April 3, 2002
Volume 4, Issue 14
Midwifery Today E-News
“Stretch Marks”
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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.

"Five-Day Intensive Workshops"
Eugene, OREGON: August 26-30, 2002

Choose from one of two intensive workshops:

  • "Working with Women - The Heart of Midwifery Care" with Verena Schmidt from Italy
  • "Shiatsu for Midwives" with Suzanna Yates from England

"Revitalizing Midwifery"
The Hague, THE NETHERLANDS: November 13-17, 2002. A two-day midwifery education conference precedes three days of international conferencing.


THIS WEEK'S ISSUE

Contents:

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Quote of the Week

"Focus on what you can do, then do it with all your heart."

- Lois Wilson


The Art of Midwifery

An isolated increase in blood pressure at the end of pregnancy is more often than not a propitious sign of good placental activity: the placenta, which is the "advocate of the baby," asks the mother to provide a little more blood. When a health professional presents this physiological response as bad news, although it is radically different from the disease preeclampsia, the nocebo effect may be dramatic.

- Michel Odent, MD

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News Flashes

A study of 265 breastfeeding mothers in New York examined the effects of pacifier use on breastfeeding frequency and duration. On average, infants who used pacifiers were breastfed eight times a day compared with nine times a day among babies not given pacifiers. The babies who used them also spent less overall time breastfeeding. In addition, mothers who turned to pacifiers weaned their babies off the breast one month earlier than those who relied solely on breastfeeding.

- Pediatrics, 1999


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Stretch Marks

Some women report gaining a pound or two per week as the harvest time draws near. Good attention to this inevitable reality in the earlier part of pregnancy is the best way to nourish the skin and prevent stretch marks. Keeping the skin supple and hydrated with certain herbs can be beneficial.

The ideal herbs for this use are classified as emollients and vulneraries. Emollients are cooling in nature and moisturizing, and they give elasticity to tissues and membranes. These types of herbs are specific for skin issues and allow deep penetrating action and healing. Vulneraries promote healthy growth, repair on a cellular level, and are suited for both internal and topical use. They work well in a natural oil base applied externally right where they are needed. They all share nutritive tonic qualities and are perfectly safe for extended periods of time. The following herbs have all these qualities:

  • comfrey (Symphytum officinale)
  • chickweed (Stellaria media)
  • violet (Viola odorata)

Herbal Oils and Butters. Herbal oils are a type of extract similar to an alcohol- or water-based extract. An herb infuses a selected oil for a period of time, and the oil then is strained and bottled. Any quality vegetable oil will do; some good choices include olive, almond, apricot kernel, or coconut. These oils are easily absorbed and have moisturizing qualities of their own. Oils of this nature are naturally abundant in vitamin E and preserve well.

When preparing an herbal oil, dried herbs must be used. Fresh herbs tend to leak moisture from the plant into the oil, causing spoilage. Fresh wilted plants can be used, but the plant material must be sufficiently free of internal water.

Fill a clean, dry glass jar about one-third full with dry plant material and pour in the oil, covering the herb completely and filling the jar to its brim. Cap tightly and let it sit away from direct light or heat for 2-4 weeks. When the steeping time is complete, strain the oil through a cloth-lined sieve and store in a clean glass bottle. Herbal oils can be applied freely to the stretching belly as often as the mother likes.

Stovetop method: Place water in the lower pan of a double boiler and the oil and herbs in the upper pan. The oil/herbs must be sufficiently warmed but not boiled -- boiling oil immediately spoils it. Simmer the oil and herbs for 20 minutes. Strain and bottle as usual.

Herbal Belly Butter. Use an herbal oil as a base and warm it on the stove -- do not boil. Add 1 teaspoon of grated beeswax to 1 ounce of the warm oil. Melt and blend well. Add additional drops of oils such as jojoba, wheat germ, cocoa butter or vitamin E. These are highly concentrated emollients and will add to the overall richness of the butter.

