January 16, 2002
Volume 4, Issue 3
Midwifery Today E-News
“Healing Perineal Tears”
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Midwifery Today Conference News

IMPROVING YOUR PRACTICE WITH RESEARCH, INSIGHTS, AND REALITIES: class taught by Michel Odent, MD. Learn how to look at birth through the eyes of a physiologist. Class presented at Midwifery Today's conference in Philadelphia, Pennsylvania, March 21-25, 2002. Look for the conference program on the Midwifery Today website:
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UPCOMING CONFERENCES

Guangzhou, Guangdong, CHINA, "Healthy Birth": June 7-9, 2002
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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Healing Perineal Tears
5) Check It Out!
6) Midwifery Today Online Forums: Midwifery in England
7) Question of the Week: Placental tear
8) Question of the Week Responses: Circumvallate placenta
9) Switchboard
10) Classifieds

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QUOTE OF THE WEEK

1) "I threw away the things I was trained to do. I had to go back to basics, go back to nature and let this body, this woman, this pregnancy, grow on its own steam. Remember, if you're getting your training among wolves, you're going to act like a wolf."

- Tom Brewer, MD

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2) The Art of Midwifery

I helped a massage therapist friend who was trying to introduce more people to the benefits of this therapy. As part of a marketing plan, we correlated all the information she had on how clients were referred to her. We discovered over 85% came by word of mouth. As a consequence, she stopped wondering about expensive advertising and instead focused more on talking to people she met. I believe this is also how it works in the world of birth. We simply must keep talking to people, one at a time, and ensure they have both sides of the picture in terms of the information upon which they will be basing their birth decisions.

- Sara Wickham, Midwifery Today Issue 44

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MIDWIFERY TODAY ISSUE 60 (current issue): 23 full-length articles for
birth practitioners and parents searching for information about birth.

View MT Issue 60 contents here:
http://www.midwiferytoday.com/magazine/issue60.asp

Read these new articles from Issue 60:

A Natural Alternative to Suturing
http://www.midwiferytoday.com/articles/default.asp?t=suturing

Education Priority Check
http://www.midwiferytoday.com/articles/default.asp?t=education

Order MT Issue 60 here:

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3) News Flashes

Researchers at the University of Illinois reviewed cases of maternal mortality for a 7-year period. They found a rate of 22.8 deaths per 100,000 births, a rate several times higher than that obtained from national death certificate data in the United States. Of these deaths, 37% were deemed preventable, and a provider factor was determined to be the cause in more than 80% of the cases. The leading causes of death were pulmonary embolism and cardiac disease.

- Amer J of Ob and Gyn 2000 183:1207-12

4) Healing Perineal Tears

While on an Indian reservation, I had studied with a shaman and observed the use of seaweed to heal burns and deep lacerations. I decided to use seaweed in a similar manner to promote healing of a perineal tear. I cut a piece of seaweed that was twice the length and width of the tear, folded it in half, and moistened it with sterile water. I placed it down the center of the tear and brought the edges of the tissue together, carefully aligning them. I also covered the entire length of the tear with a second patch of moistened seaweed. Before departing, I included in my postpartum care plan instructions for the mom to replace the outer patch of seaweed each time she used the bathroom. I also instructed her to keep her legs together and to stay in bed as much as possible, caring only for herself and the baby.

Upon my arrival 24 hours later for the first postpartum check, all was well with mom and baby. Breastfeeding was going very well. When I examined the perineal area, I discovered the tissue had healed miraculously well. I could not even distinguish a separation of the tissue where the tear occurred. The mom also had virtually no pain in that area. She mentioned that the salt in the seaweed stung a little when first applied but quickly faded to a healing tingle.

Ever since that birth in 1986, I have been using seaweed patches with great success as an alternative to suturing. I have taught this technique to other midwives and apprentices. They have also been pleased with the results.

