|September 20, 2000|
Volume 2, Issue 38
|Midwifery Today E-News|
“Nausea in Pregnancy”
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In This Week's Issue:
1) Quote of the Week
1) Quote of the Week:
"The ways in which we deal with childbirth and how we treat our babies, both in the womb and in the first year after birth, intimately affect us all, not only as individuals, but our culture and the planet as well."
- Suzanne Arms
2) The Art of Midwifery
I distributed a flier in my neighborhood asking to meet other pregnant women with a close due date and similar lifestyle. We became a group of five that supported each other throughout our pregnancies and into newborn care. We also worked together on childproofing our homes. Although we are now spread out over the country, we still maintain our support of each other.
- Sandra Dickson, Wisdom of the Midwives: Tricks of the Trade Vol. 2, a Midwifery Today Book
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3) News Flashes
Women smokers are at higher risk of having an ectopic or tubal pregnancy, according to a recent study. In women who smoked around the time of conception this risk was found to be three and a half times greater. One possible explanation is that the chemicals in cigarettes hinder the effectiveness of cilia, which sweep the egg from the ovary down the fallopian tube to the uterus.
- Pregnancy & Birth, October 1998
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4) Nausea in Pregnancy
Researchers are looking at stimulation of the nei kuan acupressure point as a way to relieve nausea and vomiting in pregnancy (NVP). A study tested acupressure wristbands, designed to stimulate the nei kual, for their effect on both NVP and the emotional state of early pregnancy. This study pointed out the correlation between nausea and vomiting and psychological problems such as anxiety, depression, and hostility--that persistent nausea leads to these psychological problems, and not the other way around. Study subjects showed significant improvements in both physical and mental status after brief use of the acupressure wristbands, and some whose nausea was not relieved still found their emotional state much improved.
If a woman is capable of moving at all, have her try moderate exercise. Be sure she keeps her exertions within reasonable limits. Vigorous exercise may leave a woman exhausted, dehydrated, and overheated--conditions likely to increase nausea.
Two women interviewed by the author report that singing was one of their most effective weapons against nausea. Breathing exercises or reading aloud may produce the same calming effect.
Aside from the effectiveness of hypnotherapy, a self-hypnosis routine that incorporates feelings and goals is effective in helping a woman feel calmer and more in control of her body. The fact that hypnosis can assuage nausea or control vomiting does not mean that NVP is all in a woman's head. People undergo dental work and even surgery under hypnosis, and no one would presume to suggest that the pain of being drilled or cut open is produced by a bad attitude. Hypnosis is also used to help chemotherapy patients overcome nausea and vomiting. The mind is a powerful force that can override the physical sensations within the body. -Virgina Hege Tobiassen, The Birthkit Issue 26
E-News readers share their experiences and remedies for nausea
I correspond online with a number of women suffering from nausea in pregnancy through the Pregnancy and Childbirth Topic Area at Suite101.com. (www.suite101.com/welcome.cfm/pregnancy_childbirth) Here are some personal tips that reflect much research over the years, personal experience, professional experience and correspondence with my readers at Suite101.com:
1. Manage nausea with food when you are able to do so. Read the book, "No More Morning Sickness" by Miriam Erick, RD, who specializes in working with women with nausea and vomiting in pregnancy (NVP). The book gives numerous ideas on foods to try instead of the same old saltine crackers and Jell-O.
2. Try small frequent meals and not eating and drinking at the same time. If you must drink, take tiny sips to just wash your food down. Don't gulp. Overfilling your stomach can trigger nausea and may cause you to vomit.
3. Try chewable prenatal vitamins, taken at lunchtime. I took NataChews, prescribed by my doctor. (I once took the advice of a well-meaning nurse to take them with orange juice in the morning. I never did that again!)
4. ReliefBand is a battery-operated wristband that gently stimulates nerves in the wrist. The impulses put out by the band interfere with the normal process of nausea and vomiting, allowing the stomach to return to its normal rhythm. It requires a prescription from your doctor or midwife. You can read more about it at the website http://www.reliefband.com.
5. Stock your pantry and refrigerator with sick-day foods. Lemonade and orange Gatorade, push ups and juice bars, cantaloupe and honeydew melon and chicken flavored dehydrated noodle soup mix kept me going and kept me hydrated on really sick days. Did I mention potato chips?
