|July 18, 2007|
Volume 9, Issue 15
|Midwifery Today E-News|
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In This Week’s Issue:
Quote of the Week
"There can be no assumption that today's majority is 'right' and the Amish and others like them are "wrong." A way of life that is odd or even erratic but interferes with no rights or interests of others is not to be condemned because it is different."
— Warren E. Burger (Supreme Court Chief Justice, 1969–1986)
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The Art of Midwifery
Midwifery is more than securing safe passage for our clients. It is more than creating a satisfying experience, or helping a new family to bond, or empowering women and their loved ones. In its finest hours, midwifery involves magic, spirit and miracles.
— Elizabeth von der Ahe, excerpted from "Amish Miracle Baby," Midwifery Today Issue 42
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 firstname.lastname@example.org.
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Amish Birth Story
Harley said, "Martha needs you." I said, "OK, I'm on the way." I had grabbed the birth stool and the Doppler when I went in, thinking my assistant, Megan, would be right behind me on the road and could bring in her instruments and the oxygen, in case Martha was ready to push.
I went in and Martha was sitting in the tub in about two inches of water, washing herself with a bar of soap and a washcloth. She said that the bath had helped her immensely and that the contractions had stopped. Maybe she had called too soon, she wondered.
I listened to the baby, who was fine. I asked Martha if I could check her in the tub and she said I could. She told me that the labor had started around 10:30 the night before, and that she had had a rough night—not much sleep—but didn't know when to call. She had almost called because she had felt the urge to push a couple of times, but she didn't want to get us out too soon, as cold as it was. She said the contractions had started and stopped, and this time she had a lot of pain in her back. I checked her and she was complete with a big bulging bag. She had not had a contraction in quite a while, she said. I told her that we could break her water if she wanted, or we could wait because her body was giving her a rest. She said that she very much wanted it broken because the kids were still home, and she wanted it over before they woke up. Amish children are not told where babies come from and are never told that mom is expecting a baby.
Megan arrived, and I went back in the bathroom to check on Martha, who said that she still had not had any contractions. "Could I break her water anyway, without contractions?" she wondered. I told her I could. I put her on the birth stool and checked vaginally, and a big bag was right inside at the introitus and the head a lot farther down. I popped the bag with my finger and told her that she would probably have a contraction soon.
We waited a couple of minutes and Martha said, "Can I go ahead and push anyway?" I asked if she was having a contraction. She said no, she could not feel anything. I told her to go ahead and push if she wanted. She pushed and the baby moved way down and was just inside. She waited a few seconds and said, "I can't feel a thing. Can I push again?" I said yes. She pushed again and the baby came nearly to a crown. She kind of intermittently pushed for a few more seconds. I could tell that she did not have an urge. I joked that the baby did not know it was being born. She pushed again and the baby crowned. "Can you just pull it out?" she cried. "No, just push," I said.
About that time the head came out, and then she pushed again, and the rest of the baby emerged. He cried loudly as he was placed on his mother. The bedroom door rattled and you could hear little voices on the other side, wanting in.
The baby put his thumb in his mouth expertly, like a two-year-old would, and he lay there under the towels, looking around in the dark room. A minute or two went by and I reminded her that she still needed to have the placenta. I told her to tell me when she started cramping. She laughed and said, "Well, I didn't have any for the baby."
"Oh yeah, you're right," I said. "Just go ahead and push."
She pushed and the placenta instantly slid out, a textbook battledore with velamentous insertion. It was such a good one that I brought it home, hoping that we would have another placenta workshop soon. Martha lost about 1/4 cup of blood, maybe less. She started pushing at 6:45 am and the baby was out by 6:47. The placenta came at 6:50 am.
Martha said as we were leaving, "I learned something new today. I didn't know you could have a baby without contractions. That was pretty easy."
— Jennifer Williams, excerpted from "An Amish Birth Story," The Birthkit Issue 38
Don't miss out! Back issues of The Birthkit are available here.
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Research to Remember
A small, prospective, controlled study of Echinacea taken during pregnancy indicates that it does not cause major fetal malformations. The study was conducted by researchers at the Hospital for Sick Children's Motherisk program (a teratogen information service and research program) and the Canadian College of Naturopathic Medicine.
The study involved 206 women who contacted Motherisk between 1996 and 1998 about the safety of Echinacea in pregnancy, and subsequently used Echinacea products (112 used them during the first trimester). Their pregnancy outcomes were compared with those of 206 women who contacted the program about the herb's safety in pregnancy but did not use it.
— www.motherisk.org/women/herbal.jsp Accessed 5 Jul 2007
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Products for Birth Professionals
The University of Nottingham in England, funded by the National Institute for Health Research, is recruiting 1050 pregnant women to determine whether nicotine replacement therapy (NRT) is safe, effective and cost-effective for moms-to-be who want to give up smoking. It will also study the effect on the behavior and development of the child. Because of the health problems and deaths caused in unborn children, smoking is considered a major public health problem.