- Denise Gilpin-Blake, LM

(Read this article in full at:
http://www.midwiferytoday.com/articles/default.asp?t=suturing)

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Post-suturing: If there is swelling after the repair, apply an ice pack (crushed ice in a sterile glove works fine). Make sure to tell the mother to rinse with warm water with a squirt of Betadine added, each time she uses the toilet. After the first 24 hours it is perfectly OK for the mother to soak in the bathtub. It will not dissolve the sutures. It is also a good idea to expose the perineum to a lightbulb or sunlight to dry it. The mother should avoid applying vitamin E or other oils to the wound as these retard the healing process. If you have done a good job, the majority of the healing will take place within a few days.

- Elizabeth Davis, Heart & Hands, 3rd ed., Celestial Arts 1997

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To relieve pain and soreness when suturing perineal tears, try tea tree oil. The oil also helps the perineal tissue recover and helps prevent infection. Tea tree oil penetrates below the upper skin layers, soothes and relieves pain, is a natural antiseptic, and is noncaustic to most skin types.

- Tricks of the Trade Vol. 2, a Midwifery Today book

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TRICKS OF THE TRADE is available in three volumes, each one full of techniques, tips, articles, formularies, drawings, and photos. Order yours today:

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5) Check It Out!

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A Web Site Update for E-News Readers

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A NATURAL DELIVERY OF VERTEX TWINS video. Institutional and individual prices available. To order, go to:
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6) Midwifery Today Online Forums

I'm an aspiring midwife living in England. I haven't come across doulas in this country or had the chance to be an apprentice without going to college. I am (hopefully) taking the plunge in September, which is quite scary as I don't actually know anyone else in my position at the moment. Scary, but very exciting! Any advice/encouragement would be appreciated from any of you, but especially anyone in England.

- Kristal

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Go to our forums to share your thoughts and experience.

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7) Question of the Week

Q: What can be done to repair a small placental tear in the third trimester? A client lost her baby in the seventh month of pregnancy as a result of a tear in her placenta. She is pregnant again and due in May. Her OB told her he could see a small tear on her placenta. Apparently there was only a 10% chance of this happening again. Is there anything she can take or do to help correct this problem?

- Anon

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SEND YOUR RESPONSE to mtensubmit@midwiferytoday.com with "Question of the Week" in the subject line.

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8) Question of the Week Responses

Q: A mom just delivered after a 43-week pregnancy. The labor was terribly long but OK for her. The baby looked 40 weeks; the gestational age came in at 38 weeks. There is no way we were off on dates. She had a circumvallate placenta. The cotyledons were really mushy where they tore really easily. I've read that a circumvallate placenta has a higher risk for postpartum hemorrhage, which she had - a long, trickle bleed. What causes this type of placenta? Did it cause her baby to stay in so long yet look and test out to be a normal, term baby?

- Heather Zanon

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A: I recommend the book Placenta: To Know Me Is To Love Me, by Doris Schuler-Mahoney, MS. It states: Clinical Associations: White; hypertensive states of pregnancy (preeclampsia, eclampsia); maternal cigarette smoking while pregnant; or it may be familial. Etiology: unclear. Suggestions include: abnormal implantation (too shallow or too deep); uncoordinated placental growth and uterine growth; placental marginal separation with hemorrhage; oligohydramnios; cigarette smoking; preeclampsia and eclampsia. These are all thought to cause decreased uteroplacental blood flow particularly to the placental margin, with subsequent decidual necrosis. This wonderful book is a great tool. I was introduced to it by the Ancient Art Midwifery Institute.

- Jennifer Crowley, CBE, doula, midwifery student

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A: I imagine the placenta had nothing to do with either the fact she went postdates or that the baby looked only term. We shouldn't be surprised that a 43-week baby is born without signs of postmaturity. The majority of them show no signs or symptoms of the syndrome. A generally accepted statistic to keep in mind about postdates is that less than 10% of babies born after 43 weeks actually show signs of postmaturity syndrome. Given that fact, one could conclude that the calendar is actually a rather poor predictor of postmaturity syndrome! This means that the vast majority of women who are induced at 42 or even 41 weeks to prevent "postmaturity" are being unnecessarily induced (and possibly sectioned for failed induction) since the risk of postmaturity is so low for them.

