October 1, 2003
Volume 5, Issue 20
Midwifery Today E-News
“Multiple Gestation”
Subscribe • Print Page
Search Archive • Index

Remember to share this newsletter. (Please see copyright notice for restrictions.)

To subscribe, unsubscribe, or otherwise change your E-News subscription, click here.


Midwifery Today Storefront

SECOND STAGE HANDBOOK:
How to keep your faith in the process, best serve the birthing mom, protect her from interventions, and handle complications. A Midwifery Today book.


This issue of Midwifery Today E-News is brought to you by:

Look for their ad below!


Midwifery Today Conferences

  • Attend a full-day herb workshop.
  • Learn the healing effects of singing in pregnancy and birth.
  • Discover Mexican remedies, techniques and customs.

Come to the conference in Paris, France, Nov. 6–10, 2003. For more information and a complete program, click here.


Thinking about becoming a midwife?
Learn the basics of normal pregnancy, birth and postpartum care in a full-day Beginning Midwifery Class.

Attend the Philadelphia Conference, March 18–22, 2004. Click here for details and to register.


Send submissions, inquiries, and responses to newsletter items to: mtensubmit@midwiferytoday.com.

The Art of Midwifery

Mitchella repens, also known as partridge berry or squawvine, is a great uterine tonic. I am drawn to this one as a tincture. Take as directed. If you are experiencing pelvic congestion—signaled by constipation, bloating, hemorrhoids, varicose veins, and/or menses with clots—add 5 milliliters of ginger root, cinnamon, or ocotillo tincture per ounce of partridge berry. If you don't mix the tinctures together, just make the dose 25 drops partridge berry and add 5 drops pelvic decongestant to the glass of water before you guzzle.

Adrienne, Midwifery Today forums

In This Week’s Issue:


Quote of the Week

"Everything is about language, and when we master speaking the importance of natural childbirth, we will easily enlist the whole of North America in the project of returning birth to women."

Gloria Lemay


Save up to $20 on Midwifery Today products!
Check out the savings in the Online Holiday Pack.
online holiday pack


Are you enjoying your free copy of the Midwifery Today E-News?
Then show your support by making a donation of $3 or more.
Click here to donate.


ALL BIRTH PRACTITIONERS: The techniques you've perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to mtensubmit@midwiferytoday.com.


News Flashes

To evaluate the effect of acupuncture on the length of labor, 57 women were treated with acupuncture during first and second stage labor and a control group of 63 birthing women were not, in a study at the Department of Obstetrics and Gynecology, University of Vienna, Austria. The median length of first stage labor for the first group was 196 minutes, and for the control group it was 321 minutes. For the first group, second stage lasted an average of 57 minutes, and for the control group it lasted the same amount of time. In the entire study population, 30 women had premature rupture of membranes. Women in the control group received a significantly increased amount of oxytocin during first stage and second stage than did the acupuncture group—85% and 15%, respectively, for first stage, and 72% and 28% for second stage, respectively.

Gynecologic and Obstetric Investigation, Karger Publishers, www.karger.com

PLEASE SUPPORT OUR ADVERTISERS!

HypnoBirthing Instructor

Become part of the most effective, fastest growing childbirth education program by attending one of our intense four-day trainings.

Calmer, gentler, safer birthing techniques using hypnosis.
Fear influences birth—hypnosis is the most effective way to eliminate it.

Upcoming training classes:

Houston, TX—November 6–9
Jacksonville, FL—January 29–February 1

To register contact Aaron Aldridge: Aaron@HypnoSolution.com 801-319-8885
For more information about HypnoBirthing: www.HypnoBirthing.com


Multiple Gestation

It is vital for the mother's liver to be functioning at full capacity to meet the demand for increased blood volume to supply an extra placenta (or two). When women do not get the nutritional support they need, clinical symptoms begin to become apparent around the 24th to 26th week of pregnancy, just before blood volume should peak. Problems crop up sooner than in a singleton pregnancy because the demand for more blood volume is so much greater.

Be sure to check for a history of liver disease or disorder (which includes drug use). Four droppersful daily of spring dandelion root or yellow dock root tincture will give the liver a boost. It is normal to see more swelling, a lot more weight gain, a somewhat higher blood pressure, an increased desire for salt, and a somewhat lower hemoglobin than in a singleton pregnancy. These physiological compensations are no cause for alarm. Because multiple fetuses are all storing iron, supplementation is a good idea.

