May 14, 1999
Volume 1, Issue 20
Midwifery Today E-News
“Drugs in Labor”
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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Stopwatch
5) Assessing Fetal Response
6) Drug Pushers
7) Question of the Week
8) Switchboard
9) Checking In
10) Midwifery Today Conferences 2000
11) Coming E-News Themes

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1) Quote of the Week:

"When marathon runners hit that 26th mile, they are in excruciating pain. Has anyone said to them, 'Let us give you a spinal block to finish the race'?"

- Gregory White, MD & Mayer Eisenstein, MD in 21st Century Obstetrics Now!, 1977

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2) The Art of Midwifery

For a posterior baby, place a trochanter roll on the bed beneath the place on the spine that corresponds to the iliac crest. The angle of the pelvis increases, therefore increasing hyperextension of the fetal head. This is uncomfortable for the fetus, so he assumes a more comfortable anterior position. Alternate with side lying position at 15 minute intervals (removing the roll) until rotation is complete. This method can be used at any stage of labor.

In transition the method of pushing is contrary to the classical methods. Remove pillows and allow the mother to rear her head back. Legs can either be held up or slightly bent. When rotation occurs classical methods of pushing can be used.

- Clara Yochem Zuxley, RN in Midwifery Today's Tricks of the Trade Volume 1

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3) News Flashes

Caine Derivatives in Epidurals

The Physician's Desk Reference (PDR) states the following about the Caine derivatives used in epidurals: "Local anesthetics rapidly cross the placenta (by passive diffusion) and when used for epidural blocks, anesthesia can cause varying degrees of maternal, fetal and neonatal toxicity. Adverse reactions in the mother and baby involve alteration of the central nervous system, periperal vascular tone and cardiac function."

On average, 70 percent of women receiving an epidural during labor experience side effects. The PDR repeatedly states that "no adequate and well-controlled studies [exist] for use [of these drugs] in pregnant women" and that "it is not known whether [these drugs] can cause fetal harm when administered to a pregnant woman." The brain and heart of an unborn baby during labor are vessel-rich, therefore hypoxemia (inadequate oxygen) and the resulting lactic acid buildup in the fetal blood during labor and birth can increase the uptake of drugs given to the mother by the baby's heart and brain.

- Nancy Griffin, excerpted from "The Epidural Express" in Birthing magazine, Summer 1998

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4) Stopwatch

Resuscitation of drugged newborn infants resulting from central nervous system depression is so commonplace in the United States that such a condition is no longer considered by many to be a cause for alarm. Blue hands and feet are so common among our newborn infants an hour after birth that expectant parents are told such a condition is normal.

I propose the use of a device which I feel could do more to change obstetric care in the United States than forceps or fetal monitors or anything else we have. It is a stopwatch. If we could give every couple who goes into a delivery room a stopwatch, and have the couple announce to the obstetrician during labor that they are going to time how long it takes their newly born baby to breathe and to have pink fingers and toes, I am sure they would get a better baby.

- Doris Haire, The Cultural Unwarping of Childbirth: How Can It Be Accomplished?, 1977

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5) Assessing Fetal Response

Neonatal behavior in a group of infants whose mothers received pethidine (Demerol) during labor was assessed at delivery and during the first six weeks of life by means of the Brazelton Neonatal Behavioural Assessment Scale (BNBAS). Higher cord blood levels of pethidine were associated with babies who were more prone to respiratory difficulties, and drowsy and unresponsive immediately after delivery. Infants of mothers who had had a high total dose of pethidine were likely to spend more time in a cot, and less time held by the mother or father, interacting with the mother or being looked at by her. Throughout the six weeks in which the assessments were made, depressed attention and social responsiveness were found in infants with high drug levels. At three and six weeks, the infant whose exposure to pethidine had been high tended to change state more frequently, to cry during the test and to be less capable of quieting himself.

No relation could be established between performance by the baby in the first hour and the measures of pethidine. This suggests that when the infant is aroused to an optimal alert state by the tester, his orientation skills and tone are not impaired by the degree of medication induced in this study. It has been suggested that birth itself may sufficiently stimulate the infant to cope with events in the first few hours, but that in the following period behavioral organization may temporarily disintegrate. The "drugged" infant would take longer to recover from such disorganization.

Overall the authors conclude that greater exposure to pethidine results in neonatal behavior which is significantly depressed in areas of functioning which might affect the ability of the mother to adjust to her baby in the first few weeks of his life.

