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In This Week's Issue:
1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) The Box
5) Facing Reality
6) Check It Out!
7) Question of the Week
8) Question of the Week Responses
9) For Coming E-News Themes
1) Quote of the Week:
"I stay quiet, do a good job, have my focus on the need that is there and try to meet it, and thus become so entrenched in the community that the community then becomes my support."
- Sr. Angela Murdaugh
2) The Art of Midwifery
Work as a doula in unwed mothers' homes, where there are
high numbers of abused women. They can learn the efficacy of
touch from you. Check the woman's comfort level and respect
her boundaries. Touch is an international language.
- Midwifery Today conference Tricks of the Trade circle
Share your midwifery arts with E-News readers! Send your favorite tricks to firstname.lastname@example.org
3) News Flashes
A study of the acquisition of herpes simplex virus (HSV) in pregnancy and its effects on the newly born involved 8,538
women. All were tested for the presence of antibodies
against HSV-1 And HSV-2, and serum samples obtained for
routine prenatal tests at 14 to 18 weeks and at 24 to 28
weeks were saved and tested to pinpoint the time of
seroconversion. Of the women, 24% were HSV negative at the
onset of prenatal care; 48% were seropositive for HSV-1, 11%
for HSV-2, and 17% for both. Ninety-four women, or 2.1% of
all susceptible women, converted to herpes positive during
pregnancy. Of these, 64% had subclinical infections. All 26
women with clinical symptoms of HSV-2 infection and 6 of 8
with symptomatic HSV-1 infection had genital lesions. About
the same ratio of serum negative women and women who
initially had antibodies only against HSV-1 converted to
seropositive for HSV-2; however, no woman who was
seropositive for HSV-2 converted to positive for HSV-1,
suggesting that the former confers immunity against the
latter. Younger age, not being married, and occurrence of
other sexually transmitted diseases were associated with
seroconversion. The only babies in the study who contracted
neonatal herpes were born to women who acquired genital
herpes near the onset of labor and who had not yet developed
antibodies. No baby of the 94 women who seroconverted during
pregnancy developed herpes; neither was an increased risk of
preterm labor, intrauterine growth retardation, or
spontaneous abortion found.
- New England Journal of Medicine, 1997, Vol. 337 No. 8
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4) The Box (excerpted)
From early childhood I had been excruciatingly afraid of
people. I never experienced true intimacy. With the very
first birth I attended I found my need for intimacy met with
the birthing family. They needed me, they were totally
vulnerable, they responded with gratitude to me. I could
love them, give to them selflessly without fear of
My relationships with these families lasted only a short
time. This was vital. An intimacy that begins and ends
quickly is not a demanding intimacy; it is perfect for those
who are afraid of rejection. While this element of midwifery
met my needs wonderfully, my family life suffered. I became
alienated from my husband and children.
When I discovered midwifery, I had been looking for
significance and purpose in my life, for a cause that
transcended the mundane. It was my false belief about the
nature of spirituality that caused me to make midwifery my
religion. To say midwifery is a calling and to tell myself I
was one of the "called ones" was a poor cure for my lack of
self worth. My level of significance and security depended
on numbers, my self worth depended on successful outcomes
(no transports and drug free births). Needless to say, poor
outcomes shook my universe terribly.
When my family, social, emotional and spiritual life finally
hit bottom after spiraling downhill for years, I began to
see what no one could tell me. At the same time, I met
another midwife who hit bottom the same way with the same
effects on her. Ironically, I met her before our
simultaneous collapse and thought, "Finally, here is another
midwife who is as dedicated as myself." Meeting her again at
the treatment center was like looking in the mirror.
- Carolyn Eustace in Life of a Midwife, a Midwifery Today Book
Life of a Midwife is chock full of articles and stories
about what it's like to be a midwife. For more information,
go to: www.midwiferytoday.com/books/lifemw.htm
5) Facing Reality: How to Begin Your Midwifery Career (excerpted)
It is likely that your mate is a major influence in the
decision-making process [to become a midwife]. If you were
to choose to begin your career, what would this mean to him?
More work, more money, more sacrifices from him, more, more,
more? Certainly it challenges his present lifestyle that may
be quite comfortable the way it is. You can determine his
true feelings by using gentle encouragement, and quiet his
fears as well. After all, you are not replacing your
marriage with a career, only complementing it. It is sad
that our society continually places women in a position in
which they must validate their right to happy and fulfilling
work. For those considering a change, an encouraging partner
is valued beyond gold. Generally, men tend toward one of
three reactions when informed of their mate's desire to
begin a career in midwifery: He will wait it out patiently
until she "changes her mind when things get rough"; he will
use guilt to make things as tough as possible; or with love
and support, he will take pride in the growth and
fulfillment she is experiencing.
Every relationship has weaknesses that can become more
troublesome with change. You can prepare yourself by
strengthening your commitment both to your partner and to
your career. Make it clear that anyone who continually
argues your limitations or makes life difficult during your
work hours is not using acceptable behavior. Your happiness
is your right and personal responsibility. Gold stars to the
loving supportive mate who thrills at your joys and can be
your spine when yours can't hold you up anymore. Blessed be
the mate who can listen to his partner's desire to challenge
herself outside the home and supports her in word and deed.
