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In This Week's Issue:
1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Let's Talk!
5) Question of the Week
6) Assisting Anterior Rotation During Labor
7) Why Posterior?
8) My Story: Painless OP
10 How I Became a Midwife
12) Coming E-News Themes
1) Quote of the Week:
wise (wo)man does at once what the fool does finally."
2) The Art of Midwifery
For a firm hotpack that holds
heat for a considerable period of time, dampen a folded bath towel, fold
it up in a Chux (waterproof bed pad) and heat in a microwave for approximately
two minutes, turning after one minute. Wrap again in a soft dry towel
or receiving blanket. This can be rolled or folded as needed and is especially
useful for back labor.
- Arlene Settle in Midwifery Today's Tricks of the Trade Volume One, 1996
To ease back labor: The laboring woman positions herself on hands and knees or in any forward leaning position
she finds comfortable. The midwife stands next to her at her waist, facing
away from the woman's head. She puts pressure with the heel of her hand
on the posterior aspect of the sacrum (behind) and applies downward pressure
to the sacrum in the direction that is away from the woman's head. From
a chiropractic and neurological view, this technique is more beneficial
than applying pressure to the sacrum in an upward or directly inward direction
while positioned behind the woman.
- Douglas Carlstrom D.C. in Midwifery Today's Tricks of the Trade Volume One, 1996
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.
Visit Baby T's Gifts for Families! Check out our adorable Birth Shirtificates for your new born babies. Need a fundraiser? We can help - Call 1-800-322-2987
3) News Flashes
Women have commonly been denied trials of labor if their first cesarean
section was performed for failure to progress or for cephalopelvic disproportion,
the most common indications for primary cesarean. In a 1987 study published
in the American Journal of Public Health, the largest percentage of women
attempting vaginal birth after cesarean (VBAC) had cephalopelvic disproportion
or failure to progress cited as the primary indication for their initial
cesarean. Of these women, 65 percent, or almost two-thirds went on to
have normal births; many of the babies were much larger than the baby
for which the original cesarean section had been performed.
- ICAN Clarion, September 1997
4) Let's Talk!
Sixteen hundred of you are now receiving this weekly transmission and
almost one hundred new subscribers join us each week. (Remember to forward
E-News to your friends.) I call that a rich global community of maverick
I love the Internet and the many ways we can use it. One of its major benefits is how quickly information
can be communicated. We at Midwifery Today E-News are trying to find ways
to get all the wonderful experience and ideas you have accumulated over
the months and years out where we can all learn from it.
We would like to pose a question in each week's issue. Let's talk!
Those of you who have a little time to look into your experience or to
pass on your research, please share it with E-News readers by responding
to the question. We are looking for the kind of information you feel would
help other practitioners in their work or in their lives. Moms are invited
to share their knowledge and experience too, though the general emphasis
will be on practitioner oriented information and questions.
For starters, we are repeating a question that appeared in Issue 12 on meconium. Give it some thought,
then please get in touch!
- Jan Tritten, editor
5) Question of the Week: At what rate in your practice do babies pass meconium before birth, not counting breeches? Are your statistics from a homebirth practice or hospital practice? Also tell us how you handle the problem of meconium. Send your response to: email@example.com
See Switchboard below for Ina May Gaskin's statistics from her community, The Farm.
6) Assisting Anterior Rotation During Labor
1. When it is verified that the baby is in a posterior position, the first thing I do is have the
mother assume and maintain a knee-chest position for approximately 45
minutes. Although this position is not the most comfortable one for the
mother, it is very effective as it allows the baby more room in which
to rotate. I find the mother tolerates this position well if she is not
in advanced labor. We make sure that she is well supported by lots of
pillows and give her lots of encouragement and emotional support. Often,
contractions become more regular and more effective while in the knee-chest
position, which also assists the baby's rotation.
2. If the mother cannot tolerate the knee-chest position for as long as necessary to turn the baby, we
alternate by placing her in an exaggerated Sim's position (lying on left
side, two pillows under right knee, which is jack-knifed, left leg straight
out and toward the back).
3. Every effort should be made to avoid rupturing the membranes, as the "pillow" offered by
the forewaters gives a cushion on which the baby's head may spin more
easily. Furthermore, if the waters break before the baby has rotated to
the anterior, it is possible that sudden descent of the fetal skull will
result in a deep transverse arrest.
4. If labor is more advanced when the posterior is identified, say to four to five centimeters, it
may be helpful while the mother is in the knee-chest position for the
attendant to place her hand in the mother's vagina, gently lifting and
somewhat disengaging the head, thus allowing it to turn to anterior.
If the posterior has not been discovered until complete dilation, or if
the other methods have not been applied in early labor, the baby's head
can still be turned to make delivery more likely. With the mother in a
knee-chest position, knees slightly apart, the midwife inserts her hand
into the woman's vagina. She should attempt to lift the head by grasping
it firmly, waiting for a contraction, then turning the baby into an anterior
position. As soon as the head is correctly positioned, hold on tightly.
