January 14, 2000
Volume 2, Issue 2
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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Pregnancy With an Intact Hymen
5) Check It Out!
6) Questions of the Week
7) Question of the Week Responses
8) Switchboard
9) Classified Advertising

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1) Quote of the Week:

"Be bold. Be proud. Persist in spreading the word that midwives are not only experts in normal birth, but also expert at keeping birth normal."

- Judy Edmunds, CPM

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2) The Art of Midwifery

Placenta delivery techniques were taught to me when I was studying basic midwifery in London many years ago. I recall the demonstration with a smile every time my hand goes to a uterus after the birth of a babe and before the placenta comes out. The Sister asked one of my classmates to stand up and put her arms out; she threw a sheet over her and said, "This is the uterus, tubes and ovaries." She then jabbed the student moderately firmly in the sides, making her jump and quickly bring down her arms. Sister then said, "When you are getting impatient waiting for the placenta to let loose, the first rule is to never fiddle with the fundus! It makes the uterus jumpy, and it clamps down, keeping the placenta trapped for longer than it needs to be. It can lead to hidden hemorrhage between the placenta and uterine wall."

- Roberta Gehrke, CNM

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3) News Flashes
A study that looked at outcomes of pregnancies complicated by a multiple nuchal cord entanglement included 8,565 deliveries. A single loop of cord around the fetal neck at delivery was found in 2,191 deliveries, and more than one loop was found in 326 deliveries. Pregnancies with a multiple cord entanglement were more likely to have an abnormal cardiotocograph consisting of persistent variable deceleration in advanced labor. These infants were also more likely to have meconium, a low Apgar score at one minute, and a low umbilical artery pH of <7.10. There was no difference in the rate of cesarean sections, placental abruption and Apgar scores at five minutes between the two groups, and no stillbirths occurred in the cord entanglement group. The study concluded that with multiple nuchal cord entanglement there was no risk of adverse neonatal outcome, and that a multiple cord entanglement is not a contributing factor in intrapartum stillbirth, placental abruption or cesarean delivery.

- MIDIRS Dec. 1996

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4) Pregnancy With an Intact Hymen

A 19 year old woman pregnant with her first child came to me after having seen a doctor several times. He had done vaginal exams and hadn't found anything unusual. Among the usual things I tell pregnant moms, I recommended perineal massage each night beginning five to seven weeks before the baby is due. She called me after the first time she and her husband tried it saying, "Brenda, I have two vaginas!" I asked her to come the next day and let me check so I could see what might be confusing her. Upon examination I caught something between my fingers. I got out my speculum and sure enough something in there prevented me from moving freely. I turned to my Tabor's Medical Dictionary and looked up hymen. I didn't really know what they look like, and to my surprise I found there are several kinds of hymens. The kind she had is described as "Buffers--hymen with two parallel openings with a thick septum between." It is hard to explain what it looked like. It is best described as a thick membrane attached to the upper and lower vaginal opening, with an opening on each side and open behind so that you could wrap your finger around it. I had never seen or heard of this before so I called my good friend who is also the midwife who trained me. I asked her what I should do and if she had heard of this before. She told me to let it be, that in childbirth it would either tear or move to one side or the other and baby would come through.

I did just that. In labor as she was pushing and as the head started to crown I tried to get the hymen to go to one side. It did, but it was too tight for baby to pass through. I tried to get it to break with baby pressing against it, but it was just too thick, so I told her I was going to have to cut it. As soon as I did, baby slid right out. She bled from the bottom part of the hymen, which I assumed was due to pressure against it, because as soon as baby was born the bleeding stopped.

I was told by a doctor the only thing that could be done is cut it short but if it does not bother her to leave it alone. When I checked her nine days after the birth it had almost completely gone away.

It still amazes me that the hymen was still there during her pregnancy, but according to Tabor's it is folklore that whether the hymen is broken or not determines whether or not a woman is a virgin, and that women can in fact become pregnant if it is still intact.

