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Editor's note: In this and the next issue of E-News, we will include responses
to a news item [Issue 3:23] about an American obstetrician who believes vaginal
birth creates "needless" pelvic floor disorders later in a woman's life.
The news story appeared to favor cesarean section as an acceptable alternative.
I think Dr. Charles Butrick, along with other OBs, is trying to create panic
and hysteria in a time when vanity, narcissism, and the willingness to go under
the knife are at an all-time high. Because the doctor is foremost a surgeon (OBs
are surgeons first), and because a lot of the birthing dollars are going to midwives
and "natural," less costly vaginal births, he's upset. The doctor is
an opportunist and is seeking to continue making money in his trade by offering
his repair via the knife, after birth, while at the same time trying to urge the
public to see c-sections as safe and needed. (Income from surgery twice in a woman's
life is quite a boon. And let's not forget that 90% of hysterectomies are unnecessary--that
would make it three income-producing surgeries per woman!)
If he's now repairing women whom he claims were damaged 20-30 years ago, weren't
they more likely to have delivered in hospitals and by c-sections? Could it be
possible that forceps and vacuum extraction and unnatural--lying on the back--delivery
positions with mom numb and unable to work her muscles during labor are the real
cause for pelvic floor damage? Could it be that the most common, medically sanctioned,
female genital mutilation operation for women during that time--episiotomy--could
be the cause of "pelvic damage"?
- Asiila, aspiring midwife
San Diego, CA
Did I miss something, or are they trying to say that a c-section will save you
from damage? Have they forgotten that a c-sec is major abdominal surgery--that
it IS damage? It is so typical of male OB/GYNs to think they will fix us if they
just interfere more. I am appalled. In all the births I have been at or even heard
of, I can think of no major perineal damage in the homebirths or even hospital
midwife deliveries. However, I have been at countless hospital doctor-attended
deliveries where the woman tore extensively. Last Feb a woman had a 5-pound baby
and had a second-degree perineal tear because she could no longer feel the biofeedback
of the burning at her perineum because the doc had lidocained her in anticipation
of cutting an episiotomy, all against her wishes. In fact the woman and I caught
the baby together as the doc turned around to reach for his scissors. Disgusting.
I've seen an episiotomy and forceps on a 7-pounder, reconstructive surgery after
a fourth-degree tear for a 6-pounder with a nuchal hand, and I've seen more lithotomy,
stirrups births with 7-lb babies and subsequent second-degree tears to last me
a lifetime.
All these are examples of how the medical model handles things. It is no wonder
women are showing up with major trauma and problems. I just don't get doctors,
who insist we are the ones broken when it is really they who are breaking us.
- Augustine Daniels, CBE and doula
Notice how they say damage to nerves, muscles and ligaments, yet they say absolutely
nothing about the decrease in outdoor activity in the last 20+ years. I'd love
to see a study on the amount of women who have "women problems" and
how sedentary lifestyle worsens these conditions. Let's face it, most of us barely
exercise. We used to walk, garden, play with our children. Now we spend time on
the computer, drive to the mailbox, and our children watch TV instead of being
outside.
- Chantel Haynes
Tucson AZ
This kind of vague, statistics-based misinformation is hurting women. I wonder
why these doctors don't put their obviously ardent energy into creating statistics
that support women, that support our natural birth processes? I'm going to choose
to believe that the real reason this growing body of "doctors and researchers"
is seeking out this type of misinformation is that we as a society have an inherent
fear of the natural, of death, of the lack of control we have on the world, of
the inherent power that lies in a woman's body.
Vaginal deliveries can stretch a woman's nerves--hah! This article stretched *my*
nerves more than five vaginal deliveries ever could!
- Anon.
Don't underestimate the contribution of the techniques of the careprovider during
pushing and crowning. Forced, extreme pushing, combined with not allowing enough
time for the head to mold or the tissues to stretch, can seriously contribute
to additional perineal trauma. Allowing a woman to push to the point of comfort,
in her own time, and gradually ease the baby out can go a long way toward protecting
tissues.
- Amy V. Haas, BCCE
Fairport, NY
Learn about Cesarean Prevention and VBAC with Midwifery
Today issue 57
In "Choosing Cesarean Section" Marsden Wagner, MD, tells us that the
risk/benefit factors of c-sections depend on the reason for doing them: "Where
the baby is not in trouble, the risks to the baby still exist, meaning that the
woman who chooses CS puts her baby in unnecessary danger."
