August 30, 2000
Volume 2, Issue 35
Midwifery Today E-News
“Rhogam”
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This issue of Midwifery Today E-News is sponsored by:

- Herbal Healer Academy
- ReSourcing Birth
- Waterbirth Website

Look for their ads below!

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NEW YORK CONFERENCE UPDATE!

** CEUs APPROVED! MEAC and ACNM have approved CEU credits for all classes, with the exception of Beginning Midwifery. ICEA has approved CEU credits for EVERY class at the New York conference!

** Midwives from Jamaica and Trinidad will be coming to the New York conference, and they are being sponsored by the Joyful Noise Fund of the Tides Foundation. We thank them and invite you to join us in New York City Sept. 6-10 for this important international conference entitled "Celebrate Diversity! An International Midwifery Model." You can register on site for any or all days. You will meet and enjoy the company of practitioners from many countries. Come meet Michel Odent, Robbie Davis Floyd, Marsden Wagner, Penny Simkin and many others in person.

For all the information you'll need:
www.midwiferytoday.com/conferences/newyork2000

Thank you to the following businesses for sponsoring the New York conference:

- Mothering magazine: Mothering is in its 24th year of providing inspiration for attachment parenting. Mothering guides, nurtures, and supports while providing the latest on controversial parenting topics.

- Cascade Health Care: Cascade HealthCare Products, Inc. began business in 1979 with the primary goal to provide supplies and equipment for the emerging profession of midwifery. We have developed a complete product line that not only serves midwives, but nurse midwives, childbirth educators, lactation consultants, visiting nurses, birth centers, WIC programs, nurse practitioners, doulas, and professionals dealing with expectant parents, families and women's healthcare.

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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) Rhogam
5) Check It Out!
6) Question of the Week
7) Question of the Week Responses
8) Question of the Quarter for Midwifery Today magazine
9) For Coming E-News Themes
10 Switchboard
11) Classified Advertising

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1) Quote of the Week:

"The common belief is that women seek certain kinds of medical care because they want the best for their baby, and they do so in a context of what makes them feel safe. The kind of birth they choose matches their beliefs about how safety is defined."

- Connee L. Pike-Urlacher, MS

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2) The Art of Midwifery

An electrolyte-balancing tea for nausea in pregnancy: 1/2 cup lemon juice, 1/3 cup honey, 1/4 teaspoon salt, 1 calcium tablet, powdered (not bone meal of dolomite), water to make one quart. Have the woman take spoonfuls at regular intervals.

- Virginia Hege Tobiassen, "Am I Glowing Yet? Understanding and Coping with the Common and Not-So-Common Miseries of Pregnancy." (Available at 2837 Frank Dillard Rd., West Jefferson, NC 28694. Tell Virginia that Midwifery Today E-News sent you!)

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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

Increasing evidence shows that schizophrenia, a debilitating mental disorder that usually manifests between the ages of fifteen and thirty, reflects aberrations in development rather than a degenerative process that begins in maturity. Genetic mutations may disrupt the development of the fetal forebrain during the first trimester of pregnancy. The genes that target forebrain formation also induce the creation of the heart, head and limbs, possibly explaining why these body parts are often malformed in schizophrenic patents. A study of 400 Finnish residents diagnosed with schizophrenia that compared their records with those of mentally stable adults showed that subtle abnormalities in motor development, social behavior and mental ability in childhood may be warning sings of schizophrenia. Genetic glitches may occur when mothers-to-be ingest environmental toxins, alcohol or other chemicals that affect fetal growth, making schizophrenia another illness that may be prevented during pregnancy.

- Psychology Today,
November/December 1999

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4) Rhogam: A Discussion

Clinical trials showed that in the control groups of women who were not given Rhogam, between 3.49 percent and 13.29 percent of women were immunized at six months. This implies that over 86 percent of women did not need Rhogam. Unfortunately, nobody attempted to determine who these women were, but went on to administer Rhogam to all women at risk. The result of this trial is that we have a routine intervention which may not be necessary for the majority of women....

