October 11, 2000
Volume 2, Issue 41
Midwifery Today E-News
“Birth Rituals from Around the World”
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This Week's Issue

Contents:

  • Quote of the Week
  • The Art of Midwifery
  • News Flashes
  • Birth Rituals from Around the World
  • Check It Out!
  • Midwifery Today Online Forum
  • Question of the Week
  • Question of the Week Responses
  • Share Your Knowledge: Coming E-News Themes
  • Switchboard

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Quote of the Week:

"A successful midwife is one who has learned to listen carefully with both her mind and her heart, one who has mastered the ability to blend with her client's environment."

- Valerie El Halta


The Art of Midwifery

If during crowning the birthing woman is having a difficult time relaxing, midwives on either side of her may take her arms and move them around in large circles to help her relax and not push.

- "Childbirth in Japan," Birth International 1990

Share your midwifery arts with E-News readers! Send your favorite tricks to:


News Flashes

An Australian study of nearly 2,200 children who were followed to age six years showed that giving an infant breastmilk and nothing else for at least four months after birth cuts the risk of developing asthma. Babies who were introduced to milk other than breastmilk before four months were 25 percent more likely to develop asthma and 40 percent more likely to develop a wheeze.

- British Medical Journal 319 as reported in Nursing Times, Vol. 95 No. 40, 1999


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Birth Rituals

Editor's note: I have gathered descriptions of some birth rituals from various articles in past issues of Midwifery Today. At first reading they may seem like superstitions or fear-based or prejudicial, but given some thought or research as to what they may actually accomplish beyond the superficial intention, they may be quite valuable to the mother, baby, and/or the continuance of the community and culture they live in.

If you know of other rituals, please share them with E-News readers. Send them to Mtensubmit@midwiferytoday.com

Guatemala

- If the baby will not come, a common remedy is to boil a purple onion in beer and have the woman drink the liquid.
- Midwives believe the placenta needs the "heat" of the newborn to deliver, and if the cord is cut beforehand, the placenta will rise into the throat of the mother and choke her. If she must cut the cord prior to the placenta delivering, the midwife ties it to the mother's leg with a strong stout string, using many knots to keep it from rising.
- Soon after the birth, the mother eats hot chocolate and sweet bread. She does not get out of bed for 24 hours. The only fluids she takes are hot chocolate, hot water and chamomile tea.

- Elizabeth Withhnall, Midwifery Today Issue 25

Central African Republic
A call-and-response song used during birth: "EI-OH mama ti mbi, ti mbi aso mbi" ("Ei-Oh mother of mine, my belly hurts me"). The response: "Kanda be ti MO!" ("Tie up your heart," meaning "Tough it out").

- Jennifer Wright, Midwifery Today Issue 32

Niger
In the Moslem tradition, a woman's genitals are not to be touched by anyone other than the husband. The matrone (midwife) respects this custom and rather than "delivering" the infant, she aids the labouring woman by offering herbal drinks to stimulate contractions, sprinkles herbs over the woman's abdomen, and recites prayers for a speedy, safe birth.

- Phyllis Sommer, RN, Midwifery Today Issue 32

Mexico

A pregnant woman should avoid all contact with anything death-related. She is forbidden from attending funerals or burials and from visiting cemeteries.

- During childbirth, it is thought that the woman's womb loses heat and her ovaries and genitals soften, never returning to their original position. To prevent this, some traditional midwives place themselves between the woman's legs at the moment she is giving birth, to help keep the heat in and curses out.

- During pregnancy, a woman must avoid cold or hot baths, using warm water instead. Cold water is believed to affect bones and joints; the pelvis will be rigid and this could cause a longer and more difficult and painful labor. And varicose veins and other circulatory problems seem to appear as a consequence of hot baths. Many also believe that a pregnant women should not expose herself to the sun's heat or stand near a fire, since excess heat may burn the placenta or heat the baby and irritate it.

- A 40-day period of caring for the mother and child is considered essential for the prevention of diseases and complications.

- Guadalupe Trueba, Midwifery Today Issue 32

Japan

Nutrition during pregnancy is extremely important in Japan. As soon as I told my friends I was pregnant, I often received gifts of shriasu, a tiny white fish high in calcium. The Japanese diet is normally very healthy, but during pregnancy a woman takes special care to increase her calcium intake. The daily diet almost always includes shirasu, rice, miso, and nori (seaweed).