When the uterus contracts again, urge the mother to push very hard. If
the amniotic sac has not ruptured, do so now. This will assure that the
position remains fixed and the baby will usually be born very rapidly.
This procedure is both safe and sane, yet it must be acknowledged that
it will take some physical strength to turn this recalcitrant little head
against the force of a good contraction.
- Valerie El Halta, excerpted from "Posterior Labor: A Pain in the Back," Midwifery Today Issue No. 36, Winter 1995
Read Valerie El Halta's entire article "Posterior Labor: A Pain in the Back" in Midwifery Today Issue No. 36. Get this back issue for only $6.00 plus shipping (regular price: $7.00). Call 800-743-0974 to order today! Mention code 940 and save $1. Expires April 16, 1999.
7) Why Posterior?
One of the most important lifestyle changes has been the advent of television. This has meant a change from
straight-backed armchairs and sofas to furniture which is designed to
relax in while watching TV. When a pregnant woman sits down in a modern
design armchair or sofa, her pelvis tips backward and so does her "passenger."
To balance her body in this position, the woman has to cross her legs--which
further decreases the amount of space in the front, or anterior part of
her pelvis. Her "passenger" has no alternative but to lie toward
the back or posterior part of her pelvis. If the woman spends a lot of
her time resting in modern furniture during the latter part of her pregnancy,
it is probable that her baby will remain occipito-posterior and enter
the pelvic brim in this position. The same sequence of events can happen
if the woman travels in a car seat, especially if it is a "bucket"
type seat, for long periods at a time.
Another important factor in relation to lifestyle changes is the way women work now and how they did
in the past. In times gone by pregnant women worked physically hard in
the home scrubbing floors on their hands and knees and doing other menial
tasks around the house or farm, which usually meant leaning forward. In
that era also, the importance of correct posture and good deportment was
encouraged. Young women learned to sit upright with their knees together
and to walk with their shoulders straight. All these postures are ideal
for correct alignment of the fetus into the maternal pelvis.
If a woman (primigravida) regularly uses upright and forward leaning postures, particularly during the last
six weeks of her pregnancy (the last 2-3 weeks for a multigravida), her
baby is given an excellent chance of positioning itself into the occipito
anterior position. This is because when the pelvis tilts forward, it allows
more space for the broad biparietal diameter of the fetal head to enter
the pelvic brim. Most of these postures, especially those that are forward
leaning, are positions where a woman's knees are lower than her hips.
Many postures can be incorporated into the woman's daily life; for instance,
TV watching can be accomplished by sitting on a dining room chair or kneeling
on the floor, leaning over a bean bag or a couple of floor cushions. Another
way is to sit on the sofa or armchair but to make sure a firm cushion
is placed under the woman's bottom and lower back so that she is sitting
more upright. When resting or sleeping the woman should make sure she
is lying on her side with pillows behind her back and her top leg resting
forward so that the knee touches the mattress. This ensures that her abdomen
is forward, creating a "hammock" for her baby. An extra cushion
may be needed between the woman's thighs.
- Jean Sutton & Pauline Scott, excerpted from "Understanding
and Teaching Optimal Foetal Positioning" Birth Concepts, 1996
and Teaching Optimal Foetal Positioning" should be required reading
for all birth practitioners. This little booklet is available from Midwifery Today for $12, $4.00 shipping & handling. To obtain a copy, call 1-800-743-0974.
Please mention code 940.
8) My Story: Painless OP
My first child was a persistent occipitoposterior (OP). Of course I didn't know it at the time. I had
a high stress job and was on my feet constantly. Near the end of the pregnancy
I was having to take frequent feet-up breaks to calm an irritable uterus.
My water started leaking when I was 34-35 weeks. It took a couple of hours
for contractions to start. My caregiver didn't seem concerned; he just
told me to call again when contractions were five minutes apart.
My contractions didn't seem to be very difficult and were very irregular.
My husband finally went to bed, tired of waiting for that "magic"
five minutes apart. Contractions would happen every ten minutes followed
by seven minutes followed by five minutes followed by thirteen minutes!
I didn't hurt, just needed to focus and relax and use effleurage. Finally
I got too tired to stay up and went to bed. I instinctively propped myself
up with pillows and often found myself with my fists in the small of my
back. But it still didn't hurt.
About 2 a.m. I got up to use the bathroom and had a whopper contraction.
I tried to lie down on my side afterward, but the next contraction was
a classic double peak and hurt! As soon as I sat up, the pain went away.
The contractions were still not "regular," but after that big
one I decided to awaken my husband. We got going to the hospital at about
3 a.m. I was catching my breath at the peak of contractions. We went up
to the labor and delivery floor only to be told that I could not use the
birthing room because I was too early, and why hadn't I called them to
let them know I was in labor? I coped just fine around the irritating
nurses. I found a bedside table to hang over and was gently pushing. They
didn't like that! They made me lie down for a vaginal exam, and when they
found me fully dilated they began to panic!
