Pass E-News on to your friends and colleagues—it's free!
Subscribe to E-News!
Code 940
o=o=o=o=o=o=o

YOUR BEST MIDWIFERY RESOURCE: MIDWIFERY TODAY'S STOREFRONT meets your
needs. We have subscriptions, books, audiotapes, videos, back issues,
special packages, clothing & accessories, and sterling silver jewelry,
and other special items.
Go here to shop:
http://www.midwiferytoday.com/storefront.htm
o=o=o

This issue of Midwifery Today E-News is sponsored by:

New Zealand College of Midwives
The Farm

Look for their ads below!
~*~*~*~*~

Midwifery Today Conferences

MEET THE PRACTITIONERS WHO HAVE LONG INSPIRED YOU. Midwifery Today
conference teachers always make time to get to know registrants! Meet
Michel Odent, Nancy Wainer, Marsden Wagner, Jan Tritten, Penny Simkin
and many others at the Philadelphia conference, March 21-25, 2002.
Look for the conference program and all the general information,
including status of CEUs, on the Midwifery Today Web site:
http://www.midwiferytoday.com/Conferences/philly2002/

SIGN LANGUAGE INTERPRETER NEEDED for the Midwifery Today Philadelphia
conference. If you qualify, you will receive the conference
registration cost in trade. Contact conference@midwiferytoday.com.

====

MORE MIDWIFERY TODAY CONFERENCES

Guangzhou, Guangdong, CHINA: "Healthy Birth" June 7-9, 2002
http://www.midwiferytoday.com/Conferences/china/
Get the full program online:
http://www.midwiferytoday.com/Conferences/china/program.asp
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: "Revitalizing Midwifery" November 13-17,
2002
http://www.midwiferytoday.com/Conferences/netherlands/
A two-day midwifery education conference precedes three days of
international conferencing.
~*~*~*~*~

Send submissions, inquiries and responses to newsletter items to
mtensubmit@midwiferytoday.com
o=o=o=o=o=o

In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Intact Perineum
5) Check It Out!
6) Midwifery Today Online Forum: Doula Books
7) Question of the Week: Group B Strep
8) Question of the Week Responses: Bipolar
9) Switchboard
10) Connections
o=o=o=o=o=o

1) "Women today not only possess genetic memory of birth from a
thousand generations of women, but they are also assailed from every
direction by information and misinformation about birth."
-Valerie El Halta
o=o=o=o=o=o

2) The Art of Midwifery

For pregnant women who need calcium: The best calcium herbs are oat
straw, borage and bancha twigs. Bancha twigs are LOADED with calcium.
Another thing very high in calcium is hijiki seaweed. A half-cup has
about 1,400 mg. of calcium! Pregnant women should also make sure
they're ingesting a fat/oil of some sort within an hour or so since
calcium binds with fat/oil in the stomach and assimilates this way.
-Raven
o=o=o=o=o=o

3) News Flashes

Young women who exercise regularly and use oral contraceptives may not
get the boost in bone strength seen in women who exercise and do not
use oral contraceptives. A recent study showed that while regular
resistance training and aerobic exercise over a two-year period
strengthened bones in women aged 18 to 31, oral contraceptives
appeared to prevent the buildup of bone density. The findings suggest
that women who take oral contraceptives may be compromising their
chances of attaining peak bone mass, according to Dr. Connie M. Weaver
of Purdue University. Women who did not use oral contraceptives had
higher bone mineral content at skeletal sites throughout their body at
two years compared with women who used oral contraceptives.
-Medicine & Science in Sports & Exercise 2001 33:873-880

=PLEASE SUPPORT OUR SPONSORS!=

New Zealand College of Midwives
7th Biennial National Conference

Celebrating Diversity within Unity
4-6 July 2002
Dunedin Centre, Dunedin, New Zealand

Pre-conference workshop, 3 July 2002, featuring internationally
renowned speakers:
-Beatrijs Smulders, Midwife from The Netherlands
-Wendy Savage, Obstetrician from the United Kingdom
http://www.nzcom.org.nz

For further information contact:
Mary Whitham, Convener Phone - 03 466 7945
Email: marywhitham@hotmail.com

=THANK YOU!=

4) Intact Perineum

An intact perineum is the goal of every birthing woman. Advising a
woman to do perineal massage in pregnancy implies a lack of confidence
that her tissues have been designed perfectly to give birth to her
infant. The intact perineum begins long before the day of the birth.
Sharing what the feeling of a baby's head stretching the tissues will
be like and warning the mother about the pitfalls in pushing will go a
long way to having a smooth passage for both baby and mother. The
woman will be receptive to conversations in prenatal visits about the
realities of the birth process. Here is the information I convey for
the second stage:

1. When you begin to feel like pushing it will be a bowel
movement-like feeling. We will not rush this part. You will tune into
your body and do the least bearing down possible. This will allow your
body to suffuse hormones to your perineum and make it very stretchy by
the time the baby's head is there.

