January 7, 2004
Volume 6, Issue 1
Midwifery Today E-News
“Preventing Perineal Tears, Part III”
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SIT UP AND TAKE NOTICE"SIT UP AND TAKE NOTICE: Positioning Yourself for A Better Birth," a book by Pauline Scott, explains the pivotal importance of fetal position to the outcome of labor and birth.

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In This Week’s Issue:

Quote of the Week

"'Prevention' is a worthy and good cause. The problem is that her cousin 'intervention' likes to follow only a few paces behind."

Mayri Sagady

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The Art of Midwifery

I never leave a birth until mom has urinated and been fed. Occasionally a mom will faint trying to do that first pee—it is not uncommon.

April, Midwifery Today Forums

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

Babies exposed to nicotine in utero show behavioral abnormalities similar to those exposed to illegal drugs during pregnancy, according to a Brown University study of 56 babies at 48 hours old. The babies were "overly excitable, tense, showed signs of central nervous system and gastrointestinal distress, and possible withdrawal symptoms." The study author commented that the findings may affect policymaking in terms of alcohol, tobacco, and other drug use during pregnancy.

Pediatrics, 111: 1318-1323.


A Journey of the Heart

"A Journey of the Heart" is a series of Guided Imagery and Meditation recordings from Anji, Inc., designed for women on their journey to motherhood. The pregnancy recordings contain imagery exercises for each month of pregnancy, preparing physically and emotionally for labor and birth, and supporting women with preterm labor. We invite you to explore Anji, Inc., at www.Anjionline.com.

Preventing Perineal Tears, Part III

One Australian hospital recently rediscovered an age-old method of delivering babies. "As the birth commences, support the perineum, keep the fetal head flexed, have the mother push gently or pant, gently push the anterior vagina over the back of the baby's head, wait until the mother pushes the anterior shoulder into view, and deliver the shoulders one at a time." Using this technique, which really is the optimal way to deliver babies, the hospital was able to lower its episiotomy rate from 78 percent to 7 percent, a rate comparable to that at many birth centers.

At a typical home or birth center birth, an experienced midwife will catch the baby in such a way as to minimize trauma to the mother's perineum. She helps the mother assume an upright position, encourages her to soak in warm water, and eases the infant gently into the world, one shoulder at a time. Many midwives use hot compresses and olive oil to further ease the transition. They let the mother know that she can trust her body to help the baby out as long as there is no fetal distress—which there usually isn't in a relaxed environment. According to Barbara Harper, "a woman left alone while birthing will often place a hand on the perineum or on the baby's head as it is crowning. She can work with the contractions and slowly ease the baby out without tearing."

By contrast, most hospital births involve at least some sense of hurry. The slapdash attitude many mothers receive in labor has been compared to a man trying to masturbate while several doctors tell him, "You'd better hurry or else we'll have to cut you 'down there.'"

It doesn't help that mothers are placed on their backs during delivery and that the baby has to be pushed "uphill." While good relaxed management of delivery is always important, it is especially critical in birthing larger-than-average babies and those in unusual positions.

Another concern during delivery may be the mother pushing "too soon." The main reason for a prolonged second stage is pushing before mother is ready. This happens when caregivers urge a woman to push just because she is 10 cm dilated. Sometimes the body needs to rest for a while after the hard work of labor and before pushing begins. Vulval swelling, the result of premature, prolonged pushing efforts, contributes to unnecessary episiotomies.

Many caregivers urge women to move through their labors in a linear "let's get this over with" fashion. Everyone involved begins to view labor as a series of stages to get through, and when you reach the last stage the baby comes out. Although this is certainly a popular perspective, I am not sure it is a helpful one. A more holistic, process-oriented approach helps the mother stay in the present and focus on responding to her body's own sensations. This woman is not likely to push too soon because she is not thinking about pushing until the urge presents itself.

In labor, as in life, a little common sense can go a long way. The more we can provide a relaxed, caring environment for the laboring mother, the better the outcome.

Excerpted from "Everything You Need to Know to Prevent Perineal Tearing," by Elizabeth Bruce, Midwifery Today Issue 65.

Midwifery Today Issue 65 is all about Tear Prevention. To order your copy, click here.

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Web Site Update

Read about teachers and classes confirmed for the Midwifery Today Conference in Bad Wildbad, Germany, 20–24 October 2004.

Read these articles newly posted to the Midwifery Today Web site:

Forum Talk

I have a student pregnant with twins, and her babies are transverse. The MDs are telling her they will deliver them breech, etc., but she can't get them to move out of transverse. She is due in March. Any ideas? She does not want a c-section.

Debbie H.



