March 26, 2008
Volume 10, Issue 7
Midwifery Today E-News
“Eating and Drinking in Labor”
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Whole Family RecipesCook delicious and wholesome meals for your whole family

Whole Family Recipes—For the Childbearing Year & Beyond highlights foods that are especially needed by pregnant women, breastfeeding mothers and their growing children. Taking a non-dogmatic and down-to-earth tone, the book focuses on incorporating vitamin- and mineral-rich foods and good quality fats into the diet. If you're an expectant mom or new parent this book belongs in your kitchen. If you work with pregnant women, have copies in your library to share with your clients. Recipes include Cheesy Potato Pie, Baked Lentils, and Oat and Dried Berry Bars.
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In This Week’s Issue:

Quote of the Week

"I am only one, but I am one. I cannot do everything, but I can do something. And I will not let what I cannot do interfere with what I can do."

Edward Everett Hale

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The Art of Midwifery

Labor marathons are often rooted in emotional discord. Fostering loving trust and loyal, determined commitment will usually see you through. As long as nutrition and hydration are offered freely, and vital signs remain reassuring, labor may take as long as it needs to. I don't believe there is a time limit. Families know we will only turn toward surgical options in cases of absolute need.

Judy Edmunds
Excerpted from "Prolonged Labor: Past and Present," Midwifery Today, Issue 46
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Research to Remember

A study of the food intake of nearly 2000 pregnant women showed a correlation between eating apples and a significantly reduced risk for development of asthma and wheezing by their offspring by the age of five. No other foods were considered to be related to this finding, although prior research has shown that mothers who consumed vitamins A, E, D and zinc also have a reduced risk of asthma and wheezing, as well as eczema.

The other finding was that children of mothers who ate fish were less likely to have doctor-confirmed eczema.

According to the researchers, "The present study suggests beneficial associations between maternal apple intake during pregnancy and wheeze and asthma at age five years." They also pointed out that the findings in regard to eating apples during pregnancy "suggest an apple-specific effect, possibly because of its phytochemical content, such as flavonoids."

This research has the potential to make a significant impact, in light of the fact that nine million children in the US have been diagnosed with asthma at some time in their lives, and four million of them suffer from asthma attacks each year. Asthma is shown to be a leading cause of school absenteeism, as well as the third-ranking cause of hospitalization., accessed 2 May 2007

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Who should attend: MDs, LLLI leaders, RNs, midwives, LCs, childbirth educators, and doulas. CEUs available.

Food and Drink for Labor

Some women experience an urge to load up on carbohydrates in the 24-hour period before the onset of active labor, similar to what an athlete may do in preparation for running a marathon on the following day. Go for it! (I had a bread, salad and pasta dinner at a local restaurant 12 hours before my second child was born and never felt nauseated in labor, which started about five hours after the meal.) This strategy is especially recommended for women facing a scheduled induction. Avoid having the hard work to hit after essentially fasting for 24 hours or more.

EAT IN EARLY LABOR. This is essential and must be maintained throughout the day. Don't just settle for breakfast and stop there. Eat every 2–3 hours, whatever is appealing. You may want to avoid heavy, greasy foods such as pizza or fast food (which don't digest easily under the best of circumstances).

Avoid substances that will cause a blood sugar level spike, such as soda and other forms of concentrated sugar (read labels!). These are dehydrating and ultimately lead to blood sugar crashing.

If planning a hospital birth, eat a banana on the way to the hospital. Despite most TV depictions of how women go into labor (i.e., a sudden contraction alerts her to the need to rush to the hospital where she gives birth soon after on her back, typically involving various emergencies for dramatic effect), most women have plenty of time to take care of themselves with little need for high drama.

During labor, try a variety of the suggestions below, alternating them. A little protein here, some electrolytes there, something sweet to boost your energy, the Pregnancy Tea—you get the idea. That will keep a mom going if the labor is long.

Drink lots of water, at least 4 oz per hour throughout labor, more if it's a hot day and you're sweating a lot. Have your support team help you with this. (Note to all attendants: Your job is to encourage the mom to drink throughout her labor. If she is willing to drink, asking for liquids and consistently taking several gulps when offered, then just keep the supply coming and keep an eye on her to ensure she doesn't stop drinking at some point. However, if the mom is disinterested in drinking and reluctant to do so, then frequent small sips will be necessary. Keep offering!)

Finally, don't hesitate to accept IV fluids if you can't keep anything down over a long period of time and are getting dehydrated. While healthy women will not need routine IV fluids, dehydration can cause your labor to be dysfunctional and non-productive. An IV can turn the picture around and is an appropriate use of medical intervention.

Patty Brennan
Excerpted from "The Birth Marathon—Food Drink for Labor and Birth," The Birthkit, Issue 56

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Web Site Update

Read these articles newly posted to our Web site:

A Modern Midwife's Experience with Ancient Maya Techniques of Abdominal/Uterine Massage—by Anne Hirsch
"In this article I will share some brief theory and many anecdotal experiences that are representative of what is reported over and over again by women receiving this treatment or practicing the self-care techniques."

