January 29, 1999
Volume 1, Issue 5
Midwifery Today E-News
“Ultrasound”
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In This Week's Issue:

1) Quote of the Week
2) Checking In
3) The Art of Midwifery
4) News Flashes
5) How Sound is Ultrasound?
6) From the Garden
7) Switchboard
8) Letters
9) Coming Themes

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1) Quote of the Week:

"Most ignorance is vincible ignorance. We don't know because we don't want to know."

- Aldous Huxley

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2) Checking In

The response so far to Midwifery Today's E-News has been heartening. We're on our way to building a midwifery cybercommunity where everyone is warmly welcomed and supported. We envision a time when we can quickly and easily share information, wisdom, techniques, stories, insights, research, herbal lore and more, almost as if we were sitting in a big circle together, talking and laughing and hugging. But this way the room that holds the circle is limitlessly big, and grows as the circle grows. Imagine talking with thousands of practitioners at one time; imagine adding to your store of knowledge with just a few keyboard strokes; imagine strengthening midwifery so the safety net for new mothers, families and babies is never again threatened or broken. And imagine a time when you need to have a group of wise midwives at your fingertips--it's possible!

Thank you for joining us. Help us make the circle larger and wider by passing this newsletter on to your friends and colleagues--everyone is welcome! And please feel free to write, ask questions, answer questions, share, share, share--it's what will keep us united. Send your submissions to mtensubmit@midwiferytoday.com.

- Cher Mikkola, managing editor

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3) The Art of Midwifery

Touch-Talk

Because the laboring woman is so sensitive and in such an altered state, the first physical contact between mother and midwife is very important. If the midwife is too abrupt, forceful or hasty, the mother may recoil, withdraw or push away the helping hand. On the other hand, there are women who don't want to be touched at all and the midwife should be aware of this. Touch can be a distraction for them.

The first touch should be light, gentle and done with loving and positive thoughts. The hand slowly merges with the woman's body. I was taught to begin massages by touching one of the body's poles, such as the feet or the head. If the laboring woman is tensed up, slowly move the hands to the tight areas and apply gentle pressure. These areas can be felt by the heat that radiates from the skin. When the midwife perceives that the woman is responding positively, she can massage, rub, stimulate the striated muscles as deeply as the woman can tolerate. This deep massage is especially beneficial around the pelvis. If the woman is having trouble pushing the baby out or the baby isn't descending into the pelvis because of muscle tension, massaging the psoas muscle will help bring the baby.

- Anonymous author, The Birthkit newsletter Issue No. 2 (a Midwifery Today publication)

At Midwifery Today, we have lots of tricks up our sleeves! Purchase our two volumes of Tricks of the Trade and you'll see what we mean:

Save $5 when you purchase both Tricks of The Trade Volume I and Volume II. Only $40 plus shipping! Call today to order: 800-743-0974. For more information, visit the links above. Mention code 940 and save an ADDITIONAL $2 when you buy both books. This extra savings offer has been extended until February 5, 1999.

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4) News Flashes

Ultrasound--The Answer?

A study from Norway looks at outcomes of antenatal ultrasound diagnosis in thirty-six children with serious congenital problems. It sought to determine how many of the problems were detected by ultrasound before birth, and whether outcomes were better when the problem was known before birth than for babies where the problem was missed on the ultrasound and not seen until after delivery. The women had had an average of five scans, but the average was seven in women who had a problem detected. Only two of eight congenital diaphragmatic hernias were picked up on ultrasound, half the cases of abdominal wall defects (six our of twelve), five of thirteen cases of meningomyelocele and none of the three cases of bladder extroversion.

All thirteen babies with prenatal diagnosis were delivered by cesarean section. Nineteen of the twenty-three with postnatal diagnosis had an uncomplicated vaginal delivery. Those with prenatal diagnosis had shorter gestational age (about two weeks), lower birthweights, and slightly lower Apgar scores. Three out of thirteen (23 percent) died compared with one out of twenty-three (4 percent) of those diagnosed after birth.

