to start all over. Relatives or friends were called in to take care of the rest of the family and provide mother with nutritious food and lots of healthful liquids. Baby and mother were tucked into bed together.

When Maura began work with the baby, she picked him up, held him in the air at her eye level, and gave him a stern talking to: "Your mama is giving you the best chance in life with the best food on earth. We aren't having any more of this fooling around. I'm expecting you to do this and do this right." The baby opened his eyes wider and wider and listened to every word Maura said. She was convinced (and so was I) that the baby understood every single word. Invariably, the baby settled down and suckled the breast. Within days, there was another fully breastfed baby, with a happy, confident mother. Next to the mayor, Maura was the most important person in her village, and was an honored citizen for her work with babies.

- Sue Huml, IBCLC, excerpted from "Our Common Link," Midwifery Today Issue No. 32

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5) Tongue-Tie

If a nursing mom is doing everything right and still has sore nipples, and yeast is ruled out, have a health practitioner check the baby for tongue-tie. The little piece of skin under the skin, called the frenulum, is tight, making it impossible for the baby to stick his tongue out far enough to suckle correctly. If the baby's tongue is heart shaped, it is a good indication that he may be tongue-tied. It is fairly common and seems to run in families. The frenulum can be clipped by a doctor, dentist or nurse practitioner. It takes a matter of seconds and only bleeds a drop or two.

- Pamela K. Wiggins, IBCLC in Breastfeeding: A Mother's Gift, L.A. Pub. Co., 1996

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6) Nature's Vaccine

"If a new vaccine became available that could prevent one million or more child deaths per year that was moreover cheap, safe and administered orally, it would become an immediate health imperative...."

- The Lancet

Add to the above protection from middle ear infections, diarrhea, upper respiratory infections, allergies, asthma, juvenile-onset diabetes, meningitis and certain childhood cancers. Also an increase in your child's IQ by 8-9 points and no smelly bowel movements. You'd be standing in line to give all this to your child, no doubt.

The good news is you don't have to stand in any lines for this. The vaccine is none other than nature's own: breastmilk.

One teaspoon of breastmilk has 3,000,000 germ-killing cells to protect a baby from all that he gets exposed to on a day-to-day basis. No matter the baby's age, those antibodies are always there. It's no wonder the American Academy of Pediatrics came out in such overwhelming support of breastfeeding in their policy statement that infants should receive breastmilk for a minimum of one year and beyond that if it's working for the family.

Some people may balk at that one year figure. It's important to acknowledge that our culture is not so breastfeeding-friendly. We seem to suffer a bit of amnesia, however, forgetting that not too long ago our grandmothers and great-grandmothers nursed our parents and grandparents beyond a year and they didn't know anything about AAP recommendations.

Why we feel the need to wean our babies quickly from the breast or not nurse them at all is a complex issue. One explanation is that our society very much values independence and we don't want our children to be too clingy. Why we feel the need to teach them all this independence before they can even walk or talk, though, is beyond comprehension. We have eighteen years or so to help them become self sufficient. Perhaps we could cut them some slack for that first year or two.

Another factor is also cultural and it's the No. 1 reason moms might not even consider breastfeeding: Breasts are fine on a billboard or in a magazine selling beer or cars, they're great to show off in a slinky swimsuit or dress, but to feed a baby? Again, amnesia. Feeding babies is the breasts' purpose. Instead of embarrassing a mom who is breastfeeding her baby by giving her a disapproving look, why not give her a smile? After all, a breastfeeding mother is doing important work that benefits her whole community. If all US newborns were breastfed for just twelve weeks, our nation would save $2.4 billion per year. Those are your tax dollars.

Two requests we might make of expectant parents would be to love their baby enough to put his needs above their own during pregnancy and the early years, and to get informed about breastfeeding during their pregnancy. It is a shame to see a mom choose to formula feed only because no one told her about breastfeeding.

