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This issue of Midwifery Today E-News is sponsored by:

- Herbal Healer Academy

- ReSourcing Birth
- Waterbirth Website

Look for their ads below!

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Midwifery Today Conference News

OUR HOME TOWN will be the site of our domestic conference
next March. Come join us in friendly Eugene, Oregon
("Eugene" means "good birth"!). For more information, go to:

http://www.midwiferytoday.com/Conferences/Eugene2001/venue.htm

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Send responses to newsletter items to mtensubmit@midwiferytoday.com

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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Herbs
5) Check It Out!
6) Midwifery Today Online Forum
7) Question of the Week
8) Question of the Week Responses
9) Question of the Quarter for Midwifery Today magazine
10) For Coming E-News Themes
11) Switchboard
12) Classified Advertising

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1) Quote of the Week:

"Herbs are powerful. They can do miracles if we but give them the respect and appreciation so rightfully theirs."

- Jeannine Parvati Baker

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2) The Art of Midwifery

A sitz bath brings immediate relief to swollen membranes and slows bleeding. Use a mixture that contains a combination of herbs such as comfrey, yarrow, uva ursi, witch hazel, goldenseal, or garlic. To use, pour one gallon of boiling water over one ounce of herbs. Cover and steep for twenty minutes. Strain the strong infusion into a shallow tub or a sitz bath pan specifically made to sit in on the toilet. Also, the new mom can squirt a strong comfrey tea from a bottle whenever she urinates, to prevent burning and also help perineal healing.

- Kathryn Cox, The Birthkit Issue 22

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To subscribe to The Birthkit, Midwifery Today's between-issues quarterly newsletter, go to:
www.midwiferytoday.com/birthkit Save $3 if you subscribe to both The Birthkit and Midwifery Today magazine. Please mention Code 940.

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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

Based on an examination of 4.5 million births in the United States and Canada in the 1990s, researchers at McGill University in Montreal found that compared with babies born full-term in 1995, those born at 32 weeks to 33 weeks were about six times more likely to die within their first year. Babies born closer to term but still early--at 34 through 36 weeks--were nearly three times more likely to die than full-term infants. The causes of death included infection, breathing problems, various birth defects and Sudden Infant Death Syndrome. The head of the study, Dr. Michael Kramer, said obstetricians "may perceive induction as risk-free and therefore not adequately balance the risks and benefits." - www.mayohealth.org/mayo/9902/htm/preemies.htm

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Special Offer to E-News readers: Enjoy a 10% discount on your purchase of the "WATER BABY" video. Regular price is $59.95 + $7.50 p/h. Your discount price is just $53.95 + p/h. Full ordering details are at www.waterbirthinfo.com/materials.html

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4) Herbs

Black Cohosh (Cimicifuga racemosa)
Late 19th century physician Knox, an Eclectic, presented a paper before the Chicago Gynecological Society describing his use of black cohosh in combination with sarsaparilla in 160 women during the last four weeks of pregnancy to prepare them for labor. Under its use, he had found the average duration of the first stage reduced from 17 hours to 6.25 hours, and that of the second stage from 3 hours to 1.75 hours in primiparae, and in multiparae, the first stage reduced from 12 hours to 3 hours, and second stage from 1 hour to 27 minutes. He concluded from his observations that black cohosh had a positive sedative effect on parturient women, quieting reflex irritability, nausea, pruritis and insomnia, that it mitigated, and often altogether abolished, the neuralgic cramps and irregular pains of the first stage; that it relaxed the soft parts, thus facilitating labor and diminishing the risks of laceration; that it increased the energy and the rhythm of the pains in the second stage; and that, like ergot, it maintained a better contraction of the uterus after delivery.

Isolated constituents of black cohosh have peripheral vasodilitory and hyptensive effects in animals (Leung & Foster, 1996). Researchers reporting on human studies have stated, "In man, this drug (isolated constituent of black cohosh) has no hypotensive effect, though its peripheral vasodilatory effect is evident."

Prepartion and Dosage: Fresh or dry root tincture, 10-25 drops up to 4 times daily; or capsules, "00" size, 1-2 times daily.