6. Get plenty of rest. Take a nap if you can. Don't keep an immaculate home. Since you are having kids, there's no better time than the present to get used to a less than tidy house! If you can afford to, consider cutting back on your work hours.
7. Finally, I very much believe there is a psychological component to nausea and pregnancy. Do not discount the stress in the pregnant woman's life. I'm not saying nausea is all in a woman's head. However, as I talk to other women who have had debilitating nausea in pregnancy, they relate some of the same beliefs I have about stress and nausea in pregnancy. Some have had undiagnosed mental illnesses like anxiety and depression. Some stressors others have had early in their pregnancies are decisions to keep or terminate the pregnancy, abuse issues, abandonment by their partners, financial concerns, marital trouble, family discord, work- or school-related problems, trouble with the law and so on. Help these women find the support they need, whether it be family, friends or a good therapist to work through these issues because they can continue to affect the pregnancy and future parenting.
These and other tips are posted at the Suite101.com website in a format better suited for pregnant women. Go to: http://www.suite101.com/article.cfm/pregnancy_childbirth/33749. If the tips are reproduced, please make sure credit is given to the author.
Perhaps someone can elaborate on the belief that the baby's gender affects the degree of nausea in pregnancy. I look forward to seeing what others have to contribute to this topic.
- Maurenne Griese, RNC
I vomited several times a day from 6/40 until around 18/40, and continued to experience occasional bouts until term. Nausea never left me until my son was born. I found sipping lemonade and tonic water helpful when I couldn't tolerate food. I finally consulted a naturopath at 12-13/40 gestation. She urged me to change my diet to wheat and dairy-free. I also drank lots of water when I was able to tolerate it. Almost overnight I felt like a different woman. I didn't vomit and only felt nauseous when I diverted from the diet. I would love to have another baby, but the thought of nine months of nausea and sickness is not attractive. I hope I can prevent the same from happening next time with the advice of my naturopath.
- Kellie, midwife
I had nausea in my first and only (thus far) pregnancy. Smelling a freshly cut lemon worked for me.
- Gail J. Dahl, Childbirth Researcher, author of national bestselling "Pregnancy & Childbirth Tips," and executive director of The Canadian Childbirth Association. International Toll-Free Order Line 1-888-999-2080; www.pregnancytips.com.
Many excellent homeopathic remedies work for nausea. Ipecacuanha in a 200C potency is for persistent, constant nausea. Nothing relieves this woman; even vomiting does not make her feel better. As soon as she vomits she feels the need to vomit again. Nausea lasts all day and is worse from lying down. This remedy is for the most severe cases when the woman has to be hospitalized due to weight loss and dehydration. Give a single dose (2 pellets) before getting out of bed in the morning.
- Piper Martin, B.Ed., DS Hom.Med
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6) Midwifery Today's Online Forum
I would like to know alternative treatment to Trichomoniasis in pregnancy. I would also like to hear any success stories, complications or just any tidbit you might think would be helpful.
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7) Question of the Week
I am interested in hearing about successful protocols for lactation without pregnancy. Please describe the method including duration or dose or other appropriate units. -Morgan
Send your responses to firstname.lastname@example.org
8) Question of the Week Responses
Q: 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.
A: Anyone who is involved in labour and delivery care who is not Hep B immunised is a danger to themselves and their patients/clients/mothers.
- Phil Watters
A: The vaccine has been shown to be highly effective with minimal side effects. I am a healthcare provider, pursuing midwifery licensure. The risk of contracting Hepatitis B while providing care for people/patients has far outweighed the risk of side effects for me. My school-age children received the three-part series last spring and experienced no side effects.
A: Like you, I certainly do not want to contract Hep B. But for me, the bigger issue would arise if I contracted it without knowing it and then passed it on to my clients or their babies. I would never forgive myself if that happened. So yes, I am vaccinated, and I feel that any risk of doing so is more than compensated for by my peace of mind. Same with malpractice insurance--I do it for my clients, not myself. If heaven forbid I should ever make a mistake that means a mom or baby needs care that I cannot afford to pay for, I want to make sure that there is a way they will get the care they need.
- Cynthia Flynn, CNM, PhD
A few years ago I read a statistic that 600 healthcare workers DIE annually of Hep B. This was several years after routine vaccination of healthcare workers became the norm, so perhaps the numbers were old, the vaccine isn't very effective, or lots of workers chose not to be vaccinated. Hep B is terribly contagious and although usually the disease course is relatively innocuous (stomach flu-like), it can become chronic (I think I remember it's something like 20% of cases), which is where the mortality comes in, with chronic liver disease and liver cancer.
