|October 1, 1999|
Volume 1, Issue 40
|Midwifery Today E-News|
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In This Week's Issue:
1) Quote of the Week
1) Quote of the Week:
"Our doubts are traitors, and make us lose the good we oft might win, by fearing to attempt."
- William Shakespeare
2) The Art of Midwifery
An interesting article in an old British ob-gyn journal indicated vernix should be left on a newborn rather than washed off because it helps the infant maintain body temperature. Forget the newborn bath!
- Phylis Austin, Midwifery Today Issue 40
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3) News Flashes
Researchers at the University of Texas Southwestern Medical Center reported that a deficiency in short-chain L-3-hydroxyacyl-coenzyme A dehydrogenase (SCHAD) may be responsible for a small portion of otherwise unexplained deaths in children younger than one year old. The researchers studied 150 infant deaths and found the deficiency present in 2% of the cases. A deficiency of SCHAD is a congenital metabolic error that occurs as fatty acids derived from fat stores in the body are metabolized. As a result, fatty acids can enter the liver but cannot generate energy or produce ketones. The brain starves from the deficit of ketones, and the infant becomes comatose.
- JAMA Vol. 2, No. 12, Sept. 22/29, 1999
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4) Question of the Week
What are others doing when a woman has a shallow secondary degree tear, haemostasis has occurred naturally, and the wound edges sit nicely together even with the woman's legs apart?
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In response to Jean (Issue 35) regarding a tilted uterus and ability to get pregnant: Give yourself some time (certainly a year), and don't worry. If you don't feel like having sex sometimes, don't. Many women feel more interested in sex around the time they ovulate. I have heard it recommended that right after sex stay lying on your back with your knees up for around half an hour before getting up. I also have a "tipped womb." Don't know if I'm especially fertile, but the first time I got pregnant on the second month. The second time I got pregnant the very first time, and was feeling morning sickness within a week.
- Susan Hodges
I am not a medical expert nor do I have statistics on this issue, but my mother was diagnosed with a tipped uterus and was told she would probably never be able to have children. She went on to have six (whether she wanted that many or not) without any problems.
- E. Stukel, AAHCC
I teach Natural Family Planning, a method in which a woman charts her cycle and depending on the couple's intention (to avoid or achieve a pregnancy) they either abstain or not. The worst advice I have seen OBs give their patients is to wait until Day 14. If you have a 21 day cycle, you ovulated around Day 7. From the time of ovulation to the time of bright red bleeding (your period) is between 12-16 days (average 14). No matter how long your cycles are, ovulation to period is 12-16 days. Always. So I have had couples who have been told by their doctors to abstain until Day 14, then try every other day after that until the woman gets her period. When a woman recently told me her OB advised this, I asked how long her cycles are. She said 20-21 days. For over a year they have been trying; it does not take Einstein to figure out why she is not getting pregnant.
I am not sure why the medical profession assumes every woman has a 28 day cycle. I have seen a range of 20-45 and these women are all "normal." (This is why the medical profession states that babies are "late" when they really are not. The due dates are calculated as if all women have a 28 day cycle). So after the couple is not able to achieve pregnancy after a year, she is now on Clomid. I asked this woman if any tests were done to determine why she was not getting pregnant (though I knew why), she said no. They just put her on drugs regardless.
It is so frustrating when the medical community uses women as lab rats for the drug companies. It is far easier to write a prescription than it is to take the time to find out what is going on with her body.
Chart your cycle and see where you are at. Keep in mind that being on the pill, Norplant or Depo for an extended amount of time can greatly reduce your chance of achieving. Note I said *can* reduce, not *will*. Why some women on the pill (or any other hormone) for many years get pregnant the first month and other women try years after going off the pill is a mystery. My midwife friend tells her patients that when they take the Depo shots, it could take them over a year to get pregnant after the last shot was administered. When one messes with Mother Nature and how our bodies were designed, infertility can be an outcome.
I have also told women to quit all caffeine, alcohol and processed foods. In addition, after coming together during your most fertile time, prop a pillow under your bottom and keep still for at least a half hour. As well, the book Nutrition, Cycles and Fertility is an excellent resource.
I also have a tilted uterus and am extremely fertile. Two of those pregnancies were for friends who couldn't have children. Because my uterus is tilted toward my back, my cervix is not placed high inside my vagina. It is just barely inside on my anterior wall. Even with my cervix in that position, I have had easy conceptions, healthy pregnancies and delightful births. I hope the following information about myself will be helpful to you.
