March 13, 2002
Volume 4, Issue 11
Midwifery Today E-News
“Prenatal Care”
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SEE YOU NEXT WEEK at Midwifery Today's Philadelphia conference, March 21-25,2002! Look for the conference program and all the general information, including status of CEUs, on the Midwifery Today Web site.

SIGN LANGUAGE INTERPRETER NEEDED for the Midwifery Today Philadelphia conference. If you qualify, you would receive the conference registration in trade. Contact

Midwifery Today has a unique opportunity to spread seeds of birth change and exchange in China. We are working with some exciting people in China to bring a joint conference to Guangzhou. It is an expensive propositon. We need help in sponsoring some of our teachers' flights.

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More Midwifery Today Conferences

"Healthy Birth"
Guangzhou, Guangdong, CHINA: June 7-9, 2002.

Get the full program online. The three-day conference will have components of Midwifery Today conferences as well as the presentation of several papers. Chinese doctors have been asked to arrange for midwives to be present as well as doctors, and it has been noted that we are interested in Chinese medicine. A hospital focused on the practice of Chinese medicine is located across the street from Shamin Island, where our venue is located.

"Revitalizing Midwifery"
The Hague, THE NETHERLANDS: November 13-17, 2002.

Get the full program online. A two-day midwifery education conference precedes three days of international conferencing.



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Quote of the Week

"The true sense of community lies in understanding our interconnectedness and acting from a sense of relatedness. It is a challenge. Let's begin at the beginning. That is where we can start to reweave the sacred web of life so that it once again becomes whole."

- Suzanne Arms

The Art of Midwifery

In-home prenatal care is a vital tool. Often, the more I learn about a family by observing them in their own home, the less I will intervene because I know the nuances of each family and know what is normal for them.

- Jill Cohen, lay midwife

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News Flashes

Researchers in Sydney, Australia undertook a double-blind, randomized, placebo-controlled trial to explore the effect and safety on labor and birth outcomes of raspberry leaf consumed in tablet form by nulliparous women from 32 weeks gestation until the beginning of labor. There were 192 participants. Each woman in the treatment group took a 1.2-g tablet of raspberry leaf herb twice daily. The control group received an inert tablet that was identical in appearance. The herb was found to cause no adverse effects for mother or baby. The only clinically significant findings were a shortening of the second stage of labor and a lower rate of forceps deliveries (19.3% vs. 30.4%) in the treatment group.

- Journal of Midwifery & Women's Health, Vol. 46, No. 2, March/April 2001

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Prenatal Care

The basic need of the developing brain must be expressed in terms of lipids. The fetus has a real thirst for highly unsaturated fatty acids, particularly those of the omega-3 family. The first way for the mother-to-be to satisfy the demand is to have a diet rich in preformed, highly unsaturated omega-3 fatty acids. In practice, this means eating sea fish from the beginning of the seafood chain.

The second way is to make sure that the maternal body will be able to transform the parent molecule of this family, which is abundant in the land food chain, into longer and more desaturated molecules. Yet certain hormones such as cortisol are blocking agents of the metabolic pathway of unsaturated fatty acids. People who are not happy release cortisol at a higher level, typically when they feel dominated by somebody or by a situation. We can conclude, from modern scientific data, that it is better for a pregnant woman to be happy.

Health professionals can have a spectacularly positive effect on the emotional state of pregnant women through their vocabulary, their attitude, and even their body language. They can also encourage, or even organize, events that are outside the framework of medical consultations. In the maternity unit at the Pithviers hospital in France, we used to meet around the piano and sing together on Tuesday nights: pregnant women, young mothers and newborn babies, midwives, cleaning ladies, secretaries, etc., could join the group. After singing, and often dancing, there was an atmosphere of happiness and even euphoria. Such sessions were probably more beneficial for the growth and the development of the fetuses than would be a series of sophisticated ultrasound scans or a Doppler screening of placental perfusion.

- excerpted and condensed from
Eat Sardines, Be Happy ... and Sing!
by Michel Odent, MD
, Midwifery Today Issue 59

Order Midwifery Today Issue 59 (Theme: Prenatal Care) online.

Language: It is important to remember the exquisite sensitivity of the pregnant woman. What you say and how you say it can have a profound impact on the attitudes and beliefs she brings to her birth experience. Be sure to praise her, letting her know at every step how well she is doing and how ideally suited she is to birth her baby. For example, instead of telling a woman her pelvis is adequate, you might say, "Wow, you have a wonderful pelvis! It's perfect." Instead of referring to risk factors, you could call them special circumstances. Instead of telling a woman what she is dong wrong, tell her what she is doing right first and then, when appropriate, direct her toward the healthier choice (e.g., "I see you are drinking more water and less sodas - wonderful. Also, you ate salad on Tuesday, and that's great. It would be fantastic if you ate a salad like that every day."