2. The feeling will increase until it feels like you are splitting in
two and it's more than you can stand. This is normal, and no one has
ever split in two, so you won't be the first. Because you have been
educated that this is normal, you will relax and find this an
interesting and weird experience. You may have the thought, "(My
midwife) told me it would be like this, and she was so right. I guess
this has been going on since the beginning of humankind."

3. The next distinct feeling is a burning, pins-and-needles feeling at
the opening of the vagina. Many women describe this as a "ring of
fire." It is instinctive to slap your hand down on the now-bulging
vulva and try to control where the baby's head is starting to emerge.
This instinct should be followed. It seems to really help to have your
own hands there. Sometimes women like to have very hot cloths applied
to their perineum at this point. If you like or dislike the feeling,
say so.

4. Most women like pushing more than dilating. When you're pushing,
you feel like you're getting somewhere and that there really is a goal
for your efforts.

5. This is a time of great concentration and focus. Extraneous
conversation will not be allowed in the room. Once you begin feeling
the ring of fire, there is no need for hurry. You will be guided to
push as you feel like until the baby is crowning. All that will be
touching your tissues is the hot cloth and your own hands. It is
important for the practitioner to keep her hands off because the
blood-filled tissues can be easily bruised and weakened, which can
lead to tearing.

6. The point of full crowning is very intense and requires extreme
focus on the burning. It is a safe, healthy feeling but unlike
anything you have felt before.... Panting and rising above the pushing
urge will help you focus, and you will have less discomfort in the
long run.

7. You will be offered plain water throughout this phase because
hydration seems to be important when pushing. You can take the water
or leave it.

8. Once the head is fully born, you will feel a great sense of relief.
You will keep focused for the next sensation, which will bring the
baby's shoulders out and the baby's whole body will quickly emerge
after that with very little effort on your part. The baby will go up
onto your bare skin immediately, and it is the most ecstatic feeling
in the world. Your perineum may feel somewhat hot and tender in the
first hour after birth. The remedy that helps the most is to apply
very hot, wet cloths. This is in keeping with the Chinese medicine
theory that cold should never be applied to new mothers or babies.
Women report they feel instantly more comfortable when heat is
applied, and any swelling diminishes rapidly.

I also like to twist a diagonally folded bath towel into a very tight
roll and coil that into a ring for the woman to sit on when
breastfeeding.
-Gloria Lemay, "Midwife's Guide to an Intact Perineum," Midwifery
Today Issue 59
====

ORDER MIDWIFERY TODAY ISSUE 59 AT
http://www.midwiferytoday.com/products/MT59.htm
====

5) Check It Out!

~~~WWW.MIDWIFERYTODAY.COM~~~
A Web Site Update for E-News Readers
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
CONFERENCE AUDIOTAPES FOR THIS WEEK'S THEME

Tear Prevention and Alternatives to Suturing
http://www.midwiferytoday.com/products/961T462.htm
Tear Prevention Techniques from Around the World
http://www.midwiferytoday.com/products/952T172.htm
Traditional Approaches to Second Stage
http://www.midwiferytoday.com/products/962T431.htm
~~~~

Want healthier babies and easier births?
Order BIRTH WISDOM, TRICKS OF THE TRADE, VOL. 3, and you'll learn
tricks and tips from practicing midwives, childbirth educators,
naturopaths, doulas and parents.
Topics include philosophy of care, remedies, prenatal, labor and
postpartum.

