|December 24, 1999|
Volume 1, Issue 52
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In This Week's Issue:
1) Quote of the Week
1) Quote of the Week:
"In the depths of winter I finally learned there was in me an invincible summer."
- Albert Camus
2) The Art of Midwifery
For a long, prodromal labor, put a woman to sleep with a warm oil massage and one dropperful of valerian tincture. Chances are she will awaken two to three hours later with strong, effective contractions that will lead to birth.
- Jill Cohen
Share your midwifery arts with E-News readers! Send your favorite tricks to firstname.lastname@example.org
3) News Flashes
A study at Institute for Child Research that followed 2,187 Australian
- Nursing Times Vol. 95 No. 39, Sept. 1999
4) Three Wise Women
Do you know what would have happened if it had been Three Wise Women instead of Three Wise Men? They would have:
- asked for directions
5) Effects of Child Abuse on Birth
We designed a study to explore the relationship between a history of childhood sexual abuse and birth outcomes. Data was collected retrospectively on 400 births that occurred through a clinic in Portland, Oregon between January 1990 and January 1996. Obstetrical care was provided by four naturopathic physicians/midwives. To be included in the study, patients had to be seen in the third trimester and had to have planned an out of hospital birth.
Approximately half the births were planned for home and half for an out of hospital birthing center. The average age of the mothers was 30. Payment for services included 71 percent self-paid, 21 percent insurance and 8 percent welfare. Thirty-eight percent were primips and 62 percent were multips.
Patients were asked during a routine prenatal history if they had a history of childhood abuse. Identification of survivors of child abuse (SOCA) was based on self disclosed memory of abuse. If the patient answered "no," the chart was marked accordingly. If the answer was "yes," the patient was asked to specify if the abuse was emotional, physical, sexual or a combination. By using self disclosure it is possible our identification of SOCAs is low, thus if there is a bias in our findings it is on the conservative side.
Using this method, 136 patients (34 percent) were identified as SOCAs and 264 (66 percent) were non-SOCAs. These percentages are consistent with other research reports on general populations. By including all forms of child abuse we are reflecting our belief that focusing exclusively on sexual abuse overlooks a substantial amount of damage to the human psyche. Of the 136 SOCAs, 12 percent reported emotional abuse only; 16 percent physical; 40 percent sexual; and 32 percent emotional, physical and sexual abuse.
Of the 400 births studied, 336 (90 percent) had out of hospital births. Twenty-six (7 percent) had a third trimester change of attendant, 77 percent of which were for medical reasons. There were 33 (9 percent) intrapartum transports and 5 (1 percent) out of hospital births which were transported postpartum.
When comparing the SOCA population with the non-SOCA population, there were a number of significant findings. SOCAs were almost three times as likely to have a third trimester change of attendant (11 percent of the SOCA population versus 4 percent of the non-SOCAs, p=0.00835. Statistical significance (p) is achieved when values are less than 0.05 and is considered highly significant when the value is 0.01 or less.) SOCAs were twice as likely to be transported intrapartum as non-SOCAs (13 percent of the SOCA population versus 6 percent of non-SOCAs, p=0.05462). The SOCA population was also twice as likely to utilize hospital pain medications (12 percent SOCAs versus 6 percent non-SOCAs, p=0.011342). The impact of an abuse background was also reflected when reviewing primip and multip outcomes. Of the eight multips transported, six were SOCAs. The difference is further emphasized when considering that 8 percent of the SOCA multip population versus 1 percent of the non-SOCA multips were transported. In the primip groups there was a marked difference in the cesarean rate. Eighty-two percent of the primip SOCAs who transported ended in cesareans versus 29 percent of the primip non-SOCAs.
- excerpted from "Child Abuse and Its Effect on Birth: New Research" by Nora Tallman and Cammie Hering, Midwifery Today Issue 45, March 1998
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We wish you and your family blessings and fortitude for the coming year and into the next century.
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Last, we thank you for sharing a healthy vision of birth in the next century.
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7) Question of the Week
How, as midwives, do we advise a woman who contracts cytomegalovirus (CMV) for the first time during her pregnancy? What are all the options for her and the baby? Do we continue to care for her? I am an aspiring midwife and this is a very personal issue for me as my neighbor recently had an abortion at nine weeks because of CMV. She is a student nurse midwife and had a lot of support from her colleagues and professors. Is it medically sound to advise abortion for this seemingly rare complication?
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8) Question of the Week Responses
Q: Is it possible to "diagnose" a nuchal hand before birth (other than with an ultrasound in labor)? Is there anything one can do to help keep the mother from tearing when there is a nuchal hand?
Any other useful information on the topic of nuchal hand/arm is welcome.
If you see a hand come with the head, or feel a hand when you feel for the cord, simply give the hand or fingers a little pinch and the baby will usually retract it.
Palpation may reveal a nuchal hand.
A slow, guided delivery is important. I have seen a birth with nuchal hand happen without a tear. Hot compresses to stretch the perineum were used. Downward guidance was used to keep the woman from tearing upward.
Generally, if the pregnant woman is not obese, one can feel the hand up by the baby's face by palpating the mother's abdomen. If a pregnant mother has noticed her baby has hiccups, then probably her baby has been sucking his thumb, and that situation more times than not produces a nuchal hand at birth. If you have a labor that is long or stalled with a large collar type of a cervix, this is usually either a cord that is holding the baby up or a nuchal hand. Nuchal hands can keep a woman from going into labor, so if she is overdue by two weeks, check to see if you can palpate a hand from the outside and move it out of the way. On delivery, sometimes the hand can be pushed back up into the birth canal or extended out against the head of the baby. These procedures are only valid if you are expecting to deal with a nuchal hand; most of the time they are a surprise. As far as preventing the perineum from tearing, the key of course is always controlled crowning, without or without a nuchal hand.
