November 26, 1999
Volume 1, Issue 48
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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
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

This conference highlights the many educational paths to midwifery. Students and educators, plan to attend the daylong education day seminar on the pre-conference day and choose the education track of classes during the regular conference.

Our only U.S. conference in 2000!
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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- Oregon School of Midwifery
- Waterbirth Website

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Send responses to newsletter items to mtensubmit@midwiferytoday.com

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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Question of the Week
5) Question of the Week Responses
6) Spread the Word--Support This Book!
7) Switchboard
8) Midwifery Today Conference Notes
9) Classified Advertising

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1) Quote of the Week:

"Hunger is the best sauce in the world."

- Cervantes

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2) The Art of Midwifery

As midwives, we have traditionally put ourselves on the line to protect the holiness of women's bodies, pregnancies and births. I propose we broaden our scope and recognize as our own the fight to protect the holiness of mothering. As midwives, are we ignoring our own needs as mothers and the needs of mothering as a whole? Are we assisting each other in birth, but denying each other as mothers? Are we relying too heavily on cultural epidurals like daycare or TV? How can we create change in this vitally important aspect of our lives? How can we work collectively to promote a child-focused world for families? What group other than midwives is better suited to create working conditions that truly honor mothering and place the well being of our children before anything else? While it is true we may not be able to do it all, we midwives can be exceptional at doing it differently.

- Christine Malcolm, Midwifery Today Issue 47

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Read Christine Malcolm's entire article, "Balancing Midwifery With Motherhood" in Midwifery Today Issue 47. Regular price is $10; E-News special, $8.00. 20% off all back issues; offer good through Dec. 10. Call 1-800-743-0974. Please mention Code 940.

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Share your midwifery arts with E-News readers! Send your favorite tricks to mtensubmit@midwiferytoday.com

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3) News Flashes

Women with puerperal psychosis, the most severe form of postnatal mental illness that affects about one in 500 mothers, are not often spotted until their behavior becomes extreme. Access to specialist mental health services is delayed because of practitioners' "wait and see" attitude. Obvious symptoms such as the "blues" are not the only warning signal of postnatal depression. New mothers who are extremely elated or "high" after having a baby are at an increased risk of postnatal depression. In a study of 300 mothers who gave birth at Queen Charlotte's and Chelsea Hospital in London, England, it was observed that an unnaturally high mood, often marked by boundless energy and apparent self confidence, could collapse into depression. Twenty-two percent of the women who appeared high after having a baby went on to develop depression, compared with 28% of women who had the blues. One of the research team observed that the behavior of "high" women was quite different from that of "just a happy person." "They are disinhibited," he remarked.

- Nursing Times Nov. 3-9, 1999

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=PLEASE SUPPORT OUR SPONSORS!=

Check out this great web site with links to the Oregon School of Midwifery, now offering a distance learning program in addition to its renowned on-site program.

**A special discounted tuition for those who apply before Dec. 15,1999.**

Links to midwives and birth centers in the state, legislative activities,
supporters and other resources are all here:
www.oregonmidwifery.org

=THANK YOU!=

4) Question of the Week

Any ideas, advice or recommendations on how to naturally induce labour? I am a midwife with a high percentage of first time mums overdue; they get fed up, and I have run out of tips.

- Anon.

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Send your responses to mtensubmit@midwiferytoday.com

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5) Question of the Week Responses

Q: I am concerned about the safety of the Rhogam injection, most especially when given during pregnancy. I have no information that makes me concerned; I guess it's just my natural way of questioning *any* kind of injection or intervention. Does anyone know of a reason why we as midwives/moms should be concerned?

- Elaine Friesen

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As a CNM practicing for many years, I have had several mothers ask about the safety or necessity of the Rhogam shot. I assure them that it is produced and that it is closely monitored. I discuss with them the greater risk of current or future pregnancy complications by *not* taking the shot. They usually want to do what's best for their baby and get the shot.