Read more informational articles by Robin Lim, Judy Edmunds, Gloria Lemay, Nancy
Wainer and many more!
Click here for the
full table of contents
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Critical issues in pregnancy and neonatal care with current interventions for
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- Anke
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Question of the Week
Q: While listening to fetal heart tones late in labor
(when heard right above the pubic bone) it seems at times I hear cord sounds.
This usually happens when the baby comes with a nuchal cord. I now prepare myself
for a nuchal cord when I hear a cord pulsing at a woman's pubic bone, and I must
say, it is nice to anticipate this fairly unexpected event. Have any other midwives
found this to be true?
- Dawn
Send your responses to:
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Question of the Week Responses
Q: I am dealing with a bilateral inguinal hernia, which
became apparent at about 24-26 weeks. I am in the eighth month of my third pregnancy.
I am very active and get a significant amount of exercise. I am wearing a hernia
belt, bathing with epsom salts, doing external compresses and trying to rest regularly
and minimize excess lifting. My chief concern is pushing. We will be birthing at
home, probably in water and I don't really expect to push until I feel a primal
urge to (my 8 lb. daughter slid out pretty well on her own, a few pushes were called
for). My midwife is inexperienced with hernias and as a doula I have never encountered
them. Any insight would be gratefully appreciated!
- Anon.
A: During my last trimester, I developed an umbilical hernia. I received
acupuncture surrounding the hernia (very superficially) and at other places in
my body. I was also informed to moxa (charcoaled mugwort that you heat and hold
above the skin) every day. Within three weeks the pain and the hernia were both
gone and never came back.
- Anon.
More on hemorrhoids [Issue 3:23]
I have found lemon juice to be absolutely marvelous. Every time you use the
bathroom, wipe your bottom with a piece of fresh lemon. You will find the hemorrhoids
will heal from the outside in. When you first apply the lemon the area will itch
because the lemon is shrinking the hemorrhoids.
I also suggest doing pelvic rocks before bed and resting during the day with your
feet up to relieve the pressure on your body.
- Robe
Many good herbal and homeopathic remedies that can be used prenatally are available
to strengthen your vessels. For labor and birth, lying on the side opposite your
hemorrhoids is an excellent position. Also have your midwife keep some 4x4s or
washcloths soaking in a bowl of ice water (with a squirt of antibacterial). This
can be used to provide you with counter-pressure during pushing. Most women find
the cool pressure nice against the "ring of fire" and the cold/pressure
reduces and prevents the hemorrhoids from coming out, along with the reduced pressure
of being on your side.
Borion makes a great combination homeopathic for hemorrhoids that can be used
postpartum, if necessary, and the standby trick of soaking pads with witch hazel,
putting them in the freezer, and applying them as needed also works great.
- Christina Di Eno, midwife
Question of the Quarter for Midwifery Today Magazine
Theme for Issue No. 59: Prenatal
Question(s) of the Quarter: What are the essential elements of good prenatal
care? How does prenatal care create better birth? As a midwife/doula, what do
you hope to accomplish in the prenatal period with a pregnant woman?
Please submit your response by June 30, 2001 to editorial@midwiferytoday.com
Switchboard
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International Connections
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EDITOR'S NOTE: Only letters sent to the E-News official email address, mtensubmit@midwiferytoday.com,
will be considered for inclusion. Letters sent to ANY OTHER email addresses will
be NOT be considered.
====
E-News asked "What are the essential elements in prenatal care?" Readers
should know that the latest issue of The Lancet has a paper from WHO (first author
Jose Villar) that reports on a very large study of prenatal care in a number of
countries as well as another article, also from WHO, that reviews the scientific
literature of prenatal care.
The results of this study and review of the literature is that the usual schedule
for prenatal visits is excessive and not productive. They found that half as many
visits--around a total of six rather than around 12--gave just as good results
in terms of the health of the baby and woman during and after birth. So we need
to take a long hard look at the way we do routine prenatal care in the U.S.
Of course, these studies focused on the medical outcomes and had little to say
about the emotional and social support prenatal care can give. In the U.S. having
surgical specialists (obstetricians) give routine prenatal care is unnecessary
and foolish. In the rest of the world, it is midwives who give routine prenatal
care and that is the way it should be here. But these WHO studies do have implications
for prenatal care in that they show you don't need to do the medical part of prenatal
care nearly as often as thought.
I urge those interested in prenatal care to read these articles in The Lancet.
- Marsden Wagner, MD, MSPH
To read full-length articles by Dr. Marsden Wagner, go to Midwifery Today's
web site!