- Cathy O'Bryant CPM
I typically have four-hour births but my third lasted 15 hours. I pushed for what seemed like forever. I pushed down and the baby would float back up. The apprentice said she thought the cord was over and around the baby's head but the FHTs were fine so we kept going. I got very tired and I wanted to sleep. At 10 hours my midwife suggested I take some herbs and honey to give me some energy.
The birth video is truly amazing. I have always birthed with my sac complete but my midwife suggested breaking it. I was adamant that I wanted it to happen naturally. In the video you can see the head crowning with water bubbles on the crown and the baby's hand on the head. At that point the water breaks and the baby slips out, hand, head and arm together. I didn't tear, and the baby and I were both fine.
I suppose the reason for the length of the birth was the floating baby. The head could not get a good suction in the pelvic cavity because the hand was in the way.
- Valerie Monterrey
Q: 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.
No one has mentioned preparing moms to avoid needing induction. In many other cultures there are taboos, traditions and restrictions around what a woman may/may not eat while pregnant, possibly resulting in smaller babies and babies who come out promptly (or even a little early) because they're hungry. Maybe we eat a little too well here. (This is just a thought, not a well developed philosophy.)
Anyway, in our practice we start our moms on Labor Prep tincture at 36 weeks. It consists of:
2 parts Partridge Berry
Take 1/2 tsp twice a day and 1 tsp before bed. At 40 weeks we add 1 part Spikenard and increase the dose to 1 tsp three times a day. No one has gone more than 7 days past EDD since we started the protocol this year.
Have you tried a spot of evening primrose oil on the cervix? I know some midwives who say this works to help ripen the cervix--only if client is post dates.
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My first child was born in 1996 via cesarean due to breech position.
I am looking for a birthing gown for a religiously modest patient who will be birthing at a birth center. Is there anything out there that is lightweight and practical?
- Jackie Kuschner CNM
My wife is currently in her late 7th month of pregnancy. The doctor told her the placenta is too low a position. I'd appreciate your advice on the risk and precaution that could be taken to avoid miscarriage or other consequences. She is working as an engineer with a semicon company and her daily work involves a lot of walking and sitting. She also drives to work. This is her second pregnancy. Four years ago our son was delivered normally.
- Lua Thiang Poh
I have an 8 1/2 month old and wonder about supplements for myself. Also someone said she should be taking iron drops! I bought some glucosamine sulfate and kelp for different problems. Is there a problem taking these products while nursing? I take vitamins C and E, iron, calcium and flax oil. I have read lots and ended up being more confused than anything. Are there things I shouldn't take while nursing?
- Lisa Saunders
Re: Valerie El Halta's information on risk for miscarriage [Issue 50]:
- There is no strong evidence that sex increases the risk whether there has been bleeding or not. If that was the case a lot more pregnancies would be lost. -"Paw paw" is used by South Pacific women to cause abortion. The papaya in various preparations can have the effect of abortifacients. -Advising bedrest is turning pregnancy into an illness out of the 1800s. Normal everyday light activity will not affect the outcome.
- The cervix and uterine body are separate entities. The cervix will not be affected by previous pregnancies until after 14 weeks. And uterine tone decreases in multiparae leading to less rather than more uterine irritability.
- As for not lifting toddlers, pity the poor 2 yr old who doesn't understand. There is nothing to support this at all.
- Phil Watters
Re: Gail Hart's comments about postpartum bleeding [Issue 50]: I wonder about the "pushing before full dilation" part. Telling someone *not* to push comes under my definition of coached pushing. Many of "my" moms--especially multips--push before full dilation and simply open up and give birth. If there is spontaneous bearing down, I'm inclined to leave it alone and just ask them how it feels. If it's really too soon, it hurts, and they're willing to back off. I usually don't even check (ie vag check) them unless it's not working (to evaluate for "complete dilation"). The most frequent reason for a vag check at that time is moms who think they aren't "allowed" to push until the magic 10 because of previous birth experience and/or training. I'd like to hear more about others' experience with this.
- Kip Kozlowski
Re: Doris Haire's statement [Issue 50] that adverse effects to drugs are not reported so no one really knows how often they occur: Strictly speaking she's correct, as there is no *law or regulation* regarding this, but the British National Formulary does request that doctors (in the case of newer drugs) "report any adverse or any unexpected event, however minor, which could conceivably be attributed to the drug... (for established drugs) Doctors are asked to report any suspected adverse drug reaction... even though the toxic effect is well recognised." It goes on to advise "If the patient is pregnant do not use a drug unless the need for it is imperative." It would be interesting to know how many doctors in the UK follow these guidelines and what action is taken by the Committee on Safety of Medicines as a result of their reports.
Are there any guidelines or research re: VDUs, computer screens and pregnancy? There used to be worry about miscarriage, I thought.
- Monica O'Connor
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10) Why I Want to be a Midwife
It was 12 years ago that the first little baby made her way into my hands--accidentally. I was only there to see the birth, help with the other children and do a little support. The babe was posterior which was not detected until delivery. She slid out and down the side of the mother and I caught her before she went any further. It was very exciting. I loved the feel of the whole thing. I had three children of my own and hoped for more and a homebirth. I had my fourth in the hospital and ended up with a C-sec. for a brow/face presentation. I started studying after that and tried to figure out what to do to help others with brow/face and posterior presentation. I then learned of all the other things women went through with their births and what babies went through too and it was very enlightening.
I have done a lot of studying on my own and attended births with other midwives although I don't consider myself a midwife yet. It has been ten years since that c-sec. and I am still learning new things all the time. I want to be a midwife because I feel called to do so--it's that simple!
- Kelly Ordway
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