December 27, 2000
Volume 2, Issue 52
Midwifery Today E-News
“Omnium Gatherum”
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Midwifery Today Conference News

Attend Midwifery Today's Eugene Conference

WATERBIRTH, a class taught by renowned waterbirth pioneer Barbara Harper, will explore the many benefits and ways of using water in birth. Attend this class and many others at Midwifery Today's Eugene, Oregon conference March 22-26, 2001.


THIS WEEK'S ISSUE

Contents:

  • Quote of the Week
  • The Art of Midwifery
  • News Flashes
  • Empowering Women
  • Check It Out!
  • Midwifery Today Online Forum
  • Question of the Week
  • Share Your Knowledge: Coming E-News Themes
  • Question of the Quarter: Midwifery Today magazine
  • Switchboard

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Quote of the Week:

"After almost twenty years of marriage, some of my best memories are the births of our children, and seeing my wife give in to this powerful maternal act called childbirth."

- Tony Wilson


The Art of Midwifery

St. John's wort oil massaged into the lower back during back labor seems to take the edge off painful contractions for about twenty minutes. Reapply as needed while the woman's back is massaged.

- Donna Vidam, Midwifery Today Issue 49

Doula tip of the week

When I am working with a mom with an epidural or one who is unable to get out of bed, I encourage her to sit up in bed tailor-style (legs crossed in front, feet tucked under the legs). This opens the pelvis, helps gravity bring baby down, applies pressure to the cervix and helps dilation. It works every time!

- Jodie Minniear, C.D. DONA, Brownsburg, Indiana

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News Flashes

Two new committee opinions issued by The American College of Obstetricians and Gynecologists (ACOG) last month affirm the efficacy of misoprostol for induction of labor and for medical abortion in combination with RU 486. The ACOG document strongly reaffirms existing ACOG opinion that misoprostol--a drug manufactured for treatment of gastric ulcers under the trade name Cytotec--can be used safely and effectively off-label for cervical ripening and labor induction. ACOG is issuing the opinion in response to an August letter from G.D. Searle & Co., the manufacturer of misoprostol, which was sent to physicians just a few weeks before the FDA's September approval of RU 486/misoprostol. The Searle letter cited safety concerns in advising against the use of misoprostol in pregnant women.
After reviewing published data and adverse outcomes reported to the FDA, ACOG concludes that misoprostol when used appropriately is a safe and effective agent for cervical ripening and labor induction as well as a resource for treating serious postpartum hemorrhage. Expressing its concern about the "content, timing and tone" of the manufacturer's letter, ACOG notes that the letter could limit the availability of misoprostol in women's healthcare.

Empowering Women

I AM A MIDWIFE WHO ATTENDS TO THE NEEDS OF WOMEN BIRTHING IN THE HOSPITAL. I find that many "modern" (i.e. dot.com) American women and a large percentage of my Chinese immigrant women have difficulty recognizing and validating their strength and power in the process. I think the midwives who attend the [Midwifery Today Eugene] conference probably identify the same problem, especially those whose client have the good fortune of being cared for by midwives by virtue of showing up at a clinic that midwives attend and having no knowledge of the issues of philosophy, etc.

I would find it useful and interesting to include "ways to inspire confidence and a sense of the inherent power and brilliance" of women into the section on women who care for women in the hospital. I work hard at this endeavor every day, but because our presence is diluted by all the non-midwives who work in the "institutions," I find it draining.

Your conferences are restorative and invigorating. However, I also feel a sense of disappointment or frustration because I don't attend homebirths and the most glorious stories usually are from homebirths. I fully support homebirth and would love to see a movement to take normal birth out of the hospital and into the home. There are women who don't have a home suitable for homebirth--they live in what the Chinese call "pigeon houses" where many families share a common bathroom and kitchen, are often alone and unsupported. I hope there will always be midwives willing to attend these women in the hospital.

There is a strong need to remind midwives why they are midwives and ways of bringing those midwives back to the fold.

- Zora

====

Dear Zora, sister midwife,

Please join the movement to take NORMAL birth out of the hospital and into the home where it belongs! That is the first step to empowerment of your clients, by empowering yourself to autonomy. You don't have to practice in the home to help those of us on the frontlines of midwifery. Every person you meet and with every opportunity, tell them how safe birth is in the home in the hands of a trained midwife. Let your legislators know. We midwives are excellent at what we do, and not validated or appreciated by the medical community at large. This movement starts with the midwife in the mirror...me.

