February 25, 2000
Volume 2, Issue 8
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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) Teratogens: Should This Woman Worry?
5) Check It Out!
6) Questions of the Week
7) Question of the Week Responses
8) Switchboard
9) Classified Advertising

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1) Quote of the Week:

"Somewhere between the beginning of the third year of medical school and the completion of residency, many of us seem to lose our ability to discriminate fact from belief as we are exposed more and more to practical techniques that "seem" to work and less and less to scientific theory and proof that our theories and practices are scientifically valid."

- Don Creevy, M.D.

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2) The Art of Midwifery

I tend to avoid giving moms cold things to drink or eat after a bleed, preferring to change room temperature or to offer warmed foods and beverages. She has lost much heat as well as blood, and warmed liquids are digested far more rapidly and easily than our culturally preferred ice cold drinks. Ask what she'd prefer to have at this time, because she may have a specific craving for more salt or a more sweet-tasting fluid replacement.

- Lisa Goldstein, Midwifery Today Issue 48

===

Midwifery Today Issue 48 is a mini-textbook on hemorrhage. Order it by calling 1-800-743-0974. Regular price $10; mention code 940 and pay only $8.50 (plus shipping & handling). Offer good until March 10, 2000.

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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

The last hour of the intrapartum heart rates of 1,884 term singleton fetuses collected during routine clinical monitoring over 19 months in Oxford, United Kingdom was analyzed. The records were selected for completeness and continuity until within at least 30 minutes of delivery. It was found that female fetuses had significantly faster heart rates than male fetuses. Epidural analgesia, weight percentile (adjusted for age and sex), parity, the duration of first and second stages of labor, and a fall in umbilical arterial blood pH at birth also independently modulated the fetal heart rate. The effects of these independent variables on heart rate were additive, the most important being epidural analgesia as a cause of tachycardia. The effect of fetal gender was less in the first stage, 6 to 7 hours before deliver, and was not present before the onset of labor.

- MIDIRS, June 1999

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4) Teratogens: Should This Woman Worry?

The following question about exposure to teratogens in early pregnancy was recently posed to Midwifery Today. Staff member Jennifer Rosenberg came up with the following information and suggestions.

Q: A client had several brief exposures to paint thinners in an art studio early in pregnancy. What is her risk of birth defects?

- Karen Carr, CPM

Midwifery Today answers:

Resources on the web relevant to the question:

http://images.babycenter.com/expert/5113.html (ask an expert)

www.babycenter.com/news/19990329 (news brief)

http://artdept.umn.edu/Administrative_Services/MERKTA/hazards.html (hazards in the arts)

http://www.craftsreport.com/september97/pregnancy.html (pregnancy and the crafts professional)

http://www.sciencenews.org/sn_arc99/3_27_99/fob2.htm (Science News: full article on the study)

Best answer from brief survey of the above pages:
While it is clear that prolonged exposure to solvents and other toxic agents is quite hazardous and can be associated with a high rate of birth defects, miscarriage, and stillbirth, (up to a third of pregnancies miscarrying, up to 15% rate of major defects depending on type and duration of exposure), brief exposures are not as likely to cause problems. Nevertheless, some substances can cause defects with only tiny exposures in the first trimester.

The page "Pregnancy and the Crafts Professional" puts it very succinctly when it says, "Do not stress about past exposures." Realistically, you can't do a thing about what has happened in the past and stress, as the article points out, does no one good.

It is wise, particularly in the first trimester, but realistically throughout pregnancy, to avoid all toxins. This includes "natural" solvents like citrus or pine-based thinners and cleaners. Turpentine is quite toxic.

The incidence of birth defects is much higher when mothers report headaches and other symptoms themselves, especially over longer periods of time (weeks or months). So looking to the future, women who are pregnant or may be pregnant need to be very careful about exposures to chemicals, both inhaled and through the skin.

The woman in question was modeling for an art class in her first trimester. As there were only two episodes of exposure, each for relatively brief periods of time, her risk is low relative to say, a print shop employee or other professional exposed for 8-10 hours per day five days per week for three solid months. In any event, there is little that can be done retrospectively.

