March 28, 2007
Volume 9, Issue 7
Midwifery Today E-News
“Body Piercing and Pregnancy”
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In This Week’s Issue:


Quote of the Week

"We need to get the information out there, babies are dying, women are crying and doctors are lying."

Penny Groner


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The Art of Midwifery

During the first three months [of pregnancy] women are transforming at a rapid rate. Pregnancy can induce nausea, fatigue and uncertainty, along with elation and joy. In addition to advice on nutrition and necessary remedies, midwives can give newly pregnant women encouragement regarding birth and the future with their families. Hands-on care is about planting the seed of love and encouragement early on, giving women confidence and trust in themselves to do the work and do it well.

During the second trimester women come into acceptance and elation. Fear of miscarriage or losing the pregnancy fades and is replaced by the growing belly. The mother feels the baby move for the first time. This triggers a maternal response to plan and get organized. While we do monthly visits, many questions surface between visits. Midwives usually make themselves very accessible. "Presence" is an essential component to hands-on care. The knowledge that a woman can call her care provider whenever she needs to gives her peace of mind. Presence is not only being available but really listening to the pregnant woman. Stepping out of whatever distractions you have and making that woman feel like she is the only one who matters at that time. This sort of care increases the pregnant woman's confidence and makes her feel special. We all deserve this!

The third trimester marks a time of countdown! Time to focus on the birth and how it will go best. Women in the last trimester become thoughtful and introspective. They ponder their motherhood, womanhood and partnerships. If they are happy, life swims gracefully around them. However, if turmoil is at hand it can show up physically and emotionally, fast and furious. Midwives stay alert to this potential and respond to what they see.... Sitting and talking openly is the best hands-on care we can give.

Jill Cohen
excerpted from "Hands-on Care"
Midwifery Today Issue 70


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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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Body Piercing in Pregnancy

As more and more women share their "private" piercings with health care providers, they are finding greater acceptance and understanding. Despite that, misconceptions, bias and negativity still exist. In the future midwives are likely to encounter clients who are pierced, if they haven't already, and need to have accurate information to share with them.

A good place to start in obtaining information is the Association of Professional Piercers (APP). The APP is an international nonprofit association dedicated to the dissemination of vital health and safety information regarding body piercing to piercers, health care providers and the general public. www.safepiercing.org

Piercing is not recommended during pregnancy because of the risk of infection, the long healing time and the changes in the body that come with the growing baby. Most piercers will not even consider piercing women during pregnancy, preferring that they wait until a safer time. The APP advises against it.

In regard to healed piercings, in general no special care is required during pregnancy.

Three areas for piercing that are of particular importance during pregnancy and postpartum are the navel, the nipples and the genitals. Those who already have gotten pierced and are now pregnant or planning to breastfeed often have questions about what to do. Should they remove the jewelry? Will they be able to breastfeed? Will the piercing come out?

As body art and piercings continue to grow in popularity, birth professionals need to be aware of any pregnancy-, birth- or breastfeeding-related issues that may be relevant. Sooner or later they will have a client with piercings and should be prepared to provide accurate advice.

Cheryl K. Smith
excerpted from "Body Piercing in Pregnancy and Breastfeeding"
The Birthkit Issue 52


Do you have clients with piercings and want to know how to advise them? For further information and references, you need Issue 52 of The Birthkit.


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Research to Remember

A case was reported in 2002 regarding a woman with a pierced tongue who had emergency postpartum surgery. She sustained injury to her tongue with bleeding and swelling, along with complications to airway management. The authors of the study expressed concern that such tongue jewelry may increasingly become problematic leading to inability to intubate or ventilate the patients. They recommend that oral jewelry be removed prior to anesthesia in the interest of safety.

Journal of Clinical Anesthesia 14(6): 447–48, September 2002


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I have heard recently about an interesting ethical dilemma. A surrogate mom (who has given birth vaginally four times, loves pregnancy and birth and wants more children of her own) is pregnant through IVF (in vitro fertilization) with twins. The twins' family insists "their" twins be born in hospital with all the high-tech around; the pregnant woman knows she's walking straight into a c-section and is not willing to have one. This is something I never thought about with surrogacy.

