January 7, 2000
Volume 2, Issue 1
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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Checking In
5) Check It Out!
6) Needs Help With Birth Center Guidelines
7) Questions of the Week
8) Question of the Week Responses
9) Switchboard
10) Classified Advertising

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1) Quote of the Week:

"I had the overwhelming feeling that what we needed to do was nothing."

- Elizabeth von der Ahe, midwife

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2) The Art of Midwifery

If a woman is having a hard time during labor, acknowledge it; remind her to do only one contraction at a time. Describe a hard contraction as a "good" one. When you make suggestions, tell her why the shower feels so good, why a walk will move things around, why a change of scene is good, why you're going to give her some privacy, why making deep sounds will open her up.

- Linda McHale, CPM & Barbara Noble Schelling, CPM

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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

A statistical study of 4,800 Swedish women under fifty years of age with breast cancer, and a control group of 47,000 women without breast cancer, showed that mothers of twins were nearly one-third less likely than other mothers to contract the disease. A 29 percent reduction in the risk of breast cancer was shown in the study.

One explanation could be the higher than normal level of pregnancy hormones to which mothers of twins are exposed. Although there is some evidence that pregnancy increases the risk of breast cancer for a time after birth, it then seems to give long-term protection. It may be that the higher hormone levels associated with twin pregnancy give extra protection.

- Professional
Care of Mother & Child, Vol. 7 No. 5, 1997

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=THANK YOU!=

4) Checking In by Jan Tritten, Midwifery Today founder & editor

Happy New Century to all of you who are working hard "toward better birth." Each time we begin a new year I enjoy reflecting on how much Midwifery Today has progressed since we started publishing the magazine in February 1986. I then try to look forward and plan with our brilliant staff what we should be doing in the future.

Mere survival of small publishers is a miracle in itself. I think it is our staff's dedication to improving birth that has been the key to Midwifery Today's continued growth. For that, I am grateful.

At the beginning of each new year I go through all the back issues of our publications so I can see where we have been and what we have covered. I am always amazed at how relevant those back issues continue to be and what a great job all of us have done. I say "we" because all of you writers and those of you who have interacted through Midwifery Today are the essence of our publications.

Looking back through our publications isn't the only way to appreciate Midwifery Today's reach. Thirty-five Midwifery Today conferences since 1992 have each had their own personality and have been a wonderful way to "make the pages of the magazine come alive." We have made close friends in so many countries, and been able to learn midwifery arts from people from many cultures.

Our website, up since 1994, has been getting a major overhaul. Among many other plans, we hope to put up a lot of our back issue articles, archive more and more E-News issues, and become incresingly interactive. Our web site will be steadily fuller and better and will serve hundreds of thousands of practitioners and families every month.

You E-News readers are an important part of that reach too. Senior Editor Cher Mikkola and I had always been frustrated that a quarterly magazine couldn't attend quickly to important issues in midwifery and birth, whether they were political issues, help needed by a pregnant mom, or a midwife who needed immediate help and support from her sisters. E-News has helped us get all manner of information, questions and challenges out to you quickly, and field responses overnight. I love that you are from so many different practitioner backgrounds, traditions and cultures. As well, I am thrilled that so many parents have joined us.

In that we have experienced so many changes in just a few years, I wonder what the next five years will look like. I hope increasing information technology will help birth-changing knowledge get through to parents much more quickly and effectively. News and information travels faster and wider, and as a result the use of midwives has increased to 7% in the United States, up from 3% when I first became a midwife 23 years ago. As our field broadens its influence, let's hope midwives hold to the same courage and integrity we started with a few decades ago. I hope we will always remember the importance of the work we do as childbirth practitioners. We touch lives at their most important time. We are witness to miracles. We get to touch on the most sacred ground. Let's always remember that.

