|August 3, 2005|
Volume 7, Issue 16
|Midwifery Today E-News|
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Quote of the Week
"Learn from mothers and babies; every one of them has a unique story to tell. Look for wisdom in the humblest places - that's usually where you'll find it."
— Lois Wilson
The Art of Midwifery
For postpartum hot flashes, night sweats, headache, all-over body aches, women should nourish the liver, which has to process the excess of hormones postpartum. Dandelion root is good for relieving heat and helping the liver. Drink lots of water with lemon. Eat beets.
— Helena Wu, Manchester Center, Vermont
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 Johnson & Johnson Pediatric Institute and National Institute of Mental Health and March of Dimes study concluded that body massage for pregnant women reduces levels of stress hormones in the mother, including cortisol and norepinephrine, and increases the likelihood that the pregnancy will proceed to full term. The study focused on second trimester massage given by the pregnant women's partners. Massage was also found to relieve normal discomforts and swelling common to pregnancy, improve sleep and ease depression; massage by the partner also contributed to a stronger bond between the parents-to-be.
— Women's Health News, May 5, 2004
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I tend to use "complementary therapies" in an integrated way, using typical, basic care such as taking a history, ordering lab work, assessing blood pressure, fundal height, heart tones, and so on as a foundation to build on. What follows are some supplementary approaches I have found especially helpful.
Love/support: "As important as [diet and lifestyle] are, I have found that perhaps the most powerful intervention the most meaningful for me and for the people with whom I work, including staff and patients is the healing power of love and intimacy and the emotional and spiritual transformation that often results from these." I've concluded that Dean Ornish's remarks (from his book "Love and Survival") are absolutely true for me as well. I treat the women I work with as friends, not just clients or patients, and nurture our relationship well beyond a strictly health care model. I want to know each woman as a unique person and learn what is important to her within the context of her individual family/friends/spiritual support systems. I work hard to facilitate and strengthen these support systems. The most meaningful aspects of care include rediscovering inner sources of peace, joy and well-being; learning to communicate in ways that enhance intimacy with loved ones; creating a healthy community of friends and family; developing more compassion and empathy for themselves and others; and, experiencing directly the transcendent interconnectedness of life. These seemingly esoteric concepts result in measurably better outcomes and can often offset frank medical difficulties. Ideally the midwife is herself a model of these findings.
Nutrition: My general recommendations are simple. Eat a variety of fresh (preferably organic) vegetables daily. Seriously limit dairy products, if used at all. Restrict sugar intake. Eat plenty of easily digestible protein. Eat small, frequent meals so you have some protein every few hours. Use ginger, peppermint and sips of protein-powder drinks for nausea. Avoid drugs. Use high quality prenatal supplements; go easy on the iron.
Herbs: Some herbs such as raspberry, dandelion and nettle leaves are valuable for their nutritional density and may be used freely as teas or in capsules. In general, however, I don't recommend herbs in a routine manner, but rely on them for specific indications and incorporate a comprehensive approach for satisfactory results. For example, a carefully peeled clove of garlic is useful as a vaginal suppository to reduce yeast overgrowth, along with a drastic reduction in refined carbohydrates and sugars, increase in non-starchy vegetables. An external application of a frozen goldenseal tea-saturated cloth works wonders for symptomatic relief of late night vulvar itching. Live culture yogurt may be added to the diet, with a reminder to drink plenty of water. An oral intake of caprylic acid, rosemary, thyme, and pau d'arco may be added for stubborn cases.
Taking an extract of milk thistle (sylimarin) is useful in cases of liver congestion or impairment, in concert with dietary changes such as increase in non-meat protein and reduction of empty calories with careful monitoring. Bladder infection responds well to flushing with a gallon of water daily for several days. Also use fresh cranberry juice and garlic with the addition of nettle (tea or capsules) for kidney involvement.
There is no one-size-fit-all solution. It depends on the underlying cause of the problem, contributory factors, and the individual, as well as your expertise.
Storytelling: This technique is right up there with love and support as far as seeming trivial but actually being hugely important. We are the tellers of tales of beautiful birth, the weavers of courageous empowering visions to set before the women and families we serve. Our stories must be told often, until they become more compelling and convincing than the horrible "you are weak and defective, prone to failure, need our technology, and might as well give up and give in now" myths people hear all around them. What poisonous propaganda! Speak out! Share something marvelous at each visit. Encourage, defuse tears, paint a portrait of success.
Suggestion/visualization: This refers to specific situations you are trying to alter. The baby has to receive a clear picture of what you are trying to achieve if it is to work for you. The mother needs the same thing. You must first be clear yourself, then communicate this vividly. I like to cover my office walls with luscious photos of big bellies, bulging perineums and crowning scalps so everyone knows this is the game plan.
Movement/position: While some women do just fine with babies in the persistent posterior position, and a few have pelvic structures that even favor it, most will have tough going. Therefore I take this very seriously and advocate prevention by means of detection and correction. Careful palpation will uncover an anterior abundance of fetal small parts and lack of a well-defined back-line. I see this more often in cooler weather when the baby's back is cold and it snuggles up against the mother's back. Encourage the woman to keep her tummy warm and to spend time on her hands and knees (three times a day, twenty minutes each) as well as perform pelvic rocks - arching her back up high and dropping her belly down - as well as wriggling her hips back and forth. The goal is to dislodge the baby's back away from the mom's back and allow gravity to pull the heavier back around forward.
