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Take the opportunity to sound off at the Midwifery Today conference in Austin, Texas, March 4-8, 1999. A general session titled "Let's Talk Controversies in Midwifery!" invites you to talk about breech birth, among many other things. The conference is a great way to learn from other practitioners, and for them to learn from you. It's our only U.S. conference in 1999!
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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.
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In This Week's Issue:

1) Quote of the Week
2) See You in the Village!
3) The Art of Midwifery
4) News Flashes
5) Some Reasons for Breech Presentation
6) Breech Delivery: Note the Time
7) Abstract
8) Switchboard
9) Letters
10) Coming Themes
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1) Quote of the Week: "Sometimes you just have to stand up and take back what's rightfully yours." -Judy Edmunds, midwife
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2) See You in the Village! -by Jan Tritten, editor

Midwifery Today turned thirteen years old on February 3. The concept for the magazine came to me while I was trying to write a book on the preceding ten years of my homebirth practice. As the years pass and we continue with this endeavor in new ways, I feel more and more like an overseer and visionary at Midwifery Today, while much of the writing, editing and organization of our efforts is carried out by staff and by colleagues in the birthing community. We are, as always, a forum for the many ideas and techniques having to do with birth, and invite everyone to participate.

From the very beginning the effort was a community one: we declared it to be "of the midwives, by the midwives and for the midwives." We define midwife broadly as anyone "with woman" who loves and cares for birthing women whether she is a doula, midwife, nurse, childbirth educator or doctor. Midwifery is a lifestyle, thought process and mode of caring, among many other things.

As I look at how far we have come in the past thirteen years and where we are going, I am in awe. As someone who continually cautions against the use of technology in birth, I am in awe of what other kinds of technology can do to help women have safe, natural births. I'm talking about the kind of technology that allows us to communicate in email newsletters, at websites, bulletin boards and in chat rooms. This instant communication allows us to create a birth and midwifery village where the power of networking unites us and our efforts, and fends off the forces that would alienate us from one another. This is a whole new way of building and maintaining community and strengthening our professions.

By subscribing to this newsletter you have become a citizen of our birth village. You are a permanent resident whereas those who occasionally visit the website are like vacationers in the village. All are important, but you are key.

I envision this village to be something we are building together. The website we have maintained for the past five years laid the foundation; now I see E-News as the first structure in our new community, the meeting house where we convene each week. But a community needs more than a meeting hall to function well. We are in the early stages of building the community. How will it look? Think of Midwifery Today's time-honed style of communication. What are the components, the buildings and huts? Think of all the ways we can communicate electronically through Midwifery Today. What will comprise our constitution in this new community? Our mingled philosophies, ideas and ways of getting along.

I have had a great time communicating with some of you as you email your concerns and ideas to us. We are trying to develop the best ways to make Midwifery Today a "watering hole" that serves you well. I would love to hear your ideas on what you would like in your village. Bulletin boards and chats are planned in the future. What are your major concerns? What should be on them? I would like to see our first chat look like a tricks of the trade circle, the kind we do at all our conferences. I'll share more of my ideas with you as time goes on and we'll keep you posted about new developments, but for now I would love to hear your visions of the village. This is your community and we want to make it one that works well for you. Thanks for joining! See you in the village.

Write to us at: mtensubmit@midwiferytoday.com
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3) The Art of Midwifery

Breech with an extended head: When the hanging of the baby's body does not bring the nape of the neck and the hairline into view, the baby's head is probably extended. Lay the baby with legs astride the midwife's arm so his bottom sits in the crook of her arm. Her first and third fingers are placed on the baby's cheekbones with her second finger placed well back in the baby's mouth to aid with flexion. The midwife's dominant hand is then used to hook two fingers over each side of the baby's shoulder and she pulls in a downward direction. This is the Mauriceau-Smellie-Veit grip. -Maggie Banks, "Breech Birth Woman-Wise"

Breech baby: The newborn baby who has been in a breech position for a prolonged period may be unable to relax his legs down flat in the first few hours after birth due to the tightness of tendons and muscles. It will especially be so where his legs have been extended. His legs should not be forced down by diapers or swaddling but be allowed to straighten themselves as his movement releases the tightness in his hamstrings. -Maggie Banks, "Breech Birth Woman-Wise"

I do not advocate the squatting position for breech delivery for four very important reasons: 1) I do not want the birth to happen quickly. Head decompression can lead to subdural hemorrhage. 2) Squatting may cause the baby's arms to be swept up over its head, further complicating the delivery, and possibly causing Erb's paralysis during the extraction of the arms. 3) The baby's body hangs straight down, causing an almost military emergence of the head, which exerts undue pressure on the base of the baby's neck, and increases the risk of spinal cord damage. 4) The mother's perineum will tear at a much higher rate. -Valerie El Halta

