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This issue of Midwifery Today E-News is sponsored by:
- Real Birth
- Waterbirth Website
Look for their ads below!
~*~*~*~*~
Midwifery Today Conference News
OUR HOME TOWN will be the site of Midwifery Today's domestic conference next March. Come join us in friendly Eugene, Oregon ("Eugene" means "good birth"!). For more information, go to:
http://www.midwiferytoday.com/Conferences/Eugene2001/
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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) Prenatal Care
5) Check It Out!
6) Midwifery Today Online Forum
7) Question of the Week
8) Question of the Week Responses
9) Share Your Knowledge: Coming E-News Themes
10) Switchboard
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1) Quote of the Week:
"Many of us seem to lose our ability to discriminate fact from belief as we are exposed more and more to practical techniques that 'seem' to work and less and less to scientific theory and proof that our theories and practices are scientifically valid."
- Henci Goer
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2) The Art of Midwifery
Relieve back labor pain and tension with a massage using an oil made with herbs such as chamomile, rose, calendula, and lavender. You can also add an essential oil with a scent that the woman finds comforting. An herbal oil of comfrey or St. John's wort works well for perineal massage before labor or as the baby crowns. If a woman does tear or have an episiotomy, this oil will promote rapid healing.
- Kathryn Cox, The Birthkit Issue 22
====
HERB CLASSES are included in the Midwifery Today Eugene
conference in March 2001. Herbalist Linda Lieberman offers
an herb walk and teaches a class called Herbal Remedies in
the Childbearing Year. Adrienne Borg, ND, will teach the
class Herbs and Homeopathy for Common Problems in Pregnancy,
and an all-day herb workshop will be presented by herbalists
Judy Edmunds and traditional Mexican midwives Naoli Vinaver
and Dona Irene Sotelo. For all the information you need
about the conference, go to:
www.midwiferytoday.com/Conferences/Eugene2001/
====
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 conducted at the Prudential Center for Health Care
Research found that among its study group of 200 women on
Medicaid, personal factors influenced use of prenatal care
more than sociodemographic factors. More than half the women
received late or inadequate care, or both. Factors such as
age, race, marital status, and income level were not
associated significantly with when or how often the women
sought prenatal care, nor were factors such as access to
transportation. Women were more likely to receive late or
inadequate care if they experienced adverse personal
circumstances such as physical violence during pregnancy
(3.5 times more likely), tiredness (2.2 times more likely),
or lack of help from the father (1.9 times more likely).
- Birth 27:1, March 2000
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4) Prenatal Care
Prenatal care consists of everything a woman does for
herself during pregnancy, punctuated by a series of visits
with you," says midwife and author Anne Frye. One way a
woman cares for herself prenatally is the process by which
she chooses a midwife. Following are suggestions from
midwives Jill Cohen and Marti Dorsey on how to choose a
midwife.
Questions for mom to ask a potential midwife:
- Why did you become a midwife?
- How did you receive your training?
- Are you certified or licensed by any organization?
- Do you belong to any midwifery organizations, attend conferences, workshops, or subscribe to professional journals?
- What is your basic philosophy of childbirth?
- How many births have you attended as the primary midwife?
- Do you handle higher risk situations such as twins or breeches?
- What do you charge for your services, how must it be paid, what does it include?
- What services are included in your prenatal care (early detection of problem areas for mother baby; nutrition information; exercise recommendations; in-home care; recommendations for parent education via books, videos, or classes)?
- Do you work with another midwife or assistant at births?
- What do you do if there are two births at the same time?
- How do I reach you? Do you have a pager that allows 24-hour access?
- How do you handle any problems/complications that might develop during labor?
- What standard and emergency equipment do you carry? What herbs or medicine do you use?
- Do you have an affiliation with a physician to answer unusual questions during the pregnancy or an emergency situation during labor?
- What is your policy for transporting?
- What medical facility do you use and have you developed a good working rapport with them?
- What kind of postpartum care do you provide (how frequent are baby check-ups, assistance with nursing)?
In addition to asking questions, it's important to be clear about what you expect from her. Be prepared to share your vision of the birth. Discuss any fears you may have. Tell her how knowledgeable you are about birth and how informed you would like to become.
Determine if the midwife's answers to your questions agree with your desires. If your heart trusts her and you are both in harmony physically, mentally and spiritually, then you have found your midwife.
