March 1, 2006
Volume 8, Issue 5
Midwifery Today E-News
“Nutrition”
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In This Week’s Issue:


Quote of the Week

"Love is a powerful miracle worker, and miracles are what keep me doing my work despite political persecution, low pay and stress aplenty."

Elizabeth von der Ahe


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The Art of Midwifery

Add one tablespoon peppermint extract or tincture to four ounces aloe vera gel; apply it to the birthing mother's perineum when she feels the burn of crowning. It is well absorbed by tissue and promotes tissue healing after birth. It also helps decrease swelling.

Julie Williams
Midwifery Today Issue 42


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Passionate Midwifery Education

Informal Paths

There are many skills and experiences you can gather prior to getting a more formal midwifery education. These experiences will be helpful to you throughout your birth practices and are useful no matter what route of entry you choose. Of course, the very most helpful experience is to have and breastfeed a baby. Michel Odent contends that to be a midwife you should have had a natural birth but any experience gives you empathy and understanding of birth that will help you to help others. In the early seventies many of us had a good birth or a bad birth that propelled us into the great need to help other women in birth. Those were the days babies attended births with us. A common question aspiring midwives ask is, "Do I have to have had a baby?" Some of the best midwives I know have never had a baby. It isn't a requirement but it does teach you a lot.

If you can find other aspiring midwives in your community, form a study group. You can take turns researching subjects and giving reports. Ask different practitioners in your community to speak to you. Use your favorite textbooks for self study. Midwifery Today magazine is an excellent source of articles, birth stories and other information about important issues. Some student midwives have bought all of our back issues and worked their way through them as an educational method. There are approximately 200 articles as well as eight years of Midwifery Today E-News back issues on our Web site you may read for free.

Go to a series of La Leche League meetings. Listening to mothers talk will give you a good foundation in breastfeeding which is an important part of birth, and not separate from it! Volunteer at one of the organizations that deal with birth or prenatal care, or with one of the midwives in your area. Be an activist letting your community know about childbirth in your area. You can create a library display about the advantage of midwifery. Become a childbirth educator or doula. You will often be invited to births. Wear your birth art T-shirt because it initiates conversations about birth. There are many things you can do now that help you on your path to midwifery; so many, in fact, that I will continue this subject in the next issue.

love, Jan
Jan Tritten, Mother of Midwifery Today

To read all installments of Jan's column on midwifery education, go to our Better Birth and Babies Blog.


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Nutrition

The selection of nutrient-rich foods is most critical to the maintenance of the blood/tissue pH. The typical American diet, high in animal protein, fats and refined sugars/carbohydrates, produces a pH imbalance toward acidity. Cells exposed to continuous acidic conditions adapt by mutating and becoming malignant, which results in autoimmune diseases, cancer and other illnesses. Maintaining a normal blood/tissue pH provides oxygenation and carbon dioxide balances important to the respiratory system, and contributes to a symbiotic microbial body flora.

Antibiotic therapy to reduce the burden of toxins on the liver of a pregnant woman…produces ecological imbalances of the large intestine microbial population, which results in fungal infections, immune system deficiencies, resistance to antibiotic therapy and various degenerative diseases.

…The destruction of "friendly" bacteria, without supplementary probiotic therapy creates an environment that will produce countless future infections and ill health. The alternative to antibiotic therapy is probiotic supplementation. The large intestine hosts a community of living bacteria called "flora." This microbial intestinal flora is colonized by bacteria within the first few days of birth. Both friendly bacteria and harmful bacteria exist together in this flora. Antibiotics are not selective in their mission to destroy and will eradicate all bacteria in the flora—good or bad—which creates a sterile intestinal environment.

When the intestinal environment becomes dangerously sterile, one's diet is critical. The types of foods eaten will determine which bacteria will dominate the reestablishing flora. The rate of harmful bacteria overgrowth which causes infection and systemic symptomatology is inevitable when the body is malnourished.

Eating an alkaline diet high in complex carbohydrates (vegetables, fruits, whole grains) is imperative. The consumption of complex carbohydrates will encourage increased levels of bifidobacteria growth, the dominant friendly bacteria in the large intestine of both healthy adults and breastfed infants. Fruits should be eaten in moderation because they are rich in natural sugars, as are grains, and may facilitate a yeast proliferation depending upon individual variables, including the status of the client's immune response.