I am not comfortable giving this vaccine to little babies or young children, but I am glad to have received it myself, since I am in a high-risk line of work. Even family members of those considered at high risk of exposure are encouraged to be vaccinated, again because it is so contagious and lives a long time on surfaces. I mention this just to point out that you are not the only one placed at risk due to your potential for professional exposure.
Out of my nursing school class of ten, one of us developed arthralgia for six months during and following the vaccine series for Hep B. After the fact, she attributed this to the vaccine. The joint pain interfered with her tennis-playing during that time, but did resolve completely.
- Jennifer Seymour CNM
9) For Coming E-News Themes
1. FETAL HEART TONES: How would you explain to a student
midwife how to learn to listen to fetal heart tones?
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I am currently 39 weeks pregnant with my first child. I have had severe nausea and vomiting throughout my pregnancy and from about four months on started taking Diclectin (antihistamine and B6 tablet available in Canada). I was vomiting from 10-30 times a day and had tried everything I could think of or read about, from ginger tea to chiropractic. I am a firm believer in trusting my body to grow and birth my baby in the best way, but my life of vomiting had gotten so miserable that I was desperate for relief or a miscarriage. I have just recently tried to come off the Diclectin again and am feeling gaggy and nauseous again.
Does anyone know why this happens? I can only believe that there are toxins my body desperately wants to get rid of for the baby's sake. Have I done my baby harm by taking the Diclectin? Is it better to be on the pills and keeping down nutritious food or not to be able to keep down food or drink at all?
There are some very positive results from the vomiting however, that I think are worth sharing: First, my stomach and back muscles are stronger than they've ever been. My midwife at times has difficulty telling how my baby is lying due to the strength of these muscles and my massage therapist says that he has never seen such strong back muscles in a pregnant woman this far along. Also, during massages I've noticed that my nose is no longer stuffy at all. Apparently stuffiness is related to the release of toxins into the blood after deep muscle manipulation. Any thoughts?
International Conference on the Humanization of Childbirth
November 2nd, 3rd and 4th, 2000
Throughout the 20th Century, advances in science and technology have affected every aspect of our lives, including the way we are born. In many parts of the world, quick and arbitrary changes in maternity care have often resulted in the excessive use of perinatal technology, a loss of community-based models of care and an overcrowding of large hospitals.
The International Conference on the Humanization of Childbirth will take place in tropical Fortaleza, Ceara, where Project Luz, a humanization project currently being implemented, is based. The objective is to bring the international community together in order to deepen our understanding of the global situation of maternal and perinatal health, thus strengthening the humanized approach in the new millennium.
Goal: To promote humanized maternity care leading to healthy
For a complete listing of seminars, instructors, events, cost, etc.: Secretariat Eventuall Promocoes & Assessoria, Rua Dr. Gilberto Studart, 369, Papicu, CEP: 60190-750, Fortaleza, Ceara, Brazil; tel. (55) (85) 265 4022; fax (55) (85) 265 4009; e-mail: firstname.lastname@example.org; web site www.humanization.org.
More on Cytotec:
Cytotec is used in very small quantities--micrograms (mcg) and not 'mg' or milligrams as stated in the article published last week. The difference between micrograms and milligrams is one thousand fold.
- Lisa Betina Uncles, RN, student midwife
I have heard from several different sources in the last two months that Cytotec has been causing ruptured uteruses in unscarred women during early first and second trimester inductions for fetal demise. This may be because larger doses are used in these circumstances. Here are some comments I've heard:
I have a feeling that there are a great many more ruptures that we are not hearing about.
- Angela Cross
I can't understand the sudden interest and desire to induce that midwives seem to have developed! Whatever happened to our strong belief in "mom's body knows best"? What has happened in our belief that patience and nature's timing are still the safest, best way? What is going to be the benefit of having a baby at home if we give them "all the comforts of the hospital." I thought one of the biggest reasons to birth at home with a midwife is because parents believe we are PROTECTORS of the healthy, natural, functions of birth the way God planned it. They are trusting us to be different, to be honest and to be protectors. If our client couples are requesting induction, it is an excellent sign that we midwives have NOT done our jobs throughout pregnancy or that we have forgotten what our jobs are! If we let parents talk us into unsafe, unhealthy procedures for the sake of convenience, what makes us different than the medical way? Why would anyone even in the hospital use Cytotec, when there is so much information about it that shows its dangers? Do midwives out there not know or are we refusing to admit to the dangers of things like induction and Cytotec? What is happening to us? Let's start sitting on our hands and get back to watchful waiting while we protect those who trust us! Let's get back to trusting a mom's body to do its intended job, one it is very capable of doing safely and joyfully.