- Gail Hart, midwife
Oregon

9) Switchboard

Re: transverse baby [Issue 4:2]:

I would have her do a lot of hands and knees things, mop her floors, etc. Have her take homeopathic Pulsatilla 30 C potency. See if she can find a Walkman and listen to recordings of some Mozart concertos. Chiropractic and acupuncture can also help. I used all these methods, except acupuncture, and my son (twin "A") turned from breech to vertex at about 35 or 36 weeks. But by far, it seemed to me that it was prayer, not just mine but also the prayers of my family and friends, that helped.

- Holly Sippel
Peabody, MA

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A wonderful, short magazine article written by Andrew Weil MD tells of his wife having a guided visualization experience by telephone with a practitioner to help turn the baby (which was breech or transverse). Twenty minutes later, as Weil puts it, "she clutched her belly and bent over, saying, 'I think the baby's turning.'" This was later confirmed by the midwife. The article appeared in 1995, I think, perhaps in New Age Journal.

- DW

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A midwife once told me that for persistent breeches, do a handstand in the pool. The water supposedly equalizes pressure and allows the baby to turn. Since that time I have known two women with stubborn breeches, an upcoming due date, and a doctor with itchy scalpel fingers. Both tried this and both babies turned (one at 39+ weeks). Tell her to try an underwater handstand a few times - if she feels the baby moving get out of the water so baby can't flip head up again. If she feels nothing, don't give up hope. One of the ladies, pregnant with her fifth child, didn't feel anything, but her baby was head down at her next checkup.

A midwife friend once did a version. She placed her hand behind the head and before the knees and just gently pushed and talked to the baby. Whoosh! The baby turned and dived head down - it took about 5 minutes. I know some doctors put women in the hospital and give them drugs to relax the uterus and for the pain they inflict while they try to muscle the baby into position. Personally, I'd go with the midwife!

- Cat

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Do a search of back issues of Midwifery Today E-News for some excellent information about turning a baby. Go to: http://www.midwiferytoday.com/enews/subscribe.asp and use the search function in the upper right corner of the page.

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"According to Henci Goer in her book, Obstetric Myths vs. Research Realities, external version, or turning the baby from the outside, is a viable option before resorting to cesarean or vaginal breech birth. This involves turning the baby by manipulating the woman's belly and monitoring with ultrasound. While there is an average success rate of 63% it is important to note that the risks of external version include: a prolapse of the umbilical cord, uterine rupture, premature rupture of membranes, cord entanglement, placental abruption, hemorrhage, and preterm labor. Each woman and pregnancy should be evaluated on an individual basis. The chapter about breech presentation is an excellent synopsis of the clinical literature on this topic and is well worth reading.

Another alternative to investigate is the Webster chiropractic technique that is used to encourage the baby to turn. As with external version, it is important to find a care provider with training and experience in applying this technique. Also, in The Birth Partner, Penny Simkin describes a posture or exercise called a breech tilt. Apparently this posture encourages some babies to turn head down when done in the last six weeks of pregnancy. Supposedly placing earphones low on the mother's abdomen and playing rhythmic music may encourage the baby to turn to better hear the music. Another excellent source of suggestions for turning a breech, or making the choice between vaginal or surgical birth, is Anne Frye's book Holistic Midwifery.

- Amy V. Haas, BCCE

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HOLISTIC MIDWIFERY VOL. I is available from Midwifery Today. To order,
go to:
http://www.midwiferytoday.com/products/C610HM1.htm

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As a doula I have come across a great number of occiput posterior presentations lately. I am looking for suggestions to encourage turning, barring the manual manipulation I am not trained to do. Things I know of are: cat-cow, walking, squatting, swimming, pelvic rocking, hot tub/relaxation. What else is out there?