====
Prenatal visits serve much more purpose than merely
monitoring the course of a pregnancy. Given the incredible
level of fear around birth in North America, prenatal care
with midwives can provide a safe haven, a subculture in
which women can reclaim trust in themselves and the birthing
process. In Europe, where women are far less terrorized
about birth, midwives report that they see women
infrequently during their pregnancy. The midwife's job
during the prenatal period is much more important in North
America, where the midwife must stand between the women she
serves and the larger society. Counter this undermining
societal attitude by empowering the mother to realize that
she is the only real care provider for her unborn baby. Show
her that you value her sense of well-being or danger
regarding her health and that of her baby; the baby is in
her body, after all, and who should know better than she if
something is not right? Your support of her intuitive
perceptions about the pregnancy will go far in helping to
distinguish real problems from imaginary ones throughout her
care.
Supporting responsibility-taking during your care: Prenatal
care is only as useful to a woman as she allows it to be.
The real prenatal care in any pregnancy is what the woman
does for herself between visits: how she eats, if she avoids
harmful substances, when she exercises and rests as needed,
and whether she works to resolve psychological issues that
she knows of which may interfere with her birthing process.
Your job is to guide, monitor her health and well-being and
offer your expertise and experience as a midwife. Many
midwives encourage women to take on specific
responsibilities such as checking their own urine during
care, weighing themselves, learning how to palpate and
generally understanding everything you are doing and why, as
well as making them responsible for following up on
appointments with other practitioners when needed.
- Anne Frye, Holistic Midwifery Volume 2
====
TO ORDER ANNE FRYE'S COMPREHENSIVE BOOK Holistic Midwifery Vol. I, go to:
www.midwiferytoday.com/books/annefrye.htm#holistic
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5) Check It Out!
~~~WWW.MIDWIFERYTODAY.COM~~~
A Web Site Update for E-News Readers
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
AUDIOTAPES ON THE PRENATAL PERIOD are available on the Midwifery Today web site. Go to
www.midwiferytoday.com/tapes/audiocompli1.htm#pre
~~~~~~
"THE USE OF ULTRASOUND in antenatal care is big business,
and in any big business marketing is all-important. As a
result of decades of enthusiastic marketing, women believe
they can ensure the well being of their babies by reporting
for an early ultrasound scan and that early detection of a
problem is beneficial for these babies. That is not
necessarily so, and there are a number of studies which show
that early detection can be harmful."
For Beverley Beech's compelling article on prenatal
ultrasound, go to:
www.midwiferytoday.com/articles/ultrasound.htm
~~~~~~
MIDWIFERYTODAY INTERNATIONAL CONFERENCES: Join us around the world!
www.midwiferytoday.com/Conferences/international.htm
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6) Midwifery Today's Online Forum
During my last pregnancy (the only one I've had so far), the
only discomfort I experienced was heartburn. I didn't take
any medication for it. We are hoping to conceive our next
child in the coming months and I wondered whether there was
evidence of this condition being related to any types of
deficiencies of vitamins or minerals, or is it purely
because of the "squashing up" of the digestive system? It
may be worth mentioning that I began to suffer from
heartburn quite early in the pregnancy. Also, if there's
just no getting away from it, are there any effective
natural remedies?
- Jo
====
To share your thoughts and experience, go to Midwifery Today's bulletin board:
www.midwiferytoday.com/forums. Click on "Midwife Chat."
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7) Question of the Week
While I was at the Midwifery Today conference in New York
the midwife covering for me attended one of my women. The
woman was dilated fully at 5 am and had no urge to push. Six
hours later, after trying several things, including AROM,
they transported to the hospital and the woman was given
Pitocin and an epidural. She was sectioned four hours later
for FTP. Heart tones were fine all through and mother,
although tired, did not want to be sectioned. The mother now
believes that if they had simply waited, not broken her
water, and trusted, the baby would have been born vaginally.
What is the longest you have seen from full dilation to the
beginning of pushing--or to the birth of a baby? What were
the outcomes??
- Nancy Wainer
====
Question of the Week (Repeated)
In my prenatal fitness class I have a G1P0 due 12-4-00 who
has intercostal neuritis. She has been adjusted by her
chiropractor with no result. Gallbladder has been ruled out.
