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In This Week's Issue:
1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Caffeine and Miscarriage
5) Check It Out!
6) Questions of the Week
7) Question of the Week Responses
9) Classified Advertising
1) Quote of the Week:
"What separates most birthing women today from women in the past is the loss of familiarity with the birth process, the loss of community with other women, and the loss of traditional feminine wisdom."
- Suzanne Arms
2) The Art of Midwifery
About the only time you will see a healthy grand multip at risk is if she
has overstretched uterine muscles ("pendulous abdomen"). This will keep the
baby from engaging, resulting in danger of uterine prolapse, back pain and
lack of progress because the baby isn't engaged or aimed at the exit. Use a
"prenatal cradle" during pregnancy and have the mother labor lying down or
with a "belly wrap" to help the baby stay vertical.
- Rahima Baldwin Dancy, CPM in Midwifery Today Issue 40
Share your midwifery arts with E-News readers! Send your favorite tricks to
3) News Flashes
A Sydney, Australia study showed that breastfed babies develop an appetite
for flavors from having tasted them in their mother's milk. A comparison
group of artificially fed infants showed less inclination to start new
foods. When they did eat them, the portion taken was about half the amount
the breastfed babies took. -Journal of Human Lactation, Sept. 1996
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4) Caffeine and Miscarriage
Researchers from the National Institute of Child Health and Human
Development (NICHD) and the University of Utah, Salt Lake City, analyzed
stored blood samples from more than 3,000 women, of whom nearly 600 had a
spontaneous abortion. Using a new method to estimate overall caffeine
consumption, the researchers measured blood levels of paraxanthine, a
marker for caffeine consumption. Paraxanthine is a substance produced by
the liver when caffeine is metabolized. It remains in the blood longer than
Paraxanthine was found in 82 percent of women in both experimental groups.
The mean paraxanthine concentrations were significantly higher in the
miscarriage group than in the control group. However, the risk for
miscarriage is not increased until blood concentrations of paraxanthine are
Very high levels of paraxanthine were fairly rare, occurring in 11 percent
of the miscarriage group and 5 percent of the live-birth group.
"Healthy women with a good pregnancy get a pregnancy signal by the fifth or
sixth week," said Dr. Mark Klebanoff, director of NICHD's division of
epidemiology and primary author of the study. "They are more sensitive to
odors and food flavors, and they don't want to drink coffee first thing in
the morning. Women who miscarry often don't get this pregnancy signal and
continue to consume their normal amounts of coffee."
One factor that complicated this study was that the blood samples had been
stored for more than 30 years. While the long-term stability of
paraxanthine is unknown, the researchers conducted a pilot study that
demonstrated "marked deterioration of paraxanthine was unlikely to have
During the 1960s, women were not cautioned against consuming caffeine
during pregnancy, and according to the National Coffee Association, the
national per capita coffee consumed was higher in the 1960s than it is now.
Currently it is very difficult for investigators to recruit a large sample
of women who consume large quantities of caffeine while pregnant.
Since there is no exact way to equate paraxanthine concentration with an
amount of caffeine intake, the study cannot precisely say how much caffeine
is safe during pregnancy.
- The New England Journal of Medicine 1999;22:1639-1644, 1688-1689
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5) Check It Out!
A Web Site Update for E-News Readers
Midwifery Today's Product and Services Directory--The Birth Market--has
opened its doors for birth practitioners to join! We are asked every day
for help locating birth practitioners of all kinds--here is Midwifery Today's savvy solution!
ON SALE: For the cost of $25 and a static banner on your web page, you may
join our listing. This means if you have a web page that is EXCLUSIVELY
about your practice and DOES NOT SELL A PRODUCT, you may add our banner to
your site and pay a $25.00 registration fee to be included in the Birth Market. This is a special price to you--a regular entry to the Birth Market
costs $150.00 for businesses/websites that sell products. See
www.midwiferytoday.com/ads/bannertrade.htm. If you don't have a web page, call or e-mail Cynthia the
You may also read more details at
On March 29, 2000 Jan Tritten, Mother of Midwifery Today, and Cynthia Yula,
WebGirl@midwiferytoday.com, invite you to join them at 7 p.m. for drinks, 8
p.m. for dinner at Panchitos Mexican Restaurant, 103 MacDougal St., NYC, NY
212-473-5239. We are "going dutch" (is that politically incorrect?). But
Cynthia's buying the first round of nachos!
As you know, our international conference is scheduled for September 6-10,
We are looking for Birth Change Agents to brainstorm with. Have any addresses or phone numbers
we should have? Is there someone you think we should invite? Any marketing
tips to share? We're all ears! Please bring a floppy disk of addresses if
you have a long list. And also, if you are interested in a web page, bring
three photos for Cynthia to scan for your page.