- EM Belsey, et al, "The influence of maternal analgesia on neonatal behaviour: 1 Pethidine," British Journal of OB and Gyn, April 1981, Vol. 88

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6) Drug Pushers

In America, women are being arrested and put into jail for taking drugs during their pregnancies and woe betide any woman who has a glass of wine or a cigarette. The whole of American society appears to be prepared to act punitively against any woman who is perceived as putting her baby's life at risk.

No attempt has been made, however, to put into jail the delivery room drug pushers. A woman can spend the whole of her pregnancy not smoking, drinking or taking even so much as an aspirin because she is concerned about the welfare of her baby. If, however, she chooses to give birth in a large, centralised obstetric unit she may well find that she, over a period of a few hours to a couple of days, will have taken more hard drugs than she would have ever been exposed to during the whole of her pregnancy, or indeed her life.

Because these drugs are prescribed by the medical profession, women's desire to protect the health of their baby goes out the window and they happily submit to whatever cocktail the doctors choose to prescribe. And nobody is even slightly concerned about the long term effects. Indeed attempts to discuss the potential side effects are often dismissed or even shouted down by enthusiasts. And heaven forbid we should make women worry.

- Beverley Beech, AIMS Journal Spring 1998

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Learn more from these Midwifery Today issues:
No. 18, The Challenging Birth (Regular price $7.00)
No. 26, Natural Remedies (Regular price: $7.00)
No. 37, Threat of Technology (Regular price: $7.00)
No. 46, Prolonged Labor (Regular price: $10.00)
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7) Question of the Week: What is your favorite technique for educating the public about midwifery and natural birth?
Send your response to:mtensubmit@midwiferytoday.com

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8) Switchboard

I am a CNM with 15 years' experience. I believe that women often give birth as they live. The problem is that we are trying to overcome a lifetime of fears and attitudes in a few months. I work in a community hospital that offers many alternatives to drugs for relief of labor pain, with a low epidural rate. But the majority of our clients still utilize drugs, even if only small doses of Nubain. This bothers me. I believe that my role is to educate and inform, then support a woman's choice, but I feel frustrated that so many choose drugs! They do utilize the birth ball, water, mobility, etc., but still want medication.

Then there are the few who are determined from the first visit to have an epidural, and are unwilling to even try other methods of coping. I feel sad that they have so little faith in their own bodies and the process of birth, but have not found any way to alter this attitude. Part of the problem is that many of these women don't want to alter their attitude, thanks to our pervasive cultural beliefs. Often, these women approach life in the same way, wanting to be numbed from pain and work, or have someone else do it for them.

I try to just let it go and chalk it up to personal preference, but I still have the nagging feeling that I could do more. Does anyone have any suggestions or experience they could share?

- Rose Evans, CNM

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I'm not a midwife but a UK journalist specialising in pregnancy, birth and parenting issues. I really enjoy the newsletter and am happy for any professionals to contact me, especially if they have views on breastfeeding for the book I'm currently working on. How can mothers be encouraged to breastfeed? Rates vary around the world--why? What do midwives do in various countries that is so different and just how can we create a pro-breastfeeding culture?

- Dawn Robinson-Walsh, dawnaur@dircon.co.uk

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Maggie Tisserand's aromatherapy information [Issue 13] may be contraindicated for breastfeeding mothers. Jasmine--the essential oil or even the smell (as delicious as it is)--can cause a mother's milk to dry up. I get this information from Robert and Rhiannin Harris of Essential Oil Research Consultants in Paris. In an informal workshop with them I asked about this specific oil as I am an aspiring midwife. Rhi told us a story of a midwife friend of hers who had a client with a newborn that was not gaining any weight and started to reject the breast because the mother's milk was not letting down. The midwife, in talking with Rhi, had mentioned that a friend of the mother's gave a beautiful jasmine plant as a birth gift. Rhi suggested moving the plant completely out of smelling range.
Within two days the mother's milk let down and baby soon began gaining some weight. Although Maggie Tisserand is a respected professional in the aromatherapy field I have seen and studied Bob and Rhi's work and highly trust their research and input.

Maggie also suggested using jasmine for perineal massage. This may be OK a month before birth, but not at birth. Jasmine would be better in a bath or in the air at this point, though not overwhelming as the newborn will be taking its first breath of this air. Essential oils are very potent and you wouldn't want the baby picking up a large amount as they pass through the vagina during birth. From what I know to be true of essential oils and babies, the oils are much too strong and should be avoided until about 3-4 weeks when liver function has kicked in and it can help the baby expel the essential oil compounds.

