January 21, 2015
Volume 17, Issue 2
Midwifery Today E-News
“Tear Prevention”
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In This Week’s Issue



Eugene conferenceSpend a Day with Michel Odent!

Michel has been involved in childbirth for more than 60 years, has practiced on the European and African continents and has experience with both hospital births and homebirths. He has a unique knowledge of the medical and scientific literature and is raising questions about the future of our species in relation to the modes of birth. Now you have an opportunity to spend a day learning from this amazing man.

Learn more about the Eugene, Oregon, conference.



“Pillars of Midwifery: Insight, Information and Intuition”

Eugene conferenceJoin us for our conference in Bad Wildbad, Germany this October. You’ll be able to choose from a wide variety of classes including Hemorrhage, Spinning Babies, Breech, Mexican Techniques and Shoulder Dystocia. Planned teachers include Robin Lim (pictured), Carol Gautschi, Gail Hart, Sister MorningStar, Gail Tully, Debra Pascali-Bonaro and Michel Odent.

Learn more about the Bad Wildbad, Germany, conference.



Quote of the Week

There is no other organ quite like the uterus. If men had such an organ they would brag about it. So should we.

Ina May Gaskin


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The Art of Midwifery

My midwifery partner and I have had great results using the Chinese herbal remedy Yunnan Baiyao, both for postpartum hemorrhage and bleeding from perineal tears, even vascular tears. We purchase it in capsule form, open each capsule as needed and sprinkle the powder directly on bleeding tissue or onto the mother’s tongue with some water to chase it. We tell her to swish the water and powder around in her mouth first (sublingual route), then swallow it.

Kim Mosny
Excerpted from “Chinese Remedy, Tricks of the Trade,” Midwifery Today, Issue 65
View table of contents / Order the back issue


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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Editor’s Corner

Visions and Dreams for 2015

With a new year comes a clean slate. What is your vision or dream for 2015? On December 30, 2014, I asked on my Facebook page: What is your 2015 dream for yourself or for the world of birth? It is always important to keep our visions and dreams current if we are going to change birth practices for the better, which is my vision! My great hope for the upcoming year is that through conferences, the magazine, Midwifery Today products and social networking, more people will be able to understand the importance of how we are born. I hope that women everywhere will have an optimal birth experience and that their babies get what they need, which first and foremost involves their microbiome seeded from their mother. It is my hope that babies everywhere receive love and bonding from their mothers in the deepest possible way. Each motherbaby deserves this. It is our job as midwives, doctors and doulas to do everything in our power to facilitate this.

The visions of some of my friends are noted here:

Eneyda Spradlin-Ramos: To strengthen midwifery and midwives around the globe, reminding the midwives that they are not alone in the love and care of the women they serve. To continue to fight for protocols that are supported by current evidence.

Fernando Molina: One of my visions is to educate more doctors to trust in women’s wisdom for natural hands-off sacred births—in other words, to shift to the midwifery model of care. Happy New Year to all the loving midwives all over the world!

Roberta Ortiz: To have the opportunity to share the power of storytelling surrounding normal pregnancy, birth and beyond. To spark the idea of birth work by creating talking circles with different topics of midwifery opened to the public with monthly potlucks—this could be magical in circles not exposed to holistic care. To keep midwifery simple.

Carol Gautschi: To spread the word about quality, clean, viable probiotic food to feed the gut, heart and mind, encompassing the soul and spirit!

— 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.

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Conference Chatter

Greetings everyone! We here at Midwifery Today hope you had a wonderful holiday season and that your new year is off to a great start.

The subject of this issue is tear prevention, a popular topic not only in our publications, but at our conferences as well. At the upcoming conference in Eugene, Oregon, you can learn more about preventing tears and helping to facilitate smoother labors for your clients. One class that addresses this issue specifically is the class B5, Solving Common Complications with Gail Hart and Elizabeth Davis. This class will be held on Thursday, March 19, 2015. Gail and Elizabeth are amazing teachers with decades of experience as practicing midwives, and they fuse their experiential knowledge with the latest research and techniques. Come to this full-day workshop to learn how to enhance your midwifery skills.

To learn more about the class and other offerings at this conference and to register online, please go to our Eugene conference page.

Additionally, the program and registration form will be up soon for our conference in Germany this fall. Keep checking Germany conference page for more information.

All the best wishes to you in this new year, and we look forward to bringing you two more amazing conferences.

Many blessings,
Andrea Straw

If you’d like to keep abreast of the latest news and info about our conferences, be sure to follow us on Facebook:


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Featured Article

Champagne and the Fetus Ejection Reflex

The more I try to combine what I have learned from my experience of hospital birth and homebirth, the more I am convinced that the best way to protect the perineum, to avoid a serious tear and to eliminate the reasons for episiotomy is to deviate as little as possible from the physiological model. In other words, the best way is to create the conditions for an authentic fetus ejection reflex (Odent 1987; Odent 2002).