Indications for the use of black cohosh:

• Alone or in formula with other herbs during the last month of pregnancy to prepare for labor.
• Pelvic discomfort, excessive uterine activity or tone, false labor during the last month of pregnancy.
• To augment or intitiate labor contractions.
• Dull, achy heavy feeling in pelvis or legs.
• Postpartum uterine subinvolution with heavy, aching pain.

CAUTION: Do not use before 36 weeks gestation.

- Cindy Belew, CNM, herbalist, in The Birthkit, Autumn 1998

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Two herbs used as symptomatic treatments for heartburn include meadowsweet (Filipendula ulmaria) and licorice (Glycyrrhiza glabra). Both herbs serve us well as anti-inflammatories and reduce stomach acid, but act in different ways in the digestive tract. Licorice reduces the irritation of acid through a buildup of mucous secretion, whereas meadowsweet is believed to assist in the proliferation of stomach and intestinal cell reproduction/repair.

Caveats exist for both herbs. Avoid the use of licorice with gestational hypertension/toxemia. If the woman has aspirin or salicylate sensitivity, meadowsweet should not be ingested. Ironically, although extended use of aspirin can lead to stomach ulceration, meadowsweet does not exhibit the same negative side effects.

Both herbs can be taken internally using a tincture or infusion. If the mother is close to term and experiences gas as well as heartburn, fennel should be considered a treatment possibility. Fennel is considered a strong laxative and uterine stimulant, so its use earlier in pregnancy is not desirable.

- Chris Hafner-Eaton, The Birthkit Issue 15

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Comfrey salve is easy to make and is famous for using on sore nipples. The comfrey leaf contains alontoin which promotes regeneration of epithelial (skin) cells. To make the salve: Submerge clean, dry comfrey leaves in a good quality oil for six to eight weeks. Strain, then heat to kill bacteria. Thicken with beeswax and/or paraffin and pour into small jars.

- Lisa Goldstein, The Birthkit Issue 12

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Birth Overview Course - 10 Correspondence Modules plus 2
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5) Check It Out!

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

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TAKE AN HERB WALK with herbalist Linda Lieberman during the Midwifery /today Eugene conference in March. To learn about the conference, go to
www.midwiferytoday.com/conferences/Eugene2001/venue.htm

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HERBS & NATURAL REMEDIES audiotapes from Midwifery Today conferences are a great way to learn. To read descriptions and to order, go to
www.midwiferytoday.com/tapes/audioherb.htm

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PROCLAIM YOUR LOVE of birth with jewelry from Midwifery Today.
www.midwiferytoday.com/birthart/birthjewelry.htm

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6) Midwifery Today's Online Forum

I am a doula for a woman who will soon give birth (EDC 8-27-00). I have just learned that she is a survivor of sexual abuse. I know that Penny Simkin has written and lectured on this topic--another author who comes to mind is Connie Wescott from Oregon. I am wondering if anyone has info handy or other references or tips that you could share so that I might be better prepared to help my client.

RESPONSE:
As a male midwife I have benefitted greatly from the numerous articles and references contained within the UK publication MIDIRS pertaining to sexual abuse and birthing care.

Because of the high incidence of sexual abuse, assault etc., one must always assume that their client could have indeed issues pertaining to this and care should be provided in a sensitive and understanding way for all. One thing certainly to avoid is the use of paternalising/maternalising language. Horrible expressions such as "there's a good girl" etc can although be innocent have attachment to abusive episodes. As always, respectful, open and appropriate CLIENT initiated and centered care is the answer. Much love and support to you and your client.
Love and Peace
Nigel

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To share your thoughts and experience, go to Midwifery Today's bulletin board:
www.midwiferytoday.com/forums. Click on "Legal Battles and Birth Politics."

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7) Question of the Week

I am a student midwife and have a client who is a Hepatitis B carrier. I am interested in hearing from other providers who have been in similar situations, and what they have done about being vaccinated or not for Hepatitis B. I am concerned about not contracting it, but also concerned about the risks/side effects of the vaccine. Any information would be helpful.

