|June 20, 2007|
Volume 9, Issue 13
|Midwifery Today E-News|
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In This Week’s Issue:
Quote of the Week
"The pains of childbirth were altogether different from the enveloping effects of other kinds of pain. These were pains one could follow with one's mind."
— Margaret Mead
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The Art of Midwifery
The pain of labor is based in fear. We, the professionals, should transmit positive things: that the body contracts, but it is not pain, it's the body's process. We can help with massage, hot water.... When the midwife connects with the birthing woman, birth is warm and nurturing. But in an institution, birth is cold. The colder the birth, the more pain a woman will feel. But if you are brimming with confidence, if you touch the woman, hold her, kiss her, massage her, you will transmit of feeling of safety and security. She will feel loved and understood and her pain will diminish. It's very important not to deceive the woman, saying that it doesn't hurt. When she screams, we must give her a sense of tranquility. That's why we are there. We should say, "Open the window because the baby is going to come out. Breathe deeply, because the sensation will pass."
— Doña Irene Sotelo
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Midwifery Revolution in Argentina
Argentina is a very large country. It has different climates, different populations, different landscapes—but it also has a repeated reality: violence against women, their babies and their families; routine interventions; horrendous birth stories and the intentional disappearance of midwives caused by the biomedical hegemonic system.
Birth assistance for the masses moved to a hospital setting fifty years ago. While failing to completely erase midwives, the system gobbles them up, whether nurse-midwives or lay midwives. Argentine midwifery philosophy is: "be the doctor's 'right hand'" and "surpass speed records (by accelerating birth times)." Yes! That is what we are taught at universities. In addition, a residency system for midwives was established, in which they work more than 70 hours per week. The outcome: more mistreatment towards women.
The midwife, long known as a woman's advocate and ally, turns into her inquisitor and even her torturer. Technocratic midwives (obstetricas) ridicule traditional midwives and their methods. They don't understand remedies such as herbs, homeopathy, visualization, the rebozo way, etc. They see this as charlatanry.
They, who have never assisted or seen a homebirth, retell the lies that are spread by the biomedical believers. You can find them everywhere: at the hospitals, at the midwives' colleges, at the universities, at the federation and in the associations. They represent us in the world.
Although we may think "they" have won, another reality exists. It is hidden, like an underground river, the fire at the earth's center, the magma below the tectonic plates or bamboo cane roots; it seems that nothing is happening and then suddenly the change becomes visible.
New generations of midwives are arising and, despite their education under the invasive interventionist system that fears the power, bodies and wisdom of women, are allowing themselves to ask, to criticize, to not rely on those "absolute truths"; and finally, to free themselves and women from the chains of submission and domination. Some find those with whom they can share, while others continue alone building support nets through e-mail or pagers.
In all the provinces of Argentina, more independent midwives are assisting in homebirth, in order to meet a professional need to escape from submission and loyalty to doctors and in response to increasing demand from women themselves.
I am amazed at the number of women who, despite the brain-washing, prefer to give birth in a non-traumatic way. Some women have the privilege to live up to their potential without censure only with their last child (the third or fourth), after a long journey of rehearsal and mistakes—where the body, soul and self-esteem were left scarred.
These women are fearless and brave, because they decide to swim against the cultural tide, with its strong doctor-dependent commandments. Many think they are crazy and negligent. They have to work hard to maintain their self-confidence, while society, the obstetrician/gynecologists, and even their families, tell them "you can't do it," "it is dangerous," "you'll be responsible if anything goes wrong," and threaten that the baby or mother will die if they don't do it the modern way.
— Marina Lembo, excerpted from "Midwifery Revolution," Midwifery Today Issue 75
You can read this article in Spanish on our Web site.
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Research to Remember
Researchers at Aberdeen University Medical School in Scotland found, in a 17-year-long study of more than 25,000 women, that those who had had a cesarean were less likely to have another baby, and that those who did have another baby waited longer than mothers who had vaginal births. The researchers also found that women who had a caesarean also were more likely to have an ectopic pregnancy the next time.
