December 31, 1999
Volume 1, Issue 53
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**This issue of Midwifery Today E-News is dedicated to Henny Ligtermoet, who passed away at her home in Western Australia yesterday morning, Dec. 30. Henny was a loved and renowned fighter and crusader for the homebirth movement and the simple right of women to be well informed about birth options. She was a beacon of light around the world, and we cherish the legacy she left. Thank you, Henny.**

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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) For the New Year: Uplifting Excerpts
5) Check It Out!
6) Question of the Week
7) Question of the Week Responses
8) Switchboard

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1) Quote of the Week:

"It is strange that very thorough research always seems necessary where homebirth is concerned but when it comes to technological changes such as ultrasound, CTGs, DES and Thalidomide, etc., only a few tests are necessary and hey presto, they are routine."

- Henny Ligtermoet

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2) The Art of Midwifery

Develop a series of cards that depict labor and birth positions. They should incorporate three components: a photo demonstration of a position and its variations; specific suggestions for incorporating the position into labor and birth; and the benefits associated with the position. Use them in childbirth classes or one-on-one discussion with pregnant clients. Ask clients to study the cards and practice the positions during their pregnancy.

- Caroline Brown & Barbara Shocker

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Share your midwifery arts with E-News readers! Send your favorite tricks to mtensubmit@midwiferytoday.com

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3) News Flashes

The proportion of episiotomies performed in the United States decreased from 57 per 100 vaginal deliveries in 1989 to 39.5 in 1997,continuing a decline that began in 1985, from 64 percent to 61.1.

- Birth, Vol. 26 No. 4, Dec. 1999

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4) For the New Year: Uplifting Excerpts from Midwifery Today Articles

The more we encourage a woman to find her voice, tell the truth, let go and be all that she is and feels during pregnancy, the less likely pathology will develop in labor. Better outcomes render healthier, happier mothers and babies--our ultimate objective. Healthy outcomes also help foster a midwifery practice that is inspiring and less susceptible to burnout. Clarissa Pinkola Estes in her book Women Who Run With the Wolves tells a tale of a woman who tries diligently and painstakingly to reassemble the skeleton of a wolf, and has all the bones except one in the left rear foot. She struggles and suffers to complete her task; she prays, and finally finds this bone. She places it, and is rewarded for her efforts as the skeleton comes to life as a spirit woman who then promptly departs, smiling back over her shoulder. In response to this story [an acquaintance] states, "We have so many myths about dismemberment, fragmentation of ourselves, and the longing to find parts of us that are disenfranchised. Finding the parts of ourselves most difficult to retrieve is trying and sometimes disgusting, but incorporating these is how we become whole, how we transform."

- Elizabeth Davis, CPM, excerpted from "Variation is the Rule," Midwifery Today Issue 47

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Another group of pelvises that inspire me are those of the pygmy women of Africa. I have an article in my files by an anthropologist who reports that these women have a height of four feet, on average. The average weight of their infants is eight pounds! In relative terms, this is like a woman five feet six giving birth to a fourteen pound baby. The custom in their villages is that the woman stays alone in her hut for birth until her membranes rupture. At that time, she strolls through the village and finds her midwives. The midwives and the woman hold hands and sing as they walk down to the river. At the edge of the river is a flat, well worn rock on which all the babies are born. The two midwives squat at the mother's side while she pushes her baby out. One midwife scoops up river water to splash on the newborn to stimulate the first breath. After the placenta is birthed the other midwife finds a narrow place in the cord and chews it to separate the infant. Then, the three walk back to join the people. This article has been a teaching and inspiration for me.

- Gloria Lemay, "Pelvises I Have Known and Loved," Midwifery Today Issue 50

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We all know unexpected things happen in birth, ranging from difficult to devastating, but fearing or avoiding them should not be the substructure of our practice. Knowledge, practice, understanding, intuition, practicality, and especially love are the foundation blocks; trust is the shelter built on that solid foundation. With the practitioner's skills assisting her, a mother can best prepare for birth by building trust in her body and herself, trust in her midwife and family, trust in the birth process, and trust in her baby. Trust shelters the mother from fear that something is wrong, from hurry and disrespect, from unnecessary interventions, and from fear of her own weaknesses or shortcomings.

- Jan Tritten, excerpted from "Trust Builds a Shelter," Midwifery Today Issue 44

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Storytelling is right up there with love and support as far as seeming trivial but actually being hugely important. We are the torchbearers of truth, the weavers of courageous empowering visions to set before the women and families we serve. Our stories must be told often, until they become more compelling and convincing than the horrible "you are weak and defective, prone to failure, need our technology, and might as well give up and give in now" myths people hear all around them. Right now I am seeing eight gorgeous women nearing term, due within a few weeks of each other. All are carrying single, normal sized babies and are healthy and active. Every single one has been told repeatedly by all kinds of people that she looks abnormally huge, must be carrying twins, will probably have a tough time, will beg for drugs, may need a cesarean and so on. What poisonous propaganda!