I recommend that clients who have intestinal dysbiosis drink the "life enhancer drink" four times daily. It's made by mixing one tablespoon powdered bifidobacteria, a half tablespoon powdered lactobacillus acidophilus bacteria and a half tablespoon liquid chlorophyll into six ounces of distilled water. This drink will initiate colonization of friendly bacteria in the intestine. The dosage of bacteria should be adjusted to meet the individual levels of each client's toxicity.

The acid/alkaline level of the colon's environment is critical to influencing the colonization or destruction of friendly bacteria. Friendly bacteria reduce the colon pH (increases the acidity) by creating an undesirable environment for harmful bacteria through the production of acid secretions. These secretions maintain the large intestine at a level of acidity that enables ammonia to remain in ionized form and prevents it from diffusing into the bloodstream.

— Katie Gates Gatsa, excerpted from "Internal Ecosystem Health," Midwifery Today Issue 42


Read this extensive article in Midwifery Today Issue 42.


Daily Pregnancy Requirement: 80–100 grams protein

  • Why You Need It: promotes growth of fetal tissue, helps develop breasts and uterus, increases blood supply, helps growth and development of placenta, maximizes fetal brain development.
  • Food Sources: Milk, cheese, eggs, meat, fish, poultry, beans, nuts & seeds, flours & grains, fruits, vegetables

Daily Pregnancy Requirement: 1200 milligrams calcium

  • Why You Need It: Promotes development and formation of fetal skeleton, aids the development of baby's tooth buds
  • Food Sources: Milk, yogurt, cheese, egg yolk, whole grains, leafy vegetables

Daily Pregnancy Requirement: 2 servings vitamin C-rich foods

  • Why You Need It: Heals wounds, repairs tissues, develops teeth and bones, promotes various other maternal/fetal metabolic processes
  • Food Sources: citrus fruits & juices, tomatoes, peppers, potatoes (not fried), melons, strawberries

Daily Pregnancy Requirement: 400 micrograms folic acid (0.4 milligrams)

  • Why You Need It: Significantly decreases risk of neural tube defects such as spina bifida
  • Food Sources: Dark green leafy vegetables, citrus fruits & juices, fortified breads & cereals, whole grains, liver, dried beans & peas

Daily Pregnancy Requirement: 8 glasses of fluids

  • Why You Need It: Builds fetal cells, develops circulatory system, helps deliver nutrients to the fetus, assists with excretion of wastes, prevents dry skin, reduces risk of urinary tract infection
  • Food Sources: Water, fruit juices, vegetables juices

Daily Pregnancy Requirement: 30 milligrams iron

  • Why You Need It: Increases maternal blood volume, prevents anemia
  • Food Sources: Green leafy vegetables, fortified breads & cereals, meat, fish, poultry, beans, nuts, eggs

— Darynee Blount, excerpted from "Growing a Baby: Diet and Nutrition in Pregnancy," The Birthkit Issue 46


The Birthkit Issue 46 can be ordered.


Nature intends for us to get the nutrients we need from foods. While it may benefit pharmaceutical companies to market supplements, it dos not benefit people to depend upon them for nutrition. A supplement will contain only those nutrients which are recognized as important, often with a focus on the "active" substances, the chemicals that seem to effect changes within the body. In addition, a supplement which is not derived from natural sources will be a petrochemical substance which has the same molecular composition as the natural nutrient but is not the same. Petrochemical substances do not break down in the body the same way that natural ones do.

A whole food is a carefully balanced nutritive complex which provides everything the food has to offer, whether we are aware of its value or not. This includes "passive" ingredients which may help to balance or support the more active ingredients. Since science does not focus on passive ingredients, their value is not well understood; since nature put them there, they are, no doubt, equally important. Foods also offer us the vital force of the plant. This energy is renewing and sustaining to our whole being, not just the physical body.

…The facts are that a woman who eats well will gain what she needs to gain to have a healthy pregnancy, period. While one may be able to point to some general trends in healthy weight gain there is no magic number of pounds which represents what all women need to gain. Neither is there a magic pattern of gain that will apply to every woman. Both will vary according to each woman's physiologic make-up. To hold a woman to a pattern of gain or to set a limit on how much she gain for the entire pregnancy, no matter how "reasonable" or individualized that limit is considered to be, sets a woman up for trouble.

