April 11, 2007
Volume 9, Issue 8
Midwifery Today E-News
“Mothers and Mothers-in-Law”
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Midwifery Today Conferences

Attend the full-day First and Second Stage Workshop in Norway…

…and learn how you can help the mother move through the first stage of labor. Elizabeth Davis, Ina May Gaskin and Annett Michelsen will also teach you about good prenatal care as a way to prevent labor complications, prolonged rupture, failure to progress, abnormal labor patterns, non-medical intervention and more. Come and learn from these experienced midwives as they discuss constructive and effective ways to handle both normal and difficult situations. Part of our September conference in Oslo, Norway. Go here for info.


Do you want to be a doula?

Join DONA International Doula Educator Debra Pascali-Bonaro for a three-day Doula Workshop at our May 2007 conference in Costa Rica. You'll learn the history, research and doula skills that enhance labor and birth while decreasing many medical interventions. Attend all three days and you'll have taken one step in the certification process for DONA International. Go here for more information about this special doula workshop.

SPECIAL FOR E-NEWS READERS: The March 30 early registration deadline for the Costa Rica conference is extended through April 18! Mention Code 940 (or say you saw it in E-News).


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In This Week’s Issue:


Quote of the Week

"The moment a child is born, the mother is also born. She never existed before. The woman existed, but the mother, never. A mother is something absolutely new."

Rajneesh


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For Mother's Day give her the Mother and Child Pin
…and watch her eyes light up as she opens the package to uncover a delicate sterling silver outline of a mother embracing her child. Designed by Matt Willig, this 1-3/4 inch pin makes a lovely gift for mothers, grandmothers or anyone who nurtures small children.



The Art of Midwifery

The pregnant woman herself, not her husband, not her mother, not her mother-in-law, has the legal right in most of the Western world to decide on the place of birth, the attendants and the plan of care. This is true even if she's a legal minor, under the age of eighteen. A woman having a baby is automatically considered an emancipated minor, able to decide for herself, although local legal precedents may vary.

The prenatal period is the time for a midwife to work with her clients to decide who will attend the birth and the roles they will take. Pressure from family members may make these decisions difficult. Remember that it is the pregnant woman who will be going through labor and delivery, and her needs and wishes are your best guide to a successful birth. Help her clarify what those needs are and who she wants for support. Help her understand that she may have different feelings about the presence of people when she's actually in labor and when she is in early labor versus the time of birth. Encourage her to have frank conversations with those who plan to attend. Ideally, any person should be ready to leave the room for the privacy of the woman giving birth if this is what she wants. People can become very attached to seeing the birth, and it is best that, from the start, they get used to the idea that they might not end up being present.

— Marion Toepke McLean, excerpted from "Marion's Message: Midwives, Mothers and Mothers-in-law," Midwifery Today Issue 77


For more on dealing with mothers and mother-in-law, you need Midwifery Today Issue 77.

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.


Send submissions, inquiries, and responses to newsletter items to: mtensubmit@midwiferytoday.com.

Catalyst for Birth Change

At Birth without Borders, a Midwifery Today Conference in Costa Rica, hands-on learning is an important part of the program. If you want to learn some useful, unique techniques, our conference in San José is the place to do it. The conference will run May 23–27, 2007.

One of our goals is to be a catalyst for birth change throughout the world. Twenty years ago, following the lead of so-called developed countries, the government of Costa Rica virtually eliminated midwifery there. Despite that, some great midwives, working mostly from different countries, have kept the tradition of midwifery alive. Many traditional Costa Rican midwives still want to practice there and a few still do. In addition, there are some aspiring traditional midwives there. We hope that this conference will help to change birth in that country.

Classes will be offered in either Spanish or English, with many translated into the other language. This will be a good opportunity to practice birth Spanish or take the "Birth Spanish" class. You can find this powerful program here.

Angelina Martinez Miranda, Debra Pascali-Bonaro and Ina May Gaskin will be there to share their midwifery knowledge with you. Besides a rich offering of classes, we have planned a full two days on "Traditional Midwifery." In these classes traditional midwives will share their birth ways. We also will discuss reclaiming and preserving traditional midwifery, as well as the barriers to practice. We plan to bring as many traditional midwives as possible from all over Latin America. This will provide a rich time of sharing.

Inspired by the beautiful and varied ecology of Costa Rica, we have decided to offer a class on the "Ecology of Birth." Because the country is so beautiful, we recommend that you take some extra time to see it. Take one of the many easy day trips from San José, or just go out and explore when the conference is over. Talk to others at the conference for ideas on what to see. Please do consider joining us for an amazing and fulfilling time!

SPECIAL FOR E-NEWS READERS: The March 30 early registration deadline for the Costa Rica conference is extended through April 18! Mention Code 940 (or say you saw it in E-News).


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Mothers: Birth Helpers, Bosses or Intruders

Many pregnant women can now choose who will hold their hand and wipe their brow when they go into labor and give birth. Some want to have Mom at their side; others are confused by their choices. Should they invite Mom and/or Mom-in-law to the birth? Should they allow Mother in if the baby's father doesn't want her there? Many women want to please their own mothers, as well as their lovers, and often they can't please both at the same time. This produces unwanted stress and anxiety.