To order BIRTH WISDOM, click here:
http://www.midwiferytoday.com/products/01TT3.htm
~~~~

READ ARTICLES FROM MIDWIFERY TODAY MAGAZINE ON-LINE - FREE!
We have chosen numerous informative, supportive, fascinating articles
for Midwifery Today Web site visitors to read.
http://www.midwiferytoday.com/articles/
~~~~~~~~

5) Midwifery Today's Online Forums

What are everyone's favorite books about supporting women during their
births? I have read The Birth Partner by Penny Simkin and enjoyed it,
but feel it's really geared toward dads.
-Anon.
====

TO SHARE YOUR THOUGHTS AND EXPERIENCES ON THIS TOPIC, go to
http://www.midwiferytoday.com/forums/topic.asp?TOPIC_ID=1780
**PLEASE DO NOT SEND YOUR RESPONSES TO E-NEWS!**
o=o=o=o=o=o

6) Question of the Week

Q: A friend was just diagnosed, by urinalysis, with Group B strep. She
is planning to have her baby at home (this will be her third
successful homebirth). She has been told she will need IV antibiotic
intrapartum. Is it safe to have a homebirth and if so what
precautionary measures should be taken? She is due March 20.
-Colleen
====

SEND YOUR RESPONSE to mtensubmit@midwiferytoday.com with "Question of
the Week" in the subject line.
o=o=o=o=o=o

=PLEASE SUPPORT OUR SPONSORS!

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:
midwfeWS@bellsouth.net
http://www.midwiferyworkshops.org
The Farm Midwifery Workshops
P.O. Box 217
Summertown, TN 38483

=THANK YOU!=

7) Question of the Week Responses

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 1,500 mg,
which we know can cause birth defects, specifically neural tube
defects. She stopped taking her med's 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?
-Anon.
====

A: I served a bipolar mom who gave birth at home. She went off med's
before she hired me. She went through many mood swings, repeated
herself often and had to be counseled often, but nothing outrageous
happened as is often portrayed. She needed praise, trust and as much
info as she could get. This super-intelligent woman had a great
pregnancy and ate well, although she had a few bouts of high anxiety,
mainly from a boyfriend who wasn't at home much and drank often. She
birthed a 9 lb., 8 oz. baby after many days of prodromal labor. She
lost herself a few times in labor screaming and letting energy out,
but nothing abnormal about that - she just needed to let go. It took
some time for her to birth the head; baby was a mild dystocia but was
perfect in 2 minutes.

I think if she had had a hospital birth, she would have been violated
many times. She would have been pressured to have an epidural to "shut
her up," and I think she would have had an "episode" from the trauma.
She planned to take something in the upcoming months after the birth,
but wanted to give baby breastmilk for some time, so held off. She did
much research on the 'net to find out what would work best. She did
confess that she smoked marijuana 2 to 3 times during her bad times in
pregnancy. I assume she had planned to use it after birth only if
absolutely necessary, until she could go back on med's.
-Midwife
====

I am bipolar and take Depakote. I was taking it before each pregnancy
(I have five children), and they were all just fine. The doctors will
look for things throughout the pregnancy using ultrasound and other
tests to know if something could be wrong. But as long as she has
stopped taking it, she should be fine!
-Carmen Rae
====

A: It is important to remember that just because a drug "CAN" cause
birth defects doesn't mean that it will. It just means there is a
higher risk of this rare problem. Fortunately neural tube defects are
easily detected in pregnancy. There are several screening procedures
your daughter can use to find out if all is well. Only "IF" you see a
problem would it be worth worrying about where the baby should be
born. At this point in pregnancy, there is no reason why your daughter
should not be able to begin prenatal care with a midwife in the
anticipation of a homebirth -- unless problems become apparent later
in the pregnancy.
-Gail Hart, midwife
====

A: Unfortunately, neural tube closure happens during the days in the
first week after that first missed menstrual period. Taking folic acid
at eight weeks will not make any difference in preventing neural tube
defects, although less well-documented potential benefits such as a
possible reduction in lip and palate abnormalities makes continuing
with the supplementation a good idea anyway.

At this point I would recommend she inform herself on options for
prenatal diagnosis of neural tube defects. The easiest of these is a
blood test for maternal serum alpha feto-protein which is drawn at 16
weeks and, when elevated, picks up 80 percent of spinal defects and 95
percent of brain defects of the neural tube defect category. (Just
remember most women with an elevated result have perfectly normal
babies. It is a screen for the defect, not a diagnostic tool. So an
elevated result does not mean there is something wrong with the baby
most of the time. Nor does a normal result guarantee the baby is
fine.) MSAFP screening in combination with fetal assessment by
ultrasound is the best option for prenatal diagnosis of neural tube
defects. If the baby is fine she can then deliver wherever she
chooses.

