August 2, 2000
Volume 2, Issue 31
Midwifery Today E-News
“Omnium Gatherum”
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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Omnium Gatherum
5) Check It Out!
6) Question of the Week
7) For Coming E-News Themes
8) Switchboard

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1) Quote of the Week:

"Without autonomy, I would never have the flexibility to serve women in all the ways their lives require."

- Naoli Vinaver, midwife

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2) The Art of Midwifery

Constipation during pregnancy: Avoid botanical medicines with strong laxative or purgative actions; choose botanicals that act as aperitives, bulking agents, or autonomic visceral relaxants specific for the gastrointestinal tract such as flax seed, psyllium seed, taraxicum officinalis (dandelion), rumex crispus (yellow dock), nepeta cataria (catnip), and viburnum opulus (cramp bark).

- Mary Bove, ND, LM, The Birthkit, Winter 1998

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To subscribe to The Birthkit, Midwifery Today's between-issues quarterly newsletter, go to: www.midwiferytoday.com/birthkit Save $3 if you subscribe to both The Birthkit and Midwifery Today magazine. Please mention Code 940.

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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

Researchers studied all the women referred to a gynecology clinic for menorrhagia (heavy menstrual bleeding). Women with an obvious cause of bleeding, such as taking anticoagulants or having fibroids, were excluded from the study. The remaining 150 women had blood tests to check whether they had an inherited bleeding disorder. Tests revealed that 17 percent had such a disorder. Von Willebrand's disease, which causes prolonged bleeding mostly from mucous membranes and has a general incidence of one in 100, was diagnosed in 13 percent of the women. A co-author of the study said heavy menstrual bleeding might be the only sign of a potentially dangerous disorder.

- Nursing Times, Vol. 94, No. 9, March 4, 1998

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4) Omnium Gatherum: A selection of letters to E-News

I live in Bali, Indonesia. I would like to share a story and get feedback from midwives or mothers who have had similar experiences. I am not a midwife. I once apprenticed in direct entry midwifery in Australia but had to discontinue my training. I lived in India and now live in Indonesia. Somehow or another I often end up being at births at home or otherwise, usually to support the mother. Sometimes I am the only one attending and even though I am not a midwife, end up acting as one.

In this case my friend who was about to give birth to her fourth child at home asked me to be present at the birth. I had been at the birth of her third child. She had decided not to go to hospital and to give birth at home, and asked me to be with her. Since she was going to do it anyway I decided to attend. The birth went well and she had a healthy baby girl.

This time we were prepared as usual. I borrowed a fetascope from a Balinese midwife and bought clamps and scissors for the cord. I had been checking the baby's heartbeat for two or three months so I would know its normal baseline sound and be able to check it in labour. Although I am not a midwife and in reality I was only there as a labour support person, I decided to monitor the pregnancy and labour as if I were the midwife, simply because there wasn't one!

The baby's heart rate was always around 117 to 120 and the day my friend went into labour the heartbeat was steady and reassuring. Her labour progressed in a funny sort of a way, with the contractions not regular or increasing in length and frequency but continuing nevertheless. I checked the heartbeat regularly but did no internals since I figured it was safer that way and the contractions could do their work without my checking on progress.

After about eight hours of these contractions the mom had some blood issue from her vagina (not a lot, but not reassuring). It was fresh blood but dark in color, like it didn't have a lot of oxygen in it. My feeling was that it was from the placenta or the cord. The mother is a heavy smoker and I wasn't in the mood to take any risks whatsoever. I suggested she transport even though the baby's heartbeat seemed fine when I checked it. The mother said she couldn't move, that the baby felt really low down and she wasn't going anywhere. I checked the heart rate again and it was 125. I asked her man to call an ambulance because I figured that if an ambulance turned up, she could hardly refuse to get into it! But in Indonesia such luxuries like ambulances and fire engines only turn up in the movies or, for ordinary people, when it's too late. Her contractions continued and they seemed to be intensifying, although inconsistent. I checked the heartbeat constantly while the dad tried to get hold of a doctor. We had no more blood but the heart began to speed up at the beginning of a contraction, slow right down at the end of a contraction, and take forever to recover. The heartbeat was descending rapidly too, and although my mind for some reason refused to accept the reality of the sound, somehow my instinct knew that something had gone wrong with the cord. I thought it may be pinching between the head and the pelvic bones.

