July 5, 2000
Volume 2, Issue 27
Midwifery Today E-News
“Premature Rupture of Membranes”
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This issue of Midwifery Today E-News is sponsored by:

- Infantime
- Nacer en Casa
- Waterbirth Website

Look for their ads below!

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Why should you attend Midwifery Today's Oregon Coast Retreat? Scroll down to read what Midwifery Today's Jan Tritten and Jill Cohen have to say about it! For more information on how you can register:
www.midwiferytoday.com/conferences/Oregon2000

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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) Come Join Us!
5) Premature Rupture of Membranes
6) Check It Out!
7) Question of the Week
8) Question of the Week Responses
9) For Coming E-News Themes
10) Switchboard

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1) Quote of the Week:

"It wasn't long before I could see that there was a lot more to being a midwife than doing deliveries."

- Gladys Milton

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2) The Art of Midwifery

Several of my clients thought they'd like to deliver on a birth stool, but after trying it decided they weren't as comfortable as side-lying. One of the reasons they cited was the inability to totally relax and let go between pushes. Another important reason why clients decide against using the birth stool is that sitting on the sacrum reduces the pelvic diameter. The sacrum and coccyx encroach into the birth canal, sometimes dramatically. Rolling a woman back off the sacrum will increase the diameter, especially if she is assisted in pulling her legs up as well. In addition, this also helps pull up that cervical lip that seems to plague so many women.

- Alison Osborn

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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 study of 199 pairs of twins evaluated the effect of delivery interval on the outcome of the second twin. All twins in the study weighed greater than 1,500 grams and were at or beyond 34 weeks gestation, and the first twin was delivered vaginally. Neonatal data evaluated included the five-minute Apgar score and evidence of birth trauma. Time intervals between the births of each twin were divided into four categories: 15 or less minutes, 16 to 30 minutes, 31 to 60 minutes, and greater than 60 minutes. The range of delivery interval was two minutes to 866 minutes. An interval of greater than 60 minutes between twin deliveries did not have an adverse effect on outcome, as judged by Apgar score, length of stay in the hospital, or birth trauma.

Researchers concluded that a prolonged delivery interval between twins did not have an adverse effect on the outcome of the second twin.

- MIDIRS, June 1996

=PLEASE SUPPORT OUR SPONSORS!=

Nacer en Casa, 1st International Congress of Home Delivery and Childbirth
October 20-22, 2000, Jerez de la Frontera, Cadiz, Spain.
Co-sponsored by Midwifery Today.
Speakers include Robbie Davis-Floyd, Marsden Wagner, Michel Odent, and many midwives and practitioners from Spain, Germany, Denmark, the Netherlands.
Program and registration information at:
www.nacerencasa.org/congress or congreso@nacerencasa.org

=THANK YOU!=

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4) Come Join Us!

Healing Task Force

At the Midwifery Today conference in Philadelphia, we became increasingly aware of the hurt and bruising that midwives endure as they try to fulfill their call to serve women and babies in the birth journey. This is nothing new, but it seems to be increasing. Its cause is rooted in the witch hunt from the culture around us and from the midwifery community itself. We cannot seem to form the kind of unity and protection that draws a circle to include everyone.

In response, we formed an informal healing task force with Yeshi Neuman as our mother. Yeshi has a gift for helping women work through issues and arrive at healing. We are blessed to have her teach at both the Oregon Coast Retreat and the New York conference. These are great opportunities to meet and work with this gifted healer. Because we will be living together at the Oregon Coast Retreat at a beautiful place right on the beach, it will be an especially good place for you to come to be loved and healed.

The retreat also includes great educational sessions for the seasoned and aspiring midwife, doula and childbirth educator. Please join us for healing, loving and learning on the stunning 7-mile stretch of beach between the sweet coastal towns of Yachats and Waldport. We plan good food, classes and the delightful company of your sisters.

- Jan Tritten, mother of Midwifery Today Inc.

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Midwifery Today's intimate healing retreat on the exquisitely beautiful Oregon coast will be a special time and place to learn, nurture and be nurtured, connect and relax. The retreat's theme, "The Heart Of Midwifery," means that we will discuss all the realms of midwifery in its pure form. There to guide us will be a panel of educators full of wisdom but open to learning. Practical sessions on labor complications, fetal monitoring, postpartum and more will be complimented by time spent on the more refined aspects of midwifery care: communication, diversity (creating a safe place for all women), and using our hands and senses as vital tools. In addition, we'll have plenty of time to make new friends, walk on the beach or enjoy quiet moments surrounded by Mother Nature's treasures.

