|November 1, 2000|
Volume 2, Issue 44
|Midwifery Today E-News|
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THIS WEEK'S ISSUE
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Just months after its initial publication, this critically acclaimed collection of birthing narratives is already headed into its second printing. In this unique collection, thirty-six women tell their intimate and personal stories of the transformative experience of childbirth. Read about everything from cesareans and hospital births to homebirths, car births, and multiple births. MIDWIFERY TODAY hails REAL BIRTH as "absorbing reading for newly pregnant women who wonder what might be ahead for them." LIBRARY JOURNAL applauds "this is an excellent complement to typical books on pregnancy and birth...these narratives fill a gap for those seeking a realistic description of the birthing process from the mother's perspective." REAL BIRTH is available at leading online and retail bookstores. To order direct call Generation Books toll-free at 888-398-7110 or visit Generation Books online at http://www.generationbooks.com [U.S. $14.95 paper (online discount available), 240 pages.]
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Quote of the Week
"[In my dream], under siege from the advancing army of holistic practitioners and from the unified legislative front the midwives will present, MDs will lose legislative clout as their petty 'because I said so' tactics to maintain their hegemony in each state are exposed, and midwives will increasingly be able to control their own destinies."
- Robbie Davis-Floyd
The Art of Midwifery
Ginger, an older, very experienced OB nurse, has enlightened
our department with a great trick for pushing when the baby's head is
having trouble descending past the pubis symphisis, or "coming around
the corner." She noticed years ago that some women naturally got
into this position and it worked really well.
- Luisa Lucero
Share your midwifery arts with E-News readers! Send your favorite tricks to:
More than seventy diseases can give a false-positive HIV test. False positivity has been found to be significantly associated with any brand of influenza vaccination, or a history of recent acute illness and allergies. A cluster of false-positive blood donations in the United States in 1991 was most likely caused by the test kits used. High rates of false positivity have been found in patients with systemic lupus erythematosus and in patients with alcoholic liver disease. Even previous pregnancy can trigger a false-positive result. Antibodies to malaria can cause a false positive. A large study from Zaire reported that patients with leprosy had high rates of false positivity. Caution should be exercised when interpreting HIV-1 ELISA and WB data from regions where leprosy or other mycobacterial diseases (i.e. tuberculosis) are endemic.
- The Practising Midwife, Vol. 2 No. 7, July/August 1999
When I first started working as a doula I took everything
to births, then realized there are some items I rarely use. With some
women I use almost everything; with others I never open the bag and
just use my hands, heart and head! Here is a list of some of the items
I carry in my birth bag and what I use them for:
Editor's note: Doulas, tell E-News about a favorite item or two you keep in your supplies kit.
The philosophical objection to a doula providing clinical
care is that when a labor support person "crosses the line"
and checks heart tones, blood pressure or cervical dilation, she takes
on a different role to the woman and a different level of responsibility
for the birth. By not providing clinical care, we leave the medical
and clinical responsibility with the client and her care provider, and
are better able to focus on the emotional needs of the client. This
is a two-edged sword. It is freeing not to take responsibility for the
life of the baby and the mother, and allows us to stay with the woman,
talking to her, explaining to her, if problems do arise. On the other
hand, my clients go to the hospital a couple hours sooner than they
might if I were doing vaginal checks. It is a two-edged sword professionally
as well. On the one hand, caregivers are less threatened by my presence
when they learn that I'm leaving the clinical duties to them. On the
other hand, my opinion weighs less with them, I believe, than if I had
the weight of several years of formal training behind me.
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E-News asked readers, If a birthing woman has good midwifery care, why might she also benefit from having a doula attend her birth?
A doula's role can be very different in the hospital versus
homebirth environment. In the hospital there is a much greater need
for advocacy and education. I will usually start with the couple in
their home and transition to the hospital when labor has progressed.
In my area the midwives may not arrive until pushing, much like many
physicians, though sometimes they may come sooner depending on their
schedule, who else is in labor, etc. So the doula's role is clear in
terms of support during those hours before pushing.
- Pam Martin, MS, CD (DONA), CM, apprentice midwife
It depends on what you mean by good midwifery care. A midwife
can give excellent prenatal care but not always good labor support.