The fact that typical biotechnical medical management results in a toxemia rate of 50% in twin pregnancies and 75% in triplet pregnancies is ample proof of the nutritional neglect = hypovolemia = toxemia etiology. Modern practice includes several ultrasound exams to monitor fetal growth. Cervical cerclage and labor suppressing drugs may be recommended along with bed rest, weight restriction, and cesarean section. Predictably, this results in low birth weight, premature babies as well as a higher incidence of abruption and hemorrhage in mothers.

Anne Frye, Understanding Diagnostic Tests in the Childbearing Year, 6th ed. Labrys Press, 1997


When the first twin is delivered, check inside the mother to find out what part of the second baby is presenting and how far it has descended. If the baby is in a transverse position, try to turn it into a breech or vertex externally. If the head or butt is down far enough so that the cord won't prolapse, you can break the water bag.

It will normally take less time to push out this baby, as the cervix is well dilated and the mother's bones are already stretched apart as far as they need to be. Check the fetal heart tones often. Keep track of how much time has passed, but go by how the energy feels. If the time lapsed is feeling like too much, you may need to pull the second twin out by "internal podalic version," which means taking hold of the baby's feet and turning the baby's body so that the feet come out first, pulling the baby slowly out and delivering as for a breech. Wear a long sterile glove. This maneuver should not be done routinely; it should be used only if the spontaneous delivery of the second twin does not happen within an hour or so after the first twin, or if there is fetal distress.

Ina May Gaskin, Spiritual Midwifery, 4th ed., Book Publishing Company, PO Box 99, Summertown, TN 38483


Nutrition

Mom is now eating for three, and must increase her intake. Common complaints of pregnancy multiply due to low blood sugars and lack of adequate caloric intake. She has to be committed to nutrition, and I ask her to give me a complete diet history weekly. I ask for her family's support in making sure she is adequately nourished.

Education

Parents have to be fully informed of the risks and benefits of a midwife-attended delivery. They must accept their role in the decision-making process. I encourage them to read books, join "twin clubs," and talk with other families with twins. If problems arise during the prenatal course or during birth, the parents will know what to expect.

Birth plans

  1. Are backup systems for early notification of the midwife or for transport in place? Often, early signs of labor go unnoticed, and delivery can be imminent.
  2. Twice as many birth supplies (towels, blankets, etc.) and an extra set of birth instruments are needed. Can extra oxygen be borrowed? A way to identify each twin should be established beforehand.
  3. Extra support persons may be needed. I usually have two midwives, two assistants, someone to take notes and record times, and someone to be on hand to run errands. Everyone should be trained in neonatal resuscitation.
  4. Have mom choose support carefully. With twins, there is often pressure from family and friends to be there to "just watch." Support persons should be willing to provide snacks, back rubs, and encouragement to both mom and dad. They should be discouraged from bringing babies and small children.

Postpartum

Provide educational materials for breastfeeding. Locate La Leche League support groups, lactation consultants, and other mothers of twins for support. Postpartum care often includes extra home visits and more-frequent phone calls. Exhaustion, overwhelming sense of responsibility, and loss of a sense of self need to be addressed.

Diane Barnes, "When Twins Are on the Way," Midwifery Today Issue 39


UNDERSTANDING DIAGNOSTIC TESTS IN THE CHILDBEARING YEAR may be ordered from Midwifery Today's Web site. Click here.


BACK ISSUES OF MIDWIFERY TODAY can be ordered from the Midwifery Today Web site. Click here.


Products for Birth Professionals

CONFERENCE AUDIOTAPES FOR THIS WEEK'S THEME:

Other Products and Services of Interest

Gentle Birth Choices

Gentle Birth Choices, a book by Barbara Harper, outlines the many choices pregnant women and their caregivers face today. It belongs on the shelf of every practitioner and is a great gift for an expectant mom.

Order your copy today!


The "Birth is as Safe as Life Gets" T-shirt features a photo of a precious newborn. It makes a fine gift for anyone who loves babies.
Ash Gray, Crew Neck. Photo copyright Harriette Hartigan.
Click here to order.