Come join us! Whether you are a student, aspiring midwife, midwife, doula, doctor, nurse or educator, everyone will have something to give and something to take home in respect to better care for birthing women. Rejuvenate yourself and nurture each other--it's what we are renowned for! Come join us!

- Jill Cohen, midwife and associate editor

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To learn more about the Oregon coastal community of:
- Waldport
- Yachats

To learn all about the Oregon Coast Retreat:
www.midwiferytoday.com/conferences/Oregon2000

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5) Premature Rupture of Membranes (PROM)

Following are excerpts from numerous articles on PROM in Midwifery Today's Wisdom of the Midwives: Tricks of the Trade Volume II:

A team of nurse-midwives from Cooperstown, NY reported on the success of an essentially hands-off approach to premature rupture of membranes (PROM). Where appropriate, women with ruptured membranes were permitted to wait at home for labor to start. In the year that the program has been in effect, it has led to a decreased cesarean section rate without increase in neonatal or maternal morbidity. Crucial to the program's success was refraining from performing digital vaginal exams on women who are not yet in labor....

- CBE Reporter, Sept. 1994

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The cesarean rate is between 30 and 50 percent for women who were induced to deliver within 24 hours of PROM. Since most women will spontaneously go into labor within this time frame, the patient (and wise) birth attendant will wait.

- Yvonne Lapp Cryns

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Teach the parents how to listen to fetal heart tones at least once a day--it will save you many trips to their home. Have the mom drink at least four to eight ounces of fluids per hour, preferably water. The mom should check her temperature every morning before rising; the reading will be more accurate than after she has been up and moving around. Have her take up to 1,000 grams of vitamin C daily. Check for an amniotic fluid thrill daily. This will tell you if there is still plenty of water for the baby so the cord does not become compressed.

Parents can be taught how to do the fluid thrill. Have the woman relax in a semi-sitting or almost flat position. Put your hand on one side of her abdomen, flat against it. With your other hand, very gently flick your finger against her tummy. You should be able to feel the ripple of the water against the hand that is flat on her tummy. Do this all around, feeling for pockets of water, until you have a general sense of how much water is around the baby. If her bag is leaking, and if you feel like there is less and less water as the days elapse, seek medical advice and/or ultrasound.

- Patty Sherman

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A good, healthy diet will help keep the immune system strong. Have the woman eat a diet low in fat and sweets, lots of green leafy vegetables, and drink plenty of water or tea to replenish lost amniotic fluid. Herbs and vitamins help boost the immune system and fight infection. Have the woman take 1 tsp. echinacea tincture four times daily, 1/4 tsp. goldenseal powder, twice daily, 4-5 grams vitamin C daily.

- Clarebeth Loprinzi Kassel, CM

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TO ORDER Wisdom of the Midwives: Tricks of the Trade Volume II:
www.midwiferytoday.com/books/tricks2contents.htm

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6) Check It Out!

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

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THE BIRTH MARKET storefront web pages are up and running! Check out these shopkeepers' web sites, provided by Midwifery Today:

MotherLove, Inc., Doula Services and Postpartum Training Manual:
www.midwiferytoday.com/loves/motherlove
Grieving Bags by Allie Alden:
www.midwiferytoday.com/loves/alliealden.html
Birth Stools by Steve's Woodworking:
www.midwiferytoday.com/loves/birthstools.htm
Expectancy Resources:
www.midwiferytoday.com/loves/expectancyresources.html
Birth Balls and Doula Services by Cindy A. Morris, CD (DONA): www.midwiferytoday.com/loves/birthballs.htm

You too can have your own web page to promote your products and services!
For all the information you'll need, go to:
www.midwiferytoday.com/birthmarket/info.asp

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7) Question of the Week

I would appreciate any information about caring for women with vulvar and leg varicosities--easing, reversing the effects of or treating them during pregnancy, the actual birth and for postpartum care. Do you have documentation or studies about the possibility of rupture at any point, techniques used to support these women during birth, and information on the usefulness of a waterbirth?

- Kathy Berry

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Question repeated:

My wife gave birth to a 10 lb. 1 oz. baby boy on June 15. According to her doctor, the baby was six days late. Currently our baby is suffering from meconium aspiration syndrome. My wife had an emergency c-section; however, our boy had already taken the meconium into his lungs. He is being given oxygen through a ventilator and appears to be having a difficult time at the moment breathing on his own. It appears the levels he has are relatively rare from the few articles I have found. My questions are:

* What are the percentages of babies that get this type of syndrome?
* What are my baby's chances of surviving without any lung damage?
* What are the survival rates?

