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Broaden your education in Jamaica and Philadelphia, Pennsylvania!
Make plans now to attend one or both these conferences:
Ocho Rios, Jamaica, December 2-6, 1999
Birth Without Borders--Weaving a Global Future
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Look for the link on the homepage.
- Mothering magazine: Mothering is in its 24th year of providing inspiration for attachment parenting. Mothering guides, nurtures, and supports while providing the latest on controversial parenting topics.
- Cascade Health Care: Cascade HealthCare Products, Inc. began business in 1979 with the primary goal to provide supplies and equipment for the emerging profession of midwifery. We have developed a complete product line that not only serves midwives, but nurse midwives, childbirth educators, lactation consultants, visiting nurses, birth centers, WIC programs, nurse practitioners, doulas, and professionals dealing with expectant parents, families and women's healthcare.
* Philadelphia, Pennsylvania,
March 23-27, 2000
Mainstreaming the Midwifery Model
This conference highlights the many educational paths to midwifery. Students and
educators, plan to attend the day-long education day seminar on the pre-conference
day and choose the education track of classes during the regular conference.
Our only U.S. conference in 2000!
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In This Week's Issue:
1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Question of the Week
5) Question of the Week Responses
6) Gestational Diabetes: Brief Background
7) My Own Experience with Gestational Diabetes
9) Midwifery Today Conference Notes
1) Quote of the Week:
"You don't drown by falling in the water; you drown by staying there."
- Edwin Louis Cole
2) The Art of Midwifery
For the woman who is already vomiting and acting transitional before 7 cm, administer some kind of salty soup or broth such as chicken bouillon or miso, to sip between contractions. A half cup is usually enough to stop the vomiting.
- Wisdom of the Midwives, Tricks of the Trade Vol. Two, a Midwifery Today Book, 1997
Midwifery Today magazine's Tricks of the Trade column has kept practitioners informed for years. Join the forum by subscribing to the magazine! Mention code 940 and receive $5.00 off a one-year subscription. Call 1-800-743-0974 to order. Offer expires Dec. 3, 1999.
Share your midwifery arts with E-News readers! Send your favorite tricks to email@example.com
3) News Flashes
Peak alcohol levels in breastmilk occur 30 to 60 minutes after ingestion on
an empty stomach and 60 to 90 minutes when taken with food. The alcohol content
of breastmilk falls as the blood alcohol level falls due to retrograde diffusion
of alcohol from the milk back to the bloodstream. Emptying the breast ("pumping
and dumping") does not increase the speed of elimination of alcohol either from
the milk or from the body as a whole. Alcohol imparts a detectible odor to breastmilk,
which apparently stimulates sucking initially. However, only one drink taken just
before nursing has the net effect of decreasing milk intake by almost one-fourth
during the nursing session.
- Journal of Human Lactation, Dec. 1995
4) Question of the Week
I am concerned about the safety of the Rhogam injection, most especially when given during pregnancy.
I have no information that makes me concerned, I guess it's just my natural way
of questioning *any* kind of injection or intervention. Does anyone know of a
reason why we as midwives/moms should be concerned?
- Elaine Friesen
Send your responses to
5) Question of the Week
Q: If you have any new insights or information about gestational diabetes, please share it with E-News readers.
With my first pregnancy I had symptoms of gestational diabetes in my last 5 weeks of pregnancy. I was placed on a diabetic diet and monitored my blood sugar levels at home. I found the diet strange and difficult, but followed it. I gained 35 lbs on my 5' 1" frame, and did not exercise. My son was born 11 days early after a drugged labor, was 7 lbs. 4 oz., and had multiple health problems. He was recently diagnosed with learning disabilities and ADHD.
During my next full term pregnancy I followed the Brewer diet, ate a well balanced and varied diet, and
exercised regularly. I gained exactly the same amount of weight, was regulary
tested for gestational diabetes, but all tests were within normal limits, and
I remained very healthy. My second son was born exactly on his due date after
a natural labor, weighed 8 lbs. 14 oz., was extremely healthy, and continues to
The only difference between the two pregnancies was diet, exercise, a midwife, and education.
