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In This Week's Issue:
1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Normal Birth
5) Check It Out!
6) Question of the Week
7) Question of the Week Responses
9) Classified Advertising
1) Quote of the Week:
"There is nothing on earth more wonderful than helping women birth with respect and power."
- Jennifer Gallardo
2) The Art of Midwifery
I use a prenatal technique taught by Penny Simkin in a full day Midwifery Today conference workshop she did with Phyllis Klaus back in 1996. I
strongly recommend the audio tape of that class [see ordering information
below] because the technique has so dramatically affected each and every
client I work with, survivor or no.
The technique, called "The Triggers Worksheet," is designed to help
survivors of sexual abuse figure out ahead of time what parts of the birth
process may be problematic in terms of flashbacks and other abuse-related
reactions. The doula or midwife will spend about 2-3 hours prenatally doing
the worksheet with her client, but it's time very well spent. I've had
clients with no abuse issues who nevertheless found the worksheet to be
wonderful because it demystified the birth process in a non-scary way.
The basic technique is to go through a list of common birth practices,
interventions, and birth sensations and describe them bluntly with vivid
detail. The client then tells the doula or midwife if she had a strong
reaction, a mild reaction, or no reaction at all. When the list is
finished, they go back and look at all the "reaction" topics and clarify
why they are an issue, then develop strategies for making them more
tolerable/less likely to happen/less scary.
For example, I might say, "In a hospital birth, there's often a lot of
traffic in the room during the pushing stage. There may be a lot of nurses
or family coming in and out. Your bottom will be exposed to the room and you might not know all the people there." A mom might have a strong
reaction to this and say "I really don't like the idea of being naked in
front of strangers. It's very scary to me to be exposed that way." I would
then use active listening to help her expand on that idea, and arrive at a
couple of ways to limit traffic and exposure. Or she might discover after
thinking about it that it's not so scary after all.
Clients who have not been abused react with a bit of shock to many of the
worksheet topics, but upon looking closer realize they can probably handle
it. We may strategize or write a birth plan for one or two "hot topics,"
but most of the time the best use of the technique is to remove the "fear
of the unknown" issue from the equation. I've seen this worksheet session
dramatically raise the confidence level of my clients, and all of them have
said it was well worth the time. Kudos to Penny for this great technique.
It's a godsend for me as a doula as it makes an enormous difference in how
much I know about specific nitty gritty issues in the client's life as they
relate to birth.
- Jennifer Rosenberg, doula
Save $3.00 on the Midwifery Today conference tape set "Counseling
Techniques for Helping Sexually and Physically Abused Birthing Women,"
Penny Simkin and Phyllis Klaus, teachers. Regular price $26. Email
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3) News Flashes
Researchers studied more than 2,000 at-risk pregnancies, some of which had
an amniocentesis in the middle of the first trimester while the rest had
one earlier. In the mid-trimester group, 0.1% of babies were born with a
club foot, compared with 1.3% of the babies in the earlier amniocentesis
- Nursing Times, citing Journal of Medical Genetics; 36:11, 843-846
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4) Normal Birth: Do We Believe? Can We Remember?
When a woman is considering having a homebirth and we meet for an
interview, she often asks, "What is the difference between a midwife and an
obstetrician?" Although I can think of many differences both in philosophy
and in practice between us, I have simplified my answer to explain what I
believe to be a very basic difference in perspective. The obstetrician may
say to the pregnant woman, through attitude, words or continual reliance on
technology, "You have to prove to me that you can give birth to a baby."
The midwife, on the other hand, with her attitude that birth is, in most
instances, a reliable event, says to this same woman, "You have to prove to
me that you cannot have a baby!"
The midwife is (or should be) an expert in normal birth, while the
obstetrician must be an expert in pathology. This is exactly the way it
should be. For it is that expert to whom we must turn when we do encounter
the abnormal. I believe that oftentimes, the midwife is more likely to
recognize situations that demand attention than the caregiver who sees all
pregnancy and labor as a potentially dangerous and lethal process.
How have midwives developed such a positive attitude toward the birthing
process? Is it that after watching birth and birthing women through
countless generations, we know that "babies come out"? Of course, we have
also seen birth tragedy, and yet after less than perfect outcomes, we are
able to go on to the next labor with our belief in the process intact.
The first factor paramount to maintaining normalcy in birth and obtaining
an optimum outcome for mother and her baby is our ability to provide both
constancy and continuity of care. As the relationship between midwife and
mother develops during the course of prenatal care, a mutual trust between
the caregiver and cared for brings a sense of safety and security.