Two major states are involved in rhesus isoimmunization: transplacental hemorrhage and antibody formation....Researchers seem to agree that transplacental hemorrhage is seen only in around 15 percent of cases where a rhesus negative woman carries a rhesus positive baby. We also do not know whether transplacental hemorrhage is related to maternal or birth-related factors, although a study of the incidence of transplacental hemorrhage during curettage following abortion found that trauma to the uterus increased this. Conceivably, the same is true during birth, with the likelihood of transplacental hemorrhage being increased by interventions such as managed third stage, manual removal of the placenta, or caesarean delivery.... It has been assumed that transplacental hemorrhage automatically leads to antibody formation, although Woodrow et al have suggested that some women may be more likely to produce antibodies following transplacental hemorrhage than others. Of the women who had a negative Kleihauer in their study, only 3.6 percent had developed antibodies six months after delivery. These researchers proposed that, if anti-D had not developed within six months after delivery, it was unlikely to do so later.

- Sara Wickham, excerpted from "Rhogam: do Midwives Hold the Evidence?", Midwifery Today Issue 46

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I trained [as a physician] in Winnipeg, Manitoba where much of the original research on RH disease was done....On one occasion I was involved in caring for a woman who had not received Rhogam during or after her first pregnancy. Her second baby developed severe RH disease and required intrauterine transfusions. When he was thirty-three weeks we had a debate at rounds about whether to induce or buy a few more days with another intrauterine transfusion. The parents and physicians opted for a last exchange. This was done but the baby died after the transfusion....I was on call the following day and helped the mom birth her beautiful but hydropic and stillborn baby. The saddest part of this story was that it was completely preventable.....

I don't want to live through any more preventable deaths or see any more sick neonates requiring exchange transfusions. Maybe "86 percent of women do not need Rhogam" but 14 percent is too high a risk for me to accept. I want to see 0 percent isoimmunization rates. Routine Rhogam administration seems like a lifesaving intervention which is justified on a routine basis to me.

- Karen E. Mason, MD, in Midwifery Today Issue 47 Letters to the Editor

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In my two decades of practice, I have critically analyzed many routine obstetrical practices, many of which I concluded were unnecessary, even harmful. Other common practices withstood this scrutiny, and are still a part of my care. Rather than rely on anecdotes, we seek to thoroughly reason on rational findings, carefully weighing risk versus benefit data, in reaching conclusions. These conclusions may even change as more information becomes available. This is crucial especially where the product under consideration is derived from blood or other biologically active material....I note the recent discovery of Prions, the agent associated with spongiform encephalopathy (CJD and Mad Cow Disease), which reside silently in biological material and are not readily inactivated by standard processing methods....In the meantime, until we have further information, I will gladly continue to offer Rhogam. I will also continue to seek more information.

- Judy Edmunds, CPM, in Midwifery Today Issue 48 Letters to the Editor

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..my points were that our knowledge of this area of maternity care is not inconclusive, and that all the research to date has been carried out within a medical paradigm....I have never suggested that Rhogam is dispensable, neither have I made any recommendations as far as practice in this area is concerned. This is a vastly under-researched area as far as the long-term effects of Rhogam on women and subsequent babies are concerned. What I am trying to do in my research is look at all the evidence in this area, much of which, to date, has not been as rigorous as it could have, and enable midwives and women to make up their own minds in this respect.

- Sara Wickham, MT Issue 48 Letters to the Editor

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An E-News reader writes:

According to Christian Midwifery, 2nd ed., by Peckman, there may be compromise to the immune systems of children who are exposed in utero to Rhogam since immune compromise is shown in children who receive it and since the shot typically is given during the time that the unborn baby's immune system is beginning to "come online." What the shot does to the unborn baby's immune system is simply unknown.

- Debby Sapp

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5) Check It Out!

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

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EUGENE, OREGON MIDWIFERY TODAY CONFERENCE program is online on the Midwifery Today web site! Come meet with us in our home town!
www.midwiferytoday.com/conferences/eugene2001

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FIND FOUR NEW ARTICLES about fathers on Midwifery Today's web site: www.midwiferytoday.com/articles

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NEWBORN COMPLICATIONS & DISEASE is a subject covered in a series of Midwifery Today conference class audiotapes. For further information on what is available and how to order, go to
www.midwiferytoday.com/tapes/audiocompli2.htm

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6) Question of the Week

A friend recently had a late miscarriage (18 wks) due to a partial septum in her uterus. She is now considering surgery to remove the septum, and wonders whether the risks/complications and success rate of such surgery would make it a better choice than simply continuing to try to carry a foetus to term (she realizes she may have to endure many miscarriages if she chooses the latter). Does anyone have any experience with this kind of surgery?