The studies on the subject tend to reinforce the notion that moms need to listen to their bodies. A strong physical reaction, such as nausea or headache, to fumes or smells is a signal that should be heeded.

- Jennifer Rosenberg, CD (DONA), ICCE
Midwifery Today Graphics & Design Editor

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This comprehensive guide provides succinct clinical-pathological correlations based upon indications for placental examination and the answers to many of your clinical and pathological questions. Check out www.netins.net/showcase/placenta for detailed book information and ordering information.

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5) Check It Out!

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

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This week we turned our website into a fully functional cornucopia of birth information. Please visit us! www.midwiferytoday.com. It's now easier than ever to find your way around our site! Please take a look, but keep in mind that it is still under construction. Our special thanks to Chrystal Otto, our webmistress, who has spent every waking moment working on our web page since she joined the Midwifery Today staff. You Rock, Momma-Mistress!

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This week's new article on the web site is
Technology in Birth: First Do No Harm by Marsden Wagner. M.D.

Make yourself a cup of coffee, change the ink cartridge in your printer, do what you must, but be prepared to read for a while. This article is some of Marsden's best work. It is thought provoking, straightforward, and a must-read for ANYONE expecting to be involved in birth IN ANY CAPACITY, ANYWERE!

Marsden writes, "We are living in the age of technology. Ever since we succeded in going to the moon, we have believed that technology can do everything to solve all our problems. So it should come as no surprise that doctors and hospitals are using more and more technology on pregnant and birthing women. Has it solved all the problems that can arise during birth?" www.midwiferytoday.com/Library/articles/technology_in_birth.html

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It is a Hyperlink War out there in the World Wide Web. Join our web of INCLUSION! Every one of you is a birth soldier! Build your army on our website!

We'll make your business cards, offer small business counseling and even give you a redirected web address so it's short and sweet! Let us help you change the world! Contact Cynthia at netads@midwiferytoday.com

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We are currently accepting bids for sponsorship of our International Conference in New York, September 2000! Contact Cynthia at netads@midwiferytoday.com

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Would you like to sell your product at the Midwifery Today conference in Philadelphia? Elise would love to explain what advertisement options are available. E-mail: ads@midwiferytoday.com

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6) Questions of the Week

I would like to hear from other midwives who have dealt with women who have pinworms in pregnancy. Did the women experience periodic spotting? Also what, if any, natural remedies are effective and safe in pregnancy?

- Deren Bader, CPM, MPH

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Could anyone provide information on herpes and vaginal birth vs. c-section? A client is considering opting for a c-section rather than risk the possibility of transmitting it to her newborn (She is currently at 27 weeks). Any suggestions or information/resources would be appreciated.

- Anon.

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Send your responses to mtensubmit@midwiferytoday.com

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resourcing@earthlink.net
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7) Question of the Week Responses

Q: I had a manual extraction of the placenta by a CNM in the hospital after my first birth, about 5 minutes after I had delivered. I hemorrhaged quite a bit after and BP dropped to 60/30. With my second (at home), contractions stopped immediately after birth. We waited for 2 hours, had about 2 cups of blood at home, then was transported for another manual removal. The placenta was taken out in pieces. I was on the borderline for needing a blood transfusion. I smoked with the first two pregnancies but have now quit with my third.

I would like to know of any natural intervention you have as I am planning another homebirth and if necessary a manual extraction at home.

- Alida

Three homoeopathic remedies are commonly used to counteract retained placenta. They are:

1. SABINA 30c: Useful for haemorrhage with retained placenta. It will promote expulsion. There may be watery blood with dark clots. The patient typically feels chilly, with cold hands and feet. Give every 10 minutes for 4 doses.

2. SECALE 30c: Patient is relaxed and contractions have no expulsive action. Hourglass contractions. Haemorrhage with continual oozing of thin, dark-coloured blood. The patient is typically hot, wants fresh air and doesn't want to be covered. Give one dose every 10-20 minutes depending on situation.