Whether a mom decides to breastfeed for six weeks, six months or past a year, she'll be giving her baby something priceless no one else can give him: nature's vaccine. No waiting in line, either.

- Kendall Cox

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7) From the Garden

Chaste berry and milk thistle are herbs that increase milk production. Take three capsules of each per day. Other herbs commonly used to increase milk production are fennel, marshmallow, goat's rue, blessed thistle.

At weaning, one to two capsules each of sage and parsley should be taken every two to three hours.

- Shonda Parker, The Naturally Healthy Pregnancy, Naturally Healthy Productions, 1998

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8) Breast Yeast

In a nursing relationship it is imperative that both the mother and baby be treated even if only one is symptomatic. Many times the father and siblings require lower level treatment as well. In co-sleeping arrangements, all members who sleep in close contact should be treated. A particularly frustrating aspect of yeast management stems from the fact that treatment needs to be continued for two weeks after symptoms subside.

Breast yeast frequently does not have visible symptoms, but can be quite painful. In most cases the offending agent is Candida albicans, but there are several other strains of candida. I have seen several other agents of fungus overgrowth, and although they are much less likely to cause nipple and breast pain, they are possible, and practitioners should be aware of them.

Personal hygiene: wash hands in soap and warm water. Switch to paper towels until the problem is under control. Temporary use of disposable diapers may help. A spray bottle of one-quarter cup white vinegar to one cup water should be available for all family members to spray any body areas that stay or get moist (pubic areas, armpits, under breasts, under any folds of skin). This should be done twice daily for those not symptomatic and four times per day by those with symptoms, continued for two weeks beyond the time anyone shows symptoms.

Bath towels should not be shared, and should be used once or thoroughly dried after each use. Items such as toothbrushes and make up can also harbor yeast spores. Once the anti-yeast regimen is started, each family member should get a new toothbrush, and again once all symptoms disappear. No cornstarch powders or deodorants should be used as they are a food source for yeast.

Sources of mold (ubiquitous yeast has a synergistic or compound relationship with other fungus or molds which increase during damp, rainy weather)--wet windowsills, damp laundry hampers, bathtubs, for example--need to be cleaned with either a 10 percent bleach solution or white vinegar in water. Laundry should be washed in the hottest possible water and a cup of white distilled vinegar added to the final rinse. Relying on bleach is not sufficient. Boiling clothing and bedding for five minutes will work, as will microwaving on high for five minutes. Freezing will not kill yeast spores. Cloth diapers, either from a service or one's own, should be microwaved for five minutes. Toys and other items babies mouth or chew should also be cleaned this way. They may be put in the dishwasher if the water is over 130 degrees F., and you add vinegar to the rinse.

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To read the full, extensive article on how to treat breast yeast, purchase Midwifery Today Issue No. 42. The article "Breast Yeast" also includes a comprehensive explanation of methods for mom and baby to use to eradicate mouth and breast yeast. A list of over 25 references are included. To order, call 800-743-0974, or visit the Midwifery Today website at www.midwiferytoday.com
Please mention Code 940.

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9) Switchboard

I wonder if anyone could help me track down an RCM breastfeeding video. I think it was intended as a companion to the Successful Breastfeeding book. Does anyone know if it's still available? I'd appreciate a contact number/email for ordering a copy.

- Gill Ryan
babymilkaction@tinet.ie

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Why is it that I find so few Dutch entries in your newsletter? Are we so blase about our system that we don't even bother to be interested in our sister's problems?
Between the three of us we look after some 450 women a year, and yes, we work very hard, but it is worth it! Hereby we would like to offer ourselves to whoever would like to discuss midwifery subjects from our (double-) Dutch point of view.

- Annemieke van der Peet, Eveline Arends and Frederika de Ruiter

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Greetings, fellow midwives and travelers!

My family and I are currently weeks into our six month world tour. During our travels I hope to meet with local midwives in the countries we visit--Zimbabwe, Zambia, Nepal, NZ, French Polynesia, Peru and Curacao.

