|January 28, 2000|
Volume 2, Issue 4
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In This Week's Issue:
1) Quote of the Week
1) Quote of the Week:
"The traditional midwife remains an apprentice to birth in her ever-evolving experience."
- Sher Willis
2) The Art of Midwifery
A while ago my husband overheard me talking to a couple on the phone about stripping the membranes. The woman was a little past her due date, had read about this procedure in a medical text, and wondered what it was and if I could do it for her. My husband asked me why it was called "stripping"; it sounded rather violent to him. We decided together that the term "separating the membranes" sounded much gentler, and I have since started to use that term exclusively. Words are powerful!
- Sue Rusk
Share your midwifery arts with E-News readers! Send your favorite tricks to email@example.com
3) News Flashes
Women who develop fever during labor are much more likely to have received epidural analgesia than women who do not. If greater than 101 degrees F., fever is likely to have a negative influence on early neonatal outcome. A Boston research team investigated the association between elevated maternal temperature and early neonatal outcome in 1,218 mother-infant pairs. They found that 16.6% of women given an epidural for pain relief developed fever of 100.5 degrees F. or greater during labor, versus only 0.6% of women who did not receive epidural analgesia. The mean time from epidural to fever was 5.9 hours.
The researchers found that babies born to women whose fevers were over 101 degrees F. during labor "...were almost 4 times as likely to have a 1-minute Apgar score <7 than were infants of afebrile mothers." They were also more likely to need bag and mask resuscitation immediately after delivery, to need oxygen therapy in the nursery, and to have a seizure during the neonatal period. Infants born to mothers whose fevers were 100.5 degrees F. or greater were more likely than others to be hypotonic.
- Pediatrics, January 2000
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4) Triumphs and Struggles
Iowa Moves Toward Decriminalization of Midwifery
Two weeks ago at the Iowa Department of Public Health, a public hearing was held with the Midwifery Scope of Practice Review Committee. Twenty-eight individuals presented their views on homebirth and the safety of midwife-attended birth. Women and men--mothers, fathers, grandparents--spoke eloquently and with emotion about birth in the home setting. One brave doctor from Cantril, Iowa came forward in favor of direct entry midwives and homebirth. Children spoke. One midwife (a NARM certified CPM) risked jail to be heard asking the question, "Why do I not enjoy the constitutional right to ply my trade in this state?" It was the last chance for citizens of Iowa to be heard.
A woman representing the state's surgeon general opposed direct entry midwives (since the 1970s non-nurse midwifery has been a felony in the state of Iowa). The Iowa Association of Nurses was also opposed. Beverly Francis, a direct entry midwife indicted and forced out of practice, has remained the cornerstone of the battle to re-legalize midwifery in Iowa. Beverly, after promising not to attend births as long as it is illegal in Iowa, told the judge that she would then fight tirelessly to legalize midwifery, one of the state's oldest professions, once again. For years Beverly has worked toward this endeavor. She earned herself a seat on the scope of practice review committee and made it her business to educate the other members. She had warned that the members, mostly doctors, were split, but more than half were opposed to direct entry midwifery and homebirth. For those in favor of midwifery, it looked grim.
At the end of the day the committee decided to recommend that the Iowa state legislature decriminalize direct entry midwifery as the current laws posed a potential threat to the public's safety (i.e. homebirths without the benefit of midwives in attendance). So you see there are still miracles on earth. With the help of angels like Beverly Francis the legislative body of one Midwestern state will now decide to respect the recommendation of this learned committee or not. Prayers are still needed.
- Robin Lim
New Midwifery School Soon to Open in Manitoba
The new Manitoba School of Midwifery may be starting its first class as soon as Sept 2000, although realistically, according to the dean of the nursing school (under whose auspices the new school will begin but will not remain), it will more likely begin in September 2001.
The new program will be a four year professional degree designed to produce midwives who can work relatively independent of the entire hospital experience for normal births, providing prenatal care, delivery, and postnatal care. In other words, they will be real midwives functioning as real midwives should. The description of the kind of people they are seeking for the first class was positive and encouraging: supportive of women and women's issues, professional, mature, able to work independently and so forth.
The long-term goal is to finally have a fully functioning midwifery system in Manitoba. Midwives would be professionals who work closely with all the other members of the current system and provide the kind of care women currently get piecemeal, with special emphasis on things like encouraging breastfeeding. Manitoba has imported midwives from England, Holland and Ireland for decades and they have provided an invaluable service in remote regions. Now we can start training and producing our own.
As someone who had to fight to have a delivery eighteen years ago without a routine episiotomy, drugs, stirrups, epidural and so forth and who had to fight to be allowed to nurse her baby; as a woman who saw enough improvement that I labored with the benefit of a wonderful midwife the third time around, only to watch her have to step back at the precise moment of delivery because the doctor walked in ... well, all I can say is; IT IS ABOUT TIME!!
- Natalie K Bjorklund
Help Needed in Illinois
I have been working for years to bring about birth choice in Illinois. Although midwifery licensure for direct entry midwives was eliminated in 1963 and numerous attempts have been made to have it reinstated over the years, we have been up against the big guys--the AMA in the guise of the Illinois State Medical Society. In the past 2 years, a number of midwives have been issued cease and desist orders and charged with practicing medicine without a license. Last week I received a rule to show cause (will soon be posted on my website: www.weedpatch.com/home.html) charging me with practicing nursing without a license and practicing nurse-midwifery without the proper credentials. This is a new tactic in Illinois, and one that is sure to divide the midwifery community--pitting CNM against direct entry/CPM. I will undoubtedly be issued a cease and desist order also, as that is how our Department of Professional Regulation works--you are tried and convicted before you ever get a hearing!