- AIMS Journal, Vol. 10 No. 2

Blood Clotting Disorders and Birth Complications

Israeli researchers conducted genetic tests looking for mutations that could predispose women to blood-clotting disorders that may lead to higher risk of complications in pregnancy. In the study group of 220 women, half had had normal pregnancies while the other half had been affected by such complications as preeclampsia, abruptio placentae, fetal growth retardation or stillbirth. Authors of the study concluded that altogether, 65 percent of the women with complications had some form of inherited or acquired thrombophilia (a tendency to form blood clots), as compared with 18 percent of the women with normal pregnancies. Two thirds of women experiencing obstetrical complications in successive pregnancies carried at least one genetic mutation for a blood clotting disorder. However, nearly one in five (17 percent) of the study subjects with normal pregnancies carried at least one of the three genetic mutations. Since normal pregnancies comprise 95 percent of all cases, many women who have one or more types of thrombophilia will never have any of the complications. Widespread testing for thrombophilia should be delayed until there is better understanding of the risks to patients. (New England Journal of Medicine 1999; 340: 9-13)

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5) How Sound is Ultrasound? - gleanings from Beverley Beech

Much of the attraction that ultrasound has for obstetricians is that they can for the first time "see" the baby. What most lay people do not realize is that much of the achievement lies in identifying problems which they cannot yet successfully treat (IUGR, for example). Even for those that are treated, there may be little or no evidence that treatment before birth is more successful than treatment afterward.

More information does not necessarily mean improved outcome. In a 1992 study from Denmark, 1,000 high-risk women were given screening at 29 weeks and every third week until delivery to estimate fetal weight. Obstetricians were only told the results for half the women. This did not improve fetal outcome; there were more perinatal deaths in the revealed group (7 vs. 4) and that group spent more time in hospital at more cost, but to no benefit.

There is rampant "failure to ensure that potentially dangerous equipment was used only by those who were adequately trained and at least understood the possibility of risk. Anyone can buy a scanner and anyone can use it." Scans are commonly done by personnel who have no specific training and have learned only by watching others. A properly trained sonographer can obtain necessary information from the scan more quickly, thereby reducing exposure to the baby.

In 1982 an Overview of Ultrasound commissioned by the Department of Health and Human Services suggested (from animal studies) the possibility of damage to the immune system, as well as neurological and behavioral effects. The authors concluded "the potential for acute adverse effects has not been systematically explored and the potential for delayed effects has been virtually ignored."

A 1984 study of children ages seven to twelve years born at three different hospitals who had been exposed to ultrasound in the womb showed that, compared with a control group of children who had not been exposed, they were more likely to have dyslexia and to have been admitted to hospital during their childhood.

Early ultrasound scans will often show a low-lying placenta and the mother will be classified as having a higher risk of placenta previa. The problem is that all the women who are considered to be at risk at this stage will not in fact have the problem at all. In a study in Finland, of 4,000 women who were scanned at sixteen to twenty weeks, about 250 were diagnosed as having placenta previa. When it came to delivery there were only four placenta previas, and one of those had not been diagnosed. No studies exist that demonstrate that early detection of placenta previa by ultrasound improves the outcome for mother or baby.

In a study of routine scanning, records were kept of the effect of anomalies on the attitude of parents and the extended family. The news of a minor anomaly can alter parental outlook and affect prenatal bonding. A further possibility is that the mother will undergo treatment or more investigations, or both, during pregnancy, and that the baby will have extra, possibly hazardous, treatments after birth. Finally, of course, the mother could choose abortion--whether it is based on a false ultrasound diagnosis of abnormality or not.

Accuracy and interpretation of scans varies enormously from center to center and also with the experience and training of the operator. False positive diagnoses are common, and in fact false negatives are even more so; both vary from place to place.

If mothers are having ultrasound scans, might informed consent not include the success rate [of diagnoses] of the unit she is attending?

Authors of a 1992 study report that for a number of serious conditions, more than 10 percent of antenatal diagnoses were completely wrong. As in most other published studies, however, no information is given on number of babies aborted which turned out to be normal.

In a 1987 University of California-San Diego animal study in which three to five day old rat pups were exposed to diagnostic levels of diagnostic ultrasound for thirty minutes, the exposed animals showed damage to myelin, the substance surrounding nerves. The development of myelination in rats at that age is similar to that of the human fetus at four to five months of pregnancy.

