January 21, 2000
Volume 2, Issue 3
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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Taking "All Fours" a Little Further
5) Check It Out!
6) Question of the Week
7) Question of the Week Responses
8) Switchboard
9) Classified Advertising

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1) Quote of the Week:

"My real work as a midwife has been to get out of the way and let women do their work."

- June Whitson, CNM

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2) The Art of Midwifery

Consider pairing a woman who is due to deliver soon with a woman who has a much later due date. Each can assist the other postnatally. This could be the beginning of a wonderful friendship!

- Kerry Vincent

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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

A study in Perth, Australia found that male infants were more likely to be weaned at any time before 6 months of age than female infants. The 556 women in the study were followed from discharge until 6 months postpartum, or until they ceased to breastfeed. At discharge 83.8% of women were breastfeeding their infants (83.0% boys vs 84.6% girls). At 3 months 61.8% of mothers were either fully or partially breastfeeding (58.5% boys vs 64.8% girls), and by 6 months the percentage had fallen to 49.9% (43.5% boys vs 55.7% girls). It was suggested that mothers and/or health workers perceive that male infants have higher nutritional needs and should therefore receive non-breastmilk fluids and foods earlier than female infants.

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

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Taking "All Fours" a Little Further

Ina May Gaskin's suggestion to get a woman into an "all fours" position
when faced with suspected shoulder dystocia made a lot of sense to me. I incorporated it into my practice and it is now the first thing I try when I see one of those fat little faces creeping out over mother's perineum. Over time, I began to think more about what the baby was doing while the woman is turning over, and it occurred to me that we might give the baby an even better chance of freeing his anterior shoulder and coming out quickly if we get the mother to turn over onto all fours in a specific direction. The baby is rotating as it comes through the birth canal, and it is this rotation that is prevented when the baby's anterior shoulder gets stuck under the pubic arch. Can the direction in which the mother rotates assist the baby with its own rotation?

As the head is born, it will be facing toward the mother's back (I am using the examples of LOA and ROA babies, although the process can be worked out in the same way for any position). Once the head is born, it undergoes restitution in which it "untwists" to compensate for the twisting it did to come through the pelvis and external rotation. Following these movements the baby's head will be facing the same way as it was in utero. An LOA baby will look toward his mother's right leg, and an ROA baby toward his mother's left leg. By this time, the shoulders will be undergoing internal rotation and they will be in the anteroposterior diameter of the pelvic outlet.

The anterior shoulder of the LOA baby will want to rotate across the pubic arch from right to left (from the mother's perspective); as he is born he will continue to rotate in the same direction. Thus, if his shoulder sticks under the arch the mother may do better to turn over by keeping her left hip downward and taking her right arm and leg "up and over" the top of her left; she then helps the baby rotate by going with, rather than against, his direction of rotation. (If this makes no sense, you may want to demonstrate with a pelvis and a doll!)

Conversely, if the baby is ROA, his anterior shoulder will be moving across the pubic arch from left to right; you may want to get the mother to turn over by keeping her right hip downward and taking her left arm and leg over the right. The weight of the baby's back, in combination with the movement, might also help with the rotation and the birth of the shoulder.

A simpler way to remember this might be as follows: whichever side the baby's back is lying, keep that hip downward as the mother moves over onto all fours. You can just indicate with your hand the direction you want the woman to move in it is much simpler in practice than it sounds here!

I have no concrete evidence to suggest that this works any better than simply moving the woman onto all fours in a random direction, although since I have tried it I have had several babies whose anterior shoulders had delivered by the time the mother completely turned over. However, it takes no more time to move onto all fours in a particular direction, and it just might help free a few of those shoulders and maximize the chance of this maneuver working without recourse to further intervention. Let us know your experience.

- Sara Wickham, Midwifery Today Issue 49

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5) Check It Out!

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

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Do you enjoy what you're reading in E-News? Tell a friend or colleague about us! Just click: www.recommend-it.com/l.z.e?s=111968

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Our NEWEST additions to the website: two articles by Beverley Beech! Print them out... photocopy them... carry them in your birth bag! Use them to be a Birth Change Agent! These are two topics EVERY mother needs to concern herself with: Drugs in Labor and Routine Ultrasound. Please--read on!

