|February 20, 2002|
Volume 4, Issue 8
|Midwifery Today E-News|
“Oxytocin and Security”
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Midwifery Today Conference News
BIRTH DANCE: Led by Michel Odent and Marina Alzugaray at Midwifery Today's Philadelphia conference, March 21-25,2002. With theory (Michel) and a birth dance (Marina), this renowned theater class will touch your heart and your mind. Look for the conference program and all the general information, including status of CEUs, on the conference Web site.
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MORE MIDWIFERY TODAY CONFERENCES
Get the full program online. The three-day conference will have components of Midwifery Today conferences as well as the presentation of several papers. Chinese doctors have been asked to arrange for midwives to be present as well as doctors, and it has been noted that we are interested in Chinese medicine. A hospital focused on the practice of Chinese medicine is located across the street from Shamin Island, where our venue is located.
The Hague, THE NETHERLANDS: November 13-17, 2002.
A two-day midwifery education conference precedes three days of international conferencing.
THIS WEEK'S ISSUE
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Quote of the Week
"Perhaps too many of us see pain as a badge of courage -- proof that we are just as strong as men."
- Laura Kaplan Shanley
The Art of Midwifery
When mom is trying to stick to the Brewer diet while pregnant yet feels just too full to meet the requirements every day, have her try eating some concentrated foods at some point in the day - smoothie with some powdered milk added, protein shakes, liver, sardines, etc. With some careful meal planning you don't have to end up eating like a horse, but eating plenty of good grains is vital. Short-grain brown rice, millet, barley (brown rice & barley porridge is a great breakfast meal) have excellent quality carbohydrates. Things such as granola with whole-milk plain yogurt have tons of calories and protein.
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A new test for ovarian cancer is the first diagnostic tool to emerge from the field of proteomics, the study of proteins and what they can reveal about a person's disease state. After ovarian cancer was linked to a characteristic protein pattern, researchers screened blood samples from 116 women -- 50 with cancer and 66 with benign conditions. The new test enabled doctors to pick out all 50 malignancies, including each of the 18 early-stage cases. The test, which takes 30 minutes to perform and will be easily affordable, will have to withstand larger trials before gaining FDA approval.
- Newsweek, February 18, 2002
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Women respond to stress differently than men do. Fortunately, we also have a better way to fight it: each other. Friendships between women are special. They shape who we are and who we are yet to be. They soothe our tumultuous inner world, fill the emotional gaps in our marriage, and help us remember who we really are. But they may do even more. Scientists now suspect that hanging out with our friends can actually counteract the kind of stomach-quivering stress most of us experience on a daily basis.
A landmark UCLA study suggests that women respond to stress with a cascade of brain chemicals that cause us to make and maintain friendships with other women. It's a stunning finding that has turned five decades of stress research -- most of it on men -- upside down.
"Until this study was published, scientists generally believed that when people experience stress, they trigger a hormonal cascade that revs the body to either stand and fight or flee as fast as possible," explains Laura Cousino Klein, PhD, now an assistant professor of biobehavioral health at Pennsylvania State University and one of the study's authors. It's an ancient survival mechanism left over from the time when humans were chased across the planet by saber-toothed tigers. Now the researchers suspect that women have a larger behavioral repertoire than just fight or flight.
In fact, says Dr. Klein, it seems that when the hormone oxytocin is released as part of the stress response in a woman, it buffers the fight or flight response and encourages her to tend children and gather with other women instead. When she actually engages in this tending or befriending, studies suggest that more oxytocin is released, which further counters stress and produces a calming effect. This calming response does not occur in men, says Dr. Klein, because testosterone, which men produce in high levels when they're under stress, seems to reduce the effects of oxytocin. Estrogen seems to enhance it.
The discovery that women respond to stress differently than men was made in a classic "aha!" moment shared by two women scientists who were talking one day in a lab at UCLA. "There was this joke that when the women who worked in the lab were stressed, they came in, cleaned the lab, had coffee, and bonded," says Dr. Klein. "When the men were stressed, they holed up somewhere on their own. I commented one day to fellow researcher Shelley Taylor that nearly 90% of the stress research is done on males. I showed her the data from my lab, and the two of us knew instantly that we were onto something." The women cleared their schedules and started meeting with one scientist after another from various research specialties. Very quickly, Drs. Klein and Taylor discovered that by not including women in stress research, scientists had made a huge mistake: The fact that women respond to stress differently than men has significant implications for our health.
It may take some time for new studies to reveal all the ways that oxytocin encourages us to care for children and hang out with other women, but the "tend and befriend" notion developed by Drs. Klein and Taylor may explain why women consistently outlive men. Study after study has found that social ties reduce our risk of disease by lowering blood pressure, heart rate, and cholesterol. "There's no doubt," says Dr. Klein, "that friends are helping us live longer.It may take some time for new studies to reveal all the ways that oxytocin encourages us to care for children and hang out with other women, but the "tend and befriend" notion developed by Drs. Klein and Taylor may explain why women consistently outlive men. Study after study has found that social ties reduce our risk of disease by lowering blood pressure, heart rate, and cholesterol. "There's no doubt," says Dr. Klein, "that friends are helping us live longer."