- Debbie Treijs, Midwifery Today Issue 32

Peru
If the placenta doesn't come out on its own, put salt on the woman's tongue.

Angola
The Umbundu people do not take the new baby outside the home for the first seven days because they believe the child's life is tenuous and bad luck might befall it.

- Eliza Buck, International Midwife Issue 2

Malaysia
The bleeding postpartum woman is considered polluted and polluting. At the same time, she is still vulnerable to evil spirits. Therefore she is forbidden to leave the house or participate in cooking and cleaning.

- Tina Kanagaratnam, International Midwife Issue 3

Ghana

The mother is to close or cross her legs during the postnatal period, based on the belief that it would reduce the air entering the body which could result in a bleeding and/or a permanently fat abdomen.

- Yvonne Lefeber, International Midwife Issue 4

Inuit
If mothers begin a project such a sewing she should finish it so the labor won't be long.
- Every newborn is greeted with a handshake by everyone, even the children.
- Don't make bubbles with gum or blow up a balloon or your membranes won't rupture.
- Don't wear a ring or have braids in your hair because this will cause the umbilical cord to be wrapped around the baby's neck.

- Leah Qinuajuak, Midwifery Today Issue 40

The United States

- Midwife Margaret Charles Smith was taught to place the fathers' shirt around the birthing woman's shoulders and place his cap on her head so the father's energy would help his woman in labor.

- Clarebeth Loprinzi-Kassel, Midwifery Today Issue 50

- I know two midwives in Montana who won't attend a birth unless a cat is in the house because they feel it is likely the child will not live to its first birthday.

- Anon. E-News reader

- If my senior midwife saw a black cat on the way to a birth she would say, "I saw a black cat on the way here, stay on your toes--we're going to have trouble." She was always right. Something would happen like a tight nuchal cord or a really tight shoulder, maybe a bleed. I am not superstitious and didn't believe these things happened because of a black cat. A few years after my apprenticeship was over I attended a birth with another midwife. That night we came to the door and I saw two black kittens playing. I chuckled to myself, remembering the past and thought nothing of it. When we stepped in, a huge black cat rubbed against my leg. I still laughed but started to feel a little concerned, yet thought better of mentioning it to the other midwife. That birth turned out to be the scariest birth I have been to. All was well with mother and baby, but it was scary. I now pay attention to black cats and when I see them on the way to a birth I "stay on my toes."

- I.Duncan

Uganda
The mother is instructed not to drink water while standing, to prevent the baby from being born with squinted eyes.

Bolivia
Don't do any knitting while you're pregnant, as it will cause the umbilical cord to become wrapped around the baby's neck.

- Ann Davenport, International Midwife Issue 6

Bihar, India
If a woman's labour was not progressing she was made to drink a glass of water in which her mother-in-law's big toe had been dipped.

- Janet Chawla, Midwifery Today Issue 52

Two ways Midwifery Today can help you learn about and understand birth traditions around the world:

1. SUBSCRIBE to Midwifery Today magazine. It includes an extensive section called International Midwife which is filled with midwifery and birth stories and birth knowledge and experience from around the world.

2. ATTEND a Midwifery Today international conference.


Check It Out!

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

"A DISTRESSING CROSS-CULTURAL TREND is showing up in the growing body of anthropological literature about midwifery and birth in the developing world. From Tanzania to Papua New Guinea, anthropologists who observe professional midwives giving prenatal care and attending births increasingly note that, far from the midwifery ideal, professional midwives often treat women very badly during birth, ignoring their needs and requests, talking to them disrespectfully, ordering them around, and sometimes even yelling at them and slapping them." Read more about how the professionalization of midwifery has changed birth practices in many countries, by anthropologist Robbie Davis-Floyd.

MEDICINE WOMEN, CURANDERAS and Women Doctors. Click here to read the book review


Midwifery Today's Online Forum

I am in my final year as a student midwife (direct entry) in the UK. It is a requirement of our course that we complete a 2-week overseas placement. I am writing in hope that a midwife overseas would be willing to take me on for 2 weeks. Please if you are interested contact me and I will be able to answer any questions you may have.

- Michelle

To share your thoughts and experience, go to Midwifery Today's Forums


Question of the Week

How important and under what conditions is a sterile field a primary concern in delivery?

- Karen Stokka

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Question of the Week Responses

Q: 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

A: I have served some women with a similar problem who have had incredible results with the Feldenkrais method body reeducation called Functional Integration. A similar, but also different, modality is Alexander. Feldenkrais teachers are often found in larger metropolitan areas.