As with the birth of my first son in 1996, my midwifery team was excellent
in the care aspect yet very lacking in labor support. They were a hospital
practice and they were very busy during my labor/birth and were unable
to be with me at all times, and my husband was like a deer caught in
headlights. This is where a doula comes in. She is there for the woman,
and only that woman, for the duration of her labor and birth.
- Charisse Lawson, doula/nursing student/aspiring CNM
Although midwives provide far more labour support than the
average GP, I believe a woman can always benefit from the specific care
a doula provides. As doulas, our primary (and only) responsibility is
the emotional well-being of the mother. This care naturally spills over
to the father.
- Julie Keon CD
Even if a woman has excellent midwifery care she can still benefit from a doula. It's important to feel very supported emotionally as well as physically during labor and birth. The doula can help support a leg, hold a hand, cheer the mother on, apply counter-pressure, wipe her face with a cool cloth, etc. During the actual delivery, the midwife will be busy at the perineum delivering the baby. The midwife is also not always free to stay with the mom from early labor all the way through, depending on her schedule. I had an excellent midwife at my homebirth, but still appreciated the support of my doula.
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SAFE AND INTIMATE HOME BIRTH: Visit one of Midwifery Today's
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Midwifery Today's Online Forums
What effects, positive or negative, have you seen as a direct or indirect result of mom vomiting in labor?
To share your thoughts and experience, go to Midwifery Today's Forums.
Question of the Week
I have a client who had urinary retention between her ninth and 12th week with her first pregnancy. She is pregnant again and she recently, again during her ninth week, developed urinary retention. She has been treated by catheterization both times. She is fearful that she will develop a UTI as she did the first time. The urologists have no idea why this happens to her. Has anyone else had clients with urinary retention? Does anyone have a theory as to why it occurs in some women? Are there any prevention measures?
- Cindy Schierlinger
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Question of the Week Responses
Q: Are midwives' clients experiencing any medical problems from refusing the vitamin K shot and eye prophylaxis (assuming, of course, they tested negative for chlamydia and gonorrhea)?
A: We had a homebirth in New Zealand where happily, eye drops
are not mandatory for newborns. My 13-month-old baby's eyes are quite
healthy and normal. My baby has had no eye infections that I am aware
of. If she did, I would squirt breastmilk into the eye. The opthalmologist
said my baby does not have a true strabismus problem (only pseudo-strabismus
due to the low nasal bridge and skin folds, which are quite normal), and
she has the normal amount of farsightedness in each eye for a baby her
- Anna C.
A: I have had two homebirths. With the first I accepted the vitamin K shot. During the second pregnancy, I drank alfalfa tea during the last trimester and refused the shot. I can see no effects of refusing the shot in my 20-month-old.
Coming E-News Themes
1.INTACT MEMBRANES: What are the fetal benefits to labor with intact membranes? Do you have any documentation to share with E-News readers?
2. PROM: A 1996 study at the University of Toronto randomly assigned 5,041 women with premature rupture of membranes (PROM) to either have their labors induced or to wait for up to four days for labor to start spontaneously. In both groups, about 3 percent of babies developed infection, and about 10 percent were delivered by cesarean section. The study concluded that physicians should present this research to patients, who should choose the option they prefer. Comments?
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From health and safety to fun and games, NANNY'S NOTES offers
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Question of the Quarter: Midwifery Today Magazine
Issue No. 57 (Theme: Cesarean Prevention/VBAC)
Deadline: Dec. 15, 2000
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More on birth rituals:
Religious Jewish women swallow a pearl when they are 4-5 cm dilated as a blessing for easy and quick labor. When the baby is born its hands are washed three times with a blessing as an omen for good luck.
- Zinger Orna, midwife
Editor's note: Continue to send birth customs from your country and culture and we will include them as a mini-column in E-News.
In response to the obstetrician's concern about lengthy second stage [Issue 2:43]:
First, I would like to say that second stage is not necessarily any more
dangerous than any other stage of labor, which most of us midwives consider
to be a normal, healthy function. Second, women are not machines that
are dangerously defective and at any moment would kill or hurt their babies
or themselves. Third, we are there to provide information (risk/benefits)
to the woman and her family so she can decide for herself what is the
course of action or inaction that she feels is appropriate. We are not
in control of women and their births. We are guardians/lifeguards. We
give them the facts (without emotional manipulation) and they decide.
