December 5, 2007
Volume 9, Issue 25
Midwifery Today E-News
“Miscarriage”
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Attend the full-day massage class at our March 2008 Philadelphia Conference and learn how you can use massage to help your clients before and during birth. The morning session covers topics such as basic prenatal massage strokes, body mechanics and precautions and contraindications of prenatal massage. You'll also learn about the Swedish and support massage strokes you will need for prenatal, labor and postpartum care. In the afternoon, you'll participate in an experiential workshop as you learn about foot reflexology. Go here for information.


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In This Week’s Issue:


Quote of the Week

An angel in the book of life wrote down my baby's birth. Then whispered as she closed the book "Too beautiful for earth."

Unknown


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The Art of Midwifery

Miscarriages are labor; miscarriages are birth. To consider them less dishonors the woman who womb has held life, however briefly. The physical pain from miscarriage can be as intense as that of a full-term birth.

All the comfort measures that ease the pain of a laboring woman may help with the physical sensations of miscarriage: heated blankets, hot water bottles, warm baths or position changes. She needs to be held and allowed to cry. She needs someone to acknowledge that her loss is real and powerful. One shouldn't downplay length of gestation or offer biological facts in an attempt to minimize her grief.

— Kathryn Miller Ridiman, excerpted from "Supporting a Mother Whose Pregnancy Has Ended," Midwifery Today Issue 41, Spring 1997

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Early Pregnancy Loss

Studies show that 71–75 percent of women who miscarry experience the miscarriage as the loss of a baby. When they interviewed over 100 women who miscarried, Allen and Marks found that their experiences went beyond the physical realm. Searching for reasons that the miscarriage occurred, feeling isolated and lonely, wondering if their dreams mean they are going crazy, grieving differently than their partner or other family members, and wondering how long these feelings would last were issues of importance to women who miscarried. The message is, when pregnancy ends in a miscarriage, it is a crisis within a crisis. The whole person is affected—physically, emotionally, socially and spiritually.

Physically, the hormonal changes of early pregnancy require the body to use much energy adapting to a new state of physical equilibrium. With miscarriage, the body needs even more energy to readjust hormonal levels once more.

Driven by a desire to decrease morbidity and mortality, medical care is inundated with new techniques designed to increase the efficiency of health care delivery. The focus of care with early pregnancy loss is on the physical needs of the mother. But there are psychosocial effects from adjusting to the idea of being pregnant, preparing to become a new parent or parent a baby again. When suddenly it all ends, many questions arise: "Why me, why my baby, what did I do wrong?"

Socially, seldom is there a public display of sympathy or an acknowledgement of the loss for the parents. Family and friends may express concern over the other's traumatic experience, but may not acknowledge the experience as the loss of their baby. A sense of aloneness or isolation can be very deep.

— Fran Rybarik, excerpted from "Early Pregnancy Losses," Midwifery Today Issue 41

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Research to Remember

In a study of women who had suffered a spontaneous abortion, 10.9% experienced an episode of major depressive disorder, compared with 4.3% of women in the non-pregnant control group. The risk was substantially higher for childless women than for women with children. Among miscarrying women, 72% of these cases of major depressive disorder began within the first month after loss. Fifty-four percent of those miscarrying women with a history of major depressive disorder had a recurrence. No differences were found in relation to prior reproductive loss or by maternal age, nor did risk vary by time of gestation or attitude toward the pregnancy.

JAMA 277(5), February 1997


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Forum Talk: What Happens to Placenta

I have been approached by a potential client that asked the hospital to return her placenta. She made this request before and after the birth of her child. The hospital refused. Forgive me for my stupid question, but what does the hospital normally do with the placentas? Do they sell it off or do they actually treat it as waste and discard? Thanks ahead for any response.

— jjuan


To share your thoughts and experience about this topic, go here.


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Web Site Update

We have revised the Books page on the Midwifery Today Web site, including an introduction to our new Motherbaby Press. Have a look here.

Midwifery Today Bookshelf
Midwifery Today Bookshelf

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New Book Coming in 2008 from Motherbaby Press:

Survivor Moms: Women's Stories of Birthing, Mothering and Healing after Sexual Abuse

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Question of the Week

Q: My eight-week-old daughter's pediatrician wrote her a prescription for vitamin D—Tri-Vi-Sol. He said that breastfed babies don't get enough of it in this part of the country. Is this really necessary? Is there another way to get vitamin D that is effective?