Test the butter by placing a small amount on the tip of a teaspoon and place the spoon in the refrigerator. Check the spoon after a few minutes. The butter will have solidified to its final consistency, and at this point you can adjust it as needed. Adding more oil will make a softer butter and adding more beeswax will create a firmer one. Remove to a small shallow jar and let it cool, uncapped. When the butter has completely solidified, cap it and store in a cool, dry place. Apply liberally as needed.

- Susan Perri, The Birthkit No. 32, Winter 2001


Learn more about The Birthkit by clicking here.
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Check It Out!

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

CONFERENCE AUDIOTAPES FOR THIS WEEK'S THEME

AND MANY MORE!


LOOKING FOR A MIDWIFERY WORKBOOK to help you with your studies? The Birth Song Midwifery Workbook has eleven chapters that cover the basics of normal birth and midwifery. Included are exercises, informative line drawings and a nine-page glossary of midwifery terms.


THINKING OF BECOMING A MIDWIFE? Life of a Midwife, a Midwifery Today book, tells you all about what it's like to be one.


INTERNATIONAL ALLIANCE OF MIDWIVES
Midwifery Today's Web-based organization that networks international midwives.


Midwifery Today's Online Forums: Rhogam

In a recent issue of Mothering magazine, I read that Rhogam has mercury or a form of it as a preservative. Does anyone know if there is a mercury-free version of Rhogam available?

Go to our forums to share your thoughts and experience.


Discovery Health Channel

Attention Midwives and Doulas!
The Discovery Health Channel Needs Your Help

The Discovery Health Channel's top rated show "Birth Day" is gearing up for its third season. The producers are looking for mothers who are interested in featuring their delivery for this daily series. If you live in the Albuquerque, St. Louis or Philadelphia area and know of a mother who will deliver during our shoot dates please let us know! Those days are as follows:

  • Philadelphia: April 2 - May 1, and June 10 - June 28, 2002
  • St. Louis and Albuquerque: April 15 - May 17, 2002

Birth Day is produced by Banyan Productions and is the #1 rated daytime series on the Discovery Health Channel. For more information please contact Mary Beth Anderson at (215) 928-1414 or manderson@banyanprod.com.


Question of the Week: Muscular Dystrophy

Q: A woman with muscular dystrophy is planning to get pregnant for the first time. She leads an active lifestyle. She attributes her good health to her daily swimming routine, which she plans to continue if she gets pregnant. An obstetrician has told her she will definitely have to have a cesarean section. She would like to have a waterbirth, preferably at home, but we really don't know how the pregnancy will affect her physical fitness and capabilities. We would love to know of other women's and midwives' experiences.

- Anonymous

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Question of the Week Responses: Hepatitis B

Q: How many of today's midwives, doulas, and others in the birthing field feel the need to get the hepatitis B vaccine? I believe the actual incidence of contracting this disease is low, but I wonder what other professionals think.

- Christy, doula
Illinois

A: A logical way to approach issues such as vaccines is to look at risk/benefit. The hepatitis B vaccine is made by genetically altered bacteria, which makes it very safe, as it is not a live attenuated virus nor a blood product. The risk for most midwives of acquiring hepatitis B is very low, especially if you have your moms tested for antigen and know their status. The risk of serious lifelong sequelae or death for someone who has hepatitis B is about 10%. I feel better knowing I'm vaccinated.

-Anonymous


A: While the incidence of contracting hepatitis B via nonintimate contact is low, the postinfection effects of the disease are not insignificant. Any break in the skin could put you at risk for contracting HBV. I work in a drug-treatment facility and I see the long-range effects of both HBV and HCV.

Below is information from the Centers for Disease Control.

The hepatitis B virus (HBV) can cause short-term (acute) illness that leads to loss of appetite, diarrhea and vomiting, tiredness, jaundice, pain in muscles, joints and stomach. It can also cause long-term illness that leads to liver damage (cirrhosis), liver cancer and death. About 1.25 million people in the U.S. have chronic HBV infection. Each year it is estimated that 80,000 people, mostly young adults, get infected with HBV and 4,000 to 5,000 people die from chronic hepatitis B.

