March 3, 2010
Volume 12, Issue 5
Midwifery Today E-News
“Music and Dance in Pregnancy and Labor”
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Ina May Gaskin ~ Michel Odent ~ Elizabeth Davis

These are just three of the teachers you'll learn from at our conference in Philadelphia, April 2010. Other confirmed teachers include Gail Hart, Marsden Wagner, Naolí Vinaver, Carol Gautschi and Elaine Stillerman. Plan now to attend!

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Birth Is a Human Rights Issue

The right to have the most joyous and healthy pregnancy, birth and postpartum possible should be a human right for both mother and baby. Learn how you can help. Come to our conference in Strasbourg, France, September 29 – October 3, 2010. Classes will include Mothers' Birth Rights, Babies' Birth Rights, and Maternal Mortality Is a Pressing Human Rights Concern.

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In This Week’s Issue:


Quote of the Week

“For years I have humorously used the phrase, ‘Open throat, open vagina!’ But the statement really rings true: When the throat is open, the opening is reflected in the throat of the uterus, the cervix.”

Debra Flashenberg


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The Art of Midwifery

Tuning In

When a woman is having an especially difficult time dealing with contractions, I often ask the husband what her favorite radio station is and "tune her in" to something other than how each contraction is feeling. My most memorable example is when I was working with a mom who was having her third large baby. The baby was posterior and she was really hurting. We turned on the oldies station and the woman went from fighting her contractions to trying to sing through them! What a beautiful birth!

Amy K.


Dancing the Baby Out

I once attended a wonderful birth during which the woman and her partner slow danced during second stage, rocking back and forth until the head was on the perineum. The woman then calmly sat back on the bed and pushed her baby out.

Jill Cohen
Excerpted from Midwifery Today's Sharing Midwifery Knowledge, Tricks of the Trade, Volume IV
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Jan's Corner: Ultrasound and Autism

Research Shows Women over 40 More Likely to Have Autistic Babies, but What's Really Going On?

Another "research" joke appeared in last night's paper, stating that the chance of having an autistic baby increases when the mother is older than 40. The research was meant to be taken seriously. Instead it just gives older mothers something else to worry about unnecessarily.

This study looked at all single births in California in the 1990s, and showed that women who birth after the age of 40 are almost twice as likely to have a child with autism as women who birth before 25 years old. The authors noted that the older mothers only accounted for less than 5% of the autism diagnosis increases.

As quoted in an interview with the Los Angeles Times, Janie Shelton, one of the study's authors, said, "Five percent is probably indicating that there is something besides maternal age going on because we are seeing a rise in every age group of parents."

Women over 40 are considered high-risk, and I bet if you look into the number of ultrasounds these women received compared to low-risk women who birthed during the same time period, you will find that they had many more ultrasounds—and this was in the 1990s, when women received fewer ultrasounds than they do today. Increased ultrasound use in all forms follows about the same curve as increased autism. And remember that Dopplers are also ultrasound and their use is also ubiquitous now.

Basically, anyone who is over 40—and anyone deemed too old, too young, too tall, too short, too fat, too skinny or too normal—gets the over-medicalized treatment, which includes many more ultrasounds. They get ultrasound scans at prenatal visits, sometimes as early as 8- to 10-weeks, and then there are the ultrasound photos a pregnant woman can get at the mall. Oh, and yes the vaginal ultrasounds that go right next to the baby and are considered a form of rape by many victims, to say nothing of what the babies think.

I remember a couple of years ago when a woman at my church showed me the very detailed ultrasound photo of her in-utero baby that she'd gotten at the hospital. I almost got sick, but just tried to smile. Ultrasound is the norm, even for the women who attend my tiny, Spanish-speaking church. I wonder what the rate of autism is in places where no ultrasound is used, places too poor to have the machines.

I really wanted to be wrong about this theory that ultrasound is linked to increasing autism rates, and now I want even more to be wrong. But I don't think I am. We will probably be able to watch the rate of autism jump again as mall and vaginal ultrasounds become more popular. Autism rates in the US are around 1 in 92–100 now. When I worked in a mental hospital 44 years ago the rate of autism was about 1 in 20,000–30,000. It was really rare. And there were no ultrasounds back then! Unfortunately, I think there is too much money made on ultrasounds now for the medical establishment to give them up.

Midwifery Today magazine has printed many articles on the dangers of ultrasound, but still physicians—as well as midwives—use it routinely in prenatal care. Here are few great articles on this topic, in case you missed them:

Caroline Rodgers, one of our authors who researches the connection between ultrasound and autism, has found more interesting information and is planning to write another article for Midwifery Today on the subject. Please subscribe to Midwifery Today's print magazine, so you don't miss these and many other important articles. (Subscribe here.)

Included in Caroline's most recent research is the following:

  • CDC figures show that white women, who are more likely to get first-trimester prenatal care, have a higher rate of autistic children
  • California autism clusters show that educated white women have a higher rate of autistic children

Read more of Caroline's outstanding work at: http://carolinerodgers.wordpress.com/

It is interesting to note that many midwives use Doppler ultrasound to check fetal heart tones. When I was practicing, the reasons we checked FHT—with a fetoscope—was to date the pregnancy, double-check the baby's position, and help mom and dad joyfully connect with their baby. Note that all of this can be done safely with a fetoscope. Since a Doppler can hear the FHT so early and so loudly, I am not sure it can even help establish the due date or double-check position.