3. SEPIA 30c: Situations where there is back pain which is better for hard pressure in the small of the back. The Sepia patient has a tendency to prolapses and often has a history of severe "dragging down" pains in the abdomen during menses. During labour just one dose should be given initially and the patient's response carefully monitored. Never repeat the dose when it is still working or it will cause an aggravation of the pain. Also useful for retained placenta.

Caullophyllum 30c (blue cohosh) can also be given to bring on contractions
if they have ceased.

I think it would be preferable to be in a hospital if a manual removal of placenta is required due to the possibility of serious haemorrhaging.

- Glenis

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Often, angelica tincture (also called dong quai) can be used after a birth to help release the placenta. Also make sure the vitamin E intake the last month before birth is no more than 400 IU daily.

But of most importance is patience in waiting on the placenta. There will be a tendency to hurry the placenta out and that can definitely lead to hemorrhaging. Some placentas are much slower to detach than others and pulling them off too soon is what actually causes the hemorrhaging. Waiting patiently is actually the best treatment for accreta as long as blood loss is not excessive. But her care provider must be well aware of her previous history and have emergency plans in place.

- J. Jones, CPM

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Visit the multiple award-winning WATERBIRTH WEBSITE for the most complete waterbirth information available on the net!
www.waterbirthinfo.com/
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.

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=PLEASE SUPPORT OUR SPONSORS!=

Benig Mauger, Jungian psychotherapist and author of Songs from the Womb will be in the USA late March for the publication of her book Reclaiming the Spirituality of Birth and will be available as conference speaker/lecturer. A pioneer in pre-and perinatal psychology, her presentations include: Millennium Babies-Restoring Soul to Childbirth. Contact her at www.globalireland.com/soulconnections

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8) Switchboard

Please pass this message to all midwife supporters in California. We have an opportunity to change/remove the "physician supervision" clause in our Midwifery Practice Act. Call and/or email Liz Figuroa to say "I support midwives and SB1479."
Phone number: 916-445-6671
E-mail: senator.figueroa@sen.ca.gov mailto:senator.figueroa@sen.ca.gov
Email MUST include street address and zip code to be counted. Put "SUPPORT 1479" right at the top, and the subject line. Please forward this message to as many as you can. We need hundreds of calls each day before March 10. To know more about SB1479,go to this web link:
www.goodnewsnet.org/Law/AB1418/bpmembers00a.htm

- Kimberly Marie Ferguson

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I feel really concerned about all this interest in "natural induction" (seems like an oxymoron to me), stripping or sweeping the membranes (whatever it is called, it's still an intervention with accompanying side effects) and other *interventions*! Are midwives not protectors? Don't families come to midwives and prefer to stay at home for the birth of their babies so they can avoid these interventions? Why would we want to sweep OR strip membranes when we know that this can cause premature rupture and all its possible side effects? Why not just go ahead and rupture the membranes. It's the same; the results are just postponed a bit by stripping as opposed to outright rupture. WHY would we want to induce?

I recently assisted at a birth where a mom was already in good labor and progressing well, but evidently not fast enough to suit her impatient midwife, who offered her cytotec no less, to "move things along faster"! She didn't tell her what she was offering or what the side effects could be. Now who does that sound like? What is happening here?!

We midwives need to sit back and take a good hard look at what we are allowing ourselves to do. What makes us better than the medical pattern we say we don't believe in, if we do things like this without true need, just because we can do it, legally or illegally? Midwives, we are the only ones who stand between home and hospital for families who want to birth joyfully and without intervention. Are we going to stand for what we say we believe in, or are we going to slowly move over and join the medical models that we say is not the best way. Think about it!

- Anon.

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I am a licensed midwife practicing in eastern Washington state. My friend has a twin pregnancy and she is being following by a family practice doc. The doc wants the usual ultrasound schedule. My friend does not feel comfortable with so many ultrasounds. I am searching for some well designed studies that might indicate the efficacy of the standard ultrasound routine. Does anyone know of any such studies? Specifically, does all the ultrasound actually improve outcome? All the studies I have come up with so far speak to justifying the rather heavy handed use of ultrasound.

