April 14, 2000
Volume 2, Issue 15
Midwifery Today E-News
“Breastfeeding”
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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Breastfeeding Nemesis
5) Vitamin K Deficiency
6) Check It Out!
7) Question of the Week
8) Question of the Week Responses
9) Switchboard
10) Classified Advertising

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1) Quote of the Week:

"The human breast itself is capable of something the formula industry will never be able to duplicate: adjusting the contents of milk to suit a baby's daily, even hourly needs."

- Rita Laws

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2) The Art of Midwifery

Midwives, here's a trick to help new mothers breastfeed successfully: Breast pressure during feeding enhances milk flow, helps empty clogged ducts and makes more high calorie hindmilk available to the baby. Once the baby has latched well, pay attention to her pauses in suckling. When she pauses, gently press your fingertips against the milk-producing glands located in the upper outer quadrant of your breast, near your underarm. You will notice a burst of suckling as milk is pressed toward the milk sinuses and into the baby's mouth. If the baby pauses again, rotate the position of your fingertips and press another quadrant of your breast. Be careful not to press too close to your areola as this can interfere with your baby's latch.

- Pregnancy, Childbirth and the Newborn, Penny Simkin, Janet Whalley, Ann Keppler, 1991, Meadowbrook Press

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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 prospective cohort study of 1,015 women discharged from the hospital at a mean of 41 hours postpartum found there was no difference in breastfeeding rates between them and a longer-stay group. A second study on early discharge was conducted on 146 subjects who were discharged at less than 36 hours postpartum. The investigators studied not only breastfeeding outcomes but also mother-infant interaction and security of attachment. At three months there was no significant difference in the incidence of exclusive breastfeeding between the early or the late discharge groups.

- Breastfeeding Outlook, Issue 1, 2000

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4) Breastfeeding Nemesis, by Susanne Colson (excerpt)

The technology of engineering an artificial feed of cow's milk in a bottle with a rubber teat literally initiated an unprecedented event in human history. Human mothers are the only mammals who have a choice about whether or not to give their own milk to their infants. The decision to use cow's milk was not based on any scientific investigation to compare the suitability of other mammals' milk for human consumption. Expediency was the priority and cow's milk became the substitute of choice mostly for economic reasons as there was at least one cow available in every village farm. During the first thirty to forty years of the twentieth century, cow's milk was diluted with water, and sugar was added to make it palpable to the infant. Because the proportion of the basic constituents of cow's milk are inappropriate to human needs (large amount of protein and small fat content with no long chain fatty acids), constructing a safe formula using cow's milk as a breastmilk substitute became the subject of intense medical scientific investigation.

It was the pure arrogance of the situation that provoked a response from Nemesis. Divine retribution to this scientific hubris was immediate. Breastfeeding Nemesis stealthily crept in with her disastrous side effects, punishing mothers and babies through soaring infant mortality rates. But the vanity of Hubris would heed no warning, and it was not long before infant feeding changed from an activity of daily living which had required no expert advice to one requiring its own specialised discourse. Discourse, a term central to the work of French social philosopher Michel Foucault, is the language used to structure dominant ideas, thus shaping the boundaries of a particular area of knowledge. The discourse of infant feeding was produced by agriculturists, scientists, medical doctors and commercial manufacturers. Through the expression of their dominant ideas, a science of infant feeding was created based upon the imperatives of formalising a feed of cow's milk safe enough for human infant consumption.

We can imagine the scene: a scholarly-looking gentleman speaks with conviction to a group of male experts seated around a large table. He focuses attention upon infant mortality statistics and the urgent need to make artificial feeding scientific. He stresses the benefits of rigorous exactitude not only in the formulation of infant food but also in parenting techniques to produce hardy rigorous youths. He stresses "ignorance and fecklessness of mothers" as major contributing factors to the unacceptably high death rate of Britain's future citizens (RCM 1985: 5). He emphasises the convenience of bottle feeding and predicts that very soon many mothers will no longer need to breastfeed. "We all know," he says, "that cow's milk given in a bottle is preferable for those mothers who are sick or too frail to breastfeed. But any mother who fears the physical and psychological trauma of sore nipples, or that she won't have enough milk, should have the choice. Furthermore, mothers will save money because they won't have to pay the wet nurse."