- Amy V. Haas, AAHCC
Q: I would like to know how to treat pregnancy induced carpal tunnel and what causes some pregnant women
to get it.
I've found that many people, myself included, have had relief from carpal tunnel by doing the "crunchy" style
sit ups that have the person keep their lower back flat on the floor the whole
time the exercise is being done, with their arms folded across their chests. The
exercise is done straight up toward bent knees as well as toward the sides (right
elbow toward left knee, and vice versa). It should be done slowly, coming up to
a slow count of five, holding it to a slow count of five, and going back down
to a slow count of five, sitting up to the center. Each side is considered one
set. Doing three sets twice a day is what seems to help the most. The woman should
not remain on her back, but get up after she's finished each set. This seems to
stretch the upper back and has brought relief to many women. Maybe it relieves
pressure on the brachial plexus; I don't know.
- Debby S.
I am a hand surgeon. My fiance is a homebirth midwife and asked me to respond. One must first confirm
the diagnosis of carpal tunnel syndrome. Not all numbness or pain is indeed carpal
tunnel syndrome. The diagnosis is usually confirmed by the history and physical
exam. Occasionally, a nerve test may be required. Treatment may depend on whether
the symptoms are only at night or occur during the day with activities. If only
at night, a splint and anti-inflammatory medication may be helpful. One should
avoid anti-inflammatory medication during the first trimester. If symptoms occur
during the day, the best initial treatment is often an injection into the carpal
tunnel with a steroid preparation (I use depomedrol combined with lidocaine).
The injection is minimally painful (really !) and often can eliminate the symptoms
entirely. The steroid is a very small dose and given once has effectively no side
effects or risks. Most of the time, but not all the time, the symptoms will go
away after the person delivers. Occasionally, the symptoms persist and further
treatment, even surgery may be required. One should therefore try to delay surgical
treatment until after delivery since surgery may not be necessary. This response
is general information--you should consult your doctor for specifics for yourself.
When pregnant moms come into my store/office and mention the problem of their wrist hurting, I ask them
if they want to try a magnetic wrist band. They have all been very surprised when
it doesn't hurt anymore within 10-15 minutes. But remember, magnetic therapy products
are not all created equal. I only use the big name from Japan!
- PJ Jacobsen, IBCLC
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6) Gestational Diabetes: Brief Background
In 1964 O'Sullivan and Mahan reported that pregnant women with glucose values at the upper end of the
spectrum were more likely to develop diabetes later in life; the added stress
of pregnancy revealed a woman's "predaibetic' status. Since diabetes was known
to pose serious threats to the fetus, researchers extrapolated that subdiabetic
levels of glucose intolerance during pregnancy might also do harm.
During the 1960s and 1970s doctors began studying the effects of glucose intolerance in pregnant women; however,
the studies were poorly designed [and] thoroughly obscured the true risk of subdiabetic
glucose intolerance in pregnancy. Results convinced researchers that they had
discovered a serious problem, and in 1979 they convened the first of what became
a series of exponentially larger international conferences.
Opening the first conference, one of the organizers suggested that pregnancy be viewed as a "tissue culture
experience." Given the preconceived notions of the researchers, the confused state
of the research and a metaphor that reduced women to incubators supplying potentially
faulty growth medium, it should come as no surprise that by the end of the second
conference, gestational diabetes (GD) was established as a new disease. It was
officially defined as: "carbohydate intolerance of variable severity with onset
or first recognition during the present pregnancy--irrespective of whether or
not insulin is used for treatment or the condition persists after pregnancy. [It
includes] the possibility that the glucose intolerance may have antedated the
pregnancy." (Second International Workshop-Conference 1985)
Thus, women with blood glucose values in roughly the upper 3% for pregnant women have come to be defined
as diabetics, although the situation is different from either type of true diabetes.
The only problem GD shares with Type I and Type II diabetes is that chronic hyperglycemia
can overfeed the fetus, resulting in macrosomia . Even here, other factors-race,
age, parity and especially maternal weight far outweigh glucose intolerance in
determining the baby's weight.
