Second Stage (Cephalic Baby), Part I
When receiving a baby into this world, the first suggestion is to breathe deeply and relax your shoulders.
Perhaps you will be positioned between the knees of a woman in a well-supported sitting position. Place your dominant hand on the perineum. Have a steady supply of clean warmed compresses available to place on the perineum and over the vaginal labia while the mother is pushing. This helps relax the area and focuses the mother's attention on her bottom. While touching the mom, keep up a verbal connection with her. Let your touch and movements be fluid, kind and gentle.
When crowning occurs, the head is quite visible between pushes at about +4 to +5. It is important to keep the head flexed by placing gentle downward pressure on the uppermost part of the head near the top of the vaginal opening. This pushes the baby's chin toward the baby's chest, allowing the smallest diameter of the skull to navigate the maternal pelvis. There are a couple of ways to do this. One way is to use the fingers of your nondominant hand. Press firmly with the fingerpads of your first three fingers; do not use the fingertips. This holds the head in flexion. The other way is to use the heel of your hand. Your elbow points toward the sky. With the heel of your nondominant hand, press firmly downward on the occiput. Again, this keeps the head flexed. This is most easily done if you are standing to the side of the mom.
During crowning your perineal hand can hold the perineum like this: The thumb is placed in the crease of the groin area half way on the side of the perineum. The middle finger is placed in the crease of the groin on the other side of the perineum. Pressure is applied inward toward the baby's head. Slightly pinch the fingers toward one another to gather as much slack in the perineum as possible. The pinky side of your hand should stay in contact with the perineal body to help give added support. Also keep an eye on the perineum that is visible between your thumb and fingers.
I suggest you hold the head in this manner until the chin is born over the perineum. This allows a slow extension of the baby's head/chin so there may be a decreased chance of the larger diameter of the baby's head causing a super stretch/tear in the perineum.
- Kimberly Hulsey, LM,
The Birthkit Issue 29, Spring 2001
--TO BE CONTINUED IN ISSUE 4:30--
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Birth in Bali, Bolivia and Bangladesh.
Midwifery in Japan and Jamaica.
Articles from Germany and England.
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Forum Talk: Cord Clamping
I am pregnant with my fourth child and having a homebirth. I talked to a midwife who said she only clamps the cord immediately if the mother has RH- blood. I have talked to other midwives who let the cord pulsate even if the mother has RH- blood. I am looking for any information I can get about why midwives have different opinions about this in order to make my own decision.
To share your thoughts and experience, go to Midwifery Today's Forums.
Mothering celebrates the experience of parenthood as worthy of one's best efforts and fosters awareness of the immense importance and value of parenthood and family life in the development of the full human potential. As a readers' magazine, we recognize parents as the experts and wish to provide truly helpful information upon which parents can base informed choices. For more information please visit www.mothering.com.
Question of the Week: Pregnant After 40
Q: I am a midwife and family nurse practitioner who has had two full-term breech babies (bicornate uterus), one 34-week vertex baby with prolapsed cord, and C-section at age 36. I want to have one more baby. The oldest woman I have delivered was 44 years old and it was her first. She did great. I am in great shape and so is my husband. I want to know what others have experienced with women this age. I was pregnant five months ago but had a very early miscarriage, so I know I could get pregnant. I am now using OTC Progest to help maintain my hormones. What experience do others have with women in their 40s having babies?
- Shawna Doean
Send your responses to email@example.com.
Question of the Week Responses: Hypertension, Loose Stools
Q: Has anyone else noticed an increase in hypertension for women who conceived soon after 9-11? I just had five hypertensive clients in a row, and I normally only have a maximum of two each year.
- Lisa Goldstein
A: I have a related experience. Immediately after 9-11 I missed a period. I was 46 years old, feared I might be pregnant, but wondered if it was the start of menopause. I missed an entire month menstruating again when the next period would have been due. This had never happened to me before and I have had regular periods since. This also happened to an acquaintance of similar age. Upon hearing this I wondered just how many women put their bodies on hold at that time.
- Alexandra Smith
A: I was just noticing how I haven't had anyone with pregnancy-induced hypertension for a long time.