— BJOG 112(8): 1061, August 2005
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The Female Genital Cutting Education and Networking Project reported that the Eritrean government and civil society have expressed optimism that efforts to combat female genital mutilation (FGM) were bearing fruit, particularly in rural villages where excision was most common. Some villages have passed provisional laws to discourage the practice and a national law is being drafted to outlaw it in Eritrea. While FGM prevalence rates in Eritrea were estimated at 94 percent, a decline is expected because an increasing number of parents were choosing not to have their daughters subjected to FGM.
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Question of the Week
Q: My pregnancy is going well; I am about 32 weeks right now. We are having another little girl. I think that's why I was so miserable during the first trimester. I threw up every other day. It was similar with my first daughter, although not so extreme. With my son, I did not even suspect that I was pregnant for the first three months.
I am now debating whether to have a repeat C-section or try natural. My first son was born naturally, and then my daughter was born by c-section three years later because she was breech.
This baby has already turned head down, but when it's going to be born, it will be only 15 months between the two deliveries. Any ideas?
SEND YOUR RESPONSE to email@example.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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Question of the Week Responses
Q: I just bought a birth stool at: http://www.birthwithsol.com/birthstool1.html, and it came today. I'm really excited to start having it available to my students and clients. HOWEVER, I tried sitting on it today for quite a while and could not figure out for the life of me how I'd push a baby out on it. Do you want the sit bones on it or in the opening, for example?
Does anyone have any specific tips (from your own experience or births you've attended) about how to properly use a birth stool? Thanks!
A: A friend of mine sent me your question because I have used a BirthRite birthing seat for years. It is a different style than the one you have. I am not sure how much help I can be, but I will try. The birthing woman sits on the seat with the opening of the seat facing to the front. When I use my birthing seat it is positioned so the labor support person is sitting behind the birthing woman, and supporting her back so that she can lean back, if she wants. The openings on the side of the seat are for her hands so she can hold on while pushing. A mirror on the floor helps to see where the baby's head is. You will have to find a comfortable position for yourself. I put my seat on the floor and then position myself accordingly. Some people place the birthing seat in the bed or on a low table.
There are many other "tricks" to using a birthing seat and experience, as always, is the best teacher. Just make sure that the seat is stable and no one is going to topple over. That particular seat looks narrower at the base and stability could be a concern.
— M. Heldwein, CNM
A: I have this birth stool too. My biggest complaint is that it slopes forward a bit and moms sometimes complain of feeling like they are sliding off it.
You can sit on it with just your sit bones perched on the back of the opening or let them fall down into the opening, as long as your have enough "substance" to your buttocks to hold you in place. Just like sitting on the toilet really, but more open. I had one woman try it backward, too!
— Jan Wolfenberg, CPM, LM
Q: My daughter's son is seven days old and she is breastfeeding him. He latches on and sucks well. Despite some soreness and bleeding of the nipples at first she is coping well and the soreness is clearing. She uses nipple shields for alternate feeds to help her breasts heal.
The baby rarely settles after a feed unless he also has some formula either from a cup or a bottle. However, once he has formula he sleeps well.
Does this indicate a shortage of milk? I recall when I was breastfeeding many years ago, my breasts were full and leaky most of the time. My daughter does not seem to feel like this and there is no leakage. Is there something we can do to make sure she has plenty of milk?
— Brenda (Sian's Mum)
A: Please visit www.icpa4kids.com for more information and a referral to a Doctor of Chiropractic who specializes in pre- and postnatal care in your area and who can evaluate your daughters' health.
Below you will find some great articles from cases in which dramatic improvements in lactation issues have been shown. If you have any questions please contact me directly at 203-272-3239 or firstname.lastname@example.org.
— Luigi DiRubba, DC
Responses to any Question of the Week may be sent to E-News at any time. Write to email@example.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.