Drugs in Labour: What Effects Do They Have Twenty Years Hence?
by Beverley Lawrence Beech

Childbirth is a normal physiological event. However, since the advent of universal hospitalisation, for the majority of women childbirth has been transformed into a medical event where labour is processed, monitored and controlled by the medical profession from beginning to end.

To read more, click here:

www.midwiferytoday.com/articles/drugsinlabour.htm

Ultrasound--Weighing the Propaganda Against the Facts
by Beverley Lawrence Beech

The use of ultrasound in antenatal care is big business, and in any big business marketing is all-important. As a result of decades of enthusiastic marketing, women believe they can ensure the well being of their babies by reporting for an early ultrasound scan and that early detection of a problem is beneficial for these babies. That is not necessarily so, and a number of studies show that early detection can be harmful.

To read more, click here: www.midwiferytoday.com/articles/ultrasound.htm

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6) Questions of the Week

I am (hopefully) pregnant again. Will refusing Rhogam this time affect me in any way? Will the Rhogam I received before have any effect on this pregnancy, my future health, or my baby's health? Please verify that it is impossible for two RH negative parents to produce an RH positive baby.
Samantha

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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.

My ob-gyn recommended threading a garlic clove and inserting it carefully into the vagina. After recurring cases of yeast infection toward the end of my pregnancy, I tried it. It worked!

- K.F.

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I made a "tampon" by tying a peeled, unbroken clove of garlic into a small square of sterile gauze, leaving a tail for easy removal. I changed the garlic tampon every 24 hrs for 2 days. I was prepared for odors or discharge, but there was nothing unpleasant at all. The whole process was very easy and effective.

- C.

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Q: I am six weeks pregnant and have two small places where the tiny fetus is slightly disconnected from the uterine wall. I 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 and the fetus had grown. 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. What herbs or vitamins can help "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.

Check Ann Frye's two books. Vitamin E, bioflavinoids and A; herbs: wild yam tincture (15 drops a day) and nettle leaf. I have a friend who had a c-sec for her first baby (weighed 7 lbs) where she had a myoma growing at the same time during her pregnancy. What helped her were Anne Frye's books, rest, no stress, excellent nutrition and prayers.

- Connie Dello Buono

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Did you have a real-time "ecography"? If so, at six weeks the doctor would have been able to see your baby's heart beating and the issue of retained abortion would have been answered. Also, I'm sure you were talking about the placenta's attachment to the uterine wall and not the fetus. Bleeding in the first trimester is not uncommon, especially near the times you would have been menstruating. It's most likely caused by the growing placenta attaching to the uterine wall. As a midwifery student you must know that all pregnancies are not successful. There are so many millions of things that must be "right" to get a healthy baby. When some of those things aren't right--genetic pairing for instance--nature is kind and abortion results. Between the early 1940s and mid 1970s "glue" was discovered, prescribed, and used on millions of women and their babies. It is called Diethylstilbestrol or DES. The devastating results of this "glue" were not evident for many years after it was taken. Unfortunately, DES can still be purchased *over the counter* in many developing countries.

My advice: keep yourself healthy--eat well, drink water, exercise and don't worry! Worry is interest paid on trouble before it comes due, and it doesn't change a thing.

- Jeanne Batacan, CMA, ICCE, CLE

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I am a master''s student in human genetics currently preparing my thesis before I go on to my PhD. I am studying the role of folate in early pregnancy for prevention of neural tube defects. I have come across a fair amount of literature connecting a common enzyme variant involved in folic acid metabolism with this type of placental accident. If you were to have this variant enzyme, it is possible your folate requirements cannot be met by a good diet because this enzyme works less efficiently than the more common one most of us have. Additional folate may also help you prevent further problem with the placenta. As long as you do not have a vitamin B12 deficiency you will not be harmed by taking extra folate nor will the baby.