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5) Check It Out!

~~~~~ WWW.MIDWIFERYTODAY.COM~~~~~
A Web Site Update for E-News Readers

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6) Needs Help With Birth Center Guidelines

I am convenor of a support group that supplies women with information and support about birth choices after a c-section. We are basically a pro-VBAC group, but we do realise that c-sections can be necessary and do save lives. We support informed birth choices for all women and their babies, and their right to have a positive c-section if that is their choice of delivery.

It is in this role of supporting women that I have raised the question of the restrictive guidelines for women entering a local birth centre attached to a major women's hospital.

This birth centre's many guidelines seem harsh and contradictory, especially considering that it is attached to the hospital and is approximately 100 metres from the emergency department. Some examples of these guidelines are: a woman is not eligible to use the centre if she has any previous uterine scar (including previous c-section), epilepsy or seizures, a malignant disease, parity 5 or more, previous severe preeclampsia or eclampsia in most recent pregnancy, previous poor obstetric outcome (e.g., stillbirth, etc.), retained placenta, etc.

All women *must* sign a form prior to being accepted into the birth center that says they will receive oxytocic administration immediately after delivery. This is a prerequisite to acceptance. Similarly women are also denied admittance if they have refused routine oxytocic administration for third stage management at a previous birth.

These are only some of the many guidelines involved, and I find most of them excessively restrictive when considering the close proximity to an extremely technologically up to date hospital. They seem to question the mother's ability to make the right choices in relation to the birth of her child and deny her involvement in the decision making process. Instead of providing guidance and support for the mother in making good decisions about her labour and birth, they provide rigid guidelines for health professionals that severely restrict her autonomy and personal rights.

I will be questioning some of the many guidelines, including those mentioned above, during a meeting with the hospital at the beginning of February. I need to find out how other birthing centres' guidelines/restrictions compare with the above guidelines, especially birthing centres located within Australia. I raise these questions in the hope that consumer-friendly guidelines will be adopted that will safely support women by honouring and respecting their right to make informed decisions in regard to the birth of their children while offering emotional support. If I can provide evidence of current policies in similar establishments nationally, then this will help me present a better discussion in support of consumer's needs.

Women make an informed choice when they apply to birth in a birth centre, especially when trying to avoid the technology that may have surrounded a previous birth experience. This technology, which may have been 100% necessary during previous birth experiences may be the exact reason they will be denied admittance to the birth centre for a subsequent birth experience. This denial occurs even with no presentation or indication of a similar or related problem in the subsequent pregnancy. These policies must be questioned and updated according to the latest studies and research available in order to provide evidence-based care.

If these women were given the option of being accepted into a birth center after being individually assessed rather than judged on their past record of obstetric outcomes, the secure and positive atmosphere they are given may provide the emotional healing they crave, along with the safety that is their right.

My request is that you supply me with other current birth centre guidelines so I can compare them to those above. I look forward to hearing from you and thank you in advance for any help you can provide. Please email me at birthrites@edsite.com.au and I will email you my postal address so information can be sent to me directly.

- Jackie Mawson.
Convenor, Birthrites: Healing After Caesarean Inc.

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7) Questions of the Week

I am a student midwife living in Chile. I am six weeks pregnant and have two small places where the tiny fetus is slightly disconnected from the uterine wall. Due to this, I have had very light bleeding (like a dry paintbrush) for about two weeks, although it stopped almost 100% about 5 days ago.

After the first ecography my doctor said it could be a retained abortion. I returned in 10 days to see if there was any growth, and yes, the fetus had grown. Of course this made me very happy, but there were still two small places in the picture where he saw the slight disconnections. He said "It looks like this one is going to be successful," but I am worried. I want to know what herbs or vitamins can help to "glue" the fetus in place to help ensure that it doesn't spontaneously abort. Also, in the first ecography he said he saw what he would initially diagnose as a benign myoma in the front wall of the uterus, not very big.

- M.A.G.