I intend to work on her with massage and am wondering if
anyone has any other suggestions on things she may try.
Acupuncture has been suggested and declined, though she was
planning to have a nerve block!
- Pam Martin, MS DONA CD, CM, apprentice midwife
====
Send your responses to mtensubmit@midwiferytoday.com
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8) Question of the Week Responses
Q: 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
A: I am a family doc who includes obstetrics in my practice.
One of my young moms had preterm labor (at 28 weeks) with
her first delivery. Her second pregnancy ended in a first
trimester miscarriage. Her third pregnancy ended at 17 weeks
when I helped her have a perfect little girl. At autopsy,
nothing was found. Because of this history, she underwent
testing as I'm sure that you did. She also had a septated
uterus--nearly complete, giving us all cause to once again
be amazed at the wonder of nature that allowed her to carry
her little boy close enough to term to survive. Anyway, she
did have hers fixed. This made her "high-risk" so she
delivered at our nearby university. I now take care of her
three children, the last two born healthy and at term.
- Lynette I.
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9) Coming E-News Themes
1. BIRTH RITUALS: E-News is curious about birth rituals
around the world that would usually be called "old wives'
tales." For example, birth attendants may be told to untie
their shoes at a birth so there would be no knots in the
umbilical cord, or they may avoid wearing red to prevent
hemorrhage. We would love to hear other midwives' stories
along these lines. (E-News thanks Fiona Thomson for this
topic idea.)
2. ELECTRONIC FETAL MONITORING: Does it belong in good care
during labor? Why or why not? What are your experiences?
====
**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
I am a social sciences student entering my third year at
Teesside Uni. I hope to study midwifery after it. I would like to do my dissertation on midwifery but I don't really
have an idea for a question or research. Would any midwife
out there like to suggest a research topic I could use to
help midwives in the future?
- Claire Russell
Answers from readers:
I think it would be interesting if Claire examined our
changing birth practices (from home to hospital, babies
taken from mom, etc.) to see if there is a correlation to
the increase in social unrest and violence especially in the
1960s to today. -Elenie Smith, CNM
Are the outcomes of midwife-assisted homebirth better than
hospital delivered ob/gyn births? (You'd have to
define/operationalize "better.") You are in a state with The Farm midwives.
They are a GREAT source of data!
- K.K.
I'm particularly curious about any possible correlation
between vitamin K given to infants and breastfeeding
problems, i.e. babies becoming disinterested in the breast,
not having the urge to suck, after the vitamin K injection
is administered. Also, get a copy of Michel Odent's newest book, The
Scientification of Love [available from Midwifery Today. Go to:
www.midwiferytoday.com/reviews/scienlove.asp]. The
primal health research is all cited there. It's exciting
news for those of us who have devoted our lives to
protecting normal birth. You may find some direction by
looking at the CPM statistics project 2000. Contact NARM and
see what they are gathering.
- Robin Lim
What to do what about men in the delivery room! -Julie
The importance of fetal heart tone monitoring, frequency, to
establish a protocol for second stage. Study to include how
it can guarantee a positive outcome and prognosis for
intervention.
For me the discussion about medwives and midwives which was
going on [in E-News]is a good opportunity to study. It would
be of great interest for midwives to know what kind of
questions one asks themselves before entering the profession
and how they think one, two, and five years later.
- Mary C. Scheffer-Zwart
I would like to see some research done to see if midwives'
clients are experiencing any medical problems from refusing
the vitamin K shot, and the eye prophylaxis (assuming, of
course, that they tested negative for chlamydia and gonnorhea).
====
Greetings from Fortaleza, Brazil! As you may know, in
Brazil, a country where midwifery does not exist as an
established profession, the cesarian section rate in most
private hospitals is as high as 90%, whilst poor women give
birth in degrading conditions in the world's most crowded
hospitals.
What you may not know is that in the same country, a number
of initiatives have been created since the 1980s that
attempt to recover human values in childbirth, a movement
known as the "humanization of childbirth." On November 2, 3
and 4 midwives and others interested in maternity care from
all over the world will gather at the International Conference on the Humanization of Childbirth to promote
humanized childbirth.
Contact the Conference Secretariat at +55 85 246 4302/246
0232, by fax at: +55 85 246 2697, e-mail: childbirth@eventuall.com.br, WWW at
www.humanization.org.