It will also benefit you later in pregnancy, reducing your chances for other placental difficulties including intrauterine growth retardation and placental pervia. You should be on a minimum of 1 mg a day combined with vitamin B12. Any standard prenatal vitamin has this. You may require more depending on your folate status. Your red blood cell folate levels should be in the high normal range. If they are in the low normal range and you have been taking folate all along, you may well need more, perhaps as much as 5 mg. Ask your midwife about that. Refs on request.

- Natalie K Bjorklund

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8) Switchboard

Thank you to all E-News readers for supporting Jenn, who first asked for advice about getting a VBAC in Issue 52. Here is her happy news:

Guess what? On Jan 9, just before midnight, my water broke and contractions started immediately at 2 minutes apart. I waited until 3 am Monday, Jan 10, before going to the hospital. I arrived with my husband and his mother;.my precious daughter remained home in a deep peaceful sleep with my father-in-law by her side. The nurse said I was 2 cm dilated. When contractions became closer at 1 minute apart, I asked the nurse to please check me again. Thirty minutes later I was 4 cm. The doctor on call came in and checked me 10 minutes later; I was 5-6 cm. I rolled over on my side and began meditating, trusting in the Lord and breathing in every pain. I had rejected ALL MEDICATIONS--no IV, no nothing! Immediately I began to yell, "I have got to push!" The nurse said "No way-it's too soon. I will check you in one hour." I screamed, "I have got to push!"--I couldn't control it. The nurse and doc gave in and she checked me. She looked at me, then the doc and said, "This baby is coming NOW!" Everyone rushed around and could hardly believe how incredibly fast I had dilated, "being a VBAC and all." I pushed, or shall I say my body took over, and it pushed. In a few minutes my second daughter was born. It was amazing--I will never forget the emotions. I did it!!! I accomplished my VBAC without any--ANY!--medications, nothing!

Thank you so much for all your kind words. All your support really helped me and my body focus during my contractions. I arrived at the hospital at 3 am and was holding my baby girl at 5:30 am. WOW!! I love all of you. Thank you so much for ALL your help. I really believe it helped me in every way.

As for the doc on call--who did nothing but sit in amazement and watch me practically birth my own VBAC DAUGHTER WITH NO MEDS--he was stunned. That's the only word I can come up with--the look on his face was worth a million bucks. I left the hospital in 24 HOURS. My second daughter is beautiful: 7 lbs 5 oz.; her name is Gillianne Rose. Wow!!!!

Love,

- Jenn

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In response to Glynis's question about breastfeeding support groups [Issue 2:2]:

Monday is one of the worst days for stay at home moms to get out. The weekend has left their home and activities out of order. I have tried on Mondays and it was a bomb. I will also add that in my experience with group activities, if you show great excitement, it is catching.

- Lisa

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An organisation already exists which has had astounding success "running a support group": La Leche League. While I applaud your initiative, why reinvent the wheel? If there is not an LLL group in your community, perhaps you could establish one using the resources of that organization. They have a solid reputation worldwide. The midwives in my community (Maple Ridge, B.C. Canada), while providing excellent information and hands-on support to their clients, often refer them to the local LLL group to help them establish contact with other BF moms. At monthly meetings they get information and support on BF, and their decision to BF is affirmed positively (something they don't always get from family and friends). I am a leader of that group, and we don't find it necessary to meet weekly; monthly seems to be enough. LLL International's web site: www.lalecheleague.org/

- Trudy Noort

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With regard to the letter about prolapse [Issue 2:2], I don't think the ventouse (vacuum) "caused" her pelvic floor weakness. It was more likely the length of second stage, the size of the baby, neglect after the birth (no PC exercises, oestrogen deprivation, etc.) that predisposed to the problem. Also, genetics plays a large part--it tends to be a familial problem.

The literature does not support Faradic perineal stimulation (the electric stimulator described) as a long term successful treatment, but it is impossible to comment accurately on individual cases without having assessed the actual problem by personal examination.

- Phil Watters

PS: Prolapse should be managed by gynaecologists, not urologists.

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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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