The conference definition
of GD confuses more than it enlightens because it jumbles together various levels
of severity. This is similar to claiming that everyone with a cough and fever
has pneumonia. The confusion was deliberate. The conferees considered using the
term "glucose intolerance of pregnancy" but decided on "diabetes" to make sure
insurance companies would pay for high-risk management and women themselves would
take the condition seriously.
The 1985 conference recommended-and the 1990 conference reaffirmed-that all pregnant women be screened for GD between
24 and 28 weeks by a 50 g glucose drink and that those with values of 140 mg/dl
or above be given a diagnostic 100-g oral glucose tolerance test (OGTT). Women
with two values meeting or exceeding O'Sullivan and Mahan's values on the follow-up
OGTT should be considered to have gestational diabetes. The American Diabetes
Association endorsed the conference recommendations. The American College of Obstetricians
and Gynecologists recommends the same screening and diagnostic values; however,
it recommends selected screening only for women under age 30.
Keep in mind that O'Sullivan and Mahan chose their cutoffs for convenience in follow-up. No threshold has ever
been demonstrated for onset or marked increase in fetal complications below levels
diagnostic of diabetes. Instead of raising questions about the validity of GD
testing, this lack of correlation with complications has led some researchers
to lobby for a lowering of diagnostic thresholds, which would label even more
women gestational diabetics.
- Henci Goer, Obstetic Myths Versus research Realities, A Guide to the Medical
Literature, Bergin & Garvey 1995
7) My Own Experience with
by Leilah McCracken firstname.lastname@example.org
Early in the third trimester of the pregnancy of my third child, I was diagnosed with gestational diabetes. But the diagnosis was a sham.
Three days before my diagnosis, I had a cooking accident--I sliced my hand open on a can lid. It was determined
that I had severed some major tendons, and would need microsurgery to mend them.
I was given a tetanus shot because of the can (I was assured the shot was safe),
hooked up to a fasting IV, wheeled to a ward, and proceeded to wait two days for
Those days were terrible. I was in incredible pain from the accident; I was afraid; I was lonely for my
children and worried about them needing me. I was ravenous, and I couldn't sleep
at all. The stress was incredible. Finally my turn came. I was wheeled to OR and
given a local anesthetic. Ironically, my family doctor phoned during the almost
three hour surgery. She said my one hour glucose tolerance test result was high
and I would need a three hour test. I told the surgeon to tell her I'd get one
right away. I packed my bags and left soon after the surgery was done.
First thing I did when I got home was eat lots of burgers and fries, then sent my husband out for a big
birthday cake (and lots of Coke).
I phoned the lab for instructions
on how to take the test (my doctor had called them and said I'd be coming). They
told me not to eat after 6 pm. Easy enough, so the morning after my surgery, I
had a three hour glucose tolerance test. And no one even asked me why I had a
cast on my arm! After the first three numbers were determined to be high (they
weren't *that* high), I was said to have gestational diabetes.
In learned retrospect, the diagnosis was a joke: the stress, the fasting, the junk food gorging, maybe
even the tetanus shot all contributed to my elevated blood sugar levels the day
of the test. There can be no other answer, because I have no contributing risk
factors, and in all my pregnancies before or since (seven), gestational diabetes
has never been an issue.
I learned a lot from the experience, but the burden I carried because of that diagnosis still haunts me.
I had been given a barrage of ultrasounds; I had to restrict food intake to the
point that I lost weight, and ended the pregnancy nine pounds lighter than I started.
I wasted precious time and resources constantly transporting to a vast number
of diabetes clinic appointments (and to the hand clinic and my family MD too).
The testing equipment was expensive, and taking my blood sugar up to seven times
a day was painful and awkward. I was also considered very high risk in subsequent
pregnancies and was obstetrically managed accordingly.
Gestational diabetes does indeed exist, but one has to wonder how many women are misdiagnosed and suffer
because of it. I think if women were offered optimal nutritional counseling in pregnancy, positive test results would be very, very rare. But I suppose it's
just quicker and easier for physicians to test for a condition rather than work
toward its prevention.