- Karen Ehrlich Felton, CA

A combination of acupuncture and trigger point injections with lidocaine and marcaine(a long-acting lidocaine) helped a client through. Her symptoms totally resolved by one week postpartum. I believe if she had started acupuncture earlier the injections would not have been necessary because they were rarely required after several weeks of acupuncture therapy.

- Lynette

Q: 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

A: Early in my practice as a midwife I attended a very strong and determined woman. After reaching full dilation she had no urge at all to push, which we saw simply as a plateau. After some hours we began to try a variety of things: walking, squatting, stairs, nipple stimulation to bring on stronger contractions. Nothing. After some hours the woman wanted to try an enema, a shower, a nap, forced pushing. Nothing. She had great energy but no pushing urges. The baby remained high and stable. At the 10-hour mark we all agreed that this child was not budging and went into hospital. Soon after arrival, the membranes ruptured spontaneously (no prolapse) on the toilet. No pushing urges. Soon there was meconium, and a drop in the fetal heart rate. The OB decided to do a scalp sample to check blood oxygen levels, which were fine. She instructed the woman to try pushing again. The baby began to descend. The mother pushed harder than I've ever seen. She was in a birthing bed squat. Another hour passed and there was some progress. Two nurses helped her curl herself into a "C" to accelerate her effort. She pushed even harder. The heart rate continued low, but with good oxygenation. When the head finally crowned we found the cord tightly wrapped twice around the child's neck. She had known that birthing was like hanging herself and it wasn't safe to be at home! It was managed nicely in hospital with the best outcome possible: spontaneous vaginal delivery of a vigorous female without damage to either. It took 14 hours!

- Diane Parkin, RM

A: My water broke and I started having contractions around 10:30 one evening. I couldn't sleep that night because as soon as the contractions started they quickly became very strong and stayed that way until I was 10 cm around 2 pm the next day. I had an anterior lip that eventually went away and I was having true pushing urges from about 3 cm on. My midwife could tell that the baby had quite a severe caput early on. I ended up pushing until 1:20 am, an 11-hour second stage. When he was born, we realized he had been in DTA (deep transverse arrest, where baby never does the internal rotation, so head is coming out sideways) and he came out with an extremely molded head. I have heard of other cases of DTA where women have ended up with c-sections and that in the hospital they are routine for DTA. All in all mine was a 27-hr labor with 11 hrs. of pushing.

- Andrea

My first pregnancy was at age 30. My labor began Tuesday in the wee hours of the morning. My waters started leaking about 7:00 am. Tuesday night after about 8 hours of hard labor, my midwife thought I was getting close. I was at 9 cm but she said my bones were not soft. Shortly after my contractions slowed from one right on top of the last to one every hour. (Interestingly, my labor increased with the moon and decelerated with the sun.) My contractions remained like this during the second day of labor. After the sun set, things picked up again. After a second night of hard labor, my daughter was born at 6:00 am at home--52 hours of labor and 36 hours after being dilated to 9 cm. Because of the circumstances, we didn't do any more vaginal exams. We monitored fetal heart tones and my body temperature. We watched my fluids for signs of infection. Everything was normal so we waited it out. My daughter was a bit sluggish and tired after all that labor. She had a 1-minute Apgar of ;, 5-minute, 9; and 10-minute, 10. I never had an urge to push, although when I did push the pain went away.

- Michelle Breen

Editor's note: More stories will be included in the next issue of E-News.


Coming E-News Themes

1. ELECTRONIC FETAL MONITORING: Does it belong in good care during labor? Why or why not? What are your experiences? (Issue 2:41, October 18)

2. GBS: I'm curious how other midwives counsel their clients about GBS. Do you have any new information that would make it easier to give better and clearer informed consent to clients? Do you have tricks in case the culture comes back positive?

- A.W. (Issue 2:42, October 25)

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Switchboard

E-News received numerous replies to a reader's inquiry regarding the quality of her breastmilk. Following are excerpts:

Breastmilk looks rather like skim milk anyway, but the best way to increase its quality (and therefore weight gain plus general improved health in the infant) is to follow a nutritious diet high in good-quality fruit & vegetables, full fat dairy, nuts & seeds, fatty fish, eggs and whole grains. The breastmilk will only ever be as nutritionally good as the mother's diet. Supplements of Vitamin E, Evening Primrose and Fish oils can improve milk quality, particularly in regard to the fats. Above all don't stop breastfeeding--it is by far superior to any formula.

