October 4, 2000
Volume 2, Issue 40
Midwifery Today E-News
“Prenatal Care”
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This issue of Midwifery Today E-News is sponsored by:

- Real Birth
- Waterbirth Website

Look for their ads below!

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Midwifery Today Conference News

OUR HOME TOWN will be the site of Midwifery Today's 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/

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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) Prenatal Care
5) Check It Out!
6) Midwifery Today Online Forum
7) Question of the Week
8) Question of the Week Responses
9) Share Your Knowledge: Coming E-News Themes
10) Switchboard

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1) Quote of the Week:

"Many of us seem to lose our ability to discriminate fact from belief as we are exposed more and more to practical techniques that 'seem' to work and less and less to scientific theory and proof that our theories and practices are scientifically valid."

- Henci Goer

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2) The Art of Midwifery

Relieve back labor pain and tension with a massage using an oil made with herbs such as chamomile, rose, calendula, and lavender. You can also add an essential oil with a scent that the woman finds comforting. An herbal oil of comfrey or St. John's wort works well for perineal massage before labor or as the baby crowns. If a woman does tear or have an episiotomy, this oil will promote rapid healing.

- Kathryn Cox, The Birthkit Issue 22

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HERB CLASSES are included in the Midwifery Today Eugene conference in March 2001. Herbalist Linda Lieberman offers an herb walk and teaches a class called Herbal Remedies in the Childbearing Year. Adrienne Borg, ND, will teach the class Herbs and Homeopathy for Common Problems in Pregnancy, and an all-day herb workshop will be presented by herbalists Judy Edmunds and traditional Mexican midwives Naoli Vinaver and Dona Irene Sotelo. For all the information you need about the conference, go to:

www.midwiferytoday.com/Conferences/Eugene2001/

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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

A study conducted at the Prudential Center for Health Care Research found that among its study group of 200 women on Medicaid, personal factors influenced use of prenatal care more than sociodemographic factors. More than half the women received late or inadequate care, or both. Factors such as age, race, marital status, and income level were not associated significantly with when or how often the women sought prenatal care, nor were factors such as access to transportation. Women were more likely to receive late or inadequate care if they experienced adverse personal circumstances such as physical violence during pregnancy (3.5 times more likely), tiredness (2.2 times more likely), or lack of help from the father (1.9 times more likely).

- Birth 27:1, March 2000

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4) Prenatal Care

Prenatal care consists of everything a woman does for herself during pregnancy, punctuated by a series of visits with you," says midwife and author Anne Frye. One way a woman cares for herself prenatally is the process by which she chooses a midwife. Following are suggestions from midwives Jill Cohen and Marti Dorsey on how to choose a midwife.

Questions for mom to ask a potential midwife:

  1. Why did you become a midwife?
  2. How did you receive your training?
  3. Are you certified or licensed by any organization?
  4. Do you belong to any midwifery organizations, attend conferences, workshops, or subscribe to professional journals?
  5. What is your basic philosophy of childbirth?
  6. How many births have you attended as the primary midwife?
  7. Do you handle higher risk situations such as twins or breeches?
  8. What do you charge for your services, how must it be paid, what does it include?
  9. What services are included in your prenatal care (early detection of problem areas for mother baby; nutrition information; exercise recommendations; in-home care; recommendations for parent education via books, videos, or classes)?
  10. Do you work with another midwife or assistant at births?
  11. What do you do if there are two births at the same time?
  12. How do I reach you? Do you have a pager that allows 24-hour access?
  13. How do you handle any problems/complications that might develop during labor?
  14. What standard and emergency equipment do you carry? What herbs or medicine do you use?
  15. Do you have an affiliation with a physician to answer unusual questions during the pregnancy or an emergency situation during labor?
  16. What is your policy for transporting?
  17. What medical facility do you use and have you developed a good working rapport with them?
  18. What kind of postpartum care do you provide (how frequent are baby check-ups, assistance with nursing)?

In addition to asking questions, it's important to be clear about what you expect from her. Be prepared to share your vision of the birth. Discuss any fears you may have. Tell her how knowledgeable you are about birth and how informed you would like to become.