I remember how it used to scare me when I first started practicing as a midwife: Seeing how the medical profession was doing things to mothers and babies that would cause long-term damage, such as giving drugs, using forceps and using the lithotomy position. I wondered how these professionals might feel when/if they ever realized the damage they were doing and had done. Now we have a situation where I am concerned about how midwives will feel when/if they realize they might have had a part in causing damage—in particular, autism.

I was talking to two CNM friends of mine recently and they both thought ultrasound was the main cause of increased autism. So, my message to my sister midwives is this: Please, please, please use this technology carefully, and only when clinically necessary. And to the pregnant women over 40: Don't believe your "high-risk" designation. You are having a baby. You are having a miracle.

Jan Tritten, mother of Midwifery Today

Jan Tritten is the editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.

Jan's blog: community.midwiferytoday.com/blogs/jan/default.aspx
Jan on Twitter: twitter.com/jantritten
Midwifery Today on Facebook: facebook.com/midwiferytoday


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Research

Study Finds Music Can Ease Labor Pain

Music can help reduce sensation of pain and decrease a woman's emotional distress during labor, according to a research study conducted by Sasitorn Phumdoung, a graduate of Case Western Reserve University's France Payne Bolton School of Nursing, and published in an issue of the medical journal, Pain Management Nursing.

The study included two groups of primigravid, laboring women in their 20s—including a group who listened to calming music for three hours after they were 3–4 cm dilated and the control group, who had no music during labor. The research showed that the women in the music group had "significantly less sensation and distress pain" than women in the control group. Phumdoung found that soft music had a two-fold effect on the women—decreasing the pain sensations in active labor and also delaying an increase in pain sensations for an hour after the music was turned off.

— Phumdoung, S. 2003. "Music reduces sensation and distress of labor pain." Pain Management Nursing, 4(2): 54–61.


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Belly Dance and Birth

I first understood the connection of belly dance to birth when I was learning to shimmy. The shimmy is a quick, vibrating movement done with the hips, chest, belly and entire body. I had struggled with the shimmy for a while, as many students do, and when I finally "got it" and could feel the wonderful looseness and relaxation of the muscles of the pelvic floor, I knew instantly that this move was intended to move a baby down the birth canal.

As a midwife, I have the great privilege to observe human labor and birth on a regular basis. Those of us who witness birth know that it is one of the most amazing displays of creative power that we will ever see. The forces at work are nothing less than awesome. Observing laboring women, I began to see for myself that the movements used in belly dance actually mimic many of the physical and emotional manifestations of labor in a woman's body.

In the early phases of the first stage of labor, the mood is one of excitement and anticipation, welcoming the onset of labor. Many women, if left to their own instincts, choose upright positions and naturally move their hips and pelvis in circles and crescents. These are shapes commonly seen in the slower belly dance moves. These movements help to disperse the pain and are often prescribed by midwives, especially when the woman is experiencing back pain. Many midwives believe that moving the hips also facilitates the baby in finding the optimal position for entering the bony pelvis.…

Many women, as they enter the phase known as transition—considered to be the most intense of the entire labor—will often display an uncontrollable trembling in their limbs and entire body. A natural shimmy, brought on by labor itself!

Another amazing observation for me, when I saw it with my belly dancer's eyes, was the way the woman's abdomen begins to spontaneously undulate with the uncontainable urge to bear down that signals the beginning of the second stage of labor. I have seen this phenomenon even in women who opt for epidural analgesia. The woman may no longer feel the urge to push because of the numbing effect of the epidural, but her body knows that it is time for pushing.

Cathy Moore, CNM
Excerpted from "Belly Dance and Birth," Midwifery Today, Issue 73
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Web Site Update

Read these article excerpts from the most recent issue of Midwifery Today newly posted to our Web site:

  • Doulas Supporting Teens—by Jessica Atkins
    “After giving birth, Destiny is no longer a scared 15-year-old with an uncertain future; she is a woman—confident, empowered and extremely dedicated to her baby boy. She attends high school, lives in an apartment of her own and is scheduled to graduate next year. Destiny's success story is one shared by over 200 vulnerable teen parents served by an Oregon doula program since 2003.”
  • Disturbing “New” Trends in Tear Prevention Threaten Midwives’ Autonomy—by Tine Greve
    “Going through different studies on third- and fourth-degree tears, I find a great variety of risk factors: high birth weight, primiparas, maternal age, long second stage, use of vacuum/forceps, episiotomy, use of oxytocin, epidural, perineal oedema, etc. … But I haven’t found any good scientific studies that have looked at the birthing woman’s position during crowning, vocal support, or a natural, physiological birthing process.”