My midwife friend said it is possible that during intercourse her husband's penis went through on the one side and maybe again on the other side. After seeing how thick it was, I believe her.

- Brenda Capps, DEM

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5) Check It Out!

~~~~~ WWW.MIDWIFERYTODAY.COM~~~~~
A Web Site Update for E-News Readers

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6) Questions of the Week (repeated)

I am six weeks pregnant and have two small places where the tiny fetus is slightly disconnected from the uterine wall. Due to this, I have had very light bleeding (like a dry paintbrush) for about two weeks, although it stopped almost 100% about 5 days ago.

After the first ecography my doctor said it could be a retained abortion. I returned in 10 days to see if there was any growth, and yes, the fetus had grown. Of course this made me very happy, but there were still two small places in the picture where he saw the slight disconnections. He said "It looks like this one is going to be successful," but I am worried. I want to know what herbs or vitamins can help to "glue" the fetus in place to help ensure that it doesn't spontaneously abort.

Also, in the first ecography he said he saw what he would initially diagnose as a benign myoma in the front wall of the uterus, not very big.

- M.A.G.

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I am a student midwife in Chile. I study through a distance program from New Mexico and have close contact with the largest public hospital in the region. A friend on her fourth pregnancy was told it was a hydatidiform mole, and an immediate hysterectomy was ordered. I had never heard an immediate hysterectomy was necessary. Please tell me in detail the ifs ands and buts of this pregnancy complication.

- Aiyana Gregori

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Send your responses to mtensubmit@midwiferytoday.com

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7) Question of the Week Responses

Q: I recently read of a very unobtrusive method of dealing with yeast infections and I can't even remotely remember what it was. Any interesting ideas out there?

- C.O.

A midwife friend suggested mixing a couple of capsules of acidophilus with a cup or so of warm water, and douching with that. The few times I have had yeast infections, I have never had to use this remedy more than twice in 24 hours to solve the problem. The acidophilus bacteria presumably are able to overrun the yeast population to bring the vaginal flora back into balance. I also make sure to avoid sweets.

- Susan Hodges

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Boric acid works very well. Boric acid is mild and often recommended as an eyewash. It is obtainable at most drugstores in powder form for a few dollars. Either douche with approximately 1 tablespoon of the powder dissolved in 1 cup warm water, 2 times a day for a day or so, or insert 2 gel-caps filled with the powder high into the vagina. Wear a pad as there will be watery discharge. One treatment will probably suffice but it's OK to repeat. This can be done during the day or overnight.

- Elsa Nicolosi

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The oldest treatment I know of for yeast infections is vinegar. Although very effective, tea tree oil is too strong for vaginal infections. I have had excellent results using Aci-Jel (from Janssen Cilag), a vinegar gel formula available here in Australia over the counter. It is not cheap but worth every dollar! I recommend that clients who have recurring infections during pregnancies always keep a tube on hand and apply small quantities digitally as soon as they get the familiar tingle/itch. Seems to work. I also recommend that they use vinegar in the final rinse water for their own briefs--cotton of course--and in their babies' nappy rinse water, and add a "slosh" in baby's bath water. It works for wiping over mum's nipples, too.

- Laurelle

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8) Switchboard

More on utertine prolapse [Issue 48]: Urologists recommended that I have surgery for urinary incontinence and a prolapse of the bladder and uterus. Then I found a urologist with a nurse practitioner who is specially trained in a type of physical therapy for these conditions. Over 90% avoid surgery after four weekly treatments.

She measured the strength of the pelvic floor with a computerized meter (inserted in the rectum, then in the vagina). Then electrical stimulation is done that causes the muscle to contract efficiently for several minutes until the computer indicates the patient is close to fatigue. Then I did four sets of 10 kegals a day--kegal and hold for a quick count of 10, then rest for a count of 10; repeat. Most women with poor tone in the pelvic floor do too many kegals and fatigue the muscle. The electrical stimulation was not painful; it felt like a balloon blowing up like a good strong PC contraction. It served as biofeedback as well. I had to do this because a vacuum extractor had damaged my pelvic floor.