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Question of the Week

Q: My community has no midwives, and I must settle for a doctor and hospital for my birth. This will be my fifth baby; number four was also born in this town. I hemorrhaged quite badly after the placenta was manually removed (they didn't seem to want to give me time to push it out on my own). I fear I will hemorrhage again with this one. I tend to start labour the same way every time—my water breaks, and I start to bleed with no warning. I usually have about 10-15 minutes before my contractions start, and the baby is normally here within an hour or so. I tend to move along quite quickly when in labour. I have a different doctor this time, but she is very young and not very experienced, which may be a good or bad thing.

How long is a normal wait time for the placenta to be delivered? What (if anything) can I do now to lessen my chances of a large bleed at delivery? What would be a good delivery position? I have only done semisitting, but I tend to get as upright as the nurses will allow at the time.

— Charlotte

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.


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Question of the Week Responses

Q: A friend has just been diagnosed with subchorionic hematoma. She is on complete bed rest, and she has three children already. I am seeking information about this condition as well as success stories, natural remedies, or other help. She will be entering her fifth month of pregnancy and has been told she is very high risk.

— Melanie Steenbeke, Allenstown, NH

A: I just worked with a mom who was diagnosed with subchorionic hematoma. She had vaginal bleeding in the early part of pregnancy and then had seven ultrasounds in the first trimester and two in the beginning of the second trimester. This was her third pregnancy. She came to us later in the pregnancy because she wanted a homebirth again. The bleeding had stopped early in the second trimester. Her history was to go into labor at 38 weeks. Her water broke at 37 weeks with no labor. With some encouragement she went into labor after 40 hours. She had a short labor and had a 5.5-lb boy born under water with a short cord. On examination of the placenta, nothing looked unusual. The unusual part of her experience for me was her water breaking at 37 weeks with no labor, and her baby was one pound smaller than her 38 weekers.

— Kelley

Re: Varicosities [Issue 5:25]:

A: Here are a couple things to do: Do not make love and get up and start your day; stay down for at least an hour or longer. Lovemaking is better at night so you will have plenty of time to lie down afterward.

Hot compresses with cider vinegar on it works very nicely for varicosities. She should take time throughout the day to prop her legs up (elevated). Other things that help are pelvic rocks, vitamin C/with bioflavinoids, butchers broom, 800-1200 IU vitamin E, which she should cut back by 36-37 weeks. (This amount also is a little too much for the first trimester; some say too much vitamin E causes adherent placentas). Also, she could take pycnogenol, which is an antioxidant.

— Dana Rudloff

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!


What is the ecology of childbirth?

Find out at the International Congress of the Ecology of Childbirth—A Celebration of Life, Rio de Janeiro, Brazil, May 27–30, 2004. International speakers include Michele Odent, Jan Tritten and Elizabeth Davis.
For more information or to register: www.partoecologico.com.br

With Woman

by Gloria Lemay

All humans have a certain propensity to self sabotage, and the VBAC woman must be guarded against her own self-defeating patterns. The doula and midwife must be bold in pointing out ways that the woman is repeating mistakes—there's no place for being "nice" if it will mean another cesarean. An example of this: If the woman had a cesarean with five support people, don't let her have extra people at her VBAC birth.

Privacy and quiet are a must, and attendants may have to be very forceful about setting up logistics before the birth so that the woman can birth in peace. In short, the VBAC is high priority because the woman's whole obstetrical future rides on its success.

One video is worth a thousand words. I recommend "Gentle Birth Choices" by Barbara Harper, which includes footage of a beautiful VBAC birth.

Art therapy is helpful in creating the environment before the birth day. I place a big sheet of drawing paper in front of the father and mother with lots of colored pencils and instruct them to "draw your birth cave" or "color your birth." When they are finished, I write the date on the two drawings and put them away in my files. After the birth, we take them out and are amazed at the details that were drawn weeks before and later manifested in the actual birth.

Gloria Lemay runs the Doula Course at BirthLove, it is free for all site members. www.birthlove.com/glo_doula.html

The video "Gentle Birth Choices" mentioned in this article is available in the Midwifery Today shopping cart. Click here.

Request for Birth Photos

Be a part of the Midwifery Today family by sending your birth photos to us for the Photo Album section of the print magazine. Send them to Midwifery Today, P.O. Box 2672, Eugene, OR 97402. Don't forget to include the following information: baby's name, date of birth, weight, parents' names, names of all midwives and birth attendants and photographer's name. If we use them, we will send you copies of the issue they appear in to share with your family. (We cannot return photos, but you have our assurance that they will not be used online or in any other publication.)


Home Birth Practice in Chicago area: Seeking midwives and family practice doctors to join our practice. Call 847-733-8050 or e-mail bestbirth@birthlink.com. For more info go to www.homefirst.com.

The International School of Traditional Midwifery offers quality education to aspiring and practicing midwives through our onsite, distance learning, A&P, and short course programs. Contact us at 541-488-8254 or www.globalmidwives.org.

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