Who were the Greek deities Nemesis and Hubris, and what do they have to do with breastfeeding or not? Read the remainder of this compelling article at
www.midwiferytoday.com/Library/articles/breastfeednem.html

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5) Vitamin K Deficiency Bleeding and the Breastfed Infant
>From Understanding Diagnostic Tests in the Childbearing Year 6th ed. 1997.
>Anne Frye, Labrys Press.

The exclusively breastfed infant has a 15 to 20 fold higher incidence of late-onset VKDB than a baby fed formula. Healthy human milk from an unsupplemented mother contains a small amount of vitamin K. Concentrations of vitamin K-1, thought to be the major form of vitamin K in human milk, vary widely among individual women and even vary from sample to sample in the same woman. However, the vitamin K-1 content of breastmilk obtained from mothers who had affected infants was found to be lower in only some but not most cases when compared to samples from mothers of unaffected infants.

A simple concentration difference between breastmilk and formula, although extreme, is probably not the most important factor, due to the small amount of vitamin K needed by the baby. However the volume of milk ingested during the first days of life is extremely important. Studies have shown that VK deficiency occurs primarily in babies receiving small amounts of breastmilk or even small amounts of formula during the first days of life. Nursing should begin at birth and continue every two hours or more often on demand. Be sure that mothers understand that, although the volume of colostrum is not great, it is the perfect food for their babies during the first days and is very important to prevent classical VKDB. If the mother supplements her diet with vitamin K, levels in breastmilk begin to rise almost immediately and are dramatically increased by 12 hours.

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*Midwifery Today Breastfeeding Supplement:
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6) Check It Out!

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A Web Site Update for E-News Readers

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Coming Soon to the Midwifery Today Website!

Pictures, poems and other mementos from Midwifery Today's recent Philadelphia conference. Stay tuned!

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7) Question of the Week

I just had a client receive a second c-section. She had 24 hours of back labor, contractions 2 minutes apart from 2 cm on. The doctor commented when he was repairing her that she had massive amounts of scar tissue from her previous section and we all concluded that the scarring may have played a factor in the baby being persistent posterior and unable to fully engage. She's very hopeful of attempting another VBAC homebirth next time around and would like further advice on reducing scar tissue. Any suggestions?

- Amy Jones

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Send your responses to mtensubmit@midwiferytoday.com

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8) Question of the Week Responses

Q: I have a one year old baby and recently found out I am expecting another. I had a c-section (no choice of mine) with the first baby. My doctor said that a c-section is definite with this one. Is it true that I don't have a choice in the matter? Second, If not, then I would love nothing more than to have my baby at home. Is this possible?

- Elena Moreno

A: I belong to an email list called HBAC (home birth after cesarean). We have many women on the list who've had home births after cesareans; one had a homebirth after *4* cesareans! Yes, it is possible. Join us at www.onelist.com. Just search for the group called "hbac." As for your doctor, I'd seek a second opinion. We always have choices in our healthcare options, though we often have to be the ones to seek those choices out.

- Victoria

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A: It is not possible to give a responsible answer regarding the safety of having a vaginal birth following a caesarian without knowing both the reason for your cesarean and the method used to perform the operation. I suggest you return to your doctor and have him or her explain these to you. Once you have this information, if you are unhappy with the rationales you are better placed to seek a second opinion, be it medical or midwifery based. A few tips: Ask your friends if they know any doctors or midwives who are sympathetic to the idea of a VBAC, and if and when you talk to these people, be totally honest with them.

- Jacinta Muller RM

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A: ...I think that by questioning our caregivers (doctors and midwives!) about our health, we are demanding that they be accountable for their words and decisions and we are showing that we are involved and caring about what happens to us in pregnancy and labour.