If there are any books to read on this syndrome, please let me know.

- Dan
The father of a big beautiful boy

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Send your responses to mtensubmit@midwiferytoday.com

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8) Question of the Week Responses (discussion continuing)

Q: My friend suffered from pain caused by "pubis symphasis" during her past five pregnancies. She is currently eight weeks into her sixth pregnancy, and she's already experiencing pain. Are there any exercises that can help? Any magic cures (homeopathic remedies, etc.)? She broke her coccyx during her first labour 16 years ago, but went on to have normal, uncomplicated births with her fourth & fifth children. Her youngest child will be two when the new baby arrives. Her birth was extremely fast (40 minutes). Is homebirth an option?

- Chamutal
UK

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A: With my three pregnancies I experienced pubic pain. My independent midwife, who has a certificate of midwifery homeopathy, administered bryonia 1M with immediate and wonderful results--no more pain.

- Kirsten Millinson

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A: Rest is very important, and as the pregnancy progresses the need will likely increase. Nonessential weight-bearing activities should be reduced (e.g. climbing stairs, shopping, lifting, carrying, etc.). Elbow crutches may be needed if weight bearing is painful. Straddle movements (e.g. getting in/out of bath, bed, and car) should be avoided due to the hip abduction involved. Avoid standing on one leg, like when getting dressed.

Exercise should be approached with caution. Swimming is acceptable, as long as the breaststroke is avoided--it further stresses the symphysis pubis.

I had success with the homeopathic remedies arnica, bryonia and symphtum. Chiropractic care can provide wonderful results if the practitioner is very knowledgeable about the symphysis pubis area and this condition.

Homebirth is definitely an option. Sometime before labor begins the pain-free range of hip abduction should be measured. During labor, the legs should not be separated beyond that measurement. Prone kneeling or the left lateral position is best for keeping hip abduction to a minimum. Lithotomy position should definitely be avoided.

Immediately postpartum the woman should maintain bed rest for a day or two if there is acute pain. Getting up and around should be a gradual process.

I would like to invite anyone who has suffered from symphysis pubis pain/dysfunction to take part in a survey I have prepared. This will help the director of AAMI and myself with the booklet we are writing about the condition. Email me at sempek@ncfreedom.net to request a survey, or if I can help you in any way.

- Dawn Sempek

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I heard of one case in which the only thing that relieved the pain postnatally was for the woman to walk backward until the condition resolved.

- L.T.

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I have a couple of questions: First, in regard to the broken coccyx, how did pregnancies/births two and three go? Basically, if the labor/birth is "normal" (by midwifery standards, not OB standards), then this mom is a pretty good client for a homebirth, especially with a forty minute labor! As for dealing with the pain of the separated pubic bone, the only thing I have heard that helps is to "bandage" the lower abdominal area with an Ace bandage, sort of like a supportive girdle for the pubic bone.

- Karla Morgan

=PLEASE SUPPORT OUR SPONSORS!=

INFANTIME
An interactive educational software package focusing on pregnancy and childbirth that takes a woman through pregnancy week-by-week. Written by a doctor and a midwife. Includes a fun bonus screen saver that helps in choosing the baby's name.
www.infantime.com

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9) For Coming E-News Themes

1. What do you carry in your birth bag? Anything unusual, and if so, for what purpose? (July 12 issue)

2. How do we help women in isolated communities birth with dignity and freedom, trust themselves, and not be separated from their families? Who in their communities will provide midwifery services and how will they go about doing so? And what can we do to help? Where do we start? (July 19 issue) (Editor's note: These questions were asked by a midwife who lives and works in the Yukon Territories. Let's help her help her communities!)

3. Who most strongly influenced the way you practice, and in what way(s)?

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**Take part in E-News! Sound Off-Give Advice-Share Your Knowledge!**

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Send your responses to mtensubmit@midwiferytoday.com

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Visit the multiple award-winning WATERBIRTH WEBSITE for the most complete waterbirth information available on the net!
http://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.

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 price is just $53.95 + p/h. Full ordering details are at www.waterbirthinfo.com/materials.html

=THANK YOU!=

Know a strong woman? Helping empower one? If you haven't already done so, please forward this issue of Midwifery Today E-News to one or two of your friends or business associates. Thanks so much!