A recent and lively commentary on www.babycenter.com, involving over 200 women, revealed that although it is not uncommon for a mother to want to be present at the birth of her grandchild, one or both of the expecting parents may not want her there. Many women, however, appear not to have a choice. Other people—or their family's cultural traditions—may decide for them who will attend the delivery. The baby's father or grandmother may make this decision, leaving the birthing woman no choice. In the old days, the hospital determined who could enter the space by the bed in the labor ward. Now that hospitals are more flexible, the husband or partner may be the one who insists on having privacy and no mother or mother-in-law in the birthing room, even when the pregnant woman really wants her mom by her side. Alternatively, he may decide that the presence of an older woman is required and call on his mother or mother-in-law to attend.

In some families, the older woman may determine that her role is to attend the birth of her grandchild and may have the last word. If she is determined to attend, the pregnant woman may be powerless to keep her out of the room. In traditional societies the world over, the older mother (hers or his) expects to assist with birthing. While modern couples are moving out of the extended family home to start families of their own, a traditional mother may still make a huge effort to arrive in time to attend the birth. In Korea, for example, 70% of birthing women still rely on their mother's attendance during and after childbirth and 15% get help from their mothers-in-law.

In the US today, a common occurrence is for a Korean mother to turn up at her child's apartment when she hears that a grandchild is expected. A pregnant woman may have difficulty telling her mother or her mother-in-law that she isn't wanted (for fear of hurting her feelings or incurring her anger, or because tradition demands that she obey the older woman's will), and the midwife may be asked to do this job for her.

The midwife's job is obviously easier when a laboring woman enjoys the support of loving and understanding helpers who know the birthing woman well. Many blissful women tell grateful, gushing birth stories, in which family members and the midwife move happily together toward their common goal. But the midwife's work can be much more difficult when family members who are not loving or understanding invade the birthing room. Then what is the midwife to do? Should she avoid getting involved in family tensions and go about her duties? Or should she try to reduce the stress in the room by being assertive? Should she remove whoever seems to be causing the stress or make constructive suggestions that might render the older woman a bit more helpful?

— Michele Klein, excerpted from "Mothers: Birth Helpers, Bosses or Intruders," Midwifery Today Issue 77


For more on the subject of grandmothers and birth, don't miss Midwifery Today Issue 81, which has an article by Becky Sarah entitled "The Midwife's Grandchild: When the New Grandmother Is an Expert on Babies and Birth."


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Birth Works International Conference 2007

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Research to Remember

A study was done in Sweden regarding breastfeeding support and the confidence of primiparas and multiparas in relation to duration of breastfeeding. Among other findings, the study showed that an effective support strategy for breastfeeding was for care providers to discuss the grandmother's perception of breastfeeding with them. The study's author suggested that a helpful strategy would be to get grandmothers who advocate breastfeeding to provide support for their daughters.

Birth December 2003, 30(4): 261–66


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  Midwifery Today Issue 64

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Birth Interventions Are Routine but Costly

Findings from a two-year review of the science behind maternity care indicate that the common and costly use of many routine birth interventions, such as continuous electronic fetal monitoring, labor induction for low-risk women and cesarean surgery, fail to improve health outcomes for mothers and their babies and may cause harm.

A two-year research review entitled the Evidence Basis for the Ten Steps to Mother-Friendly Care, and premiered at the Coalition for Improving Maternity Services (CIMS) Forum in March showed that:

  • Women whose labors are induced for non-medical reasons are more likely to suffer from intrapartum fever and need instrumental or operative intervention to deliver their babies.
  • Labor induction increases the rate of fetal distress, shoulder dystocia, jaundice requiring phototherapy and breathing difficulties requiring intensive care.
  • More than 85% of women with low-risk labors had electronic fetal monitoring, despite the fact that it does not provide a benefit, and puts women at risk for an instrumental delivery, cesarean section and infection.
  • One-third of women in the US now have cesareans, putting them at risk of infection, hemorrhage requiring transfusion, surgical injury and a variety of complications. Babies delivered by cesarean are more likely to have lacerations, respiratory complications and require intensive care.

The complete results can be found in the Journal of Perinatal Education, which is published quarterly by Lamaze International. For more information visit www.lamaze.org.


Web Site Update

Read these articles newly posted to the Midwifery Today Web site:


Advertising Opportunities

Costa Rica Conference 2007

Advertise at our next international conference "Birth without Borders," in San José, Costa Rica, (May 23–27, 2007). This conference will feature a three-day doula workshop, and many traditional midwives from Central American countries will be in attendance. Opportunities for program advertising and registration insterts can be found on our Web site. [ Learn More ]

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Question of the Week

Q: I am a senior midwife working in an obstetrical hospital in Malta and I am very interested to know how you manage the mothers in the stages of labour. Moreover, since we are migrating to a new hospital with a completely different system, I would appreciate knowing whether the mothers stay in the same ward in the prenatal, labour and postnatal care. Is there a continuity of care by the same midwife with every mother?

— Josette


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.