This precious man is worth all the juicing up you can
provide along with constant acknowledgment of his output and
- Karen Parker, CNM in Paths to Becoming a Midwife, a Midwifery Today Book
Paths to Becoming a Midwife shows you how to make reality
out of your dream of becoming a midwife. For more information:
6) Check It Out!
A Web Site Update for E-News Readers
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7) Question of the Week
My friend suffered from pain caused by "pubis symphasis"
during her past five pregnancies. She is currently eight
weeks into her sixth pregnancy, and she's already
experiencing pain. Are there any exercises that can help?
Any magic cures (homeopathic remedies, etc.)? She broke her
coccyx during her first labour 16 years ago, but went on to
have normal, uncomplicated births with her fourth &
fifth children. Her youngest child will be two when the new
baby arrives. Her birth was extremely fast (40 minutes). Is
homebirth an option?
Send your responses to email@example.com
8) Question of the Week Responses
Q: What experience has anyone had of trisomy 18 (Edwards
syndrome) in a natural birth, homebirth situation? This is
what mum would prefer but has been told that possible
complications may require a cesarean.
A: We recently helped a mom with a trisomy 18 baby deliver
at home. She found out about three weeks before the birth
and knew that he had multiple anomalies incompatible with
life. The consulting doctor did not have a problem with her
having a homebirth/homedeath. He was delivered, in a
double-footling breech position, after a fairly short labor.
Baby Noah lived for an hour and died in his daddy's arms. I
am wondering what complications for your client would
necessitate a cesarean? Babies with trisomy 18 generally do
not live very long and it seems that the risks would
outweigh the benefits for both mother and child.
- Holly Richardson, CPM
A: The organisation SOFT is a wealth of knowledge on trisomy
18 and trisomy 13 (Patau's syndrome) as well as related
disorders. They have an office in the United States as well
as Australia and the UK. Unfortunately, I cannot get the USA
web page to come up but if you go to the UK home page at
http://www.soft.org.uk/ and click on the CONTACTS button,
there is information on how to contact the US group. They
provide booklets on all sorts of different aspects of
trisomy 18, and local support groups are available.
In investigating trisomy 18 for a client a long time ago
when I was living in the UK, I found that many of the
"facts" surrounding trisomy 18 and the prognosis for these
babies were in fact myths. I had had a client who had
previously chosen to terminate a pregnancy with her first
baby, who was diagnosed with Edward's syndrome because the
prognosis was that he would never survive childbirth.
However, I discovered that it is very difficult to determine
the extent of the syndrome and that in fact many babies
lived beyond one year when they had full Edward's (10%), and
those with partial or mosaic Edwards had an even better
prognosis. It's a terrible tragedy that so many parents are
given so much inaccurate information and make choices that
are not informed in any way.
- Nikki Macfarlane, CBE, doula
A: Why perform major surgery on a mother when the child has
a condition incompatible with life? Trisomy 18 babies rarely
live long. To even suggest cesarean as a possibility is
medical abuse unless it is for a complication related to the
mother's well being. This baby should be born at home to
protect both mother and baby from unnecessary medical
intervention in a very private, sorrowful, and holy event.
Monitor the baby only if mom has a need to know how baby is
doing. Find a friendly ND or MD who will agree to come at
the last minute and quietly note time of death and sign a
death certificate. Make sure the family has sufficient time
to bathe, love and take pictures and footprints of their
child before relinquishing it. It helps to call the coroner
ahead of time to let him know that you are attending a home
labor with a baby who has been diagnosed with a condition
incompatible with life. Tell him a doctor will be present to
confirm time of death. This will protect you from any
unnecessary inquiry. The funeral home can pick up the baby
when the family is ready, or they can choose to have a
trusted friend or family member transport the baby by car
themselves. A car seat can be used. Call the funeral home to
let them know baby is coming.
Two weeks ago I had a mother who gave birth to a trisomy 18
baby. Unfortunately, the problem was not picked up until an
ultrasound at term to rule out IUGR. Because there was no
time to perform chromosomal studies for a positive
diagnosis, the perinatologist encouraged the parents to give
birth in the hospital. However, the baby also had a major
diaphragmatic hernia with the liver displaced up next to the
heart as well as a ventricle septum defect of the heart.
Despite the parents' expressed wishes to have the baby at
home if it was not viable, the physician continued to offer
them hope if they would stay in the hospital "just in case
it wasn't a trisomy." I believe this pressure was based more
on fear of liability than an actual belief that the baby
wouldn't have a trisomy or could live through the necessary
surgeries. It wasn't until mom was four hours into a cytotec
induction that the parents had the opportunity to consult
with a neonatologist about the seriousness of their baby's
problems. At that time the parents discussed going home to
have the baby. The neonatologist supported this choice, but
the perinatologist was upset. The couple decided to stay for
the sake of an epidural. This was mom's sixth birth and she
had never had pain medication before. She said she wasn't
certain that she could cope with both the pain of labor and
the pain of loss at the same time. This was a valid choice.