Aromatherapy Workbook by Shirley Price says that "for those who have insufficient milk and want to breastfeed, apply one drop of fennel in 10ml/2 teaspoons carrier lotion three times a day to your breast immediately after feeding (not on nipples), to ensure complete penetration before the next feed." For safety the nipples should be washed before feeding to avoid ingestion of any oil. - Debbie Healy

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Radical Midwives Association

http://members.aol.com/flmidwifes/radical/midwives.htm

The Radical Midwives Association discussion list web page, founded in honor of the Association of Radical Midwives of the UK, is a new place where midwives can speak freely about the importance of natural childbirth, challenge the medical model of birth and its consequences to mother and baby, and explore and share evidenced based medicine and midwifery and everyday midwifery concerns. It is a place to teach each other and be free to openly question and query the acceptance of increased intervention in childbirth not only in the hospital but in the home as well.

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Reminder: CIMS Workshop

Learn more about mother-friendly care at this year's ACNM Annual Meeting in Orlando, Florida. On Saturday May 29 from 12:45 to 4:30 p.m. participants in an interactive workshop titled Making Mother Friendly Care a Reality:
Birth Professionals as Agents of Change will receive in depth education on the development of the document, the scientific evidence for each of the ten steps, options for utilization of the document in specific work settings, an overview on the dynamics of change theory and an opportunity to interact and network with other birthing professionals. Cost of the workshop is $45. For more information or to receive a registration form, contact: Donna Haegele at dhaegele@acnm.org or call 202-728-9860.

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9) Checking In

In researching this issue of E-News, I was both overwhelmed by the long lists of side effects that drugs in labor have on both mother and baby, and on the whole surprised by how little passion is given the subject. While much is written about the joys of natural birth, or techniques to use in birth to avoid intervention, or even why to refuse drugs in labor, few authors and practitioners are screaming from the rooftops about the effects of drugs on mothers and babies--and what it means for the future of our world.

So I'm going to list some of the words I've come across that have to do with drugs and labor in hopes the list in its entirety will move some of you to find your vocal cords and start screaming: illiterate, central nervous system depression, mental retardation, delay in respiration, fetal hypoxia, low IQ, cyanosis, prolonged labor, altered neurological development, alteration in sexual behavior, epidemic of learning disorders, asphyxia neonatorum, bardycardia, lowered pH, neurological injury, seizures, incessant crying, depression, flaccidity, death, agitation-hyperirritability, vaginal adenosis, adenocarcinoma, dizziness, disorientation, prolonged labor, respiratory depression, decreased responsiveness, impaired sucking, amphetamine addiction in later life, increased use of instrumental delivery, blurred vision, heart palpitations, prolonged second stage, predisposition to malrotation, hallucinations, suppression of lactation, amnesia, newborn hemorrhage, confusion, changes in blood pressure, drop in body temperature, drug addiction, euphoria, nausea, severe headache, chronic backache, vomiting, slowed digestion, bladder problems, sweating, trembling, tingling and numbness, withdrawal symptoms, reduced uterine activity, elevated temperature, neonatal hypoglycemia, problems with lipid metabolism, postpartum hemorrhage, inhalation of vomited material, poor reflexes, interference with bonding and breastfeeding, low Apgar scores, autism, and on and on and on. Is this birth or a nightmare?

- Cher Mikkola, E-News managing editor

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10). Midwifery Today Conferences 2000

Philadelphia, Pennsylvania USA will be the setting for a domestic conference slated for March 23-27, 2000. One of the highlights will be an entire day focused on midwifery education, with intensives for educators, interactive discussion on the goals of midwifery education, assessing competence, key issues in education, apprenticeship, mentorship, and inquiry-based learning.

A Midwifery Today international conference has been scheduled for Sept. 28 - Oct. 2, 2000 in Aachen, Germany. Plan to meet midwives from all over Europe as we come together to heal our fears and carry midwifery and birthing powerfully into the next century. In addition, we will plan how to keep midwifery an independent and autonomous profession worldwide.

In order to learn from the most experienced teachers, Midwifery Today is searching the world over to find highly experienced midwives who will share their decades of knowledge with you. If you would like to recommend one of these world treasures, please let us know.

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11) 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:

- premature rupture of membranes (May 21)
- doulas (May 28)
- induction (June 4)
- educating the public (June 11)
- episiotomy (June 18)
- Group B Strep (July 9)
- episiotomy
- epidurals
- breastfeeding
- waterbirth
- breech birth
- nutrition
- homebirth

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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