|April 11, 2012|
Volume 14, Issue 8
|Midwifery Today E-News|
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In This Week’s Issue
Quote of the Week
Hope has two beautiful daughters. Their names are anger and courage; anger at the way things are, and courage to see that they do not remain the way they are.
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The Art of Midwifery
The simple act of lovemaking before or during labor facilitates a quicker birth and can trigger the onset of labor. When a woman is sexually stimulated, oxytocin flows through her system, causing her uterus to contract, either in the form of orgasms or labor contractions.
— Marnie Ko
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.
Eneyda Spradlin-Ramos, my conference planning partner, and I just got back from China. Our friend and colleague Dr. Chen invited us to go to Guangzhou because he wanted us to do midwifery training. I had not heard from him since Midwifery Today did a conference there in 2002. It was exciting to hear of his plan because when we were there in 2002 the thinking was, “We have enough doctors—we don’t need midwives.” How exciting it is that the realization that midwives are needed has taken root in China once again. All countries need midwives. They are the force working to keep birth normal and extra special for families.
The hospital in Dr. Chen’s area is very important because it is the main hospital for all the problem cases related to pregnancy and newborns in the province. They care for some very sick mothers and babies there. There is also a whole floor for normal birth, which is Dr. Chen’s area. The midwives are already nurses with training in midwifery but not as many alternative practices have been taught. There is great enthusiasm from the staff at the hospital. I am sure we can have a lot of fun exchanging information and birth stories in the future.
The hospitality extended to us was unparalleled. It seems we never quit eating! I did not recognize what I was eating, but it was always delicious. They took us site-seeing and we visited another hospital a couple of hours away. We were impressed that the family members were in the birth room with the mothers. In one birth, the husband, the mother and a couple of other family members were present—more relatives than are allowed in US hospitals. They don’t seem to suffer from the epidural epidemic since the moms labor naturally. I look forward to more and stronger relationships with the people of China. The eight days we were gone seemed like three weeks because of all that was accomplished!
— 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.
Midwifery Today on Facebook: facebook.com/midwiferytoday
News and Research
Breast Cancer Patients Told Pregnancy Is “Safe”
The surge of hormones in pregnancy was thought to increase the chances of cancer returning. Some women have even been advised to have abortions because of this. But researchers are finding that there is no difference in the survival rates of women who have previously had breast cancer and become pregnant compared with women who have not had breast cancer.
Because more and more women are delaying having children until later in life, there has been an increase in the number of women faced with the decision about trying to conceive after having had cancer.
Dr. Hatem Azim, a medical oncologist in Brussels, Belgium, researched women who became pregnant after being diagnosed with breast cancer and said the following, “…we found that patients who became pregnant within two years of breast cancer diagnosis appeared to have a better disease-free survival compared to those who did not become pregnant.”
— Smith, Rebecca. “Breast Cancer Patients Told Pregnancy Is ‘Safe.’” The Telegraph. Mar. 21, 2012. http://www.telegraph.co.uk/health/healthnews/9154925/Breast-cancer-patients-told-pregnancy-is-safe.html
When Love Hormones Become Useless
The Good News: Among the spectacular recent technical advances that will influence the history of childbirth, we must give a pre-eminent place to the modified and simplified cesarean technique. Introduced by Michael Stark, it is often referred to as the “Misgav Ladach cesarean.” A c-section can now be performed in 20 minutes, with minimum blood loss and, therefore, a reduced risk of further adhesions. This new technique is considered by many to be very safe. Although only recently described and evaluated in the medical literature, it is now known and used all over the world.
Evaluation of the safety of the cesarean is difficult via the usual statistical methods, because cesareans are performed for a great diversity of reasons that cannot easily be determined. However, these difficulties may be overcome by looking at a homogenous series of cesareans performed for the same reason. We have at our disposal three huge statistical studies on planned pre-labor cesareans for breech presentations. The most important one looked at all elective cesareans for breech presentation in all of Canada (except Quebec and Manitoba) from 1991 to 2005 (46,766 cases).(1) A Danish statistic looked at 7503 elective cesareans, also for breech presentation.(2) In addition the famous randomized controlled study by Mary Hannah and co-authors about breech presentations at term included 941 elective cesareans.(3) When adding the data provided by these three studies, we find a total of 55,210 cesareans with no maternal death. Such hard data, among others, lead us to conclude that today, in well-organized and well-equipped obstetrics departments, the safety of the cesarean can be compared with the safety of the vaginal route.
