January 9, 2002
Volume 4, Issue 2
Midwifery Today E-News
“Omnium Gatherum”
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Herbal remedies. Singing in pregnancy and birth. Birth dance. Therapeutic touch. Waterbirth.

Learn about these topics and more at the Midwifery Today conference in Philadelphia, Pennsylvania, U.S, March 21-25, 2002.

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THIS WEEK'S ISSUE

Contents:

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MIDWIFERY TODAY ISSUE 60

  • A Vision for Midwifery in the United States, by Ina May Gaskin
  • The Essentials of Midwifing Midwives, by Sara Wickham
  • Supporting Midwifery Apprenticeship in the New Millennium, by Terra Richardson
  • The Power of Independent Practice, by Sandra Stine

AND 19 OTHER FULL-LENGTH ARTICLES!

Quote of the Week:

"As diverse as we may be, a common thread weaves us together: our firm belief in, and experience of, the divine presence that is inherent in life and the divine presence that is transmitted during the birth process."

- Miriam Medicine Prayer


The Art of Midwifery

For healing the postpartum perineum, I mix 1 part rosemary, 1 part sea salt, 1 part uva ursi, and 2 parts comfrey (roots and leaves). Simmer the mixture, strain it, and keep in the refrigerator. My ladies really like it and will use it as a sitz bath, a wash with a peri bottle, or on a compress. Arnica taken internally for the first few days or week postpartum helps heal the bruised tissue. Use lots of oil and hot compresses during second stage.

- April H. Bailey
Midwifery Today Forums

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News Flashes

A study to measure the impact of socioeconomic deprivation on rates of teenage pregnancy, the extent of local variation in pregnancy rates in Scotland, and how both have changed included 62,338 teenage mothers who gave birth between 1981 and 1985 and 48,514 who gave birth between 1991 and 1995.

The overall maternity rate among Scottish teens increased during the 10 years of the study; however, that increase was consistently less dramatic among the socioeconomically deprived. Teenagers in rural areas had smaller increases in birth rate than teenagers in the cities. The only group among whom the maternity rate decreased was that of teens 18 to 19 years old in affluent areas. Abstinence or use of contraceptives was more common among affluent teenagers.

- British Medical Journal, July 2001, 323: 199-203


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I think baby and I might have thrush, but I've been keeping it in check with a low-sugar, no-fermented-foods diet that includes yogurt. I plan to start using acidophilus and I'm working to reduce my stress level. I'd like to see some resources for treating thrush naturally.

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Question of the Week (repeated)

Q: A mom just delivered after a 43-week pregnancy. The labor was terribly long but OK for her. The baby looked 40 weeks; the gestational age came in at 38 weeks. There is no way we were off on dates. She had a circumvallate placenta. The cotyledons were really mushy where they tore really easily. I've read that a circumvallate placenta has a higher risk for postpartum hemorrhage, which she had--a long, trickle bleed. What causes this type of placenta? Did it cause her baby to stay in so long yet look and test out to be a normal, term baby?

- Heather Zanon

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Question of the Week Responses

More about kidney stones [Question of the Week, Issue 3:50]:

Does anyone have ideas about how to avoid kidney stone formation for a woman who got them in her first pregnancy and would like to avoid them the next time around?

- Cyndi

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Our family has had success with dissolving both kidney and gallstones using fresh-squeezed lemon juice or raw apple cider vinegar. The lemon juice may be taken first thing in the morning with warm water and honey. If the acid bothers your stomach, take it as lemonade with a meal. Same with the vinegar, a teaspoonful with honey and water. The lemon is superior for the enzymes that offer healing to the liver, but the vinegar is cheaper and also effective.

- Francie Smith


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or call 541-488-8273


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Fused labia {Issue 3:50}:

If the baby is six months old, I doubt it is a congenital problem. Things like this are checked closely at birth and the first few pediatric checkups. What has probably happened is labial adhesions. This happens *after* birth as a baby girl gets older. It has to do with the mucus membranes of the labia sticking together and then becoming stuck to the point that it can't be separated without causing pain and/or tearing of the skin. Doctors usually prescribe estrogen cream and the parent is asked to apply a very small amount to the area with a cotton swab or Q-tip once or twice daily. The hormone gives the skin more moisture and elasticity and the labia slowly come apart. The treatment then is stopped and the parents are asked to check the labia daily.

If the baby does have congenitally fused labia, the scan is a good idea. There is a chance she doesn't have any internal female genitalia. If she does have internal genitalia she will have to have her labia surgically opened, but it will be years before it would be necessary.

