Research to Remember
A National Institutes of Child Health and Development study of more than 1,000 women between the ages of 18 and 39 included 392 women diagnosed with functional ovarian cysts and 623 cyst-free women as controls. Researchers computed the odds that would link the use of oral contraceptives with either cyst reduction or formation. Factors that could influence the outcome, including a history of cysts or smoking, were included in the analysis. Results of the study showed that low-dose contraceptive pills didn't increase the risk of cysts, but they also didn't help prevent them in the overwhelming majority of women. It had been previously determined that high-dose contraceptive pills provided a more than 90% effectiveness rate in preventing ovarian cysts as compared with a 28% rate determined by this study in those who used a low-dose contraceptive pill. The study also found a 70% increased risk of cyst formation in women who had tubal ligation.
— Obstetrics and Gynecology, August 2003
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Keeping Birth Normal
Part of a midwife's job is to facilitate spontaneous labor. I've found that if I spend enough time with a woman prenatally and address issues with her honestly as they arise, labor will usually be straightforward. I lay the groundwork for birth with the first contact. During the conversation, my client and I talk about how her body is made to delivery a baby. I emphasize that the work of labor involves going within, as in deep meditation, and permitting the uterus to do its job. I encourage her to cultivate that part of herself during pregnancy. I discuss the importance society has placed on doing things—exercising, taking classes, watching diet—rather than on relaxing, and suggest at least 10 minutes of daily relaxation.
At the initial visit I explain what tests we'll do and what they will reveal, such as the need for better nutrition. For example, if her blood pressure is elevated, I tell her to increase protein to 100 grams per day, calcium to 2000 mgs a day and water intake to at least two quarts a day, and tell her to return in three days for a recheck. I don't tell her that high blood pressure is one sign of preeclampsia or toxemia. These frightening words imply that her body doesn't know how to sustain a baby.
I use the initial visit to record my client's history. I ask open-ended questions such as "When you were growing up and thought about having a baby, what did you think about?" Answers vary and range from "I always knew it would be fun/easy/normal" to "I never thought about it" to "I thought I would die." Obviously, women who have thought about dying in childbirth need to deal with the cause of those thoughts. Remembering confidentiality, tell these special-need clients—and all clients—positive birth stories. Keep in mind midwives are not therapists. Refer clients for counseling if you feel it's necessary.
History-taking also includes asking about past or present abuse issues such as alcohol use or verbal, emotional, physical or sexual abuse. I determine if a referral is necessary. I may talk through vaginal exams about the feelings they may experience during birth.
Doing a vaginal exam before a relationship with a client is established can be traumatic and feel invasive for many women. However, dating a pregnancy may help diminish fears. There is little value in early pelvic assessment because the size of the baby is unknown, especially in relationship to the relaxed pelvis at term. Yet many women tell me a former doctor said they'd probably have a difficult time birthing because of their small pelvis. I tell my clients again and again that their bodies are capable of growing and delivering just the right-sized baby.
Teaching a client to do "kick counts" or to keep a fetal movement chart is another way of indicating that her body doesn't know how to be pregnant. It tells her the baby might die if she doesn't monitor its movements.
Childbirth education classes often present too much information, which inhibits the natural process of pregnancy. I do two private classes with each of my couples. The classes include the anatomy and physiology of labor and delivery; how the partner can use touch and how he/she can allow the laboring woman to go within; relaxation; a discussion of how endorphins will produce all the painkillers she needs at each level of labor; when to call me and how to time contractions; the need for water, juice, and any food she desires; a demonstration of how late first stage sounds; how pushing feels; informed consent about infant eye drops and vitamin K; and the care and nursing of the newborn. I also show a video of one of my clients using sound to push her baby out—it encourages my clients to make any noises they feel like during labor.
My discussion of emergencies is limited to telling my client and her partner that I'll make the decision to transport if needed. I tell them I will inform them about what is going on, I will call the hospital and I won't leave them once we arrive at the hospital. I used to teach all the complications, but I found I had a lot more transports and cesareans, so I stopped.
Fear is the primary cause of long labors. I encourage midwives to learn to present information prenatally in a way that won't frighten clients. Don't overeducate them about the midwife's "world of worst nightmares." Instead, educate them with the knowledge that their bodies are designed to do this work. Deal fearlessly with any spiritual, physical or economic issues that may come up during the prenatal period, and lovingly help their process unfold.
— Excerpted from "Causing Labor to Unfold," by Alison Osborn, Midwifery Today Issue 31
It is not that faith creates the reality of birth; it is the reality of birth that creates faith. Birth is a normal, natural function that is designed so well physiologically that it rarely needs outside assistance. Many midwives know this intellectually, but it can take time to develop a heart's worth of trust.