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Send your responses to mtensubmit@midwiferytoday.com

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8) Question of the Week Responses

Q: Is perineal massage necessary? Does it help or hinder tearing? I have been trained to do perineal massage and it seems to me that all it does is make the tissues edematous. I'm beginning to think that hot compresses and oil as well as positioning may be enough.

- Karen

A: In my experience as a mother I found perineal massage to be unpleasant and intrusive, both prenatally and during birth. That was a signal to me as a midwife: If something is unpleasant, maybe it's not really a great idea. Over the years as a midwife I was able, with my Amish clients, to back way off on everything without fears of litigation, etc. and what I saw in most every case is the least you do, the better the process works. So perineal massage was the first to go. I never in my entire practice had to sew more than three women, and one of those was the birth of a baby that came before I got there. In the hospital I now work in, they do vigorous massage and it looks savage and the moms don't appreciate it. I say, trust the process. Perineums can birth.

- Elizabeth von der Ahe

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I don't believe perineal massage is necessary. I have had five births, no episiotomies, and two tears. The tears healed with NO pain, so my experience is that tears are not to be feared greatly (although the stitching does hurt). My babies weighed from 6-9 pounds, and the tears occurred both with a 6- and a 9-pound baby, so there goes the idea that size makes a difference. I believe position is important, both of the mother and baby.

My doctor did massage during the crowning of the first baby, 6 pounds and a small tear. There was a lot of burning with crowning. Was it due to first time birth? Subsequent births burned only a little or not at all. My fourth birth resulted in a large tear, and that was also the largest baby (9 lb. 6 oz.). I believe the tear was due to my pushing hard during crowning, and the baby's arm was also up (I tore during delivery of the shoulders). However, all my 2nd stages were rapid (3-15 minutes), and the 3-minute one resulted in no tear and an 8 pound baby. I just wanted to share my experience and dispel the myth that episiotomies prevent tears and are not a big deal to recover from (just read the literature).

- Michaela

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I am a Filipino who has been in the US for almost five years, and I am a midwife. I have practiced midwifery for more than half of my life and I just turned 50. I started in rural areas with populations of five thousand with no doctors or nurse but myself, and some volunteers. The doctor and nurse would only visit me when something came up that I couldn't handle. In my areas I had a minimum of 15-20 deliveries in a month. Even with the experience I got as a midwife in a clinic at my house, there were so many cases that I thought I couldn't do but thanks to God I didn't experience any fetal or maternal death.

Regarding perineal massage, please don't do it. The perineum is a very sensitive part of a woman's body. Try to touch it and it is soft and thin and if you keep on massaging it, surely it will swell. Try positioning, and the best position is to let the mom stand and walk. And the mom will always say she can't do it. This is the time that you as a midwife will stand beside her, walk, talk, give tender massage of the tummy, a little hug, fix her hair, and other little things that divert attention from the pain. That's what a midwife is for. Avoid doing internal exams, but instead monitor the time and frequency of the pain. Remember, though, these things that I said won't work for everybody.
Fanny Bermudo

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I've been practicing for 20 years and I think massage in labor just swells the tissue. I think doing it prenatally might help, because it gets the tissue used to it over a prolonged period of time, doing it just a little (a few minutes) each day. Even if doing this doesn't make the tissue stretchier, it does make the woman aware of what it feels like when she has her perineum stretched, so it feels more familiar at birth and she is less panicky (like some women are) and more able to tolerate a slow controlled expulsion.

- R.B.

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9) Question of the Quarter for Midwifery Today magazine

Who is in your birth community? What does the concept "birth community" mean to you? How have you or how would you go about organizing one? Send us your favorite story about your birth community.

