January 17, 2001
Volume 3, Issue 3
Midwifery Today E-News
“Preconception Counseling”
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THIS WEEK'S ISSUE

Contents:

  • Quote of the Week
  • The Art of Midwifery
  • News Flashes
  • Preconception Counseling
  • Check It Out!
  • Midwifery Today Online Forum
  • Question of the Week
  • Question of the Week Responses
  • Share Your Knowledge: Coming E-News Themes
  • Question of the Quarter: Midwifery Today magazine
  • Switchboard

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The International Alliance of Midwives (IAM)

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Quote of the Week:

"A skilled midwife is one who directs the responsibilities of pregnancy and birth back to the parents and offers herself as a guide, support and resource person."

- Alison Parra


The Art of Midwifery

Herb specialists find the mineral supply to be very low in most women these days. The thyroid needs lots of minerals to function properly. Taking care of this need before starting another life would benefit the way a pregnant woman feels. An herbal combination "Three," with alfalfa, dandelion and kelp, has been a favorite with our pregnant clients. These are herbal foods that are king of minerals.

- Anon.

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News Flashes

Data on the incidence of placenta previa and its associations with previous cesarean delivery and abortions were abstracted from 36 studies. A strong association was found between having a previous cesarean delivery, spontaneous or induced abortion, and the subsequent development of placenta previa. The risk increases with number of prior cesarean deliveries. The researchers conclude that "the study provides yet another reason for reducing the rate of primary cesarean delivery and for advocating vaginal birth for women with prior cesarean delivery."

- Amer J Obstet & Gyn, Vol. 177, No. 5, 1071-8


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Preconception Counseling

Following are a few of author/midwife Anne Frye's points to discuss with a couple who are thinking about getting pregnant:

- Women who are 15% below their ideal weight can be told the benefits of gaining a few pounds before conception. Providing an extra cushion of calories can take them through the early pregnancy discomforts such as bouts of nausea.

- Overweight women should be warned not to go on a crash diet before conceiving. This is likely to deplete their bodies of stored nutrients, which could adversely impact a pregnancy. However, they can begin eliminating junk foods and start a program of moderate exercise.

- Carefully review a woman's diet and lifestyle habits (smoking, drugs, etc.) and support her to curtail harmful habits and make dietary adjustments now.

- A program of vitamin and mineral supplementation and nutritive herbal infusions such as alfalfa, nettles and red clover will maximize her health before conception. Be sure a woman knows to begin taking at least 0.4 mg of folic acid daily to reduce the likelihood of neural tube defects in the baby. This should begin at least one month before trying to conceive.

- Vegetarians who eat no dairy products can be advised to begin taking 3 micrograms of B12 two to three times weekly.

- Ask about the work and environment of both parents and inform them of any associated risks.

- If social services or other community resources are available to a woman, given her income and other factors, make her aware of those now so she can explore when and if she is eligible.

- Discuss how emotional factors are impacted by pregnancy and parenting, and explore options if issues need to be dealt with through therapy.

- Be sure to let women know to avoid taking any over-the-counter or prescription medications; also discuss exposure to environmental hazards which should be avoided before conception.

- Anne Frye, Holistic Midwifery, Vol. 1: Care During Pregnancy, Labrys Press, 1995.

It is not uncommon for potential new parents--even those who deeply desire and feel they have prepared for their child--to also feel some ambivalence about conceiving and giving birth to a new life. Having a baby requires major shifts in your lifestyle and relationships, as your priorities will be forced to change. Once you become pregnant, you may experience a wide range of conflicting emotions.

There is a difference between healthy ambivalence and chronic ambivalence about becoming a mom or dad. Healthy ambivalence includes the natural tendency to have fleeting fears or doubts about yourself, your partner, or your future child. Chronic ambivalence is characterized by a persistent pattern of reluctance to becoming a loving parent. Continual hesitation about your readiness to handle the challenges of parenthood can profoundly affect your ability to bond with your future child, thus leaving yourself and your baby vulnerable to significant emotional pain. Prospective fathers are also vulnerable to emotional upheavals as they adjust to their future relationship to the new child, along with profound changes in their partner.

