January 10, 2001
Volume 3, Issue 2
Midwifery Today E-News
“Home and Hospital Birth, Part 2”
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THIS WEEK'S ISSUE

Contents:

  • Quote of the Week
  • The Art of Midwifery
  • News Flashes
  • Empowering Women, Part 2
  • Check It Out!
  • Midwifery Today Online Forum
  • Question of the Week
  • Share Your Knowledge: Coming E-News Themes
  • Question of the Quarter: Midwifery Today magazine
  • Switchboard

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Quote of the Week:

"A good midwife learns quickly that humility will help her become more receptive to the needs of the mother and baby, thereby blessing her with greater intuition."

- Lydi Owen


The Art of Midwifery

[To apply a remedy] I have women with vulvar varicosities apply pads first thing in the morning and leave them in place when they are on their feet. If they lie down or put their feet up for a period of time, they can remove them and then reapply when they are back up.

- Anne Cunningham CNM

Doula tip of the week

In response to the suggestion to tailor-sit on the bed for women with epidurals or women who cannot get out of bed [Issue 3:1]: If a woman can't get out of bed because of hypertension or because she has had an epidural, I have had great results with a side-lying lunge. Mom lies on one side with three or four pillows stacked in front of her tummy. Her top knee is bent and placed on top of the pillows at as strong an angle as she can stand. Her lower leg is kept straight and angled back on the bed as far as she can stand. She'll look like a hurdler lying down. Turning from side to side about every half hour, repeating the position, is very effective. The nurses in our area hospitals are starting to use this position because they've seen how well it works.

- Marla Lukes, certified doula, Minneapolis, MN

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News Flashes

A randomized, controlled open clinical trial in the Women's Hospital of Jiangxi Province, Nanchang, and Jiujiang Women's and Children's Hospital in the People's Republic of China studied the effect of traditional Chinese moxibustion treatment of acupoint BL 67 to promote version of breech babies. The study included 260 primagravidas with breech presentations at 32 weeks who were treated with moxibustion or given no treatment. The intensity of moxibustion was just below the individual tolerability threshold. The intervention group was divided into two, one which performed moxibustion once a day for 15 minutes on each side, the other for the same length of time twice a day. By the end of two weeks, 72.4% of the women in the once-daily treatment group and 81.4% in the twice-daily treatment group had vertex babies. There were 47.7% vertex presentations in the control group.

- J Amer Med Assoc, Vol. 280 No. 18, pp. 1580-1584


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Empowering Women: Hospital Birth and Homebirth, Part 2

Editor's note: Following are further responses to Zora's question about hospital and homebirth in E-News Issue 2:52. Thank you for the many heartfelt and thoughtful responses!

There is absolutely no comparison between a hospital and a homebirth experience. Because each one of our ancestors successfully empowered herself to birth her babies, each one of us is successfully here today. We live in a fear-based society and allow the powers that be who have gained a degree to take our God-given power from us. Our society has become wimpy. Women are living in fear when in truth the process of birth is a normal, natural, beautiful, worthy, godly experience. Our creator has not left us alone to bear the future.

Women understand one another. We want to be mothered into birth whether it be with our own mother or another woman who can share the experience with us. We want to be nurtured and loved into birth. Ultimately the time given by a midwife to a mom is much more than that mom would receive from the hospital experience.

Yes, hospitals do have their place for those times when they are needed.
But it is not natural to administer epidurals, Pitocin, etc. in a normal birth. We birthing mothers have innate abilities to have our babies if given the time, patience, love, and quality prenatal care.

Our children depend on each one of us to make conscious choices that will make the difference in their future as parents. Babies born with drugs and forced to be born when they are not ready may result in drug abuse in their future. Please realize what is at stake. Birth is the highlight of a woman's life. Each life brought here is precious and worthy of the very best.

- Robleigh, midwife

I am a doula who works in the local small-town hospital. I've had all of my children at home, but I choose to work with women in the hospital because that is where most women choose to give birth. It is also where they feel the most powerless, so it seems that that is where I can offer the most help.