Remember, too, that the subconscious does not hear negatives such as not, don't, etc. So instead of telling a woman to focus on not tearing or not bleeding after birth (which the subconscious understands as an instruction to tear and bleed!), frame it in positive language such as "See your perineum stretching as the baby is born and returning to its original shape like a piece of strong elastic. You can get huge, as big as you need to stretch to let your baby out. Your uterus will continue to contract after the birth, the placenta will be born, and there will be very little blood," and so on. In short, think before you speak!

- Anne Frye
Holistic Midwifery Vol. 1: Care During Pregnancy

Labrys Press, 1995

HOLISTIC MIDWIFERY VOL. 1: CARE DURING PREGNANCY is available at Midwifery Today's Storefront. 1150 densely packed pages!

Conceptualizing the ideal outcome is an essential first step in providing effective prenatal care, because it helps determine which subsequent actions will support (or detract from) the realization of your aspirations. Working backward from the desired conclusion, form intermediate goals and step-by-step plans to reach them. If the challenges seem insurmountable, consider a Plan B and C without losing your focus as you continue to work hard toward your original dream. Consider the big picture as well as the details. What are your client's strengths? Her challenges? Your concerns? In striving for excellence, there's no room for "routine" care. Each person has a unique array of individual circumstances that merit personalized responses. Even if all the concerns cannot possibly be resolved, you always can at least improve something -- probably many things.

Compiling a thorough history and reviewing it together reveals vital insights to guide you ... Gradually the vision comes into focus. Repetitive weight, blood pressure, urine collection, and fundal height rituals provide structure around which you do your truly meaningful work. Leisurely visits, where discussions unfold without pressure, interspersed with friendly phone calls, uncover aspects of each woman that exemplify her strength, power, creativity, and one-of-a-kind grace and beauty. Everyone has a measure of these traits, and the midwife is charged with finding and magnifying them, helping a woman identify her resources, and building her up for the journey ahead. Family meetings allow everyone's questions to be addressed and a shared bond of trust to develop. One-on-one visits allow the privacy one needs to broach intimate topics. Problems are identified and tasks assigned. As goals are reached, they are highlighted and celebrated.

- Judy Edmunds, CPM
excerpted from "Providing Effective Prenatal Care"

Midwifery Today Issue 59

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Midwifery Today's Online Forums: Fifth's Disease

Anyone have experiences with Fifth's to share? I have two moms who are at risk for exposure. One is 35 wks and one is under 20 wks. Anne Frye has a good chapter on it in Understanding Diagnostic Tests in Pregnancy: avoiding exposure to an infected person, especially to body fluids, seems to be the key -- no changing diapers of a child with Fifth's. Any other ideas? The pediatricians here are not concerned for pregnant moms.

- April

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Question of the Week: Waterbirth

Q: We have more and more mothers who want to give birth in water. I've made a literature review and find it's very difficult to draw an objective conclusion about waterbirth. For many years I have practiced waterbirth but it's difficult to give confidence to my colleagues. It's always the same -- people remember only the bad things. I would like to hear reflections on the subject as well as some experiences.

- Dominique Porret, Quebec, Canada

Send your responses to:

[Editor's note: Please keep in mind our space limitations. Be helpful and informative, but succinct!]

Question of the Week Responses: Broken Coccyx

Q: A friend pregnant with her first child was told she must have a caesarean because her coccyx has a noticeable, abnormal curve and that in a vaginal birth, the baby would break it. I've heard of a sprained or bruised coccyx but never broken. Is a broken coccyx possible and avoidable? Is a trial of labor desirable in this case?

- Elizabeth Cheron

A: I once served a woman with a previously injured coccyx. During her homebirth she felt it pop -- she had refractured it. It didn't hinder the birth at all other than maybe having to push a little harder and longer than would otherwise have been needed. Baby was fine. I'd rather recuperate from a broken tailbone than from major abdominal surgery!

Because the coccyx bones are all "hinged" by relaxin-softened cartilage, it is especially important, with injuries or deformities in that area, to give it room to swing out away from the baby as it comes down the birth canal. This can be achieved in many positions, such as Sims, squatting, standing, kneeling, etc. The woman shouldn't sit or lie on it!


A: I have known a couple of women to whom this happened and except for a long, painful recovery of their tailbone, all else was OK. I would personally prefer going for a vaginal delivery rather than a c-section because the problems associated with a c/s far outweigh the problems that MIGHT occur if her tailbone breaks. Besides, no one said it will definitely break. Odds are it will scoot nicely out of the way, especially if she births in any position other than on her back and if forceps are avoided.

