|August 29, 2001|
Volume 3, Issue 35
|Midwifery Today E-News|
|Subscribe • Print Page|
Search Archive • Index
E-News is free! Pass it on to your friends and colleagues.
This issue is sponsored by:
Midwifery Today Conference News
EPIDEMICS: EPIDURAL ULTRASOUND, INDUCTION, EPISIOTOMY: Learn about the levels of birth intervention around the world in a stimulating class at Midwifery Today's international conference in Paris, France, 18-22 October 2001.
Are you a hospital midwife? Now you can learn about appropriate technology, working under restraint, closing the evidence-practice gap, humane hospitals and more.
Attend the full-day pre-conference class, "Serving Women in Hospital Births" at the Midwifery Today conference in Philadelphia, Pennsylvania, U.S., March 21-25, 2002.
Join Midwifery Today in China and The Netherlands! Updates coming soon!
THIS WEEK'S ISSUE
Send responses to newsletter items to:
Please Support Our Advertisers
Don't be fooled by imitation; insist on the REAL thing. If it doesn't say HypnoBirthing® Institute, and it doesn't have a capital "B", it's NOT the authentic HypnoBirthing® program founded by Marie Mongan, Director of the HypnoBirthing® Institute and author of HypnoBirthing®: A Celebration of Life.
Questions? E-mail: firstname.lastname@example.org
Quote of the Week:
"I believe I was born at this time to help keep birth normal while using technology when it is necessary."
- Jill Cohen
The Art of Midwifery
Placing a beanbag chair under the tub liner is a great way to increase choice of positions at a waterbirth.
- Marlene, CPM
Learn more about waterbirth, order these great books and videos!
Hundreds of tips and techniques for midwives, doulas, and childbirth educators!
Watch for Volume III of Tricks of the Trade, coming soon!
Share your midwifery arts with E-News readers! Send your favorite tricks to:
Researchers planned to compare misoprostol to oxytocin for induction of labour in mothers attempting a VBAC. After two uterine ruptures among just 17 mothers receiving misoprostol, the trial was stopped on safety grounds. They concluded: "When misoprostol is used in women with previous cesareans, there is a high frequency of disruption of prior uterine incisions."
- Obstet Gynecol 1998 May; 91(5 Pt 2):828-30 [Thank you to: http://www.homebirth.org.uk/misoprostol.htm]
Department of Obstetrics, Northwest Permanente PC, British Columbia, Canada.
- Am J Obstet Gynecol 1999 Jun; 180(6 Pt 1):1535-42 [Thank you to: http://www.homebirth.org.uk/misoprostol.htm]
The common medical methods of induction in the United States today include intravenous oxytocin infusion, intravaginal or intracervical dinoprostone, and misoprostol. Each of these can cause excessive uterine contractility: contractions may be too forceful, too close together, or too long. When this happens, maternal perfusion of the placenta is reduced, and the baby may not receive enough oxygen. The degree of fetal compromise depends on several factors, including the health of the placenta, the fetal reserves, and the degree of uterine overactivity. Uterine overactivity also poses risks to the mother. There is a risk of rupture in even the unscarred uterus. Cervical lacerations are possible. A precipitous second stage can cause severe vaginal and perineal tears. Excessive contractility can also cause placental abruption.
When uterine overactivity occurs, an attempt must be made to remove the drug that is causing the problem. Turning off an oxytocin infusion is fast and easy and usually results in a rapid return to more normal uterine activity. Some dinoprostone products are made with a string and are easy to remove quickly. When dinoprostone gel is used, attempts can be made to flush it from the vagina with sterile saline-clearly a slower and less effective procedure. With misoprostol, attempts can be made to remove the pill if it has not yet been absorbed. More often than not, the pill has already been completely absorbed. In this case there is no choice but to ride out the excessive contraction pattern with careful monitoring and measures to maximize the supply of oxygen to the fetus.