- RufusCNM@aol.com

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I am assuming that you are referring to Anti-D, given to rhesus negative women when the partner is rhesus positive, leading to a rhesus positive baby. There are associated dangers with this vaccination as it is made of human blood products, obtained from a pool of rhesus negative male donors. However, the risks far outweigh the benefits of the mother being prevented from developing antibodies and being unable to have any normal pregnancy with a rhesus positive baby. I am Rh neg and recently had an early miscarriage because it was prior to eight weeks gestation and I did not have the vaccine. This is usual practice in New Zealand as the placenta was not fully formed and no fetal blood cells would have been able to enter my system. A fabulous way of avoiding lots of these vaccinations is to avoid or minimise interventions during pregnancy, i.e., amniocenteses.

- Karen Blake

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I am Rh negative and my husband Rh positive, therefore the Rhogam injection was an issue for me. With my first pregnancy, I did not give it too much thought until after the nurse gave me the injection of Rhogam at 28 weeks. After receiving the injection it was as if a light went off, and I realized I had just received a *blood product*! Foolishly I had not read up on Rhogam nor asked to read the package insert before the injection. My concern was HIV.

So I did some investigating to see whether or not my concern was justified. What I discovered from calling the American Red Cross, inquiring into the procedure used to make Rhogam and speaking with other people who had some background in blood products is that, first of all, there has never been a documented case of HIV transmission from Rhogam, and Rhogam has been around for quite some time (I want to say 30 years or so, but I am not certain.) Second, if I remember this correctly, Rhogam is made from blood plasma, not the whole blood product. And third, the plasma used to make Rhogam is heat treated which would, in theory, kill any HIV present.

This is the information as I recall it. I would advise you to double-check this information with a knowledgeable source in case I have recalled something incorrectly.

Two suggestions I would make to any pregnant Rh negative woman: 1) Have the baby's father's blood type checked before submitting to the Rhogam injection. If the baby's father is Rh negative, there's no need for Rhogam. 2) Type the baby's blood after birth (cord blood). If the baby is Rh negative (like the mother), there is no need for the postpartum injection.

- Dianne Oliver

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Q: I would like to know how to treat pregnancy induced carpal tunnel and what causes some pregnant women to get it.

It is best treated with acupuncture. I have had great results in my office with the acupuncturist treating carpal tunnel in pregnancy.

- Sara Liebling, CNM

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In reply to some responses in Issue 47 to the question about how to treat carpal tunnel in pregnant women:

How is a woman eight months pregnant supposed to be able to do this exercise [modified sit-ups]? I know that after about four months, I can hardly use my abdominal muscles in this way without straining my back.

- E Stukel

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My philosophy is that no pregnant woman should be doing crunches at all. The rectus muscle in the abdomen that runs vertical is quite prone to separation. There are lots of exercises for abs that do not require direct exertion on these muscle groups. So my advice is to abstain from abdominal exercise until six weeks postpartum and let the belly stretch and grow.

- Jill Cohen

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As a massage therapist doing myofacial and trigger point therapy, I would be a bit wary of steroid injections, pregnant or not. I would find a therapist who has knowledge of carpal tunnel and ways of treating it a bit more naturally. I have seen countless cases cured through mayo facial and trigger point therapy who had been told that surgery was the only choice.

- C.H.

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Includes a Photo Gallery, over 50 firsthand waterbirth stories from moms, dads and waterbirth practitioners, a tutorial, information on great products you can order, and lots more. Special Offer to E-News readers: Enjoy a 10% discount on your purchase of the "WATER BABY" video. Regular price is $59.95 + $7.50 p/h. Your discount price is just $53.95 + p/h. Full ordering details are at www.well.com/user/karil/materials.html

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6) Spread the Word--Support This Book!