…Tell women to focus on what they eat, not what they gain; that there is no normal amount of weight to gain during pregnancy. In fact, most healthy women gain 35 to 45 pounds during pregnancy. Since each woman is an individual, it is impossible to say what any one will gain. Therefore it is best not to give women any number which they can attach to as "enough." The thin, underweight woman may gain more, the woman of size may gain much less. As long as the dietary choices are good ones, and weight gained will be different than that gained by eating junk food and empty calories, because empty calories create more fat than nutrient-rich foods.

You should instead praise women for gaining weight. They need to hear that gaining is desirable, that their baby is growing nicely, that getting bigger is what you want to see! If a woman is concerned about how much she might gain, I make a deal: if she will eat, I won't ask her to weigh herself at each prenatal visit. Instead of focusing on weight gain you should be asking a woman how she is doing with her diet and if any changes have occurred which increase her stress and activity levels so you can counsel her concerning necessary dietary changes. When women see that your primary concern is what they are eating, not what they are gaining, their focus will shift as well.

— Anne Frye, excerpted from "Holistic Midwifery Vol. I: Care during Pregnancy,"
Labrys Press: Portland, OR


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Research to Remember

A University of Washington study examined data from two case-controlled studies of 688 women and 897 women during which women were asked to rate their level of exertion during their normal exercise routine in the year before becoming pregnant. The objective of the study was to identify the effect of regular exercise on the incidence of gestational diabetes. Women who had maintained "very strenuous" usual exertion were 81% less likely to develop gestational diabetes compared with women who reported having had minimal exercise. Women with moderate prenatal exercise habits reduced their risk of gestational diabetes by 59%. Reduced risk was found even in women who had exercised less than recommended levels.

Epidemiology, Jan 2006


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Web Site Update

Though walk-ins are welcome, the pre-registration deadline for the Philadelphia area conference is March 13, 2006. Please do not mail registrations to be received later than this deadline; simply bring them to the conference. Don't miss this opportunity to study with Ina May Gaskin, Michel Odent, Elizabeth Davis, Robbie Davis-Floyd, Marsden Wagner, Naoli Vinaver, Marina Alzugaray and Eneyda Spradlin Ramos. Conference dates: March 23–27, 2006. More information here.

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Forum Talk

Does anyone know if and how the odds of a successful VBAC change as the number of previous cesareans increases? What is the most anyone has had experience with?

Marlene Waechter


Share your thoughts and experience about this topic.
**Please do not send your responses to E-NEWS!**


Question of the Week

Q: Has anyone out there had any experience with the autoimmune disorder, morphea, and pregnancy? I currently have a client who has it and it has been very difficult finding any information about its effect on pregnancy and pregnancy risk. As I understand it, and this is mostly from being educated by the client herself, morphea is a sister disease to scleroderma but does not affect the internal organs, just the skin. My client has an area of hardened scar-like tissue on her lower back but otherwise she has no problems. She is an acupuncturist and very well educated about her condition.

At first I didn't think much of it, but I decided to run it past my backup OB just to make sure she would be low-risk. Once he heard that it was related to scleroderma he said that even he wouldn't take care of her, he would refer her to a perinatologist. Apparently he had a woman with scleroderma who ended up dying at 35 weeks or so because a blood vessel popped in her brain. I tried to explain to him that this condition was different because it doesn't affect the internal organs. So he recommended a perinatologist consult.

The first perinatologist I sent her to had no idea what morphea was but nonetheless recommended a whole slew of coag studies and genetic tests. I decided to get a second opinion and phoned a perinatologist in my area. He hadn't heard of it, but when I described my understanding of it to him and he did some quick research, he said that my client is right and it should pose no problems with the pregnancy or birth. I'm much more inclined to go with his assessment, but I'm wondering if anyone out there has ever dealt with this before and what the outcome was.

— Corina Fitch, LM, RN
Miami


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.


Question of the Week Responses

Q: What do you do to encourage women to trust birth?