Birth is as Safe as Life Gets T-shirt

Midwifery Today Issue 64

What's black and white, read by birth professionals around the world, filled with informative articles and inspiring birth stories, and shows up in your postal mailbox four times a year?
MIDWIFERY TODAY!
Subscribe today.


Web Site Update

Read these articles newly posted to the Midwifery Today Web site:
Birth of a Midwife - by Amanda Moore
How to Make a Portable Waterbirth Tub - by Melanie Moore
Question of the Quarter: What is your favorite homebirth story?
A Declaration of the Rights of Childbearing Women - by Leilah McCracken


Forum Talk

A woman in my care recently took Zythromax antibiotic for a sinus infection. She is now spilling moderate ketones in her urine. She says she is feeling fine, she eats well. She is 30 weeks pregnant and has been the picture of health. I was wondering if anyone knows if Zythromax could cause false positives? I am a bit baffled. After a high-calorie diet it has been a week and she is still spilling ketones.

Anon.


TO SHARE YOUR THOUGHTS AND EXPERIENCE ABOUT THIS TOPIC, click here.
**PLEASE DO NOT SEND YOUR RESPONSES TO E-NEWS!**


Question of the Week

Q: I am 26 years old. About two years ago I was 42 weeks pregnant and desperate. I had been having contractions for weeks but had not dilated at all, so my midwife scheduled me for an induction. I arrived at the hospital early in the morning and was given Cytotec (not knowing anything about its experimental use), and within hours I was in extremely hard labor. My contractions were seconds apart for 5–6 hours, and I felt like I couldn't move or breathe. The intensity of the contractions was beyond anything I had ever imagined. Luckily I delivered a healthy baby boy, and aside from a heart murmur, which is gone now, he is very healthy. I on the other hand have had numerous health challenges. When my fertility returned after ceasing breastfeeding I became very nauseated and sick. I took several home pregnancy tests; all were negative. A couple of days passed and I started having extremely sharp pains in my lower abdomen. A nurse practitioner did another pregnancy test, which was negative, and sent me home. Later that day I started bleeding and didn't stop for about 10 days. Ever since then I have had terrible cramping throughout my cycle with and without my period. I have hot flashes, extreme mood swings, and episodes of nausea and dizziness, all of which I had never experienced before giving birth. Has anyone else had a similar experience to mine?

I feel the use of Cytotec is a very grave injustice to women who have been, without their knowledge or consent, subjected to the experimental use of a very powerful and potentially very dangerous drug. I would be most interested to hear from readers who have anything to say about the effects of Cytotec, long or short term.

— Shannon


SEND YOUR RESPONSE to mtensubmit@midwiferytoday.com with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.


Question of the Week Responses

Q: We have a client who in her first birth had a retained placenta. Retrieving was complicated by a vagal response. She ended up needing to be transported, and the placenta was removed while she was under anesthesia. We are trying to collect data about incidence of repeat retained placentas and any suggestions for reducing its incidence. We are aware of the possible role of vitamin E, and she is minimizing her intake in this pregnancy.

— SC

A: I had a retained placenta with my fifth birth. I strongly believe it was from a combination of Pitocin being given to me during labor and premature traction of the placenta. My sixth birth was a homebirth with a skillful midwife. She told me to drink lots of red raspberry tea, and I did. I took a good multivitamin and I made sure my protein intake was strong. When it came time to deliver the placenta, she was very gentle and let me push it out. I did not retain any placenta. Definitely diet, herbal teas, and a skillful midwife who does not use traction are important.

— Bernice


Editor's Note: Responses to any Question of the Week may be sent to E-News at any time. Write to mgeditor@midwiferytoday.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.


Exclusively on the BirthLove Site

Gloria Lemay, celebrated midwife and teacher, is offering advanced online doula education. She covers a vast amount of topics that today's doulas and student midwives need to know: herpes simplex II, medical terminology, pediatric exam of the newborn, prenatal diagnostic tests, business and professionalism, pregnancy-induced hypertension, gestational diabetes and so much more. The course is free for all BirthLove members. Check it out!