Gloria Lemay


Web Site Update

Read these articles from the most recent issue of Midwifery Today (Number 81) newly posted to our Web site:


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Question of the Week

Q: What are the possible damages that can be caused by using IUD as a birth control method?

— Bella


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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ICAN

International Cesarean Awareness Network Silver Anniversary Conference

Dr. Mark Landon, primary author of the first large-scale American prospective study on VBAC, is among seven keynote speakers, April 20–22, in Syracuse, NY, at 25 Years of Discovering ICAN. Joining him are Henci Goer, Sharon Storton, Dr. Marsden Wagner, Nancy Wainer, Diane Wiessinger and Esther Booth Zorn. Registration costs $299; add $50 for CEUs applied for from DONA, ICEA and MEAC. http://conference.ican-online.org


Question of the Week Responses

Q: I will be getting pregnant soon, and I want to treat my contracted pelvis condition before getting pregnant, to avoid the dangers of dystocia. It got contracted while doing a series of seated bent leg poses, and I know my pelvis can open up again. Any advice on how to proceed?

— Pascha

A: In response to the reader who was concerned about her contracted pelvis during pregnancy and labor—try chiropractic! Specific chiropractic adjustments can help relieve imbalances in the pelvis, which removes tension on the various pelvic ligaments, which in turn removes torsion from the uterus, as these ligaments connect the pelvis to the uterus. When this is accomplished, the mother's body can function more normally, and the chance of problems occurring is greatly minimized. The International Chiropractic Pediatric Association (ICPA) has chiropractors across the world who are skilled in this technique, called the Webster Technique. It is very gentle, non-invasive, and great for the mom and the baby. Moms who utilize chiropractic during pregnancy tend to have fewer problems during labor and delivery, and their babies also enjoy multiple health benefits. You can contact the ICPA at www.icpa4kids.org for a list of certified chiropractors, and for more information on the benefits of chiropractic care during pregnancy.

— Jennifer L. Johnson, DC

A: I teach Pilates, sensuous movement, pole dancing (for women's empowerment) and primal labor and birth movement, as well as being an eager student of the female pelvic floor and all the things it does or can do, including Taoist pelvic floor studies and Western and European studies.

In my experience the pelvic floor becomes tense for many reasons, physical and emotional. Relaxing the pelvic floor is an idea that is full of emotional discomfort for most people because society has taught us from early on that it is vital to learn how to control and hold the pelvis tight (due to potty training, as well as sexuality and not to make any noises like gas). So, what can women do to undo all this training to be tight?

The best place is to practice on an exercise ball that is not too big. Really make sure it is for your height. It should also be very full. The full ball will push up into the pelvic floor when you sit on it; this makes a closed kinetic chain so that you can feel what's happening to your pelvic floor. Three exercises follow to get the bones of the pelvic floor moving more fluidly and easily.

  1. While sitting on the ball imagine you can draw your tail bone and pubic bone closer together, like shortening the space between the bones. Keep this contraction, then imagine drawing a diagonal line between your left pubic bone and your right sitz bone (this creates a diagonal pull that gets more of the pelvic floor activated), now keep that and add the other side, right pubic bone to left sitz bone. Now adding on, draw the walls of the vagina together, and also draw the walls of the rectum together, pulling both up the body as if they can draw all the way up to your throat. Keep this together and breathe into your back for three breaths, then on the next exhale allow the contractions to release. Do this three times. Each time you will feel the bones move more easily than the last, and if you do this regularly your bones will become very much more mobile.
  2. Sitting on the ball, have a sense that your ribs can stay quiet, not still like a statue—you want your energy to flow—but a general stillness is good. Now, begin to draw hip circles rolling the ball around. Really focus on reaching your hip to the side as far as you can disconnect the pelvis from the ribs, then really reach your tail back and up and allow the sitz bones to spread apart, opening your pelvic floor, then roll the hip around to the opposite side, again reaching far. The curling under portion of these circles should not be the focus, the sides and the back are. Breathe in one half of the circle and breathe out the second half, use big breaths. Two minutes each direction, daily.
  3. Sitting on the ball, have a sense that you can move your ribs out of your pelvis. The reverse of example #2. Open your chest forward, then circle the ribs as far to the side as possible, then curl the ribs back, then far to the side, and around to front again. Breathe in one half of the circle, breathe out the second half for two minutes each direction, daily. Allow the pelvis to do whatever it wants to naturally as the ribs rotate around in large circles.