I never feel as if I've done all I'd like to do. I have to walk a fine line of cooperating with hospital staff and serving my clients. Frustration is a constant companion. And if I pursue my goal of becoming a certified nurse-midwife, I'll only be asking for more of the same. People like us walk with feet in two worlds. We try to bridge the gap between our dreams (all healthy women birthing at home) and reality (most give birth in a hospital). We will always be uncomfortable because we are not wholly a part of one world or the other. We dream, but we cannot escape reality.

The changes that we make seem small, but I believe their effect is no less profound than that of our sisters who choose to birth at home. Our influence will be found tucked in the hearts of women and their families who have grown because of us. I was once a woman who would not speak up, would not ask a question. But someone reached out to me and drew me out of my narrow way of thinking. I've had six children in the wonderful comfort of my own home. I was blessed because someone else chose to walk between two worlds. You cannot repay anyone for such a kindness. You can only pass it on.

- Bonita

I am an out-of-hospital childbirth educator (Bradley Method) whose clients mostly use hospitals for birth with an OB or CNM in attendance, and want natural childbirth in a state with the highest epidural rate in the country (Utah-95%). I strive to remind women of the inherent power and knowledge their bodies and their spirits have when it comes to giving birth. Perhaps combining your efforts with a truly loving, empowering childbirth course would help women have more confidence in dealing with "the system" and the overall process of childbirth.

A good childbirth course combined with the caring and education a loving midwife provides can help women remember their inborn brilliance and power during the birth process. Whether it's a natural birth or if medical intervention becomes necessary, as Pam England states, all women can learn to "Birth From Within."

- Adrianna Olnhausen, AAHCC
Salt Lake City, Utah

Yes, most homebirths are beautiful and statistically quite safe. Of course we should be active in promoting midwifery and tearing down the legal barriers. However, the reality of the situation is that we will always need physicians at some point, and in order to work with them we should proceed gently and instructively, not as an adversary, which only antagonizes them and results in obstinence and anger. As far as doulas go, one must review what their role is. It is not to promote one's own personal agenda, but rather to act as an advocate for what the birthing woman wants. Most instruction as to options, etc. should have occurred prior to labor. If a woman has a healthy vaginal delivery after two previous c-sections, then that indeed should be construed as a "success!" If one cannot separate her personal opinions and feelings from those of her clients, then she has no business being in a helping profession of any kind.

- Jane

I am aspiring to become a midwife and have just begun my research and education on the subject. I want to let Marla Lukes know that her comments really touched me [Issue 3:1]. She wrote "Many women will know normal birth for the first time because of you." When I read that, I cried and was reaffirmed that being a midwife is my journey in life. If I could make that true for one woman, all of the lifestyle changes and sacrifices it takes to become a midwife would be worth it.

- Michelle Carroll


EACH ONE TEACH ONE has been Midwifery Today's motto since Issue 1 of its print magazine. E-News readers, if you don't already subscribe to Midwifery Today magazine and/or the Birthkit newsletter, consider this:

Each issue of E-News provides midwifery knowledge but because of space limitations and because the Internet and email are much better suited to short "sound bites" of information, E-News can't cover topics as thoroughly as our paper publications can.

Midwifery Today MAGAZINE is the definitive magazine about midwifery, and every three months, it provides an excellent addition to your birth library. Each issue includes a wonderful balance of experiential and research-based articles. From prenatal care to breastfeeding, from homebirth to hospital birth, Midwifery Today covers such important issues as woman-centered care, informed consent, birth politics, birth technologies, and much more. Each issue fosters an ongoing dialog among those in the diverse community of midwives, from CNMs to CPMs to lay and traditional midwives. It provides information on current "hot topics" in birth and steppingstones to other resources. Its advertisers provide products and services aimed specifically at the birth community and ties to resources that are often difficult to find any other way. And each issue includes a large section called International Midwife, with articles from midwives around the world.

MIDWIFERY TODAY MAGAZINE is a must-have for every midwife, from the student and apprentice levels to senior midwives and educators. Midwifery Today inspires, teaches, and affirms your deep love of birth and birthing women. Midwifery Today respects and values all midwives and the right of birthing women to have informed choice and nurturing support during the childbearing year. If you are not subscribing to it, you are missing out. If you work with birthing women, you need this magazine.

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TABLE OF CONTENTS for Midwifery Today Issue 56.