Position: My conceptions, both natural and artificially inseminated, have occurred when I am upright and active within 30 minutes or so. I don't have any proof that this works except my own pregnancies. When I have tried to become pregnant by making love just prior to sleeping, I didn't conceive. For my artificial inseminations, a latex cap held the semen against the cervix. I removed it four hours after the insemination. This worked on our first month of inseminations with the first surrogate baby. With my second I appeared to have an allergic reaction to the cap during the first and second month of trying. On the third month we just inserted the semen into my vagina, waited 10 minutes, and went home. I got pregnant. With my three natural conceptions I didn't use any device. All three were a result of afternoon or morning love making where I was up and busy within 30 minutes.
Timing: Many women who have difficulty conceiving have an unusual cycle. Their periods may or may not be regular, but they may not ovulate at the "normal" time (14 days after the first day of your menstrual cycle). Three of my pregnancies were accomplished by using an ovulation test kit, which can be bought over the counter. It involves a urine test every day, beginning around Day 11-12 of your cycle. A test reaction (check the directions) indicates a hormone surge that precedes ovulation by 12-36 hours. That is your cue to begin trying to conceive. If this doesn't work within a few months, you can also see a gynecologist/fertility specialist for daily ovarian ultrasounds after the test reacts to pinpoint the day of ovulation.
Frequency of love making: If the male sperm count is low, or has low motility, you may get the best quality semen by making love every other day. If the male does not have count or motility problems, it may be fine to try daily. The sperm are usually alive and active for 24-72 hours after ejaculation. The ovum is viable for up to 3 days as well. So daily love making is not necessary. Also, 40% of infertility is due to male factors. A sperm count and motility test is non-invasive and relatively inexpensive.
Other factors: I have personally found that stress is the greatest inhibitor to conception. It's too easy to get caught up in the mechanics of ovulation and conception. Find your balance, and keep laughing. A sense of humor is the only way to stay sane during conception attempts, pregnancy, and certainly parenting. I also recommend the national infertility support group RESOLVE; contact them at: www.resolve.org
- Candy Hall Brunk
From a few fairly "dry" days post menstruation, you will progress to a couple of very "wet" days mid-cycle. This is a sign that ovulation is imminent. A day or two later you will notice your mucous is like egg white, very thick and stretchy. You may notice a big glob of it when you wipe after going to the toilet. This is fertile mucous. Sperm can live in fertile mucous for up to seven days. If you start having sex when you notice that you are wetter, or by counting the days from your period, you will be more likely to have sperm lying in wait for the ovum to be released. Most eggs are actually fertilized in the fallopian tubes, not the womb itself. Once an ovum is released it only lives for around 36 hours, so to have sperm waiting will increase the chances of fertilization. Some women actually have a physical sensation with ovulation, a sort of low, dull pain. Ovulation alternates between ovaries each month (generally speaking), so the sensation will alternate as well. In our culture we tend to focus on menstruation rather than the monthly cycle which includes ovulation. You can also monitor your basal temperature to recognize ovulation.
For information needed to maximize chances of getting pregnant, I recommend a book that will not cost you thousands of dollars: Taking Charge of Your Fertility by Toni Weschler. It covers every aspect of your cycle, including how to conceive, how to avoid it, health issues, when to get other professional help, and more.
- Jenny Griebenow
My son's foreskin had never retracted and when he started developing at age 12 a paediatrician suggested circumcision to reduce the risk of phimosis. The foreskin was very tight and ballooned a little when my son voided. After referencing many sources I consented, after full consultation with my son. He had been concerned and was keen to have it done. I stress this was with no coercion from me or his father and I made sure he fully understood all about the procedure, risks and aftercare. He has been fine since having it done and had no ill effects.
Now I have read it can take up to 17 years for a foreskin to retract [Issue 37] and I am devastated. Any reassurance anybody? Any further info on 17 year olds having a foreskin retract for the first time with no risk of phimosis?
When I talk about circumcision in my childbirth classes I start out by
I had my latest son circumcised because my husband wanted it done. My son objected to having his legs strapped down and was crying so that he never noticed the needle he was given for the local freezing. The method used was the Plastibell. I stayed with him during the procedure and he sucked unconcernedly on my finger while it was being performed as he couldn't feel a thing. I was instructed to apply an antibiotic ointment to the circ for a few days until the plastic ring came off. He had no noticeable pain upon urination at any time and he never had a problem with inconsolable crying, nursing or anything else that I can see. So circumcision isn't always necessarily the horrible event some people would like to make it out to be.