Please support our advertisers!

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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:

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Question of the Week Responses

Q: I have a friend whose three-month-old baby girl has closing labia and is now only peeing out of one-third of what the opening should be. The doctor says that sometimes they open again themselves, but has prescribed estrogen cream to put on it. He said not to worry if you see her breasts become large for a while. He also said that sometimes this happens when there has been a sore or tear and it healed wrong, and that they may have to think about cutting it open again.

Does anyone know how common this is and if there are alternatives to putting estrogen on the baby? They don't want to do this, but we don't know anything about this problem.

— Audrey Lynne

A: I had a similiar experience as a child. Having male doctors say they were going to tear my vagina has traumatized me to this day. I don't trust male physicians. Mine changed as I got older and my own hormones kicked in. We did try estrogen cream for a while, and the skin thinned, but I developed breast buds. My mother stopped that, and we found a female OB who said that it would heal in time. Everyone was worried about infection, urine retrograde, etc. (Think: the vagina is dirty, so infection will be there). It was all for naught and eventually the inner labia opened more fully on their own. I would caution against cutting down there, but be extra vigilant about changing diapers frequently, soaking in the tub to clean the area, and look out for infection. Why assume problems when none exist yet?

— Anonymous

A: Estrogen creams can help to open a baby's partially fused labia, however whether it is necessary in the short run would be based on whether there is a resulting functional impairment, such as urine being retained in the labial folds, risking infection, or history of localized infections. If a baby is otherwise healthy, allowing time to see whether the labia open spontaneously could be a reasonable option.

Even though a physician may prescribe estrogen cream, further discussion could clarify whether it would be reasonable to observe the situation for a while and revisit treatment options in the future. In my experience, low doses of estriol creams made by compounding pharmacies are very effective used on the labia with fewer systemic side effects than the more potent estrogens contained in other creams, and that might be somewhat of an alternative to consider if an estrogen cream appears necessary.

— Eden G. Fromberg, DO, FACOOG, DABHM
Osteopathic Physician

A: I had never heard of this before my own daughter had a similar problem at four months of age. She did not have any trauma to her labia, but our pediatrician mentioned that some girls have this problem simply because their inner labia stay together too much and don't get full separation. While not trying to be too invasive when changing her diaper, we tended to neglect spreading the labia often enough. By not being fully separated, urine can collect behind the labia and cause an infection. The estrogen cream only needed to be applied at bedtime, and it was less than a week before her labia separated. My daughter did not experience breast swelling or any other side effects. I definitely recommend using the estrogen cream before going to the extreme of separating her labia through surgery.

— Tammy Bayer, CD (DONA), LCCE

A: My daughter had her labia close up. She had a hole the size of a pinhead that stayed open because she peed out of it so often. She was less than six months old when this happened. I was very concerned, but decided to wait and see what happened before allowing her to be cut open. I didn't want to submit her to such a surgery that (in my mind) may be very traumatic. My pediatrician said it would probably open back up on its own. For a while, after asking her permission, I would rub olive oil onto the area, applying pressure where her vaginal opening should be. I am a Christian and so whenever I would change her diaper I would pray for her to open back up. Occasionally I would put other creams such as calendula gel on her. Eventually I quit doing much of anything except praying for her when I changed her diaper. Almost an entire year (maybe more) passed and one day I saw a very small hole where her vaginal opening should be. I didn't do much, but occasionally would put some more calendula cream on her because calendula is a healing cream and I didn't want her to close back up. Eventually she opened back up entirely. I didn't do anything, really. I think it was because she was growing and becoming more active and perhaps her tissues were able to be stretched enough to open back up. We didn't give her any drugs (estrogens or other hormones). I hope this helps.

— Anonymous


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

Stripping the membranes might more accurately be called stretching or playing with the cervix. But how would it sound to say, "Lie down and let me play with your cervix" ?

The membranes are not attached to the cervix, so there is nothing to "strip." The cervix is next to the membranes. The stimulation of labor is thought to come from prostaglandins released from stretching the cervix, not on concentrating on "stripping the cervix" from the membranes, which of course entails a slight danger of breaking the water. It is just very hard or nearly impossible to stretch the cervix without touching the membranes.

Stripping the membranes should actually be called "fondling the cervix." That may remind practitioners to do it more safely and gently.

— Judy Slome Cohain, CNM


Feedback

Watch an online film http://video.google.com/videoplay?docid=5736044891704882660&pr=goog- [Editor’s post script: This URL is no longer active.] of an elephant birthing in the wild at Ulusaba private game reserve in South Africa.


I am a CM from New York State with a homebirth practice. In issue 9:6 of this newsletter there is an inaccuracy. Our professional Midwifery Practice Act does not require nursing as a prerequisite to practicing midwifery, and as a matter of fact, I was a fellow student of Julia Lange-Kessler when she was in school at SUNY Downstate getting exactly the certification I have. There are more than 50 CMs practicing in New York in home, birth center and hospital practices.

Karen Jefferson, CM
JJB Midwifery
Brooklyn, New York


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.


Classified Advertising

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Midwifery Today: Each One Teach One!