Within 10 minutes of first seeing the blood, the heartbeat slowed to 88 and then disappeared altogether. I was saying to the mother, "I have no heartbeat and there is no doctor (her man still hadn't returned from his search). We need to get this baby born right away." The mother kept saying, "It's OK, it's just descended so far that you can't hear it anymore behind my pelvic bones." But I wasn't so sanguine. Within another five minutes she was pushing and begged me to break the waters, which I refused to do because of the bleeding and my worries about the cord. However, after one more round of pushing (about five minutes) I had a presenting, bulging waterbag that I nicked and the baby's head was out, dark blue. I checked for the cord immediately and it was twice and very very tight around the neck. I clamped and cut it immediately--I must say even I am amazed how fast I did it, since I'd never done it before. The baby slid out and she was cold and white and gone from this earth. I only tried to resuscitate her for a very short time because I knew she was gone and it was too hard for the mum to keep on going.

This experience was really hard for all of us. I don't know what I could have done better or to prevent this from happening. I would like to hear from anyone who has had a similar experience. The mother is very depressed now, and many Balinese are telling her it was black magic. This is making it worse and harder for her to accept. I don't know if I ever want to go to another birth.

- Janma

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During the past three years, eight Illinois midwives/doulas have received cease and desist orders from the Illinois Department of Professional Regulation. Six of them were ordered to cease and desist the unlicensed practice of medicine, one was ordered to cease and desist the unlicensed practice of nursing and midwifery, and one (myself) was ordered to cease and desist the unlicensed practice of medicine, and I am also about to receive another order to cease and desist the unlicensed practice of nursing/midwifery. In between those two events, I also received a five part complaint against my nursing license seeking its suspension or revocation because I also happen to be a direct-entry midwife. Three weeks ago I was terminated from my labor & delivery nursing job for "jeopardizing my nursing license and the reputation of (the hospital) by acting illegally outside the scope of the Illinois nursing license."

I have had a preliminary hearing before IDPR; my attorney was there and I was not. Its primary purpose seemed to be to set the schedule for the next round of complaints, responses and hearings. But we did also get the lDPR Reply to our Response to Rule to Show Cause; what is especially significant about that is the State of Illinois response regarding non-CNMs:

"...certification by the North American Registry of Midwives as a Certified Professional Midwife (CPM) does not meet the CNM requirements. The appropriate certifying body for midwives will be the American College of Nurse Midwifery."

Apparently for the State of Illinois, the only real midwife is a CNM. I am interested in hearing from other states where CNMs and direct-entry midwives co-exist, and any legislation defining each group. It is likely to be a long haul here in Illinois, but various orders and such to the contrary, I have no plans to quit what I am doing. I am an Illinois midwife, I will continue to be an Illinois midwife, or as the latest IDPR paperwork put it, "Respondent has in the past and will continue in the future to thwart the law and the legislative purpose of the Nursing and Advanced Practice Nursing Act."

We come to a point where we have to decide what is the right thing to do, and do it. We don't weasel out of it, or work out of an out-of-state P.O. box while saying "nooooo.... I am not practicing in Illinois anymore, nosirree, not me." If we believe what we do is right and good and true, then we have a moral obligation to follow through with that--for ourselves, our clients, and our children.