Birthing From Within
by Pam England, CNM and Rob Horowitz, PhD
Are you a birth enthusiast? You need a web page! After all, isn't a picture
worth a thousand words? Have a web page created that you can hotlink from
Midwifesearch.com, Midwife Link and Midwifery Today as well as your paper
marketing! We even register your site into search engines! Contact Cynthia
the WebGirl@midwiferytoday.com for more details.
7) Questions of the Week
Is a cesarean indicated for premature babies? If so, how premature? The
study I recall concluded that outcomes were no better having done a
cesarean no matter how premature. Of course I can't find the study now, so
if any of you have any information or studies on hand, please let me know
- Amy Jones
Send your responses to email@example.com
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politicians, scholars, authors, activists, celebrities and entertainers,
will host FEMINIST EXPO 2000 FOR WOMEN'S EMPOWERMENT to share strategies
and fuel the women's movement, its ideas and vision for the future.
Register online at www.feminist.org or
8) Question of the Week Responses
Q: I would like to have my fourth baby at home with a midwife, supported by
close family. My only hesitation is that my third birth was precipitous. I
had the urge to push at 1:25 and was holding a 10 lb. baby in my arms by
I disagree with induction, but am determined to have a wonderful birth
experience where I am surrounded by people who will support me. There is
the chance that my midwife (not to mention my husband and doula) could get
stuck in traffic. What would you recommend for a mom in my position?
Just make sure your midwife is called at the first signs of labor or
impending labor (backache, bloody show, etc.). Even two hours is plenty of
time if the midwife is not a hundred miles away. Also, have a kit for
delivery ready at home and have your midwife review how to assist in the
birth, support the perineum and stimulate the baby if necessary. Your
partner will feel more comfortable if these basics are reviewed in the
event the midwife does not arrive in time.
I had planned my fifth birth to happen at home with my family and midwives.
Everyone involved knew I had a prior birth that lasted 53 minutes from
start to finish. As it happened, my baby came in 34 minutes, emerging
beautifully and born into the hands of his daddy and grandma (the birth
happened at two in the morning.)
Our bodies are made to do this and if it happens that your midwife, husband
or doula don't make it (very unlikely) it would still be better for you to
be at home with all necessary supplies and education rather that YOU being
the one stuck in traffic! Induction is not necessary. Just rely on
planning. If your water breaks, call everyone immediately. You can even
plan to have a family member stay with you for a few days before your due
I learned that unnecessary worry does nothing. I know I could have
delivered my baby by myself if needed. On the other hand, you may have all
the time in the world. Our sixth baby took over 6 hours!
- Deana Sodders
I have five children, and my longest labor was five hours (my second). I
average around two hours. My last two were born at home. With the first
homebirth the midwife skidded in just in time to catch the baby. Number
five was a beautiful waterbirth, 50 minutes start to finish. My husband and
a friend were there and my midwife was stuck in midnight construction
traffic. She got there in time to see the placenta delivered. However, by
my estimates, had we opted for the hospital, the baby would have been born
on the side of the road in a car.
If I had to make the decision over again, I'd still have the homebirth. I
did make sure both times that I had a (doula) friend who is familiar with
"emergency childbirth" with me.
- Chava Weiman
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From prenatal care to postpartum care needs of the mother/child and
family, Harcourt Health Sciences is your PREMIER source for all of the
latest midwifery information.
W.B. Saunders, Mosby, and Churchill Livingstone are all part of Harcout
Health Sciences-a team of leading publishers dedicated to meeting the
information needs of health professionals.
In response to the question about the timing of baby's first bath [Issue 2:9]:
Here in the United Kingdom we bathe babies more than 24 hrs after birth and
mum always performs this first ritual. Generally they almost self-clean.
Vitamin K synthesis is a liver function; our liver is situated in the
abdomen. In some Asian cultures a belly wrap for both mother and baby is
used to keep any cold air from the baby's and mom's abdomens which have
been stressed from births. My first homebirth baby had a bath a day after
birth yet he still had newborn jaundice. But my second homebirthed baby was
not given a bath even after the second day and she had no jaundice. I would
recommend the bath only after the third day.
- Connie D.
I am a student midwife and want opinions about some of the methods my
preceptor uses and believes in. First, he thinks of birth as a biological
process and that the midwife's/doctor's job is to let the body birth in
peace. They should only help the mother be more comfortable, etc. He also
has a very low intra-hospital cesarean rate--10%--which is the lowest in
the region. He definitely believes in VBAC as long as there is no danger to
the mother or baby, and often sees cesareans as "unnecesareans."
