May 22, 2002
Volume 4, Issue 21
Midwifery Today E-News
“International Doula Month”
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DOULAS - You'll find numerous educational supplies at Midwifery Today's Storefront: books, audiotapes, videotapes and subscriptions.

Go here to shop: www.midwiferytoday.com/storefront.htm

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Midwifery Today Conferences

CHINESE MEDICINE IN BIRTH CARE:

Chinese Traditional Medicine to Change Breech Presentation
Use of Postpartum Acupuncture
Guangzhou, Guangdong, CHINA
"Healthy Birth": June 7-9, 2002

http://www.midwiferytoday.com/Conferences/china/

Get the full program online:

http://www.midwiferytoday.com/Conferences/china/program.asp

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.

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INNOVATIVE MIDWIVES: Midwifery Today literally searches the world for them. Then we bring those midwives to you for the most in-depth learning experiences.

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

http://www.midwiferytoday.com/Conferences/intensive

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

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

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Send submissions, inquiries and responses to newsletter items to

mtensubmit@midwiferytoday.com

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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Doulas
5) Check It Out!
6) Midwifery Today Online Forum: Movement/Bodywork
7) Question of the Week: Tandem nursing
8) Switchboard
9) Classifieds

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1) Quote of the Week

"Women's strongest feelings [in terms of their birthings], positive and negative, focus on the way they were treated by their caregivers."

- Annie Kennedy & Penny Simkin

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2) The Art of Midwifery

Doula trick of the trade: All our local hospitals have a policy of mandatory 20-minute electronic fetal monitoring upon admittance to labor and delivery. (Most are lax about further monitoring once they observe the laboring rhythm a woman has established at home.) That 20 minutes is usually a readjustment phase, so to help mom relax and get back into her labor groove, I give her a foot massage. Pressure points and essential oils can be used, and mom is pleasantly distracted from hospital admissions procedures.

- Hilary Biesecker, CLA

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DOULAS: We encourage you to continue to send in your favorite tricks of your trade!

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What works to help relieve standard edema with no other symptoms? Warm weather is approaching, and the problem of edema will increase.

- Jennesse
Maple Ridge, BC

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3) News Flashes

In a randomized study of 314 nulliparas who delivered in one of three health maintenance organization-managed hospitals; 149 had doulas and 165 had usual care. Women who had doulas had significantly less epidural use than women in the usual-care group. Women who had doulas also were significantly more likely to rate the birth experience as good, to feel they coped very well with labor, and to feel labor had a very positive effect on their feelings as women and perception of their bodies' strength and performance. The two groups did not statistically differ significantly in rates of cesarean, vaginal, forceps, or vacuum delivery, oxytocin administration; or breastfeeding, nor did they differ on the postpartum depression or self-esteem measures.

- "Effects of providing hospital-based doulas in health maintenance organization hospitals."
Obstetrics & Gynecology, 93(3):422-6.
Source: http://www.birthsource.com/proarticlefile/proarticle21.html

4) What is a Doula?

The doula is professionally trained and may even be certified in labor support. However, she does not use medical skills, does not offer medical advice, and does not deliver the baby, which is what makes her different from a midwife. She may have personal experience with birthing her own children. She is caring and compassionate, yet emotionally detached from both the mother and her partner. She is knowledgeable about a variety of laboring and birthing matters and is available to discuss the pros and cons of advice from the medical staff. She does not make decisions for the mother, nor does she speak to the staff directly about the mother's wishes. Rather, she reminds the mother of her birth plan and asks her questions that empower her to be her own best advocate.

The doula typically stays with the couple throughout the labor and for the first hour or two after birth. During that time she usually witnesses more than one shift change of the medical staff. As everyone else comes and goes, the doula remains a constant presence for the couple. When the intensity of labor increases, the doula is there to suggest new positions or activities to assist the progression of labor and help the mother feel as comfortable as possible. When mom is feeling scared and feels she can't go on, the doula is right there to provide reassurance and instill confidence that all is well. She is also there to provide massage, apply counterpressure to mom's back when needed, get food for the couple, and do whatever else supports the birth process.