====
More on kidney disease [Issue 3:22]:
As an herbalist, I would avoid any vitamin supplements in preference to herbs
that will benefit the kidneys and urinary tract and strengthen the uterus. My
favorites for this are, in order, nettles, urva ursi and raspberry. The only one
of these that requires care in dosage during pregnancy is urva ursi because it's
quite strong and should only be taken as symptoms persist. Red raspberry and nettles
should be taken throughout and on their own could more likely solve the problem.
I would also add some dandelion leaf to the tea to help with toxins elimination
and to assist the liver. Add 3 parts to a pot of water (liberally--2 tbsp. each),
bring to a boil, simmer 5 minutes, strain and enjoy. Continue 2 times per day.
- Tessa Neilson, DTCM
I would like to echo Jill Cohen's call for revamping the language of birth so
it appropriately reflects the kinds of births that midwives are regularly seeking
and seeing [Issue 3:21]. When medical language is being used regularly, it's difficult
to ask a mom to expect anything different from the kind of experience her friends
are having in medicalized hospital birth. Being a hypnotherapist, I find it very
disconcerting to hear the words "multip" and "primip" in the
middle of a paragraph that is describing beautiful, gentle birth. In England and
Australia, midwives refer to this woman, whether she has birthed or not, as the
"mom." I did a workshop in Australia recently and was quite taken with
the way the nurses and midwives refer to birthing mothers as "a woman I was
caring for," and, "one of the moms I was looking after."
Could we at least get away from the word "deliver"? Pizzas and packages
are delivered--on time and charted and voluminously documented. Babies are birthed.
And can the person attending the birth receive the baby and not "catch"
it? No one is throwing the baby. Actually, in the best of circumstances, shouldn't
it be the mother who receives the baby? After all, isn't birth a celebration of
life and, indeed, a reception for the baby?
- Marie Mickey Mongan
Avondale, Arizona
Re: neonatal seizures and cardiac arrest and their relation to "high tech
births" [Issue 3:22]:
I have seen research relating external fetal monitoring to an increase in neonatal
seizures but the research says there is no difference at one year. (I think we're
supposed to find that comforting!) I haven't seen anything about cardiac arrest.
- Susan Mooney
I have worked in OB in hospitals for 13 years and seizures and arrests in neonates
are very rare under normal circumstances. The only times I have seen this is with
a catastrophic event leading to prolonged fetal hypoxia such as an abruption,
bleeds, maternal seizures or codes, etc. Babies with other underlying disorders
who have had some kind of prenatal insult or who are in withdrawal from their
mom's drug use may seize.
Incompetent practitioners (both in and out of the hospital) may mismanage a delivery,
but in my experience this is thankfully very rare. I have a lot of respect for
the vast majority of midwives, nurses and doctors I have known over the years.
There is a place for both homebirth and hospital births in our spectrum of care,
a place for high-tech and low-tech based on a mom's preference and medical needs.
Everyone's goal is a healthy, happy mom, babe and family, whether we work with
homebirths or hospital births.
- Tracey Ledel, RNC
Do you know if there is a common thread in their births or postnatal care? Have
these babies received vaccinations? You may want to read up on the effects of
vaccinations. So many factors are being investigated--ultrasounds, Pitocin, and
vaccinations being the main ones I am aware of, but I'm sure any invasive procedure
could potentially be causing it. Every baby is different and will react differently
to different assaults.
- Colleen Morris
Re: use of oregano oil for yeast infection [Issue 3:22]: Anyone who practices
the use of aromatherapy or has read about it knows that internal use of essential
oils is forbidden because it can cause tissue damage. Furthermore, the use of
this oil is forbidden during pregnancy for it can cause uterine contractions!
- Zaramati Caroline, R.N. midwife
I am contemplating a third pregnancy. I have had 2 c-sections and have met with
much apprehension upon my request for a natural and peaceful birth. I dearly want
a midwife to care for me during this time, but feel I would be unwise not to have
the backup of a specialist OB in case of a problem. The few who respect my feelings
keep stating one thing: it is essential for dilation not to occur too slowly.
I have been told that in the later part of dilation, 1 cm every three hours is
not enough (which is what happened previously)--they would want 1 cm per hour
or similar. I am well educated in birthing matters, but can find no real reason
why slow dilation, without feotal distress and an active/well mother, causes such
a problem. Their answer is that "something" must be wrong. Can anyone
explain this reasoning?
- Anon.
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