The first factor paramount to maintaining normalcy in birth and obtaining an optimum outcome for mother and her baby is our ability to provide both constancy and continuity of care. As the relationship between midwife and mother develops during the course of prenatal care, a mutual trust between the caregiver and cared for brings a sense of safety and security. Communication becomes forthright and honest, and words and ideas flow easily between them. When it comes to the time of birth, rarely must we deal with psychological issues, which may stall or impede labor, since specters of the past have been met, dealt with, and put in their proper place. The midwife has said to the mother through her manner, her touch, and even with her words through the preceding months: "I will never lie to you." ... When her eyes gaze into mine, when I feel her contractions crashing through her body like tumultuous waves against the rock, and I know she is doubting her strength to go forward despite her great desire to complete her task, I say to her, "OK, now you will have to walk on water." She grasps my hand a little harder and replies, "How far do you want me to walk?" Then, we walk together.
- excerpted from Normal Birth: Do We Believe, Can We Remember?
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CONFERENCE AUDIOTAPES FOR THIS WEEK'S THEME
PATHS TO BECOMING A MIDWIFE: GETTING AN EDUCATION, the definitive book about how to follow your dreams of becoming a birth practitioner. A Midwifery Today book, 332 pages.
Are you an aspiring midwife who wonders what a midwife's life is really like? Or maybe you're a practicing midwife who would like to know what other midwives have experienced? Read LIFE OF A MIDWIFE and learn about the problems, challenges and rewards of a midwifery career. For more information, click here. To order LIFE OF A MIDWIFE, click here.
INTERNATIONAL ALLIANCE OF MIDWIVES
Midwifery Today's Online Forums: Doubt and Fear
At the end of a very long birth with many twists and turns, there was meconium in the water and the baby aspirated. The baby should be OK, is on a ventilator, other vitals are really good. I was not the primary caregiver but I still feel a sense of responsibility because of my positions and beliefs. Mom was free to make her own decisions and did that, but I just saw birth when it didn't work. As much as I know in my head, I feel that fear and understand why our medical system is so fear-based. I know that I cannot base my beliefs on fear or on the times that the "risks" in birth become evident but it doesn't change how I feel right now. My heart is hurting.
Go to our forums to share your thoughts and experience.
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Question of the Week: Medication
Q: My daughter is 18 and just discovered she is about 9 or 10 weeks pregnant. She has bipolar disorder and was on Depakote ER 1500 mg, which we know can cause birth defects, specifically neural tube defects. She stopped taking her meds as soon as she suspected she might be pregnant (at about 8 weeks). She is taking prenatal vitamins with folic acid to try to help the situation, if such a thing is possible. Is there anything else she should be taking to help with this? Can she deliver with a midwife out of hospital or should she go to a hospital for birthing? If there are any birth defects, what can she expect to happen at delivery?
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Question of the Week Responses: Stroke
Q: I have a client who is 24 yrs old and is due March 14 with her first baby. She just had a stroke. It occurred in the right temporal lobe and was caused by a heart defect (atrial septal defect). She has had the heart problem all her life and never knew it. She was always into sports, very active, and it was never a problem. Now with blood increase with pregnancy it became a problem and she threw a blood clot. She is now on blood thinners (Lovinox) and going through rehab. Her left side is paralyzed at this point. Has anyone ever had a similar case? One doctor wants her to carry this baby (who is fine at this point) to term so she has time to heal. Another says she needs to be induced (38-40 weeks) and needs Pitocin and epidural because she can't push this baby out -- it could cause another stroke and may damage her heart. They may want to use forceps or vacuum extraction. C-sec is out of the question because of the blood thinners. The doctors in this area have never seen this happen before so they don't really know what the limitations or side effects are. Both dad and mom wanted the birth to be as natural as possible. What is a realistic expectation? Will natural birth be riskier than the meds and side effects of interventions? What about not pushing the baby out and letting mom let the baby come down with minimal pushing and minimal breath holding?
A: A patient of mine who had a blood clot (but not a stroke) in her first pregnancy took Lovinox until the third trimester and then was switched to heparin twice a day. She stopped her heparin 12 hours before her induction (heparin may cause bleeding problems during labor and delivery). She was induced at term -- not before -- and had a normal vaginal birth without complications. For her second birth she is being induced at 39 weeks gestation. The only real reason for induction is planning when to stop heparin injections to avoid problems with the birth. This patient did push her baby out and had no problems with her first birth.