- Excerpted from my article here: www.babyzone.com/features/content/display.asp?contentid=83

For more information:
Perez & Snedecker, Special Women: The Role of the Professional Labor
Assistant
Simkin, The Birth Partner: Everything You Need to Know to Help a Woman
through Childbirth
Klaus, Klaus, & Kennell: Mothering the Mother
Baldwin: Special Delivery
Harper: Gentle Birth Choices
Korte, Scaer: A Good Birth, A Safe Birth

- Judi Fitts, CD (DONA)
Boston, MA

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I am a doula in the US. My work was born from my love of birth, having my own babies, and my desire to "be there." I didn't know much about doulas when I first started to attend births as support for friends. Now I am certified through Doulas of North America (DONA) and love my "job." It is a calling much like midwifery. Some doulas eventually progress to midwifery, and others are content to be non-medical support who care for the physical and emotional comfort of the mother. I see my role as helping the mother feel she has a voice and seeing that she has a positive memory of her birth no matter what happens. Though I use comfort measures and tricks of my trade, some moms are just content to know that a caring empathetic woman is in the room and will not leave her.

- Shawna Becker CD (DONA)

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Over the past year and a half, I have been asked, "What is a doula?" several times. I answer that I am a pregnancy and birth assistant and that I provide physical, emotional, informational, and advocacy support to birthing families. Of course, as most doulas know, this leads to the next question: In what ways are doulas like midwives? If I'm lucky, I get asked a question or two about the births I have attended. However, during the last year and a half I have also found myself explaining to other doulas what I do as an assistant. At first, this really caught me off guard, for why would a doula not understand what another doula does? I came to understand that birth work has different comfort levels for different people. I have concluded that there is no one definition for a doula other than that we are not the primary caretaker and we are not responsible for the medical health of mother and baby. There are doulas certified through various agencies with various standards of scope, there are uncertified doulas, there are doulas who have other training that gives them skills to enhance their care, and there are doulas who give only emotional and informational support and are valued just as highly for their work. To me, being a doula is a job and a passion. I breathe birth. Sometimes at the least likely moments I find myself deep in conversation about pregnancy and birth with the least likely person. Sometimes my passion intimidates women and causes fear and uncertainty when I tell them they have choices and they insist they have none. In America the doula is quickly becoming the first line of defense for birthing families. We see the day-to-day struggles of families, the economic hard times, the nutritional deficiencies, the battered, the abused, the coerced and the forgotten. We have become watchdogs for humanity. Often we remind the care providers that they are dealing with a human being who needs compassion, understanding and patience. I am proud to be a doula. Question me all you want; in the end, we both may learn a thing or two.

- Chantel Haynes, pregnancy and birth assistant
Tucson, AZ

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I listen, I educate, I offer suggestions for non-medical solutions to issues the mother faces in her pregnancy, labor and birth. I support the birthing woman's choices and help her stay confident in her ability to birth her baby. I do this work because too often women are told they cannot birth their babies the way their bodies tell them they can, so I am the counterweight to what they hear from their medical doctors. I do this work so that a woman never labors alone and so partners don't have to carry the entire load of supporting the laboring woman. I do this work so I can feel joy on a regular basis.

- Amy Hyams, doula
San Francisco, CA

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The birth guide and partner should be present to support a woman but not direct her. If a woman is walking the path of her labor and doing well, she should not be told how to do things differently. If she begins to need assistance - encouragement, affirmations, suggestions - that is when the birth guide should offer to gently guide her back onto the path.

When a doula arrives too early in a woman's labor she interferes with the natural process of letting labor unfold. She may be close to the mom, but she is still an outsider of sorts. This is the time for mom to start allowing her mind to totally trust her body's ability to give birth. It is essential that a woman start to see how her body can manage through the early stages of labor, a self awareness that will build confidence in her ability to handle the ever-increasing intensity of labor. Being able to talk to her doula about anxieties or fears is helpful, but having a doula present in early labor causes some women to feel pressured to perform, when it should be an empowering time of self-discovery.

If it is early in the day, the mom can try her normal routine of daily activities until labor demands her full attention. If it is late in the day, a restful walk followed by a warm bath can help her achieve rest before labor becomes more active. The most important thing is for her to mentally prepare to let go and unfold for the upcoming birth.

As the mom's labor progresses, she may want her doula to come to her home. The doula can help the mom with techniques to cope with pain, positioning and ways to help labor progress. When the mom wants to move to the birth location, the doula will accompany her, helping smooth the transition from home to the birthplace. The doula will stay with the mom throughout the labor, giving continual support whether the labor is long or short. Most doulas are able to facilitate mom's initial bonding time with the new baby and help get baby latched on properly. In short, mom can rely on her doula when she needs her, but she is encouraged to rely on her instinctive voice beforehand and along the way.