When an ultrasound takes place at sixteen to eighteen weeks, the most vulnerable organ is the forebrain. Neuroblast division occurs between the tenth and twentieth week. "If exposure to ultrasound... causes death of cells, then the practice of ultrasonic imaging at sixteen to eighteen weeks... will cause loss of neurons with little prospect of replacement of lost cells.... the vulnerability is not for malformation but for maldevelopment leading to mental impairment caused by overall reduction in the number of functioning neurons in the future cerebral hemispheres" (R. Mole, Birth 1986).

Editor's note: The preceding are merely excerpts from Beverley Beech's excellent book, "Ultrasound? Unsound" Practitioners and parents, please take time to give this little book a cover to cover read; it can be done in an hour or two. It will give you serious pause before you order the next ultrasound scan for a client or accept one for yourself and your baby. Excellent references listed within it will put you on a more extensive track toward finding out the truth about ultrasound. The book is available from Midwifery Today at a cost of $12 plus $2.50 S&H in the United States, $3.00 S&H to Canada and Mexico, and $3.25 S&H (ground) to all other international addresses. Call your order to 1-800-743-0974. The book may also be purchased through Beverley Beech, 21 Iver Lane, Iver Bucks SL0 9LH England, Fax: 01753-654142. Inquire about cost.

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6) From the Garden

Arnica Massage Oil

No herbal list would be complete without reference to arnica. It often is like an answer to prayer for muscle, joint pain, bruising and any kind of tissue trauma. Rub it on or in, and the pain is relieved. Try it during perineal massage, both prenatally and during the birth itself. I once used olive oil during births, but arnica works much better. It seems to make perineums "feel like silk," as my friend says. The books say do not use arnica oil on broken skin, but I have no problems with it during a birth. There has also been concern that the oil weakens latex gloves. Change to new ones if using arnica longer than ten minutes, to reduce chances of breakdown. I have never had gloves break down due to arnica oil--and I have saved some bottoms!

- Lisa Goldstein in The Birthkit newsletter Issue No. 12 (a Midwifery Today publication).

To subscribe to the quarterly newsletter The Birthkit, call 800-743-0974, or email
inquiries@midwiferytoday.com. Save $3.00 if you subscribe to both The Birthkit and Midwifery Today magazine. Please mention Code 940.

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7) Switchboard

In response to Jen Taylor's question about the efficacy of using vitamin B6 to help treat morning sickness (E-News Issue 4), Jen herself found this on the Internet:

Sahakian V, et al. "Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study." Obstet Gynecol 1991 Jul;78(1):33-6 (91261334 NLM)

Fifty-nine women completed a randomized, double-blind placebo-controlled study of pyridoxine hydrochloride (vitamin B6) for the treatment of nausea and vomiting of pregnancy. Thirty-one patients received vitamin B6, 25-mg tablets orally every 8 hours for 72 hours, and 28 patients received placebo in the same regimen. Patients were categorized according to the presence of vomiting: severe nausea (score greater than 7) or mild to moderate nausea (score of 7 or less). The severity of nausea (as graded on a visual analogue scale of 1-10 cm) and the number of patients with vomiting over a 72-hour period were used to evaluate response to therapy.

Twelve of 31 patients in the vitamin B6 group had a pre-treatment nausea score greater than 7 (severe) (mean 8.2 +/- 0.8), as did ten of 28 patients in the placebo group (mean 8.7 +/- 0.9) (not significant). Following therapy, there was a significant difference in the mean "difference in nausea score (i.e., baseline - post-therapy nausea) between patients with severe nausea receiving vitamin B6 (mean 4.3 +/- 2.1) and placebo (mean 1.8 +/- 2.2) (P less than .01). In patients with mild to moderate nausea and in the group as a whole, no significant difference between treatment and placebo was observed. Fifteen of 31 vitamin B6-treated patients had vomiting before therapy, compared with ten of 28 in the placebo group (not significant). At the completion of 3 days of therapy, only eight of 31 patients in the vitamin B6 group had any vomiting, compared with 15 of 28 patients in the placebo group (P less than .05).

Another E-News reader contributed this interesting information:

My favorite supplement I recommend to pregnant women is brewer's yeast tablets/powder for many reasons: it contains protein, it's a whole food source which means it's easily digestible, it contains most, if not all the B vitamins, it helps put you in a good mood, it increases your energy level, and... it eases nausea! All my moms have positive results with brewer's yeast and they also say their nausea is eased somewhat, if not totally.