A: I'm a doula and childbirth educator. I had a stroke about a month before I got pregnant, and I am due at the end of February. My stroke was also caused by a heart defect (patent foramen ovale) that I didn't know I had. Thankfully, I recovered very quickly from the paralysis (upper right side) and other deficits, so I'm "completely functional" now. When I got pregnant, I heard a lot of different things too. I took baby aspirin in the first trimester, and then switched to heparin until 38 weeks. My doctor hasn't worked with this before either, but we couldn't find one who had. Originally he recommended a c-section followed by blood thinners because they were worried that the strain of labor and birth could cause another stroke. When I told him I didn't want a c-sec if at all possible, he said I could have a strong epidural and "wait the baby out." He had worked with paraplegic women who couldn't push, but if you wait long enough the uterus will push the baby out. If there start to be problems, then a vacuum or forceps delivery might be necessary, but he is willing to wait. That way, I can stay relaxed though the labor and birth and not push.
This is my second baby, so we're anticipating a shorter pushing phase than a primip might have. I pushed my first daughter out before we knew about this heart defect (took me an hour and a half and no stroke-like problems), so he's feeling pretty confident about this baby sliding right out. My doctor has been very adamant that I come to the hospital as soon as I'm sure it's labor -- he doesn't want me to get to the hospital in transition and barely have time to get the epidural in before the urge to push hits. I talked to a midwife and my doctor about not pushing without an epidural by breathing the baby down, and they both responded, we could try, but the urge to push can be very strong. I decided that having an epidural was worth it, knowing I won't have an irresistible urge to push that could cause another stroke. The truth I came to is that no one can accurately predict whether you will have another stroke because of pushing your baby out -- there aren't any odds to work with.
A: Consider the breathing that is taught in HypnoBirthing. The idea is that even after the baby is through the cervix and coming down the birth canal, the mother stays very relaxed and breathes deeply. Only in the last 10 minutes or so, when the rectal pressure is intense, does she really push. Does the mom practice relaxation techniques? A friend who is a brain surgeon tells me that any meditative practice is beneficial in dealing with epileptic seizures. I wonder if it would help in this situation.
- Suzanne Fremon, HypnoDoula
A: Sounds like she needs to talk with a doctor who has experience working with women who have heart problems and paralysis. I've heard of women in both those categories having vaginal births without actively pushing. It's the mom's uterus, not her abdominal muscles, that ultimately brings the baby down.
A: Hypnobirthing generates no additional stress on the laboring mom. She looks as though she is napping while her uterus is doing all the work it was designed to do, without any real need to do "purple pushing."
A: This woman needs a maternal-fetal medicine specialist. This is not from a heart defect but rather from an arterial/venous defect in the brain. She needs as gentle a birth as possible, and while an epidural will help, she probably will require forceps, as she might not be able to push gently and effectively. A c-section may actually be in order. Lovinox is low-molecular weight heparin (the preferred choice for pregnant women) and does not pass the placenta. Since it is a prophylactic dose (I assume given subQ) it should not result in prolonged bleeding or untoward complications in surgery.
A: I had a baby in August 2001 following a stroke. I got the same runaround as this mother from the physicians. Essentially, the incidence of young women having strokes is so rare that there is no guidance for childbearing women who are poststroke or who have cardiac or clotting problems.
My stroke doctors were a neurologist/stroke specialist, a maternal-fetal medicine specialist and an obstetrician. Essentially what I discovered is that pregnancy and postpartum are prime times to throw a clot. During labor, however, the biggest risks were during pushing (if the purple variety was used) and some clown fiddling with the placenta as physicians in my area love to do.
An epidural and forceps means the mother will probably receive an IV infusion and Pitocin, both contraindicated if a mother has a clotting problem or is on antiplatelet agents. Of course a c-section should be avoided; however, an IV, Pitocin and an epidural dramatically increase her chances of a c-section. Long's Valsalva maneuver is also contraindicated, which is probably why the mother's doctors are encouraging her to allow them to use forceps: they probably have never seen a baby born vaginally outside "purple pushing."
I sought out cases, in the absence of any research on the topic, and found many mothers who had wonderful births following stroke. With a heart defect they advise antibiotics upon hospital admission; however, at home one is immune to one's own germs.
I decided if it was my time to die I would rather die at home. I took Lovenox and heparin up to the last week or so of pregnancy; it has a short half-life. I birthed at home, walking once I hit 10 cm, grunting the baby out. My midwife took her time with the placenta, and it was a wonderful birth. My physical therapist and midwife told me that when one is dehydrated, blood clots more easily and it was critical to keep my intake of water up. I did that.
- Anne Boyd, Birmingham, AL
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!
I have found that women with repeated miscarriages [Issue 4:7] are actually minimally low thyroid. It is very important for them to be on an iodine supplement. An excellent product from Standard Process, Thytrophin PMG, helps heal the thyroid. It helps diffuse the autoimmune attack on the thyroid and allows the body to heal the thyroid if there is adequate iodine intake. The ovary is the only other organ in the body that also uses iodine and that also may have a relationship to the whole process.
- J. Jones, CPM
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