-M. Durbin, CNM

A: During the delivery of my first child (3 weeks late and 11 lbs, 6 oz) I believe I broke my coccyx. My tailbone was severely sore, but because I didn't know that wasn't normal, I never asked. Thirteen years later, my tailbone at the coccyx is bent at a 90-degree angle. I have never been questioned about it nor has any physician even noticed. I have since had three more children (one by c-section) without any related complication. Women were never meant to have babies while lying down or on their backs. That goes against the laws of nature and a woman's anatomy.

-Julie Ives

A: I attended a birth as a doula for a woman who broke her coccyx in the 7th month. The doctors were worried that it would refracture, but she delivered vaginally with no problems. Of course, every woman is different. I think a lot of it depends on the size and position of the baby, as well as the level of pain caused during the labour by the coccyx-risk. She should weigh the risks involved with a trial of labour against the known risks of c-section.


A: According to a lay midwife in New Zealand who teaches birthing skills, it is possible to massage the coccyx bone and actually push it downward. She encourages all her mothers to do this. The coccyx apparently is quite flexible, it has a cartilaginous joint, and can be moved backward. I would be inclined to do this as a first step and it may well solve the problem.


A: Nobody can tell what the os coccyx will do when a woman is in labour. It is absurd to predict that it will break during labour -- not because it wouldn't be possible, because it is, but because it's unpredictable how bendable it is during labour. It would make much more sense to consider positions during labour that will lessen the risk of damage to the os coccygis, like sitting on hands and knees.

-Rebekka Visser, Amsterdam, The Netherlands

A: As an osteopathic, board-certified obstetrician/gynecologist who has personally had my own dislocated coccyx put back in place, it seems this woman might want to explore having her coccyx evaluated by an osteopathic physician who does osteopathic manipulation and is comfortable with techniques that reposition the coccyx. Repositioning is done by pressing it back into position through the rectum. When my coccyx was dislocated, it hurt terribly and was acutely inflamed, and repositioning it was painful, but soon after the pain disappeared and it's been fine ever since. If this woman's coccyx is in fact malpositioned, perhaps it could be repositioned. At least an evaluation by someone who is familiar with what I describe above would give this woman a broader sense of what her true options might be. Just getting a second opinion from another ob/gyn might be valuable. It seems strange to limit this woman's option to c-section only.

-Dr. Eden


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!

More on bipolar medication [Issue 4:9]:
Dr Thomas Hale is the leading US expert on antidepressants and breastfeeding. Check out his Web site or books. Essentially, all SSRIs are present to some extent in the milk. A study of kindergarteners exposed to SSRIs in-utero showed no differences socially or academically compared to the nonexposed control group. In my opinion, an appropriately medicated mom is much better than a depressed/manic, potentially abusive mom.

- Lynette

I have epilepsy and am the mother of two children, both of whom have anticonvulsant syndrome. When born, both children showed signs of withdrawal from the medication I took during pregnancy. The drug was Epilim (sodium valproate). Both children were born with dysmorphic features, hypotonia, difficulty with feeding and were very sleepy. As they have grown they have had difficulties with development and have speech and language problems, hearing and vision difficulties, and learning difficulties.

We set up a support group in the UK and have spread not only nationally but internationally. Our Web site is at present under construction but there is a poster there explaining the syndrome. The address is

- Janet Williams

In response to the question about hepatitis B [Issue 4:10]:
It sounds like the woman is recovering from hep B but is still contagious. Immune globulin and vaccination are a good idea for the newborn because hep B is much more serious when acquired perinatally, with 85-90% of neonatal infections progressing to chronic-carrier state. The baby should also have an immediate bath, the immune globulin should be given within 1 hr of birth, and the baby should also be followed up by a pediatrician. *Maternity and Women's Health Care* from Mosby gives clear explanations of management for hep B. Did they test for HBVeAG (hep B virus antigen)? Positive for that would be the most contagious and put the baby at the highest risk.

- Charity Bailey, midwifery student, New York

A friend had the LEAP procedure done a couple years ago that resulted in the removal of some cervical tissue. She has had some pain during intercourse since the procedure. She is now expecting her first child and wonders what to expect as far as pain during dilation and birth. Does anyone have experience with this procedure and how it affects birth?

- Kimberly Lenderts, student midwife

EDITOR'S NOTE: Only letters sent to the E-News official e-mail address,, will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will not be considered.


I am writing a book about cesarean recovery. My research includes a questionnaire for women who have experienced cesarean births. It is located at: Please participate and share this link with other women.

- Carol Gray

Classified Advertising

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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