- Amy Jones
childbirth educator and doula

In response to E-News Issue 2's information on using arnica for shoulder dystocia:

My understanding of homeopathy is that it can not be used prophylactically. The same situation will manifest differently in each individual, which would require a different remedy for each. So two cases of stuck shoulders could make different symptoms in the babies. One might need aconite, the other arnica.

- Nikki Lee RN, MSN, mother of two, IBCLC, ICCE, CST

Other feedback:

I wholeheartedly agree with the article about fetal heartbeat [Issue 4] and asking the mom about her baby's sleep/wake patterns. My seventh child was a week overdue, so I had a non-stress test. My midwife accompanied me and my husband. While we were there I told them that the baby typically slept during this period. He received a very poor score, much to our dismay. We were given an hour to try to waken him. After much belly shaking, orange juice, candy, an IV (not enough good pockets of fluid) and oral hydration, we went back and he was awake! He tested at a nine. Four days later he was born at home with two fabulous midwives, my husband and my best friend present. He weighed 9 lbs. 12 oz. and was very healthy.

I think all healthcare providers should listen a little better to moms and what they say about their baby's daily, in-utero activity.

- Cindy Traynor, CCE

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8) Letters

Thanks so much for the newsletter. I'm a student midwife and a lot of the information is hard for me to understand, but I still find it very informative, convenient and inspirational. I really liked your link to Lora Lee's web site and I'd love to see more links to great sites. I do appreciate being included.

- Mary
Chicago, IL

I want to let you know how much I appreciate your newsletter! I am not a midwife, but I am four months pregnant with my first child. Two weeks after I found out I was pregnant, I met Kathy, my midwife. My entire life I have wanted to deliver at home (it's what my parents did); a hospital was never an option. Lucky for me, I married a wonderful man who is open minded enough to try homebirth. Since I found out I was pregnant, I have been doing plenty of research... consider it "ammo" against the skeptics! Your newsletter has been wonderful, informative, and easy enough for me to understand. It also makes it easier for my husband to understand why homebirth is the most logical choice. Thank you, and keep up the good work. I look forward to the upcoming issues.

- Nicole
Florida

I am very excited about the new newsletter. I find it to be very educational and refreshing, and I like hearing from other midwifery people. At present, I am a doula and am studying to become a traditional midwife. Birth is the most exciting thing to me and I enjoy helping a woman through labor. You are there with a woman and you work through each contraction, giving her plenty of emotional and physical support. Then she delivers a beautiful baby--that's the best thing in my world. I am the mother of four children, one cesarean and three vaginal deliveries. So I support vaginal delivery to the fullest.

- Cynthia Matthews
doula, midwifery student

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9) Coming E-News Themes

Coming issues of Midwifery Today E-News will carry the following themes. You are enthusiastically invited to write articles, make comments, tell stories, send techniques, ask questions, write letters or news items related to these themes:

- breech birth
- placenta previa
- infections
- episiotomy
- epidurals
- breastfeeding
- waterbirth
- posterior labor
- postpartum depression
- meconium aspiration
- tear prevention

We look forward to hearing from you very soon! Send your submissions to mtensubmit@midwiferytoday.com. Some themes will be duplicated over time, so your submission may be filed for later use.

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Cascade Health Care Products
Birth & Life Bookstore
Moonflower Natural Products

We offer a complete line of products for midwives, birth centers, childbirth educators, lactation consultants and expectant parents.

Visit us at www.1cascade.com or call 1-800-443-9942.


Disclaimer

This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.

Midwifery Today, Inc., does not assume liability for the use of this information in any jurisdiction or for the contents of any external Internet sites referenced, nor does it endorse any commercial product or service mentioned or advertised in this publication. Always seek the advice of your midwife, physician, nurse or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding any medical condition.

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The content of E-News is copyrighted by Midwifery Today, Inc., and, occasionally, other rights holders. You may forward E-News by e-mail an unlimited number of times, provided you do not alter the content in any way and that you include all applicable notices and disclaimers. You may print a single copy of each issue of E-News for your own personal, noncommercial use only, provided you include all applicable notices and disclaimers. Any other use of the content is strictly prohibited without the prior written permission of Midwifery Today, Inc., and any other applicable rights holders.

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