If a defect is present, she will then have the option of deciding to
terminate the pregnancy, trying to arrange one of those new
experimental in utero repair surgeries, which seem to have good
outcomes, or planning the birth that will best care for and protect
the baby. If she were to carry a baby with a neural tube defect to
term, there are advantages to knowing in advance of the birth. These
include: arranging for a c-section delivery if that is determined to
be best for the baby; an earlier delivery if the baby develops
hydrocephalus (a common problem in babies with spina bifida); birthing
in a center that specializes in the surgical procedures that close the
open defect of the spine after birth. This way she can remain with the
baby throughout the recovery period. She can also arrange for support
and prepare herself mentally for the stress she will experience.

Let's hope that her baby is fine and that the neural tube has closed
perfectly and no other part of the baby's system has been affected. In
the meantime she has to take care of herself and continue on med's for
her bipolar disorder that will not affect the baby. She will need
careful monitoring by someone familiar with both pregnancy and bipolar
disorder or two people who can work closely together for her and her
baby's benefit.
-Natalie Bjorklund
====

A: It is wonderful that your daughter is taking a naturopathic
approach to her unborn baby's health! And your support is an added
positive element. Yes, other preventatives may help with good
development of her baby. One of them is zinc. When we take it in a
water-soluble form and with a little vitamin C, the amount the body
needs is easily absorbed. Zinc helps brain development and is
considered helpful to prevent brain defects and other developmental
anomalies. Also the usual supplements: B vitamin complex (brown rice
based) along with the folic acid and a good calcium/magnesium (citrate
or a water soluble form), etc., not only help with baby's development
but also the well being of the mother during (and after) pregnancy.
There is no need to overdo any one supplement, which can be harmful. A
balance of good foods and a little extra supplementation on a regular
daily basis is of great benefit. Even if she may not have a homebirth
for some reason, I would certainly employ a very
nutrition-knowledgeable midwife during the prenatal period. This kind
of prenatal care has shown to be one of the reasons for better
outcomes. She might wish to consider a naturopathic physician for the
bipolar condition as well, to help achieve healthful,
confidence-building results. Whatever your choices, positive thoughts
will also be very helpful.
-Julia
====

A: Several issues in your letter need to be addressed: The increased
risk of neural tube defect with Depakote use is 1 to 2 percent, about
the same as in someone with a family history of neural tube defect.
The risk is when women take the medication between days 17 and 30,
during formation of the neural tube; thus taking folic acid now, as
well as discontinuing her Depakote use will not decrease the risk of a
neural anomaly. Your daughter needs to do several things: First, she
should discuss the risks and benefits of drawing an AFP and other
antenatal testing with her care provider. Next, she should consider a
level II ultrasound for fetal anatomy. Finally, she should discuss
with her psychiatric provider and her OB provider (preferably a
perinatologist who has experience taking care of women with bipolar
disorder in pregnancy) the risks of discontinuing her bipolar
medication during pregnancy and other medication options for her
depending on the severity of her illness. I think delivering at home
is the least of her worries. But then again, if through antenatal
testing birth defects are ruled out and her psychiatric condition is
under control, why else would it be a problem?
-Linda Simon-Price CNM
o=o=o=o=o=o

8) Switchboard

Editor's note: Last week's insertion about how women handle stress can
be found in its entirety at
http://www.psu.edu/ur/2000/womenstress.html
The study, led by UCLA principal investigator Dr. Shelley E. Taylor,
will be published in an upcoming issue of Psychological Review, a
journal of the American Psychological Association.
====

The article about women's responses to stress in Issue 4:8 reminded me
of the motto two of my friends made up for themselves at a time a few
years ago when they were both pregnant moms with young children at
home: "When the going gets tough, the tough make dinner."
-Marion
====

Repeat miscarriage [Issue 3:7,8]: Raven Lang suggested in one of her
lectures that women should at least wait the duration of the pregnancy
before trying to get pregnant again - unless age is an issue. I would
highly recommend she seek out a practitioner of traditional Chinese
medicine. We have many herbs that are for repeated miscarriage.
-Colleen
====

Getting enough protein [Issue 4:8]: When I was following the Brewer
diet, I started my day with two slices of wheat toast, two eggs, two
pieces of cheese (2 ounces total) and two ounces of ham or sausage.
While this is a hearty sandwich, I never had trouble finishing it and
it gives 25 grams of protein right off the top.
-Erika O.
====

I have found very little medical study or information about pregnancy
massage beyond "good for relaxation." Can someone point me in the
right direction?
-Kathryn
====

10) Connections

I saw Midwifery Today in a health market in my area. A front-cover
line caught my eye: "A Natural Alternative to Suturing." I had a
median episiotomy and suturing from a physician somehow dragging the
scissors down toward my midline region - about one extra inch on each
side of my fourchette. I was never told I was getting an episiotomy.
Ever since, I have had a constant dull ache in this area, an ache that
was at first a burning ache. My physician assured me everything looked
normal and treated me like this was all in my head. I have been
frustrated to the point of tears.