- Karen McElroy, Naturopath/Herbalist
Melbourne, Australia

My daughter also fell off of the growth charts, but is very healthy (never been sick), very active, and ahead of the charts in terms of developmental markers. A lactation consultant with La Leche League told me the growth charts we compare our children to are based on the growth of babies who are formula fed! Formula is higher, by huge amounts, in fat, protein, calories, but totally lack the antibodies and many other things that can't be reproduced.

- Pam Martin

After a little weight loss after birth, while the milk supply is increasing, healthy breastfed babies will gain between 4 and 7 ounces per week. They are expected to surpass their birth weight no later than three weeks of age. Some babies whose mothers are blessed with an abundant supply of milk may gain faster than 7 ounces per week, but it is not that common.

Normal breastmilk is quite watery at the initiation of a feeding, and becomes richer during a feed. It certainly can look thinner than skim milk at the beginning and become much creamier at the end of a good feed. It's kind of like a four-course meal--soup and salad first, then the entree, with cheesecake for dessert. Allow/encourage your baby to nurse long enough so she gets her share of cheesecake.

The composition of our milk changes depending on the breastfeeding style. Frequent nursing will result in a higher fat content than infrequent feedings. If your daughter likes to nurse often (every 30-90 minutes), that will encourage your breasts to make higher-fat milk.
Cigarette smoking results in lower fat content in our milk. If you are a smoker (or live with a smoker), please quit.

- Heidi Reinhart, MD

Is the baby growing fairly consistently and is she showing all the normal advancements for her age? Does she have at least 6 wet diapers per day? Is she having regular and healthy bowel movement? Take a look at your own size and your husband's--are you on the small side? If you are uncomfortable with your doctor, maybe you need to find another one.

- J.C.
Texas

I highly recommend nettles. I began drinking a half quart a day of nettle infusion (a very strong tea of the dried herb) when I was pregnant with my first child eight years ago.

- Anelia, CD, CBC, CNM assistant

Your best assurance for keeping your milk supply in "good working order" is to nurse on demand for as long as she wants, avoid all artificial nipples including pacifiers as artificial nipples will keep your daughter from being at the breast (and milk production is based on the supply and demand principle: the more she nurses, the more your breasts produce) and can cause nipple confusion which may keep her from nursing well at the breast, eat a well-balanced diet (keeping in mind that nursing uses an additional 500 calories a day), drink plenty of fluids especially water and juices, and rest as much as possible.

- Dianne Oliver, LLL leader
Wrentham, MA

I am a doula and apprentice midwife and have found so much help with things like this from La Leche leaders and a few lactation specialists. The only caution I've needed to watch with some lactation specialists is that sometimes they are very quick to suggest pumping when other, less complicated methods would work just as well.

- Lis Worcester, SF

Formula babies grow at a slow but steady rate as the formula doesn't change as their nutritional needs do. Breastfed babies usually have a large growth spurt in the first several months of life, then slow way down. If the doctor isn't aware of this, it appears that the child is dropping percentiles. I have been told that the new growth charts for breastfed babes are available on-line, but haven't found them yet. Rest assured that the formula companies will not supply them to docs for a long time as the charts will further emphasize the difference in growth between natural and artificial food. If your doctor recommends adding formula, point out that both the American Pediatrics Association and the American Academy of Family Physicians support breastfeeding as the ideal source of milk for at least the first year. If your babe truly needs help growing, run to your nearest lactation consultant, breastfeeding friendly doc or LLL.

- Lynette (a family doc)

One study (Darling study) found that breastfed boys fell below the 50th percentile around 8 months and girls at 6 months. Girls fell below the 25th percentile around 12 months. There are also tons of studies on supplementing before 4-6 months. Check Medline. The Darling study can be found in Pediatrics 1992;89:1035-41.

- Charlotte Baici

The fat content of breastmilk increases as each feed progresses, the hind-milk being much higher in fat than the rest. Alternate breasts at each feed, rather than letting her suckle one then the other each time.

