|June 26, 2002|
Volume 4, Issue 26
|Midwifery Today E-News|
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THIS WEEK'S ISSUE
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Quote of the Week
"I'm an advocate of truly having your eyes opened and honestly appraising how much power you really have, not pretending that you will have as much power as you desire, just because you really want it. I think that's the essence of informed consent."
- Gretchen Humphries
The Art of Midwifery
While helping one mother breathe through her contractions, I noticed her forehead was very tensed. At the next contraction, I softly told her to relax her forehead. She began to concentrate so much on relaxing her forehead that her contractions did not seem to be so hard to get through. I have tried this during other labors and it really seems to work!
- Courtney Lovell
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Breastfeeding virtually eliminated crying and grimacing in infants undergoing the collection of blood samples from their heels in a recent study. Thirty infants who were held and breastfed by their mothers while undergoing the procedure were compared with 30 who were swaddled and placed in a bassinet. Crying and grimacing were reduced by 91% and 84% respectively among the breastfed babies. The researchers say these findings show that pain relief and stress reduction should be added to the long list of proven benefits of breastfeeding.
- Pediatrics 2002, 109(4), 590-93
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Q: I am following a woman through her pregnancy, and lately she has been unwell with flu-like symptoms, aching joints and a rash. After repeated blood tests, her GP has told her that she has parvo virus! (measles and rubella negative). In Australia, this is something we immunise our dogs against, not ourselves. Her obstetrician was quite evasive as to how she may have contracted the virus and also what the effects on the foetus may be. He mumbled something about congestive cardiac failure. Does anyone know anything about this virus?
A: Parvo virus is also called "fifth's disease" in humans. It is not uncommon in children, but is usually not diagnosed appropriately because of the generic symptoms it causes: fever, aches, etc. Some kids will get a characteristic "slapped cheek" rash that will trigger a provider to run a blood test for antibodies to parvo. Fifth's is not usually serious in adults or older children, but it can make young infants quite ill.
If a woman contracts parvo/fifth's while pregnant, she has a significantly increased chance of miscarriage, stillbirth and birth defects -- including congestive heart failure. I believe the disease attacks the baby's red blood cells and bone marrow. It can cause anemia and hydrops and adversely affect development. This woman should be seen by an OB and/or a perinatologist with experience managing pregnancies complicated by parvo virus. At the very least, she should get ultrasounds for at least 6 weeks post-infection to evaluate growth and look for signs of hydrops. If nothing shows up, she might still be a candidate for midwifery care.
Read the Centers for Disease Control bulletin on parvo virus and pregnancy.
- Melissa Jonas, LM
A: The parvo virus will cause the baby to become anemic and will require intrauterine blood transfusions. Anemia causes fetal hydrops, which is generalized edema. I had a baby (4 months ago) who had severe anemia in utero and after 3 intrauterine blood transfusions she was born healthy, and there were only slight residual effects of the edema she experienced.
- Julie Fuller
A: The following research may be of use, but may also scare the heck out of the woman. Talk with the midwife or your head of midwifery before showing these to the mother.
- Annemarie, student
A: Many people are immune to it, but some are not, and if passed to the baby it can indeed cause heart failure. Your sister should have an ultrasound to check heart size and possibly cordocentesis to check for anaemia in the baby. It is treatable, but needs early treatment. Contact MIDIRS in the UK for a literature search on the subject: www.midirs.org
- Jane Dolby, ex midwife trainee A/N teacher
A: The only incidence I have come across was a lady at term whose labour was uneventful, but the baby was apnoeic and we were unable to clear the airway as it was continuously occluded by very thick clear fluid. It was extremely hard to ventilate the baby, who eventually died after three hours. Parvovirus B 19 and amnionitis was found at postmortem. The only other thing of note in the postmortem findings were only 2 cord vessels, and a small placenta weighing 290 grams.
- Linda W.
A: This is a very common childhood illness and is usually seen in clusters as one child infects all nonimmune persons around her. If a mom in her first trimester contracts parvovirus (meaning that she didn't have it as a child), her chance of having a miscarriage goes up, but is certainly far from guaranteed. Rarely, in the second half of pregnancy the baby may develop hydrops featalis characterized by anasarca secondary to severe anemia. Generally, nothing happens to the mom or baby.
A: It is easy for children to tolerate, but adults have a harder time with it. It took 6 weeks for me and my 3 kids to clear it out of our house completely. They each looked scary for a week, but I was feverish for 2 days with no symptoms, followed by itchy extremities and arthritic knees and fingers on the following day. My husband must have had it as a child because he never caught it from us.
- -Evelyn Walker, AAHCC
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Midwifery Today's Online Forums: Anemia
I have a client who is about 30 weeks pregnant. She is very anemic. She tried a few things like Floradix with iron, eating beans and nuts. She doesn't eat beef, however. She is taking a high dose of iron supplement prescribed by her GP. She also takes folic acid, B vitamins, and vitamin C. Any ideas what could cause the anemia and what else she can do?
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