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10) Switchboard

My daughter has hepatitis C. She does not have the active disease but is a carrier. She has been advised not to breastfeed her newborn. Is this good advice? She really wants to breastfeed. Now she is suffering from breast engorgement. If she can't breastfeed, are there any remedies that will help alleviate her discomfort?

- Anon.
Reply to: curfmanl@grapevine.net

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In response to the inquiry about breech birth in Issue 2:26:

I have personally delivered full-term twins at home, both breech. The mom was scheduled for a c-section when the ultrasound revealed one breech. The first baby was frank, weighing 6 1/2 lbs. The second baby was complete, weighing 5 1/2 lbs. Both were delivered very easily and quickly, with no problems at all. The mom had an intact perineum. The family was very grateful and happy. Too many birth attendants have lost the art of delivering twins or breeches. C-sections are now the preferred choice. What a shame!

- Alison

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This is a hard one to comment on but I'd have to disagree with the "all breech c-section" idea. Part of the problem is lack of confidence and lack of experience on the part of younger OBs who've mostly never done breech deliveries. That's a compounding factor. The twin pregnancy is another factor but a confident, experienced OB who is "noninterventionist" in outlook would probably say that the advice given is defensive medicine--i.e. they are afraid of legal complications more than anything else.

- Phil Watters (OB in Australia)

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More on the urge to push:

I am a midwife who has worked with families during birth for more than 35 years. I have worked both as a midwife and a labor nurse (bringing, of course, a more holistic world view to that role than would have been possible without my midwifery background). I have been present during more that 6,000 births.

It is my experience that it is rare when a woman has an urge to bear down that the cervix does not move back to allow the descent of the baby. And of course, it is usual for a woman to have a lip of cervix present when she has the urge to push in a posterior presentation.

I have had the privilege to spend time with two traditional South American and Jamaican midwives, both who massaged plant oils on the cervix to support effective labor and to shorten transition. I would love to know more about this.

- Anon.

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I have delivered six babies and I did not always have the
urge to push. Many times with first babies you don't have that urge and sometimes with subsequent deliveries. I delivered all my children with midwives and they were all noncomplicated deliveries.

- Anon.

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In regard to ob/gyn protocols for working with pregnant women [Issue 2:26]:

Ambulatory Obstetrics: Protocols for Nurse Practitioners/Nurse-Midwives by Star, Shannon, Sammons, Lommel & Gutierrez, published by School of Nursing, University of California, San Francisco, 1990. A new edition is supposed to have been available by now - I tried to get it in 1998 and couldn't but was told that it would be out any month. (Ed Note: This was recommended by two other readers.)

Also, Anne Frye's Holistic Midwifery, Vol I, Care During Pregnancy. It's not exactly a protocol book, but it is for complete care of the pregnant woman. I think it would be a great addition to a conventional medical setting.

- Karen Ehrlich

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Two wonderful books for protocols of OB/GYN related materials:

1. Protocols for Gynecologic and Obstetric Health Care Mary K Barger editor with Vanda Lops, Judith Fullerton and Mary Ann Rhode, authors. This book may have been updated with different authors. The WB Saunders Company carried it in the early 1990s.

2. Varney's Nurse Midwifery.

I encourage you to study obstetric procedures and protocols if you are going to be assigned to pregnant women. It will only be for their benefit. The University of California San Diego has a family nurse practitioner to midwife program. I encourage you to become a CNM. It will benefit your patients greatly!

- Sandra

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In regard to the question about use of ring forceps {Issue 2:25}:

I have worked as an L&D nurse for ten years and I am now in midwifery school. We have residents at our hospital who are taught OB by the attending family practice doctor. They are taught to pull the cervix out with ring forceps to check for tears. I find this practice horrendous and unnecessary. When one of the obstetricians witnessed this he told the resident that that was bad medical practice! I am sure we all agree.

- Anon.

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I am searching for the video "Birthing in the Squatting Position," the classic film of South American Indian women giving birth. It seems unavailable at Cascade Health Care. Any suggestions as to where else I might find it?

- Rochelle
Reply to: rochellearuti@juno.com

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Two Sign Language Interpreters Needed for Midwifery Today's International Conference

Are you proficient in American Sign Language and are you involved in midwifery? FREE ATTENDANCE at Midwifery Today's international conference in New York City, Sept. 6-10, 2000 in exchange for being available all day, Sept. 6-9 (Wed.-Sat.). E-mail conference@midwiferytoday.com or phone Karen at 1-800-743-0974.

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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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