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.
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4) News Flashes

No Increased Risk
A study of 1,240 singleton breech infants delivered at northern California Kaiser Permanente Medical Care Program hospitals between 1976 and 1977 has indicated that routine cesarean delivery of all breech fetuses is not necessary to prevent adverse morbid events in the breech infant or child. In order to qualify for the study, the infants had to have weighed at least 1,000 grams. Neurologic sequelae were considered up to four years of age. The study concluded that vaginally born breech infants were not at increased risk for asphyxia, head trauma, cerebral palsy or developmental delay. -Obstetrics and Gynecology, May 1990.

Vaginal Breech Birth Compares Well
A Swedish study of 6,542 singleton fetuses born in the breech presentation was made to compare intrapartum related infant mortality in term breech presentations in terms of vaginal delivery or delivery by cesarean section. The main outcome measures were intrapartum and early neonatal deaths, stillbirths and congenital malformations, low Apgar scores, and mode of delivery. The intrapartum and early neonatal mortality rate was two per 2,248 (0.09 percent) in the group delivered vaginally and two per 4,029 (0.05 percent) in the group delivered by cesarean section. The relative risk was 1.81, thus the difference was not statistically significant. Authors of the study concluded that the intrapartum related mortality in the group delivered vaginally was low and the result could not verify an increased mortality in term breech presentations delivered vaginally compared with those delivered by cesarean section. -MIDIRS, March 1998
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5) Some Reasons for Breech Presentation

Prematurity: The greatest incidence of breech presentations occurs with women who labor and give birth before the baby is at term.

Uterine septum: The uterus may be divided along its whole or partial length by a septum, which gives the baby less room to turn to the cephalic presentation.

Uterine growths: Tumors or fibroids that are low in the pelvis may prevent a baby from assuming a cephalic presentation.

Position of placenta: If the placenta is very low or previa, the baby has more room only by turning to a breech position.

Shape or size of the pelvis: An oval or shallow pelvis can lead to a breech presentation. Poor healing of a pelvic injury or malnutrition in childhood can leave a misshapen pelvis. Rising estrogen levels causes faster bone production and narrowing of the growth plates of bone, including the pelvis. The use of oral contraceptive pills shortens the period of estrogen fluctuation during the menstrual cycle, and in adolescence, this can result in restricting the normal growth and size of the pelvic cavity.

Multiple pregnancy: Approximately 40 percent of twin pregnancies will see one baby presenting breech.

Polyhydramnios: When there is an excess of amniotic fluid, the baby may have more room to move in a less confined space.

Muscle tone: The strength of the woman's abdominal muscles helps maintain the baby's position. Weakened muscles may be unable to keep the baby in a head down position. On the other hand, very tight muscles may prevent a breech baby from turning.

Emotional factors: Does the baby need to be noticed by a busy mother? Is the mother excessively fearful of a breech?

Congenital abnormality of the baby: This occurs in 6.3 percent of breech births as compared to 2.4 percent of non-breech births. The breech presentation may be due to the baby's diminished muscle tone, abnormalities of the skull, congenital dislocation of the hip joint or a reduced amniotic fluid volume. Any combination of these factors may result in a reduction in the baby's ability to move from a breech to a cephalic presentation. -"Breech Birth Woman-Wise" by Maggie Banks, Birthspirit Books, New Zealand, 1998
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6) Breech Delivery: Note the Time

At the point of "rumping" in a breech birth (analogous to crowning if the baby is vertex) it is worth noting the time because this is when the oxygen is cut off, not for the mistaken reason given in textbooks that baby's head compresses the cord against mother's bony pelvis, but for the obvious and realistic reason that the uterus contracts and shrinks down behind the descending baby, and in doing so it cuts off the maternal blood supply to the placenta. This cutting off of baby's oxygen is often signaled by a sudden slowing of baby's heart rate to well below 100, not because of anoxia (it happens well before baby starts going blue), but an automatic reflex slowing in order to conserve the oxygen in baby's system. (The same slowing is often noticed with crowning in a vertex birth; it is of no significance then, because the birth will be completed within a minute or two.) But in a breech, you need to contemplate that within 30 minutes at the very most, or within 15 to 20 minutes at the least, baby will be in trouble with anoxia. But as the body descends, you can usually count on completing the birth within the very safe limit of ten minutes.