Fourth, from the accounts of these stories of long second stage [Issue
2:41 & 42], we can get the picture that long is not necessarily bad.
These births had great outcomes. Fifth, cesarean section is 10 times more
dangerous than vaginal delivery. It is not the answer to everything. Women
come to us so that they may avoid this most-often-than-not unnecessarily
performed surgery. Sixth, if the baby sounds good and the mother is in
great health and spirit, why would we not let her continue?
- Michelle Bartlett, CPM
Dianat may have been taught and may still believe that prolonged second stage is harmful but there is no evidence that this is so. There is ample evidence that second stage need not be rushed. The following are just four abstracts of studies that found that prolonged second stage is not harmful to the baby or the mother. Both midwives and OBs need to be professional enough to change practices which are useless or harmful. There is no justification for arbitrary limits on second stage.
- Angela Cross
I am always filled with confusion when I hear a wonderful birth story
about a midwife-assisted birth at home (such as the one where the second
stage continued so long, the midwife went home and returned days later
to catch the baby) in one of the recent issues, and then a reply by an
OB (in this last issue) that expressed the doctor's surprise at the length
of the second stage and dismay that the midwife would "let it be"
so long without recommending an OB referral and c-section due to the dangers
of unmanaged labor. Obviously the midwife in this case did not see anything
wrong with "letting it be" and saw no danger (or she surely
would have referred), and the OB in a similar situation (presented with
a mom with failure to progress in the second stage) would have surely
gone on with a c-section, believing there to be imminent danger.
- Tiffany Collins
Measuring motherbaby's well-being by the clock is a very narrow and arbitrary
definition. If you have never seen a second stage that took more than
the short ones you described (10-30 minutes in multipara & 20-60 minutes
in nullipara) I would venture that it is because you have never seen birth
outside of an institution that dictated these protocols and/or attended
by a caregiver who had been educated as to their limitations.
In reply to Jackie's reflexology question [Issue 2:42], there is a wonderful
book called "Maternity Reflexology" by Elsa Reid and Suzanne
Enzer that can be ordered from ACE graphics in Australia (they are on the Internet). As you use reflexology in your practice, your experience
and intuition will make you very aware when to use it and when not to.
The book is very specific about indications and contraindications, pressure
points, etc. I'm sure relaxation, lymphatic drainage and gentle touch
is fine to use at any stage of pregnancy but we practitioners must be
alert and aware at all times. Suzanne has also just released an excellent
new workbook for midwives.
- Gloria Whyte
To answer your question regarding GBS urine cultures [Issue 2:43]: Our hospital protocol is to test every patient for GBS around 35-37 weeks with vaginal to rectal swab. Also, if women have their urine sent for C&S due to complaints indicating UTI or a routine screen done due to rule out UTI in the presence of preterm contractions, and GBS grows on those cultures, our providers (midwives, family practice docs or OB docs) treat with oral antibiotics at that time, and then with IV antibiotics during labor, even though it was a urine culture. If a woman has it in her urine, she may very well carry it intravaginally or externally, and they want to provide the best protection to these kiddos during labor by giving them antibiotic coverage if the patient ever has +GBS. We even treat if a woman is negative this pregnancy, but was positive during previous pregnancies.
My hospital is planning to purchase new furniture for our OB unit. We
are interested in having mother or family beds with a baby bed which will
attach and detach to the bed, allowing mom and baby to have their own
space when desired and still remain in touching distance. As this will
be used in a hospital setting, it will have to be durable, easily washable,
and on wheels.
I have to find out more about birth rituals of Jehovah's Witnesses. I know they refuse blood transfusions, but are there other particular things that are typical for their religion?
- An De Vleeschauwer
A friend is looking for information about a consequence of her brutal OB attended, forceps delivered birth. One of the results of the birth is that her vagina gapes open, allowing air in--which is then passed out as flatus. The gap is large enough that my friend can no longer go swimming because her vagina fills with water and makes her very uncomfortable. The physician she saw said nothing could be done because it is due to overstretched muscles and she will just have to live with it. I had read about this somewhere and now can't find the reference. Has anybody heard of this condition and if so, do you have any suggestions to help her?
I would like to thank those who responded to my "supportive presidential candidate" question [Issue 2:43]. You were incredibly helpful!
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.
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