- Cindy Schierlinger

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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]: My homebirthed son was way late--three days plus two weeks. "This baby doesn't want to come out" my midwife said. It was a very healthy pregnancy, healthy baby, and I am a very healthy woman. So my midwife said, "Well, make love! Lots of love!" She explained that the movement of the penis and the contractions during my orgasm would definitely and naturally help me get labor going.
It helped!

- Sonia N. Molina

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I currently live in a state where homebirthing is legal, yet I reside on a military installation. My husband and I are *not* military; this installation allows civilians to reside here due to commute times. We have had a homebirth here with a midwife present. Since then the post has made a policy of not allowing non-military or non-government contracted medical professionals to practice on the base. This was done to stop homebirths after another woman after me had a birth here. Permission to bring a midwife on post has been denied even though we are civilians and pay for all medical costs. We believe there is a civil rights violation here, but are having trouble finding a specific law to help us. Can you be of any assistance? Delivery of our 4th is expected in February.

- Kerri Utnage
Reply to: REVELATIONS227@msn.com

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I am 30 weeks pregnant and have heard much about the advantages of using red raspberry tea leaf and evening primrose oil to help promote labour. I am a little confused as to when to start using them. I don't want to have my baby too early nor too late (three of my friends have gone weeks past their due dates this month!). I have had a very healthy pregnancy aside from having severe morning sickness up till 18 weeks.

- D.O.

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I am a community midwife in England. I have started a breastfeeding support group that meets each Monday morning. Unfortunately it has not been the success I hoped it would be. We have had very little attendance despite advertising by poster, leaflets and word of mouth from midwives and health visitors. Has anyone out there had success running a support group?

- Glynis Rainey

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I would like to know if there are any midwifery organizations that specifically support Traditional Midwives, not CNMs or CPMs. I live in a state where direct-entry or traditional midwives are not recognized and CPMs are pursuing licensure. It seems as if MANA has abandoned traditional midwives and embraced all others! It's very frustrating to receive no validation from any midwifery organizations. (Yes, I know how rewarding it is to be recognized and validated by the clients I serve.) It would be wonderful if there were an entity embracing us and our interests, not systematically erasing us from existence!
Alison

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I've been a long-time subscriber to your magazine and find it helps me improve my curriculum and back up my knowledge base as an educator, doula and humanist. More importantly, it helps me keep the faith that birth can be magical and normal. Most of the women I work with have decided to birth in the hospital setting and they are intimidated by the system and authority. I see my job as helping them to become empowered so they can truly make decisions around the birth of their child that are best for them, their baby and their family. I find the articles in Midwifery Today very often speak to the very issues I encounter with my childbirth ed. and doula clients.

- Kris Avery

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[Editor's note: A Book's Worth of Information in Every Issue! To subscribe to Midwifery Today magazine, a quarterly 72-page magazine for all practitioners and parents, email inquiries@midwiferytoday.com or call 800-743-0974 for information on how to order. Please mention code 940.]

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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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9) Classified Advertising

Beautiful home w/ 2 bdrms, studio/office & handsome housecat, available Feb-June 2000, Hornby Island, BC, Canada, $550.00 (Canadian)/month. Privacy & solitude in unique community of 1000 islanders, perfect for 1 or 2 seeking exile, respite from the world out there. I am a midwife working in India helping start new birth clinic in Tamil Nadu. I welcome queries.
250-335-2890. Namaste, Diane Smith

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Need your article, thesis, essay or book edited and/or proofread? I have more than thirteen years' experience working with pregnancy, birth and midwifery related manuscripts and know the field well. Sliding scale. E-mail cherjm@aol.com


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