June 22, 2005
Volume 7, Issue 13
Midwifery Today E-News
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Midwifery Today Conferences

Learn about midwifery in the Caribbean

This full-day pre-conference class will explore the past, present and future of midwifery in this vast region. Sections include Anthropology of the Caribbean with Robbie Davis-Floyd, Birth Change in the Caribbean and Projects and Programs for Humane Women-centered Birth. Part of our conference in Nassau, Bahamas, September 22–26, 2005. Go here for info.

"Liberty in Midwifery and Birth"

Come to our conference in Philadelphia, March 23–27, 2006. Teachers include:

  • Ina May Gaskin
  • Michel Odent
  • Elizabeth Davis
  • Robbie Davis-Floyd
  • Marsden Wagner

Go here for more information.

In This Week’s Issue:

Quote of the Week

"Delivery rooms all over the world have become a focal point of bipolarity between rational and intuitive forms of knowledge."

Mindy Levy

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The Art of Midwifery

When a family has experienced a stillbirth/infant death, remember to check on them and talk with them periodically—weeks and months—after the passage. Many parents are doing great days after a loss, but in a couple of weeks everyone else expects the parents to be "over it," and the support from others starts to dry up—just as their shock and numbness begins to wear off. The three- to four-month mark is often the worst time of grieving.

Anon., Midwifery Today forums

Editor's Note: Correction—In E-News Issue 7:11, the following statement appeared in The Art of Midwifery:

"One grain of blood is equal to one milliliter (mL). Any vaginal bleeding greater than 15 mL is considered hemorrhage and by medical standards necessitates placing that client from a low-risk status to a high-risk status."

THE CORRECT WORD IS "GRAM" [of blood], and THE CORRECT AMOUNT IS "about 500 mL." We regret the error.

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.

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

Research to Remember

A British study that linked risk of stillbirth to the father's amount of exposure to workplace radiation determined that stillbirth increased by 24% for each millisieverts (mSv) of radiation a man had been exposed to in his lifetime. For every 10 mSv of exposure in the 90 days before conception, the odds of stillbirth rose by 86%. Records of 9208 births between 1950 and 1989 in county Cumbria where the fathers were employed at a nuclear plant revealed significantly more stillbirths among women whose partners were employed at the nuclear plant than among women whose partners were not employed there, when data were standardized for year, social class and birth order.

Lancet, 1999, 354(9180):1407–1414

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Mammals in general and women in particular control the pain of labor by releasing morphinelike substances called endorphins. It has been demonstrated that these endorphins stimulate the secretion of prolactin, the key hormone of lactation.

Oxytocin is necessary for the contraction of the uterus during labor and also for the contraction of the breast during the milk ejection reflex, when the baby is sucking. It is questionable whether women who have had no labor can release oxytocin as effectively as those who gave birth in physiological conditions. A Swedish study found that two days after birth, when the baby is at the breast, women who gave birth vaginally release oxytocin in a very pulsatile—therefore effective way—compared with women who gave birth by emergency cesarean section. The study found a correlation between the way oxytocin is released two days after birth and the duration of exclusive breastfeeding. In other words, the duration of breastfeeding seems to depend on how the baby was born. The same Swedish team found that the cesarean women laced a significant rise in prolactin levels at 20-30 minutes after the onset of breastfeeding (1).

An Italian study found that the amount of endorphins in breastmilk of the first days is much higher among mothers who gave birth vaginally compared with mothers who underwent cesarean section (2). It is probable that one of the effects of morphinelike substances is to induce a sort of addiction to mother's milk. One can anticipate that the more addicted to the breast the newborn baby becomes, the longer and easier the breastfeeding.

It seems more important, where the initiation of lactation is concerned, to contrast "cesarean during labor" with "scheduled cesarean." Nonlabor cesareans seem to be associated with more breastfeeding difficulties. We can easily offer an interpretation: when the time of birth has been planned, mother and baby have not been given the opportunity to release the hormones involved in both childbirth and lactation. A study from Turkey compared the starting time of lactation and the amount of milk produced within 24 hours among several groups of cesarean births. Researchers found that the beginning of lactation occurred earlier and the amount of milk produced was higher among women whose second cesarean was performed during labor, compared with women whose second cesarean was scheduled (3).