A: To encourage women to trust birth, I begin with openness—first she must trust me and her partner. Then we move to open communication and good listening: to any fears, any past experiences, and communication hurdles—these all need validation but cannot define who this woman is in her own mind for her to trust birth. I also need to meet her where she is—my opinions don't matter, hers do. I submerge her and her partner with positive images, movies, stories, scenarios and positive birth affirmations along with guidance toward good nutrition, exercise and the physiology of what is happening during pregnancy, labor and birth. My goal is for her to be empowered through knowledge, to know the truth that replaces fear, to acknowledge and vocalize any reservations and/or fears and to emerge a whole person prior to labor. We train, rehearse, encourage and prepare to submit (in the most positive sense of the word) to the needs of her body. I offer constant reassurance and help her to see the small areas where her body can be and is trustworthy.

Often, women who have had a hard time conceiving or have had sexual trauma have a really hard time learning to trust. This is perfectly understandable. Trust is earned and should be something protected between people. Trust is not to be taken casually. Then, I also impart to her that her baby will trust her completely, through their birth experience together, and isn't that a blessing and miracle?

Some women need professional help from a licensed therapist. I am more than willing to ask for help and offer a referral. Often, though, healing takes place after birth.

— Robin Jozaitis, CBE

A: It depends on where we are in the pregnancy—if she's in labor I ask her to close her eyes, take a deep breath and visualize all the women who have done this over the ages—and trust her body to follow the same path.

If she seems to be expressing fears during her pregnancy, I express similar ideas, and suggest visualizing these ideas on a regular basis.

— Mary Alice DeCoursey

Q: A friend has had two cesarean sections, the last one 19 months ago. She is now considering getting pregnant again and wants to have a VBAC next time. She is concerned about uterine rupture. She wants to know if there are any great remedies for healing uterine scar tissue from her previous c-sections.

— Anon.

A: The best way to prevent uterine rupture during a VBAC is to avoid any form of induction.

— Amy V. Haas, BCCE

A: Association for Improvements in Maternity Services (AIMS) comment: Without the use of oxytocin and protaglandins, the risk of rupture of the uterus even after a caesarean operation seems very small—about one in 33,000 deliveries in this series, and it confirms the findings in other areas. Dublin still has women who have had large families, and therefore have a uterus more vulnerable to rupture. This study confirms our experience, that using prostaglandins and oxytocin is a major risk factor for rupture in women who had a previous caesarean.


Editor's Note: Responses to any Question of the Week may be sent to E-News at any time. Write to mtensubmit@midwiferytoday.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.


Feedback

On the subject of the wisdom of squatting during pregnancy [Issue 7:25]:

As a midwife experienced in assisting some 4000 births, most of them vertically, I am very enthusiastic about squatting whether before or after labor has started. However, there can be a hitch. First of all we need to differentiate between squatting with the heels being pulled up and squatting with the foot soles making full contact with the floor. The latter position means squatting more deeply. This allows the abdominal contents to come down and gives rise to greater pressure being exerted onto the uterus from the thorax for instance. When the baby's head is not yet engaged in the pelvic inlet, the membranes may rupture prematurely and consequently a prolapsed cord can develop. Again I am talking from experience. Therefore, I do not recommend deep squatting during the last two months of pregnancy if the head is not engaged. During labor deep squatting means opening the pelvic outlet. If the baby's head is still high in the birth canal, no form of squatting is appropriate at that moment. Opening of the pelvic outlet goes at the expense of the measurements of the pelvic inlet. The pelvis is involved in a scissor-like movement depending on the hip joints being either stretched like in a standing position or flexed as during squatting. If the presenting part is above the pelvic floor, meaning that the pelvic inlet is still involved, fetal distress can be brought on by squatting.

However, when at the start of the second stage the woman takes a standing position, labor continues in a wonderfully relaxed manner. She need not push actively, because the baby's weight takes the child down. So she does not get tired. Once the baby's head touches the pelvic floor, the woman feels the need to push, and nobody can stop her from bearing down and ending in a squatting position. And when the baby's forehead is born, most women lean backward, thus allowing the pelvic inlet to widen to allow the shoulders to pass. I call this the ballet of the second stage.

Gre Keijzer, midwife
The Netherlands


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.


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