A study to determine whether breech presentation at term is more common among women with at least one prior cesarean delivery showed a rate two times that for women who had had vaginal births. The study records of 84,688 women showed the relative risk of a breech presentation at term for women with a history of cesarean was 2.18, with no difference related to the number of cesareans. While a total of 2.46% of all women in the study had breech babies at term, 14.91% of those who had had a cesarean had a breech. The researchers took into account other factors, including gestational age, maternal age, parity, birth weight and oligohydramnios.
— Am J Obstet Gynecol, 13 Feb 2008 (10.1016/j.ajog.2007.11.009)
Being Paid for Birth Work
Personally, it took a lot of time on the path of martyrdom for me to really get clear about how that self-sacrifice thing does not serve anyone. I have done many births in my career for free because I "felt sorry" for the couple. This is a kind of arrogance about others that usually ends in disaster. Now it seems particularly ridiculous that I did a lot of this free work when I was a struggling single parent with two little kids who I could barely feed. What was I thinking? I would burn out my friends with unreasonable requests for babysitting, let my pantry get bare, be exhausted and cranky with my children and still not collect money from the clients because they were "so poor." Learning to see others as whole, complete, capable adults took a long time.
When we charge a fair fee for service, as other workers do, we leave the relationship with the client whole and complete. I remember doing a birth for a couple for a ridiculously low fee because I was told "He is a seasonal worker and they really want to have a birth in their own home." About three months after the birth, the family phoned to tell me they were going on a trip to Disneyland. I was very resentful and did not want them to have a nice holiday when I had gone into debt to be at their birth. Lesson learned. Now I'm thrilled when my clients tell me they are buying nice things because they owe me nothing.
Even if people have a tough time with finances, there are still things they can sell if they want the service you offer. There are enough pop bottles on the street to generate the money for a doula. There are grandparents who would love to pay for a doula service for the new grandchild. There is a way to pay $50 per month for a year if one really wants a doula.
I love this quote from Dr. Kloosterman of Holland, who is an obstetrician and a great friend to the natural birth movement:
"All over the world there exists in every society a small group of women who feel themselves strongly attracted to give care to other women during pregnancy and childbirth. Failure to make use of this group of highly motivated people is regrettable and a sin against the principle of subsidiarity." (Editor's Note: The principle of subsidiarity is that nothing should be done by a larger and more complex organization that can be done as well [or better] by a smaller and simpler organization.)
It's important to note that Dr. Kloosterman doesn't say "give care for free or for a ridiculously low return." "Make use of this group" does not mean "make this group into martyrs." I have seen so many good women come and go from the birth movement who do not have a balance between what they give and what they receive. It simply doesn't work to be dishonest about our own needs and the needs of our families when we go to births.
— Gloria Lemay
Excerpted from "Midwifery Tip from Gloria Lemay," The Birthkit, Issue 36
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Web Site Update
Read this article excerpt from the most recent issue of Midwifery Today newly posted to our Web site:
Herbal Applications - by Demetria Clark
Many midwives work with or have some knowledge of herbal medicine, but still often have questions about different types of applications. Each herbal application is valuable in its own right. Some applications will feel familiar and some will seem to be more work than they’re worth, but I suggest that midwives experiment and have fun. Sometimes one of these experiments will have a real-life application in the home or in midwifery care.
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Question of the Week
Q: I'm looking for any information you have on safe birthing positions while suffering from symphysis pubis dysfunction (SPD). My local public hospital hasn't been able to help me at all, with two midwives I've talked to telling me that my only options is a C-section! (Something I'm adamant I don't want). Can you help me in finding some more useful information?
SEND YOUR RESPONSE to firstname.lastname@example.org 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 currently a labor and delivery nurse at my local hospital and am preparing to enter school to become a midwife. One of the most common questions/concerns I'm confronted with is the issue of meconium-stained amniotic fluid in a homebirth. I usually have answers for other concerns, but this one is always a little hazy. Do midwives who help moms deliver at home bring suction of some sort with them? Do they automatically transport to a hospital at the sight of meconium? Is it all dependent on the situation and the midwife?
Thanks for your help in understanding!
A: I don't see meconium all that often. Maybe because we don't put the baby into distress in the first place. I would pay attention to the fetal heart rate and its variability (as usual protocol) more than the presence of meconium. I would also note whether it is staying the same color or getting darker. If it was just an old insult that does not progress, I wouldn't do anything different. If it is getting darker with decels, I would head to the hospital. Yes, I do have a bulb syringe and DeLee, but hardly ever use them.
