March 29, 2006
Volume 8, Issue 7
Midwifery Today E-News
“Postpartum”
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Midwifery Today Magazine Issue 66MIDWIFERY TODAY magazine: Now in its 20th year of publication!

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Learn about First and Second Stage with Ina May Gaskin and Marina Alzugaray.

Attend this full-day workshop to discover ideas and techniques to help the mother move through the first stage of labor. This discussion will include prolonged rupture of membranes, failure to progress, abnormal labor patterns and non-medical intervention. Ina May and Marina will then review second stage research from a midwifery point of view, focusing on how the standing, squatting, kneeling, hands-and-knees, supine and other maternal positions affect childbirth outcomes. They will demonstrate hands-on skills to use in a variety of situations during the moment of birth that safeguard the integrity, beauty and power of birthing mothers and newborns. This class is part of our conference in Bad Wildbad, Germany, October 2006.

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In This Week’s Issue:


Quote of the Week

"If I could wave my wand, our culture would be matriarchal...one of peace, of softness...where children are beloved, where women are revered and taken care of, where birth and mothering are honored and supported."

Raven Lang
Midwifery Today Issue 70


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The Art of Midwifery

Encourage husbands, mothers, in-laws, children, birth attendants, whomever your women want to share their birth with, to attend one prenatal visit, preferably far along in the pregnancy, to meet you, listen to and touch the baby, and to share their doubts with you. As midwife, I am often considered a "disinterested expert" on friction points or hidden fears the couple may not have been able to bring up on their own.

Alison Bastien


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.


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Passionate Midwifery Education

Guard Your Heart and Mind

I have been saying that if we midwives would treat each other as well as we treat pregnant and birthing women we would move midwifery rapidly forward, at least in the United States. This is also true of midwifery students and aspiring midwives. They need to be treated with respect. If you are looking for a school or preceptor, look for one that will treat you well. So many programs and learning experiences can be brutal. You deserve respect and should insist on it, as well as give it. Culture passes one to another by modeling. You are learning a birth culture as well as the clinical and didactic aspects of birth care. What reality do you want to learn?

The same goes for a curriculum. It must contain only ideas that respect Motherbaby. Does the program you are considering require you to learn and perform medical interventions that are damaging to Motherbaby? Watch for the subtle but common and potentially dangerous routines, such as ultrasound, epidurals and prenatal testing—all of which have their uses, but not routinely on every woman. Being forced to carry out dangerous and unsafe routines just because that is the way the program conducts birth is something you need to really consider. Can you ethically do so? You must guard your heart and mind like the pregnant mother must guard hers. You are as vulnerable.

A subtle process takes place as you are learning or, once trained, as you work as a midwife. Things that you know to be dangerous interventions can become so routine that you do them without thinking. The process is like the proverbial frog in a pan of cold water. When you gradually heat the water to boiling, the frog does not jump out. The slow subtle overtaking of your soul is barely perceptible, but very real. I have personally known great homebirth midwives who, upon becoming nurses or midwives and working in the hospital, completely change their practice and philosophy. I have also had dinner with a lovely certified nurse-midwife who told me about how she carried out hospital routines for fifteen years. Only after she had burned out and stepped away from the practice did she realize that she was just rationalizing the things they did to women. Although you, as a midwife, are the protector of motherbaby in this culture of birth, first you must protect yourself.

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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Postpartum

The behavioral effects of hormones

All the different hormones released by mother and fetus during the first and second stages of labor...have a specific role to play in the mother-newborn interaction. The key hormone involved in birth physiology is undoubtedly oxytocin....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. 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....

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....

The maternal release of morphine-like hormones during labor and delivery is well documented.... The baby also releases it 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 dependence 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 have an obvious role to play in the interaction between mother and baby immediately after birth.... It is advantageous 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 it 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 pupils dilated. 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, MD
excerpted from The First Hour following Birth: Don't Wake the Mother!
Midwifery Today Issue 61


Research demonstrates the biological specificity and the benefits of exclusive breastfeeding from birth to six months postnatal (Inch, 1996; Lawrence, 1997; World Health Organization, 2001). Epidemiology reveals short- and long-term health benefits for mother and baby associated with breastfeeding (Inch, 1996; Lawrence, 1997). Many of these benefits appear to be dose related. For example, research has demonstrated associations between increased respiratory and urinary tract infection, infantile gastrointestinal illness, obesity, asthma, early-onset insulin dependent diabetes, and lower cognitive and acuitive functions with early introduction of artificial formula (Lawrence, 1997). In view of these dose-related benefits, it is surprising that more mothers do not wholly breastfeed during the first three days postpartum. Conflict has been identified between policies for breastfeeding and some of those to prevent neonatal hypoglycemia (Dodds, 1996; Colson, 1997). The first policies require that breastfed infants be given no food or drink other than mother's milk. The latter policies stipulate supplementation, defined as precalculated amounts of infant formula, to be given to healthy tiny infants and healthy problem feeders even when breastfeeding is going well (Lucas, 1992; Dodds, 1996; Thureen et al., 1999). Supplementation in hospital is strongly associated with decreased maternal confidence and decreased rates of breastfeeding duration (Blomquist et al., 1994; Dodds, 1996; Foster et al., 1997).