As a firm believer in the past work of Michel Odent to lead the way to gentler birthing practices worldwide, I began reading "Exclusive Interview with Michel Odent: The Autism Epidemic" in Midwifery Today E-News 9:11 with excitement and deep interest. As the mother of two boys diagnosed with autistic spectrum disorders, my interest and excitement quickly turned to disbelief and then to outrage. I am appalled that Dr. Odent would suggest that we "study autism as an impaired capacity to love." Obviously Dr. Odent has not spent much time around children with autism. Autistic children DO NOT have an impaired capacity to love. Children with autism have an inability to effectively communicate their needs, wants and desires. That inability to communicate effectively is a far cry from an impaired capacity to love.
Autism does not have one single cause. Research is being done and more is being discovered every day. I am deeply disturbed by the apparent attempt of Dr. Odent to discredit the truly valid studies and unbiased research that demonstrate an association between vaccines and autism. The primal health research database to which readers are directed by Dr. Odent in the interview contain nothing but abstracts of studies that, in the areas of autism and vaccination, are completely out-of-date.
In this interview Dr. Odent makes reference to a study published in the New England Journal of Medicine (NEJM) (347 : 1474–75) regarding Autism and MMR vaccination. Much updated information is available regarding this particular study done in Denmark. The original study was flawed for reasons too numerous to list. I would encourage Dr. Odent to look at the study in the Fall 2004 Journal of American Physicians and Surgeons 9(3), which revisits and refutes the one published in NEJM. There IS an association between autism and the MMR vaccination.
Dr. Odent also cites a study published in 2003 by JAMA (290: 1763–66), to continue to make his point that no association exists between thimerosal-containing vaccine and autism. Dr. Odent is not clear and does not inform us that this study was specifically looking at only the DTP vaccine and not the MMR.
The JAMA study is flawed for numerous reasons. First, and probably the most important to note, is an apparent conflict of interest. Michael Stellfeld, MD—one of the authors—is affiliated with the Statens Serum Institut Medical Department, the maker of the vaccine being studied. Second, the study authors were not certain who received thimerosal-containing vaccines. They "considered" vaccines administered before 1992 to contain thimerosal and those administered after to be thimerosal-free. This is not sound methodology, especially because not until 1992 were the last batch of thimerosal-containing vaccines released and administered. That potentially means that the vaccines administered that were "considered" thimerosal-free may have contained thimerosal well into 1994.
In addition, from 1991 to 1994 the authors only included those children hospitalized (inpatient) and diagnosed with autism; yet in 1995 they included both inpatient and outpatient diagnosis of autism. As most children are diagnosed on an outpatient basis, the number of children used in the study between the years of 1991 to 1994 would be inaccurate and far below the actual number of children diagnosed with autism during those years. One also should consider that the study period concluded prior to when many of the youngest children in the study would have reached the age of three. Many children are not diagnosed until age three or later.
Comparing children in the US to children in Denmark is useless. The vaccination schedules are different and although at age three months children in both countries would have received the same amount of thimerosal according to the JAMA study; children in the US receive many more vaccines than in Denmark. When looking at the DTP vaccine in particular; children in Denmark received the vaccine at five weeks, nine weeks, and then not again until 10 months. In the US, children receive the DTP vaccine at two months, four months, six months, and then again at one year of age. The comparison is unreliable at best and dangerous at worst.
Last, I would also like to point out that the authors admit at the end of the study that the methodology and follow-up may be a "weakness," yet they continue to say that this is more likely to be a problem in an incidence study versus a risk factor study.
Dr. Odent points out that the data suggest that significant risk factors occur before the age at which children receive the MMR vaccine. The significant risk factors would include medication and environmental toxins and pollutant exposure both in utero and during the first year of life, and all the vaccines children receive prior to the MMR vaccine one year of age.