- Jennifer White, Nova Scotia

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A: If you read the research surrounding the issue, the risk of a ruptured uterus is no more than the risk with a first time labour. Encourage your baby into the optimal foetal position. When a baby is in the correct position it is amazing how easy the labour is even when the baby is quite large. Also research was conducted in 1987 that stated how important it is for the baby to experience labour in order to build its own endorphins for survival outside the womb. Babies had six times the level of stress hormones on board following birth than that of someone experiencing a stroke. That gives them an incredible start in life. Research also indicates that babies born by elective C/S tend to give up easily in life and don't have the staying power. Babies born by C/S have a higher risk of respiratory problems. Even if you need another C/S it is important to labour first; so what if your doctor has to be called out in the middle of the night to do the C/S. Elective C/S are mainly for doctors' convenience. If baby ends up needing a C/S at least a mom knows she has given it her best shot and the baby has the necessary endorphins.

We recently had a client who presented with a frank breech--both knees either side of the cervix. She had a lot of pressure to have an elective C/S, but she stayed strong and waited until she went into labour first. This meant her baby was ready and she was ready. When she went into the hospital she also set the operating theatre up with music and made sure the screen was down so she could see what was happening and see the birth of her son. As soon as the baby was born it was handed to dad, he put the baby immediately down his overalls so that the baby has skin to skin contact and remained warm. Mum fed baby whilst she was being stitched up. I have never seen a happier mother following a C/S--she said it was as close to a natural birth as she could get. The experience you have will stay with you for the rest of your life.

- Vicki

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A: Some of the issues to address here are: having sufficient support from others to go natural; having confidence in the wisdom of your body to birth naturally; yourself being confident and relaxed enough with going a route which fallible authority figures called doctors often do not seem to support; how much of your life is governed by outer authority figures as opposed to what you really feel is right deep within you for you.

- Bruce Mitchell

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A: VBAC is called a "trial of scar" and is successful in at least 50% of women who chose to try it. A trial of scar does carry with it a degree of risk and because of that, you would be best to labour in hospital. Remember, this is only one opinion, just as your doctor has only one.

- Kelly Chisholm

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A: As a homebirth midwife I am happy to assist women to have a homebirth after a C/S. In most instances the women have had beautiful births with no difficulties. I always watch closely, listen well to mother and baby, transfer early. For me there is no difference in the support of a woman birthing after a C/S, for this is how it should be for every woman.

- Sally Westbury
Australia

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A: Read Henci Goer's new book "The Thinking Woman's Guide to a Better Birth," Cohen & Estner's "Silent Knife: Cesarean Prevention & VBAC," Nancy Wainer Cohen's "Open Season: A Survival Guide for Natural Birth and VBAC in the 90's," Johanne C. Walters, Karis Crawford's "Natural Birth After Cesarean: A Practical Guide," Diana Korte's "The VBAC companion." Hire a doula. Contact ICAN--International Cesarean Awareness Network
www.childbirth.org/section/ICAN.html

- Chrys Holland,

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A: I had a c-sec on my second pregnancy (a planned homebirth) for pre-eclampsia. Of course, I was told (in the hospital) that I would never be a candidate for homebirth but just 20 months later I had the fabulously empowering experience of a homebirth. I am so grateful that my independent midwife was prepared to study with me to see just what, and how big, the risks were. (It was her first VBAC). I guess if we had had to go to hospital it would have taken 40-60 mins. I am quite certain that in hospital I would have been over-monitored and not allowed to relax into my labour. Some of our closest hospitals now have a c-sec. rate of 20-25%.

- Monica O'Connor
Home Birth Association of Ireland
hba@iol.ie

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A: It has only been a year since the c-section so you may have added risk, but definitely go for what YOU want. It can't ever hurt to ask.

- SM Reed

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More on blocked fallopian tubes:

In response to the letter about obstetricians having the right to tie tubes without the woman's consent [Issue 14]: Can this be true? What state is she referring to? In the U.S.? I have real trouble believing this. Please support this claim; it sounds like urban legend.

- Amy Stone

Editor's note: Readers, do you have any knowledge of or experience with
this subject? Write to E-News and let us know.