Michel Odent, excerpted from "Nursing the Caesarean Born," Midwifery Today Issue 69


  1. Nissen, E. (1996). Different patterns of oxytocin, prolactin but not cortisol release during breastfeeding in women delivered by caesarean section or by the vaginal route. Early Human Development 45: 103–18.
  2. Zanardo, V., et al. 2001). Labor pain effects on colostral milk beta-endorphin concentrations of lactating mothers. Biology of the Neonate 79 (2): 79–86.
  3. Dogany, M., and F. Avsar (2002). Effects of labor time on secretion time and quantity of breastmilk. Int J Gynaecol Obstet 76 (2): 207–11.

Preliminary data and related research on the pregnant uterus suggest that breastfeeding and healthy term births are quite compatible. The specter of breastfeeding-induced preterm labor appears to spring from an incomplete understanding of the interactions between nipple stimulation, oxytocin and pregnancy.

The first little-known fact is that during pregnancy *less* oxytocin is released in response to nipple stimulation than when a woman is not pregnant (1). The key to understanding breastfeeding during pregnancy is the uterus itself. Contrary to popular belief, the uterus is not at the beck and call of oxytocin during the 38 weeks of the preterm period. Even a high dose of synthetic oxytocin is unlikely to trigger labor until a woman is at term.

Oxytocin receptor sites, the uterine cells that detect the presence of oxytocin and cause a contraction, are sparse up until 38 weeks, increase gradually after that time, and increase 300-fold *after* labor has begun. In order for oxytocin receptor sites to respond strongly to oxytocin, they need the help of special agents called "gap junction proteins." The absence of these proteins renders the uterus down-regulated, or relatively insensitve to oxytocin even when the oxytocin receptor site density is high. And natural oxytocin-blockers, most notably progesterone, stand between oxytocin and its receptor site throughout pregnancy (2,3,4). The uterus is in baby-holding mode, well protected from untimely labor.

Hilary Dervin Flower, excerpted from "Breasfeeding during Pregnancy," Midwifery Today Issue 68


  1. Amico, J., and B. Finley (1986). Breast stimulation in cycling women, pregnant women and a woman with induced lactation: pattern of release of oxytocin, prolactin and luteinizing hormone. Clinical Endocrinology 25: 97–106.
  2. Chwalisz, K., et al. (1991). The progesterone antagonist onapristone increases the effectiveness of oxytocin to produce delivery without changing the myometrial oxytocin receptor concentrations. Am J Obstet Gynecol 165: 1760–70.
  3. Grazzini, E., et al. (1998, April). Inhibition of oxytocin receptor function by direct binding of progesterone. Nature 392 (6675): 509–12.
  4. Zingg, H.H., et al. (1998). Genomic and non-genomic mechanisms of oxytocin receptor regulation. Adv Exp Med Biol 449: 287–95.

The Cost of Not Breastfeeding

  • U.S. families spend $2 billion a year on human milk substitutes such as artificial milk, otherwise known as formula.
  • It costs an additional $1.3 billion to cover sick-child office visits and prescriptions for respiratory infections, ear infections and diarrhea in nonbreastfed infants during the first year of life.
  • In the first year of life, it will cost more than $25,000 to treat lower-respiratory infections in 1000 never-breastfed infants.
  • The cost of treating Type I diabetes in formula-fed children is more than $1 trillion.
  • Private and government insurers spend a minimum of $3.6 billion a year to treat medical conditions and diseases preventable by breastfeeding.
  • Formula has a long history of recalls for bacterial contamination or mis-manufacture that has in many cases resulted instances of illness, permanent injury of death.

"Breastfeeding Is Priceless" (excerpted from a CIMS Fact Sheet) in The Birthkit Issue 40, Winter 2003

MIDWIFERY TODAY Back Issues are available online.
Issue 68
Issue 69

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Mexico Midwifery Immersion Program

National College of Midwifery announces the Mexico Midwifery Immersion Program. Spend 2 months in Tepoztlan Mexico, learning intensive midwifery academics, Spanish and clinical care with professional and traditional Mexican midwives. Beautiful colonial mountain town. $5,000 includes airfare from Albuquerque, ground transport, room and board, great home-cooked meals, tuition, excursions and field trips. Contact NCM at 505-758-8914 or www.midwiferycollege.org

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The Caesarean Do we know the long-term consequences of being born by caesarean? Do we have any idea of what the eventual effect on humanity might be?
Read The Caesarean, by Michel Odent and find out. You'll also learn how this magnificent rescue operation become such a common way of being born and discover why the c-section rate varies so widely from place to place. Order the book.