- Jennifer Enoch, excerpted from "Misoprostol (Cytotec): A New Method of Inducing Labor," Midwifery Today Issue 49
Midwifery Today Issue 49 can be ordered from the Midwifery Today storefront
An induction with Cytotec should never be attempted anywhere, most especially in out-of-hospital settings. Incredibly, the American College of Obstetricians and Gynecologists (ACOG) recently approved Cytotec induction: 1) in spite of lack of FDA approval; 2) in spite of a letter to doctors earlier this year from Searle (which manufactures Cytotec) imploring doctors not to use it for induction; 3) in spite of lack of approval from the Cochrane Library (the best scientific opinion); and 4) in spite of the fact that it is not approved nor used for induction in any country in Western Europe.
Recent articles in prestigious medical journals like The Lancet have questioned the validity of standards of practice from professional organizations like ACOG, because its goal of protecting the health of women through using scientific evidence to guide members toward best practices too often conflicts with its other role as a trade union representing the interest of its members. As a result of this "trade union" role, ACOG recommendations are too often compromised by the needs of the obstetricians. A classic example of putting the doctors' needs ahead of the families' needs is the ACOG recommendation not to permit videotaping by families of a hospital birth.
So ACOG quotes studies of Cytotec induction, none of which have a sufficient number of research subjects, and consequently, none of the studies quoted have sufficient statistical power to detect small but potentially important risks such as uterine hyperstimulation and uterine rupture. Furthermore, because published studies of Cytotec induction have such wide methodological variability, meta-analysis is impossible and the published attempts at such meta-analysis are seriously flawed. But Cytotec is a godsend for busy obstetricians because its use allows them to schedule the woman's labor at a convenient time and speeds up the labor, resulting in a return to "daylight obstetrics"--pharmacological induction of labor has increased from 10 percent to 20 percent in the past decade in the United States. So with their members' needs in mind, ACOG plows ahead, ignoring the best scientific evidence as well as the recommendations of the best scientific bodies, of government agencies not only in the United States but in every country in Western Europe, and of the pharmaceutical company. Instead, ACOG uses weak, inadequate evidence to approve Cytotec induction. Midwives should stay as far away as possible from such vigilante obstetrics-obstetricians taking matters into their own hands while ignoring the recommendations of the real judges.
- Marsden Wagner, MD excerpted from "Midwives and Cytotec: A True Story," www.midwiferytoday.com
Learn more about misoprostol from Midwifery Today conference audio tapes:
Take time to relax.
When you subscribe to Midwifery Today magazine, every three months you'll receive 72 pages packed with birth-related articles, news, stories and photos.
Subscribe today! Just $50/year U.S., $60 in Canada, $75 for all other countries
Check It Out!
REGISTER YOUR BIRTH SERVICE OR DOULA SERVICE on Midwifery Today's website!
HAVING A BABY TODAY quarterly newsletter, A NEW Midwifery Today publication for parents!
INTERNATIONAL ALLIANCE OF MIDWIVES: A wonderful way to network with midwives and other birth practitioners from around the world.
Please Support Our Advertisers
The Farm Midwifery Workshops
The Farm Midwifery Workshops, taught by Ina May Gaskin and The Farm midwives,
strive to teach the skills and knowledge you will need to make the birthing environment
safe, pleasant and responsive to the needs of women and their babies. For more
information with dates, curriculum, and fees, write to us:
Midwifery Today's Online Forum
I am a nurse working with CNMs, and I am going to begin doing vaginal exams soon. I want tricks, advice, etc. What, exactly, does it feel like? If the cervix is stretchy, do I call it what it feels, or do I call it what it can stretch to? How easy/difficult is it to ascertain station? I'm not trying to begin a discussion on whether or not VE should be performed; we don't do them very often, so I'm not going to get a whole lot of practice all at once, but it is a skill that I personally want to learn. If anyone has any tips, please share them!
To share your thoughts and experience, go to Midwifery Today's Forums. Click on "Aspiring Midwife Chat" and "From
doula to OB nurse to midwife?"
Please Support Our Advertisers
2001 MAWS Conference