- Mary

Editor's note: Please visit the Midwifery Today website and read Marsden Wagner's article "Technology in Birth: First Do No Harm" at
www.midwiferytoday.com/Library/articles/technology_in_birth.html
Midwifery Today also sells an excellent book by Beverley Beech called Ultrasound? Unsound, which reviews and evaluates ultrasound research; price is US$14. For more information go to
Ultrasound? Unsound
Read more about ultrasound in Midwifery Today E-News Issue 5, now archived on Midwifery Today's website. Includes excerpts from Beech's book. www.midwiferytoday.com/E-News/enews1n5.htm

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To Paula regarding GBS positive women with short labors [Issue 2:7]: In the hospital where I work, the protocol for GBS positive women is to give 2 doses of Ampicillin, 4 hours apart in labor. If the 2nd dose can't be given due to short labor, the baby is "observed" for 48 hours in the hospital (although the baby doesn't need to leave the mom if all is well). Also blood cultures are drawn shortly after the birth. Since it takes 48 hours for these cultures to come back, this corresponds to the 48 hour observation period. The blood culture is for GBS. If positive, antibiotics are started in the infant.

- Tanya Mchale

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In response to Phil Watters' response to the option I have pursued for a weak pelvic floor [Issue 2:3}: First, a gynecologist and urologist work with the physical therapist. I go to their offices in order to receive the treatment. Second, the Journal of Urology has published several studies that indicate that 85% of women who have their pelvic floor strength measured (via a pressure catheter in the rectum and vagina), receive electrical stimulation and do pelvic floor exercises prescribed based on the woman's strength, will avoid having to have surgery. Often women with damaged pelvic floors will be doing too many "kegels" or doing them ineffectively (using abdominal muscles). Another advantage to the electrical stimulation is that you feel your muscle contracting the way it did prior to the pregnancy/birth.

Remember, many women who suffer from this condition have been victims of obstetrical routines such as episiotomies. Mr. Watters, like traditional obstetric beliefs, blames the woman's body or the process of birth as if it were a medical event instead of a natural process. He commented on more likely "reasons" for my pelvic floor problems: the size of the baby (6 lbs 8 oz), length of second stage (20 minutes of pushing to the point of comfort), neglect of the muscle after birth (I began doing PC exercises daily from the day of birth). I am quite sure that Mr. Watter's comment about estrogen deprivation has to do with that "abnormal" thing called breastfeeding. And in response to his comment that "it tends to be a familial problem," no it seems to be a problem of obstetrician-managed birth as opposed to a midwife-attended birth. The belief that the woman's body is defective is what allows the standard of care in obstetrics to continue despite that fact that it is far from evidence-based.

Let's be honest here. Vacuum extractors are forceful. They bring a baby through a birth canal that has not stretched at nature's pace. Recent studies on vacuum extractors focus on the risks to the baby. Anything capable of causing cephalohemotomas, retinal hemorrhages, skull fractures, hemorrhage beneath the scalp, facial paralysis and Erb's palsy is certainly capable of damaging the mother's tissues. Several paraurethral tears and a penineal tear ought to be a clue that this vacuum birth was far more traumatic than the size of the baby, length of second stage and neglecting PC exercises after birth.

A woman can feel confident having a urologist manage prolapse, especially when it is hard to trust obstetricians who have been known to cause routine trauma to the pelvic floor with epsiotomies, forceps and rushing births (instead of using effective pushing positions, patience and perineal support). When a young woman is urinating every time she sneezes, coughs and runs, a urologist certainly should be capable of assessing and treating the problem. I commend the gynecologist and obstetrician in my area who offer non-invasive therapy first and provided me with the literature discussing the success that Mr. Watters claims does not exist.

