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In This Week's Issue:
1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) What Midwives Want From Their Clients
5) Check It Out!
6) Question of the Week
7) Question of the Week Responses
9) Classified Advertising
1) Quote of the Week:
"No matter how much data has been accumulated on however many mothers, we can never know scientifically exactly what will happen in the next birth."
- David Stewart, Ph.D.
2) The Art of Midwifery
I often joke with a first time mother who is preoccupied with watching the
clock that no woman has ever missed her birth by sleeping through it. It is
important that the mother be encouraged to rest and sleep as much as
possible in very early labor. If exhaustion has occurred, labor will slow
down and inertia and constriction rings may lead to operative intervention.
The risk of maternal hemorrhage increases as well as the possibility of
subinvolution with excessive bleeding and postpartum infection.
- Valeria El Halta, Midwifery Today Issue 46
Read Valerie's wise comments on sixteen different causes of prolonged
labor, in Midwifery Today Issue 46. Mention Code 940 when you order your
copy and receive $1.50 off the regular price of US$10. Please add shipping
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3) News Flashes
A recent study found that women whose diets are relatively high in
saturated fat in the year before they conceive are at higher risk of
experiencing severe nausea and vomiting during pregnancy (hyperemesis
gravidarum). This condition can lead to dehydration, weight loss and if
left untreated, liver and kidney damage. The author of the study suggests
that women who have had an earlier pregnancy where they were very ill may
want to consider altering their diet to alleviate the symptoms in the next
- American Baby, April 1999
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4) What Midwives Want From Their Clients
Be Honest: One would think that this would go without saying, but
unfortunately, it does not. Not only does this quality stand as the first
and foremost obligation of a woman to her midwife (and the midwife to her
client, of course), but it permeates all the other qualities listed [in the
remainder of the article]. Without honesty there can be no trust, and
without a trusting bond between midwife and client, there can be no safe
There are many reasons why a woman would be untruthful. Perhaps a woman has
had several abortions and has not told her husband. If an oral history is
taken with the husband present, she may hide the information from her
midwife. A woman may be too embarrassed to let her midwife know that she
has herpes. Or perhaps she has learned from interviewing other midwives
that she has a certain risk factor that would preclude a homebirth. She may
think that if she hides the information from the present midwife, she can
get the homebirth she wants. But there are dangers inherent in these
Each woman has the right to choose her birthplace and attendant.
Conversely, midwives have the right to choose their clients according to
self-imposed limits and protocols. Some midwives do not hesitate to take
women who have had multiple abortions or who have herpes; others do not
feel comfortable doing so. Most midwives will not assist at the delivery of
twins or breeches; others do not take VBACs. And there are some conditions
for which few midwives would agree to be the primary caregiver, such as
preexisting medical/health problems that require the care of an OB. In
these cases, the midwife might be able to co-manage your care with her
Unfortunately, there are some women who so desperately desire a homebirth
and/or midwifery care that they are willing to do almost anything to get
it. This is unfair and potentially dangerous to everyone involved. If you have any medical condition or significant past OB history, you must tell
your midwife, even if other midwives have turned you down. Without thorough
knowledge of your history, the midwife cannot make safe decisions regarding
your care. Remember, however, that what one midwife may not feel qualified
to handle, another may feel perfectly comfortable handling.
If you have special requirements or requests of a midwife, such as
religion, lifestyle, philosophy, education/training or legal status, make
these clear during the initial phone contact and ask if she can meet them.
There is no point in signing up with a midwife only to discover later there
is something about her you find unacceptable. Most midwives know other
midwives in their area, and can refer you to another who might better suit
Read the remainder of this article on Midwifery Today's web site-it makes a
great handout for new clients! Go to:
Can you think of other things midwives want from their clients?
Email your ideas to us at E-News:
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5) Check It Out!
A Web Site Update for E-News Readers
New Articles Continue to Go Up! Check them out at
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,
2000 (www.midwiferytoday.com/conf/2000and.htm ). 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) Question of the Week
Does anyone know of any natural remedies for blocked fallopian tubes? The
woman in question has already had two children and is not aware of having
had an infection that could have caused this.