— Danielle Kimball-Smith


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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Question of the Week Responses

Q: I need some help for a friend of mine who is due with her second baby any day now. She very much wants a homebirth and has a birthing pool set up. Her first birth was in a birthing center and was without any problems. Her second baby has been transverse and breech for a while and her midwife easily turned the baby head down twice in the last two weeks, but the baby goes back to breech position. The midwife thought there must be some reason why the baby keeps turning head up, so she and my friend decided to get a sonogram. The sonogram showed the baby in a footling breech position with the cord wrapped twice around the neck. The doctor said the cord is short. The midwife herself was a footling breech birth and she is willing to go ahead with the homebirth if my friend is sure that she wants to do so. The husband does not want to risk a homebirth, so she is feeling some tension and distance as she doesn't feel that he is supporting her.

The mom is willing to try natural techniques like acupuncture, homeopathic pulsatilla, playing music at the cervix, swimming and getting in inverted positions. She visited the doctor who was at her first birth and he tried moving the baby a bit and checking its heart beat to see how tight the cord was wrapped. He said the heart showed no signs of distress, so moving the baby can be tried. This doctor is the head of the birthing center that is in the Roosevelt Hospital in Manhattan and he hasn't "delivered" a breech baby in five years.

I keep reminding this woman that the baby can turn head down at any moment, even during labor. Any thoughts or advice for her?

— Anonymous

A: I would not advocate a home delivery in this instance, although I am a strong supporter of homebirth. I think the risk factors are too high. If it was a straight forward footling breech I'd say yes, but the short cord around the neck is far too risky.

— Cotty
England

A: I fully understand and respect the desire to have a homebirth; I myself have had two. If the baby insists on being breech, I would try positioning in the hands-knees position every day for a time, and see if that encourages and coaxes the baby to turn.

I have participated in external versions (in the OR at a hospital though, in case during the version the heart rate dropped and didn't recover...a c-section would be performed), and I have not seen successful versions where the infant stayed vertex, unfortunately.

That said, babies DO turn themselves—sometimes right before labor. So I would hold tight, see what labor brings and whether the baby remains breech. I think the hospital is the safest place to attempt a breech vaginal delivery.

— Cindy Covill, RN, BSN

A: The cord being around the baby's neck is a common thing. As for cord length, that really isn't accurate or even an issue. If this mom delivers in the hospital she will be sectioned. She has a proven pelvis, so as long as the midwife knows how to deliver a breech baby and she is okay with it I don't see the problem. It sounds to me like hubby bit the bait that was set out.

Breech babies simply know which end is up! I, too, was a footling breech delivered vaginally. I have seen EMTs deliver a footling breech.

— Kathleen Metzler, RN
Peterborough, New Hampshire

A: I've heard that the Webster Technique—a chiropractor's way of making room in the body for the baby to change positions—is effective.

— Kelly Camden


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

The most common factor leading to miscarriage is a chromosome abnormality in the fetus. Up to 70 percent of first-trimester miscarriages are caused by such abnormalities, most of which result from a faulty egg or sperm cell. Sometimes, one or more cells splits unevenly, resulting in egg or sperm cells with too many or too few chromosomes. If a cell has the wrong number of chromosomes, the embryo has a chromosomal abnormality and is usually miscarried. Chromosomal abnormalities become more frequent with age, and women over age 35 are at higher risk of miscarriage than younger women.

— March of Dimes, www.marchofdimes.com/professionals/14332_1192.asp


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Feedback

Don't miss The Business of Being Born, a film by Abbie Epstein and Ricki Lake. The film's fundamental question is: Should most births be viewed as a natural life process, or should every delivery be treated as a potential medical emergency?

The film will open theatrically on January 9 in New York City at the IFC Film Center. The theater will schedule special "Bring Your Baby" matinees. The New York opening will be followed by a release in Los Angeles on January 18 at the Music Hall Theater on Wilshire Blvd. and in San Francisco on January 25. The film is also being shown in special screenings throughout the US and will soon be released to Netflix. To learn more about this fantastic film, which shows some beautiful homebirths (including Ricki Lake's), or to host a screening or add it to your Netflix queue, check out: www.thebusinessofbeingborn.com


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