|July 20, 2005|
Volume 7, Issue 15
|Midwifery Today E-News|
|Subscribe • Print Page|
Search Archive • Index
Welcome to Midwifery Today E-News !
Midwifery Today Online Store
SERVING WOMEN IN HOSPITAL BIRTH, An audiotape series from Midwifery Today conferences:
This issue of Midwifery Today E-News is brought to you by:
Look below for more info!
Midwifery Today Conferences
Learn about 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:
Go here for more information and a complete program.
Send submissions, inquiries, and responses to newsletter items to: email@example.com.
In This Week’s Issue:
Quote of the Week
"Keep your hands off and keep your hands out; keep the lights dim and the talking down. Expect normalcy."
— Vicki Penwell
Are you enjoying your free copy of the Midwifery Today E-News?
The Art of Midwifery
During the first prenatal visit I tell each client how keeping a journal can serve her. I begin with a few ideas:
— Dinah Waranch, The Birthkit Issue 46
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 firstname.lastname@example.org.
Research to Remember
A study to determine the potential pain-reducing effects of ice massage applied to various acupuncture points during labor included 49 pregnant women between the ages of 16 and 38 years. Ice massage, administered by way of crushed ice in a hand towel, was applied for 20 minutes or until the fourth contraction, whichever came first, to Large Intestine 4 (LI-4), located on the hand. The women rated intensity of pain during each contraction while the ice was applied; on a scale of 1 to 5, 1 indicated mild discomfort and 5 indicated extreme pain. A postpartum questionnaire revealed that pain had been decreased by 19% after ice massage was applied to the right hand and by nearly 50% to the left hand. LI-4 is located in the webbing between thumb and index finger on the back of the hand.
— Journal of Midwifery and Women's Health 2003; 48:317–21
Please support our advertisers!
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: email@example.com
It is after the birth of the baby and before the delivery of the placenta that women have the capacity to reach the highest possible peak of oxytocin. As in any other circumstances, the release of oxytocin is highly dependent on environmental factors. It is easier if the place is very warm (so that the level of hormones of the adrenaline family is as low as possible). It is also easier if the mother has nothing else to do but look at the baby's eyes and feel contact with the baby's skin, without any distraction. To be effective, release of oxytocin must be pulsatile: the higher the frequency of pulses, the more effective this hormone is.
Oxytocin is never released in isolation. It is always part of a complex hormonal balance. That is why love has so many facets. In the particular case of the hour following birth, in physiological conditions, the high peak of oxytocin is associated with a high level of prolactin, which is also known as the "motherhood hormone." This is the most typical situation for inducing love of babies. Oxytocin and prolactin complement each other. Furthermore, estrogens activate the oxytocin and prolactin receptors. We must always think in terms of hormonal balance.
The release of morphine-like hormones during labor and delivery is now well-documented. The baby also releases its own endorphins in the birth process, and there is no doubt that for a certain time following birth both mother and baby are impregnated with opiates. The property of opiates to induce states of dependency is well-known, so it is easy to anticipate how the beginning of a "dependency" or attachment will likely develop.
Even hormones of the adrenaline family (often seen as hormones of aggression) have an obvious role to play in the interaction between mother and baby immediately after birth. During the very last contractions before birth the level of these hormones in the mother peaks. That is why, in physiological conditions, as soon as the "fetus ejection reflex" starts, women tend to be upright, full of energy, with a sudden need to grasp something or someone. They often need to drink a glass of water, just as a speaker may do in front of a large audience. One of the effects of such adrenaline release is that the mother is alert when the baby is born. Think of mammals in the wild, and we can more clearly understand how advantageous it is for the mother to have enough energy and aggressiveness to protect her newborn baby if need be. Aggressiveness is an aspect of maternal love.
It is also well-known that the baby has its own survival mechanisms during the last strong expulsive contractions and releases its own hormones of the adrenaline family. A rush of noradrenaline enables the fetus to adapt to the physiological oxygen deprivation specific to this stage of delivery. The visible effect of this hormonal release is that the baby is alert at birth, with eyes wide open and dilated pupils. Human mothers are fascinated and delighted by the gaze of their newborn babies. It is as if the baby was giving a signal, and it certainly seems that this human eye-to-eye contact is an important feature of the beginning of the mother and baby relationship among humans.
— Michel Odent, excerpted from "The First Hour Following Birth: Don't Wake the Mother!," Midwifery Today Issue 61
MIDWIFERY TODAY Back Issues are available online. Order Issue 61.
For the past few decades, neonatal resuscitation doctrine has directed us to flood the lungs with high concentrations of oxygen instead of air in order to speed recovery from asphyxia. However, too much oxygen is a poison, and the body takes steps to protect itself. Putting 100% oxygen into a newborn baby's lungs is not the same as filling them with air. The body reacts to the difference. Tiny blood vessels spasm. The breathing center shuts down. The body responds by breathing more slowly and less deeply, or not at all. The hope that fueled the proponents of oxygen therapy has been that the extra oxygen will work so quickly it will short-circuit those reflexes. Oxygen resuscitation became accepted as standard of care in many regions, even though it was controversial.