- Julia Duthie
Send your responses to firstname.lastname@example.org
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8) Question of the Week Responses
Q: How does previous cervical surgery (such as LEEP) for dysplasia affect
the ability of the cervix to dilate during uninduced labor? One CNM
estimated that about 60% of her clients who have had LEEPs have cervical
scarring that temporarily prevents the progress of dilatation for up to
- Kari Michalski
My experience seems to be either/or: short labor, long labor.
I would recommend that any pregnant woman with cervical scarring take evening primrose oil during the last month of her pregnancy, even applying it directly to her cervix. I had a cervical biopsy done between my third and fourth pregnancies and my labor for my fourth was very painful, and long. I rubbed evening primrose oil on my cervix during labor and it seemed to really help things get moving.
- Lorrie White
I had a primip student in my Bradley class who decided to have a
midwife-attended homebirth. She was in excellent health throughout her
pregnancy and was not particularly concerned about the fact she had had
LEEP surgery many years before. She was in labor for over two days, and at
7 centimeters (midwife could stretch her to 8 centimeters) for twelve
hours. She was handling the experience well, but getting truly fatigued.
The midwife finally suggested they transport to the hospital. On arrival,
the doctor lost his mind that she had been that dilated for that long and
wanted to do an immediate c-section. The couple refused and requested an
epidural and some more time (hoping for sleep and dilation). She did not
dilate any more and they did end up with a section. The midwife's response
to this (according to the mom) was that her cervix was fairly well scarred.
The doctor who examined her said he didn't feel any scarring. I would love
any feedback you can offer on this. The couple is hoping for another baby
and wants a homebirth VBAC.
- Samantha Ste.Claire
I have been a labor and delivery nurse for years and am an aspiring
midwife. I have found that often times cervical procedures such as LEEP do
produce tough scarring that takes a bit longer to get going, but once the
scarring has been broken up with a little digital manipulation, the cervix
has the potential to open much more rapidly.
I always list a history of LEEP on the Problem List to remind myself during
labor that there might be a problem. There never has been. Don't worry.
More on cesareans for premature babies:
Here are three studies you might want to look up. They seem to indicate
that after taking other complications into account, cesarean is not
routinely warranted for the premature infant.
- Jill MacCorkle
Dietl J, Arnold H, Mentzel H, Hirsch HA.Effect of cesarean section on
outcome in high- and low-risk very preterm infants. Arch Gynecol Obstet
1989;246(2):91-6 "Cesarean section was associated with a highly
significantly improved survival rate in the high-risk group, but was not
associated with differences in fetal outcome in the low-risk group. The
results of this study do not support primary cesarean section as the method
of delivery for all very preterm fetuses."
Malloy MH, Onstad L, Wright E. The effect of cesarean delivery on birth
outcome in very low birth weight infants. National Institute of Child
Health and Human Development Neonatal Research Network. Obstet Gynecol 1991
"These data suggest that after accounting for certain maternal and fetal
factors, cesarean delivery is not associated with a lower risk of either
mortality or IVH."
Malloy MH, Rhoads GG, Schramm W, Land G. Increasing cesarean section rates
in very low-birth weight infants. Effect on outcome. JAMA 1989 Sep
"We conclude that there is little evidence that the use of cesarean section
for the delivery of very low-birth weight infants, independent of maternal
or fetal compromise, improves overall survival. We were unable to find
reasons to justify the sharp increase in the use of cesarean sections for
these small infants."
More on pinworms in pregnancy:
A low sugar and white bread diet helps pinworms and all kinds of parasites
thrive. Also I have heard that fennel tea helps [alleviate pinworms],
although I do not know if it is contraindicated during pregnancy. It won't
be hard for you to find out.
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according to a bumper sticker. If you have a heart for laboring women and
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support to birthing families.
Attend a DONA approved doula training May 19-20, 2000 in Waterloo, Iowa.