- Valerie Vickerman Morris, Law-Thwarter for over 17 years
Elgin, IL

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Presently midwifery is allegal in the Yukon. The Yukon has not had a practicing midwife or traditional birth attendant for several years.... The Yukon is a huge and sparsely populated chunk of land. Most of its people live in or very close to Whitehorse. Outside town there are 12 other communities, the largest having a population of just a few hundred, most having 30-100. The communities are all quite far apart...and some are completely inaccessible by road most or all of the year.

Women are flown to Whitehorse (and some to Vancouver) at least two weeks (and up to four or five) before their EDD and are put up in hotels/motels...or whatever to wait for their baby to be born. They are separated from their families, isolated in a town overrun with crack, cocaine, heroin and alcohol, child prostitution and every other addiction you can imagine packed into eight square blocks, and birth in a hospital that, despite being one of the best for maternity care I have ever seen, still maintains that they have an extremely low epidural (and other intervention) rate. Little mention is made of the horrendous amounts of morphine administered to women in labor, of course.

... Once in a blue moon a woman will show up on the step of one of the community nursing stations in labor, having kept her pregnancy quiet, or having been too busy with her several other children to seek out any prenatal care. She will deliver quickly, pack up her things and disappear again. Maybe one of the aunties will help her; maybe she did a little prenatal care for her. Maybe not. Traditional midwifery is not completely non-existent, but almost so, and there seems to be little trust in it, and even less use of it.

The Midwifery Planning Group is...trying to build a practice and spearhead the public awareness side of midwifery in the north. The goal of the group has been to get funding for midwifery and, as it goes, the group has mostly concerned itself with finding ways to dance with the government to that tune....

The MPG has drafted... a discussion paper outlining what midwifery could look like in the territory. The paper had been approved by Cabinet to go to the House in the fall sitting. Then an election was called, we had a complete change of government and midwifery got pushed aside...BUT, we came dangerously close to getting midwifery regulated without any public input or community awareness.

So many questions remain. How do we help women in isolated communities to birth with dignity and freedom, to trust themselves, to 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? I am looking for ideas, stories, advice, experience.... I have a feeling that a birth center would be a great thing in Whitehorse, that this is a step that many people here would take toward normal birth, but that still leaves much unsolved in the other communities. If you have any input, please do share. I can be reached at (867)333-1758, P.O.Box 10501, Whitehorse, Y.T. Y1A 7A1 or heatherbennetts@hotmail.com.

- Heather Bennetts
community midwife

Editor's note: The previous article has been heavily excerpted. Read the article in its entirety in a coming issue of Midwifery Today magazine. To subscribe to Midwifery Today, go to:
www.midwiferytoday.com/order.htm#subs

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5) Check It Out!

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

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AUGUST 1-7 is World Breastfeeding Week. Read "Breastfeeding: Food for Thought at
www.midwiferytoday.com/articles/foodforthought.htm

A NEW GLOBAL ORGANIZATION FOR MIDWIVES? Read about it at:

www.midwiferytoday.com/articles/worktogether.htm
www.midwiferytoday.com/articles/globalalliance.htm

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FREEDOM: Some compelling thoughts on what it means when you are a midwife:
www.midwiferytoday.com/articles/freedom.htm

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6) Question of the Week (Repeated)

Q: I am a happy, healthy 39 year old mom with thalessemia minor who is considering a homebirth for my second child. My first was born when I was 37 at a birth center with CNMs. Precautions taken (planned before labor) because of my thalessemia were a heparin lock at the beginning of second stage and a shot of Pitocin in my thigh immediately following labor to help clamp down my uterus. I labored naturally and normally with the exception of third degree vaginal and perineal tears (baby came fast, kicked his way out, and my position was not optimal). My normal hematocrit is between 27 and 30. My pregnant hematocrit just before labor was 25. Three days after it was 23 and back to 30 at six weeks. I believe my platelet count was and is normal. Am I a candidate for homebirth?

- C.M.