- Mary Ann Durbin, CNM
A: Mildred Seelig, M.D., who works for the American College of Nutrition and Trace Minerals Research, has dedicated her career to magnesium and the effect it has on pregnant women. Magnesium deficiency is a major factor in high blood pressure and the requirements for a pregnant woman are grossly underestimated. She suggests a daily magnesium intake of 500-600 mg.
Q: Do readers have insight or remedies for a pregnant mother who has had loose stools all of first and second trimester? Why does this happen, and is it normal for some pregnancies?
A: In Chinese Medicine there are two main causes for loose stools. One is spleen qi deficiency and the other is spleen and/or kidney yang deficiency. I would recommend that she see an acupuncturist who also practices Chinese herbalism. This condition can be effectively treated with Chinese medicine and will most likely help mom and baby be healthier in the long run.
The BirthLove Web site has helped many women grow trust in birth and in their bodies. It has helped women resist Cytotec, find good midwives, and stop believing everything their doctors say. There are hundreds of homebirth stories: unassisted VBAC, fathers' stories, twin (and triplet home VBAC!) stories, breech stories -- for things that people get sectioned for daily, there are homebirth stories on the site. Marsden Wagner, MD is a contributing expert, as are Sarah Buckley MD, Gloria Lemay and Gretchen Humphries. BirthLove has changed and saved lives through education, communication and love. Become a member of BirthLove today and be inspired! www.birthlove.com.
Question of the Quarter, Midwifery Today magazine
Issue 64, Unity
Is unity possible in this diverse midwifery community? Can we stand up for and support one another when there is such a range of philosophical approaches to training and practice?
Please submit your response by Sept. 30, 2002, to firstname.lastname@example.org.
All responses subject to editing for content and style. Sorry, but we cannot reply to each individual submission.
by Gloria Lemay, compiled by Leilah McCracken
Strep B: A Holistic Approach
The concern about Strep B involves two groups at high risk of infection:
- Premature infants under 37 weeks gestation
- Any infant in utero with membranes ruptured longer than l8 hours
Contractions are a possible indicator of infection, but this situation is a concern in weeks 0-36. After 36 weeks, Braxton Hicks are normal and a good sign of a healthy toned uterus getting ready to push a baby out. Strep B in the vagina is not necessarily illness related. Just as we commonly have Strep A in our throats on a swab and have no sore throat symptoms, from one day to the next we can all culture positive for Strep B without any symptoms or danger to our unborn babies. This is why many practitioners refuse to test for it and simply wait to test until such time as the above two "at-risk infant scenarios" show up. One day a woman might test positive and the next be negative. To treat with antibiotics before labour would NOT be recommended.
The mother's body could build up a resistance to the antibiotics and so could her babe's body. Then if either got a more serious infection after the birth, the antibiotics might be ineffective. It can also lead to thrush, vaginal yeast and severe colic in the months after birth.
I would advise mothers to do as many things as possible to minimize their risk of ANY infections and maximize their immune systems. Some safe suggestions:
- Boost vitamin C in your diet—e.g., eat 2 grapefruit per day. Other good sources are red peppers, oranges, kiwi fruit.
- Drink a cup of echinacea tea or take 2 capsules of echinacea every day.
- Get extra sleep before midnight. Slow down your schedule.
- Take 3 tsp colloidal silver per day. Take it between meals. Hold the liquid in your mouth a few minutes before swallowing. Colloidal silver can be purchased in most health food stores. It is silver suspended in water. It is antibiotic in nature and safe in pregnancy.
- Plan ahead for extra warmth after the birth for both the mother and baby. Hot water bottles, heating pads, hot packs, big towels dried in a hot dryer during the pushing phase all help keep the mamatoto extra toasty after birth and reduce stress. Have a friend or family member assigned to be in charge of the mother/baby warmth team. Colostrum is the best antibiotic treatment the baby could ever get.
- Other good prevention tips: Keep vaginal exams to a minimum -- 0 is best. Do not permit artificial rupture of the membranes. Do not allow children of other families to visit the new baby for the first three weeks. Keep the older kids healthy so they are not sneezing and coughing on the new baby.