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Question of the Week

Q: I am currently studying for my midwifery degree at Oxford Brookes University, UK, having been a registered nurse since the early 1990s. During a recent module exploring perineal trauma, I came across an article published in the Winter 2001 issue of Midwifery Today, by Denise Gilpin-Blake and Summer Elliot, titled, "A Natural Alternative to Suturing." Having elected to further explore methods of repair of trauma for my dissertation topic, I conducted a literature search in order to find current evidence for the use of seaweed in perineal repair and came up blank! I e-mailed the Accouche centre in California where this article was based, and despite a very pleasant, prompt reply, no further information was offered apart from the fact that this practice is no longer carried out there.

Do you have any further information regarding the use of seaweed or any insight into why it may no longer be used in this capacity?

— Sarah Brennan, RN, student midwife


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.


Question of the Week Responses

Q: I have a question about fibroids in pregnancy.

I am currently 5-1/2 months pregnant with my first baby. At 16 weeks, an ultrasound showed that I have three large fibroids in my uterus, ranging in size from 4–6 cm. The 6 cm fibroid is located directly in the center of my placenta (which is at the top of my uterus), and the placenta is attached to this fibroid. Additionally, both edges of my placenta seemed to have separated some. Also, the two other fibroids (4 cm and 5 cm) are located on either side of my cervix; so unless they shrink or move, I am told that I will have to deliver by c-section. My midwife screened me out for a homebirth. There is also concern about me hemorrhaging at birth because of the fibroids, and of the placenta not delivering properly because it is attached to the placenta.

Is there anything I can do to facilitate a more natural birth—hopefully not a c-section—and to avoid hemorrhaging and placental delivery problems? I am drinking 2–3 cups of raspberry leaf/nettle tea a day, and I am working hard to build up my iron levels with green leafy vegetables and yellow dock tincture.

— Jackie Ladomato

A: Natural Birth With Fibroids: Fibroids respond really well to Traditional Chinese Medicine. I would look into contacting someone in your area who practices, is licensed and has a good reputation and see him/her as soon as possible.

— Jennifer


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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Entry Deadline is August 10, 2010, so get your creative gears spinning! Go here for more information and instructions:


Think about It

New Zealand fetologist William Liley found that from at least 25 weeks into the pregnancy, babies responded to orchestra music by jumping in rhythm to the beat of the timpani drums. In 1977, researcher Michele Clements found that babies in the fourth to fifth month of pregnancy were soothed by Vivaldi and Mozart, but were distressed by passages of Beethoven and Brahms, as well as rock-and-roll music. And in a research study performed in 1987, newborn babies showed a preference for familiar tunes, responding more to songs their mothers sang while they were pregnant than completely new songs.

http://www.birthpsychology.com/lifebefore/sound1.html. Accessed 10 Feb 2010.


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Letters

Dear Midwifery Today,

I have heard Dr. Lisa Masterson, OB, say "You don't get a gold star for giving birth without pain medication," many times on morning television. However, I would like to shout to the world: "I beg to differ!" Women do get a gold star for giving birth without pain medication. I see it often. It isn't a cheesy trophy that they can display on their mantle. It may not be a medal they can wear to announce their achievement. What women do get is paramount—a new sense of strength and knowledge about oneself that comes from within the woman and moves her confidently into her new role as a mother. It is beautiful, it is powerful, and it is real!

Michelle McClafferty, CD, ICCE
www.BetterBirthPartners.com


Dear Jan,

Over the last 20 years in Hungary, approximately 3,500 women have decided to give birth at home instead of in an institution. Although homebirth is not actually illegal, the absence of legislation has put parents choosing homebirth, as well as the health professionals assisting them (midwives and doulas), in an extremely precarious position. Parents choosing homebirth are subjected to systematic negative discrimination and humiliation, while midwives and doulas are threatened with criminal proceedings. In the criminal proceedings currently pending, the prosecutor representing the Hungarian state has, in one of the accusations, clearly placed the burden on the midwives for the fact that homebirth is carried out without an appropriate legislative background.

We have learned that the Ministry of Health will be drafting the necessary legislation within the next few weeks, in the form of a Governmental Decree. The government's efforts to put an end to this unregulated situation are unquestionably welcome. However, we have serious concerns as to the quality of the legislation, given the experts who are being consulted. The legislation on out-of-institution birth is being drafted exclusively by OB/GYN specialists having only hospital experience, who believe that homebirth is dangerous. The advice and recommendations of Hungarian midwives, with their two decades of experience, is being completely ignored, as are the homebirth practices and legislation in other countries, which we have drawn to the legislators' attention.

Given the above, we are planning to start a national and international petition as soon as the final form of the legislation becomes known to us. Our aim with this petition is to put pressure on the government to ensure that it produces legislation based on consultations with a wide range of experts and that it takes the interests of all stakeholders into consideration.

We would like to see as many organizations and individuals as possible sign our petition. With this letter, we are attempting to make a preliminary survey to find out which organizations are interested in giving us their support—contingent, of course, on the content of the petition—in the near future. We appreciate your time and consideration to this matter, and look forward to your response.

With best regards,

Dr. Ágnes Geréb, independent midwife, and Dr. Bea Bodrogi, human rights lawyer,
on behalf of Alternatal Foundation


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