May 13, 2009
Volume 11, Issue 10
Midwifery Today E-News
“Postpartum”
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In This Week’s Issue:


Quote of the Week

"If one feels the need of something grand, something infinite, something that makes one feel aware of God, one need not go far to find it. I think that I see something deeper, more infinite, more eternal than the ocean in the expression of the eyes of a little baby when it wakes in the morning and coos or laughs because it sees the sun shining on its cradle."

Vincent Van Gogh


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The Art of Midwifery

Prenatal preparation for the realities of early parenting can play an important role in helping mothers go through the transition from pregnancy to parenthood. Midwives, doulas, childbirth educators and other birth professionals can play a critical role in helping mothers prepare for a healthy, happy postpartum. Prenatal education, helping facilitate a positive birth experience and coordinating a family plan for postpartum support can make all the difference.

Jennifer Rosenberg
Excerpted from "Having a Healthy, Happy Postpartum," Midwifery Today, Issue 61
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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.


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Research

Despite the fact that the American Academy of Pediatrics (AAP) recommends that children two and under watch no TV, a 2005 survey of 1051 parents found that only 37% of children between birth and two years old do so. That leaves 63% of infants who are watching TV. Even more alarming, the study found that about 20% of children under two even have a television in their room and more than half of these could turn it on themselves.

The guidelines call for no more than two viewing hours per day for children up to age six, which the study found was more commonly the case. However, about one-third of kids in this age group had a TV in their bedroom.

The study found that on an average day, 75% of children watched at least some television and about one-third watched videos or DVDs. The average viewing time was one hour and 20 minutes. One concern expressed by the researchers was that TV may replace time spent interacting with parents. Another was that prior studies showed that too much TV can lead to a variety of negative outcomes, e.g., violence linked to real-life aggressive behavior.

http://www.nlm.nih.gov/medlineplus/news/fullstory_48893.html
Accessed 31 May 2007


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The Fourth Trimester

How can we best help women in the postpartum period? First we must treat each woman individually. Part of good prenatal care is the ability to get to know women and their needs. Investing the time early-on can be valuable in creating postpartum solutions. Many women experience postpartum "blues," caused from normal hormonal changes combined with all the emotional changes that occur. I tend to worry if I do not see some irrational moods or a bout of tears during this time. This experience is perfectly normal and it may be a good outlet, enabling the mother to process and release her emotions. This too shall pass within a short period of time.

Some first-time mothers become totally overwhelmed with their newborns. The new mom may have not been taught by the women in her family how to care for a child. The basic maternal instinct is present but she has no idea how to go about care. Do not assume that all women know how to care for a baby. I have had to tuck more than one first-time mom under my wing and "show and tell." Left unattended, these new mothers can become confused, frustrated and depressed after birth. I have seen moms do just great for the first few weeks, and then suddenly crash and burn into deep depression.

Although it doesn't happen to many women, it is important to identify postpartum depression. This condition is often a combination of hormonal, chemical and emotional imbalances. It can be a very tender process to reestablish the balance. I recommend collaborating on care when it goes out of your realm. A homeopathic, naturopathic or allopathic care provider can help with nutritional, herbal, homeopathic and/or allopathic remedies, all of which can help to re-establish balance. Teamwork is key—it will heal the imbalance and create a dynamic that helps you to help moms without exhausting yourself. This is important! If you become frustrated and burned out, you are of little use to the mom and her family.

There is also a lot of information that is vital to the new mom's partner. During pregnancy I try to establish the role the partner envisions he/she will play during the immediate postpartum period. I find it extremely helpful to have the partner read The Birth Partner, by Penny Simkin. This book covers in detail everything a partner should consider. When will the partner need to return to work? What expectations of care are important in regards to establishing in-home care from others? These questions lead to dialogue between the two partners and a plan gets set in motion. This can be very reassuring to the couple. I remind him or her that I am there for them 24/7 and can always be consulted. Building confidence and trust with the partner is just as important building it with the mom. The bond they form after birth sets the pace for their parenting.

Jill Cohen
Excerpted from "The Fourth Trimester," Midwifery Today, Issue 61
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Web Site Update

Read this article from Midwifery Today recently posted to our Web site:

  • Tradition, Birth and the Kitchen to Cook It All In—by Naolí Vinaver
    Food recipes, manner of speaking, expressions in dress, body care and rituals—whether religious or mundane—are all elements of culture that remain strongly-rooted and cherished by family and community.

Read this review from Midwifery Today recently posted to our Web site:

  • A Midwife's Story—by Penny Armstrong and Sheryl Feldman
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Question of the Week

Q: My 21-year-old daughter has been advised to have a LEEP (loop electrosurgical excision procedure) for moderate dysplasia due to HPV. I know this may leave scarring on the cervix or possibly pose a small risk of preterm labor when she becomes pregnant. My midwife said she would be put on a preterm labor protocol. What experiences have midwives had with this situation?

Have you seen cervical scarring or preterm labor after a LEEP? Does scarring lead to slower dilation or "stalls" in dilation? Does she have any alternatives for treatment other than the LEEP? What is your advice regarding pregnancy? Would this preclude her from using a midwife?

— Michelle


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.


ed page graphicYou want to be a midwife, but where do you start?

Are you an aspiring midwife who's looking for the right school? Or maybe you're trying to decide if midwifery is the path for you. Visit our Better Birth Education Opportunities page to discover ways to start or continue your education.



Question of the Week Responses

Q: Is one dose of tetanus vaccine enough for mother and newborn, if the newborn was not delivered with sterile instruments? If the serum is unavailable, what is the solution?