The Resuscitation with Air (RESAIR) study first tested room-air resuscitation (RAR) on tiny newborns who were unlikely to survive regardless of whether they received oxygen. They then began to carefully test RAR on larger babies, always ready to switch to oxygen if needed. Preliminary results in 1993 showed no advantage in the group resuscitated with oxygen. The time of ventilation was shorter in the RAR babies, as was the time to first cry. Apgars and blood gases were the same.
Results of RESAIR 2, published in 1998, showed that first week mortality was 12.2% in the RAR group and 15.0% in the oxygen group. Neonatal mortality (28 days) was 13.9% in the RAR group versus 19.0% in the oxygen group. Death within seven days of birth and/or moderate or severe hypoxic-ischemic encephalopathy (primary outcome measure) was seen in 21.2% in the room air group and 23.7% in the oxygen group. Heart rates were the same among both groups at all times. Apgar scores at one minute were significantly higher in the room air group (5 v. 4). Apgar at five minutes averaged higher in the room air group (8 v. 7). There were more one-minute Apgar scores under 4 in the oxygen group (44.4%) than in the room air group (32.3%). More infants with five-minute Apgar scores under 7 were found in the oxygen group (31.8%) than in the room air group (24.8%). Acid base status was the same at all points. Average minutes to spontaneous breathing were less in the RAR group than in the oxygen group (1.1 v. 1/5). Average time to the first cry was shorter in the RAR group. RESAIR 2 concluded that asphyxiated newborn infants can be resuscitated with room air as efficiently as with pure oxygen. In fact, time to first breath and first cry was significantly shorter in room-air- versus oxygen-resuscitated infants. Resuscitation with 100% oxygen may depress ventilation and therefore delay the first breath.
Later data have shown that over-saturation with oxygen (introducing 100% oxygen into the lungs) reduced breathing efforts in all air-breathing creatures. Chemical receptors—markers for oxidative stress—can be detected in the baby's blood for weeks. Spontaneous breathing was delayed after oxygen resuscitation compared with room air. Oxidative stress was still detectable four weeks after birth in infants exposed to oxygen at birth, compared with the RAR babies. The oxygen group showed evidence of hyperoxemia during resuscitation. Researchers concluded that increased oxidative stress might have long-term effects on brain growth and development.
— Gail Hart, excerpted from "The Air We Breathe" Midwifery Today Issue 73
MIDWIFERY TODAY Back Issues are available online. Order Issue 73.
The following herbs for common postpartum problems support mother in a holistic fashion. If she has been given any type of drug, properly research the drug and herb combination.
Mom will need extra nutrition postpartum, and this tea is a staple in my herbal and doula practice. It is rich in nervines, vitamins and minerals.
You Rock! Mamma Tea and Infusion
All hemorrhage mixtures should be made ahead of time.
If a woman is hemorrhaging, follow proper protocols and seek appropriate medical attention. Transport to hospital if the herbs are having no effect.
— Demetria Clark, excerpted from "Herbs for Mother's Care Postpartum" in The Birthkit Issue 44
ORDER THE BIRTHKIT Issue 44.
Please support our advertisers!
Earn Your Master's Degree Online
Master of Science in Nursing
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.
Products for Birth Professionals
Web Site Update
Don't miss the July 25 early registration deadline for our conference in the Bahamas in September. With this early registration, you may take a discount on conference prices.
Read this sneak preview from Birthkit Issue 47 newly posted to our Web site:
Please support our advertisers!
Does anyone use cord banders, and if so, what do you think of them? Ninety dollars is a big initial output, but I can't get metal clamps anymore and I hate the plastic clamps. The bander looks a lot more comfortable to the baby, and the latex thrown away is negligible compared to the plastic clamps. Thoughts?
Go to our forums to share your thoughts and experience.
Please support our advertisers!
DoulaShop.com has everything you're looking for! Quality and practical products is our mission; excellent customer service is our goal. We carry birth balls, rebozos, labor kits, books, birth art, bookmarks, birth model kits and more. Come visit soon and receive free shipping on orders over $50.
Question of the Week
Q: (Repeated) 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?
SEND YOUR RESPONSE to firstname.lastname@example.org with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message. Responses to any Question of the Week may be sent to E-News at any time.
A few months ago I read that having the mom put her heels together (like frog legs) during pushing was an effective way to bring baby down. I used this method while birthing my youngest child, but didn't really remember that until reading your article. I am a doula and while attending a birth this week I suggested to the nurse this position. She said she would try anything once. Mom brought the baby down in just a couple of pushes. She pushed her first baby out in just a little less than 40 minutes. We used the "frog legs" position until crowning.
— Shelley Bailey, doula, Uniontown, Ohio
Editor's Note: Only letters sent to the E-News official e-mail address, email@example.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!
Want to stop receiving E-News or change your e-mail address? Or would you like to subscribe? Then please visit our easy-to-use subscription management page.
On this page you will be able to:
If you have difficulty, please send a complete description of the problem, including any error messages, to our newsletter.
Learn even more about birth!
Midwifery Today Magazine - mention code 940 when you subscribe.
E-mail firstname.lastname@example.org or call 1-800-743-0974 to learn how to order.
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.
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
E-News subscription questions or problems:
Editorial submissions, questions or comments for E-News:
Editorial for print magazine:
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: email@example.com. Please send submissions in the body of your message and not as attachments.
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.
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.
© 2005 Midwifery Today, Inc. All Rights Reserved.
Midwifery Today: Each One Teach One!