Determine if the midwife's answers to your questions agree with your desires. If your heart trusts her and you are both in harmony physically, mentally and spiritually, then you have found your midwife.

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Prenatal visits serve much more purpose than merely monitoring the course of a pregnancy. Given the incredible level of fear around birth in North America, prenatal care with midwives can provide a safe haven, a subculture in which women can reclaim trust in themselves and the birthing process. In Europe, where women are far less terrorized about birth, midwives report that they see women infrequently during their pregnancy. The midwife's job during the prenatal period is much more important in North America, where the midwife must stand between the women she serves and the larger society. Counter this undermining societal attitude by empowering the mother to realize that she is the only real care provider for her unborn baby. Show her that you value her sense of well-being or danger regarding her health and that of her baby; the baby is in her body, after all, and who should know better than she if something is not right? Your support of her intuitive perceptions about the pregnancy will go far in helping to distinguish real problems from imaginary ones throughout her care.

Supporting responsibility-taking during your care: Prenatal care is only as useful to a woman as she allows it to be. The real prenatal care in any pregnancy is what the woman does for herself between visits: how she eats, if she avoids harmful substances, when she exercises and rests as needed, and whether she works to resolve psychological issues that she knows of which may interfere with her birthing process. Your job is to guide, monitor her health and well-being and offer your expertise and experience as a midwife. Many midwives encourage women to take on specific responsibilities such as checking their own urine during care, weighing themselves, learning how to palpate and generally understanding everything you are doing and why, as well as making them responsible for following up on appointments with other practitioners when needed.

- Anne Frye, Holistic Midwifery Volume 2

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TO ORDER ANNE FRYE'S COMPREHENSIVE BOOK Holistic Midwifery Vol. I, go to: www.midwiferytoday.com/books/annefrye.htm#holistic

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5) Check It Out!

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

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AUDIOTAPES ON THE PRENATAL PERIOD are available on the Midwifery Today web site. Go to www.midwiferytoday.com/tapes/audiocompli1.htm#pre

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"THE USE OF ULTRASOUND in antenatal care is big business, and in any big business marketing is all-important. As a result of decades of enthusiastic marketing, women believe they can ensure the well being of their babies by reporting for an early ultrasound scan and that early detection of a problem is beneficial for these babies. That is not necessarily so, and there are a number of studies which show that early detection can be harmful."
For Beverley Beech's compelling article on prenatal ultrasound, go to:

www.midwiferytoday.com/articles/ultrasound.htm

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MIDWIFERYTODAY INTERNATIONAL CONFERENCES: Join us around the world!
www.midwiferytoday.com/Conferences/international.htm

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6) Midwifery Today's Online Forum

During my last pregnancy (the only one I've had so far), the only discomfort I experienced was heartburn. I didn't take any medication for it. We are hoping to conceive our next child in the coming months and I wondered whether there was evidence of this condition being related to any types of deficiencies of vitamins or minerals, or is it purely because of the "squashing up" of the digestive system? It may be worth mentioning that I began to suffer from heartburn quite early in the pregnancy. Also, if there's just no getting away from it, are there any effective natural remedies?

- Jo

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To share your thoughts and experience, go to Midwifery Today's bulletin board:
our forums. Click on "Midwife Chat."

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7) Question of the Week

While I was at the Midwifery Today conference in New York the midwife covering for me attended one of my women. The woman was dilated fully at 5 am and had no urge to push. Six hours later, after trying several things, including AROM, they transported to the hospital and the woman was given Pitocin and an epidural. She was sectioned four hours later for FTP. Heart tones were fine all through and mother, although tired, did not want to be sectioned. The mother now believes that if they had simply waited, not broken her water, and trusted, the baby would have been born vaginally. What is the longest you have seen from full dilation to the beginning of pushing--or to the birth of a baby? What were the outcomes??

- Nancy Wainer

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Question of the Week (Repeated)

In my prenatal fitness class I have a G1P0 due 12-4-00 who has intercostal neuritis. She has been adjusted by her chiropractor with no result. Gallbladder has been ruled out. I intend to work on her with massage and am wondering if anyone has any other suggestions on things she may try. Acupuncture has been suggested and declined, though she was planning to have a nerve block!