Serious reasons lead us to present these technical advances as good news, insofar as our interpretations are exclusively based on conventional criteria: perinatal mortality and morbidity rates, maternal mortality and morbidity rates, and cost effectiveness.
The Bad News: The price of technical advances, such as simplified cesarean techniques, is a lack of motivation for studying the factors that can make the act of birthing easier or more difficult. It is as if, in the current technical context, making efforts to “rediscover” the basic needs of women in labor and of newborn babies is simply not worth the effort. It would be a real “re-discovery” indeed, after thousands of years of culturally controlled childbirth. We have a quasi-cultural lack of understanding of the physiological processes. Medical circles, natural childbirth movements and the general public share this lack of understanding. Understanding the physiological perspective would make possible the necessary steps forward.
The point is that, everywhere in the world, the number of women who can give birth to a baby and the placenta by themselves—which means with their own hormones—is getting smaller and smaller. Of course, the safety of the cesarean is the main factor that makes this operation more and more trivial. We must also keep in mind that most women who give birth by the vaginal route rely on pharmacological substitutes for the hormones that they cannot release in an inappropriate environment: for example, replacing natural oxytocin with drips of synthetic oxytocin and endorphins by epidural anesthesia is easy. These pharmacological substitutes do not have the behavioral effects of the natural hormones, though.
Michel Odent will be hosting The Mid-Pacific Conference in Honolulu, October 26–28. Below is some information about the event.
For the first time, Ernesto Mesa will present hard data provided by the Malaga study about the side effects of synthetic oxytocin (Syntocinon or Pitocin). This important study has been feasible at the university hospital in Malaga, where there are about 6000 births a year. Thanks to detailed birth records, it is possible to evaluate the doses of synthetic oxytocin received by the parturients during induction, the first, second and third stages of labour or as a uterotonic agent during a cesarean section. The basis of the study has been the first to analyse the 2006 birth records, and then to interview the families in 2011–2012. According to preliminary results, synthetic oxytocin interferes in a negative way with breastfeeding, and there is a dose-response relationship. Furthermore, there are detectable effects on the psychomotor development of the children.
Such results are easily interpreted when considering the enormous concentration of oxytocin in maternal blood during pharmacological assistance. One of the anticipated effects is a desensitization of the oxytocin breast receptors. Let us recall that the milk ejection reflex is under the control of the oxytocin system. Another anticipated effect is on the development of the fetal brain during a critical period, since oxytocin can probably cross the placenta and also the immature blood brain barrier.
While the use of synthetic oxytocin is by far the most common medical intervention in childbirth, it is paradoxical that such a study is unique.
Web Site Update
Read these articles from Midwifery Today magazine now available on our Web site:
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Ask your library to order natural birth and midwifery books for you. When a mother has more information about natural birth available to her, she can make more educated decisions about how she wants to birth her baby. Making requests is easy; here’s how.
Q: For moms who have experienced a variety of births, did you notice a difference in bonding with your hospital-birthed baby compared with your homebirthed baby?
— Midwifery Today
A: I’ve had three very different birth experiences and have three very different children. I can proudly say the bonding began long before the birth and I am equally bonded to each of them, though our relationships are all different.
— Sunshine Tomlin
A: I have eleven children. First 5 in the hospital, last 6 at home. Numbers 4 and 5 were twins born via c-section and that was the hardest bonding experience. Thanks to being determined to nurse them no matter what, we did bond, but it was a long, hard road.
— Vicki Davis
A: I had my first in a birthing centre and bonding took a while. My second was born at home and bonding was instant. BUT I don’t know how much of that is due to first baby “shock” vs. second baby “acceptance,” which I experienced. Both births were vaginal, in water, little interference, un-medicated.
— Kathy Reynolds
A: No, I did not, and actually, I feel just as close to the two I bottle fed as I did to their breastfed siblings. They’ve grown up to be two of my very best friends.