- Robin E. Williams, doula and former medic

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My daughter had a similar condition as a baby. One of my favorite OBs said, "Don't let anyone cut her!" She told me it was "vaginal or labial agglutination" and prescribed a conjugated estrogens cream (Premarin) to apply 3x/day. Within a week the vagina had an opening.

- Kimberley Schmidt, RN CD

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My daughter had this condition and the GP pulled it apart at age 6 months. I put vitamin E cream on the edges and it healed beautifully. She grew into a healthy young lady and is now pregnant with her first child.

- Anon.

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I wonder about the wisdom of using hormones on infants. The problem can be corrected surgically at puberty if it does not self-correct before then.

- Merrilyn

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The overwhelming tendency for children born not obviously male or female is for their parents and medical doctors to subject them to surgery to "correct" their "aberration." Many of these people experience trauma, pain, and other difficulties in puberty and adulthood as a result of both their families' lack of acceptance and the surgery. The Intersex Society of North America is comprised of individuals born with other than XX or XY chromosomes (they estimate 1 in 500 children are born this way) and they advocate for greater societal acceptance of people of all types. Contact them for more information: www.isna.org

- Seanain

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I would not allow anyone to do anything unless and until the baby has been evaluated by a specialist in human genetics. There are a multitude of reasons for abnormalities of the external genitalia. Usually they are very minor and unimportant and easily repaired. Sometimes they can be extremely serious with potential physical and psychological long-term consequences. Be aware that the typical general practitioner and pediatrician have not been trained to handle more complex situations such as a baby who is chromosomally a normal boy but who lacks a full complement of male external genitalia. This can present as fused labia. There are also genetic conditions that can cause abnormalities of the genitalia in which these abnormalities are just one aspect of a whole syndrome requiring treatment and monitoring. Again only a trained geneticist can pick these up.

In the past (and regrettably in the present in some places) male babies with abnormal external genitalia have been made over into "females" by surgically removing any testicular tissue and/or penis material they do have and by telling the parents if these genetic boys are raised as girls, they will become girls as adults. This appears to be true for some genetic conditions and some individuals, but definitely not for others. For some people, this kind of forced surgical gender reassignment can lead to extremely difficult psychological adjustments in these "girls" as they reach adulthood and they find themselves with a normal male sexual orientation and male gender identification. Plus, the childhood surgery that removed any testicular or penal tissue they once had also removed any choice about becoming fathers if they find themselves with a male sexual orientation as adults, compounding the problems they face.

- Natalie K Bjorklund

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Midwifery Today Issue 44 includes the excellent full-length article, Advocating for Intersexed Babies and Their Families.

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Paths to midwifery:

I will graduate in June with a BSN and plan to go the CNM route. I worked in a homebirth practice with a senior midwife. My hard-won CPM certification just went inactive and will remain so for one cycle. Four to six years ago, I was asking all the same questions about paths to midwifery. What a quandary it is.

After two years of science prerequisites and almost two years of nursing school, I am still a fervent advocate of homebirth and noninterventionist by nature. I have surprisingly gained pride in becoming a nurse, an underappreciated profession. I have not sold out to the hospital-based system of Western medicine. I will be a nurse-MIDWIFE, and serve women and families with pride.

- Jennifer McGeorge, CPM

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I'm a doula finishing my BSN in May. I began nursing with the sole purpose of becoming a CNM. I had no interest in working hospitals. I was afraid of becoming a medwife and I know quite a few. They've become afraid of birth, they love gadgets and doohickeys. But after doing an externship in L&D, I realized that we are needed in the hospital to offset the medwives, doctors and RNs from hell. We can't run away. Running away is hiding from the real situation, putting blinders on. Women must be empowered in these sometimes horrific situations, cared for, smiled at, cheered for, and treated as if they're the first one to ever give birth. Working in a hospital has done the very opposite of what I thought it would do. I love women and birth and I won't turn my back on them for the easy, more pleasurable route. It is hard and I won't say that I'll stay in the hospital setting forever, but I will do my part for as long as I can.

- Charisse Lawson, CD
Brooklyn, NY

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In Issue 3:51 many hospital midwives said positive things about their hospitals and the success rate in terms of natural birth and acceptance of alternative methods of healing. Is it within the scope of the email newsletter to name the state, city, and hospital? I am not a midwife or doula. I am just a strong believer in making the right birthing choices for myself. I think to share that information would be very helpful to someone like me who researches birthing options.

