January 16, 2008
Volume 10, Issue 2
Midwifery Today E-News
“Prenatal Testing”
Print Page

Welcome to Midwifery Today E-News !

Got Holiday Gift Money to spend?
Check out the Online Holiday Coupon Page for $10 and $20 discounts in the Midwifery Today store. Or, save $5 on your Midwifery Today subscription. You'll also find special offers on Childbirth Educator Labor Assistant/Birth Doula training. Hurry, these special offers expire Jan. 31.

Midwifery Today Online Store

Learn the how and why of diagnostic testing.

Understanding Diagnostic Tests by Anne Frye will give you a holistic perspective on test results. The new 7th edition is updated and expanded by around 395 pages, to give you 1365 pages packed with valuable information.
Order Understanding Diagnostic Tests.

This issue of Midwifery Today E-News is brought to you by:

Look below for more info!

Midwifery Today Conferences

Are you ready for first and second stage difficulties?

Attend this full-day class with Gail Hart and Ina May Gaskin and discover how good pre-natal care can help prevent labor complications. Other topics covered include protocols and techniques to help the mother move through first and second stage, prolonged ruptures of membranes, failure to progress, abnormal labor patterns and non-medical intervention. Part of our Philadelphia conference, March 2008.

Learn more about the Philadelphia conference and get a complete program.

Learn how childhood sexual abuse can affect women during pregnancy, labor and postpartum.

Discover what you can to do help. Attend Midwifery Today's "Hope and Healing" Conference in Ann Arbor, Michigan, May 2008. You'll be able to choose from classes on topics such as abuse counseling, positive coping and care of the caregiver. There will also be a full selection of practical classes for midwives and aspiring midwives.

Learn more about the Hope and Healing conference and get a complete program.

In This Week’s Issue:

Quote of the Week

"Technological obstetrics makes the assumption that more knowledge is better, but, like Eve's apple, the knowledge that we gain through prenatal diagnosis can cast us from our pregnant paradise, with major and long-lasting sequellae for mother, baby and family."

Sarah Buckley

Are you enjoying this issue of Midwifery Today E-News? Then show your support by making a donation of $3 or more.

The Art of Midwifery

In a recent survey, women were asked to rate their fear of birth before reading positive birth stories, and again three weeks after reading birth stories. Participants reported an average of 33% less fear after they read empowering birth stories.

Sheri Menelli
Excerpted from "Positive Birth Stories," Midwifery Today, Issue 84
View table of contents / Order the back issue

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.

RSS Feed Subscribe to the Birth Products RSS feed for information about the products available from Midwifery Today. Find out what's new, what's on sale and more.

RSS Feed Subscribe to the Web Updates RSS feed to stay on top of what's new or highlighted on the Midwifery Today Web site. Be alerted when conference programs go online, new articles are posted and more.

Research to Remember

An analysis of discussions at the first prenatal visit regarding prenatal testing between obstetric providers and pregnant women found that women who were older than 35 were counseled for over twice the length of time as younger women. The most common topics discussed during the visit were practical details of testing, its purpose and the fact that such testing is voluntary. In comparing the discussions of obstetricians with those of nurse-midwives and women, they found that the obstetricians were more likely to make a recommendation about getting the testing, and they were less likely to indicate that such testing was voluntary. The researchers concluded that the information provided was inadequate for ensuring true informed decision-making.

Obstet Gynecol 91: 648–655, 1998

Please support our advertisers!

A Revolution in Obstetrics ~ Only $9.99 + S&H

Obdisk3™'s innovative new obstetric calculator features a unique third wheel for highlighting the sonogram due date, enabling quick comparisons to last menstrual period estimates (includes a key appointments planner and printed instructions). Obdisk3™'s accurate pocket pregnancy calculator is designed for obstetricians, family doctors and midwives.