Contact Debbie at 1-800-648-3662 or
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Visit the multiple award-winning WATERBIRTH WEBSITE for the most complete
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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
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A friend was just told that her blood has tested positive for "Anti-C" and
that she will likely miscarry in her second trimester. She is ten weeks
now. She has had five live births and last year miscarried twice, at six
and eight weeks gestation. Her doctor did not (would not) take the time to
explain what this is, other than some sort of sensitization from a previous
pregnancy. He said it did not cause her two recent losses.
I could not find any information on this condition. If you have heard of
this, please help enlighten us!
- Eileen in Maryland
In response to Aiyana Gregori's questions regarding her preceptor's routine
practices [Issue 2:10]:
It sounds like your preceptor has the right attitude toward birth, at least
in theory, but some of his routine practices seem to contradict his basic
ideals about birth being a biological process and his role being only to
allow women to birth in peace.
He seems to have a reasonably low c-section rate, but what about other
interventions? Does he do a lot of forceps or vacuum deliveries,
episiotomy, etc, due to women who are induced when neither their bodies or
babies are ready for birth? Induction causes a higher incidence of
instrumental delivery, which raises the risk of infection (according to
Judy Barret Litoff, "American Midwives--1860 to the Present" (Greenwood
Press, 1978), pp. 108-113), usually due to failure to progress. Well,
that's because the baby was not yet ready to be born! There is no reason to
induce a healthy woman with no medical indications other than 40 weeks. The
due date is only an estimate. And if the average is 40 weeks, there will be
some women who go longer. Forty-two weeks or even 44 weeks is not dangerous
in and of itself; some babies take that long to prepare for birth. The
placenta does not deteriorate just because the pregnancy has gone past the
estimated due date. As long as both mom and baby are doing well there is no
reason to induce at 40 or 41 weeks.
There is also no reason to do a c-section simply because the baby is
estimated to be 10 pounds or more, besides the fact that prenatal
estimations of weight are notoriously inaccurate, often by a pound or more,
even with the use of ultrasound. Shoulder dystocia has more to do with
positioning of babe and mom than birth weight. Many ten pound babies are
born vaginally with no complications at all. The birth attendant's ability
to loosen a stuck shoulder is important too, and something that must be
learned. And always consider the fact that by having a c-section, the
maternal death rate is up to 16 times greater than a vaginal birth
(according to the British Medical Journal).
He does seem to be on the right track, but if he really believes that birth
is a natural process, he needs to let it be that. And let birth happen in
its own time and its own way. There are lots of studies that show the
increased risk associated with these interventions; it would do you good to
find them so that you have all the facts at your disposal to make a
decision. Many are available on the Internet and very easy to find. The
British Medical Journal is a good place to start (www.bmj.com).
- Michal Lynn Moyer, aspiring midwife
In response to Jackie's question [Issue 2:11] regarding mobility in labor:
I can't tell you how often a woman will suddenly progress after I get her
up and moving. My usual excuse is, "It's time to go pee" or "How about a
shower?" This most commonly occurs in multips. I find a LOT of women prefer
to stay still in bed. They are afraid, of course, that the more they move,
the more it will hurt. On the other hand, I have had a disappointing number
of women, usually primips, who make no progress in labor despite tremendous
effort on their part to remain mobile during labor or to become mobile with
my encouragement. These women's births end in cesareans. So, I find it can
work beautifully or not at all.
- Mary Ann Durbin, Toledo
An Ob/Gyn conference entitled "Update 2000" will be held April 13-14, 2000
at the Marriott Downtown in Kansas City, Missouri. This conference promotes
the use of medically unnecessary cesarean section as a standard of care.
The following lectures are being offered:
Cesarean Section Goes Mainstream
Strategies to Optimize a Cesarean Delivery Rate
Cesarean Section: Is it Time to Change the Tune?
Vaginal Delivery and Pelvic Floor Damage
A debate "that normal gravida should be offered elective cesarean section at term"
Elective Cesarean Section at Term (38 weeks) as a Cost Control Measure
Elective Cesarean Hysterectomy at Term for the Last Delivery
A portion of the "course objective" for this conference reads "At the
conclusion of this meeting, participants should comprehend: 1) that every
age applies cesarean section in consideration of the obstetrical problems
of the day, the safety and effectiveness of the supporting treatments, the
trade-offs of cesarean and vaginal birth, and patient and societal
preferences; 2) current considerations in the application of cesarean
section; 3) possible future trends in cesarean section."