[Long-time natural birth activist] Henny Ligtermoet is dying of cancer. She is in Albany in Western Australia
and hasn't very long to live. Please send her Reiki, light, prayers or good vibes,
according to your beliefs. She needs help to be calm and accept death and her
Passing Over to a new life.
- Mary Murphy, midwife
Perth, Western Australia
In response to the issue
of a black midwives' forum [Issues 45 & 46]:
Midwifery Today has always attempted to give away a scholarship to a promising
aspiring midwife of color because there are not enough non-Caucasian midwives
coming up to serve women. At our midwifery meetings, there is a great lack of
Factors within our culture are keeping the stream of aspiring midwives from being diverse. Racism is real.
I think as midwives we need to do all we can to nurture women from all backgrounds
to come into this wonderful calling. The U.S. needs midwives from as many backgrounds
as are represented in this beautiful tapestry of people we are blessed to have
living here. When no Caucasian midwives were practicing, black granny midwives
and Mexican American midwives were practicing all over the South. They were persecuted
later than others because they were taking care of the poor that no doctors wanted.
It's to our advantage to take great pride in our diversity and nurture all midwives. I don't think it
means disunity when midwives of color, Christian midwives or lesbian midwives
want to meet within larger groups. Each group has issues to discuss that are unique
to them. It doesn't mean they are pulling away from being midwives united in our
- Jan Tritten
1. Read and encourage your clients to read Henci Goer's new book The Thinking Woman's Guide to a Better
Birth. This book may be the key to turning around the way women (in the U.S. in
particular) give birth. It is easy to read, is affordable and packed with the
evidence and research that would be very hard for doctors/hospital policy makers
to argue with. It may be the most empowering tool women have had in the last 60
years. Her other book, Obstetric Myths Versus Research Realities, contains most
of what we need to know in one volume. Let's all try to get "Better Birth" into
our local library systems.
2. My supplier of "birth balls" has stopped providing them. I was able to sell heavy gauge 55-65cm vinyl
balls for $15.00 to my clients. They weren't as heavy duty as the $30 phys. therapy
balls but served their purpose very well! Most of my clients cannot afford more
but would like the benefits of using the ball in labor. Does anyone out there
have a supplier I can buy from? I hate to send them to a physical therapy retail
- Jeanne Batacan
Reply to: email@example.com
In response to the inquiry about a healthy alternative to breastmilk [Issue 46]:
My chiropractor recommended goat milk because it most resembles breastmilk. You also add molasses for iron and brewer's yeast to help digest the milk since it isn't breastmilk. It comes in powdered form at most health food stores. One drawback: when the baby spits up it smells awful!
- Tendai Phiri
There is a recipe for "Canned Milk Formula" in Varney's Midwifery, 3rd edition. This is what my mother fed me after weaning me at four months old. I have heard that it can be made with fresh or condensed goat milk. Some recommend adding infant vitamins to this regimen.
I don't remember where I found this recipe. It is to be made fresh daily: Mix equal parts whole grains:
oats, barley, wheat, millet, buckwheat, rye, flax seeds, brown rice Use 2 Tablespoons
(or 3 depending on grain mixture) per quart cold water Cook slowly in covered
stainless steel or glass pan for 1 1/2 hours Drain cereal through two layers cheesecloth
while hot and retain liquid Use equal amounts grain liquid and cow or goat milk
(I guess you could also use soy?) Add 1/4 teaspoon orange or lemon juice
Once a day add 1/8 teaspoon vitamin C and 1/4 teaspoon brewer's yeast per bottle
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9) Midwifery Today Conference Notes
Philadelphian Birth Enthusiasts!
If you are interested in bringing Midwifery Today Conference flyers to a meeting with LLL Leaders, CBEs, nurses, doulas, doctors, parents, etc. contact:
Mothering Mommies Doula Service
4548 Market Street
Philadelphia, PA 19139
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Midwifery Today: Each One Teach One!