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9) Switchboard

She has been a midwife for 25 years. She has touched so many of our lives in countless ways. Valerie El Halta has received 2,500 babies into her loving hands. She has supervised many, many more deliveries at two free-standing (truly autonomous) birth centers. She has trained hundreds of midwives all over the world.

Thousands of women have been saved from cesarean sections directly or indirectly as a result of Val's teaching. She has taught about twins, breeches, fear, the sacredness of birth, post-dates, and of course preventing posterior presentations. She went to Africa at her own cost to teach and help women give birth, and taught doctors and midwives there. She teaches, then teaches more. She gives of her self endlessly.

Valerie has answered countless middle-of-the-night, holiday and weekend phone calls, daytime, breakfast time and dinner time phone calls every day of the year for the past twenty-five years. They are calls from midwives who are at a prenatal, or attending a homebirth, who have run into a situation, or have a question, or who need help in an urgent situation. She has never accepted a dime for her thousands of hours of consult time.

Valerie has spent the majority of her waking hours midwifing, sharing, instructing, and supporting us. Chances are you have been taught directly by her, or perhaps the midwife who you trained with was. She teaches us, she reminds us, to keep birth normal. She was attending VBAC births at home long before any other midwife in the country was willing to do so. She has a 1 percent transport rate and her outcomes are superb. She has traveled the four corners of our globe to assist women who were otherwise unable to find competent and gentle care. These women would no doubt have been unnecessarily cut or badly bruised without her care. She has tirelessly shown us, by her unwavering faith in the process of birth and through her experienced and trusting hands and her broad and open heart, how to assist women as they birth. Valerie has been called by many, rightly so, the mother midwife of us all.

And she needs your help. Valerie El Halta is being sued by one of her couples. Her legal defense will take hundreds of thousands of dollars, and untold strains on Valerie and her family. We must support and believe in the woman who has given so much to midwifery and to the world. In medical situations, the death of an infant is surrounded by a cloak of silence. In midwifery, we are dragged through the streets by the media, and endure public and legal humiliation. The media has already tried and convicted her. Not only will Valerie be on trial, but all of midwifery will be on trial. We must form a solid wall surrounding our sister, friend and fellow midwife--a wall of support, love and solidarity.

Your help is desperately needed. We are in great need of funds for the VEH Support Fund. Please, please help. Checks can be made out to the VEH Support Fund and sent to VEH Support Fund c/o Katie Heffelfinger, 27 North 14th St., Allentown, PA 18102. All letters of support can be sent to the fund and will be forwarded to Val. They can be snail-mailed or sent to VEHSupport@excite.com.

Please send your donation immediately and please get this out to everyone you know immediately. Thank you so much for your help, your caring, and your prayers. With eternal gratitude and love to Val, and to all of you: thank you for your caring,

- Nancy Wainer Cohen, midwife, childbirth educator and childbirth author Katie Heffelfinger, doula, birth activist, pregnant mom

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In response to I.D., who asked about a pregnant woman who wants a homebirth and takes Atenolol to control tachycardia [Issue 2:14]:

Atenolol is a hypertension medication, also known as Tenormin. It may also
be used in angina, and with acute M.I. It is pregnancy category D. This
patient may want to speak to her doctor about another medication if she
wants to be pregnant.

- M. Osborne

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I am working on getting my doula certification. I have a question that requires more knowledge than I have right now. My friend, who is due May 15, is having a problem with what she says is borderline high blood pressure. Her doctor has had her cut out salt and rest a little more and says that he may induce her a week early. Is there anything else she can do that would help bring her blood pressure down so that she might avoid being induced? Are there any herbs that would help?
Cristi Horne
Reply to: e-mail: revcpl@hotmail.com
(Please CC E-News at mtensubmit@midwiferytoday.com to share your information with readers.)

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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

Stay-at-home mom starting retail business seeks pregnancy, birthing and parenting products. Jewelry, artwork, journals, birth announcements, home-birth supplies. If you have information about any products, e-mail jettdog@sprint.ca

Thanks, Krista

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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 thirteen and a half years and know the field well. Sliding scale.
cherjm@aol.com


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