November 5, 2008
Volume 10, Issue 23
Midwifery Today E-News
“Herpes”
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In This Week’s Issue:


Quote of the Week

"When one door of happiness closes, another opens; but often we look so long at the closed door that we do not see the one which has opened for us."

Helen Keller


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The Art of Midwifery

A Pap smear and screening for sexually transmitted infections may be the most important health care practice for a sexually active woman. Chlamydia and gonorrhea are totally curable, can occur without symptoms and can cause long-term problems, including infertility, if untreated. Cervical cancer is also, essentially, totally curable if caught early and is the most common form of cancer in young women. I recently read that the Pap smear, by detecting potentially cancerous changes in their early stages, saves 20,000 lives a year in the US. We are currently instituting new national guidelines for Pap smear screening that are based on long-term research. We recommend annual Pap smears starting three years after the onset of sexual activity, or by the age of 21.

Marion Toepke McLean
Excerpted from "Marion's Message: The First-time Women's Health Exam," Midwifery Today, Issue 86
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Research

A drug widely used to treat genital herpes has been shown to prevent its spread as well. The drug may offer a new way of curbing the infection. A study released in September found that people who have herpes simplex virus type 2, cut in half the risk of passing the infection to others by taking a once-daily Valtrex pill. It is not yet known if the pill is more effective than using condoms to halt communication of the disease.

www.prnewswire.com, 27 Sep 2002


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Herpes Simplex II Tips

The primary (first) outbreak of herpes simplex virus II (HSV II) is usually the most painful and widespread. It is also the primary outbreak that can most damage the nervous system of the fetus/newborn. For this reason, the woman who has had HSV II for some time before her pregnancy began is in a better position to have a healthy child than the woman who contracts the virus during the pregnancy. Fifty percent of women who have a primary outbreak in the first trimester miscarry.

Only about 1 in 5,500 babies gets neonatal herpes, even though the virus is widespread in the adult population. Neonatal herpes is not a reportable disease in most countries, so there are no hard statistics on the exact number of newborns affected. However, most researchers estimate there are between 1,000 and 3,000 cases a year in the US out of a total of four million births. To put this in greater perspective, an estimated 20 to 25 percent of pregnant women have genital herpes, while less than 0.1 percent of babies contract an infection. Although remarkably rare in newborns, herpes outbreaks can cause severe damage to those who are infected with the virus.

Transmission rates to the baby are lowest for women who acquire herpes before pregnancy. One study (Randolph, JAMA, 1993) places the risk at about 0.04 percent for such women, who then have no signs or symptoms of an outbreak at delivery. The chances of transmission are highest when a woman acquires genital herpes late in pregnancy. With monogamous partners, this is a very rare occurrence.

Medical practitioners are concerned about release of the membranes for longer than four hours when a woman has a herpes outbreak. Great care must be taken not to release the membranes. The speculum exam should be the only pelvic exam. Internal scalp monitors must not be inserted, as this can infect the child through the scalp puncture.

Dangers to the baby who develops herpes include death (60 percent mortality rate), herpes encephalitis or aseptic meningitis (inflammation of the brain or spinal cord), which, in turn, leads to neurological damage. The first symptom of disease in the newborn may be a sore on the skin, which can be tested with a fluorescent stain to diagnose it as a herpes lesion. If left to develop into full-blown herpes, it can cause the baby's death, brain damage or blindness. Early treatment is imperative if there is a suspicion that a baby might have a herpes skin eruption. Premature or otherwise compromised babies are at greater risk when a woman has a recurrent outbreak of HSV II.

Gloria Lemay
Excerpted from "Herpes Simplex II," The Birthkit, Issue 37
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Learn how sexual abuse affects women during pregnancy and childbirth and what you can do to help.

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Midwifery Today Magazine Issue 71What is MIDWIFERY TODAY magazine? A 72-page quarterly print publication filled with in-depth articles, birth stories from around the world, stunning birth photography, news, reviews and more.
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Web Site Update

The complete program and registration form for the Denmark 2009 conference are now online here. Also, a PDF of the Denmark 2009 Conference program and registration form is now available for downloading.


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Question of the Week

Q: I'm looking for information on giving birth again with an existing rectocele. I want to have more children and have read that it's pointless to have surgery on a rectocele if you're planning to have more children. Are you aware of any articles, books or information from midwives who have had clients give birth with this condition? I'd really like to hear from other women who have continued on with childbearing in spite of this condition. Or maybe some midwives who've had some clients with many children who are continuing to have more children.

I've had eight children. My first was born in the hospital and I had a terrible tear (all the way through to the rectum). I'm thinking that's when the damage was done. I've had one more in the hospital and six at home, all vaginal deliveries. Now I have a rectocele.