Patience: Practice patience during prenatal visits to answer all questions, especially the ones at the very end of pregnancy. Allow as much contact time as a person needs to feel confident. Re-answer lingering questions as necessary. Then, during labor wait through dilation plateaus without feeling pressure to "do something." Use patience to refrain from artificially rupturing the membranes. This is an irreversible intervention that locks in malpresentations and greatly increases chances of bacterial infection and transmission of viruses, with the risk increasing exponentially as time passes. Use patience to wait through progressive pushing past two hours without moving toward the door. Use patience with your detractors. Practice patience on yourself.
External cephalic version: Not every midwife can or should be proficient in this technique, as it requires tremendous sensitivity, practice and time. Used properly, this can be a very safe procedure. Please note: I am not talking about the sonogram/terbutaline/wrench and twist most medical professionals envision - this can be very dangerous! A gentle version involves spending lots of time carefully mapping out fetal and placental position by way of palpation, Doppler, and if necessary, vaginal exam. (I do not routinely use ultrasounds for this.) Site preparation includes allotting several hours of uninterrupted time; full explanation of the procedure for informed consent; slight elevation of the pelvis and lower back on a firm but padded surface; placement of warm, wet towels over the fundus to aid relaxation; a gentle, rocking, palpation massage with oil; and very gentle, gradual displacement and rotation of the baby into the desired position. Heart tones are taken frequently, the mom's comfort is continually assessed, and direct communication with the baby is maintained. Once baby is vertex, mom is encouraged to stay upright for several hours and to praise the baby for its cooperation. Hands-on instruction is best; I suggest those who find this intriguing take one of our herb and massage workshops at Midwifery Today conferences.
— Judy Edmunds, excerpted from "My Top 10 Favorite Complementary Modalities," Midwifery Today Issue 52
Midwifery Today Back Issues are available online. Issue 52
Creating a Positive Birth Environment
Knowing that for every stranger who walks into a birth room, labour can be lengthened by another hour, I am extremely territorial about who comes into the room. At a homebirth, it is easier because people knock first, but in hospitals I make a point of putting a sign on the door as we enter the labour room. It is very pretty and says "Please knock and wait for someone to open the door for you before entering. Thank you for your consideration."
At home we encourage mothers to bake something because the smell of baking is often soothing and relaxing and the fact that their minds are off the contractions is calming.
Keep the father occupied by giving him specific but gentle instructions. Extremely anxious/protective fathers transfer their anxiety to the mothers and this causes complications. I have heard husbands asking their wives to please accept an epidural! I find that if fathers feel they are being proactive, it takes most of their stress away. Great activities for fathers include filling the birthing pool and maintaining water temperature; in winter, maintaining the fire in the fireplace; making sure the mother drinks and eats at regular intervals; screening phone calls; massaging the mother; and maintaining eye contact and supporting breathing with the mother during contractions.
— Maria Sterrenberg, Midwifery Today Issue 66
Protecting the birth environment means helping women bargain for one more day of pregnancy. Help women "just say no" to induction. Women need someone who knows birth to help them do this. Being an advocate from the start protects the birth environment. Saying "no" to prenatal testing is easy if a woman understands what it entails. But how do we convey the message that "one more intervention leads to another" to someone who is new to childbirth? "The doctor said..." is chorused over and over again. It is important to let a woman know that "she does have a choice!" Follow this closely with information, so she can make an informed choice. Test after test is administered for fear of being found liable for not doing a test. Birth in the United States has become medical and legal centered, instead of women centered.
— Andrea Mietkiewicz, Midwifery Today Issue 66
While the physical environment is an important element in creating a positive birth experience, the attitudes, beliefs and behaviors of the people who interact with the laboring mother are paramount. If women were asked to name their heart's deepest wishes for their births, it would usually come down to these two things: baby and mother's healthy outcome and a positive, respectful, caring experience with a partner and/or attendants. Of course many of our clients desire a natural, vaginal birth, but even if this does not occur my ultimate goal is to keep the atmosphere positive, loving and supportive. That is the memory she will have forever imprinted on her.
— Michele Klein, Midwifery Today Issue 66
MIDWIFERY TODAY Back Issues are available online. Issue 66
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Has anyone been diagnosed with, or had a client diagnosed with gestational diabetes who was planning a homebirth? How did this affect homebirth plans? Did it change prenatal care in any way? I just failed all four blood draws on the three-hour glucose tolerance test this week, and I'm still not sure what it means other than I need to change diet and exercise more. I have not gotten the actual numbers yet for the test, even though I asked what they were. The clinic's basic plan for care is to see a dietician, start a strict diet based on six meals a day, then after two weeks on the diet see the OB, then go from there. I'll be at least 32 weeks along before I see anyone. I'm curious about how other people have dealt with this situation.
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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?
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