Communication becomes forthright and honest, and words and ideas flow
easily between them. When it comes to the time of birth, rarely must we
deal with psychological issues, which may stall or impede labor, since
specters of the past have been met, dealt with and put in their proper
place. The midwife has said to the mother through her manner, her touch and
even with her words through the preceding months: "I will never lie to
you." This is great comfort to the woman with so many questions, meeting
birth for the first time. So many times I have sat with a young woman who
is having her first baby. When her eyes gaze into mine, when I feel her
contractions crashing through her body like tumultuous waves against the
rock, and I know she is doubting her strength to go forward despite her
great desire to complete her task, I say to her, "OK, Suzy, now you will
have to walk on water." She grasps my hand a little harder and replies,
"How far do you want me to walk?" Then, we walk together.
- Valerie El Halta
To read this fine article in its entirety, go to
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5) Check It Out!
A Web Site Update for E-News Readers
New Articles Are Up!
How does the International Code of Ethics for Midwives fit your practice?
The International Confederation of Midwives invites your feedback.
Did you like what you read in the "Normal Birth" excerpt above? Read the remainder of the article at
Midwifery Today's Product and Services Directory--The Birth Market--has
opened its doors for birth practitioners to join! We are asked every day
for help locating birth practitioners of all kinds--here is Midwifery Today's savvy solution!
ON SALE: For the cost of $25 and a static banner on your web page, you may
join our listing. This means if you have a web page that is EXCLUSIVELY
about your practice and DOES NOT SELL A PRODUCT, you may add our banner to
your site and pay a $25.00 registration fee to be included in the Birth Market. This is a special price to you--a regular entry to the Birth Market
costs $150.00 for businesses/websites that sell products. See
www.midwiferytoday.com/ads/bannertrade.htm. If you don't have a web page, call or e-mail Cynthia the
You may also read more details at www.midwiferytoday.com/birthmarket
On March 29, 2000 Jan Tritten, Mother of Midwifery Today, and Cynthia Yula,
WebGirl@midwiferytoday.com, invite you to join them at 7 p.m. for drinks, 8
p.m. for dinner at Panchitos Mexican Restaurant, 103 MacDougal St., NYC, NY
212-473-5239. We are "going dutch" (is that politically incorrect?). But
Cynthia's buying the first round of nachos!
As you know, our international conference is scheduled for September 6-10,
2000 (www.midwiferytoday.com/conf/2000and.htm ).
We are looking for Birth Change Agents to brainstorm with. Have any addresses or phone numbers
we should have? Is there someone you think we should invite? Any marketing
tips to share? We're all ears! Please bring a floppy disk of addresses if
you have a long list. And also, if you are interested in a web page, bring
three photos for Cynthia to scan for your page.
Birthing From Within
by Pam England, CNM and Rob Horowitz, PhD
Are you a birth enthusiast? You need a web page! After all, isn't a picture
worth a thousand words? Have a web page created that you can hotlink from
Midwifesearch.com, Midwife Link and Midwifery Today as well as your paper
marketing! We even register your site into search engines! Contact Cynthia
the WebGirl@midwiferytoday.com for more details.
7) Questions of the Week
How does previous cervical surgery (such as LEEP) for dysplasia affect the
ability of the cervix to dilate during uninduced labor? One CNM estimated
that about 60% of her clients who have had LEEPs have cervical scarring
that temporarily prevents the progress of dilatation for up to several
hours. I am a 20 week primip and am trying to prepare myself
psychologically for this possibility. I have seen several women experience
very painful early labor as a result of this problem.
- Kari Michalski
Send your responses to email@example.com
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Attend a DONA approved doula training May 19-20, 2000 in Waterloo, Iowa.
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8) Question of the Week Responses
Q: Is a cesarean indicated for premature babies? If so, how premature? The
study I recall concluded that outcomes were no better having done a
cesarean no matter how premature. Of course I can't find the study now, so
if any of you have any information or studies on hand, please let me know
- Amy Jones
In the hospital where I gave birth at 25 weeks gestation, preemies are born
vaginally unless medically contraindicated. Even though Olivia's birth
required a section, they did a sonogram for me to check her position
minutes before the surgery (I had an 8 cm fibroid deep in the pelvis; she
was breech with cord presenting) just in case something had changed and we
could chance a vaginal delivery. Since preemies are so small and the
problem is not inducing labor but stopping it, many can be born vaginally
with little additional trauma. But it depends on the baby & mother's
condition. I never thought I would have been happy to have a c-section
until it saved Olivia's life. My midwives were there, of course, through it all!
- Regina Paleau
To my knowledge the indicators are similar to term babies, although the
threshold for fetal distress tends to be lower. Also, the risk of
malpresentation is higher. But it also needs to be taken into account
whether or not the lower segment is fully formed, because otherwise the
woman is looking at a 'classical' upper segment cesarean which to my best
knowledge commits her to cesarean birth for subsequent deliveries.