I am often asked to clarify the difference between the fetus ejection reflex and the well-known Ferguson reflex (Ferguson 1941). The Ferguson reflex is related to mechanical conditions: the pressure of the presenting part on the perineal muscles. A real fetus ejection reflex can occur long before the descent of the presenting part, or long after. It can start before complete dilation, or after. Usually it does not occur at all because the prerequisite is complete privacy. In the context of homebirth, I am familiar with this reflex when I follow the progress of labor from another room through the sound the woman is making, while her husband or partner goes shopping and there is nobody else around other than an experienced, motherly, silent and low-profile doula. I cannot remember one case of an authentic reflex in the presence of the baby’s father. During the reflex, there is a short series of irresistible, uncontrollable contractions, with no room for voluntary movements; the laboring woman can be in the most unexpected postures (often complex, asymmetrical, bending-forward postures).

I have interpreted this reflex as the effect of a sudden spectacular reduction in neocortical activity, making possible the release of a complex hormonal cocktail. The release of high levels of hormones of the adrenaline family is suggested by the sudden expression of fear (often a very short episode of fear of death) that precedes the irresistible contractions (Odent 1991), and by a sudden tendency to grasp something and to be upright. The most helpful thing to do in terms of facilitating the fetus ejection reflex is just to accept this sudden expression of fear (e.g., “Kill me,” “Let me die”) without interfering: reassuring rational words—a stimulation of the neocortex—would inhibit the reflex. The release of a high peak of oxytocin is of course suggested by the sudden power and efficiency of the uterine contractions. As for the ecstatic state of the mother, it suggests that the hormonal cocktail includes morphine-like hormones.

We must keep in mind that the term fetus ejection reflex was originally used by Niles Newton, when she was studying the factors influencing the birth of mice (Newton, Foshee and Newton 1966)—mammals who do not have a neocortex as powerful as ours. The reflex can occur among humans, provided that the activity of the neocortex is dramatically reduced so that the human handicap is overcome.

I learned from a powerful fetus ejection reflex induced by a cup of champagne. Around 1980, a woman in not-yet-hard labor shared a room in the hospital in Pithiviers, France. Her roommate, who was already celebrating the birth of her baby, gave her a cup of champagne. The unexpected effect was a sudden series of such powerful contractions that the second mother’s baby was born on the way to the birthing room. My interpretation is that the bubbles sped up the absorption of alcohol, causing an immediate effect on brain activity that other types of wine cannot have. The capacity champagne has to release inhibitions has been widely tested, whenever the goal is to create an erotic or not-too-formal atmosphere.

References:

  • Ferguson, JKW. 1941. “A Study of the Motility of the Intact Uterus at Term.” Surg Gynecol Obstet 73:359–66.
  • Newton, N, D Foshee and M Newton. 1966. “Experimental Inhibition of Labor through Environmental Disturbance.” Obstet Gynecol 67:371–77.
  • Odent, M. 1987. “The Fetus Ejection Reflex.” Birth 14:104–05.
  • Odent, M. 1991. “Fear of Death during Labour.” J Reprod Infant Psyc 9:43–47.
  • Odent, M. 2002. “The Second Stage as a Disruption of the Fetus Ejection Reflex.” Midwifery Today 55:12.

Michel Odent
Excerpted from “Champagne and the Fetus Ejection Reflex,” Midwifery Today, Issue 65
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    Excerpt: “I was eight days past my ultrasound due date and two days past my LMP due date. My family had a lovely dinner planned at our house that evening with my parents and close childhood friends. It was overcast and drizzling outside, so my dad fired up the barbie right there to grill steaks on our covered front porch, like true country folk.”


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Birth Q&A

Q: What do you do for perineal tears? How do you prevent them?

— Midwifery Today

A: Mom needs to follow her instincts. Evening primrose oil is absolutely amazing for scar tissue. This can help with a previous tear where swollen tissue was stitched together and a scar formed. Rub a little on the scar daily in the shower, but don’t rinse. It is not even necessary to do perineal massage, just rub it in. Seriously amazing!

— Danielle Bergum

A: Absolutely no perineal massage. In my experience, when perineal massage is used, the perineum swells and loses its elasticity. When that happens, a tear is likely. I am not sure how (or why) we all jumped on the massage bandwagon, but there is nothing better than a baby’s head to stretch that area. Also, supporting the perineum with slight counter pressure is helpful. I also saw less tearing when the mother was in a side-lying position.

— Cyndi Gross

A: I see more tears with waterbirths. I believe the people [who see fewer] tears in water are fiddling with the perineum during the birth when on land, but leave it alone underwater. What I think causes the tears I see in water is that it relieves the “ring of fire” and therefore moms don’t know when to stop pushing and to breathe the baby out slowly.

— Marlene Waechter

A: Waterbirths are lovely; however, we are working with our third-degree tear rates at the moment (trying to lower them) and doing coached delivery (hands off) to try and slow down the moment of delivery. The water can saturate the tissues and they can become quite edematous.

— Gill Marchant

A: A woman should be well nourished in her pregnancy; healthy oils and fats, such as coconut oil, help to keep the elasticity of the tissue up. A study in Australia showed that perineal massage, especially for first-time mums, was good to help prevent third and fourth degree tears, but not smaller ones.

— Jutta Wohlrab


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