He induces at 40-41 weeks if there is no sign of labor. He says he checks
cervical ripeness, and if the cervix is not ready lets it go one more week
so it will be a smoother and more successful induction. He reasons that the
mortality rate of babies after 40 weeks rises very much, the placenta is
older and within a very short time it can become insufficient.
He also does an automatic cesarean if the baby is over 10 pounds. He says
shoulder dystocia is due to oversize babies who should have been cesareans,
and that dystocia is more dangerous to the baby 10 lbs and up than cesarean
He has a 10% cesarean rate, and thinks there is no reason for any clinic or
hospital to have a rate higher than 10% without putting anyone at any risks
- Aiyana Gregori
In response to the question about Doppler use [Issue 2:9]:
I work for Nicolet Vascular (formerly Imex Medical). Following are excerpts
from a letter written to another person with the same concerns.
- Diane Rugh
First, a Doppler auscultatory device in fact uses the same technology as an
ultrasound imager in that a high frequency sound wave (ultrasound) is
transmitted into the body and a return signal is analyzed and processed
either to display an image or transmit a sound. Doppler devices typically
emit a low power continuous wave ultrasound signal and detect the change in
frequency (Doppler effect) from the return signal. The frequency difference
between the transmitted and received signal is typically in the audio range
and can thus be heard if amplified to a speaker.
Ultrasound imaging devices emit a high powered pulsed wave ultrasound
signal and detect the length of time the signal takes to return. This
information is used to detect depths and can be displayed to see the image.
As you know, most imagers have a Doppler mode that will show colored blood
flow direction in addition to the image.
In either case, the revised AIUM statement issued in 1993, "No confirmed
biological effect...", applies to both technologies in that the concern is
power emitted into the body, not how you process the information you
Second, you stated that the frequency of Doppler devices is higher than an
imager device. This is also not true. The Hitachi unit ... has a
trans-abdominal probe that transmits at 3.5 MHz. The industry standard for
obstetrical Dopplers is either 2 or 3 MHz. Imex in fact sells both. Higher
probe frequencies that we sell such as 5 and 8 MHz are used for vascular
applications and are labeled "Not Designed For Fetal Use."
In addition, I would like to point out that the FDA limit for power
intensity emitted by a continuous wave ultrasound for fetal use is 0.094
watts per square centimeter. The FDA power intensity limit for pulsed wave
ultrasound for fetal use is 190 watts per square centimeter. The power
emitted by a Doppler can be 2,000 times less than an imager! Imex 3 MHz
probes emit 0.009 watts per square centimeter, a factor of ten times less
than the FDA limit.
Lastly, I also would like to point out that the duration of an auscultatory
Doppler exam typically lasts less than a minute. Though it is exciting to
hear your baby's heartbeat since there is nothing to see, the exam does not
take very long. At the demonstration, I understand you watched the twins
for at least 20 minutes. Taken with the above power limits, this can be
analogous to watching a night light for a minute as compared to watching a
photographer's strobe light for 20 minutes.
Editor's note: Visit the Midwifery Today website and read Marsden Wagner's
article "Technology in Birth: First Do No Harm" at
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
Read more about ultrasound in Midwifery Today E-News Issue 5, now archived
on Midwifery Today's website. Includes excerpts from Beech's book.
I would like to tap into your wisdom: I am nervous about parent craft
classes. We cover a multitude of issues over a period of six weeks for
about eight couples per course. My problem isn't recognising what a
valuable opportunity parenting classes are (I do), but getting my voice
across minus the wobble which instills confidence in no one.
Does anyone have any coping strategies for getting past this block of mine?
The meetings are informal and friendly, but I am still worrying. I am
hoping it will become easier to do with time. As it is, I can barely
deliver a coherent seminar with my student colleagues, no matter how much I
practice with my mirror and family! My face goes red to my neck, my hands
shake and so does my voice. I have done seminars where I have known my
chosen subject inside and out, nobody has thrown questions at me I can't
answer, but it doesn't help. I sit down afterward and can't remember a word
I have said.
Does anyone know of any practical advice on public speaking? Books,
websites? I need help! I am flapping already and don't have to do it until
Reply to: firstname.lastname@example.org
In response to the question about the birthing mom who refused to push [Issue 2:9]:
If a c-section was actually done, was it done with or without attempts at
ventouse delivery if the mother wouldn't push? I suspect the mother was
asked to push too early and that waiting for descent and appearance on the
perineum (so the mother could see how close she was) would have been a
better way of managing this labour.
More feedback please!
- Phil Watters
You might have suggested she sit on the toilet and push if she was fearing
passing stool. Oops, I just remembered that she had an epidural. Then
offering her a bed pan AND some privacy might have helped her if no one was
willing to wait for her uterus to push the baby out.