- Teresa Gelerter
Sacramento, CA

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I loved reading about all the fabulous changes in the hospital birth setting [Issue 3:51]. It is so important that we continue to promote safe, accessible births everywhere. I feel so connected to my CNM/RN sisters!

I am an apprentice with a homebirth practice; it is absolutely the right path for me. Unfortunately my husband just got a dream job in Virginia where it is illegal to practice as a CPM. Does anyone have suggestions about how I can continue my training? Although I admire my CNM sisters, I do not work well in the hospital setting, and it is not a viable option for me.

- Jeanne Catherine

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I am a nurse who has worked with birthing families for 30 years. I have worked in education, hospitals, a wonderful free-standing center, with newborns, with mothers in recovery, with teenage moms, with breastfeeding couplets in a baby-friendly hospital birth center, etc. Now my lovely little hospital birth center, which is not perfect but a sweet place to work because of the wonderful nurses and its philosophy toward birth, may be closing.

I have just traveled to New York to assist my niece with the birth of her first child, a beautiful 10-lb. boy born at home, a lovely experience that reminded me how peaceful and beautiful it is to birth at home. I am feeling a pull toward midwifery that I have resisted before for many reasons. But now it seems it may be time to just get trained and licensed so I can use the body of knowledge I have acquired to help women have more satisfying and fulfilling births.

Can you tell me the best way to find out where the programs are that I might investigate to make a plan for the future?

- Mary Jo Terrill , RN, BSN, MSW
Santa Barbara, CA

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PATHS TO BECOMING A MIDWIFE: GETTING AN EDUCATION, a Midwifery Today book. The quintessential guide to preparing yourself to become a midwife or other birth practitioner. Read about realities, politics and philosophies, direct-entry and certified nurse-midwifery, childbirth education, labor support and postpartum caregiving, the future of midwifery. Extensive resources listings.

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A client who at 32 weeks was told by her OB that her baby is transverse. She also said that the baby will not turn, so prepare for a c-section. I have done my best to give her exercises to help turn the baby. Does anyone have suggestions other than the usual?

- Karen A., doula
Winnipeg, Canada

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Re cord clamping and twins [Issue 3:50]: Almost all identical twins have some degree of vein-to-vein, artery-to-artery, or vein-to-artery transfusion (twin-to-twin transfusion syndrome [TTTS]). Acute TTTS from the first twin to the second twin usually occurs at birth. Clamping and cutting the first twin's cord immediately after birth prevents it. Once the last baby is out, its cord can be left unclamped if desired. It is not possible for fraternal twins to have TTTS even if their placentas are fused. Fused placentas of fraternal twins simply implanted next to each other and the membranes have become joined on the outside. They still have separate placentas, bags, and circulatory systems.
Check out Anne Frye's book Holistic Midwifery--it has a great section about twins.

- Debra, midwife
Washington

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HOLISTIC MIDWIFERY, VOL. I is available from Midwifery Today.

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Re Breast hypoplasia and milk supply: A very informative study in "Current Issues in Clinical Lactation" (2000) by Kathleen E. Huggins et al. is one of many great articles compiled in this book. The illustrations are a useful and practical addition to the info provided.

- Esti, CBE ,LC
Jerusalem

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Re breastfeeding during pregnancy: I breastfed during two of my pregnancies. Although I had a history of preterm labor, my midwives and I felt that as long as I made sure to eat a bit extra and have a drink every time I nursed my child, it was no big deal. It is important to note that in each case, my children were more than a year old so breastfeeding was not their primary source of food. Is mom concerned about preterm labor? Is this part of her history?

I don't think all nursing during pregnancy situations are the same. How old is the nursing child? How does the mom feel about nursing/weaning? How is her nutrition, activity level, etc? Why is the child still nursing? It is much different to nurse a 6-month-old baby and be pregnant than it is to nurse a 3-year-old for comfort and snuggling. Each situation is unique and it makes sense to think about all the factors involved. The mother must pay attention to her actions and how her body reacts to them.

- Holly Sippel, student CBE

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Proven or not, we have to be very careful what we encourage (or fail to discourage) in pregnant and laboring women. The more emotional side to this argument are the effects that we who have been there live with every day. Both my teaching partner and I have children who have learning disabilities and other problems resulting from horrible drugged births. My three brothers who had drugged births are all drug/alcohol addicts. The only one who experienced twilight sleep is the only one who is not recovering--and he has no intention of stopping now. I am the only one of my siblings who did not have a drugged birth and the only one with no addiction problems.
Ask yourselves, is it worth the risk?

- Amy

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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 not be considered.


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