A diet composed exclusively of mother's milk during the first three days postpartum is the fodder for the physiology of metabolic transition from fetus to neonate. Exclusive breastfeeding is defined as the suckling that both mother and baby do together. This means baby ingests nothing but mother's milk. Recent research has suggested that active suckling (as opposed to the baby being the passive recipient of expressed breastmilk) may be a factor that facilitates exclusive breastfeeding from birth (Colson and Hawdon, 2002). This differs slightly from current definitions of exclusive breastfeeding. For a healthy term infant during the first three days of life, active suckling and participation in feeding are deemed as essential as an exclusive diet of mother's milk.

References:

  1. Blomquist, H.K., F. Jonsbo, F. Serebius and L.A. Persson. 1994. Supplementary feeding in the maternity ward shortens the duration of breastfeeding. Acta Paediatr 83: 1122–26.
  2. Colson, S. 1997. A cry for neonatal research. Midwives 110(1314): 174.
  3. Colson, S.D., and J.M. Hawdon. 2002. Biological nurturing increases duration of breastfeeding for a vulnerable cohort. Book of Conference Proceedings, International Confederation of Midwives Conference, Vienna, Austria.
  4. Dodds, R. 1996. When policies collide. Breastfeeding and hypoglycaemia. MIDIRS Midwifery Digest 6(4): 382–86.
  5. Foster, K., D. Lader and S. Cheesbrough. 1997. Infant feeding 1995. Office for National Statistics. London: the Stationery Office.
  6. Inch, S. 1996). The importance of breastfeeding. MIDIRS Midwifery Digest (6)1: 79–83 and (6)12: 208–12.
  7. Lawrence, R. 1997. A review of the medical benefits and contraindications to breastfeeding in the United States. Maternal and Child Health Technical Information bulletin. HRSA.
  8. Lucas, A. 1992. Infant feeding nutritional physiology, Part I; Dietary requirements of term and preterm infants, Part II: Feeding the full-term infant. In N.R.C. Roberton (Ed.), Textbook of neonatology. Edinburgh: Churchill Livingston.
  9. Thureen, P.J., J. Deacon, P. O'Neill and J. Hernandez. 1999. Assessment and care of the well newborn. Philadelphia: W.B. Saunders Com.
  10. World Health Organization. 2001. The optimal duration of exclusive breastfeeding: A systemic review on line at www.who.in/inf-pr-2001/en/note2001-07.html

Suzanne Colson
excerpted from "Womb to World, a Metabolic Perspective"
Midwifery Today Issue 61


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Research to Remember

A master stress hormone called corticotrophin releasing hormone (CRH), produced by the early cells that later will form the placenta, appears to prevent the mother's immune system from destroying newly implanted embryos in the mother's uterus. The cells secrete a protein that cause immune system T-cells to die before they can attack the embryo. Cells in the lining of the uterus also produce CRH. This process appears to occur only in very early pregnancy; other hormone system responses take over later in the pregnancy that suppress the maternal immune system. This process may open the way to explaining infertility and to prevention of miscarriage.

National Institutes of Health News Release
www.nichd.nih.gov/new/releases/stress_hormone.cfm
last accessed 02-22-06


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Web Site Update

Cristina Alonso writes about a new organization formed to strengthen authentic non-medicalized midwifery in this article from the most recent issue of Midwifery Today newly posted to our Web site:


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Forum Talk

What are some rituals you have instituted in your own birthing or have used at the birthings of your clients—rituals you preform to mark the day as special?

Anon.


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


Question of the Week

Q: Does anyone have tips to help a mom who never gets the urge to push during second stage? She is completely unable to push with the contractions even though she gets in great positions: kneeling, squatting, hands and knees, birth ball, birth pool, etc. Two babies have been born fine as mom allowed her uterus to do all the work while she breathes through contractions. Is it best to let the uterus do its work alone or is there something that can help an "urgeless" mom?

— CLM, doula


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?