====
I am a first-year student midwife in New Zealand. When first
listening for tones the midwife I worked with used a sonic
aid so everyone could hear the heart loud and clear
(mums-to-be love it). It was just a matter of learning where to position the aid after palpating. Experience was the best
teacher. I still have problems listening with a Pinard,
especially after using a sonic aid but what helped was
reading in Maye's Midwifery that using a Pinard the FHT
sounded like a "watch ticking under a pillow," which is the
best description I know.
- Pauline Dawson
====
I am one of those "hidden midwives" because of the state in
which I live. My potential clients must hear about me
through the underground. I too am appalled at the number of
so-called midwives "with woman" who are supposed to be
protecting our women/couples from unnecessary
medicalization. Please, let's take care and do sit on your
hands. Midwives can practice without any tools other than
their hands, and that should be limited!
- Anon.
====
A woman in my childbirth class had heard there is a
correlation between the use of Pitocin in labor and autism
in children. Does anyone know of studies or articles on
this?
- Robin
====
Is there any way to increase the fat content of my
breastmilk? I have noticed that it looks rather like skim
milk. My daughter continues to gain weight but she is
dropping "percentile-wise" on the growth charts. I
desperately want to continue exclusive breastfeeding but
fear that the doctor and my husband will insist on formula
supplements if she does not gain more weight.
- Anon.
====
I am a hospital-based CNM with my heart in homebirths. I have used misoprostol (Cytotec) for most of the inductions I have done until recently. (I haven't done too many
inductions--less than 5% over the past two years).
First, let me say I truly hope the rumors that homebirth
midwives are using miso and telling clients it's a
homeopathic or that it is slipped in with a vaginal exam and
not told to the client, are urban legends and not truth. I
just can't believe there is that little integrity in any
midwife.
Second, I have decided not to use miso anymore. If I have a
client who demonstrates it is more of a risk to either
herself or her baby to remain pregnant, but her cervix isn't
ready, I am again using prostaglandin gel. It has been my
experience with miso that it starts out making the uterus
irritable. It is usually slow going to get into active
labor, but once labor begins it goes unnaturally fast and
babies come flying out. I never leave once miso labors start
contracting because I know I can miss the birth. In fact the
hospital's QA committee looked at unattended births to see
if there was a pattern and how they could be prevented. They
found the majority of unattended births were primips on
miso.
I know fast labors are what everybody wants and maybe they
aren't such a bad thing. But it just doesn't seem quite
right with the miso. I don't think we have studied it enough
to find the best dosage and route.
I also know it is miso that has caused so much trouble with
VBACs. Ever since using miso in VBACs and the unacceptably
high number of uterine rupture, all VBACs have come under
question and it looks like there is a trend toward hospitals
not allowing them because they don't want to assume the
liability.
This is not a benign induction agent. It is very potent and
potentially dangerous. Frankly, I'm not convinced this
should be used even in a hospital setting unless we are
allowed to study it much more carefully.
- Molly, CNM
====
As far as I'm aware any "risks" of ginger are simply word of
mouth and are not supported by any evidence [Issue 2:39].
Getting solid information about herbal danger in pregnancy
is nearly impossible. Many books offer only quotes from each
other as evidence for the opinions presented. Almost all
information about herbal benefit and risk is simply opinion.
It may be true. It may be false. There is not enough data to
support either side. Ginger has been used for many
generations and across many cultures without observable
danger. I think any risk must be minimal.
- Anon.
====
Marilyn Shannon's book "Managing Morning Sickness" suggests
that blood sugar levels affect nausea in pregnancy. Her
recommendations are based on good nutrition and getting
enough protein. This book is available from the Couple to
Couple League at www.ccli.org.
- Kathy
====
Two of my moms-to-be were told by other moms that their
bodies will naturally tear to protect perineal nerves,
leaving perineal sensation intact and promoting quicker
healing vs. episiotomy. Does anyone have a solid reference
on this for me?
- Kelly Barnett
Coos Bay, OR
Disclaimer
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Midwifery Today, Inc., does not assume liability for the use of this information in any jurisdiction or for the contents of any external Internet sites referenced, nor does it endorse any commercial product or service mentioned or advertised in this publication. Always seek the advice of your midwife, physician, nurse or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding any medical condition.
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