— Anonymous

A: If there is tetanus exposure in a previously unimmunized person, the recommendation is to administer the immune globulin since the vaccine will not have had sufficient time for full protection. Globulin is expensive and needs to be kept refrigerated.

But let us take a step back from the question, because it is asked without a context. If this is simply a birth where instruments were well washed in water that is safe (a trusted water system or boiled) then the likelihood of tetanus is negligible. If mom received suturing or episiotomy with instruments that did not fit the above description, she would have some risk, not only of tetanus, but of other pathogens as well.

However, the most common incidence of tetanus is to the newborn through the umbilicus. Unsterile instruments do carry risk, especially if not thoroughly cleansed in water from approved systems or boiled sources. Most cases of tetanus to the newborn occur from contaminated treatments to the umbilical stump and these treatments vary from culture to culture. Any plant product or earth product carries risk. There were even cases in the US where newborns contracted tetanus via the application of powdered commercial goldenseal. For those who insist on goldenseal, use the alcohol tincture instead of powder. For plant or earth applications that are cultural, if the parents cannot be convinced to forego application, at least instruct them that the application would be more effective if first boiled for 15 minutes to release the healing properties and alcohol added into the mixture. It is usually more effective to "improve on" a cultural practice rather than try to eliminate it.

— Maryl Smith

A: As a former mainstream health care professional, I beg you to read the manufacturer's own monograph, the tetanus vaccine package insert at www.vaclib.org. Once you read all of the toxic ingredients, warnings, precautions, disclaimers, short- and long-term adverse reactions including the risk of anaphylaxis (death), please listen to your intuition, that God-given natural protective instinct and follow your heart for the sake of preserving your baby's health and well-being.

You can also go to Dr. Andrew Moulden's www.brainguardmd.com to find out that the vaccine ingredients, aluminum for example, cause microvascular strokes which lead to autoimmune and neurological diseases and disorders.

When you follow the money, you will find that those who promote the vaccines have a vested interest in them. (profits before people) Those who offer full disclosure, including unfavorable information and freedom of choice, pay the price of losing their jobs, etc. (people before profits)

We must educate ourselves to protect our children and make informed choices for them.

The only safe vaccine is one that is never used.

— Bea, parent advocate for truth and choice


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

With a staggering 31.8 percent of US births occurring by cesarean section, improved transparency in maternity care has never been more urgent. The safety of birthing women is in serious jeopardy according to the recently released 2007 US birth statistics. Birth by cesarean section has increased by 50 percent since 1996 and now accounts for 31.8 percent of all US births. While the procedure can be life-saving when used appropriately, it is a major surgery that carries extensive risks for both mother and baby—risks that are not present in a vaginal birth. The 2007 rate is more than double the US Healthy People 2010 and the World Health Organization's recommended rate of 15 percent. Despite these facts, today's birthing women have no way of knowing if their local hospitals exceed the recommended rate.

You can join the Coalition for Improving Maternity Services' (CIMS) national effort to educate the public about the urgent need for transparency in maternity care. Here is how you can help:

Forward the CIMS Press Release "Need for Transparency Increases as Cesarean Section Rates Rise" (PDF) (http://www.motherfriendly.org/pdf/PR_20090319_Ceserean_Stats_Released.pdf) to your local media outlets. Find media contacts in your area through the American College of Nurse-Midwives online Media Guide.

Join CIMS as an Individual Member. Your support helps to achieve our long-term goal of making Mother-Friendly Care a reality, and it's tax-deductible as a charitable donation.

Get tips for pitching to news reporters at the CIMS Grassroots Advocates Committee's Grassroots Grapevine Healthy People 2010, Vol. 2, Section 16: Maternal, Infant, and Child Health.

CIMS is a nonprofit organization recognized as tax-exempt under Internal Revenue Code section 501(c)(3). Their mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs. Please visit online at www.motherfriendly.org for more information.


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Feedback

In regard to E-News 11:7 on OTC drugs, Motherisk (www.motherisk.org) is run from the Hospital for Sick Children in Toronto, Canada and is an incredible resource to tap into. They even have some information on herbs in pregnancy (not much).

Shawn


In response to Karen White, RN, (E-News 11:8) after the hospital birth of my first child, I birthed five at home. I found the "After Twin Birth" story to be a very nice read. I have some similar thoughts and feelings about the birth of my fourth child who was late, after more than 12 hours of labor, stuck at birth, and then wasn't breathing. I was thankful she was born at home where I could help stimulate her breathing while her cord still pulsed. I held her and bonded with her while she breathed her first. I understand how this could not have happened in a hospital and I am thankful.

Sometimes we "home birth moms," while realizing how different things would have played out in a hospital, are so thankful for our experiences that we can't imagine it being as good anywhere else. In our zeal, we might say things that an insecure person might take offensively. While there would be, of course, other means and times for bonding for the twins in the story, the author was caught up in the excitement of allowing a particlar time for bonding that surely would not have happened in the hospital.

As a nurse, surely you know that all birth stories are different, and this story in no way attacked the choices of other moms. We mothers should feel safe sharing our experiences in the most joyful way that we choose without thinking that our words might offend those who choose differently.

While this author might not have said anything "demeaning about a home delilvery," I'm sure that she has heard many demeaning and critical words from the medical community about home birth. I know I have had my share of it, and I pray that I will choose words in response with charity and consideration, as I hope you will learn to do.

Linda Dybala, mom and home birth advocate


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.


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