Please, can someone direct me to a midwife (preferably one in my area
but I am willing to drive or fly anywhere to finally have this
corrected) who would be willing to re-do this scar using the seaweed
instead of sutures technique? My physician referred me to a vulvar
specialist, whom she sarcastically referred to as "The World's Leading
Expert." I am not averse to seeing physicians, but emotionally I would
really like to be treated by a compassionate individual committed to
women's health - physical, emotional and spiritual - and not by a
paternalistic healthcare provider.

I live in Fairfield County, Connecticut. I have no idea how to go
about finding a midwife or physician in the field of natural medicine
who might be able and willing to help me.

Please reply to: Rickkoen@optonline.net

====
Student nurse midwife seeks CNM preceptor for Intrapartum experience.
Contact Joan McCarthy, CRNP, FNM, student nurse-midwife at:
MJOAN186@aol.com or by phone at (412) 371-7238.
====

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.
o=o=o=o=o=o

Midwifery Today E-News is published electronically every Wednesday. We
invite your questions, comments and submissions. We'd love to hear
from you! Write to us at: <mtensubmit@midwiferytoday.com> Please send
submissions in the body of your message and not as attachments.

Remember to share this newsletter. You may forward it to as many
friends and colleagues as you wish -- it's free!

Need to subscribe, unsubscribe or otherwise change your E-News
subscription? Then please visit our easy-to-use subscription
management page:
http://www.midwiferytoday.com/enews/subscribe.asp

On this page you will be able to:
* subscribe to any of our email newsletters
* unsubscribe from any of our email newsletters
* change the version (text or HTML) that you receive
* change the email address to which newsletters are delivered

If you have difficulty, please send a complete description of the
problem, including any error messages, to
newsletters@midwiferytoday.com
o=o=o

Learn even more about birth! Subscribe to our quarterly print
publication, MIDWIFERY TODAY. Mention code 940
U.S.: $50 1 year $95 2 years
Canada/Mexico: $60 1 year $113 2 years
all other countries: $75 1 year $143 2 years.
Email inquiries@midwiferytoday.com or call 800-743-0974 for
information on how to order.
Or go here to subscribe online:
http://www.midwiferytoday.com/products/Sub.htm
o=o=o

To order Midwifery Today products mentioned in this issue, send a
check or money order to:
Midwifery Today, Inc.
PO Box 2672-940
Eugene OR 97402 USA

To pay by Visa or MasterCard, send your information to: 1-800-743-0974
(Orders only) Fax: 541-344-1422

OR SHOP FROM HOME in our secure online store:
http://www.midwiferytoday.com/storefront.htm

For other matters, you may call: 541-344-7438

Or email us: Editorial submissions, questions or comments for E-News:
mtensubmit@midwiferytoday.com

Editorial for print magazine: jan@midwiferytoday.com

Conference: conference@midwiferytoday.com

Advertising: ads@midwiferytoday.com

For all other matters: inquiries@midwiferytoday.com
o=o=o

All questions and comments submitted to Midwifery Today E-News become
the property of Midwifery Today, Inc. They may be used either in full
or as an excerpt and will be archived on the Midwifery Today web site.
o=o=o

Disclaimer

This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.

This publication and any information provided are not intended to constitute the practice of, or furnishing of, medical, nursing or professional health care advice, diagnosis, consultation, treatment or services in any jurisdiction. Always seek the advice of your midwife, physician, nurse or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding any medical condition.

Copyright Notice

The content of E-News is copyrighted by Midwifery Today, Inc., and, occasionally, other rights holders. You may forward E-News by e-mail an unlimited number of times, provided you do not alter the content in any way and that you include all applicable notices and disclaimers. You may print a single copy of each issue of E-News for your own personal, noncommercial use only, provided you include all applicable notices and disclaimers. Any other use of the content is strictly prohibited without the prior written permission of Midwifery Today, Inc., and any other applicable rights holders.

© 2002 Midwifery Today, Inc. All Rights Reserved.

Midwifery Today: Each One Teach One!