- Pam Martin, MS DONA CD, CM, apprentice midwife

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Send your responses to mtensubmit@midwiferytoday.com

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8) Question of the Week Responses

Q: A friend recently had a late miscarriage (18 wks) due to a partial septum in her uterus. She is now considering surgery to remove the septum, and wonders whether the risks/complications and success rate of such surgery would make it a better choice than simply continuing to try to carry a foetus to term (she realizes she may have to endure many miscarriages if she chooses the latter). Does anyone have any experience with this kind of surgery?

- Jennifer Landels, BA, CBE
Vancouver BC

A: I am a family doc who includes obstetrics in my practice. One of my young moms had preterm labor (at 28 weeks) with her first delivery. Her second pregnancy ended in a first trimester miscarriage. Her third pregnancy ended at 17 weeks when I helped her have a perfect little girl. At autopsy, nothing was found. Because of this history, she underwent testing as I'm sure that you did. She also had a septated uterus--nearly complete, giving us all cause to once again be amazed at the wonder of nature that allowed her to carry her little boy close enough to term to survive. Anyway, she did have hers fixed. This made her "high-risk" so she delivered at our nearby university. I now take care of her three children, the last two born healthy and at term.

- Lynette I.

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9) Coming E-News Themes

1. BIRTH RITUALS: E-News is curious about birth rituals around the world that would usually be called "old wives' tales." For example, birth attendants may be told to untie their shoes at a birth so there would be no knots in the umbilical cord, or they may avoid wearing red to prevent hemorrhage. We would love to hear other midwives' stories along these lines. (E-News thanks Fiona Thomson for this topic idea.)

2. ELECTRONIC FETAL MONITORING: Does it belong in good care during labor? Why or why not? What are your experiences?

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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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Know a strong woman? Helping empower one? If you haven't already done so, please forward this issue of Midwifery Today E-News to one or two of your friends or business associates. Thanks so much!

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10) Switchboard

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

Answers from readers:

I think it would be interesting if Claire examined our changing birth practices (from home to hospital, babies taken from mom, etc.) to see if there is a correlation to the increase in social unrest and violence especially in the 1960s to today. -Elenie Smith, CNM

Are the outcomes of midwife-assisted homebirth better than hospital delivered ob/gyn births? (You'd have to define/operationalize "better.") You are in a state with The Farm midwives. They are a GREAT source of data!

- K.K.

I'm particularly curious about any possible correlation between vitamin K given to infants and breastfeeding problems, i.e. babies becoming disinterested in the breast, not having the urge to suck, after the vitamin K injection is administered. Also, get a copy of Michel Odent's newest book, The Scientification of Love [available from Midwifery Today. Go to:
www.midwiferytoday.com/reviews/scienlove.asp]. The primal health research is all cited there. It's exciting news for those of us who have devoted our lives to protecting normal birth. You may find some direction by looking at the CPM statistics project 2000. Contact NARM and see what they are gathering.

- Robin Lim

What to do what about men in the delivery room! -Julie

The importance of fetal heart tone monitoring, frequency, to establish a protocol for second stage. Study to include how it can guarantee a positive outcome and prognosis for intervention.

For me the discussion about medwives and midwives which was going on [in E-News]is a good opportunity to study. It would be of great interest for midwives to know what kind of questions one asks themselves before entering the profession and how they think one, two, and five years later.

- Mary C. Scheffer-Zwart

I would like to see some research done to see if midwives' clients are experiencing any medical problems from refusing the vitamin K shot, and the eye prophylaxis (assuming, of course, that they tested negative for chlamydia and gonnorhea).

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Greetings from Fortaleza, Brazil! As you may know, in Brazil, a country where midwifery does not exist as an established profession, the cesarian section rate in most private hospitals is as high as 90%, whilst poor women give birth in degrading conditions in the world's most crowded hospitals.

What you may not know is that in the same country, a number of initiatives have been created since the 1980s that attempt to recover human values in childbirth, a movement known as the "humanization of childbirth." On November 2, 3 and 4 midwives and others interested in maternity care from all over the world will gather at the International Conference on the Humanization of Childbirth to promote humanized childbirth.