It is important that you both invest some time clarifying whether your anxieties about having a child are motivated by a true unreadiness to bond with your little one. During the earliest stages of a prenate's life, a profound connection can be instilled between you and your child. Psychological and biological studies show that a first-trimester fetus possesses enough self-awareness to sense chronic rejection from an ambivalent mother. Dr. Thomas Verny states that "a mother's anxiety-provoking hormones" can flood her baby's system, "making him worried and fearful." The developmental significance of emotional dependency between mother and child beginning in utero suggests that postnatal bonding is a continuum of security that, if missed, can cause a lifelong primal wound.

- Carista Luminare-Rosen, Ph.D., Parenting Begins Before Conception, Healing Arts Press, 2000


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:

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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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Check It Out!

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Midwifery Today's Online Forum

I recently attended a birth as an assistant where there was a moderate hemorrhage. Since then in discussion it has been mentioned that there may be a connection between postpartum hemorrhage and decreased milk supply. This mom feels that she is not producing enough milk. I have seen this with another birth about a month ago. Both moms are grand multips in their early 40s. I wonder if anyone else has heard of this connection??

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Question of the Week

A friend is due on Feb 8 with her first baby. She is 5' 4" roughly, average weight, and her baby has been in a transverse position for the last few weeks. As far as I know there are no pelvic problems in her history. She has been doing the "lying-on-the-ironing-board" trick to try and turn baby but is looking for other techniques. She asked about moxa and acupuncture, which I didn't know enough about. She is seeing an OB who definitely has the conservative, surgical mindset. She has an appointment in two weeks where a decision will be made about scheduling a c-section. I know sometimes there are reasons that baby stays in a certain position and turning may not be the best thing to do for baby; however, I welcome any thoughts, comments or ideas that might help her have a different option other than surgical birth. She is open to alternatives, so anything is welcome.

- Marisa White

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Question of the Week Responses

Q: 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

A: Betty-Anne and Ken of the MANA statistics committee shared some interesting data in 1996 at the MANA conference. Using the MANA stats, they determined that doing pregnancy perineal massage increased a woman's risk for more third and fourth degree tears. However, not doing it meant more tears overall but they were first and second degree tears. I stopped encouraging women to do pregnancy perineal massage, and do not do perineal massage in labor either. I would much rather have more first and second degree tears that I can suture if needed, than have to transport for third and fourth. I would say in talking to midwives we all do less hand work on the perineum--some oil, support and maybe some warm compresses. I think this approach has contributed to my having to do less suturing since I heard the news and heeded the advice.

- Kerry Dixon, CPM, LM


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

3. 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

I have been incorporating essential oils into my midwifery practice for over four years. At first I was extremely cautious and skeptical, but after extensive documented research, I have grown to appreciate their specific uses. I also have each woman smell the essential oil before I even think about using it because if an oil doesn't smell "good" to a person, they shouldn't use it.

I highly recommend the book Aromatherapy For Health Professionals by Shirley Price and Len Price. The second edition, 1999, has lots of excellent documented information about many different essential oils during pregnancy, birth, and postpartum. The studies have been conducted mostly in England, where they are very experienced in aromatherapy.

There are many different aromatherapy organizations that may be able to provide you with information. The National Association for Holistic Aromatherapy, in Boulder, Colorado, is one such source.

- Alison
====

More on home/hospital birth:

I am an ex-homebirth midwife of 18 years turned CNM (four years) and am now a midwife in a small rural hospital. While we may be unique in that we do rare intrathecals and inductions, you have to know the "battle" is not just with hospitals/providers, but women and our culture! Women are scared of birth and pain and they HATE being pregnant. I think it is largely socio-economic and results from lack of love and support in their lives. Just so you know, there are women out there who beg for inductions, drugs, ultrasound, etc. My clients are young, poor, single, usually without a car, job, often being abused, or doing drugs in some fashion (especially tobacco). So please do not generalize and judge so completely or you will end up sounding just like those "hospital people" who do it.

- Anon.


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Midwifery Today: Each One Teach One!