It is becoming increasingly difficult to find midwives who have not heard of or touched Cytotec. Consumers today have to be very savvy in their interviews of midwives to determine which ones practice true midwifery and are not hidden medwives.
I offer myself as an example. I had read about midwifery from "Open Season," "Gentle Birth Choices," "Immaculate Deception II," "Spiritual Midwifery," and others. Imagine my surprise when I ended up induced with Cytotec, alley-ooped, fundal pressure applied and my baby "torqued" out, not to mention the vacuum that was shown to me before labor even begun. All this in the name of midwifery and natural childbirth. Because I was attended by two homebirth midwives, I thought all those things must be necessary. I figured I must have been a rare case for all that to be used at home. Sadly enough, I'm finding other women who have experienced similar births.
What scares me most is the thought of more innocent women being used as guinea pigs for the newest drug of choice in childbirth. What saddens me more is the widespread use of this newest drug in homebirths and free-standing birth centers, places that are supposed to be havens of natural childbirth.
I've been told stories of women who've had Cytotec inserted unknowingly during "routine" exams. Women have been given Cytotec orally under the guise of a homeopathic remedy. Women have been told that this drug is "perfectly safe." All this, from midwives.
It seems the paradigm of midwifery is beginning to shift so that the lines between midwife and medwife are blurring. One cannot lecture about normal, natural childbirth and stash a supply of Cytotec nearby.
Let's stop bringing the field of obstetrics into midwifery. If we continue on the same route we're going now, there will be no need to go to medical school. People will be signing up for midwifery school instead.
- Karen Putz
I'm eternally grateful for my "purist" training with traditional midwives! Childbirth is not disease management, something to be conquered with drugs. Midwives are guardians of normal birth. We are highly skilled in the art of prevention. If we forget, "First do no harm," we should no longer be a part of this sacred process.
I appreciate your strong convictions against the use of Cytotec in birth. There sure are a lot of non-dangerous but highly effective alternatives that cannot be found with a drug manufacturer's label on them. Let us keep studying together, ladies and gents.
- Julia Swart
More on herbs:
Not all packagers of echinacea (purple cone flower) say it shouldn't be take by pregnant women. This information was not on the label when I purchased it, and the health store, when asked if it was OK to be taken by a pregnant women, found no evidence it was harmful. I bought it because my daughter had a cold, and she did not want it to get worse, so we tried it. Almost immediately, after she took only two sips of that tea, she fainted. We thought it might be a coincidence, that she was just over-tired in her 7th month. Later in the afternoon she again fainted.
I have since studied more on echinacea, and it appears it has a quality similar to penicillin. Are there allergy risks of this herb or risks to those who are sensitive to penicillin?
The Association for Research on Mothering (ARM) seeks submissions for its upcoming conferences and next journal issue. ARM is committed to maternal scholarship from a feminist, multicultural perspective.
Calls and deadlines:
I am a social sciences student entering my third year at Teesside Uni. I hope to study midwifery after it. I would like to do my dissertation on midwifery but I don't really have an idea for a question or research. Would any midwife out there like to suggest a research topic I could use to help midwives in the future?
- Claire Russell
(Editor's note: Readers, here is a great opportunity to give a future midwife a "hand up," and at the same time educate the public! Send your one-sentence ideas to E-News--we could have fun with this!)
I read with interest the comments from Nigel, a male midwife [Issue 2:37]. I wonder if there are any male midwives out there and how they have been received? Do traditional female midwives feel they are invading? I think it is great that a man would want to participate in birth in a more natural capacity!
- L.S. from Guam
My husband and I have received an offer to buy acreage in Maine. Can you tell me where to look for the status of midwives in that state? I believe it is one of the few states that allow direct entry midwifery. The farm is a three-mile walk to Canada. How can I find out about midwifery in that area?
- Leslie Siat
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