A: Light to moderate meconium is not high risk and, independently, does not necessitate transfer from home to hospital. It does raise the level of suspicion for fetal distress, however, and therefore intermittent auscultation should be done more frequently in first stage, i.e., every 15 minutes and after with every contraction in 2nd stage (about every 5 minutes). Auscultation must be done for at least one minute before and through, and for at least 30 seconds after a uterine contraction to meet standards. If fetal heart tones are concerning, in combination with meconium, or if meconium is "thick like pea soup" and the woman is remote from delivery, then certainly it is appropriate to transfer.
Current Neonatal Resuscitation Program (NRP) does not recommend routine suctioning of a "vigorous" infant at delivery in the presence of light to moderate meconium (thick is controversial). Suctioning is no longer recommended prior to the birth of the shoulders, as it is now understood that the majority of meconium aspiration happens intrauterine and not at the time of first breath. However, any out of hospital provider should carry a DeLee suction catheter (the ones that are meant for "mouth" suction) and should not hesitate to suction after the birth of the head, or after birth, if in your opinion the infant would benefit.
— Julia Vance, CNM
Home and hospital midwife
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.
A: As you can imagine, there aren't a lot of studies on menstruation out there, and definitely not on the synchronizing of women's cycles. Most of the work that has been done seems to point to a combination of hormones and pyscho-social factors. The most prominent theory is that women emit certain pheromones during different parts of their cycle that other women living in close proximity can pick up on, and over time their cycles will synchronize. Martha McClintock, a professor of Biopsychology at the University of Chicago, has studied the impact of women's pheromones on each other (Stern, K., & McClintock, M.K. Regulation of ovulation by human pheromones. Nature 392: 177-79 and McClintock, M.K. 1998. Menstrual synchrony and suppression. Nature 1971;291:244-45). Her research seems to indicate that there are biological advantages to ovulating together, becoming pregnant together and giving birth at similar times. Most of which makes sense if you consider the tribal lifestyle that was prevalent for most of human history.
Other research has suggested that women's cycles are influenced by light (or the phase of the moon, since that was the primary source of night time lighting before electricity) and by social bonds and the evolution of human culture. There are several good books on this, including Christopher Knight's Blood Relations: Menstruation and the Origin of Culture and Judy Grahn's Blood, Bread and Roses: How Menstruation Created the World. These theories focus on the interplay of biological and social factors and how they combine to create evolutionary advantage.
It's really too bad that more evolutionary biologists, anthropologists and sociologists are not interested in studying menstruation in this way, because the little research that has been done all seems to point to some fascinating possibilities for better understanding the dynamics between nature and culture.
— Jennifer Webster
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
The American College of Nurse-Midwives (ACNM) unveiled new midwifery-themed postage stamps in conjunction with National Midwifery Week, October 5-11. Stamps are available for purchase online at www.photostamps.com/acnm . These unique stamps - authorized by the United States Postal Service - capture messages and images promoting midwifery.
ACNM developed these stamps as part of its growing public education efforts. "It is important for women to know their full range of options when it comes to their health care, whether they are looking for gynecological services or maternity care," says Lorrie Kline Kaplan, Executive Director of ACNM. "Getting the word out about midwifery care in this unique way will educate even more women about why they should visit a midwife."
ACNM encourages midwives and the public to purchase these real US postage stamps to heighten the profile of midwifery. Mail them, collect them or give them as gifts. Proceeds from the stamps will help fund ACNM and the A.C.N.M. Foundation's Public Education Project.
ACNM is currently running a contest to select new artwork that will be used in a second release of stamps in Summer 2009. ACNM members and the public are invited to participate at: http://www.midwife.org/art_contest.cfm
Medela has opened its call for nominations in the 2008-2009 Lactation Consultant Hall of Excellence. Eligible nominees must be practicing International Board Certified Lactation Consultants (IBCLC) in the US and be nominated by a peer and client for their role as an exceptional professional. The nomination process requires the completion of an online nomination entry form, a letter of nomination and a letter of support from a past or present client available at www.lchallofexcellence.com.
The Lactation Consultant Hall of Excellence inductees receive a $5,000 grant to fund research, continue education, purchase equipment for use in their practice or donate to the charity of their choice. Inductees are chosen by an independent judging panel comprised of health care industry representatives. The panel is solely responsible for judging entries and selecting the program inductees.
Program guidelines and the online nominee submission forms are available online at www.lchallofexcellence.com. Entries must be submitted via the online nomination form by December 15, 2008.
— Emily Reed
I'm a CPM working on a research thesis involving the emotional impact of a VBAC. Women need to have had a VBAC to be eligible for the 10-15 min survey. http://www.surveymonkey.com/s.aspx?sm=j_2fW0Nf_2btjo0TfWZd6ST4sA_3d_3d
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