— Jennifer
lvmyjb_babies@hotmail.com


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 wonder if anyone knows of a scientific study, research or has anecdotal information or theories on the physiology behind women who live in close quarters or are close to one another menstruating together. We all know of times we have had our menses arrive early or late, to find that it was influenced by another woman's cycle. A friend asked me if two women were sleeping on either side of a wall (e.g. in an apartment complex) and didn't know each other, would their menstrual cycles synchronize? So, part of the question is, is it entirely hormonal or do the women need to have a close bond, personally on an emotional, social or spiritual level? I look forward to hearing some input.

— Molly

A: According to "Mother Nature: A History of Mothers, Infants, and Natural Selection" by anthropologist and primatologist Sara Blaffer Hrdy, the exposure to the scent of another woman's underarms causes women's cycles to be similar. Therefore women who live in close quarters tend to have cycles that are very much the same but women who sleep on separate sides of the same wall may not. Of course, women who are taking birth control that alters the natural hormonal release find that exposure to another woman's underarms would in most cases not cause their cycles to regulate.

— Brittany Sharpe McCollum, CCE

A: This is known as the "McClintock Effect." Here is a link to a PDF of the study done in 1971: http://www.nature.com/nature/journal/v229/n5282/abs/229244a0.html

I think some people have tried to discredit it, but any woman who has lived in a dorm or commune or with a bunch of other women for any reason will tell you it's true.

— Willa Grant


Q: When my daughter's pregnancy was first confirmed she was happy, eating well and putting on a pound a week. She was given prenatal vitamin supplements and a week after she started taking them she began to get violently ill. She couldn't tolerate even the smell of toast, had vomiting and diarrhea and was living on baby food, as that was all she could keep down.

She had to be taken to emergency as she was so weak and dehydrated, even though she had tried very hard to drink plenty of water. She had to be put on a drip for fluids and couldn't even walk as she was so malnourished. She initially had put on 10 pounds, which she lost in a couple of weeks. Because she is a very petite girl she couldn't afford to lose much more. I really thought she was going to die. She lives in US, so I could talk to her through Skype and I felt useless to help her.

They told her that she had a condition—hyperemesis gravidarum (HG)—that affects some pregnant women and causes this type of thing. I suggested maybe she shouldn't take the supplements, as I had heard that certain things like iron that aren't slow release can make you sick. At first she was worried about stopping them, as she thought that her baby was going to suffer. She was so desperate she thought she would try it, and within a few days she was back to her old self again. Even though she was very small she had always been a good healthy eater.

When she finally got an appointment with a doctor, she was given three other samples to try and each time she took one she was very sick. I've spoken to many doctors and they think it is a coincidence. I think not! She has stopped taking them all together and has regained her weight and is fine. I have researched about supplements and they all can cause problems and all the professionals say that you don't need these if you eat a healthy diet which she always has done.

Have other women out there been sensitive to these supplements? I hope that this information may help someone out there who encounters a similar problem.

— Teresa
smurfs1601@bigpond.com

A: Even when I am not pregnant, regular chemical-based daily vitamins make me sick! There are companies that make really good, food-based vitamins, prenatal and regular daily. The daily dose for the prenatals I take is six a day. They are loaded [with] good things, all real food-based so they can be absorbed easily. The ones I take have ginger in them, which stopped my morning sickness in its tracks. On a side note, I can't eat foods that are heavily fortified either; they also make me sick to my stomach. (Like diet drinks, and heavily fortified bag cereal.) Talk to someone who works in the supplement section of your local health food store; they [may offer] a wealth of information.

— Tamara


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.


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Think about It

Neonatal herpes is when a baby develops symptoms of herpes infection before birth or within the first six weeks of life. It may occur when the baby is still in the womb (intrauterine infection) (less than 5%), during delivery (85%) or after delivery (less than 15%). The estimated rate of neonatal herpes is one case in 2000–5000 deliveries a year, resulting in approximately 1500 to 2200 infants with the disease each year in the US.

Forty percent of neonatal herpes is confined to the skin, eye and mouth (SEM). The brain is involved (encephalitis) in 35% of cases, with or without skin lesions. The poorest outcome is for the 25% of neonates who present with widespread (disseminated) disease, involving the lungs, liver, adrenal glands, skin, eye and mouth. Sixty percent to 75% of these infants also have encephalitis and more than 20% do not have skin lesions.

http://www.herpesguide.ca/facts/neonatal_herpes.html


Feedback

My name is Zach Marion and I work at Video Arts Studios in Fargo, North Dakota. We produced the series House of Babies for the Discovery Health Network. Under the guidance of master midwife, Sheri Daniels, at the Miami Maternity Center, the show follows couples during their pregnancy and ends with the delivery of their baby. It was very instrumental in raising awareness about non-clinical birthing practices on a national level.