The real issue, having practiced in hospital and in home, is that midwives lack autonomy. If we don't get a letter from a physician, or a collaborative agreement, or signed protocols depending upon the state you practice in, you can't legally practice! That leaves too many of us open for prosecution and harassment every time we safely transport a client to the hospital. It takes a strong woman to be a midwife, to withstand the poverty, (homebirth is not volume oriented, and therefore doesn't reap a lot of financial gain in the rural areas of our country), the accusations, harassment from the medical community, the clerks who file the birth certificates and keep changing the way they want a birth certificate filed. It's disheartening! So please join us by helping to pass legislation for midwives to actually practice their profession so we don't have to go through "medical gates" in order to practice our skills. I don't need a physician to tell me how to practice within my scope of practice. I need him for my high-risk clients, for prescriptions, etc. What good is this $30,000 master of science degree that we've worked hard for, that we place on our walls, that we value so much if we can't practice without "signed" physician's backing!

And--help us win the hearts of doctors. Let's get homebirth out in the open. The physicians in the 200 miles surrounding me are scared of lawsuits, afraid of what their peers will think, afraid their liability insurance will be cancelled and they won't collaborate. There is a lot to be changed. Be a change agent; help the midwives gain their autonomy. Help midwives, CPMs and CNMs become a cohesive group that works together and honors each midwife's skill and trade.

- Sandra Stine, CNM

(Editor's note: Sandra's was the only response to Zora's letter we received at E-News, despite the fact the question ran for several issues. Hospital midwives, or homebirth midwives, do you have something to add? Please send your thoughts to mtensubmit@midwiferytoday.com)


Check It Out!

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

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TABLE OF CONTENTS for Midwifery Today Issue 56: Click here to view contents. If you're not already a subscriber, have a look at what you're missing!

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Doctors of the World

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Midwifery Today's Online Forum

I would love to know why society still has such hangups about breastfeeding. Why is it that, as a breastfeeding mum of a 12 month old, people feel compelled to come to me and tell me "isn't it time to wean him and get your life back." It is a perfectly natural method of nurturing your child and has been done for hundreds of years. The time we spend nurturing our children in this way is really such a small time in their life; does it really matter if we prolong it as long as we can? It's my choice and it is my life right here right now--I don't need to get back a life I already have! I know I won't be doing it forever; why can't people realise that and mind their own business? I think there are a lot of people out there who need to get a life and keep their noses out of everyone else's. Anyone else out there have any thoughts/experiences on this? Cheers.

- Jeannine RN/CM "MUM"

To share your thoughts and experience, go to Midwifery Today's Forums.


Question of the Week

The news article on HIV testing and false positives [Issue 2:44] was really frightening. Do all midwives require an HIV test?

- J.

Send your responses to:


Coming E-News Themes

1. PRECONCEPTION COUNSELING: What do you tell the aspiring parents who ask you for preconception services/advice?
(Thanks to Sarah, an E-News subscriber, for this topic.)

2. CHARTING CAN BE AS UNIQUE AS EACH MIDWIFE'S CARE. Do you have charting methods you would like to share with E-News readers?

Send your responses to:

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!


QUESTION OF THE QUARTER for Midwifery Today magazine

Mamatoto: Motherbaby
How can midwives best facilitate the bonding process of motherbaby in pregnancy, birth and postpartum?

Deadline: March 31, 2001

Send your response to:


Switchboard

Some of Connie, Filipina/author, apprentice midwife San Jose, CA 's ideas on placental physiology are a bit reversed. The placental maternal circulation is an arteriovenous shunt (ie no capillaries) thus it is a very low resistance region. The blood volume, cardiac stroke volume (i.e. amount pumped each beat) and pulse must all increase to compensate for this, not the other way around.
And still bashing those poor meddlesome doctors for their third stage management????? I hope they'll still be there when you really need them.

- Phil Watters
Australia

====

In response to Nikki Lee's question regarding infant mortality and morbidity rankings [Issue 2:51]:
- She should find all the information she requires on the World Health Organisation's Website:
www.who.int/whosis/
- Dave
- UNICEF has a publication called The State of the World's Children 2001 that provides this information. You can view it at:
www.unicef.org/sowc01/toc.htm

- Anita Jaynes, RN, SNM

====

For Ana Montero, I applaud her wonderful work in Peru [Issue 2:50]. I bless her efforts. I think this is a fairly important correction to make regarding Varney. I believe Varney states to NOT massage the fundus before the placenta is delivered. I have not gone back to look it up to be absolutely certain what Varney has actually stated in the latest edition.
Ana, you were right in your assessment to NOT massage the fundus prior to birth of the placenta. Massaging the fundus prior to detachment and delivery of the placenta can exacerbate postpartum hemorrhage and create improper detachment of the placenta. So save your massaging until afterward. Whether Varney is clear on this subject or not, I am glad that your heart knew not to follow this advice.

- Sandra Stine CNM

====

[Re: Peru story] There are many paths that all lead to the same conclusion....Congrats to a brave new midwife with extremely limited resources.