Speak out! Our stories must be heard. Again, this takes time, effort and creativity. Share something marvelous at each visit. Encourage, defuse fears, paint a portrait of success. Invite your ladies' relatives and friends to preparatory meetings. Facilitate support groups of women who choose to believe in their power. Inspire and incite!

- Judy Edmunds, excerpted from "My Top 10 Favorite Complementary Modalities," Midwifery Today Issue 52

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Last Valentine's Day my family gathered for the arrival of our second home-born daughter. Leslie, my wife's birth assistant, calmly supported little Elizabeth as she slid into the world. In a moment that passed too swiftly, the harvest of life was complete and we watched with silly grins as Elizabeth moved and breathed and turned a healthy pink. I wanted to remain in that moment forever, floating in its warmth and ecstasy, carefully examining each wavy dark hair on her head, each wrinkled finger and toe. But time moved on, and I carefully filed away the memories as if they were precious, fragile photos to be preserved in a family album. Like her sister Lydia Maurine, little Elizabeth felt and heard within moments the joy of all those friends and family who will be her base of support in the years to come. She knew immediately the touch of her brother and sister. And it all happened in the home where she will be anchored against the storms that threaten every growing child. The aromas of life may be sweet or bitter. They may dance together or clash in opposition. Whether at home or in the hospital, the aromas that welcome our children are our choice. When pregnancy is treated as a disease and birth as an operation, the aromas disappear in a cloud of sterility. Instead, the new life in a mother's womb should be treated as a blessing from God and birth as a miracle never to be fully comprehended. As I remember those wonderful aromas surrounding my daughter's birth, I can envision them rising as incense to the heavens where the angels, responding to the sweet perfume, dance with joy and sing her name, their voices echoing among the stars. And, cradling my daughter in my arms, I welcome them to our celebration.

- Bob Weeks, excerpted from "Welcome, Elizabeth," Midwifery Today Issue 30

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To read these articles in their entirety, order the back issues by calling
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5) Check It Out!

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A Web Site Update for E-News Readers

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We wish you and your family blessings and fortitude for the coming year and into the next century.
We wish you good health and fond memories.
We wish you the gift of forgiveness.
We hope you have a happy and safe holiday season!
Last, we thank you for sharing a healthy vision of birth in the next century.

****** Blessed Be to All! ******

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6) Question of the Week (repeated)

How, as midwives, do we advise a woman who contracts cytomegalovirus (CMV) for the first time during her pregnancy? What are all the options for her and the baby? Do we continue to care for her?

I am an aspiring midwife and this is a very personal issue for me as my neighbor recently had an abortion at nine weeks because of CMV. She is a student nurse midwife and had a lot of support from her colleagues and professors. Is it medically sound to advise abortion for this seemingly rare complication?

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Send your responses to mtensubmit@midwiferytoday.com

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7) Question of the Week Responses

Q: What is one of your favorite herbal remedies or preventatives? Be specific about amount, frequency and application. Think outside the usual!

Digestion aid (fat eater)
Take in the morning before breakfast or before a heavy meal, especially one that includes meat.

1-2 tsp. lecithen
1 tsp honey
2 tsp good cider vinegar
Mix all in a cup of hot water; if left to sit a few minutes it will dissolve a little. Often I need to add another half cup of water if I've made it too strong. This is a wonderful digestive aid.

- Maryanne Vella
New Zealand)

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Rice socks are all the rage, but I find that they are quite heavy if they are large enough to retain heat well. I use old fashioned oats in mine, filled quite full. I can add herbs if I want, but usually don't. It smells clean and sweet when heated, retains the heat well and weighs considerably less. I also sew small loops of elastic at the ends so the mom can either hold it in place if she wants or monitor belts can be used. For even more heat retention, I make a flannel sheath that Velcros at one end and the elastic loops slip through.

- Pam Martin

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My favorite remedy is for thrush/yeast infections. Because it is so new to the market there is not much information on it except one book (The Cure is in the Cupboard) that I could find. It is oil of oregano! It has been performing just as the book said it would on fungal, viral and bacterial infections. Being a lactation consultant I mostly deal with breastfeeding problems and the number of yeast infections is just tremendous these days! Sore nipples from yeast have been responding almost immediately and some had already been through the Nystatin route without relief. Most use two drops under the tongue three times a day (it is really strong so a water chaser is helpful or it can be put in juice). Two drops in a teaspoon of olive oil and rubbed on baby's feet can treat them. That same solution can be applied topically to the nipple. When I have used it my husband tells me I have the breath of a thousand pizzas or he at least accuses me of eating pizza mints!