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Midwifery Today's Online Forum

I am curious about people's experiences with Mother's Cordial in VBAC moms. Some of the traditional herbs used in these preparations are considered uterine stimulants, and my intuition tells me to use with caution in this situation.
Green blessings,

- Adrienne

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


Question of the Week

I recently heard that doing perineum massage during pregnancy does not change the outcome. Could you clarify this for me and give more information?

- Kim Johnson, doula, aspiring midwife

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Coming E-News Themes

1. INTERNATIONAL MIDWIVES: Tell us about your practice, birth customs and culture in your country, arts and techniques for the birthing year, your struggles and triumphs!

2. PRECONCEPTION COUNSELING: What do you tell the aspiring parents who ask you for preconception services/advice?
(Thanks to Sarah, an E-News subscriber, for this topic.)

3. CHARTING CAN BE AS UNIQUE AS EACH MIDWIFE'S CARE. Do you have charting methods you would like to share with E-News readers?

4. SECURING AN APPRENTICESHIP: I am a midwife in training with an impressive record as a childbirth educator, DONA-certified doula, certified infant massage therapist, and a keen interest in normal birth. Four months ago I moved to a new area with my family and began the process of trying to make contacts. I am having a difficult time finding a midwife who is willing to talk with me about the steps necessary to secure an apprenticeship. Frankly, I feel a little like I'm crossing into a territory that belongs to someone else. I have emailed a vita to many well-respected midwives in my area asking for assistance, that they pass my name along, etc. I haven't had as much as a telephone call from anyone, even to say that they couldn't help.

Is the society of midwives so closed and myopic that they have lost sight of the idea behind traditional midwifery, that midwives teach parents as well as other midwives, that they give the gift and pass along the art? My grandmother learned from her mother, and she learned from her aunt, etc. After all, wouldn't we all like to see more homebirths? This can be accomplished with more midwives who are well trained. It is difficult not to feel disheartened. What do I do? Do I need to know the secret handshake?

- Jackie McMillan

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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!


QUESTION OF THE QUARTER for Midwifery Today magazine

Mamatoto: Motherbaby

How can midwives best facilitate the bonding process of motherbaby in pregnancy, birth and postpartum?

Deadline: March 31, 2001

Send your response to:


Switchboard

More on Hashimoto's: I contacted a private obstetrician, who advised regular thyroid function tests (TFT) during my client's pregnancy and confirmed there was no danger to the baby being born at home. He cooperated with the tests, billed to Medicare, and consulted with an endocrinologist. Thyroxine supplement was recommended to the mother, dose to be changed according to the results of blood tests. The dose remained low, and the baby was born at home (unexpected breech). I was advised by a paediatrician that the routine neonatal screening test for thyroid deficiency was sufficient to check that the baby had enough thyroxine, and that further blood tests were not necessary. Interestingly, this mother had Hashimoto's with her first pregnancy, but it was not diagnosed. The baby was healthy.
Treatment is dependent on the different parameters of the TFT results, so a doctor should interpret these for you. Although my client's disease was diagnosed late in pregnancy, I was assured that she had enough thyroxine to supply the baby in its early development stage, so don't worry if you are already pregnant and haven't been taking thyroxine.

- Marianne Idle

====

More on lunar cycles:

In the 1980s I worked as a volunteer midwife in a remote, rural clinic in Ghana, West Africa. Sometime in the second year of my stay, I collected birth data for the previous 12 months (some 1,000 births) and plotted these against the phases of the moon. I think I hoped for a dramatic increase around the time of the full moon but I didn't get it. The births were generally evenly spread throughout the month, with just a slight increase as the moon waxed. I put this down to the lighter nights facilitating travel over rough tracks. I must emphasise that this project was very informal--no statistical tests or anything fancy. Just a large sheet of graph paper, a sharp pencil, and plenty of time in the long, dark evenings.

- Hannah Hulme Hunter
UK

A study was done with sheep who are similar hormonally to humans. It was found that a statistically significant number went into labor in the early morning hours before dawn. However I have not found similar results in nursing research related to humans. A review of births/time/shifts/lunar cycle at a couple of hospitals did not show any relationship even though anecdotally the staff reported being "busier" at certain times of the day and of the month. Stats did not bear this out.