I often think we must have had a lot of women who were Strep B positive in the 800 or so births I have attended. We do not test unless we have long rupture of membranes and/or a preemie. Once the baby is born, we keep all women warm and baby skin-to-skin with the cord intact and, of course, all our mothers breastfeed. I have never had a baby sick with Strep B in twenty years.
Gloria Lemay is a private birth attendant in Vancouver, BC, and is a contributing expert at BirthLove.
Read more from Gloria on Midwifery Today's Web site: "Pushing for First-Time Moms"
Note: This article is also published online in French and Spanish.
Where I live in British Columbia, Canada, I had the option of hiring a free registered midwife during my pregnancy. After comparing outcomes based on transfer of planned homebirths to hospital, use of interventions, use of medications, and infant and maternal morbidity and mortality rates, it was clear that my best chance of having a safe, satisfying home/water/lotus birth was with Gloria Lemay in attendance. During the earthquake last year, my son was born into my arms in the water, his placenta remained attached until four days later when the cord gently slipped away. Lemay did not call herself a midwife; in fact, anyone practicing midwifery as it is presently known today in BC would not make it through my front door. She did not manage my birth. I managed to birth my baby all by myself. Now, Lemay has been sentenced to five months in jail for attending women like myself who willingly pay out of their own pockets to birth how we want, when we want, where we want and with whom we want.
Set Gloria Lemay free. Reform registered midwifery in British Columbia. Donations are urgently needed and can be made payable to: Peter Ritchie, Lawyer and sent to: Sherri-Lee Pressman, 4636 218A St., Langley, BC, Canada V3A 8H8.
Gloria Lemay, grandmother, childbirth educator, and internationally respected midwife of 20+ years experience, was convicted of "criminal contempt of court" for practicing "midwifery" in British Columbia, Canada, a province where midwifery is a word and practice owned and controlled by the provincial government. She is appealing this conviction, as well as the five-month jail sentence and twelve-month probation the judge handed to her on July 24, 2002.
Gloria needs money to help fund her appeal. To donate to her appeal fund, please go to BirthLove's Gloria Lemay Defense Fund. The women of British Columbia thank you.
I am 32 and just had my fifth baby last week. My second and third labors at term (7 years apart, 1993 and 2000) were 5 hours long. My last two labors (2001 and 2002) were at 35 weeks and 36 weeks gestation and were 26 and 24 hours long. I took red raspberry and pregnancy mixture during the last trimester for each.
I wonder why my labors lasted so long. I progressed slowly (9 am, 3 cm; 3 pm, 6 cm; birth at 11:15 pm). I have considered two possibilities: premature births--my body did not have the last month to ready itself, or that my labors were close together and my uterus was tired. I had no problem with postpartum bleeding. I plan to have more children and would like to prevent this from happening again—or is this a new pattern for me?
- Annmarie, RN
I read a lot about unassisted births in America, but I am wondering if anyone knows the legal implications of unassisted birthing in the UK? I find it a difficult subject to get any factual answers about rather than everybody's opinions.
- Debra, doula
I have seen women discussing their fifth, sixth, seventh birth, midwives talking about their multip patients, or scared teenagers seeking midwives. I realize this is a forum for birthing, but I think the birthing community should also be concerned about overpopulation issues and birth control. I would be interested in hearing what folks have to say about this subject. I would also be interested in finding out what midwives do in the case of abortion or a pregnant woman who has had an abortion but may have issues or complications because of it.
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Birthing Options' Childbirth Education & Services, LLC presents Doula/Monitrice Workshops; August 29-31 in Jackson, MS; September 21-22, Oct. 5-6, 2002 in Carriere, MS; October 18-20 in Mobile, AL; www.birthingoptions.com. Contact: Renata Hillman at 251-463-2426 or BirthingOptions@cs.com
Better Birthing With Hypnosis. The complete Leclaire Method, classes since 1989. Books, trainings, audio and video tapes, CEU's. http://www.leclairemethod.com. Call (310) 454-0920 for information. firstname.lastname@example.org
The International School of Traditional Midwifery in Ashland Oregon is hiring part time teaching staff. Contact email@example.com or call (541) 488-8254 for more information. Application deadline is August 20th.
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