I had this happen to me twice. The first time the woman was 6 cm dilated,
mulitparous but not progressing, with a very 'loaded' bowel. I gave her an
enema (a rare thing for me), she had a BM and five minutes later ruptured
membranes and delivered. A few weeks ago I was caring for a woman who was
fully dilated with a full bowel. I was loath to give her an enema at that
point, but did get her up onto a commode (hospital birth) to push. She had
a small BM, then got back on the bed and delivered. In the second instance
I think it was a combination of the bowel movement and the position change
that moved the baby down.
- Kirsten Blacker
I can speak to this issue personally (as I'm sure many other mothers who
have been through labor can!). With my first child who was born in the
hospital, I did not have that "urge" to push although the midwife was
instructing me to do so. I did not know "how" to push correctly at first,
and therefore for several pushes did not make much progress. I don't recall
if someone instructed me or if I finally caught on to the "correct" way to
push, but once I started pushing as if I was trying to poop, if you will,
my baby made great progress and was out in just a couple more pushes.
Whether more than my baby came out or not, I do not know!
With my second birth, which was at home, I knew the right way to push (the
intense bearing down as if you were trying to expel whatever you could from
your lower abdomen), and was more than happy to push out my baby and
anything else just to end the pain of the contractions. In fact, as my
husband who was one of the helping hands will probably never forget, that
time more than my baby did come out!
For me, birthing without drugs is both the most wonderful and painful
experience I can imagine. During transition, I will do absolutely anything
to get the baby out, including pooping!
The epidural your mother received deadened her sensation to the
contractions (i.e., pain for most of us) AND, I believe, heightened her
sense of self-consciousness. Without that epidural, she too may have been
more than happy to push correctly regardless of what embarrassment it might
So my suggestions are 1) skip the drugs in order to let your body do the
work it's intended to do, and 2) as the midwife, coach people in pushing as
if they are trying to poop the largest poop imaginable and assure them that
midwives and doctors have seen it all!
- Dianne Oliver
In response to the inquiry about broad ligament tear as indication for
c-section [Issue 2-9]:
The broad ligament is a very loose and soft layer of peritoneal membrane.
Sometimes it is torn during uterine procedures such as c-sections. Being
such a thin membrane it heals very well and quickly--no big deals or scars.
The problem is during the procedure (c-section), mostly related to
hemorrhage of arteries or varicose veins located in the intimacy of the
To my knowledge, there is nothing like broad ligament previous tear as an
indication for c-section in a future pregnancy. I researched the Medline
for articles on that and didn't find anything.
As for the past two c-sections, the guidelines are the same for all
patients with previous c-sections, when in labor."
- Sandra Werner
In the following experience, I listened to my body, then listened to an
incompetent ER doctor and it nearly cost me my life.
One evening I stood up, took two steps and went straight to the floor. I
stayed there for two hours. When I tried to sit up I found I was in intense
pain from my knees to the bottom of my ribcage. I couldn't sit, lie down or
get comfortable. I thought I had the flu but soon found that I was bleeding
for the third time in a month.
My doctor told me to go to the emergency room. We both thought I had a
tubal pregnancy. I got to ER around 11 pm. They did numerous tests,
including an ultrasound. Finally at 3 am the doctor stumbled back in and
said I had had a miscarriage and that he would give me something for pain.
He said my uterus was empty and there was "nothing to indicate an ectopic
pregnancy." They gave me half the shot that he had ordered by IV; I lay
down and was out for two hours. When I came to, two nurses and my mom were
slapping my face to wake me up. I don't remember the trip home and I didn't
wake up again for 14 hours.
When I got up the next morning I was still in pain. Awhile later
I went to the clinic. My doctor ordered the records from the hospital; they
showed I had an ectopic pregnancy! It said that I had a 5.5 cm "cyst" on my
left tube; the doctor who read the report said he could not rule out an
ectopic pregnancy. My doctor, who was leaving town, told me to go to the
hospital and get another blood test to see if the embryo was still alive.
He said they would do something the next day.
The test at the hospital showed the embryo was dead. The next day I went
back to the clinic and lay on the floor with my kids for a couple of hours
in the waiting room. Finally the doctor came in and said he was sending me
to another doctor. He packaged up my records and sent me to a neighboring
city. I was glad when the doctor there said I was going straight to
surgery. I was doubled over on the table after his exam.
When I came out of surgery the nurses there told me I had had a ruptured
ectopic pregnancy and that I was lucky to be alive. I went home after 24
hours and other than losing my milk and having a fussy son for a couple of
days, I felt fine.
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