- Dave

Solids actually reduce the total calorie intake. Has she been getting solids, especially low-calorie fillers? If she is in her first few months and dropping, I would want your breastfeeding pattern and baby's latch examined. Some babies are not put to breast often enough. In one study, two extra feeds per day meant an extra 62% weight gain. Sometimes a baby with a latch problem, sucking weakness or disorganization can coast on mom's initial bounty squirting out on its own. As mom's supply gets established, baby's poor suck may not keep it up. For instance, some babies whose tongues are tied too closely to the bottom of their mouths cannot fully empty a breast. Is baby lean, but healthy and happy? Sometimes we find that mom or dad were thin, slow-gaining babies. Maybe grandmas can offer reassurance. Let's discover if there is a problem, not pour artificial milk over it.

Finally, some cardiac, metabolic and other disorders reveal themselves in the weight pattern. If doctor is "fixing" breastfeeding with formula and isn't looking at the baby's health, I might ask for a better doctor. If baby has a health problem, the extra strain of bottle feeding and the loss of human milk's benefits might pose a serious risk.

- Pan Easterday

Research has shown that the fat content in human milk varies, being lowest in the morning and highest in the afternoon (Myles 1999). The breast produces different types of milk and the fat content increases during the course of the feed, sometimes 5 times its initial value. The key is to make sure you exhaust one breast before you start on the next. This way baby will receive the fat enriched hind-milk.

- Helen Oates
Shrops UK

In response to an inquiry about a link between using Pitocin and autism:

In a September issue of Newsweek, the cover article was about the dramatic recent increase in autism. Within that article, it briefly mentioned one doctor who noted that 60% of his autistic clients had mothers to whom Pitocin was given during labor. There was no study cited, just an observation.

- Annie, aspiring midwife, perinatal nurse, CBE

I have a one-page article from the May 13, 1996 issue of Newsweek about the mystery of autism. The article makes this comment:

"The social phobia of autism may be linked to the brain chemical oxytocin. This molecule, best known for inducing labor and lactation, also promotes maternal and other bonds and so has come to be known as the sociability molecule. When Hollander administered oxytocin to five autistic patients, it made them four times more talkative and, according to the patients, twice as 'happy.'"

A more controversial theory focuses on Pitocin, a hormone given to women to speed up their labor. Pitocin is the man-made analogue of oxytocin. "Most of the mothers of patients we see have had Pitocin-induced labors," says Haollander. He suspects that Pitocin somehow messes up the newborn's oxytocin system, producing the social phobias of autism. This idea is very preliminary, but it's an improvement on the theory hatched when autism was first identified 53 years ago. Then, scientists blamed it on unloving mothers."
I find it interesting that autism was first identified 53 years ago. How does that coincide with the introduction of Pitocin into obstetrics?

- Melissa Schuppe, ICCE
Lynchburg, VA

In response to an inquiry regarding low basal temperatures in [Issue 2:39]:

I too had low basal body temps. When in college they were normal. When we had not conceived for more than a year I started keeping track. My thyroid was also checked as I could not get any weight off no matter what I did. My norm runs about 97.2 and the most increase that I see is .01 or .02. I did conceive and carry just fine. I think that watching your own patterns and knowing them is really important.

- Pam Martin, MS, DONA CD, CM, apprentice midwife

In response to an inquiry regarding perineal tears [Issue 2:40]:

I had first-degree tears with my first two 8-12 and 8-14 lb. boys, giving birth in a semi-sitting position in water. Both times I tore nowhere near my perineum, I actually tore on my inner labia. It was slight and needed no stitches. I can still see the separation of skin from the first tear, but since it healed (about 3 or 4 weeks after the birth) I have felt no pain whatsoever. The second tear was also more toward the inside, I can't quite remember where, and I've never felt pain after that healed either. My midwife doesn't do episiotomies, and I'm glad I stretched and tore only a little bit just where the skin was weakest and not cut through perineal tissue and muscle!

As for my third 9 lb. boy, I squatted for that birth in a tub of warm water and didn't tear at all even though he was my biggest baby. What probably helped me greatly was the fact that I took Dr. Robert Bradley's advice and didn't wear panties through my whole pregnancy. My bottom got lots of air flow and helped condition the skin.

- Sharon Thornton, AAHCC
Chesterton, IN

There's plenty of literature out there! Try this for starters: McGuinness M. Norr K. Nacion K. Comparison between different perineal outcomes on tissue healing. Journal of Nurse-Midwifery, 36(3):192-8, 1991 May-Jun.

- Dave

Please tell me more about the possible correlation between the Vitamin K shot and challenges with breastfeeding! Although I have never thought about it before, I have seen this play out with my children who received the shot as compared with my children who didn't.

- Sharon

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


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