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I recently read of a very unobtrusive method of dealing with yeast infections and I can't even remotely remember what it was. Any interesting ideas out there? I usually recommend 10 drops of teatree oil in 30 drops of a carrier oil such as olive oil, soaked into a cotton tampon. It has remarkable results but I am cautious about giving this recommendation to anyone postpartum because it is so strong.

- C.O.

[Editor's note: See last week's issue for one good suggestion.]

Send your responses to mtensubmit@midwiferytoday.com

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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.

A: My first indicators of a nuchal arm have always been fresh blood flow at +2 station of the vertex. Upon presentation of said flow, I perform a repeat Leopard's Maneuver in addition to a rectal exam. (I was trained as an L&D nurse in the 70s, and rectal exams were the standard.)

Rule 1: Apply counter-pressure to shearing force's.

Rule 2: Birth is a clean procedure--triple glove and use lots of arnica and tramulin, oral or ointment form, As the arm/hand delivers, follow it out the introitus and peel off offending gloves as you go.

Rule 3: Always support the perineum and make the lips stretch.

Rule 4: Make sure you can fix the perineal outcome while you learn these skills.

What do you do for "skid-marks?"

What products would you use and why? (Think about household astringents and "the like.")

2nd degree--Pull out your thread and prepare your client. If you are still unsure of your suturing skills, bind her at the knees and do perineal washes at bathroom breaks. Begin pelvic floor exercise ASAP; reevaluate at 10 day visit.

3rd degree or sucal/cervical tears: Call backup and establish a plan of care and location of repair site.

- Anon.

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9) Switchboard

In response to Jenn who wants a VBAC and whose doctor wants to schedule a cesarean if she goes past her due date [Issue 52]:

Try curb walking to help bring on labor. I know it sounds funny, but I really believe it helps. Walk along a curb, one leg up on the curb and one in the gutter, then turn around and go the other way.

- Calista

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As a childbirth educator, I once had a student who was due in three weeks and had a similar situation, a doctor whom she just found out had the highest c-section rate in the area. Her first birth had been very difficult, with a long recovery, both physically and emotionally. We had just finished discussing birth options in class and she wanted to know what to do. I first told her I could not tell her what to do (she really wanted some directing advice) but told her she needed to do some very deep introspection about what was most important to her.

The next week she came back and told me she had changed docs *only two weeks from her due date*, to a doctor who was much more willing to support a mom's wishes. She called me about five weeks later to share her birth story with me. It turned out that she had had another c-section, but the big difference was, she felt terrific about it. Her recovery was going very well; breastfeeding and bonding were jubilant parts of her life. She felt this c-section was the best alternative and let her bring home a healthy baby. Without it the outcome might have been far more tragic.

The whole difference was her trust in her care provider. If she had had the same c-section with the care provider who was unsupportive, she would have wondered the rest of her life whether it was necessary. But she did her homework and took that leap of faith in finding a care provider who let the mom take the lead, and it made all the difference in the world.

- Patty

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If your caregivers will not support a VBAC, then change!! Find a midwife who will support your informed choice. It is never too late to ensure that you have the best childbearing experience for yourself and your family. Take control of your journey and have the birth you deserve.

- Karen Blake

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John Jones asked about a three week old baby without bowel movements [Issue 53]. If baby is breastfeeding, he is probably not getting enough calories. A breastfed baby under a month should have many bowel movements, at least two large or five small each day. Feed more frequently, pump and spoon it into him, or supplement with cups of formula. A baby has to eat. If breastfeeding is not going well, call a La Leche League Leader or lactation consultant. A baby must grow. Don't wait.

- Pam Easterday

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I recommend my parents give their baby LBS11 made by Nature Sunshine. You can buy it in tincture form. Usually after a few does it will open them up and they will have regular bowel movements. We just used this for my granddaughter who was having problems and now she is regular.

- Brenda Capps DEM

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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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10) Classified Advertising

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250-335-2890. Namaste, Diane Smith


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