The Primal Touch of Birth: Midwives, Mothers and Massage—by Kara Maia Spencer, LMT
"The midwife will perform a massage at every prenatal visit, during the birth and at postpartum visits. The mother's mother may also massage her, as will her mother-in-law. The mother will then massage the new child. This dynamic web of touch has been played out all over the world, connecting midwives, mothers and massage, for thousands of years."

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Question of the Week

Q: I have a girl in class who has expressed a lot of fear and anxiety regarding her upcoming birth, from lots of surgeries (urogenital) as a baby/child. She remembers "things being done to her, no control, no choice, no voice, doctors talking at her, not to her, bloody surgeries, pain, etc., and "having to be strong and brave". She mentions already feeling some resentment toward baby for "having to endure labor/birth pain". She does not want her experience to prevent her from bonding and loving her baby.

This realization of fears is a huge step. It's much harder when they arise during labor and no one is prepared or knows what they stem from or what to do with them! I suggested she discuss with her midwives so they are aware and can help her during labor. We discussed the significance of having an unmedicated labor vs. having a labor where she feels safe, protected, unviolated, where she has some control of choices and that does not produce emotional trauma for her.

I welcome a discussion of whatever you can think of that may be helpful. I think they are considering hiring me as a doula, so also anything from that standpoint would be appreciated.

— B

SEND YOUR RESPONSE to 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 am looking for some feedback about menstrual cycles while breastfeeding. I understand that exclusive breastfeeding generally stops the ovulation process. Several moms that I know of experienced this, but they seem to be feeding through the night. One in particular, however, is exclusively breastfeeding, but baby sleeps for 5–8 hours at night.

The periods have returned but only a fraction of what they normally are. The baby is 15 weeks old, so I am assuming that the lochia are complete. These periods are coming about every 3-1/2 weeks.

Does anyone have info on this?

— D.C.

A: I exclusively breast fed my son: no bottles, pacifiers, etc. I did not get my period back until he was 15 months old, ironically on my very first night back at work.

— Tara Goldin, RUN

A: In my experience as a Fertility Awareness Instructor and assistant midwife, even with exclusive breastfeeding, women often return to fertility quicker than in the past. I have heard and witnessed many such stories and have my own ideas about why this might be.

A baby sleeping as much as 5–8 hours at night, though a blessing, can surely contribute to the body's return to fertility. In my experience though, even with "by-the-book," exclusive breastfeeding, one can no longer rely on any given amount of time as "safe" for remaining annovulatory.

When a woman's cycle returns, she will commonly have several months or longer (especially while still breastfeeding) where her cycles are not all regular or ovulatory, or, lack the sufficient progesterone amounts to sustain another pregnancy (hence, a shorter cycle). As breastfeeding patterns shift, so does fertility, as the amount of breastfeeding hormones directly affect the suppression of ovulatory hormones (though other factors, such as time spent with baby, skin to skin contact, return of "normal" lifestyle seem to be a part of the equation).

When using this information for birth control, I recommend to my clients that they resume charting (cervical fluid checks, cervical positioning and basal temperature) as soon as their postpartum bleeding ends, just to be safe. They may have months of no change in patterns, but at least when the shift occurs, they will be aware of and can prevent another pregnancy too soon.

I hope this helps, feel free to contact me with more questions if you'd like, as this is one of my favorite topics!

— Sarah in Oregon

Responses to any Question of the Week may be sent to E-News at any time. Write to Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.

Think about It

Lamaze International recommends that a woman allow her body to go into labor on its own, unless there is a true medical reason to induce. Allowing labor to start on its own reduces the possibility of complications, including a vacuum or forceps-assisted birth, fetal heart rate changes, babies with low birth weight or jaundice, and cesarean surgery. Studies consistently show that inducing labor almost doubles a woman's chance of having cesarean surgery.

— Lamaze International Press Release, 21 Feb 2008

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I have read the article about how not to do episiotomies and how to protect the perineal area during the second stage (E-News 10:5). An excellent article; I could not agree more. In our practice we use only organic olive oil or K-Y jelly during the time of the descent/crowning on the perineum. Organic sesame oil or calendula-infused organic olive oil also would be good choices.

Perineal massage is recommended only from 37 weeks gestation; K-Y jelly or evening primrose oil (high in EFAs) would be good choices. Mineral oil is drying; it interferes with fat-soluble vitamin absorption (A, D, E, K). Recent European studies indicate that it may contain cancer-causing chemicals. For the same reasons, please do not use mineral oils or Vaseline on babies.

Irma N. Versteegh, RM

In response to the quote in E-News 9:18, I believe the winner of the "uncontrolled experiment without informed consent" award goes to circumcision, not formula feeding. Circumcision has been happening longer, continues still and is also an experiment being performed on non-consenting human beings—the only surgery in search of a disease.

Even removing historical religious rites from consideration, circumcision was promoted as long ago as 1860. In The Lancet 1: 344–45, Athol A. W. Johnson promotes circumcision of boys with long foreskins to "cure" masturbation. But the first infant formula wasn't invented until 1867: "In an attempt to improve the quality of manufactured baby foods, in 1867, Justus von Liebig developed the world's first commercial infant formula, Liebig's Soluble Food for Babies.

Melissa Evans, AAHCC

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