- Phil Watters OBGYN
Hobart, Tasmania

====

I was always taught years ago that Pitocin should NEVER be given before the placenta. So I was quite surprised when my consulting OB suggested I run Pit very slowly in her IV to help a placenta that still wasn't out after an hour (she wasn't bleeding). After another hour he came and manually removed it with great difficulty. But everything was OK. So years later when I encountered another stuck placenta I went ahead and did the same thing. After waiting a while I tried to manually remove it and found the cervix had closed down to a tight 5 cms. I called the doc in and he manually removed the placenta with success. I remember realizing with surprise at how quickly the cervix closed down and what would have happened if it would have completely closed? Anyway, I would give Pit only very judiciously in the future for that reason.

- Mary Ann Durbin
Toledo

====

I would welcome the responses of my fellow readers:
I am a doula who specialized in working with women who wanted VBAC. I have suspended my practice because of the brutality I witnessed by a doctor at the last birth I attended. All VBACs in this area are in-hospital births. The last one was "successful" in that the baby was healthy and the mother did have a VBAC after having had two c-sections. However, the treatment she received at this doctor's hands was horrible and unnecessary. After sharing information with the husband (during the labor), I was told that if I made any more comments, I would be ejected from the hospital. I vowed never to attend another birth at that hospital, but have found that I cannot effectively practice anymore. I cannot separate my feelings sufficiently from my client's, to where I risk infecting her with my anger and mistrust. Has anyone else had a similar experience and what did you do about it?

- Debbie
New York

====

Is it routine for epidurals to be administered for a cerclage, the procedure where the cervix is stitched shut in order to halt preterm birth?

- Amy Jones
Henderson, NV

====

I am curious about fibroids during pregnancy and what to do after the baby is born. A friend is in her sixth month and has fibroids. After the baby is born they plan to remove the fibroids right away. Is there any way to manage the fibroids and/or herbs that will help dissipate them without surgery?

- Tiffany

====

Don't make your laboring mums take giant steps [Issue 2:51] if they feel it is too hard to do. It's not good for the labor. First of all we learn FROM the women.

- Claire, home midwife FWI

====

I am a midwife who suffers from Hashimoto's thyroiditis and am wondering if anyone has had the experience of caring for a woman with Hashimoto's antenatally and postnatally. What sort of neonatal care was necessary?

- Azure

====

Re Issues 2:45 and 2:50 about hemorrhage: I came upon the very beautiful and wonderful book "Creating a Joyfull Birth Experience" by Lucia Capacchione Ph.D., A.T.R., and Sandra Bardsley R.N, F.A.C.C.E., that presents a very creative way of dealing with complicated situations (hemorrhage, failure to dilate, etc.) through prenatal "creative journal work." It is a method that works to get the mother (and father) in touch with inner physical and mental processes, and it gives a special creative place to discover and heal fears, pain, problems, and emotional strife about birth. With hemorrhage, for example, there is a very simple exercise that the mother does: every time she squeezes the liquid out of a sponge, towel, washcloth or whatever, she thinks, This is what I am going to tell my uterus to do after the birth of the baby. For preventing perineal tears, there are several visualizations as well as an exercise: run fingers/thumbs along the perineum, and along the thick ligament as well, using vegetable oils (olive, vit E, etc.) or a water-based lubricant, applying slight pressure until the point of slight burning sensation. This should be done often, every day, by mother or father, as part of the preparation ritual, and very positive results (stretchy flexible perineum) are seen in a few weeks. I strongly recommend this book to parents and all birth practitioners!

- Megan Aiyana
Chile

====

I am a student midwife. I would appreciate your readers' comments on the following:

1. Relationship between lunar cycles (full or new moon) and the initiation of childbirth. I did a comprehensive literature review, and found that a) many published empirical studies have poor methodology; b) the results from different studies contradict each other. From my reading it appears that lunar cycles could indirectly influence the initiation of birth through the moon's effect on the weather and therefore on the barometric pressure which has been frequently found to correlate with the rates of childbirth; also through the effect of light on the release of hormones. Most of the studies were carried out in teaching hospitals in large cities, but the relationship--if there is one--should be much stronger in rural/nonindustrialised areas.
I would very much like to hear practising midwives'/other experienced professionals'/mum's etc. observations and opinions on the subject.

2. Does anyone have experience of using hypnosis and/or music therapy in maternity care, especially--but not only--as a method of pain relief during labour?

- Anna

====

I'm not sure what to make of [the comment on a vertical cesarean incision (Issue 2:51)]. Not all cesarean sections were "classical" even 44 years ago. The VBAC debate today is about transverse incision ops. The risks for VBAC after vertical uterine incision are just too great, and I think most mothers would agree. But it shouldn't come up as CS is (with VERY rare exceptions) transverse (ie lower segment) these days.

- Phil Watters

====

Although vitamin C may make tissue stronger and decrease the chance of stretch marks in pregnancy [Issue 2:51], it can also cause miscarriage. Vitamin C is a strong emmenagogue and an implantation inhibitor, therefore taking vitamin C can prevent conception or cause a miscarriage. I would ask that women seriously look into the side effects of any foods or herbs before using them during pregnancy. So many things that are deemed safe can be dangerous to the baby.

- Jen


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