We have traveled through Europe, stopping in Hungary to see the total eclipse. I've seen a breastfeeding mother depicted on the currency in Hungary but learnt that there are no midwives as such there and homebirths are actively discouraged.
In Cairo we saw wonderful drawings of goddesses giving birth to twins, on their knees and supported by female attendants. The lovely woman who cleaned our hotel room had her three babies at home with a daia (local midwife) in much the same way but, as in so many places, most women now go into hospital, either private or public, and have doctors/nurses care for them.

In a few days we travel to Zimbabwe where I hope to meet with Dr. Barbara Sibanda, the founder of the Zimbabwe Traditional and Medical Clinic in Bulawayo, and some of the local women and midwives who work there.

It would be lovely to hear from anyone either traveling or working in any of our intended destinations. Our website: www.papereye.co.uk/duncans; our email address: duncanworld@yahoo.com

- Annie Francis

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[In response to comment on herpes, Issues 36 & 37]: Every woman with *active* (not just a history of) herpes who presents in labour should have a cesarean, evidenced by visual inspection of the vulva. I maintain that visual inspection of the cervix is neither sensitive nor specific, i.e. has high false positive and false negative rates. The full-term cervix has lots of inflamed glandular epithelium due to the normal oestrogen effect. Most docs have given up doing a cervical swab looking for herpes virus before labour too. It did not change the outcomes.

I hope this clears the confusion.

- Phil Watters

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The midwife I apprentice with suggests the use of "super glue" during delivery when a mother is infected with herpes. She applies the glue directly to the lesion, and it protects the infant from contact. She has yet to have an infant be affected by the virus, after a 15+ year practice.

Any thoughts?

- Leighza

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I'm a third year nursing student doing maternity this semester. One of my presentation questions is: What is a normal delivery and when would newborn assessment be considered satisfactory?
If you have articles relating to my presentation question, please send it to my email address.

- Poojah
pooja_maharaj@hotmail.com

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As a childbirth educator, I encourage staying home for as long as possible. One reason is so the mother can continue to eat and drink. I suggest packing Gatorade in the labor kit. I'm wondering about adding "power bars" to the list. I also want to include the special needs of the diabetic mom. Any sound suggestions and brands would be greatly appreciated.

- Jeanne Batacan CMA, ICCE, CLE

A free international gathering of midwives will be on 2 October at the office of the KNOV (Dutch Midwives Association) from 10 am-4 pm.
For the agenda, see Issue 37 of E-News.
For more information: Sabine Schmitz, Midwife Foreign Office, KNOV, 31.20.6120024.

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

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10) Improving Your Practice by Gail Hart

Why do some prenatal forms include a column for maternal pulse at each prenatal?

The most common answer is elevated pulse is a sign of dehydration, but I would expect several other symptoms to present with dehydration. It takes serious dehydration to raise a woman's pulse! I can't imagine looking at an apparently well hydrated healthy woman and finding an elevated pulse due to dehydration.

I take the pulse once as a baseline in early pregnancy and again in late pregnancy so I know the mom's normal. I can only think of a couple things that might raise pulse in pregnancy that wouldn't show any other symptoms of abnormality, anemia or drug use being at the top of the list. The few other things--severe anemia, heart disease, thyroid disorders, fever, pain, bleeding, dehydration, etc.--include other symptoms that would lead me to take the pulse.

Another common answer is to avoid confusing the maternal pulse with the fetal heart beat. But it would be quite rare to find a mom's pulse (normal range 60 to 90) that is within the normal range for FHTs (120 to 160)!

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11) Classified Advertising

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12) 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:

- Omnium Gatherum (Oct. 1)
- Vitamin K (Oct. 8)
- Twin Birth (Oct. 15)
- Miscarriage (Oct. 22)
- Herbs (Oct. 29)

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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