Contact the Conference Secretariat at +55 85 246 4302/246
0232, by fax at: +55 85 246 2697, e-mail: childbirth@eventuall.com.br, WWW at www.humanization.org.

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I am a first-year student midwife in New Zealand. When first listening for tones the midwife I worked with used a sonic aid so everyone could hear the heart loud and clear (mums-to-be love it). It was just a matter of learning where to position the aid after palpating. Experience was the best teacher. I still have problems listening with a Pinard, especially after using a sonic aid but what helped was reading in Maye's Midwifery that using a Pinard the FHT sounded like a "watch ticking under a pillow," which is the best description I know.

- Pauline Dawson

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I am one of those "hidden midwives" because of the state in which I live. My potential clients must hear about me through the underground. I too am appalled at the number of so-called midwives "with woman" who are supposed to be protecting our women/couples from unnecessary medicalization. Please, let's take care and do sit on your hands. Midwives can practice without any tools other than their hands, and that should be limited!

- Anon.

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A woman in my childbirth class had heard there is a correlation between the use of Pitocin in labor and autism in children. Does anyone know of studies or articles on this?

- Robin

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Is there any way to increase the fat content of my breastmilk? I have noticed that it looks rather like skim milk. My daughter continues to gain weight but she is dropping "percentile-wise" on the growth charts. I desperately want to continue exclusive breastfeeding but fear that the doctor and my husband will insist on formula supplements if she does not gain more weight.

- Anon.

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I am a hospital-based CNM with my heart in homebirths. I have used misoprostol (Cytotec) for most of the inductions I have done until recently. (I haven't done too many inductions--less than 5% over the past two years). First, let me say I truly hope the rumors that homebirth midwives are using miso and telling clients it's a homeopathic or that it is slipped in with a vaginal exam and not told to the client, are urban legends and not truth. I just can't believe there is that little integrity in any midwife.

Second, I have decided not to use miso anymore. If I have a client who demonstrates it is more of a risk to either herself or her baby to remain pregnant, but her cervix isn't ready, I am again using prostaglandin gel. It has been my experience with miso that it starts out making the uterus irritable. It is usually slow going to get into active labor, but once labor begins it goes unnaturally fast and babies come flying out. I never leave once miso labors start contracting because I know I can miss the birth. In fact the hospital's QA committee looked at unattended births to see if there was a pattern and how they could be prevented. They found the majority of unattended births were primips on miso.

I know fast labors are what everybody wants and maybe they aren't such a bad thing. But it just doesn't seem quite right with the miso. I don't think we have studied it enough to find the best dosage and route.

I also know it is miso that has caused so much trouble with VBACs. Ever since using miso in VBACs and the unacceptably high number of uterine rupture, all VBACs have come under question and it looks like there is a trend toward hospitals not allowing them because they don't want to assume the liability.

This is not a benign induction agent. It is very potent and potentially dangerous. Frankly, I'm not convinced this should be used even in a hospital setting unless we are allowed to study it much more carefully.

- Molly, CNM

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As far as I'm aware any "risks" of ginger are simply word of mouth and are not supported by any evidence [Issue 2:39]. Getting solid information about herbal danger in pregnancy is nearly impossible. Many books offer only quotes from each other as evidence for the opinions presented. Almost all information about herbal benefit and risk is simply opinion. It may be true. It may be false. There is not enough data to support either side. Ginger has been used for many generations and across many cultures without observable danger. I think any risk must be minimal.

- Anon.

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Marilyn Shannon's book "Managing Morning Sickness" suggests that blood sugar levels affect nausea in pregnancy. Her recommendations are based on good nutrition and getting enough protein. This book is available from the Couple to Couple League at www.ccli.org.

- Kathy

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Two of my moms-to-be were told by other moms that their bodies will naturally tear to protect perineal nerves, leaving perineal sensation intact and promoting quicker healing vs. episiotomy. Does anyone have a solid reference on this for me?

- Kelly Barnett
Coos Bay, OR


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