- Cheryl Grenon
A public health nurse and I got into quite the heated argument about circumcision. She was all for it due to the major infections she saw in her practice. I finally realized that she was part of the problem. I explained that as healthcare workers we need to know how to care for the uncircumcised. I am not sure what the outcome of that was--did she change? Probably not. I did give her some info though. I think we all need to be sure our women know all about the why's and why not's and what to do when you decide to leave your babe alone.
- Kelley Thomas-Hill CD
While most circumcisions are not done for medical reasons, some are. My husband had to be circumcised at 34 years old because his foreskin was too tight and tore and bled profusely after sex. His father and cousins all had the same thing. My son was lucky enough to be born missing 50% of his foreskin. Had he been born with an intact foreskin I would have had to choose between not circumcising him and letting him experience what my husband did or circumcising him and having to put up with all the circ. bashing out there. Nothing is ever black and white and most people are only trying to do what is best for their children.
- Sara Mills
I am disappointed at this jab at Jewish circumcision. Circumcision, *as it is practiced today,* is a sacred commandment of the Jews. The rabbis of the past are held in very high esteem by religious Jews and are believed to have been divinely inspired. I have read studies that show that circumcisions performed by mohels are practically painless. The woman whose letter you printed is a rare exception to the rule.
I agree that routine medical circumcision is unnecessary and perhaps cruel, but bris milah is an entirely different thing. Even if you disagree with me, I still think it would have been very possible to publish an article on circumcision that politely avoided the religious issue.
Editor's note: The article excerpt included in E-News was by no stretch of the imagination meant as a jab at Jewish holy law. It was only intended as a bit of historical explanation as to why so much foreskin is removed today. I found it interesting, compassionate and a relief to read that all that was originally intended was for the mohel to excise only a small part of the foreskin. I wonder why so much continues to be cut to this day. The author of the article (printed in Midwifery Today Issue 17) prefaced her writing with this note: "I am not trying to convince Orthodox Jews not to circumcise. I am trying to show that circumcision can be done in a much less radical and painful way and still fulfill religious obligations."
Regarding Sandra's enquiry about the use of goat milk instead of formula: Goat milk, if it is prepared as a commercial formula specifically for infants, can be used for a newborn very satisfactorily. However, plain goat milk is not considered suitable for newborns as it lacks sufficient folic acid. The protein in goat milk is similar to that in cow milk, and may or may not be just as difficult for a highly allergic child as cow milk. It depends on what the child is sensitive to. A trial would be needed to check this out.
My cousin was born about 21 years ago with severe allergies to almost everything. His mother was on many different medications and couldn't or didn't want to nurse him. The only food he could tolerate was fresh goat milk. I have heard that it is the closest thing to mother's milk.
Goat milk is *not* similar to human milk. If goat milk was modified in a "formula" to be like human milk, then it wouldn't be much different than cow milk formula.
- Jill Lund, RD, MS
Goat milk is for kids, but not of the human species! Compared to human milk, goat milk has less energy, due to its lower fat and carbohydrate content. It's too high in protein to be appropriate for a newborn's renal system (two and a half times the protein of human milk) and too low in carbohydrate (about 60% of the amount in human milk). Goat milk has four times the calcium content of human milk, again a problem for infant kidneys, two thirds the iron, more Vitamin A and thiamine but much less riboflavin, niacin and Vitamin C.
The table I am citing (Handbook of Dairy Products, from the Norwegian dairy association, and yes, they include nutritional info on "women's milk" along with cow and goat milk in their table) doesn't have information on folic acid, but I seem to remember from my maternal-child nutrition course in about 1980 that goat milk is very low in folic acid as well. From the same table, one can see that cow milk and goat milk are much more similar than either one is to human milk. I hope this doesn't surprise anyone now working as a midwife!
Greetings from Norway, where the value of breastmilk is calculated into the GNP,
My midwife is open to the idea of a home VBAC, and I have instigated a change in the benefits policy of my employer to cover homebirths in the benefits package. Now my next and it seems most important task is to find a OBGYN who will act as a backup in the event I need to be transported to the hospital. It seems pretty daunting in my beyond conservative, hospital congested city. Any Internet resources that might give me some leads into finding the right OBGYN would be fabulous. Any ideas?
Saludos de Mexico! I am an aspiring midwife and would love to be in touch with others, aspiring, or otherwise, also located in Mexico. Les mando un abrazo caluroso,
6) Classified Advertising
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7) 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:
- Vitamin K (Oct. 8)
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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