Midwifery Today Issue 65Interested in midwifery? Care about birth? Then you need MIDWIFERY TODAY magazine.
Subscribe to MIDWIFERY TODAY magazine today.

Web Site Update

There is an update on the phone number to use to receive the group discount when making reservations for the Midwifery Today Conference in the Bahamas.

Read this review our Web site of a handbook designed for your birth bag:

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The University of Sheffield—Online Master of Midwifery degree

An exciting new international Master's programme aimed at qualified midwives wishing to enhance their professional standing with a postgraduate qualification from a leading UK university. Conducted part-time over three years, it is entirely online, with no travel/attendance requirements. You could join the next intake, commencing September 2005. Full details: www.sheffield.ac.uk/mmid Enquiries: c.c.stuart@sheffield.ac.uk

Forum Talk

What do you recommend to your patients for indigestion?


Go to our forums to share your thoughts and experience.

Question of the Week

Q: (Repeated) How long do you normally stay after a homebirth, and do you leave written instructions (guidelines so parents know what's normal for both mom and baby) with the couple? What things do you look for (e.g., mom urinating, baby nursing well, etc.) before you leave?

— Anon.

Q: What experiences have midwife readers had with shoulder dystocia and brachial plexus injuries? What techniques have you used successfully and unsuccessfully to relieve shoulder dystocia? Have you ever seen a brachial plexus injury where there was no shoulder dystocia, the delivery was textbook, but still an injury?

— Tanya

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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Earn Your Master's Degree Online

Master of Science in Nursing

  • Nurse Midwifery
  • Women's Health Nurse Practitioner

The University of Cincinnati is launching two new distance learning programs that make it possible for working nursing professionals to earn their Master's degrees in just two years. Coursework is completed online, while clinical experiences are conducted with preceptors in your community. More information here.


I am doing a project for my women's study class. I am collecting donations for midwife Robin Lim's organization in Bali. This will provide immediate help to pregnant moms and babies who survived the tsunami disaster. For more information about how to contribute, e-mail me at Janne37@aol.com

Jill Cohen

A friend is interested in opening a birth center. She will be finishing her midwifery education in the next six to nine months. I would like to help her. Does anyone have advice or information I can share with her about opening or running a successful birth center? Is it best to start a non-profit organization? What grants are available?

Lauren Poindexter

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.

Nature of Birth Conference

"The Nature Of Birth" conference will be held July 1–4, 2005, in beautiful Centro Vacacional IMSS, Oaxtepec, Morelos, Mexico.

This conference is an international gathering of renowned professional and lay pioneers from over 15 different countries, passionate in their work and life devoted to pregnancy, fetal development, birth and link between mother-child and family-child: Cornelia Enning (Germany), Verena Schmid (Italy), Elizabeth Davis (USA), Jan Tritten (USA), Heloisa Lessa (Brazil), Laura Uplinger (Brazil/USA), Robbie Davis-Floyd (USA), Raquel Schallman (Argentina), Adriana Tanese Nogueira (Brazil), and others, including pioneers from Venezuela, Costa Rica, England, Mexico, Guatemala, Peru, France, Nicaragua and Afghanistan.

Register at:
Contact info—Naolí Vinaver: naolivinaver@hotmail.com
Registration—Cristina Galante: crigalante@hotmail.com

EACH US/European registrant will facilitate the funding of TWO Traditional Midwives from undeveloped countries. For DONATIONS to fund one or more traditional midwives in the program "Adopt a Traditional Midwife," please send donations to:
BANK: Scotiabank Inverlat
Office: Porfirio Diaz
Plaza: Oaxaca, Mexico
Name: Maria Cristina Galante De Acevedo
Account number: 02220628
CLABE: 044610092022206288
(The "CLABE" is the International 18-digit code required by our Mexican banks in order to receive international deposits.)

Send your personal information to Cristina Galante (crigalante@hotmail.com) to receive mention for your donation in the congress program.

Classified Advertising

www.birthwares.com—Midwives, Childbirth Educators, Doulas—This IS the Web site for YOU! One-stop shopping for birth items including hardwood birth stools, childbirth teaching aids, birth supplies, gifts, consignment items. www.birthwares.com

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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.

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