- Doula in RI

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My first doula client is due in February with her first baby. She is 35 and wants a natural unmedicated birth. She has bad hemorrhoids, which she says she has had since a child. She tells me they are very painful and if she strains on the toilet, they pop out and bleed. All my books suggest a diet full of vegetables but her diet is mostly healthy yet they still persist.

Do you think the hemorrhoids will affect her chances of a natural delivery (the hospital she is birthing in has a high cesarean rate)? I have suggested she try birthing in the pool, and she is keen to try squatting on my birth ball and wants to deliver on all fours. Does anyone know of any tricks to help her? I have read about putting a damp cloth over them and literally pushing against them while she pushes the baby out.

- Debra

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I am a team midwife working in an English maternity unit and we are looking at postnatal visits at home. At present we visit selectively for the first 10 days, usually first day at home visit, day 7 to weigh the baby and take the Guthrie test (PKU), and day 10 to discharge the mum and baby to the health visitor. We then can visit for up to 28 days for further support if required. We have maternity care assistants who also give support visits and have just introduced postnatal clinics. With the shortage of staff a problem we are looking at other care pathways that may be suitable for the postnatal period. What do other units, in the UK or the rest of the world, do? What do you think we should do?

- Anon.

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Re: Looking for training in Virginia [Issue 4:2]: It is unclear whether you already have done the studying/testing for the CPM, but if you wish to continue studying, then I would suggest a distance learning course. If you want intense hands-on experience consider spending time at La Maternidad La Luz in Texas or going to Jamaica - they'll give you an invaluable experience. Check out The Farm - they have wonderful workshops and classes. There are others and Midwifery Today's book Paths to Becoming a Midwife [see ordering info above] and their journal [Midwifery Today magazine] also list ads in the back.

- Anon.

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I respect each individual's decision regarding choice of educational path toward becoming a midwife. However, that choice should be an informed one based on fact, not on hearsay or stereotypes. As a professional registered nurse (RN) practicing nursing since 1970 I have not met the nurse described "kow-towing" to physicians. The practice of nursing and medicine are separate, but we must be able to work together as directed by state licensing laws. I encourage Ms. Williams to contact an area college nursing program to learn firsthand what professional nursing practice entails.

- J. O'Connor RNC BS LCCE FACCE

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Is it possible to breastfeed triplets? How is the best way to do it - two babies at the same time and then the third one? After 20 or 30 minutes of breastfeeding, normally there is a latency time during which the breast cannot produce milk for a while. Would this be a problem for the third baby put at the breast? Should the mother try to breastfeed or should she give up and give the bottle?

- Lorraine, midwife

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Re: vaginal adhesions [Issue 4:2]: My daughter had this; her pediatrician, who avoids prescribing medications, advised against using hormone cream. He said usually an adhesion opens on its own naturally, if not in infancy, then at puberty. He said when hormone cream is used the adhesions often reappear once treatment is stopped. At 9 months, my daughter's adhesions have disappeared.

- Anon.

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Women are often encouraged to take calcium in pregnancy and breastfeeding, but excess calcium is said to cause/encourage the formation of kidney stones. Anyone needing to take calcium should always drink plenty of water and avoid dehydration.

- Terry, independent midwife
Hobart, Tasmania

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EDITOR'S NOTE: Only letters sent to the E-News official email address, mtensubmit@midwiferytoday.com, will be considered for inclusion. Letters sent to ANY OTHER email addresses will be destroyed.

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10) CLASSIFIED ADVERTISING

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The International School of Traditional Midwifery in Ashland Oregon is accepting applications for school director, classroom instructor and clinical preceptors. For information contact Kaela at 541-482-8597.

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The International School of Traditional Midwifery in Ashland Oregon is accepting enrollment for 2002 classes that start in May. For information contact: ISTM Catalog-MTEN, 3607 Hwy 66, Ashland, OR 97520 or call 541-488-8273.

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