Hepatitis B virus is spread through contact with the blood and body fluids of an infected person. A person can get infected in several ways, including by having unprotected sex with an infected person, by sharing needles when injecting illegal drugs, by being stuck with a used needle and during birth when the virus passes from an infected mother to her baby. About one-third of people who are infected with hepatitis B in the United States don't know how they got it.

Adults at risk for HBV infection include people who have more than one sex partner in 6 months, men who have sex with other men, sex contacts of infected people, people who inject illegal drugs, healthcare workers and public safety workers who might be exposed to infected blood or body fluids, household contacts of persons with chronic hepatitis B virus infection and hemodialysis patients.

People should get 3 doses of hepatitis B vaccine according to the following schedule. If you miss a dose or get behind schedule, get the next dose as soon as you can. There is no need to start over.

For an infant whose mother is infected with HBV: First dose, within 12 hours of birth; second dose: 1-2 months old; third dose, 6 months old.

For an infant whose mother is not infected with HBV: First dose, birth to 2 months old; second dose: 1-4 months old (at least 1 month after the first dose); third dose, 6-18 months old.

For an older child, adolescent, or adult: First dose, any time; second dose, 1-2 months after the first dose; third dose, 4-6 months after the first dose.

For anyone: The second dose must be given at least 1 month after the first dose. The third dose must be given at least 2 months after the second dose and at least 4 months after the first. The third dose should not be given to infants younger than 6 months old because it could reduce long-term protection.

Adolescents 11 to 15 years of age may need only two doses of hepatitis B vaccine, separated by 4 to 6 months. Ask your healthcare provider for details.

People should not get hepatitis B vaccine if they have ever had a life-threatening allergic reaction to baker's yeast (the kind used for making bread) or to a previous dose of hepatitis B vaccine. People who are moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting hepatitis B vaccine.

For more information:
Centers for Disease Control and Prevention (CDC): 1-800-232-2522 or 1-888-443-7232 (English), 1-800-232-0233 (Espanol), www.cdc.gov/nip or www.cdc.gov/hepatitis

[E-News thanks J.R. for submitting the above information.]


A: I carefully screen all of my ladies to make sure that they aren't infected and I have never received a positive result. However, from working in nursing homes, hospice and as a home health aide before becoming a midwife I happen to have had my immunization. I feel safer having it. There are a few too many unknowns and lots of bodily fluids that I come in contact with. Thorough prenatal screening is essential if you haven't been vaccinated -- both blood work and personal history.

-Ellyn Forester CPM, LM


A: I have worked in Infection Control for 4 years and the independent consultant overseeing the program at our hospital quotes figure of:

  • 30% chance of contracting hep B if you are not immunised and the source of your exposure is positive
  • 10% chance of contracting hep C for which there is no available immunisation
  • 0.3% chance of contracting HIV from a one-off exposure.

These figures are supported by NHMRC guidelines.

-Francine Douce, L2 midwife/RN,
Tasmania, Australia


The next generation of Australian midwives won't have to face the dilemma of whether to be vaccinated against hepatitis B or not. Thanks to an overzealous health department, all Australian babies are being vaccinated against hepatitis B within 48 hours of birth (except for the few who have parents discerning enough to ask why.). And the response from Australian midwives who are expected to do the vaccinations? Barely a whimper!

-M. Carrucan,
Melbourne, Australia


Switchboard

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!


The trend that "once a c-section, always a c-section" seems to be coming back. Doctors are finding new ways to suture moms. I am hearing that single suturing a c-section can be dangerous (an increased risk of uterine rupture) if the mom hopes to have a VBAC with the next pregnancy. How are midwives who are doing homebirths going to handle this as this technique gains popularity?

My sister, who just had her second VBAC, was told by her CNMs that if she were to get pregnant again, their midwifery practice can't take her -- she is considered "high risk" because she had a c-section. Never mind that she has had two wonderful VBACs. Why is this changing? Does anyone have insight? Please refer to this Web site pertaining to single suturing.