- PJ Jacobsen IBCLC

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8) Switchboard

In response to Jenn who wants a VBAC and whose doctor wants to schedule a cesarean if she goes past her due date [Issue 52]:

Please find a doctor or midwife who will be supportive of a VBAC! You have the right to change doctors--the doctor works for you! Good luck on your upcoming birth.

- Kelli

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A trick of the trade that works well was passed on to us from some Oregon midwives : Insert two 500 mg gel caps of evening primrose oil on the cervix at bedtime for three consecutive nights. They suggested opening the caps and squeezing them into a diaphragm or disposable menstrual cup for close placement on the cervix but our clients have just inserted the herb caps deep into the fornix behind the cervix. The prostaglandin qualities within this herb definitely ripen the cervix. We combine this with alternating oral low (12X-30X) doses of homeopathics caulophyllum and cimicifuga (the cohoshes) at 4 hour intervals during those three days. Works like a charm! Most important: A Huge Amount of Emotional Support and Trust of Your Body will carry you through your VBAC, Jenn. Best of luck.

- Midwives of Melrose

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I too had a c-section, for fetal distress after a long labor and 3 hours of pushing (my water broke at home one week before my due date). I was terribly distraught and felt like *such a failure* even though the logical part of me said it was needed. I did not establish breastfeeding, I was so drugged from pain, and by 10 days postpartum I was severely depressed and eventually medicated for depression. The unplanned c-section left tremendous scars, not only physical. I did deliver a healthy, beautiful girl at 8 lbs, 3 oz; she was posterior.

Knowing I wanted more children, I read about and researched VBACS completely. When I conceived my second child I went back to my OB. He was very supportive of my trying the VBAC but would not guarantee a vaginal birth. Baby's head was down from 28 weeks on, and I did have trouble with uterine irritability, some bleeding, and several trips in and out of the hospital, bed rest, etc. for about 6 weeks. At the end of 37 weeks, my doctor decided to induce me to help give me a good chance to birth vaginally before she got too big.

I went to the hospital the next day; I was having contractions. The doctor put a pill on my cervix and I dilated to 4-5 almost painlessly. He broke my water; an epidural was put in place even though I said I didn't need it. The doctor strongly suggested it in case I should need another emergency section. I agreed, and after two more hours of labor and 40 minutes of pushing, out came my second daughter, 7 lbs 12 ounces!

It was a wonderful experience, and I was out and about with just a few stitches when she was five days old, feeling great! I was able to breastfeed more successfully and I could not believe the difference I felt physically!

I think had I refused the narcotics during my first labor and insisted on a different labor nurse who I could work well with, I would not have been cut to begin with!

Take charge, find a doctor who is supportive, read and educate yourself, and be prepared that you might need another c-section.

- Meg

[Editor's note: Scheduled induction, misoprostrol, breaking the membranes to hurry labor and just-in-case epidurals are potentially dangerous interventions. The kind and patient care of a midwife who believes in women's power to birth at the right time may have meant a much safer and even more satisfying birth.]

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Three weeks ago my wife gave birth to a 9 lb boy. Her water broke Friday night and after 40+ hours of labor we rushed her to the emergency room for a c-section. She spent the next week in the hospital; then her c-section got infected and had to be reopened. Along with antibiotics and hard drugs the baby has only had two bowel movements over the past three weeks. Do you have any suggestions? We have tried to stay clear of the docs and our midwives don't have any answers.

- John Jones

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Re the absence of legally mandated reporting of adverse drug effects in the UK [Issue 50], does anyone know whether or not this is the case in the US as well?

- Helen Moore
Reply to: helen@emeraldcoast.com

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Re modest birth gowns [Issue 52]: In a birth centre I worked at in a poor area of the Philippines, the moms always wore dresses to births and we used a sheet that was about 5 feet squared to keep over the woman's legs or back side depending on positioning. Many of the moms used a birth stool or squatted for delivery which was very modest and very covered. We could use the sheet discreetly when we needed access to the belly for heart tones.

- B. Wood

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There is a great outfit with pockets to put tubes in so they don't drag when mom gets out of bed; it is longer than most hospital gowns but has snaps all the way down the back and across both arms, making IV changes easier. It comes with shorts. The crotch of the pants also has snaps so it is not necessary to take them off for an exam and/or birth. The gal who designs them is an L&D RN. For more info on Yokeyes Birthwear, Inc., go to http://www.yokeyes.com

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Unless otherwise noted, share your responses to Switchboard letters with E-News readers! Send them to mtensubmit@midwiferytoday.com. If an e-mail address is included with the letter, feel free to respond directly.


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