My doctor came in just as the nurses were trying to get me to climb up
on a delivery table. They were coming at me with leather restraints and
trying to take my glasses away! I was about to start screaming and fighting
when he calmed everything down, made them take away the straps and gave
me back my glasses. I don't remember any contractions during that time.
Finally I was given the "official" OK to push. I got poor hubby
to lift me up during each contraction since they "couldn't find"
a wedge. I pushed for three hours. Doctor never mentioned OP, thought
I had a "tight" perineum and gave me a pudendal block to relax
it. He was conferring with an OB in the back of the room who was clanging
forceps together when my daughter finally rotated and shot out! She never
fully rotated, but restituted three quarters of the way around. The doctor
cut a massive episiotomy and she was finally born at 7:05 am. The clanging
of the forceps must have scared her out! She weighed six pounds, two ounces
and measured nineteen and a half inches long. She had bruises under her
eyes like a prize fighter for weeks. I never felt pain except for the
one transitional contraction on my side. I never felt the terrible backache
so characteristic of OP. But I had/have a strong feeling that if "they"
had left me alone and let me continue to push upright as I was doing instinctively,
she would have been born hours earlier. Total labor was only twelve and
a half hours, with a four hour second stage. We concluded later that she
must have been OP judging by the rest of the characteristics of the labor.
I find it interesting that because I didn't experience severe back pain
(or much of any pain at all) people have doubted me. Yet this child, now
a young lady of 16, definitely was persistent OP!
- Pamela Golliet, LPN
My son was born eight years ago. He was in the posterior position and we didn't know it until his
head was being born. I had absolutely no back labor at all. After the
birth the attending midwife (a student midwife assisted me with the actual
delivery) said that if she had been doing the delivery she would have
"cut" me when she saw that the baby was posterior. I'm still
confused by this revelation. Why would she have elected to violate my
birth plan and give me a much unwanted episiotomy simply because the baby
was in a posterior position? Is there a protocol for CNMs on this?
This was my first baby and it was estimated just before birth that he
would weigh between five and six pounds. He in fact weighed seven pounds,
seven ounces. I only had two minor external tears that required two and
three stitches respectively. I did perineal massage with sesame oil each
night near the end of the third trimester. I feel very fortunate that
I had the student midwife who decided to take a chance and honor my wishes
to keep my perineum intact.
I'd appreciate any feedback on this. I continue to look forward to each
issue of E-News and I'm learning so much that will help me have an even
better birth experience the second time around.
I am very interested in the
"new discussion" over vaginal delivery after several cesareans.
Do you encourage mothers to try vaginal deliveries after several sections?
In response to the question asked in E-News Issue 12--at what rate do you see meconium in homebirth
or birth center situations? Do you think it differs from the rate it is
seen in hospital births? Why or why not?--Ina May Gaskin reports variations
seen at The Farm in Tennessee. Of the first nine hundred births from which
statistics were kept and which were among Farm residents--relaxed, strong
birthers accompanied by their friends--thirty-seven had evidence of meconium
to any degree, from tea colored amniotic fluid to actual stools, for a
rate of 4.1 percent. During the period when The Farm assisted at the births
of people coming in from the outside for birth and were not residents
of the community, meconium was noted in 156 out of 1,175 births or a 13
percent rate. Stress, or at least uncertainty and unfamiliarity, must
have been a contributing factor.
Obstetrics and the Newborn: An Illustrated Textbook 3rd edition, 1997
states that meconium is passed in 20 to 25 percent of births. Undoubtedly
this statistic is based on hospital births.
10) How I Became a Midwife
In the mid 1970s I lived in Australia. I was visiting at a girlfriend's house (I was about sixteen
then) when some friends also came to visit. The woman had recently given
birth and the baby was only two days old. I had never seen a baby so new
because my mother always stayed in the hospital a week when she had her
babies (children under sixteen weren't allowed to visit back then).
I became absolutely fascinated as the woman proceeded to tell us about
her birthing experience. Her birth at home with a midwife was so natural
and normal. It was completely different from any childbirth story I had
ever heard in the United States. At the end of her story she turned and
looked directly into my eyes and said "If you ever want to do anything
to help women, be a midwife." That's all it took--I was hooked. From
that moment on, I read anything I could get my hands on about childbirth
After moving back to the United States, I eventually got married, gave
birth to five children, and finally pursued my dream. Now I help women
as a homebirth midwife.
- Alison B.
How did you become a midwife? Share your experience with E-News readers around the world. Let's get to know each other! Send your story to: firstname.lastname@example.org.
Thinking about becoming a midwife? PATHS TO BECOMING A MIDWIFE: GETTING AN EDUCATION is the book for you!
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Thank you all for bridging the gap. You have been faithful and true for years. I have greatly appreciated this commitment and love. Blessings to you all.
12) 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:
- infections (April 9)
- education (April 16)
- tear prevention (April 23)
- International Midwives' Day (April 30)
- CIMS (May 7)
- breech birth
- premature rupture of membranes
We look forward to hearing from you very soon! Send your submissions to firstname.lastname@example.org. Some themes will be duplicated over time, so your submission may be filed for later use.
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