Please submit your response by September 15, 2000 to:
editorial@midwiferytoday.com

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10) For Coming E-News Themes

1. NAUSEA IN PREGNANCY: Let's talk about nausea in pregnancy (hyperemesis gravidarum)--experience, remedies, philosophy.

2. FETAL HEART TONES: How would you explain to a student midwife how to learn to listen to fetal heart tones?

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**Take part in E-News! Sound Off-Give Advice-Share Your Knowledge!**

Send your responses to mtensubmit@midwiferytoday.com

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11) Switchboard

More on Cytotec [Issue 2:36]:

Cytotec must not ever be used on pregnant women. Has anyone thought at all about what happens to the health of a mother and baby when hormones are used to induce labor? Very little information is available on the long-term side effects of any induced labor. I speak up constantly about this elective procedure as my daughter and I are still dealing with a reduced immune system caused by an adverse reaction to an induction drug four years after the birth. I believe we will see far-reaching ill effects on the health of mothers and babies who have agreed to this procedure without informed consent or being aware of the natural alternatives. Be aware that the baby is not the final result, a healthy mother and healthy baby is the final result. Using drugs or hormones to force the exit of the baby can lead to untold side effects to the mother and baby after the birth. Scheduled birth using hormones can harm both mother and baby for years after the birth.

- Gail J. Dahl, childbirth researcher & educator, author of "Pregnancy & Childbirth Tips"
www.pregnancytips.com

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From everything I've read about this pharmaceutical [Cytotec], I don't think it should ever be used, much less in a home or out-of-hospital setting. It worries me that there are midwives out there who would see it as "part of the birth bag." There are many much safer methods of starting a labor or easing a cervical lip out of the way.

- Kelley Hewitt, LM FLA

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As I read the contributions about Cytotec, my hair got more and more stiff on the back of my head. How can anyone use Cytotec as inducement on a live foetus (when you want it to stay alive!)?

I'm a midwife at a Danish university hospital. We use Cytotec 0,2 mg for inducing abortus provocatus and missed abortion after 10 weeks. We also use it for inducing labour on foetus mors, but never in the third trimester, because of the risk of rupture. The dose is applied every five hours until labour is in progress. Orificium has to be at least 4 cm before we may tear the membranes.

I've never tried to administer Cytotec myself, but I've heard my colleagues talk about it. They think it's better than the drug we used before (Cervagem) because it works quicker, and as Gina Acosta mentioned in last week's issue, there is no burning in the vagina or cervix.

For third trimester foetus mors we still use the "old" drug, Cervagem.

- Lotte Obbekjer, Danish midwife

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In your September 5 E-News was an article by Cathy O'Bryant, CPM on Cytotec to which I would like to respond. It is clear from her description that she has simply begun to use this powerful drug without first reviewing all the relevant scientific evidence on its risks. Sadly, this is a form of experimenting on women, a practice I hope midwives will never participate in. Here are the scientific facts on Cytotec for labor induction:

1) The FDA has never approved this use of this drug so if you use it, it is "off-label" use which would be impossible to justify in any court of law.

2) The drug manufacturer has written information in every package of the drug stating that it should NEVER be used on pregnant women. In the same September 5 issue of E-News is a long letter from the president of the company saying to not use it for this purpose.

3) The Cochrane Library, the most authoritative source of scientific information on obstetric practices, has stated repeatedly that the research on Cytotec for induction is inadequate to know enough about the risks and should not be used for this purpose.

I know of two court cases involving the use of Cytotec for induction, one resulting in a dead baby and the other in a baby with severe brain damage. In the second case, midwives were involved in an out-of-hospital birth and they will not be able to defend the fact that they managed a labor where Cytotec was given. This is so very sad. I hope that midwives will not be sucked into using this drug as it is dangerous to mother and baby and dangerous for the midwives as well.

- Marsden Wagner, MD

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My sister-in-law has just been diagnosed with a hernia in her groin. She is 20 weeks pregnant. Has anyone any experience of this or any ideas for self-help? She is in a lot of pain and it has been suggested by her GP that she will have to have a caesarean.

- Lucy

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Mary Foote from South Florida [Issue 2:34], are you out there? Please email the editor at E-News at mtensubmit@midwiferytoday.com.

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I am interested in finding out what states require birth certificates to be made out for babies and which states do not. I would also like to know the consequences for not giving your child a birth certificate. Can someone direct me to a good source? I am not able to pay a lawyer, so the source would have to be a book, web page or direct answer or email.

- Aurora
Reply to: faerymischief@hotmail.com

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12) Classified Advertising

Southern Oregon Midwifery Conference, October 7&8. Midwives, Doctors, Naturopaths. Featuring Anne Frye. Info: (541) 488-4260.

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