"Pregnancy & Childbirth Tips" by Gail J. Dahl, 1998. Innovative Publishing; ISBN 1896937-00-4; Softcover $18.95 (Cdn).
www.pregnancytips.com

I am not a midwife, doctor or nurse; I am a mother. After the birth of my daughter, I became outraged when I discovered that a doctor risked the possibility of permanently brain damaging my baby in order to "schedule" her birth. It took a year of in-depth research to find out what had gone so horribly wrong during the birth, and I had a choice: institute a lawsuit and perhaps change the ways of one doctor or write a book and help a lot of consumers become aware. So I wrote a book called "Pregnancy & Childbirth Tips" which is now a Canadian regional bestseller and on its way to becoming a national bestseller. I am very proud of my book; it is easy to read, accessible to new moms, and a powerful advocate for the midwifery model of care and women's rights in childbirth.

My book includes a North American birth resource directory, new discoveries on how to have a healthy pregnancy and baby, natural health remedies to use during pregnancy, tips on how to have a faster and easier birth, breastfeeding advice, new research on how mothers can help their babies stop crying, the effects of common obstetrical procedures, and crucial information on preventing premature births.

But I need help. After four years of researching, interviewing, writing, editing, publishing, selling, distributing and promoting "Pregnancy & Childbirth Tips" while raising my daughter single-handedly, I am feeling rather exhausted on this one-woman odyssey! In order to carry on this important project and to ensure that this crucial information is retained on the bookshelves, I need support from the midwifery community.

If I can sell about 100 more copies and reach national bestseller status, my book will very likely be picked up by a major publisher (I have been self-publishing) and distributed widely across the continent, giving gentle birth a very powerful voice. The best way to support this book is to purchase it: please call any bookstore in Canada or the United States or any maternity store and ask them to order it in. Ask your local library to order it in. This book showcases beyond a doubt the tremendous impact that midwives have on our North American birthing society and I know your clients will love it.

- Gail J. Dahl, gaildahl@home.com

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Happy Holidays! Give a gift subscription to Midwifery Today magazine. 10% discount through January 1. Call 1-800-743-0974. Mention code 940 to receive your discount.

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7) Switchboard

I am concerned about the use of dandelion root tincture and yellow dock recommended for itchy skin during pregnancy [Issue 44]. As stated, both herbs are mildly carthartic. Wouldn't that be dangerous during pregnancy, possibly causing uterine contraction and miscarriage or preterm labor? Have these two herbs been used extensively during pregnancy with safe results?

- Stacey Hebner

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On the history of black midwives [Issue 46]: I think you are thinking of the doctor who developed a treatment for urine and fecal incontinence and repair of fourth degree tears. He operated on many women with damaged perineal floors under very primitive conditions (until he got it right). Realistically though, women had little choice. They could go through the rest of their lives with no control of their bowels, or they could try experimental surgery. [Editor's note: For more information, read the media review of From Midwives to Medicine: The Birth of American Gynecology, by Deborah Kuhn McGregor in Midwifery Today Issue 51.]

Episiotomy itself has been with us for a long time. Records show it was practiced by the Egyptians, ancient Greeks and the Romans, and it is described in the most ancient medical texts. The only way episiotomy has changed over the centuries has been its modern use as a routine rather than an emergency procedure.

- G.H.

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A mother of eight healthy children had a ninth baby die at the beginning of the third trimester. It seemed a very normal baby in every way. Nothing indicated anything was out of the usual. A friend recently told me of a friend of hers who had a similar experience. She had two normal pregnancies, then in her third and fourth pregnancies the babies died at six months. With her fifth pregnancy she sought out a specialist, who immediately checked her hormone level. His experience was that around six months' gestation a woman's progesterone level sometimes drops to such a level that the baby cannot live. They began hormone treatment at five and a half months and the baby survived.

This situation seems so unusual that there's no one to talk to first hand about it. All the information I've obtained has been at least second hand. Does anyone have any experience with this or have any information on it? If hormone levels are a valid possibility in such a circumstance, how can a midwife prevent this from happening in future pregnancies? Is there a way to accurately check for this at home? And what would be an effective natural treatment?