No one can measure another's grief. Sadly, the epidural was
Our biggest fear was that the baby would be removed from the
parents at birth and they would not be allowed to be with
him when he died. The fact the parents had considered going
home helped the doctor accept that they did not want any
heroics. When the baby started to have severe heart rate
decels into the 50s with slow recovery, the possibility of
cesarean section was brought up by the doctor. Fortunately
we had already discussed this ahead of time and the parents
refused consent for surgery. The doctor agreed that this was
a reasonable choice under the circumstances. (But why was it
"irresponsible" to go home to have their baby if this was
OK?) He removed the electronic fetal heart monitor and let
the labor continue. When baby was born, the diagnosis of
trisomy 18 was immediately confirmed and he was placed in
mother's arms to die. He never took a breath. He only felt
tender arms, gentle kisses, and heard whispered "I love
you's." It is a midwife's sacred honor to walk with families
when life is coming in and sometimes when life is going out
as well. I send you my prayers as you walk this journey
- Maryl Smith
A: How sad the mother has been told she can't deliver a baby
with trisomy 18 at home! The abnormalities involved in this
syndrome should cause no problem whatever in birth, unless
perhaps it is associated with polyhydramnios. The only one
I've seen born was a normal birth in the hospital. Sadly,
although there is nothing that can be done for a trisomy 18
baby, before the baby was very old the hospital staff had
figured out a reason why it had to be separated from the
mother. The baby didn't live very long and the mother wanted
it there with her, but someone just felt they had to do
something, even if it was only to take the baby to the
nursery "where we can watch it." Why? To me, home would be
the perfect place for this baby to be born so the parents
can come to terms with the situation in privacy.
- Marion Toepke McLean
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9) For Coming E-News Themes:
1. "Is the fact that midwives cut far fewer episiotomies
than doctors important?" asks Marsden Wagner, M.D. in his
Technology in Birth article
What do you think? (June 28 issue)
2. Premature rupture of membranes (PROM): what is your protocol? (July 5 issue)
3. What do you carry in your birth bag? Anything unusual, and if so, for what purpose? (July 12 issue)
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How often do you currently see (following a non-traumatic
vaginal delivery) a practitioner do a ring forcep cervical
and vag vault check with the intent to suture any tears
found? I recently endured watching this done to a person I
transferred from a homebirth to hospital care. I thought
this procedure went out 40 years ago. Am I wrong?
- Roberta Gehrke, CNM
One of our patients is moving to Germany soon. Is midwifery
care is the "norm" there? They are slated to move to Berlin
or Frankfurt. If you know or have a way of us finding out
- Pam Jessee, L.M.
Reply to: email@example.com
I disagree with the response to the knots in the cord not being harmful. I recently attended a birth (doula); there was a knot in the baby's cord.
The mother kept going on and on to everyone about how her
baby had a "perfect knot" in his cord. The nurse finally
told her that a few weeks earlier they had a fetal demise
due to a knot in the cord. The mother was 34 weeks. This can
happen if the baby has enough room to be very active. It can
pull so tight that all supply is cut off.
I've enjoyed all the comments on cervical lips in the
pushing stage. In each of my three homebirths I've had a
cervical lip. The first time, the midwife held it back for
one push till the baby's head went by. No problem. The
second time, it stayed around for a few pushes, but nothing
major. With baby three, the lip hung around for an hour
before I could push past it.
Having the midwife's hand in there is not the most pleasant
sensation! I have no scar tissue, noting peculiar about my
cervix. Any comments about why this has been happening would
I am so glad to see information on pushing and when to do so
in your journal. With the birth of my first child I did not
know better and was told to push since I was "at a 10." My
baby and I were definitely not ready. The results were a
very oxygen deprived baby (the L&D nurse also coached me to
hold my breath and push to a count of 10 and beyond). I also
broke blood vessels all the way down past my waist, both
eyes were black and swollen shut, and I also broke all the
blood vessels in my eyes (I had no whites at all for over a
month). It also did long term damage to my pelvic floor and
gave me problems with incontinence for two years, even with
faithful kegel exercises. All this could have been avoided
by waiting until I had the urge to push. I never did
experience the urge to push even as my son came out!
The second time around, I was a Bradley Natural Childbirth
instructor and I knew better. My midwife never did do a vag
exam and I pushed only after the urge hit and worked with my
body--no long pushes or breath holding. There were no
bruises on me or my baby this time and I had a rather easy
pushing stage. This was so much better!
- Anna Matsunaga
Have you made much use of the reference text "Mayes
Midwifery"? It's been around for a long time but the latest
edition (that I have seen) is the 12th (1997, reprinted
1998). It has forty-one contributing authors, entirely
female, and is written by midwives for midwives. It should
appeal to those who value this type of authoritative work,
and answer a lot of questions outside the medical
model--it's not particularly pro hospital. It could go a
long way toward making the "angry powerless" feel better
about the future.
- Phil Watters
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