E-News staff

A: The most important thing is for a woman to stay aware that her body is designed to birth this baby. That realization alone can bring tremendous comfort in the face of her apprehension about going at it alone. No person has taught her how to grow her baby from seed, nor keep her breathing or her heart beating continuously. There is an innate wisdom that exists beyond the personal beliefs, and having faith in that existing body knowledge can bring an amazing sense of purpose and intent, necessary to bring forth creation.

— Naked Birth International

A: One of the most effective ways to get women to trust birth is social proof. It is also unfortunately a way to get them to not trust birth. They need to stop watching birth shows on TV—especially Special Delivery and Maternity Ward. Tell family, friends and strangers not to tell them a birth story unless it was a positive, happy birth (we don't need any more horror stories when we are pregnant than we have already heard). I collect positive inspirational birth stories for my clients to read online. I also bring in past clients to share positive stories during class. I have 30 videotaped hours of women talking about positive birth experiences from several years of classes, and I loan out the videos. I loan out several wonderful birth videos where birth is calm and serene. I also tell them to read Ina May's Guide to Childbirth. I find that the examples of the mind-body connection are extremely powerful.

After clients learn that birth can be a wonderful, positive experience, they start to trust their bodies more than ever before. It really helps that in a lot of the stories I've collected, the moms share the wisdom of how important it is to just trust your body.

— Sheri Menelli

A: To encourage trust in birth I show my favorite passages of the video, "A Clear Road to Birth," in which we see women free birthing (what a beautiful contrast to all the "help" of hospital birth). Also the Russian Waterbirth Experience video and Spiritual Midwifery book are great testimony. "Resexualizing Childbirth," by Leila McCracken from the Birthlove site, is the book I read before attending a "free" birth as a doula. It totally pumps me up with faith! Also, reading Midwifery Today online always seems to provide timely wisdom.

— Doula in the Okanagan, BC, Canada

A: To encourage women to trust birth I ensure them that their body is supposed to give birth and that they have the power to birth the baby without any pain medication. I support them when having painful contractions and remind them that they are one closer to holding the beautiful baby.

— Michele C. Williams
Englewood, New Jersey

A: As a childbirth educator and doula, I find it helpful to tell women their bodies got them pregnant, kept them pregnant, and their bodies know how to birth. Listen to their bodies. Sometimes just reminding a woman that her body is made for birth and telling her over and over she can do this can also be helpful.

— MaryEllen Cornwell


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.


Think about It: "Obstetrician"

The word "obstetrician" is derived from the Greek word for midwife, "obstetrix." It means to "stand in front of," so it is derived from the same root as obstruct, obfuscate, obliterate, etc.

The word itself doesn't have a connotation of right/wrong or good/bad, per se. However, I often think we all need to get out from in front of the birthing woman and turn our backs toward her so we can protect her space while she gives birth perfectly fine. Apparently in elephant communities the older females surround the birthing female with their trunks pointing away from her, and their large gray bums form a protective, encircling wall around her. That elephant mother-to-be has to push out a lot bigger baby than any human mother will ever birth. Their senior matriarchs have complete faith in her ability.

Gloria Lemay
Midwifery Today Issue 76


Feedback

I am 38 weeks pregnant and my due date falls on March 3. When I had a scan, I was told that my amniotic fluid index (AFI) is 12 cm—a case of hydramnios. I am very worried. Advice?

Anon.

In your interesting excerpt from Dr. Germaine Greer's book, The Whole Woman, [Issue 8:3], you leave out what is the most important factor, in my experience; that is, the stimulation of the "fight or flight response." Any intrusion into a birthing environment of a relative stranger will produce a flood of adrenaline, which is designed to halt labor while the birthing mother can seek shelter or escape an unconsciously perceived predator. Until this adrenaline is excreted through strenuous activity such as beating pillows, etc., failure to progress will ensue and progression will be delayed and intervention will occur—totally unnecessary, in my experience, except for a very small minority of laboring mothers.

Rayner Garner

I am doing some research on the use (or need) for prenatal vitamins. I am particularly interested in studies that go into detail about when folic acid is most needed for the developing fetus. I am also interested in studies that discuss the use of omega 3 in pregnancy and lactation. Can you help?

Linda Watson, RN-C, WHNP
Maternity Counselor, Franciscan Skemp
Healthcare-Sparta Campus, 310 W. Main St., Sparta, WI 54656
watson.linda@mayo.edu

[Editor's note: For a comprehensive, referenced article about omega 3 oils and pregnancy: Midwifery Today Issue 69, pp. 26–31: "Omega 3 Oils and Pregnancy," by Shawn Gallagher. BA, C.CHt. Order Issue 69.]


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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