- Cindy Schierlinger

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A woman in my antenatal classes had an undiagnosed oblique lie at 41 weeks, this after being told the baby had engaged at 37 weeks. She started having regular contractions ten minutes apart on Sunday morning after a restless night, and she was still getting them when she had her appointment to discuss induction on Tuesday afternoon.

Having been told by her consultant that the baby was oblique (confirmed with a scan), she was informed that there was no way they would let her go beyond Friday and that she would probably have a section anyway. When she was monitored she was told that had she been dilating she would have been kept in the hospital as her contractions were strong enough. That just upset her more.

Having planned for a natural birth she was very distressed, not least because she already hadn't slept for nearly three nights. So she called me for advice. Here was I, not yet fully qualified as an antenatal teacher, put on the spot. I remembered Jean Sutton's advice for asynclitism and thought it might be worth a try so I got her to walk upstairs, two steps at a time. She did it once and it was really uncomfortable. Two hours later she had to go to the hospital because her contractions suddenly picked up. When she got there she found she was 3 cm dilated! OK so she ended up with an epidural and the baby was distressed and was delivered by ventouse but she was exhausted by then and so was he.

This whole episode has boosted my confidence immeasurably and helped me believe that my chosen career as a midwife (assuming I get into college) is the right one for me.

- Jean

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More on turning a breech:

I did read some while ago of a midwife who found it very effective to use a flashlight on the mother's abdomen in a very dark room. She would slowly move the light in the direction she wished to fetus to turn.

- Rayner

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In Meryl Smith's excellent piece on how to turn a breech [Issue 2:7], she says twice that we're trying to get the head out of the pelvis. No, we're trying to get the bum out of the pelvis and the head into it.

I know that's what she means and it's obvious that she has such a clear mental picture of the baby being head down she can't even adjust her head to write an article on breech--I'll bet she has very few breeches in her practice!

- Gloria Lemay

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I sat reading, appalled, the long list of interventions, some merely annoyingly invasive, some dangerously so, being suggested to turn a breech baby! Why not simply take the baby's advice? Isn't it possible the baby wants to be born breech for a good reason? For one example, I give you my father who was born in 1946 at home, unassisted, in a frank breech position. He had an open myelomeningecele. Had he been born in a vertex position he might well have been paralyzed. However, due to lack of intervention, he was born healthy and underwent, at three months old, the first-ever corrective surgery for this condition in that area of the country.

Breech birth is not inherently dangerous if medical intervention is avoided and if the mother is allowed to instinctively choose her birth position and give birth at her own pace. It really disturbs me to not see this attitude represented at all among your readers. Every suggestion made, every time you touch a womon during pregnancy, labor, and birth, every time you hint that something about her baby, her pregnancy, her labor, or her birth is not exactly as it should be, is an intervention that could lead to complications.

- Maka Laughingwolf
maka@maka.net

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I was diagnosed with strep throat and treated with a course of antibiotics. My midwife has since said I must be treated with an IV of steroids during labour. I am strongly against this since I thought it was strep A that caused throat infection and strep B that can cause problems for the baby--two different bacteria. Has anyone been in this position or have any info. on it? I am birthing in a hospital.

- Kate

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Many thanks to the readers of Midwifery Today from "Pregnancy & Childbirth Tips". We are extremely pleased to announce that we have now hit "National Bestseller" status! Our heartfelt thanks to all the women who are supporting this important project. A Canadian Publisher has asked me to write a series of six childbirth books. The first book will be on pre-conception. Please send in your tips for pre-conception and fertility to gaildahl@home.com. Your input and expertise will be greatly appreciated and your name will be added in the book as a contributing writer.

- Gail J. Dahl

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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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9) Classified Advertising

March 18-19, 2000, the Midwives Alliance of North America and Midwives of Maine co-sponsor the New England Regional Conference, "RESTORING THE BALANCE: BRINGING MIDWIVES BACK INTO THE BIRTH EQUATION" featuring Dr. Marsden Wagner, MD, MSPH. Northern Pines Conference Center, Raymond, Maine. To receive a brochure or to exhibit, contact Anna Durand, (207)288-4243.

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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.
cherjm@aol.com


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