- Heidi


Re: Back Labor No More [Issue 4:13]:

Get the booklet Optimal Feotal Positioning from Midwifery Today. I think every childbirth teacher and midwife should be using this book to make sure their clients do everything possible to not have posterior babies. I had a posterior c-sec baby. I used this booklet to make sure my second was anterior and had a quick easy labor and a VBAC at a birth center. I had read Back Labor No More but did not feel the need to use the technique.

- Anne Gray


I have found the techniques in McCoy's book to be invaluable to my clients and to myself. When I was in labor for my second baby I had very intense back pain and the only position I could sustain during 10 hours of labor was hands and knees. During the last month of pregnancy and during labor for my third baby I practiced gentle "lifts" (I labored in a pool of very warm water). I never had back pain. Since then, when I have attended a client with back pressure, I've applied McCoy's techniques (with mom's permission) and the mom's response is usually, "Oh, that feels so much better" or "Please, don't stop doing that."

- Anonymous


My first baby was posterior and I had irregular but very strong back labor on and off for five days. Sometimes my contractions would be less than a minute apart for 8 hours at a time, then the labor would stall. I was exhausted and my provider was clueless. He assumed I wouldn't dilate, so I was told I would be induced the rest of the way. I was given every intervention short of a c-sec and managed to give birth to my daughter vaginally with an epidural, episiotomy and forceps.

I was determined to find some way to improve the next labor. I received routine chiropractic adjustments once every week for the entire pregnancy and swam for 2 hours a day, 3 days a week for the last 6 weeks. My son was born in 3 hours from the start of the first noticeable contraction. I progressed very quickly. I had no back labor, no pain meds, no epidural, no IV, no stitches and only a slight labial tear. It probably helped that I opted for a free-standing birth center, a female ob/gyn and a doula.

I recognize that second and subsequent babies are usually easier for mom to deliver. Our bodies have done it before and labors are often shorter. But to go from a 100+ hour labor to 3 hours is amazing. I credit chiropractic care. The adjustments keep mom's nerve system functioning at peak as well as open up the pelvis and allow baby to settle into a good position for delivery. I highly recommend it.

- L.S.,
Guam, USA


Following two painful back labors, one lasting 38 hours and culminating in transport to hospital with Pitocin, I read this book and had my first-ever homebirth, which lasted only 4.5 hours! I used the technique on myself in early to mid-first stage and it made a huge difference with each contraction. Although it is awkward to lift one's belly, it was a lifesaver. However, I did reach a stage where I couldn't depend upon it to bring total relief from the back labor, and my midwife arrived just in time to help me by using her wonderful massage techniques.

Become quite familiar with the technique and look forward to the relief it will bring you! Also, check out sterile water papule injections.

- Cherwyn


NONPHARMACOLOGICAL METHODS OF PAIN RELIEF
Order this Midwifery Today audiotape!


I'd love to hear from anyone who has had or attended a birth where the baby was born posterior brow. Two months ago I had a waterbirth at home and my daughter came out entirely in this position. Some midwives are telling me that this isn't possible. But the books say it's possible, just very rare. Please send your comments to rainunity@hotmail.com


As a postpartum doula, former lactation consultant and person who loves to hear, read and know about birth, I want to let you midwives know I think you are the most intelligent group of people I know. The things you discuss are so terrific, and it is obvious that you have thoroughly researched and studied subjects well. I applaud your efforts. I am 54 and my last birth was a homebirth. I regret that they all weren't. Thanks for standing in the gap for women.

- Anonymous


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


Classified Advertising

The International School of Traditional Midwifery in Ashland, Oregon is accepting enrollment for 2002 classes that start in May. For information call 541-488-8273, or go to http://www.globalmidwives.org


Hands of Light - Summer Intensives on the Southern Maine Seacoast: Postpartum Doula June 12-15, Do I want to Be A Midwife? June 17-21 and Advanced Medical Skills Training June 24-28 - Elizabeth Mazanec 978-343-7384, www.holcenter.com


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Midwifery Today: Each One Teach One!