Prenatal Diagnosis

Prenatal diagnosis represents incredible and continuing advances in technology, yet a sleight of hand—a trick, perhaps—is being played on pregnant women. We are told that prenatal diagnosis will increase our choices, but, as these tests become more available, women are feeling that they have less choice to refuse the testing. We already are, through social attitudes, individually responsible for our children's development, and now we also are becoming responsible for producing a healthy baby at birth.

As one woman comments, "I knew it was my responsibility to make sure I was not going to give birth to a handicapped child. But that meant taking the risk of losing a healthy baby. I am responsible for that too."

Finally, as we look more deeply, the parallels between prenatal diagnosis and medicalised childbirth become increasingly obvious. Both industries are centred on high technology and its superior knowledge, and both consider women's own feelings and instincts about their bodies and their babies to be of lesser importance.

Women who choose either path are at risk of a cascade of intervention—from induction to caesarean or from screening to abortion—with pressure to conform to medicalised ideas of "the right decision" at each point. As one woman notes, "…once you've got onto the testing trap you have to get to the end."

Where does this end take us, as individuals and as a society? Does prenatal diagnosis represent liberation or the beginning of a slippery slope towards selecting babies on the basis of socially acceptable characteristics? How will the "new genetics" impact prenatal diagnosis, with the huge amount of information that will soon become available about our unborn babies? And does it…make every woman feel that her pregnancy is "tentative" until she receives reassuring news?

The answers to these and other questions are as yet unknown, but this technology is certain to become more sophisticated in the coming years and our choices more complex. Mother Nature, like many women who are enrolling in these tests, does not know whether to laugh or cry.

Sarah Buckley
Excerpted from "Prenatal Diagnosis," Midwifery Today, Issue 77
View table of contents / Order the back issue

Please support our advertisers!

We’Moon ’08

Gaia Rhythms for Womyn's artists and writers speak with profound eloquence on this year's theme—Mending the Web. This week-at-a-glance appointment book features daily astrological aspects, moon phases, and astrological predictions. At this time of multiple crises, it calls on the ancient women's art of mending what is torn in our imperiled world. Order at http://www.wemoon.ws or (877)693-6666.

Products for Birth Professionals

Keep track of your appointments and client information.

MT tote bag Use the "With Woman Appointment and Resource Book." This handy little spiral bound book gives you places to record 15 months of appointments, plus a section to list your client due dates, addresses and phone numbers. You'll also appreciate the convenient pocket in the back that can hold business cards and a gestational wheel. It also makes a fine gift for any birth professional. Supplies are limited. First come, first served. Get the With Woman Appointment and Resource Book

Learn how you can have a safe, gentle birth.

Pregnancy and Childbirth SecretsPregnancy & Childbirth Secrets is packed with information that will guide you throughout your pregnancy and during your first days as a mom. Mothers, childbirth professionals and researchers share their experience and knowledge, giving you the insight you need to have a birth that is safe and rewarding for both you and your baby. Buy Pregnancy & Childbirth Secrets

Birth art makes a perfect Valentine's Day gift!

The Mother and Child PinGive her the 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.
Mother's Milk Clay SculptureShe'll also love the Mother's Milk Clay Sculpture, a warm reminder of the special nourishing bond between mother and baby. The 2-inch tall sculpture was inspired and designed by a nursing mom.

Holistic Clinical HandbooksAre you prepared for
birth problems and complications?

The Holistic Clinical Handbooks are packed with practical information you need for births. Plus, they're small enough to tuck into your birthkit, so you can always have them with you. Order your copies and be prepared for prolonged labor, shoulder dystocia, second stage, VBAC and more. Order the Holistic Clinical Handbooks.

Make sure you get the whole story.

Midwifery Today magazineMidwifery Today E-News is only a sample of what you'll find in Midwifery Today magazine. Subscribe and you'll receive a 72-page quarterly print publication filled with in-depth articles, birth stories from around the world, stunning birth photography, news, reviews and more.