- Jane

====

On hypnobirthing:

I collect relevant information and links in the Midwife Archives at
http://www.gentlebirth.org/archives/hypnosis.html

- Ronnie Falcao, LM MS CHT

Go to www.hypnobirthing.com, where there is lots of information about hypnobirthing, classes, practitioners and certification seminars.

- Carol Gaudey, R.N., labor and delivery

Music during labour decreases pain by facilitating relaxation. It can also be used to energize and support walking/dancing and hip swivels. A variety of music is needed to meet different requirements at different stages of labour. Earphones can be helpful when contractions are gaining intensity as the impulse goes more directly to the auditory nerve. Some women want the volume increased through earphones during a contraction and the music played free-range between contractions. No music is better or best for labour--beauty is in the ear of the beholder. And it is this response to beauty that will release the body's natural pain killers.
Don't forget that we are also instruments. I tone, groan and sing with women during labour.

- Mary

I studied music therapy for several years. A couple of years later, when I was pregnant with my first child and armed with all my information, I made a tape of soothing, relaxing music to get me through my labor. When labor came I had no interest whatsoever in listening to music. I just wanted to tune out everything outside of myself and turn "in" to focus on my body and the baby. In the next couple of weeks, however, I played the tape over and over again as I snuggled my new baby. I've become quite attached to it as I've snuggled and breastfed all of my newborns to those songs.

- Kim

====

I do not have access to the Internet and so cannot look up the info on mortality statistics. If someone would email the information to me at auntie-freeze@juno.com I would certainly appreciate it.

- E.F.

====

In response to the Art of Midwifery column [Issue 3:1]: cabbage is known to dry up a nursing mother's milk supply. One needs to be very careful with cabbage application especially in the early days of a breastfeeding relationship. A better remedy might be to squeeze a little colostrum/milk on the nipples, gently massage it in and air dry. I would also check mother's positioning of baby at the breast to be assured that you are not dealing with a poor latch-on.

- Kathy Pennington RNC,CBE

====

From the author of a question about vertical incision c-section [Issue 2:51 and 52]:

I was in fact replying to a question about a woman whose transverse incision for her first had been modified to a quasi-vertical "j" shape for her second incision. She was wondering if she could go ahead and have a VBAC. I was making two points:

1) That a vaginal birth is possible even after a vertical incision.
2) That in cases where the medical profession really doesn't have the facts and figures, it is usually the case that they err on the side of caution and decide that it is too risky. That is, we don't have a lot of statistical information on vaginal births after vertical incisions, but it seems risky so that is the convention.
On the other hand, many midwives are less cautious and trust more in anecdotal evidence to confirm that what a client is trying to achieve may be possible.

- Anon.

Phil Watters wrote about VBAC after classical c-sec being just too risky [Issue 2:52]. In July, at age 41, I gave birth to our VBAC son, my 10th child who was born after two previous cesareans--a classical in 1997 for placenta previa and a 28-week baby in a transverse lie who had Trisomy 18 and did not live, and in 1999, an elective cesarean which was lower segment. You can imagine the reaction of our doctor when we suggested VBAC for our next baby. The more we read and researched the more we felt that many doctors really didn't have the full picture, and that their assumptions are based more on fear than facts. Nancy Wainer Cohen's book "Silent Knife" was like a breath of fresh air. Then via the Internet we found some stories from parents who had experienced uterine rupture.

I have a deep concern for young mothers who are being fed so many fear tactics that they approach birth just assuming they are going to need some sort of medical help, when in reality that should be only for the minority, not the majority. Our prayer is that couples will get back to the place of understanding that labour and birth are not an illness, but a very normal part of life, to expect it to be hard work and painful but to know that the reward is their own son or daughter who has entered this world without the effect of drugs.

- Debey Dreaver
Qld, Australia

====

Re: Virginia Birthing Freedom [Issue 3:1]: Don't all women already have this right, inalienably? How can anyone legislate where a woman will give birth? Or where a baby will decide to be born? Can I not choose to give birth where I will, and can I not choose to have whom I want at my birth? What about car births? Can a mother be considered in violation of law if she doesn't make it to her chosen place of birth before her child appears? What am I not understanding about this situation? It seems scary to me to pass a law "giving" a woman a right that she already has by nature. Can someone please help me understand why this is a need, or what is the situation here that this would be considered a good thing?

- K.


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