|October 12, 2011|
Volume 13, Issue 21
|Midwifery Today E-News|
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Learn about Prematurity and Postmaturity in Midwifery Today 72 (Winter 2004)
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In This Week’s Issue
Quote of the Week
More babies prefer homebirth.
— Carla Hartley
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The Art of Midwifery
When I practiced midwifery in the Houston-Galveston, Texas, area, I had the opportunity to learn this technique from the parteras in the region: to nudge a woman into labor, have her drink comino (cumin) tea that has a little wedge of raw potato in it. This is especially good for the woman who is postterm and has contractions that are frequent but not quite effective enough to get things going.
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 email@example.com.
Send submissions, inquiries, and responses to newsletter items to: firstname.lastname@example.org.
Midwifery Today’s New The Postdates and Postmaturity Handbook
At Midwifery Today we work hard to bring you resources you can use in your practice if you are a midwife, doula, or doctor, and our Holistic Clinical Handbook Series is a must-have part of your "birthkit." We have just finished the next book in the series: The Postdates and Postmaturity Handbook. It will be ready to go to the printer soon and should be available for you to purchase on November 1, 2011. For this edition of E-News we have chosen an excerpt of an article by Gail Hart. I also want to share some of my thoughts on this important subject.
True postmaturity syndrome is very rare, and can happen inexplicably, even at 38 or 40 weeks. Unfortunately, many "postdates" pregnancies end in induction. The frequency with which motherbaby is induced due to fear of a pregnancy going beyond the "due date" is truly a human rights violation and comes with dangerous consequences for mother and baby.
In this book we have covered many of the realities and myths surrounding postmaturity and postdates pregnancies. We hope this book will help you to sort through the realities and myths surrounding postmaturity and assist you in applying information to your practice if and when you are faced with a true case of postmaturity. Sister Angela Murdaugh, CNM, MS, used to say, "Don't practice wish midwifery." Be a diligent midwife.
If you are a parent reading this to inform yourself, we pray you have an amazing, miraculous birth-you are carrying the future. It is possible and even probable that you will have an empowering birth. Stay informed, eat well, choose your midwife or doctor carefully, and ask a lot of questions.
— Jan Tritten, mother of Midwifery Today
Jan Tritten is the founder, 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 on Twitter: twitter.com/jantritten
News and Research
In August, two birthing hospitals in Lincoln, Nebraska, and Des Moines, Iowa, decided to discourage chemical induction of labor prior to 39 weeks, unless medical needs dictate otherwise. These hospitals and others in the area have also taken a similar stance on elective cesareans, citing that the well-being of the baby takes precedence over convenience.
Ruggles, Rick. “Hospitals induce labor less often.” Omaha World-Herald. August 31, 2011. http://www.omaha.com/article/20110831/LIVEWELL01/708319916/1161
Induction and Circular Logic
I’m a midwife with an innate faith in childbirth as a normal, natural function. When I hear that one-third of American women are given chemicals to start labor, I have to either conclude that women have somehow lost the ability to give birth or that we are witnessing a societal change. If women are being induced for the legitimate reasons of health and safety, then mortality and morbidity statistics should be improving. Yet the statistics are quite flat. We see little change in US statistics, except for in the category of tiny, preterm babies. An induction and augmentation rate of over 35% has not seemed to improve the health of mothers or babies. It has, however, strongly impacted the cesarean rate and—subsequently—the rate of VBAC and uterine rupture after prior cesarean section.
Induction is so common that many people are unaware of the risks. Even a “simple,” uncomplicated induction can begin an avalanche of interventions. It often starts with a cervical stretch and sweep to “ripen” the cervix, IV Pitocin, electronic fetal monitoring (EFM) and amniotomy; then, perhaps, it’s on to an intrauterine pressure catheter, amnioinfusion for unusual fetal heart tones, an epidural for the pain of Pitocin-induced contractions and malrotation or poor descent because of the epidural; then maybe a vacuum extraction or cesarean is performed for “failure to progress.” It goes on and on. The mother ends up with lifelong injury to her uterus. Her baby may be stressed and separated from the family. A normal birth may turn into a nightmare. And that’s if all goes well! If there are complications or a surgical emergency then the nightmare really begins.
Induction is a minefield, a setup for complications. An induced labor forces the baby out before the body is ready, before the complex hormone interaction has primed the cervix and often before the baby has reached his full intrauterine maturity. We have drugs now that can produce contractions and soften the cervix but this is only a small part of the complicated process of labor. We can make a woman have contractions but we don’t always succeed in forcing her body to release the baby and give birth. If we start a labor with chemicals, we may very well have to finish the labor with the surgeon’s scalpel.
In some studies, induction raises the risk of cesarean by 800%. EFM must be used in all chemical induction methods because of the risk of hypertonic contractions and fetal distress. Electronic fetal monitoring alone increases the risk of cesarean and of vacuum extraction or forceps. Amniotomy increases the risk again. Cesarean for fetal distress is even more common—whether the distress is real or a result of EFM artifact—since non-reassuring fetal heart tones are frequently observed. Meconium staining, meconium aspiration syndrome and even shoulder dystocia are directly associated with inductions. The rise in induction closely mirrors the rise in cesarean delivery, as does the rising incidence of post-cesarean rupture. A woman with a prior cesarean is unlikely to suffer a uterine rupture (odds are usually given under 1 %). But if she is induced, her risk may rise to 2–4 %.