— Valarie Nordstrom
A: I have three boys, each born very differently. When I finally held my oldest son, born via cesarean after a failed vacuum extraction, I felt as if I were holding someone else’s baby. That feeling faded after a few weeks, and I assumed everyone felt as shell-shocked after giving birth for the first time. I chose my care provider carefully when I became pregnant again, and he assured me I was an excellent candidate for VBAC. Two weeks before my son was due, the hospital banned VBACs, and there were no other hospitals within 150 miles, who “allowed” them (midwives were also not allowed to legally attend them). I felt forced into a medically unnecessary cesarean, and suffered from posttraumatic stress disorder after my son was surgically extracted. For over a year, I couldn’t even look at him without bursting into tears. Yes, I loved him, but I wasn’t bonded to him, and it showed in his behavior as he entered toddlerhood. He and I have since spent a great deal of time trying to heal that rift, and we’re being very successful, but it will take a little more time. My third son was born at home, in the water. To be honest, I thought very little of him as he grew inside me, but the moment he was born, I could think of nothing else. He will be a year old in a few weeks, and I lack words to describe the level of attachment we have. It’s amazing. I’m so sad I couldn’t so easily experience that level of attachment to my two older sons. A mother’s love should be effortless.
— Heather Barson
Wisdom from the Web
According to Daniel Levitin, author of This Is Your Brain on Music, sex isn’t the only thing that leads to high levels of oxytocin. What’s the other? Singing, particularly singing with other people, causes the brain to produce unusually high levels of oxytocin. Just to double check, I found a study at the National Center for Biotechnology Information that lends credibility to this claim: when people sing together, their brains make oxytocin, and that makes them feel trust, solidarity, and connectedness with the people around them.
Never in a woman’s life is oxytocin higher than in pregnancy and during labor, as well as the moments immediately after birth (when it’s at its all-time peak). Therefore if you think of birth as a sexual event, then you begin to understand how important the setting and the set of people around you really are. It’s not too far afield to say “imagine yourself having sex with a room full of strangers parading in and out of your room.” Could you change positions spontaneously? Could you move and groan and moan and do the things that are natural in birth if you’re being observed?
— Elizabeth Davis, midwife, women’s health care specialist, educator, consultant and author
When the process is uninterrupted, oxytocin is one of nature’s chief tools for creating a mother. Roused by the high levels of estrogen (“female hormone”) during pregnancy, the number of oxytocin receptors in the expecting mother’s brain multiplies dramatically near the end of her pregnancy. This makes the new mother highly responsive to the presence of oxytocin. These receptors increase in the part of her brain that promotes maternal behaviors.
— Linda F. Palmer
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.
Introducing Jennifer Reeves
By the time you are reading this we will be doing our first day at the Harrisburg conference. If you are within driving distance, you could still join us! If you missed Harrisburg, we a have a great event planned for Bad Wildbad, Germany. Go to the following link for more information: http://www.midwiferytoday.com/conferences/Germany2012/.
We have an exciting announcement to make—we have a new conference coordinator! We are very pleased. She is well organized and as sweet and kind as can be! I’ll let her introduce herself below.
— Jan Tritten
Hello! Having recently joined the Midwifery Today team, I want to introduce myself. As Karen Navarro will soon be moving on to other adventures, I will be taking over as the new conference coordinator. By following Karen’s masterful guidance, my aim is to advance Midwifery Today’s mission to “…redefine midwifery as a vital partnership with women,” and continue to bring you amazing conferences in fabulous places with beautiful people.
The Harrisburg conference and the October 17–21, 2012 conference in Bad Wildbad, Germany, “Midwifery: Birth Care for a Global Future,” will be my first opportunities to serve you. Please let me know if there is anything I can do to help—I am so excited and greatly look forward to meeting and working with you. See you at the conferences!
— Warm Regards,
My daughter reached her hand out when I was only a few centimeters dilated and shook hands with the midwife. She pulled her hand back in, and within an hour she was born. She was definitely ready to greet the world!
— Shawn Allyson Barr
Dear Midwifery Today,
Regarding the question of what items to include in a birth bag for a resource-deprived midwife, the following are the basic requirements:
— Benson Williesham Milimo, Midwifery Today Country Contact for Kenya
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