- Anon midwife

[Editor's note: Issue 46 included a good discussion of a similar situation, but if readers have anything to add, please send your comments in.]

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In response to IS and her procedure for obtaining blood from her Rh negative moms [Issue 46]: I think it is a wonderful idea and all, but I would venture to say that it would be too early after birth to determine whether or not she has become sensitized. I even wonder about the 72 hour rule. I think that is even too early to give an accurate reading on a Coombs. After my births, I type the baby. If the baby is positive, the mom gets Rhogam; if she had a negative titer during her pregnancy, no further antibody screens are needed at the birth because there hasn't been enough time for the mother to build up any antibodies--unless the baby is born totally jaundiced or direct Coombs positive (which I would attribute to the antenatal Rhogam). In the hospital, if the mom delivers a positive baby, she will receive the Rhogam despite a negative indirect Coombs anyway.

- Cathy O'Bryant CPM

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Recently there has been a discussion amongst the doctors on obgyn/net about how many episiotomies are acceptable. In my sample of 800 homebirths I have cut an episiotomy only three times. What can be so different about the vaginas of my clients and the vaginas that appear before these learned gentlemen?

- Gloria Lemay

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Private birth attendant Gloria Lemay has served birthing families for over twenty years, and is a popular writer and speaker about childbirth issues. She is internationally regarded as an expert in natural childbirth and its catastrophic medical alternative. She is now under attack by the British Columbia College of Midwives for serving families who choose to give birth outside governmental control. Her page fully details the publicly funded, registered midwife-directed witch hunt against her, and includes information on the Birth Freedom Fund (her legal fund) as well. Please see "Gloria Lemay, Symbol of the Spirit of Births Freely Given," www.birthlove.com/pages/gloria_lemay.html

- Leilah McCrachen

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A friend is desperate. Do readers have any information that might help her?

"I suffered a uterine prolapse after my fifth baby was born last winter. I have had five babies in ten years and nursed them all at least two years. I am not overweight at all and I have had very short second stages (actually very short labors). My OB says my muscle tone is great. His theory is that extended breastfeeding has caused such low estrogen levels that the lining of the vaginal wall is very thin. There was probably some ligament damage too. A friend who is a physical therapist has advised me about exercise (mostly kegels).

In my case, the bladder and rectum have herniated too. This is very common when the uterus herniates. All the prolapses are mild to moderate. Here's the big dilemma: surgery to correct the condition is not very successful and is not recommended until one is finished bearing children. Plus with my cancer history and all the chemo damage to my veins, I'm not a great surgical candidate. My physical therapist says she's seen horrible post-surgical cases.

I want to have another baby but I am afraid of further damage. What herbal remedies would strengthen the lining? Have you heard of cases like this? I am hoping that when my fertility returns, estrogen will improve the situation and that if we wait longer between babies, things will be stronger. I'd appreciate any insight you have."

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Unless otherwise noted, share your responses to Switchboard letters with E-News readers! Send them to mtensubmit@midwiferytoday.com. If an e-mail address is included with the letter, feel free to respond directly.

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8) Midwifery Today Conference Notes

Philadelphian Birth Enthusiasts!
If you are interested in bringing Midwifery Today Conference flyers to a meeting with LLL Leaders, CBEs, nurses, doulas, doctors, parents, etc., contact:

Mothering Mommies Doula Service
Enterprise Building
4548 Market Street
Philadelphia, PA 19139
215-387-2955

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9) Classified Advertising

Need your article, thesis, essay or book edited and/or proofread? I have worked with pregnancy, birth and midwifery related manuscripts for more than thirteen years and know the field well. Sliding scale. E-mail cherjm@aol.com.


Disclaimer

This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.

Midwifery Today, Inc., does not assume liability for the use of this information in any jurisdiction or for the contents of any external Internet sites referenced, nor does it endorse any commercial product or service mentioned or advertised in this publication. Always seek the advice of your midwife, physician, nurse or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding any medical condition.

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