The Kansas City area chapter of the International Cesarean Awareness
Network (ICAN of KC) will be staging a picket, phone, fax, and media
protest of this conference in the hopes that every doctor who attends will
be aware that women of Kansas City will not tolerate being cut for
medically unnecessary reasons. Your support, locally or internationally, is
essential. Please contact Anita Woods, President of ICAN of KC, at
(816)822-5040, or email ICANofKC@aol.com for more information on how you
can help maintain the rights of women in Kansas City.
There is now a website for the latest news and information, including a
response from Truman Medical Center, on the protest of this Kansas City OB
Conference. Please go to
[Editor's note: Take a few minutes to read this interesting exchange!]
- Anita Woods
Chapter Coordinator, The International Cesarean Awareness Network
Leader, ICAN of Kansas City
In response to Lisa's letter in Issue 2:9:
Do NOT let your OB talk you into an epidural, unless that's what YOU want!
My twins, born June '99, were in the same position as yours, and my OB
wanted me to have an epi for the second one too. I refused and we
compromised with a saline lock, which was put in place at the beginning of
second stage (and I regret agreeing to that, since it was unnecessary,
painful, and disruptive to what had been a very peaceful labour to that
point). His concern was that the baby would turn transverse and he would
need to do an internal version--reach in, grab the feet and pull--and that
it would be too painful for me. I decided to use gas (Entonox) if I needed
pain relief, and he was OK with that.
Eleanor was born entirely naturally, and I caught her myself with my
midwife's help. I held her on my chest, cord intact, while the OB checked
the position of the second baby. He broke her sac, found she was turning,
and decided to pull her out feet first (I think she would have turned
vertex given the chance, but he felt better safe than sorry, I guess). It
was incredibly painful having his hand in my uterus, and I was offered gas,
but couldn't concentrate on holding the mask and my baby, so didn't use it.
However, the procedure was extremely quick. Isabel was born a mere 2 1/2
minutes after her sister.
I am SO very glad I didn't have an epidural or any other drugs. Yes it was
painful, but the pain was so brief compared with the joy of being
unmedicated and able to return home later that day (about 8 hours after the
birth). Apparently they were still talking about us weeks later at the
hospital: the huge twins (8lb 10oz and 8lb 9oz) who were born without drugs
and went home the same day. (I explained to the nurses who were shaking
their heads that there was no way I could nurse two babies in a narrow
My only regrets are the saline lock, and the fact I had to give up my
homebirth when we discovered a second baby at 36 weeks. If I'd had time, I
would have found a private midwife who could deliver twins at home (the BC
College does not permit it).
My advice would be:
1. Write an explicit birth plan and sign it. That makes medical staff feel
more comfortable about honouring your wishes without fear of being sued.
State your preferences reasonably, and have contingency plans (i.e., if a
c-section is necessary, state how you would like that to proceed as well).
Don't forget to include how you would like the babies to be treated (e.g.:
type of suctioning, if any, when to cut cord, breastfeeding twin A to
reestablish contractions for twin B, etc.).
2. If comfortable, give birth in the hands and knees position for Baby A.
This makes it less likely Baby B will turn transverse (I wish I'd known
this, or I would have tried). Alternatively, have your midwife or a nurse
gently "hold" Baby B "upright" externally while you push the first baby
out, and until the buttocks are safely engaged in your pelvis.
3. Find out from your OB how long she is comfortable waiting for the second
baby. Some second babies are born hours after their twins, but not all
doctors are willing to wait that long, for fear the cervix will close and
may not dilate again for a breech, or one or both placentae will detach and
cause haemorraging or foetal distress. Establish ahead of time both of your
comfort zones in regard to watchful waiting.
Most of all, trust your body. Twins are rare but not abnormal, and if
giving birth to them was really so dangerous, natural selection would have
eliminated multiple gestations in our species long ago.