(heavily excerpted)

- Teresa Howard, CD (DONA), CLD (CAPPA), labor doula and Birthing in Awareness CBE, CAPPA Georgia State representative

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5) Check It Out!

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

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CONFERENCE AUDIOTAPES FOR THIS WEEK'S THEME

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*BIRTH AND DEATH: A DOULA'S ROLE IN SACRED MOMENTS
*THE DOULA'S CONTRIBUTION TO MAMATOTO
Articles in Midwifery Today Issue 58

http://www.midwiferytoday.com/products/mt58.htm

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DOULA AUDIOTAPE PACKAGES

Are you a doula or thinking about becoming one? Then you need one or both of these packages:

Order the Mini Doula Pack and you'll receive five double audio tapes featuring Penny Simkin. An $80 value if purchased separately, the package price is just $65.

http://www.midwiferytoday.com/products/DTP5.htm

For even more information, order the Ten Tape Doula Package. A $107 value if purchased separately, the package price is just $90.

http://www.midwiferytoday.com/products/DTP10.htm

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NUTURING BEGINNINGS - now just $49.99
Thinking of becoming a postpartum doula?
Then you need Nurturing Beginnings, MotherLove's Guide to Postpartum
Home Care for Doulas and Outreach Workers.
This comprehensive postpartum training manual is now available at a new lower price: Just $49.99 (Original price was $69.00.)

Order your copy here:

http://www.midwiferytoday.com/products/NBB.htm

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6) Midwifery Today's Online Forums

Are there doulas/birth educators who use movement/bodywork (other than massage) to educate women about their bodies, correct posture in
pregnancy, birthing and postpartum care? I'm an aspiring doula with
dance/movement education and would love to bridge those two
not-so-distant worlds. Are there any books about the subject?

- Skye

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TO SHARE YOUR THOUGHTS AND EXPERIENCE ON THIS TOPIC, go to

http://www.midwiferytoday.com/forums/topic.asp?TOPIC_ID=1965

**PLEASE DO NOT SEND YOUR RESPONSES TO E-NEWS!**

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Question of the Week

7) Are there any studies, observations, or research that indicate a correlation between nursing throughout pregnancy and postdate babies? A friend/LLL leader and I have compared notes and we see a correlation: moms who nurse throughout pregnancy and especially moms who tandem nurse throughout pregnancy seem to grow their babies for a bit longer.

- Carrie Foster Evans, future CBE

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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) Switchboard

[Editor's note: The Quote of the Week in Issue 4:20 should have been attributed to Eileen Sullivan. Thanks for your wisdom and humor, Eileen!]

I read the sections on aromatherapy with alarm [Issue 4:19]. I suffer from allergies to some scents, some severe enough to be life threatening. For example, a strong whiff of jasmine-based perfume is enough to send me to the emergency room in anaphylactic shock. I suggest the following rules for scent lovers and those who practice aromatherapy:

  • Never wear or use any kind of scented product or perfume in a public place, including especially locker rooms, buses, hotel lobbies, restaurants, places of worship, conference halls and place of employment.
  • Never wear clothing that has been used during an aromatherapy session or that was worn when you put on perfume or scents in a public place unless it is laundered first. Scents can cling for days or even weeks.
  • Avoid purchasing scented deodorants, laundry products, dishwashing soap, make up, hair-care products and medicinal products such as hand lotions.
  • Never use any form of aromatherapy or "air freshening" device without first consulting everyone in the vicinity about potential allergies. If you can't ask everyone first, don't use it. That especially applies to automatic air poisoning dispensers in public washrooms and stores.

Aromatherapy works because aromas are a powerful medicine. We have learned not to indiscriminately use antibiotics because of the potential for negative side effects and have learned not to smoke in public places where we risk hurting others. We must develop the same attitude about scents.

- Natalie K Bjorklund

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Regarding the all-fours position and risk of meconium aspiration
[Issue 4:19]:
Hands and knees is the perfect position to put mom in when we expect
meconium waters. It is actually easier to aspirate a baby on the
perineum when mom is in the H&K position than in lithotomy, because we have free and very visible access to the baby's mouth and nose.
Also, the "fetal Heimlich effect," which expels fluid, is caused by
pressure on the abdomen. It occurs regardless of maternal position.