- Kirsten Blacker
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Q: I would like to hear from other midwives who have dealt with pinworms in pregnancy. Did the women experience periodic spotting? Also what, if any,
natural remedies are effective and safe in pregnancy?
- Deren Bader
Pinworms and spotting in pregnancy are not related. However, it would be
important to rule out irritated hemorrhoids or other causes of bleeding
from scratching efforts. Pinworms are fairly common and have a life cycle
of about 2-6 weeks. They are transmitted by hand to mouth contact and
emerge from the anus to lay their eggs. The resulting irritation causes the
host to scratch; the cycle is repeated when unwashed hands touch food or
the mouth. The ova can live up to three weeks.
Before medications for pinworms were developed, gentian violet was taken
internally for 10 days to kill the worms. It cannot be used internally in pregnancy, but it does raise the possibility of external use at the anus to
kill emerging worms. Some Naturopaths prescribe spigelia for pinworms. It
is safe to use in pregnancy. Others suggest ingestion of pumpkins seeds and
garlic for a period of ten days to two weeks. It is important for all
family members to be treated and this includes bathing every morning to
wash away ova that have been deposited outside the anus. Snug fitting
underwear and regular handwashing as well as washing of bedsheets will also
- Maryl Smith
I recently had a client with pinworms in the first trimester. She also had
vaginal yeast infection, bacterial vaginosis, and urinary tract infection.
She came in with constant, dull aching throughout her abdomen, no spotting
I couldn't find any effective natural remedy for pinworms. So I treated the
UTI first, emphasized hygiene and the need for lots of water, and discussed
symptom relief through the use of warm packs. After 12 weeks gestation, the
pharmacist told me we could use Vermox pinworm medication to treat the
pinworm. Yogurt, garlic suppositories, and Monistat were used for the yeast
infection. The bacterial infection was severe, so we decided to use a
Metrogel prescription. She is now fine.
Pumpkin seeds as a remedy for pinworms is very effective. It will kill them
and eliminate them from the body. I don't have specific advice other than
to eat them until the problem resolves, and then, I'd advise until three
weeks after that to ensure no hatching visitors. A quarter cup three times
a day seems like a reasonable amount.
- Beth Germano
Understanding Diagnostic Tests in the Childbearing Year by Anne Frye
discusses pinworm infestation extensively and lists numerous
non-biotechnical means of ridding the body of these parasites. This
comprehensive book of over 900 pages is available from Midwifery Today for
$43 plus shipping & handling. E-mail email@example.com or
call 800-743-0974. Mention Code 940.
More on precipitous birth:
Yes, it is possible that you could have another precipitous birth. One risk
of a precipitous birth is postpartum hemorrhage. Your midwives, if they
weren't there for the birth, would probably arrive shortly after, and be
able to help with any bleeding, the delivery of the placenta, and check in
with you and the baby. I'm sure your midwives could do a class in emergency
childbirth for you and your partner, and educate you on when to call 911 in
case they weren't with you.
The speed of my labors is what took me from OB care with my first two
births to nurse-midwifery care with the next three, finally to a homebirth
with number six. If I am going to birth, I would rather have the
"equipment" and room ready for me. I remind couples as we tour the birth
center (in the hospital birthing classes that I teach) that these rooms
contain all the equipment the hospital prefers to have available for a
birth. Then I ask what equipment is essential to have a baby. I let them
ponder a moment, then submit to them that the only equipment necessary is a
pregnant women! The rest of the equipment is to make things more convenient
for those attending her.
I would definitely have several contingency plans worked out. Aren't most
pregnant women the masters of contingency planning? The most important
thing is that the expected event bring peace to your heart as you
anticipate it. If the overwhelming feeling is ... well, overwhelmed, then
there may still be some unfinished business to take care of, either in
planning contingency, comfort level with the homebirth idea, relationships,
etc. Follow your feelings and be wise in your planning.
- Patty Kartchner
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After reading about interventions that accost both mother and baby during a
breech birth and then finding Maka Laughingwolf's comment on taking the
baby's cue that perhaps the child just wants or even *needs* to be born
that way [Issues 2:7-8-9], May I suggest that your readers refer to the
breech birth article "Staying in the Humble" that appeared in the last
issue of Midwifery Today. It is, by far, the best article on breech birth
and acceptance of such I have ever read. It was very inspiring from both
the perspective of the attending midwife and the birthing mother! Track it
down and read it, folks! This baby *needed* to be born this way and had
been born this way each and every time he came to earth! WOW!
- Sharon Sullivan
To order your copy of Midwifery Today Issue 52 with the story, "Staying in
the Humble," e-mail: firstname.lastname@example.org
or go the Midwifery Today website: www.midwiferytoday.com
Mention Code 940 when you place your order and receive a $1.00 discount.