- Jennifer Landels, BA, CBE
Vancouver BC

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Send your responses to mtensubmit@midwiferytoday.com

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7) Question of the Week Responses

Q: I am a 28 years old African American woman who is expecting her fourth child in March 2001. With each of my last three pregnancies I gained between 35-45 pounds. I followed a healthy diet and got plenty of low impact exercise. All three of my deliveries were uncomplicated and each of my babies had Apgars of 9 and 10 in the first few minutes after birth. However, only my first child weighed the average 7 lbs 8 oz that standard pregnancy texts say a newborn should weigh. My other two both weighed approximately 6 lbs 8 oz at birth. I understand from my mother that I weighed that much when I was born (so did my husband). All three of my girls have been extremely healthy since birth.

I am puzzled when I read texts that state that babies born in the 6 pound range and under are considered low birth weight and do not do as well as babies born weighing more than this. What groups of babies are they using to carry out these studies? Are all babies around the world expected to be the standard 7 lbs 8 oz or more? Are there no allowances made for race, the size of the parents, other hereditary factors? Are all big babies healthy babies? Any information people can provide me with would be appreciated.

- Maisha Jugant

A: I gained 45 healthy pounds with my first pregnancy, my uterus always was "too large for dates," and my daughter weighed 6 lbs 10 ozs. She had great Apgars, was alert and healthy, has excellent coordination and dexterity, and has not been sick yet in her first 18 months of life. Bigger is not necessarily better! I also felt that pressure from others that my baby should have been bigger, but an average is just that, an average. Statistics require that 50% of the results be below average, that's just what it means; 50% above and 50% below. Ignore the assumption that the only healthy babies are the big ones, and respect your own body's idea of normal.

- Carla Tesar

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8) Question of the Quarter for Midwifery Today magazine

Who is in your birth community? What does the concept "birth community" mean to you? How have you or how would you go about organizing one? Send us your favorite story about your birth community. Please submit your response by September 15, 2000 to:
editorial@midwiferytoday.com

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9) For Coming E-News Themes

1. What is your experience with and your feelings about the use of Cytotec in labor?
2. Choose a favorite herb or two from your birth bag and share a use or two. Be specific about amounts, dosages, frequency, duration. Or tell a brief story as an example of its effectiveness!

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

Send your responses to mtensubmit@midwiferytoday.com

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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

More on patience [Issue 2:34]:

I like to think (especially with primips) that the cervix has to dilate to ll cm. It helps if the practitioner can just visualize that there is a hidden l cm still to go that should be waited for. Hurrying into pushing has caused so many messed up births. When attendants are tired, bored, distracted by other obligations, or impatient to see the baby, it is human to think that maybe getting the woman to push will expedite things, but it is Divine to wait a while. The three p's of good midwifery are patience, patience, patience. There is a "reflex" to pushing. Just like a sneeze, it can not be dictated by someone outside the birthing woman's body. Many hidden processes are happening inside the tissues and organs of the mother that we are unaware of. It takes trust to wait for those changes to occur in Nature's time.

- Gloria Lemay
Vancouver BC Canada

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Over the past 22 years of my midwifery experience I have come across three women who were adamant about their desire for a homebirth. They labored on and on. One woman had had a previous hospital birth and felt she'd been deprived of friend/relative support. At home it took on a party atmosphere. When, after 20+ hours the guests began to weary and went home, she got down to business and delivered three hours later. The other two ended up going to the hospital and soon after their arrival began to dilate quickly and went on to deliver healthy babies. They had never really felt comfortable with the idea of homebirth, wanting to please other family members that had talked them into having their baby at home. These women had sought me out later in pregnancy, proving that you need the times (both months and at each prenatal) to build the loving and trusting relationship with one another.

- T.S.

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We have finally seen the official hospital records of our 2 1/2 year old son's birth. I had tested positive for GBS (I am not sure which week, I don't have the records in my permanent possession yet), and was told I would receive antibiotics during labor. I had nowhere gained an education about GBS (our prenatal classes or personal research) and trusted my doctor on this.