Recently we have been approached to create a one-hour special on unique birthing practices worldwide. We are looking for families who would like to share their story on camera from pregnancy to delivery. Ideal candidates are expecting mothers due in or around early January who are planning to give birth outside of a clinic or birth center. This includes homebirths and beyond. The point of the show is to raise awareness about alternative birthing options with the help of a midwife in the US. Hopefully, the special will create a healthy dialogue among midwives, doctors, parents-to-be and the general public. Stories that are of particular interest are those that include interesting traditions during pregnancy and unique backdrops during delivery. For example, a Hindu family who want to deliver outside, or a family of hippies who are pursuing a homebirth in a tent.

As you can imagine, access is usually the greatest struggle. Families should be aware that our presence at the birth goes nearly unnoticed. We learned to be unobtrusive through experience gained while producing 26 episodes of House of Babies.

Do any clients spring to mind who might want to be a part of this project? I would greatly appreciate any and all contact leads. Feel free to contact me by phone with inquiries or information. I am available during weekdays between 8:00 and 5:00 CST. Thank you for your time.

— Zach Marion
Video Arts Studios
1440 4th Avenue North
Fargo, North Dakota 58102
(701) 232-3393
zach@videoartsstudios.com


I really enjoy receiving your e-newsletter. I do, however, get annoyed when I see articles that do not address the true causative factors of certain clinical conditions/circumstances.

I was reading the SIDS article and as expected there was no mention of the stress that is placed on the upper cervical region of an infant during STRESSED pregnancy/labor and some in humane, so-called birth "techniques."

I've enclosed some information that hopefully may spark an interest in doing a follow-up article.

Thank you again for your work.

Luigi DiRubba, DC, FICA

Crib Death (SIDS)

Studies have revealed a correlation between spinal abnormalities, including trauma and crib death or SIDS (sudden infant death syndrome). This may be one piece of a larger puzzle.

Peer Reviewed Journals:

  • Latent spinal cord and brain stem injury in newborn infants. Towbin, A. 1969. Dev Med Child Neurol (Feb), 11(1): 54–68.
    Autopsy of infants who died of SIDS revealed blood in the spinal cord, which the author hypothesized, was due to obstetrical trauma. "Spinal cord and brain stem injuries often occur during the process of birth but frequently escape diagnosis. Respiratory depression in the neonate is a cardinal sign of much injury. In infants, there may be lasting neurological defects reflecting the primary injury." Towbin further states: "mechanical stress imposed by obstetric manipulation—even the application of standard orthodox procedures may prove intolerable to the fetus. Difficult breathing in the newborn is a classic indication of such injury." He goes on to say, "Survival of the newborn is governed mainly by the integrity and function of the vital centers in the brain stem. Yet paradoxically, the importance of injury at birth to the brain stem and spinal cord are matters which have generally escaped lasting attention."
  • Sudden unexpected death in rare cervico-occipital anomalies and inadequate trauma. Gilg, T., and W. Eisenmenger. 1982. Z. Rechtsmed. 1982. 89(3): 207–14.
    Two cases of sudden unexpected death due to rare cervico-occipital dysplasia and inadequate trauma are presented, and the problems of examination are shown. At postmortem examination in equivalent cases, precise investigation of anamnesis and trauma as well as removal and maceration of the upper cervical vertebral column is indicated.
  • Birth Injury to the Cervical Spine and Spinal Cord. 1983. Reid, H. Acta Neurochir Suppl (Wien) 32: 87–90.
    Mechanical trauma to the cervical spine still occurs at birth. In 2 of 48 perinatal postmortems traumatic damage to the cervical spinal cord was found. Also in this series at least 12% of cases from one hospital showed some degree of trauma to the cervical spine but this was of a lesser degree in individual cases than 20 years ago.
  • Significance of birth trauma damage to the vertebral artery in sudden infant death. 1986. Saternus, K.S., and K. Hebold. Beitr Gerichtl Med 44: 569–71.
    Damage to the cervical spine is fairly common in a series of stillbirths and neonatal deaths.
  • Infantile atlantooccipital instability. The potential danger of extreme extension. 1979 Jan. Giles, F.H., M. Bina and A. Sotrel. Am J Dis Child 133(1): 30–37.
    During early infancy, adventitious sliding and slipping movements between the vertebral column and skull are possible in the cadaver. In ten of 17 infants, the posterior arch of the atlas inverted through the foramen magnum during extension of the head on the atlas, resulting in the anatomic potential of bilateral vertebral artery compression. These anatomic conditions may be the basis for a chain of events that contributes to death in some neonates and infants with conventional diseases and may be one source of unanticipated death.
  • Spinal injury related to the syndrome of sudden death ("crib-death") in infants. Towbin, A. Am J Clin Pathol 1968 (Apr); 49(4): 562–67.

Additional Articles:

  • Atlanto-occipital hypermobility in sudden infant death syndrome. April 1989. Schneier, M., and R. Burns. Released by Association for Research in Chiropractic.
    A triple blinded x-ray study. Increased instability of upper cervical spine was found in children who died of crib death.

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