It is good to help the body descend if you think it needs help, but do it gently and slowly, no faster than it naturally wants to come. The temptation is to snatch baby out of danger, but if you pull baby away from the contracting uterus, then the arms go up and the head extends, and then you are in very deep trouble. -John Stevenson, MD, Midwifery Today Issue No. 26

For information on how to subscribe to MIDWIFERY TODAY, our quarterly print publication, send your name, postal address and phone number to: inquiries@midwiferytoday.com. Please mention Code 940.
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7) Abstract

Prior to the thirty-second week of pregnancy, the incidence of breech presentation may be as high as 50 percent. The majority of the earlier breech presentations spontaneously convert to the vertex position. By 40 weeks gestation, study estimations of the prevalence of the breech presentation vary from 3.0 percent to 3.5 percent.

The objective of the study was to evaluate the effectiveness of hypnosis to convert a breech presentation to a vertex presentation. One hundred pregnant women whose fetuses were in breech position at 37 to 40 weeks gestation were matched with a comparison group with similar obstetrical and sociodemographic parameters from the same time period and geographical areas.

The intervention group received hypnosis with suggestions for general relaxation with release of fear and anxiety. While in the hypnotic state, the women were asked the reasons why their baby was in the breech position. As much hypnosis was provided as was convenient and possible for the women.

In the 100 cases studied, 81 percent of the fetuses in the intervention group converted to vertex presentation compared with 48 percent of those in the comparison group, which had received standard obstetrical care. The author concludes that motivated subjects can be influenced by a skilled hypnotherapist. -Mehl, Lewis, MD, PhD, "Hypnosis and conversion of the breech to the vertex presentation," Arch Fam Med, 1994; 3:881-887.
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Learn more about
breech birth and other complications from Midwifery Today conference audio tapes! Visit our web site for more information, or email inquiries@midwiferytoday.com. Please mention Code 940.

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8) Switchboard

I do not have any scientific research to share with you [on the use of vitamin B6 for nausea during pregnancy]; however, I do have a testimony or two. I am currently 18 weeks pregnant. My sixth through twelfth week were a blur of nausea--until I found out about vitamin B6, ginger and red raspberry leaf. I took a supplement called "Good Morning" made by the Solaray company. It contains 25 mg vitamin B-6, 325 mg ginger root and 325 mg red raspberry leaf. I highly recommend this supplement and have recommended it to many. A friend of a friend started taking it and was finally able to eat and function normally.
Jodie Minniear, C.D. DONA
Certified Doula
Indianapolis, Indiana

Dear Amy,
I am fascinated by your suggestion [in E-News Issue 5] that women use Brewer's yeast [for nausea during pregnancy]. I have heard that it tastes awful and I was wondering how a nauseated mother is able to tolerate it. How can you take it so that it is not so offensive?
Cindy Schierlinger, Bradley Instructor
Florida

I've always taken it in tablet form (10-grain tablets). They're tasteless and odorless with no "after effects."
Amy
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9) Letters

I so look forward to receiving Midwifery Today E-News each week and always forward it on to six sister midwifery students of mine. Keep up the great work!
In peace,
Vanessa Ross

I am pleased; this is all very interesting. I am studying to be a doula right now, and I like all the good information this opens me to. Thanks.
Alicia
B.C.

Thanks for the great "e-letters" each week. I save them and would like to have a means to reference them by topic. It would be helpful if your "subject" would include not only the date of the submission but also the subject matter, i.e. "VBACs," so that when I want to look up that subject in my files at a later date I will know where to look.
Donna, RN, CE
Florida

Editor's note: We decided to list the theme of each issue at the very top of the newsletter, right under the issue number and the date. Issues will not always be themed, however, so readers, if we don't name an issue at the top, it's a mixed bag.

I am so excited to have been receiving E-News from the very beginning. Like Cynthia M. (Issue No. 5), I am a doula and student midwife. I am located in a county where the last birthing center closed last year, and the midwives remaining have scattered to hospitals. Homebirth is a dirty word here. Your newsletter and the letters from readers are a cold drink of water in the desert. I would love to correspond with Cynthia and other aspiring midwives (email address is: doulasue@iVillage.com). Keep up the good work--you are appreciated.
Susan
Florida

Thank you so much for my first copy of your newsletter. How can I make sure I continue to receive it? I couldn't agree more with all the positive comments. It IS excellent!! I would be honored to have my most recent video 'Si! Se Puede' reviewed.
Linda B. Jenkins, RN, BSN, PHN, ACCE

Editor's note: Staff may be taking a look at Linda's video soon. And in answer to your question about receiving the newsletter, only one sign-up does it!
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10) 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:

-smoking and pregnancy
-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.

This publication and any information provided are not intended to constitute the practice of, or furnishing of, medical, nursing or professional health care advice, diagnosis, consultation, treatment or services in any jurisdiction. 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.

Copyright Notice

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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Midwifery Today: Each One Teach One!