I feel very strong in my resolve to fight the state on this issue. I'm trying to compile a list of Illinois people who are supportive of direct-entry midwifery, CPMs, and who would be willing to take some action--letter writing, going to see their legislator, attending a rally, speaking to their church group, community groups, etc. If you know of such people, please have them contact me. I also welcome, prayers, thoughts and positive affirmations.
- Yvonne Lapp Cryns
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5) Check It Out!
~~~~~ WWW.MIDWIFERYTODAY.COM~~~~~ A Web Site Update for E-News Readers
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Chalk one up for dads!
What is the role of the father who is present at the birth of his child? Is
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Midwifery Today Conference
Keep your calendar open--March 2001 will be in EUGENE, OREGON!
Theme for Issue No.54: Waterbirth
6) Question of the Week
I have Group B Strep. With my last 2 hospital births I was automatically given IV antibiotics. I am planning a home waterbirth for my next baby. What can be done at home for GBS? What are the risks to the baby if it contracts it in the birth canal?
- Sarah McKay
Send your responses to firstname.lastname@example.org
7) Question of the Week Responses
Q: I am a student midwife in Chile. I study through a distance program 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
A D&C is usually performed as soon as possible after a diagnosis of a molar pregnancy. The mom is at risk of hemorrhage and other complications, of course, but the most worrisome is the connection with later cancer. As many as 4% will develop into choriocarcinoma. If the mole has invaded the uterus, or if the pregnancy is beyond 20 weeks, a hysterotomy or hysterectomy is usually needed.
- Gail Hart
Q: 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.
I have had 20 years personal experience with Rhogam; I had it after all four of my children (ages 20, 18, 14, 12). I am Rh negative and they are all Rh positive. None of us has had any health problems that could conceivably be related to the Rhogam, and all four kids are remarkably healthy.
I am an RN and a childbirth educator. I know of absolutely no health complications from Rhogam, which is amazing when you consider that thereare so many risks to even the most innocent appearing medical interventions. I would not hesitate to take it again if necessary. I vividly remember as a teen when some of my friends' moms lost babies to Rh complications before the advent of Rhogam. I was about 16 when Rhogam became available, and was relieved because I knew I was Rh neg. and might have reproductive complications because of it.
Regarding whether two Rh neg. parents can produce an Rh pos. child: I am not a genetics expert, but it should be impossible, or at least improbable. By Mendelian genetics, it shouldn't happen, but I can't say never because of the possibility of recessive genes. I shouldn't have been Rh neg. since both my parents and all four grandparents were Rh pos.; when it was discovered, all of us were tested and retested and no one could explain it. So strange things can happen with genetics, although the probability of two Rh neg. parents producing an Rh pos. child has to be miniscule, especially if the grandparents are all Rh neg.
- Joanne Keane Noreika, RN, LCCE
I've been told if there are two Rh neg. parents the mother does not need Rhogam.
- Brenda Capps-DEM
In response to a question about preventing spontaneous abortion [Issue 2:2]: I've heard that eating the whites of orange peels strengthens the uterine lining and placenta. Perhaps this could help prevent spontaneous abortion.
- Talisyn Flagg, Doula
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I had a beautiful son 7 weeks ago, a vaginal waterbirth in my home. The experience was glorious, and I am filled will joy every time I think of it. I received warm and supportive responses from around the world after my email ran in E-News, and have corresponded with some wonderful women. One woman had a second cesarean due to a double wrapped and very short cord, but she claimed her birth, and her baby was at the breast immediately and never left her side. Another is in labor as I write this. She is 3,000 miles away, but has been my lifeline on this journey. I want to thank you for providing me with a way to reach a sister in spirit, and for creating a way for so many to learn so much.
[Posted later to E-News: My friend had a homebirth that day, after 8 hours of pushing! She is glad she didn't give up, and she knows the hospital would never have given her the chance. Though it was difficult, she is thrilled with her birth. Thank you again for bringing us together.]
My friend, pregnant with her second child, is both thrilled and terrified as her first birth (attempted homebirth) ended in cesarean. After hours of labour and rushing to the hospital it was found that Maria had a large fibroid growth blocking Luna's passageway into the world, making natural birth impossible.
Is there any hope of her having a natural birth/homebirth again? What can Maria do through diet/herbs to prevent fibroid growth in this pregnancy? Are there any articles relating to this topic that would be of help? Maria still feels a lot of pain and disappointment from her first traumatic birth experience. Are there any contacts to help her with her healing process? (phone consultation? groups? books?)
- Ocean Shine
In response to the lady who is 30 weeks pregnant and wondering about the use of red raspberry tea and evening primrose oil to start labor [Issue 2:2]: Red raspberry leaf tea has been used for thousands of years as a uterine tonic. Its use strengthens and tones the reproductive organs but does not stimulate uterine contractions, making it safe for use throughout pregnancy. Evening primrose, however, definitely plays a role in labor induction, as I have seen with women who use it as a vaginal suppository to soften the cervix and "get things going" during the last days of their pregnancies (do not insert anything into your vagina if your membranes have already ruptured, though!) Both herbs are safe and gentle to women when used with wisdom during pregnancy--red raspberry throughout, and primrose oil at the very end when both mother and baby are prepared for birth.
I would recommend 2 500 mg. tablets/day of evening primrose oil to systemically soften all tissues (including cervix and perineum, especially if cervical scarring or previous perineal injury exists) and 1 c. rasp. tea from 28 weeks, 2 c. from 32 wks. and 3 c. from 36 wks., then as needed in labor to strengthen and tone the uterus.
- Amy Darling, midwife
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