Previously, genetic counseling and diagnostic screening only of women over 35 was the standard of care for predicting Down syndrome. Beginning in January 2007, the American College of Obstetricians and Gynecologists (ACOG) stated that all women regardless of age should be offered the opportunity for screening.

ACOG Press Release, January 2, 2007

Please support our advertisers!

Give your baby a healthier tomorrow with Naturepedic

Naturepedic offers high quality eco-friendly organic mattresses and bedding for a healthy crib environment. Research, materials and design combine to remove those harmful, toxic chemicals that affect your baby's health and safety. 20 year warranty. Wholesale pricing and commission bonuses available for Independent Distributors. Inquire at: www.naturepedic.com/ or 1-800-91-PEDIC.

Web Site Update

Read this article excerpt from the current issue of Midwifery Today magazine (Winter 2007) newly posted to our Web site:
Finding Better Solutions to End Bullying: What an Organization Can Do — by Marinah Valenzuela Farrell
This final article in our series on bullying addresses what organizations can do to end bullying, as well as legislative solutions that have been proposed.

The program and registration form for the Hope and Healing Conference in Ann Arbor in May 2008 is now online in both Web page and PDF format. Start here.

Follow the progress of our Germany conference slated for October 2008 here; you'll find some of the teachers and classes lined up already. Bookmark this page: www.midwiferytoday.com/conferences/Germany2008/

Advertising Opportunities

Philadelphia Conference Advertising

Our next conference, "The Healing Touch of Midwifery and Birth," will be held in Philadelphia, Pennsylvania, March 26–30, 2008.

Start planning today to be a part of this exciting conference. Ask us about exhibiting your services and products, displaying your ad in the conference program, and having your inserts distributed to attendees. [ Learn More ]

Hope and Healing Conference Advertising

"Hope and Healing—Collaborating to Bring Midwifery and Mental Health Care to Women Who Are Survivors of Sexual Abuse" will be held in Ann Arbor, Michigan, May 7–10, 2008. Learn about the conference here. Ask our Advertising Director about exhibiting your services and products, displaying your ad in the conference program, and having your inserts distributed to attendees.

Midwifery Today E-News

Does reaching more than 14,000 readers and potential customers sound appealing to your business? An ad in Midwifery Today E-News, our free biweekly electronic e-mail newsletter, hotlinks customers directly to your Web site. Each issue is archived and continues to send you customers long after the actual run date. [ Learn More ]

Contact our Advertising Director at ads@midwiferytoday.com
View more advertising options at: http://www.midwiferytoday.com/ads/

Question of the Week

Q: I am a 28-year-old woman and I've just been told that I have uterine didelphys—with two of everything (cervix, uterus and vaginal canal). According to the gynecologist I saw, I can become pregnant but she said there is a higher risk of premature birth and of a caesarean. Other than this I am perfectly healthy and have had no illnesses or anything.

While I am not planning to get pregnant in the next two years, I would really like to think about my options, to prepare myself when the time is right. I have always planned on having a homebirth with a midwife to assist. I really want the opinion of someone who is not solely from the medical side of things. I know the doctors tell me what they think is the right thing to do but I have always felt that birth is a more natural occurrence than what the majority of the medical society seems to believe.

— Deborah

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.

Get the whole story! Subscribe to Midwifery Today magazine!

Question of the Week Responses

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

A: Breastfed babies in Northern, less sunny latitudes will not as a group get enough vitamin D from breastfeeding because mothers in those areas are widely deficient in vitamin D3 (cholecalciferol). This can be true in any area, though, as humans heed warnings to stay out of the sun and use sunscreen to prevent aging and skin cancer, blocking the UV rays that are crucial for the conversion of vitamin D in the body.