Also of note: the time frame during which China saw an explosion of autism was when the US removed thimerosal from vaccines, AND took much of the thimerosal-containing vaccine supply off shelves in the US and shipped it to other countries, one of which was China.
While I concede that birthing practices may contribute somewhat to autism, I believe that the most likely cause is vaccines. I have four children. All were born without anesthetics of any type. My boys (ages 7 and 5) were born in the hospital. I experienced wonderful labors with both in water. My oldest was "a vacuum extraction" (iatrogenic, obstetrician/gynecologist, supposed decels that were never confirmed); my younger son (CNM—learned my lesson) I birthed after about thirty minutes of beautiful pushing. Both boys had perfect Apgars. My girls (ages 3 years and 8 months) were born at home and in water. With both of my girls I was induced (thanks to my loving and compassionate midwife) with prostaglandin gel (half of recommended dose for first birth, a quarter of recommended dose for the second). Although quick (about three hours each) they were gentle, wonderful labors and births. The girls' Apgars were perfect as well. My boys had all of their vaccinations and both have been diagnosed with autism. My oldest is much milder; his vaccinations were more spread out that those of my younger son. My five year old has never had a Global Assessment of Functioning above 55: His autism is moderate to severe. Both boys had chronic ear infections and received tons of antibiotics. My three-year-old daughter had three sets of vaccines beginning at age 4 months, then 6 months, and again at 8 months. She too began with the chronic ear infections resistant to antibiotics. I said "enough is enough" and she has had no more vaccines. She is quite fine and is developmentally far beyond her age. My youngest child has had no vaccines (and won't, I might add) and is developmentally beautiful!
While that I could take up many other "issues" with this interview, the most important thing we need to remember is that only one diagnosable cause of autism is known, and that is Fragile X syndrome (a chromosome disorder). For all other children with autism, we have no sure answer. If we are to find the causes and potentially, cures, we all need to work together.
I have been in involved with the birth world for many years and am a firm believer in the education and issues that Midwifery Today brings to light. I have for many years seen a serious division among all those involved in birth. I agree that all possible causes of autism need to be explored—including the oxytocin theory. But when I finished reading this interview with Dr. Odent, I walked away feeling angry and seeing the beginning of more division in the world of autism research. I saw that because instead of saying "Here's an area (oxytocin) that should be researched along with everything else," Dr. Odent approached it from a seeming place of needing to discredit the vaccine theory in order to make oxytocin appear more relevant. It's all relevant.
— Angela Warner,
Response from Michel Odent:
I thank Angela Warner for her passionate comments. If she is aware of epidemiological studies of autism (in the framework of Primal Health research ) that are not included in our database, I would be pleased to receive the references.
I agree that some of the studies I mentioned may be considered old. For example, the huge study by C. Hultman and colleagues was published as early as 2002: We must take into account that their research protocol could not be easily replicated since it had involved all the Swedish population born between 1974 and 1993, all the Swedish children diagnosed as autistic, plus five controls for each of them. The point is that more recent studies, such as the Australian one published in 2004 and the Israeli one published in 2006 have reached the same conclusion that there are significant risk factors for autism in the perinatal period.
As for the Danish study exploring possible links between autism and MMR, I mentioned it because it involved half a million children. I might have mentioned the similar results obtained in a US study (Dales, L., S.J. Hammer, N.J. Smith. 2001. Time trends in autism and in MMR immunization coverage in California. JAMA 285(9): 1183–85) and in several British studies (such as Kaye, J.A., M. Melero-Montes, H. Jick. 2001. Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis. BMJ 322: 460–63), in spite of differences between countries regarding vaccination programs. For similar reasons, I mentioned the Danish study only among those exploring possible links with vaccines containing a mercury derivative.
As early as 1982, Niko Tinbergen (the Nobel Prize winner) was wondering why the medical community and many parents do not want to hear about risk factors for autism in the perinatal period. This led me to introduce the concept of "cul-de-sac epidemiology." (Odent, M. 2000. Lancet 355: 1371)
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