According to the researchers, NRT can double a non-pregnant smoker's chance of giving up, but as pregnant women metabolize nicotine a lot faster than other people it cannot be assumed that NRT will work for them and the Smoking, Nicotine and Pregnancy (SNAP) trial will establish whether or not this is the case. Another remaining question is whether women who quit smoking during pregnancy using this method will be less inclined to resume the habit after the birth, unlike a high percentage of women.
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Norway Conference 2007
This international conference, "The Heart and Science of Midwifery," will be held in Oslo, Norway, September 12–16, 2007. Advertisers are invited to take advantage of several advertising opportunities, including: program display ads, registration packet inserts and exhibiting. This conference will offer the opportunity for participants to learn from the skilled and talented Norwegian midwives, as well as from presenters from all over the world. There will be a decidedly "international" focus to this conference. [ Learn More ]
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Question of the Week
Q: I recently learned that a Mom with a negative Rh factor and a Father with a positive Rh factor can cause illness or death for the baby, but that giving RhoGAM to the mother around 28 weeks and at delivery prevents complications. What is the usual procedure for women who choose a birthing center or home delivery instead of a hospital? Does the midwife administer the shot when needed?
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Question of the Week Responses
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?
A: In my practice, in the UK, we would suggest you have a trial of labour. If your baby is head down, the head is engaged at the time of labour, you are fit and well and at term, the baby's heartbeat is normal prior to and during labour, the size of the baby feels right for your dates, etc., and you have good regular contractions, there is no reason for you not to deliver normally.
If anything changes during the delivery period, a c-section can be performed. Talk to your midwife and she should advise you. Good luck and have a nice, normal delivery.
— Sandra Lochhead
A: All the research shows a vaginal birth after a cesarean (VBAC) to be a safe and viable option for women. You've already had one vaginal birth; you have a "proven" pelvis. The time between a cesarean and a VBAC is not as important as how you are taking care of yourself. Why go through two major abdominal surgeries in 15 months? It will be easier to care for a newborn and a toddler after a vaginal birth than after a cesarean. Come visit ICAN at www.ican-online.org for more information, support and encouragement!
— Pam Udy, ICAN President
A: Try VBAC (vaginal birth after cesarean); it is empowering and fulfilling. I would recommend you find a doula who has the same philosophies as you, i.e., medication vs. no medication during delivery. A doula can speak the medical jargon that may save you a repeat cesarean. The doctors will classify you and "strongly" advise you to do a repeat c-section, which is easier for them. That makes the delivery very clinical, you obey the regional policies for surgery, etc. But it is nothing more than a woman being dissected on a cutting board. The recovery for you will be long and arduous. The baby is not squeezed through the birth canal, which has many benefits. Lastly, the baby will have a more difficult time nursing because of the drugs given for the cesarean. EDUCATE YOURSELF! With another repeat c-section, doctors can now dictate how many children you can have. Some doctors will not allow you to have more than three c-sections, so they limit the size your family. Knowledge is your best advocate! Ask questions! Find out what fits for you!
— Shannon Arthur
A: Fire your current OB and get a midwife/doula who is into the way birth should be handled, rather than the medical model. Also, trust your instincts more than theirs. This goes for family, friends and others, as well, even if they mean well.
If you plan to give birth in the freestanding birth center or hospital, stay home as long as you can tolerate it. If you do, the FSBC or hospital can't do interventions because you will be in regular labor or ready to deliver at that time.
Also, try to stay away from everything that's mainstream and instead educate yourself through some of the Midwifery Today materials and other similar sites. Go to International Cesarean Awareness Network Official Web site for more information.
I recommend the following books:
Good luck with everything.
— Jessica A. Bruno
A: Major abdominal surgery or natural delivery, your choice. No one else can say what's right for you. But a c-section has four times the maternal morbidity/mortality rate of a vaginal birth. Babies are twice as likely to spend time in NICU. The necessity was debatable the first time, but is not something that is likely to happen again. If it were me, I wouldn't have had the first one (for that reason) and definitely not the second; but everyone's desires are different. On the pro side, your doctor makes more money in less time, you can pencil in on your calendar, at a convenient time, the delivery date and the big long recuperation period that goes with any major surgery.
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.
Think about It
FDA is now offering a free educational kit that nurses, midwives and other educators can use to make presentations on food safety for pregnant women. The kit contains an Educator's Resource Guide with background and facts on food safety, reproducible handouts and a 20-minute video. The materials can be found on a special FDA Web site, along with a printable poster that you can display in your office and a set of PowerPoint slides for your presentation. All of these materials are available in both English and Spanish.
Pregnant women can be referred to the Web site for more food safety tips. Among the topics covered are food borne risks, including Listeria, methylmercury and Toxoplasma, as well as the four key steps needed to prevent food borne illnesses. The kit can also be obtained by calling FDA at 1-888-SAFEFOOD.
I am producing a video about touch during birth and its powerful ability to lessen pain, ground the woman's experience and provide deep connection to her birth support. I am looking for video footage and stories about being touched while in labor (both professional and home footage). You can contact me at firstname.lastname@example.org.
— Leslie Piper
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