- Gail Hart, midwife
Oregon

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Horseback riding and pregnancy [Issue 4:19]:

My warning to moms who rode while pregnant was that they must listen closely to their own body. When it begins to say, "Ouch", it means listen and don't continue to ride. All stopped riding during the third trimester. Women must remember that a fall from a horse can be very dangerous to their baby as well as to themselves and is a risk they must consider. They must evaluate their own skill, horsemanship and the degree of risk they are comfortable accepting.

- Judy, CPM

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If she is worried, she should listen to her instincts and not do it. I rode throughout both pregnancies, up to 4-5 months, at which time I no longer felt comfortable. All literature I have read suggests that it isn't an ideal sport to start up during a pregnancy, but all activities do not have to cease either, if it is a sport you already participate in. I have known women to ride until the day they give birth, whereas others say you could risk the baby's life with a fall and they wouldn't chance it. A practical tip for riding with a large pregnant belly is dismount by swinging your leg in front of you rather than having to slide down on your front. Also back supports may be helpful.

- Debra, antenatal and birth doula
Birmingham, England

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I've heard about a woman who was a horseback rider whose perineum was
made too strong by the muscle work involved in riding. (Imagine doing way too many Kegels!) The woman's perineum was quite thick and had a
hard time stretching to accommodate a fairly average-size baby.

- A. Topping, doula

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I've found out that NARM-certified midwives have a lot of out-of-hospital training and are best suited for the "out-of-hospital"
setting. I'm wondering if they are still "medically" trained. For instance, do they carry oxygen and other things for resuscitation or other emergencies if they arise?

- Jason

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I am very concerned about water requirements given to increase a milk supply. Ingestion of liquids beyond thirst has been found to have a negative impact on milk supply. Please reference Breastfeeding: A Guide for the Medical Professional, 5th edition, pg. 305. According to a controlled cross-over study of lactating women, those who forced fluids beyond thirst actually produced less milk (Dusdieker LB, Booth BM, Stumbo, PJ et al: Effect of Supplemental Fluids on Human Milk Production, Journal of Pediatrics 106:207, 1985). This is a better-designed repeat study of a 1940s study by A. Olsen. Disregarding these important lactation studies is contrary to good evidence-based practice. Mothers should be advised to drink to thirst and monitor other physiological signs, not consume a set amount of water each day.

- Charity M. Pitcher-Cooper BSN, RN, aspiring IBCLC, aspiring homebirth midwife

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Why is evening primrose oil not recommended for VBACs? I was under the impression it softens and ripens the cervix, so we use it prenatally. How could that contribute to a rupture?

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My "record" short mom [Issue 4:19 & 20] is a 5' 0" teenager who started her pregnancy 100 lbs soaking wet and who wore size 0 jeans. The day before she delivered, she weighed 140 lbs. and measured 42 cm. It was a tough push, to put it mildly, and we were ready for problems with the shoulders. Her first had been 9 lb 13 oz and took only 7 hours (though she'd weighed 120 to start). When the head was born it was literally twice as big as the top of her thigh. As our eyes bugged out, she pushed out the rest of the baby over an intact perineum. The baby weighed 10 lbs 1 oz., more than 10% of her weight. By four months the baby boy weighed 25 lbs on breastmilk. After that, I decided ANY woman deserves a chance to labor naturally. If her "failure to progress" faster than about 1 cm/3 hrs had resulted in a cesarean, everyone would have said "of course."

- Cynthia B. Flynn, CNM, PhD

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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.

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8) Classifieds
The International School of Traditional Midwifery in Ashland Oregon is accepting enrollment for Fall 2002 classes. Contact us at
541-488-8254 or visit us at www.globalmidwives.org

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DID YOU HAVE AN EPIDURAL?
Midwife wants to hear from women experiencing problems after epidural,
please share your story. Anonymity guaranteed. Write: Mo at Epicomps,
8657 Douglas #261, DSM, IA 50322 or e-mail epiduralcomps@yahoo.com

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"Returning Birth to the Family" Midwifery Conference in Asheville, NC

August 23-25th. Grand Midwife Margaret Charles Smith, Wise Woman
Herbalist Susun Weed, Waterbirth Pioneer Marina Alzugaray. Southeast
MANA meeting. Contact Cheryl - 828-628-6345 or ancientheart9@aol.com
or www.thematrona.com

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