Feedback

A group of us on the midwivestrial yahoogroups list are creating a legal manual for midwives to be titled "From Calling to Courtroom: A Midwifery Survival Guide." We are now working together on a separate yahoogroups list, and work is progressing at an amazing rate! Because we believe this information is so important for every midwife, this book will be available for FREE online upon its completion, and at cost for those who wish to have a hard copy. The outline of the book looks like this:

  1. Why You Aren't Safe!
  2. Preparing Ahead of Time: What You Need to Know and Do
  3. Understanding the Legal System
  4. Finding and Working with a Lawyer
  5. After the Dust Settles

This is an extraordinary project. Once completed, it will find its home on the MANA Web site as well as the Birthwithlove site. Please consider contributing to its success in the following ways:

  1. We still need input from persecuted/prosecuted midwives. What do you wish you had known? What do you wish you had done? What would you do differently? Your experience can be of tremendous help to midwives who have been prosecuted or may be prosecuted in the future.
  2. We are in great need of people who can help compile a resource list. This need not take a lot of your time, but please put your Internet skills to work to help track down and verify the resources needed by persecuted/prosecuted midwives.

If you are able to contribute in any way, please let us know.

Valerie, filerook@aol.com


I would like more information about why the midwife from Canada mentioned she would recommend an Epsom salt bath in early labor "provided the amniotic sac is intact" [Issue 5:18]. Please explain the provision.

Lynda, SNM, Indiana


Can you give information about the possibility of uterine rupture due to grand multiparity with no previous history of cesarean? I have found no studies that do not include previous c-section history. Does the risk go up when you have had more than five births? I would like to deliver our seventh child at home but am 45 minutes from a hospital should anything go wrong. With my last birth, I had no labor—we delivered surprised and unassisted at home.

Kristan


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.


Remember to share this newsletter

You may forward it to as many friends and colleagues as you wish—it's free!

Need to subscribe, unsubscribe, or otherwise change your E-News subscription? Then please visit our easy-to-use subscription management page.

On this page you will be able to:

  • subscribe to any of our e-mail newsletters
  • unsubscribe from any of our e-mail newsletters
  • change the version (text or HTML) that you receive
  • change the e-mail address to which newsletters are delivered

If you have difficulty, please send a complete description of the problem, including any error messages, to our newsletter.


Learn even more about birth!

Subscribe to our quarterly print publication, Midwifery Today.

Mention code 940.

 1-Year Subscription2-Year Subscription
United States$50$95
Canada / Mexico$60$113
All other countries$75$143

E-mail inquiries@midwiferytoday.com or call 1-800-743-0974 to learn how to order.

Or click here to subscribe online.


How to order our products mentioned in this issue:

Secure online shopping

We accept Visa and MasterCard at the Midwifery Today Storefront.

Order by postal mail

We accept Visa; MasterCard; and check or money order in U.S. funds.

Midwifery Today, Inc.
PO Box 2672
Eugene, OR 97402, USA

Order by phone or fax

We accept Visa and MasterCard.

Phone (U.S. and Canada; orders only):  1-800-743-0974

Phone (worldwide):  +1 541-344-7438

Fax:  +1 541-344-1422


Editorial submissions, questions or comments for E-News:

Editorial for print magazine:

Conference:

Advertising:

For all other matters:

All questions and comments submitted to Midwifery Today E-News become the property of Midwifery Today, Inc. They may be used either in full or as an excerpt, and will be archived on the Midwifery Today Web site.


Midwifery Today E-News is published electronically every other Wednesday. We invite your questions, comments and submissions. We'd love to hear from you! Write to us at: mtensubmit@midwiferytoday.com. Please send submissions in the body of your message and not as attachments.


Disclaimer

This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.

Midwifery Today, Inc., does not assume liability for the use of this information in any jurisdiction or for the contents of any external Internet sites referenced, nor does it endorse any commercial product or service mentioned or advertised in this publication. Always seek the advice of your midwife, physician, nurse or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding any medical condition.

Copyright Notice

The content of E-News is copyrighted by Midwifery Today, Inc., and, occasionally, other rights holders. You may forward E-News by e-mail an unlimited number of times, provided you do not alter the content in any way and that you include all applicable notices and disclaimers. You may print a single copy of each issue of E-News for your own personal, noncommercial use only, provided you include all applicable notices and disclaimers. Any other use of the content is strictly prohibited without the prior written permission of Midwifery Today, Inc., and any other applicable rights holders.

© 2003 Midwifery Today, Inc. All Rights Reserved.


Midwifery Today: Each One Teach One!