If the data shows that induction is a risky procedure, and we see little statistical benefit, then why are we inducing so often? Doctors and midwives will express many reasons for induction, but many of those reasons are colored by a misunderstanding of the risks involved. The risks created by induction are sometimes ignored—induction seems simple and easy. Any complications or problems are seen as simple chance—the “normal risk” of birth—caused by the situation that prompts the induction.
— Gail Hart
Web Site Update
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Question of the Week Responses
Q: A credential doesn’t make a midwife. What does?
— Jan Tritten
A: Having recently sat/taken the NARM exam, I can say that it’s not the title that matters to me. What matters is what I’ve learned and who I’ve become in the process; the ways in which my heart, my mind, my body, and my soul have been stretched and strengthened by every step along the way. I’m able to tap into it all now, when it is needed most. I feel endless gratitude for the families who have allowed me to serve them and who taught me volumes I wouldn’t have learned from books alone.
— Kim Lenderts
A: Mothers make a midwife a midwife.
— Lennon Clark
Q: Is postmaturity one of your fears?
— Jan Tritten
A: I have a client who has had 9 kids all around 43/44 weeks. She has long cycles and it is her personal herstory. As midwives I believe we need to personalize the care to this extent to safeguard reproductive health and the physical and emotional health of our moms, babies and families.
— Kamy Kamyssage Shaw
A: All my babies were late, between 8 to 17 days late, but none were postmature. I always had longer cycles. The “8 day late” baby was born exactly 9 months after he was conceived, and we were absolutely positive about his dates. For some of us, longer is just a variation of normal. It is one reason I will never be OK with regs that require transfer of care after 42 weeks.
— Terri LaPointe
Editor’s Note: 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.
Birth Wisdom from the Web
I’ve seen family members (mothers of the laboring woman most often) and even new doulas feel sorry for the woman in transition. What might better be empathy has twisted into sympathy. Sympathy rarely makes a mom feel better. I’ve seen a mom lose faith in her body’s abilities when those around her are morose and sad for her laboring state. I’ve also seen women buoyed by the positive, affirming words and actions of those around her. It has to be nicer to see people smiling and cheering you on rather than someone sitting, staring and wringing their hands with worry.
— Barbara E. Herrera, LM, CPM, on transitions.
We (the women who’d had homebirths) agreed we remembered birth as being exhausting and intense, but not specifically as painful. I can even say that having given birth both with an epidural and without, that I remember the pre-epidural time also being very painful and difficult, while the birth without was totally different. The women who had epidurals simply remembered their births as painful and were shocked and amazed that we had chosen to go through naturally.
— Kate Tietje, blogger,”Why are women afraid of labor?”
The best place for a newborn to be is with the mother.
— Ann Sober, founder of Special Beginnings Birth and Woman’s Center
If you’d like to share a bit of wisdom from the Web, please send a 4–5 sentence excerpt, accompanied by a link, to firstname.lastname@example.org.
Please Join Us in Germany
I was thinking this morning of what a Midwifery Today conference can do for you. If you are an aspiring midwife it can help you know if this is your calling. So many issues come up over the course of the event that if you think you may be called to midwifery but are not sure, the conference will help you decide. If you are a student midwife, you will learn a lot about the issues of midwifery as well as the skills. You may also find mentors who are happy to help you on your journey.
For the midwife, you will learn many more skills as you ponder the field and techniques of midwifery, and the conference can help you hone your craft. We have really amazing teachers and our monitors and registrants are people you can learn from and share with. There are also plenty of classes for doulas, anthropologists, massage therapists and herbalists.
One of the things that really touches my heart is that we have midwives come who are ready to quit doing midwifery because of the pressures of medicalization and hospital politics, or people pressures. By the end of the conference, they end up so full of hope for the future that they go back to their communities re-energized and ready to try new things. I get great reports later that the conference saved their birth soul and filled them with so much inspiration that they not only stayed in their calling but thrived again. (Please read a few of such testimonials here.)
I think one other very special part of this event is that we have people coming from so many parts of the world. Our friend Comfort from Nigeria who is studying in Bulgaria just found out after much work and many e-mails and help from Cornelia Enning and me that she will be able to get her visa to come and join us in Germany. Please come meet her and my friends from Ghana, too. As I have told you already there are over 30 different countries represented so far, with more coming in. This is going to be a fantastic event—full of fun, new and old techniques and hope for the future.
— Jan Tritten
Think about It
Traditional midwifery is not passive. It does not mean doing nothing. It means forming a bond with the birthing woman. It means finding trust; trust in the process, trust in the lessons involved. As well, preparation for birth offers a vulnerable time for personal transformation. As a woman lives, so will she birth. With this as my basic premise, I embark on each client’s journey with trust in the process yet to unfold.
— Nancy Duncan, RN
My friend Nancy’s 11-year-old daughter Cynthia White started her first round of chemotherapy today. The recent diagnosis of epithelioid sarcoma, a rare and challenging form of cancer, was a shock to everyone.
I am requesting that you will participate in a card campaign for the White family. Please send a card to their hospital room. It’s a huge morale booster to this family, to help them get through this month without going crazy.
Cynthia White—The White Family
Some of you may know Nancy personally, or have met her at a conference somewhere. She is the Area Coordinator of Leaders for LLL AL/MS/LA. Nancy has given so much to so many families over the years. Even if you haven’t ever heard of Nancy or LLL, now’s the time to share a little love with a complete stranger who really needs it!
— Sue Howley Rickman
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Register today for the American Association of Birth Centers’ conference, Practical Techniques to Support Women in Childbirth, on November 3, 2011, in Wilmington, Delaware—a conference to equip you with techniques for supporting laboring women. www.birthcenters.org
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