An individual mother can have her vitamin D status tested and supplement with sunlight and vitamins instead of supplementing her baby, but this is best done proactively to avoid the baby having to wait for the mother to attain adequate levels of vitamin D. Food sources of vitamin D can be tricky, for example cod liver oil contains significant amounts of vitamin D but also contains vitamin A in amounts that make high doses unadvisable. Women are often surprised at how much vitamin D supplementation is necessary to bring levels up, and doses of 2000-8000 IU/day or higher doses every few days is often indicated, with retesting at intervals of no more than three months to track levels and adjust doses to avoid toxic levels. High dose vitamin D therapy should be managed by a knowledgeable health care practitioner.

Recent studies have demonstrated a higher risk of diabetes in the children of pregnant and breastfeeding mothers with deficient and insufficient vitamin D levels, and other current research supports vitamin D's role in many important areas including the immune system, cancer prevention, hormonal regulation, bone formation and metabolism.

— Eden G. Fromberg, DO, FACOOG, DABHM
SOHO OB/GYN, New York City

A: This was a topic of study recently in my nutrition class. The recommendations for breastfed babies are iron and vitamin D supplementation starting around 6 months of age. The theory is that breastmilk is an inadequate source of both of these nutrients and therefore they must be added to the infant diet. The issue with this is that breastmilk is designed for the human infant in perfect order, but strongly depends on the health and nutrition of the mother.

Some studies suggest that low iron levels in late infancy and toddlerhood in a breastfed child are completely normal; a physiological normalcy. Little to no research in this area supports the supplementation of iron. Vitamin D, however, depends both on the mother's nutrition and where she lives, as geography plays a huge role in vitamin D synthesis. In northern areas, especially where cold is an issue, the sun is not enough to maintain vitamin D levels and a supplement or spectrum lighting is essential. The question is, if the mother increases her intake of vitamin D (and I personally endorse supplemental calcium with vitamin D, especially during pregnancy and breastfeeding) will this also raise the vitamin D levels of the infant? Anecdotal information backs this practice both with iron and vitamin D supplementation and it makes good sense. If the child is ingesting milk based on the nutrition of the mother, who raises her blood iron and vitamin D levels then the levels in the breastmilk would also increase, therefore increasing the availability of these nutrients to the child.

It would seem that a nice sunny window to play by, increasing the mother's levels with good nutrition and supplementation if needed and nursing on demand would be all the child needed, unless other health concerns are present. I encourage you do your own research (which would include any information from your provider) and evaluate the needs of your child and then make an informed decision as to what is best.

— Chantel Haynes
Doula/Nursing Student, Minnesota

A: You can find a variety of information on this subject, including medical study results and the various factors related to vitamin D deficiency at: www.kellymom.com/nutrition/vitamins/vitamin-d.html

— Anonymous

A: I hope you get several responses to your question. I'll answer it the best I can with the knowledge I have. First, breastfed babies get the very best of everything they can possibly get, so keep that up. I can't imagine your baby would need anything else. If your doctor mentioned vitamin D, go for a walk around the block every day. Hey, it's good for both of you to get out. As little as 20 minutes or so is all it takes to get natural vitamin D for both of you. You didn't mention what part of the country you're from, however, that should have nothing to do with it. If it's cold, bundle up and get outside. The sun is best, but even if it's not sunny, people think the sun isn't getting through when in fact it actually is. And remember, as long as you're breastfeeding, keep taking those prenatal vitamins.

All the best to you and your sweet baby,

— Natalie

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.

student deskLearn about midwifery education!

Are you an aspiring midwife who's looking for the right school? Are you a practicing midwife who would like learn more? Visit our Education Opportunities page to discover ways to start or continue your education.

Think about It

In December 2007, the National Center for Health Statistics (NCHS) reported that:

The cesarean delivery rate rose again in 2006, to 31.1 percent of all births, a 3 percent increase from 2005 and a new record high. The percentage of all births delivered by cesarean has climbed 50 percent over the last decade.