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Send your responses to mtensubmit@midwiferytoday.com

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7) For Coming E-News Themes

1. How do you counsel pregnant women about nutrition, especially in these fast-paced days of stress, little time, and junk food? (August 2 issue)

2. In two to four sentences, what is the best advice to give an apprentice or aspiring midwife?

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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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8) Switchboard

I am a mother of six home birthed children. My husband and I are both practicing chiropractors. Our practice has always centered around family wellness care. Currently, I am working with many mothers and infants. We have found the birth process is traumatic to both mother and baby. The many interventions of birth today have turned a natural process into a technological procedure that has life long consequences.

In addition to our practice, I travel on weekends to train other doctors in the importance of and specific technique for pregnant mothers and infants. There are certain techniques that can help reduce nervous system stress in babies born where there has been pulling and twisting of their delicate spines. We are finding that even minimal pull can cause damage to these babies.

For the care of pregnant mothers, I teach very specific adjusting techniques to help balance the pelvic muscles and ligaments so that the uterus is free of constraint. This allows the baby to move into the best possible position for birth.

Finally, I encourage all chiropractors to form alliances with the midwives and doulas in their communities. It is with these alliances that we will be able to make a difference in the birth process as it is performed today. As a tool for doctors to use with their patients educating them about the traumas of birth, I am putting together a video titled "Birth Trauma: an American Epidemic." I know if parents can see what is happening to their babies at birth, they will make choices during pregnancy that will allow for natural birthing. So far, I have footage of a vaginal birth. I need footage for a c-section and a vacuum extraction. Does anyone have such footage available and parents who would be willing to let me use it for this purpose? I greatly appreciate any leads--time is of the essence--one more child born without trauma is a big victory.

I can be reached at jtohm@voicenet.com or drohm@4icpa.org

- Jeanne Ohm DC

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More on fetal positioning:

I recommend the book "Optimal Foetal Positioning" by New Zealand midwives Jean Sutton & Pauline Scott. It is easy to read and although intended for midwives, I have given it to clients to read. It contains case studies too.

- Laurelle (RM, Australia)

Editor's note: Optimal Foetal Positioning is available from Midwifery Today. To order it, go to:

www.midwiferytoday.com/books/clinicalbooks.htm#ofp

or call 1-800-743-0974. Mention Code 940.

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I have had two posterior deliveries--the first baby weighed 7 lbs., 7 oz and the second, 7 lbs. and 13 oz. The back pressure was intense and the pain while pushing had me screaming. Both labors were quick--four to five hours each. I pushed the first for 20 minutes and the second for three minutes. My trick was to wait as long as possible to push and then to push on all fours. Spending transition in the shower and doing childbirth exercises (especially kegels) really helped!

- Ursula Sabia Sukinik

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I was intrigued by the long response on meconium aspiration [Issue 2:29]. It was noted that true MAS is not preventable because it happens during labor, in utero. However, it was also pointed out that stress, and indeed DIStress during labor is a major contributing factor. What I suggest is that we "treat" the pregnant woman with education to keep her healthy and allay her fear to begin with; then we "treat" the laboring woman with gentle, personal care to decrease the probability of distress. Though medicine has not acknowledged it (yet), we know that the baby and mother function as one physiological unit. We also know that birth is not an event; it is a multi-leveled process that begins early on in the mind of the mother, climaxes at the moment of birth, and continues on in the psyche of both mother and child. Let the process be handled gently, peacefully, holistically, and I believe the decrease in MAS will be notable.

- Sharon Thornton, Bradley Method teacher

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I am an apprentice midwife looking for literature that is anti-rhogam. I'm curious and would like to decide for myself, as well as have literature on hand for women who would like to decide for themselves. This is a very serious issue, and I would like all the info I can get. I would also like to hear what midwives have to say. Pro-rhogam info is easy to come by, but I would like to hear the other side.

- Jennifer

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I am a first-year student midwife based at Worcester. My two mentors are great. They give me support when I don't feel very confident, which is often, as I only started my course this May. Also, though, my fellow students need a mention. We're a close group, and support and help each other.

- Sandra Rowland

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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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