— Meli Macourek
Samsara Pilates and Pole
www.samsarapilates.com


Q: Women being discharged from hospital receive almost universal postpartum instructions to avoid tub baths. I suspect that long ago some OB thought this sounded reasonable and it was repeated from generation to generation till it became etched in stone ("common" sense??).

I rather think this is hogwash but have no evidence one way or the other. Apart from the studies cited about women in labor with ruptured membranes NOT having increased infections caused by tub baths in labor, does anyone know of any evidence supporting or discrediting the theory that bath water gets up into the vagina (postpartum or otherwise)?

— Susan Robinson
Ukiah, California

A: You are right, not advising women to have baths postpartum is complete rubbish. I don't know of any research around this, but then again many of these obstetric myths don't seem to worry about evidence. In the UK midwives often encourage women to have baths, especially if they have sutures to the perineum, as a warm bath with a few drops of lavender oil added can be soothing and help to ease the "picking" sensation felt as part of the healing process.

— Alison, Midwife
Wales, UK

A: I'm not sure what area of the country you're having this experience in, but in Minnesota, where I've practiced in many different hospitals as both an RN and a CNM, we not only recommend tub baths postpartum, we often will make them a prescription two to three times daily for sore bottoms, to improve healing. Women often get into the tub as early as the day of delivery if they like.

The only situation where we discourage tub baths postpartum is after cesarean section—women can shower as early as the day after, but they're advised to wait at least a week or two (I don't remember exactly how long at the moment) to sit in a tub in order to prevent abdominal wound infection.

— Patty, CNM
St. Paul, Minnesota


Editor's Note: Thank you to all readers who responded to this question. We received a number of article references in support of tub baths after birth. Anyone who is interested in these specific references can contact us at mtensubmit@midwiferytoday.com.

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.


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ALACE Executive Director Search

ALACE, a national, nonprofit organization dedicated to supporting women's choices in childbirth, is seeking a full-time Executive Director in our Cambridge, MA, office. The Director is responsible for administration and management of ALACE, including programs, strategic planning and business operations. Send resume and cover letter to:

Susan Cassel / ALACE
PO Box 390436, Cambridge, MA 02139
scassel@alace.org


Think about It

According to a telephone survey of nearly 12,000 families, women who never graduated high school are more likely to have their children vaccinated than women who graduated college. The National Immunization Survey showed that children of less-educated mothers were 16 percent more likely to have up-to-date vaccinations. To learn about more of the results, see www.cdc.gov/nis/.


Feedback

This was written in response to a question in Midwifery Today E-News 8:9:

I am a sufferer of Morphea. I have had three pregnancies, the first ending in an early miscarriage not related to my condition. The second pregnancy resulted in the wonderful outcome of a 9 lb 9 oz baby boy, perfect in every way and going to 41 weeks. Currently I am 37 weeks 5 days with my third pregnancy. I am not and was not followed by a perinatologist; neither of my two different teams of obstetrician/gynecologists thought it was necessary.

The first pregnancy that went to term was the one time since being diagnosed at 18 that I have felt so well. Unfortunately, I did have skin flare-ups, but the associated rheumatoid arthritis pain I usually suffer was nonexistent. With the current pregnancy I am again experiencing skin flare-ups, but the pain is much worse. As far as the need for specialist care, there has been no concern. The only concern my obstetrician and I have had is the effect a c-section on my condition.

Please let your patient know that I have had two successful pregnancies while suffering Morphea and had only the "normal" pregnancy problems. One more thing I would like to pass on is that the recovery from birth takes much longer to heal, just like any other "injury." Good Luck.

Anonymous


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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