The preterm birth rate rose slightly between 2005 and 2006, from 12.7 percent to 12.8 percent of all births. The percentage of births delivered before 37 weeks of gestation has risen 21 percent since 1990.

The low birth weight rate also rose slightly in 2006, from 8.2 percent in 2005 to 8.3 percent in 2006, a 19 percent jump since 1990.



Re: E-News Issue 9:25, Miscarriage:

This is the first time in 16 years I have felt that someone actually understood the pain I felt when I experienced four back-to-back miscarriages. They were very painful and the last actually was far enough along to have a water sac. It was in every way a labor. However, I was dismissed to the waiting room where I later passed the baby. I wish more understood that the pain is real not just imagined.

So I say "Thank You" for lifting a burden off my shoulders.


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

Living Tree College of Midwifery: June 2008 and 2009 sessions offer apprentice model academics, clinical and homebirth studies. Upcoming Doula workshops: January, April, July, and October 2008. Visit www.school.birthandwellness.com or call (505) 541-6177 for application.

Tell our readers about your business. Just $35/issue ($125 for four) gives you 30 words to promote your products or services. http://www.midwiferytoday.com/ads/enews.asp or ads@midwiferytoday.com

Remember to share this newsletter

You may forward it to as many friends and colleagues as you wish—it's free!

Want to stop receiving E-News or change your e-mail address? Or would you like to subscribe? Then please visit our easy-to-use subscription management page.

On this page you will be able to:

  • start receiving any of our e-mail newsletters
  • stop receiving any of our e-mail newsletters
  • change the version (text or HTML) that you receive
  • change the e-mail address to which newsletters are delivered

If you have difficulty, please send a complete description of the problem, including any error messages, to our newsletter.

Learn even more about birth!

Midwifery Today Magazine—mention code 940 when you subscribe.

 1-Year Subscription2-Year Subscription
United States$55$105
Canada / Mexico$65$125
All other countries$75$145

E-mail inquiries@midwiferytoday.com or call 1-800-743-0974 to learn how to order.

Or subscribe online.

How to order our products mentioned in this issue:

Secure online shopping

We accept Visa and MasterCard at the Midwifery Today Storefront.

Order by postal mail

We accept Visa; MasterCard; and check or money order in U.S. funds.

Midwifery Today, Inc.
PO Box 2672
Eugene, OR 97402, USA

Order by phone or fax

We accept Visa and MasterCard.

Phone (U.S. and Canada; orders only):  1-800-743-0974

Phone (worldwide):  +1 541-344-7438

Fax:  +1 541-344-1422

E-News subscription questions or problems

Editorial submissions, questions or comments for E-News

Editorial for print magazine



For all other matters

All questions and comments submitted to Midwifery Today E-News become the property of Midwifery Today, Inc. They may be used either in full or as an excerpt, and will be archived on the Midwifery Today Web site.

Midwifery Today E-News is published electronically every other Wednesday. We invite your questions, comments and submissions. We'd love to hear from you! Write to us at: mtensubmit@midwiferytoday.com. Please send submissions in the body of your message and not as attachments.


This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.

Midwifery Today, Inc., does not assume liability for the use of this information in any jurisdiction or for the contents of any external Internet sites referenced, nor does it endorse any commercial product or service mentioned or advertised in this publication. Always seek the advice of your midwife, physician, nurse or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding any medical condition.

Copyright Notice

The content of E-News is copyrighted by Midwifery Today, Inc., and, occasionally, other rights holders. You may forward E-News by e-mail an unlimited number of times, provided you do not alter the content in any way and that you include all applicable notices and disclaimers. You may print a single copy of each issue of E-News for your own personal, noncommercial use only, provided you include all applicable notices and disclaimers. Any other use of the content is strictly prohibited without the prior written permission of Midwifery Today, Inc., and any other applicable rights holders.

© 2008 Midwifery Today, Inc. All Rights Reserved.

Midwifery Today: Each One Teach One!