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I'd like to hear some discussion from midwives doing VBACs at home: Do you risk out women who have single-layer suturing from their previous cesarean closures? I'm trying to make up my mind about this issue since hearing Ina May and others raise it in the past few years. I now have my first client who wants to deliver at home and has single-layer suturing. Any thoughts?
TO SHARE YOUR THOUGHTS AND EXPERIENCE ABOUT THIS TOPIC, click here.
The New Zealand College of Midwives
The New Zealand College of Midwives (NZCOM) celebrates a century of midwifery in New Zealand/Aoteoroa next year and welcomes papers on relevant topics as part of the college's national conference presentations, September 2004.
The conference is to be hosted by the Wellington region of New Zealand College of Midwives. The procedure for submitting abstracts is on our Web site: www.nzcom.org.nz
Abstracts received from E-News readers within a week of the January 30 deadline will be considered.
Q: Are there others out there who took a long break from midwifery, then returned to practice? After 20 years (13 as a CNM), I left practice to heal from severe burnout. In spite of a new, enjoyable career and owning my own small business, I often wonder about returning to practice three years after having left. I've done lots of personal work through counseling, introspection, food changes, and exercise and wonder what others might have done practically, educationally, and otherwise to prepare to return. How did you feel about reentering practice? I'm sorting my feelings for now—grieve and let go vs. reevaluate and return.
SEND YOUR RESPONSE to email@example.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.
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.
A: At the beginning of my practice as a midwife, we had a homebirth client who was expecting her fourth baby. She had hemorrhaged badly after each of her prior hospital births. I called [midwife/herbalist] Lisa Goldstein and asked her, expecting a negative answer, if there was anything we could suggest so this woman would not bleed at her homebirth. Lisa's one-word answer: "Alfalfa."
Alfalfa's roots go extremely deep into the soil; it contains every vitamin and mineral known to man; and it is a good source of vitamin K, a natural blood clotter. The mom began to take alfalfa religiously and had completely normal—scant even—bleeding postpartum (she had a wonderful homebirth!).
Since then I have learned quite a bit more about avoiding postpartum heavy blood loss. During the past 11 years, it has been extremely rare for a client of mine to bleed seriously. Most of my clients choose to try the following suggestions, and nearly all have had minimal, normal bleeding. I keep medications on hand but throw them out and replace them, unused.
Here is the crux of what we do:
It is a lot of pills, but think of it as the nutrients your food is missing. I suggest taking half of them in the morning and half in the evening. Bagging one month's worth in small ziplocks makes it easier. Keep them where you will remember to take them (e.g., where you brush your teeth).
I have been able to compare my methods with those of other caregivers because I also worked in a birth center and assisted other midwives whose clients have not had the benefit of these protective components. I have seen some serious bleeding in women who don't use these methods. Even then, it is usually stopped with herbs. My favorite is 30 drops (three droppersful) of Lady's Mantle tincture, which stops bleeding "right now"! The Web site, www.gentlebirth.org/archives/, gives other midwives' suggestions.
I assume you will eat healthy food and take a good brisk walk (30–45 minutes) each day. It would be great if you found someone with a calmer approach to placenta birthing!
— Julie Martin, CPM, NHCM
A: You are wise to start preparing for the possibility of hemorrhage. In my experience, moms who have had manual removal with postpartum hemorrhage are more likely to experience it again. Ask your physician how she has handled hemorrhage right after birth. How many times has she done manual compression? What drugs does she use? When you tour the hospital or have an appointment with the prenatal coordinator, tell her your history and request that when you come in in labor the appropriate pp hemorrhage drugs be brought to the room immediately on admission. An extra nurse is needed should hemorrhage occur. Did you rehydrate well last time? If you breastfed, did you notice a marked decrease in your milk production? When the placenta is delivered it must be inspected carefully for completeness.
A: It can be normal for the placenta to take up to one hour to deliver. A hands-off approach is the best method as long as you are not bleeding heavily and your blood pressure and pulse are normal. If you are bleeding before the placenta delivers it is probably partially or completely detached and should be delivered as quickly as possible to allow your uterus to clamp down. Insist that your doctor not touch the cord until it stops pulsing and then to not use cord traction to deliver the placenta but to get you into an upright (squatting) position and deliver it yourself.
Prenatal prevention of postpartum hemorrhage includes blood-building supplements, including alfalfa and yellow dock. Homeopathic Arnica (30c) 5 pellets 3–5x per day in the last two weeks of pregnancy and at the onset of labor will reduce bleeding as well. Pitocin IM immediately after the birth will also reduce the risk of hemorrhage.
— Rebekah Rico, CPM, LM
A: I spoke with a friend's mother who homebirthed 35 years ago. She said her placenta didn't emerge for four hours. Fortunately no one felt a need to intervene. There were no complications.
Doctors and OB nurses want to get on with it, clean up, and move on, so they tug the placenta. This is a dangerous practice that can cause dangerous hemorrhage. Then the doctors do some heroics to save the mother's life.
Please remember that you are not a prisoner and the doctor cannot do anything to you without your permission. Women have been trained to "be good," and so they rarely question or protest a doctor's moves.
Discuss this with your doctor *before* the labor and also have something in writing to bring with you in case you end up with an alternate doctor.
Sometimes just getting up on your knees allows the placenta to fall out. But you should wait until it separates naturally.
Editor's Note: Responses to any Question of the Week may be sent to E-News at any time. Write to firstname.lastname@example.org. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.
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.
Regarding antibiotic administration prior to birth and its effect on the newborn [Issue 5:25]:
I opted not to be tested for Group B strep in my pregnancy and was subsequently coerced by an OB into having prophylactic antibiotics administered during labor "just in case." My son and I both developed nasty yeast infections shortly after he was born. Antibiotics kill all bacteria—good and bad. Without the presence of the good bacteria in your baby's intestines, Candida (also known as yeast or thrush) has an opportunity to grow prolifically. Start taking lactobacillus acidophilous (which is a healthy bacteria) to replace what has been killed by the antibiotic. In the meantime try not to be too concerned because most likely the worst scenario is an ugly diaper rash.
I am 18 years old and considering going to school to be a nurse midwife. I currently live in Syracuse, New York, where I spent my childhood. Within the next six months I will be returning to Brazil where my family lives to go to college there. I know that in Syracuse midwives are very appreciated and respected. In Brazil, however, they tend to work mostly in the interior, or in public hospitals where they don't get much chance to be creative or get paid very well. Midwifery seems to be a growing profession only in large cities such as Sao Paulo and Rio de Janeiro—where I would really hate to live. My family lives in Palmas, where I will probably go to college.
I would just like some encouragement and suggestions. Maybe there are places or people I don't know about and could contact who are working toward encouraging midwives and natural homebirths.
— Maira Mathews
Readers, please take time to give Maira a hand up. Direct your comments to email@example.com. —Ed.
Editor's Note: Only letters sent to the E-News official e-mail address, firstname.lastname@example.org, will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will not be considered.
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!
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 email@example.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
Do You Have a Wonderful Natural Birth Story? Deadline for submission February 7th. Your story is part of a book that gives new moms hope and inspiration. More information at: http://www.menelli.com/stories.html or firstname.lastname@example.org
CPM seeks same to start practice in beautiful Southeastern Minnesota. E-mail: Tanya Mudrick CPM at email@example.com
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