- Jennifer Landels, Vancouver BC
At a midwifery conference I attended, there was a deep blending of soul
feeding and practice-improving sessions that one always hopes for. But one
session about grief touched a spot for me that has continued to itch and
made me wonder, where is the book of shared birth stories of infant death
as either late term fetal demise, stillbirth or birth of a child too ill to
live long? The fantastic book "Our Stories of Miscarriages" helps and heals
early losses told by mothers, fathers, and care providers. One is needed,
however, for those babies born later in pregnancy not living or living but
not long for life. My clients get so much from shared anecdotes that help
heal or get them through troubled times.
My co-writer and I hope to compile a book of such stories. There are
support groups now for such loss and grief counseling. But a collection of
stories from the ones who were there, and who lived through it will really
help others. In that spirit, we'd like to ask you to share the experiences
you have had with infant death. We would like to hear from the caregivers,
moms and dads, birth assistants, nurses, and doulas. Please write, call, or
email us at:
Katy Maker, CNM, 2712 Walnut Creek Rd., Decorah, IA 52101; phone
319-382-0249; email email@example.com or Debbie Young, CD-DONA, ICCE, 244
S. Walnut St., West Union, IA 52175; phone 319-422-8833; email
Regarding the account of the ectopic pregnancy [Issue 2:10]: If things
really went as written, I would strongly suggest the writer (and victim)
insist on a medical review of her case! If she had been diagnosed
correctly, which is not difficult with an ultrasound, her doctor may have
been able to save her tube. I've never heard of a blood test to see if the
"embryo is alive" in the case of ectopic pregnancy. (In the case of
possible fetal demise, of course, we do serial Beta Hcg before the option
of D&C.) In the case of ectopic pregnancy, that is a moot point. Immediate
surgery to save the life of the mother is always the treatment.
Regarding the discussion of ultrasound [Issues 2: 9, 10, 11]: Some of the
information given in the last issue was somewhat misleading. I am not a
sonographer but I am married to one. The transducers used in ultrasound
have various frequencies to penetrate different tissues. The transducers
"not suitable for fetal studies" simply do not have the correct wavelengths
to penetrate deeply enough to get an image. They would more likely be used
for superficial studies such as for carotid arteries, etc. Different
transducers will be used for fetal studies depending on the route (vaginal
vs. abdominal) and the weight of the mother (abdominal adipose tissue).
For those who really want accurate information on the risks vs. benefits of
ultrasound, what the policies are and the guidelines of the governing
agencies are, I would recommend getting on the Internet and doing some
reading. HealthGate ob-ultrasound.net would be a good start.
For mothers who refuse an ultrasound scan during pregnancy (because they
think it is unsafe), they would also want to refuse (I would think) Doppler
for FHT during prenatal visits and in labor for the same reasons. However I
am unaware of any studies that have shown fetal damage--physical or
mental--due to diagnostic ultrasound examinations.
- Jeanne Batacan
I wonder if it's normal for the cord to take six to eight weeks to fall
off. Both my son and daughter took a long time. I am expecting baby number
three any day, and wondering if it will take this long again before I can
bathe my baby in a bath instead of just sponge bathe. I was just wondering
if there is a reason for this, if I am doing something wrong, or if I can
do anything else to speed up the process.
- Jennifer Brotherton
We have been advocating the Optimal Foetal Positioning exercises with our
women for some time with excellent results. All the women we have worked
with who have OP positions have found sitting backward on a chair every day
beneficial and the babies have turned and engaged well. Don't disregard
Jean Sutton's insight--it is very wise.
Get your copy of Understanding and Teaching Optimal Foetal Positioning from Midwifery Today-it's a book every practitioner should own. US$12.50 + shipping & handling (US$4.00 in U.S., US$5.00 Canada/Mexico, US$5.75 all other international). Mention Code 940. Ordering information below.
Unless otherwise noted, share your responses to Switchboard letters with E-News readers! Send them to firstname.lastname@example.org. If an e-mail address is included with the letter, feel free to respond directly.
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