A hep-lock for this purpose turned out to be one of few interventions in the whole hospital birth. It was a 12-hr labor from spontaneous rupturing of membranes to birth, and I managed all the sensations very well with relaxation and using many different positions. (I enjoyed the whole labor very much.) I also refused vaginal exams until I finally gave in to their pestering when I felt fully dilated. The records don't seem to state that I received ANY antibiotics, but we remember two doses, then another one attempted before pushing. The hep-lock came out and my nurse had trouble re-inserting it. So she told me the baby would be there soon and he wouldn't get the dose anyway, and we skipped it. He was a perfect baby, Apgars 10 and 10. They kept him from me with routines for what seemed like a million years, and then he went right to the breast and camped out there for a while, snoozing off and on... then the horror of checking his breathing and finding it gone and blood coming from the nostril facing down from us (pulmonary hemorrhage). No nurses were present or even available. We were paralyzed and if it wasn't for our doula running him out of our room he might not be here! He was on code for 20 minutes, then he stabilized.

He spent one week in the NICU where he received antibiotics "in case he had an infection" where the "final word" to me was that he had died because I had taken the herb feverfew for a migrane during pregnancy. Because I had taken the herb again for a migrane I got after the birth, I wasn't "allowed" to breastfeed him until 24 hrs. after we brought him home (I didn't wait that long, and he nursed exclusively from that day on).

Today as my midwife led us through the records, we saw the official diagnosis was sepsis as a result of my GSB. We saw other things we were completely unaware of. I had an elevated temperature and elevated blood pressure (I remember feeling great). We are so confused about why, with all of these signs, we were left alone with our baby for that first hour, he was not watched for signs of sepsis, and as he fell there weren't even nurses available!

Where does this new information leave us? What shadow does it cast on our next baby's birth?

At least we "know" now! For all those months, we had to accept, on an official level, that it was because I had taken feverfew. I actually asked his NICU doctor if it was my fault, he answered "Yes." The only voice that said we were not at fault was our very gracious birth instructor, and unfortunately, until now her voice was drowned out among all of our family and friends (and doctors and nurses) who would not question modern medicine.

I need to find out as much as possible about this! I prefer the perspective and knowledge of midwives. If you can recommend any resources, I'd be extremely grateful.

- Valerie Byrnes
Reply to: ChrisAndVal@Bigfoot.com Please CC E-News if possible.

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I posted a question regarding GBS+ test in late pregnancy. Many thanks to all of you who replied. We decided to go ahead with our homebirth plans and just watch for signs of infection, esp. once amniotic bag had broken. At 2:57 am on Aug. 12 I birthed our son at home after about 3-4 hours of active labor. He weighed in at 8 lbs. 2 oz., and was 20 inches long. His two sisters and three brothers are very proud! Thank you for your input!

- Joanna

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My daughter just gave birth to her second child on Aug. 14. She had a trying latent phase of labor, requiring Pitocin (ruptured membranes, no labor, failure to progress, she stayed at 1 cm, very posterior cervix after 9 hours of hard labor with Pitocin). She received an epidural; within 30 minutes she dilated to 8 cm, then delivered a healthy baby girl 30 minutes after that. Baby Vivian was very alert for three hours after birth, breastfeeding for one hour! She has been a vigorous nurser, and my daughter has a wonderful milk supply. I was able to be there a week before delivery, help her husband support her during labor and stay for two weeks to help with meals, childcare for their 3 yr. old son, help with anything and everything. It was my great pleasure. She began to feel weepy a couple of days before I left to return home. She said she was feeling bluesy. Today she called me saying she felt overwhelmed, tired and sad. The demands of the active first born have her concerned if she can handle it all energetically. Even though her mother in law is arriving in two days to stay for about a week, right now she still feels overwhelmed.

She wants to know if there is a nature remedy she could try that could help her deal with postpartum blues, or if this is really pos partum blues. She is dedicated to breastfeeding, is trying to get more rest, and is asking her husband for help the next two mornings until mom in law arrives. Do you have any suggestions for her?

- Teresa

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I have been trying to send a letter to the midwife in Scotland who responded to the questions about rural birthing. I am a midwife, doula trainer for DONA and a Birthworks facilitator. I have worked with the Native American community and they have women in remote areas who have to be flown out six weeks before they give birth. I am especially referring to the women of the Havasupai tribe at the bottom of the Grand Canyon. I would like to communicate with anyone else in rural places who assist in birth, particularly if Sue could give her email address again.

- Rhonda Howard
Reply to: 7generation@abacusnet.net

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11) Classified Advertising

Southern Oregon Midwifery Conference, October 7&8. Midwives, Doctors, Naturopaths. Featuring Anne Frye. Info: (541) 488-4260.

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