An explanation of the nature of faith: When you sit on a chair, you believe it will hold you up and you do not even give a thought that it might collapse under your body. You trust the design of the chair, and you've had experience and know it is trustworthy. Imagine trying to sit on it and having strangers walk in and attach you to a monitor—just in case this chair should collapse. Imagine being denied food and water in case the chair fails and you need surgery. What if you've heard chair horror stories all your life, and you doubt your ability to cope with the discomforts of sitting on a chair? Faith in the design of the chair creates an attitude of trust that allows you to release with abandon the tension of your body to the chair.
Sometimes pregnant women are short on faith about their abilities to give birth. Often, whether we realize it or not, it is faith that they want and need from us. Faith is a quality and an attitude that can make or break some labors. Anyone who has been in a situation that tested their mettle and caused them to doubt themselves but had at least one advocate saying, "Go for it! I know you can do it" has experienced the power of faith. In my practice, I'm amazed at the difference of wisdom that flows out of me when working with those who trust me versus those who are very fearful of birth with a midwife.
— Excerpted from "A Matter of Faith," by Caroline Eustice, Midwifery Today Issue 17
A Declaration of the Rights of Childbearing Women
- All women have the right to sacred, fantastic, profound and loving birth experiences. Childbirth must never be viewed by birth attendants as routine, cumbersome or insignificant.
- Childbirth must happen in physical and emotional privacy. Women's vaginas in birth are as sacrosanct as they are at any other time; routinely penetrating them with fingers, forceps, scissors or hooks is a severe violation against the most fundamental rights of women to privacy and protection of the self. Women have the right to vocalize, move about, assume any birthing positions they like, and allow their births to unfold uniquely, without feeling the need to gain the acceptance and approval of their birth attendants. Women have the right to refuse birth attendants altogether. All hospital staff, midwives, family members and friends of birthing women must have full consent before viewing the childbirth process. Women's bodies are never to be regarded as learning aids. No institution has the right to impose spectators on any woman's birth.
- Women have the right and power of "No": if they understand interventions and procedures and refuse to allow them to be implemented, their refusals must be respected by all medical personnel. Childbearing women will not be barraged with attempts at mind changing or browbeating.
- All women must be physically safe at birth. Instruments of routine interventions seriously harm the bodies of women: scissors, knives, harmful drugs, forceps, catheters, hooks, needles, fingers, tubes, and razors can be classified as tools of assault. Extreme caution must be used whenever obstruction of the natural birth process is considered.
- All babies, either in the process of being born or after their births, deserve not to be harmed: forceps, scalp hooks, violent extraction, careless handling, suctioning catheters, ventilating equipment, intravenous devices, and an oxygen-deprived birth environment—caused by either pain-relieving or induction drugs—all cause a great deal of distress to new babies and can upset their future well-being.
- All women have the right to complete and immediate access to information regarding all procedures done—either to them or their babies—in pregnancy, birth and the postpartum. Women must be informed of any potential harm of all procedures, regardless of the length of time the explaining takes (except in the most extreme cases). Women or their birth attendants cannot take "informed consent" lightly. Women have the right to be made aware of nonintrusive alternatives to common hospital procedures—such as the superior safety of giving birth at home, waterbirth as a safe method of pain relief and the advantages of natural, private methods of induction of labor.
- It must be recognized as a criminal act to mutilate women's bodies in childbirth.
- All women must have easy, free access to information that illuminates the natural childbirth process for them—information that helps them prepare for their births and assists them in preparation for care of their newborns. This information must be given in a way that does not view birth as a dangerous, biological anomaly, but as a natural, joyous one.
- All women have the right to give birth wherever and with whomever they choose, and to know the safety statistics of any individuals and/or institutions they choose to give birth with/in.
- All women have the right of complete access to all their own recorded medical information, as well as access to knowledgeable people for whom the information poses no personal liability.
- The newborn must be viewed as a natural appendage of its mother. Mother and child must remain together, in quiet dignity, for as long as the mother desires. Handling of the baby by anyone other than its mother for the first hours of life is to be strongly discouraged.
- Ongoing breastfeeding information and support must be available to all women.
The rights of women are inalienable, and will not be undermined by any government, male partner, professional birth attendant, nor any individual or group of individuals whose interests do not reflect the wishes of parturient women, regarding their own or their babies' safety and well-being.