Offer good through March 31, 2000.
In reference to Diane Rugh's response to my Doppler question [Issue 2:9]: I
found the information educational yet I still question the routine use of
Dopplers and wonder if *most* midwives are routinely using it. So midwives,
are you? Do you tell your clients that it is ultrasound? The AUIM says
there is "no confirmed biological effect" yet also says, "Although the
possibility exists that such biological effects may be identified in the
future, current data indicate that the benefits to patients of the prudent
use of diagnostic ultrasound outweigh the risks, if any, that may be
Physicians for Midwifery: Dedicated to healthy, safe birth outcomes through
support of midwifery services and integrative midwife-physician care.
*Do you believe almost all births are a normal and safe process without the
need for expensive obstetric technology?
*Do you believe women should have a choice of birth attendants and birth
Join other physicians and midwives in supporting collaborative efforts to
educate students, residents, physicians and consumers regarding the
midwifery model of care.
Contact: Patricia M. Burch, MD, FACOG, 112 Exchange Place, Lafayette, LA
70503; tel: 337-232-4588 or 337-232-4589; e-mail: email@example.com
In response to Aiyana Gregori's questions regarding her preceptor's routine
practices [Issue 2:10]:
It's true that the placenta, at some point, stops functioning well and the
baby can become at-risk. However, there is no reason why periodic
monitoring of the placenta post-dates couldn't happen (unless access to
this technology is absent). As long as there is sufficient fluid level, and
the placenta doesn't appear to be too calcified, there is no reason to
induce a woman only because she is past her due date. Remember, the due
date is just an estimate--women grow babies at different rates! As well,
women grow babies of different sizes. Unless we are consuming large amounts
of growth hormones from eating animal products, I firmly believe we grow
babies our body can birth! I honor your willingness to question these
- Jenny Johnson
It's odd that he says birth is a "biological process best left to occur on
its own" then is highly interventive! He may have a low c/sec rate, but at
what cost to the "biological" process? It sounds as though he wants to be
very much in control of when women birth and that it is *his* timing of
things that makes it all happen safely. As for doing a c/sec if the baby
"is over 10 pounds," this is merely an estimate and is probably wrong
fairly often, meaning a scheduled c/sec on smaller babies or even large
babies that would have birthed well despite their size. Is this doc aware
of the Gaskin maneuver: all fours for birthing large babies? Maybe he had a
very traumatic dystocia with a large baby that made him say, "Never again."
I would suggest you find a homebirth midwife in your area if possible to
precept with as well. A well rounded experience is extremely important. It
is equally important that direct entry midwifery students have hospital
- Kelley Hewitt
To Jackie, who described a fear of public speaking [Issue 2:10]:
May I suggest that you forget "public speaking" altogether? It is to
communication what "medicalisation" is to birth, which is to say an
unnatural, inefficient way of doing things, with its own equivalent
stress-problem-stress vicious circle, as you've discovered. What you're
really trying to do is something that comes naturally to you: share the
skills you have with others in order to help them become better parents.
Isn't that the sort of thing that makes you want to be a midwife in the
first place? Why not talk *with* (not "to," certainly not "at"!) your group
as an equal member, but one who happens to have a lot of good stuff to
share? In other words, don't lecture--participate. Of course, that means
listening to what others have to say too, and learning from them (tough on the ego sometimes, admittedly!), but that way perhaps you'll find that
you're all helping answer each other's real concerns and problems, not
telling them what they're *supposed* to need to know, and you won't be
worrying about how you sound, how you look, etc. Hope this helps.
More on timing of the baby's first bath:
I've been unable to locate any evidence that the timing of a baby's first
bath has any effect on anything other than the "cleanliness" of the baby.
Over the decades recommendations veer wildly from immediate to delayed
bathing. At one period women were advised to postpone baths until the cord
fell off, even though the cord-care sterilization of that time period meant
this could be as long as three weeks!
I give my clients the following advice: bathe the baby whenever they wish.
There is no need to hurry and no need to delay. Bathing before the cord
detaches does no harm and does not increase the incidence of infection.
- Gail Hart
Regarding the story about jaundice and baby's first bath: this is not a
serious way to bring genuine knowledge to people; it's non significant
anecdote. The reasons for jaundice are many and varied and have little if
anything to do with timing of the first bath.
- Phil Watters
I want to hear from midwives about their experiences with women who stay
mobile and ambulant during their labours. I have all the research I need
now, but would like some anecdotal evidence from midwives themselves, how
they feel outcomes are different for women hooked up to monitors for hours,
epidurals, analgesia etc. as compared to women who aren't.
Reply to: Infinity@cableinet.co.uk
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