— Leilah McCracken, Midwifery Today Issue 50
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Read this article newly posted to the Midwifery Today Web site:
I am wondering what everyone does with their biohazardous materials, both from prenatals and birth. Of course sharps go in a sharps container, but what do you do with gloves and bloody Chux, etc.? Usually we bundle them up double bagged and toss them in the dumpster in the idea that a woman doesn't do anything special with her menstrual pads or tampons, but I am wondering if any one has other practices. I'm pretty sure OSHA would prefer we bring them to a hazmat turn-in place, but not everyone has that option. Does your local hospital take it?
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Question of the Week
Q: A client has a degenerative kidney disease called IgA nephropathy. She is showing +1 to +2 protein in her urine, her average blood pressure (BP) is 130/82. She is seeing a nephrologist and getting her labs done monthly: sodium, potassium, chloride, carbon dioxide, calcium, glucose, phosphorus, BUN and creatine, albumin—all of which are in a normal range. I am looking into alternative methods for supporting and nourishing her kidneys through the pregnancy. She has seen an acupuncturist (per my suggestion) one time to receive treatment and herbal supplements. She is 20 weeks pregnant. In addition, we helped her with a homebirth 2½ years ago, and during that pregnancy she had no protein that spilled in her urine and her BP was more like 110/66. Do readers have recommendations and/or experience?
Q: Recently, as an L&D nurse, I ended up delivering a double-footling breech baby. I received some criticism from another nurse that I should have let the baby's head remain in the vaginal vault. She states that it is OK to leave such a presentation for up to an hour. The OB who came in later said, You have four minutes to get the baby delivered. Who is correct? I entered into this delivery at change of shift, and patient was in triage area awaiting a surgeon for c-section. I was presented with two feet and buttocks out of the perineum.
— Gretchen Jenkins, RN
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.
Question of the Week Responses
Q: My daughter-in-law has had a chronic perineal fistula that flares up every month with drainage, since she was pregnant. Her son is now 15 months old. The tunneling is so deep that surgery would be a great risk for her (possible colostomy due to nerve damage). She also got a staph infection while in hospital and has been on antibiotics a few times. She has been applying lavender and oregano oils to the site. She is still breastfeeding her baby. Any suggestions for healing would be most welcome!
A: I swear by the healing powers of castor oil. Apply a small cloth (or pad) soaked in castor oil every night when you go to sleep, possibly with a hot water bottle over it (between your legs) so that the oil soaks in better. The healing powers of castor oil on tissues is miraculous. Angry swollen perineums after birth appear normal after only a few hours of treatment. In the morning do a 15-minute warm sitz bath with herbs: uva ursi, echinacia, golden seal, witch hazel, comfrey root and leaf, rosemary, sea salt and garlic. The secret is to be constant for about one month and to be very present and conscious about healing yourself. That is 80% of the power, and the herbs and castor oil are the loving helpers. Wear loose clothing, no tight jeans, etc., which do not allow for ventilation.
— Uva, Costa Rica
Regarding uterine prolapse [Issue 7:8]:
A: Using a slant board several times a day facilitates getting and keeping the uterus back up where it belongs. If it is severe and doesn't correct after several months of this exercise, a pessary may be needed. In a pinch, you can use a tampon as a pessary to hold up your uterus, but this is not recommended due to the possibility of getting toxic shock. Any obstetrician or nurse-midwife should be able to fit you for the pessary.
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.
I was living in Brazil and completed one semester of nursing school there. I have recently moved to Syracuse, New York. I will be starting nursing school again in August for an ASN. My dream is to follow the nursing path and eventually becoming a CNM. I had trouble choosing my path like so many young people, but I have been thinking about and been in love with midwifery for a couple of years. I went to a public hospital in Brazil and saw two births. Most public hospitals there are known for their very poor conditions. The births were very hard to witness. They were miracles but very disrespectful. Since I am in the United States now I am hoping to shadow a CNM in the area for a few days and see a couple births in hospitals, at birth centers or even at home. Is this a possibility? Is there a nurse-midwife in central New York who would be willing to do this?
— Maira, email@example.com
The senate anti-terror bill now has a provision to insulate pharmaceutical companies from liability while allowing them to continue mercury-laden jabs on infants and children. The science is being hushed. Please contact your congressmen and ask what can be done to stop this sneaky practice that endangers our children's health and others who get flu shots.
Editor's Note: See http://www.commondreams.org/views05/0413-31.htm for Robert Kennedy, Jr.'s statement.
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firstname.lastname@example.org, will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will not be considered.
MIDWIFE-TO-BE training program. Pay as you go. Done by mail or e-mail. SC DHEC approved. Low cost. Much offered. www.newlifehomebirth.com email@example.com Lisa Aman, LM
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