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Second Stage (Cephalic Baby), Part II
When the head is born, the next job is to let one of your hands follow the occiput down to the neck. Feel all the way around the nuchal area for the umbilical cord. If you can feel cord and it is loose, you can either bring a loop of cord over the head or loosen the loop and birth the baby through the cord. If the cord is relatively snug but not strangling, it is possible to hold the baby's head near the mother's thigh toward which the baby is facing and "somersault" the baby out, then unwind the cord from around the baby's neck. (The somersault technique works by holding the baby's head near the mother's thigh, which allows the shoulders to birth slowly. Then the head/shoulders are kept by the perineum while the baby's body and lower limbs are brought out and away from the perineum. Again the next step would be to unwind the cord.)
If the cord is very tight, clamp the cord in two places about three inches apart and cut between the clamps. The cord should be manipulated only by your nondominant (top) hand because it has been kept away from the rectal area and shouldn't be contaminated by fecal matter. You would, of course, hold the scissors with your dominant hand.
Once the head is born, I recommend wiping the baby's face and head. This makes the baby's head less slippery for the next maneuver and also minimizes evaporative heat loss. For this next maneuver the hand positions vary depending on which direction the head restitutes.
After the head delivers, the baby brings its shoulders into the anterioposterior position. At this point when the mother has a contraction it is possible for the baby to be born with only minimal support. Oftentimes, though, the midwife will apply gentle downward pressure on the head. This can be accomplished in one of two ways.
The first technique is to use the hands to grasp the occiput and the chin. The hand used will depend on the way the baby's head restitutes. If the head restitutes looking toward the mother's right leg, the right hand would hold the occiput and the left hand would hold the chin. If the baby looks toward the left, then the midwife's left hand holds the occiput and the right hand holds the chin. The important point to remember is to never allow your fingertips to rest on or dig into the fetal/newborn neck. This is a common error made by inexperienced hands. Serious damage could be done to the brachial plexus nerves, which could cause paralysis either temporary or permanent. It is also important to apply no more than five pounds of pressure on the baby's head. A good way to practice this is to press with your fingertips and also the side of your hand on the bathroom scale. Five pounds of pressure is not a lot.
- Kimberly Hulsey, LM, The Birthkit Issue 29
-- TO BE CONTINUED IN ISSUE 4:31 --
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CONFERENCE AUDIOTAPES FOR THIS WEEK'S THEME
What was it like to be a midwife in the 18th century? Read Mother and Child Were Saved, The Memoirs (1693-1740) of Frisian Midwife Catharina Schrader, and find out. Hurry! Only a limited number of copies are available. Order yours today!
Forum Talk: Home VBAC
I'm 36 weeks pregnant with my 4th child. My first was breech and ended in C-section. My second 2 births were VBACs. I really want to have this child at home with no medication. I understand there is a risk of uterine rupture but the more I read about the actual risks and percentages of this actually happening the less afraid of it I am, especially considering that I've already had two successful VBACs. It seems that finding a midwife to assist me in what my husband and I would like to do is impossible. I want to know if anyone else is having the same difficulty and also want to hear from midwives regarding their stance on the subject.
To share your thoughts and experience, go to Midwifery Today's Forums.
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Question of the Week: Waterbirth and Postpartum Hemorrhage
Q: I am a student midwife in my final year. I have developed a fear of waterbirth because of the connection with postpartum hemorrhage (PPH) that I have seen at each one. My mentor is fantastic and is a great believer in natural birth -- especially in water -- natural pain relief, and no medical intervention. However, even she is beginning to doubt the use of water because of PPH. I have tried to restore my faith in waterbirth by attending conferences and reading books that inspired me, but it doesn't seem to happen in reality. Has anyone else had such an experience?
- M. Thornton
Send your responses to firstname.lastname@example.org.
Question of the Week Responses: Birth After 40, Hypertension
Q: I am a midwife and family nurse practitioner who has had two full-term breech babies (bicornate uterus), one 34-week vertex baby with prolapsed cord, and C-section at age 36.
I want to have one more baby. The oldest woman I have delivered was 44 years old and it was her first. She did great. I am in great shape and so is my husband. I want to know what others have experienced with women this age. I was pregnant five months ago but had a very early miscarriage, so I know I could get pregnant. I am now using OTC Progest to help maintain my hormones. What experience do others have with women in their 40s having babies?
- Shawna Doean
A: I have found B&B tincture to help as a balancer for hormones. Having a really sound, balanced diet is essential. Follow your heart and you will be able to achieve your goals.
A: I am 43 and just had my third child. I too had an early miscarriage before I got pregnant with Arlo. I have attended many births of women over 40 who had fewer complicating factors than my 20-year-olds have had. Despite the pessimism displayed about having children later in life, I think the benefits far outweigh the risks.
A: A friend delivered baby number 13 at home at 43 y.o. with no complications. If you saw her, you'd swear she was younger than 35!
A: So far, the women I've cared for who delivered over age 40 have all done great—including the 49 y.o. who had twins!
- Cynthia B. Flynn, CNM, PhD
A: My last doula client had her first baby at 43 y.o. She was physically fit (an avid swimmer) and a very type A personality. A couple of days before her due date, my client had about a 5-hour, uncomplicated labor! They were at home and contractions were 5 minutes apart when they called me. They called back 10 minutes later to say that contractions were 2-3 minutes apart and to meet them at the hospital. When I arrived a half hour after their call, the nurse was just pulling her hand out and said, "just a lip"! The mom pushed for about 45 minutes.
A: I am a new trainee as a birth assistant. I had a baby at 40 y.o. My two girls were 15 and 13 so it had been a while since I had been down the pregnancy path. I began paying attention to diet and exercise a little more closely. That and a lot of prayerful support from family and friends made it a very positive experience. When I checked in to the hospital I was dilated to 7 cm. About 2 hours and 45 minutes later, my husband, daughters and I welcomed a precious little boy into our family. I hope this will give you encouragement as I never thought this was something I would or could be doing at 40.
A: I assisted at a wonderful birth of a mom having her fifth baby at 45 y.o. She worked very hard to keep her nutritional status and fluid intake great, used high-quality supplements, exercised regularly, and so forth. Of course you must trust your midwife with all your heart and know what her skill level is to work with the special body you have been entrusted with.
- Pam, DONA CD, CM, LMT, CPMT, CIMI
Q: Has anyone else noticed an increase in hypertension for women who conceived soon after 9-11? I just had five hypertensive clients in a row, and I normally only have a maximum of two each year.
- Lisa Goldstein
A: I had the worst cramps I have ever had during my first period after Sept 11. With the toxins thick in the air and the crazy, intense energy, my body went to a place it had never needed to be before. I live in Brooklyn, right across the water from where the WTC stood, and thus like millions of New Yorkers literally breathed the tragedy. My bleeding was intense, the cramping severe -- a manifestation of the release our bodies and souls needed at that time.
- Alex Keeling
EDITOR'S NOTE: Responses to any Question of the Week may be sent to E-News at any time.
The BirthLove Web site has helped many women grow trust in birth and in their bodies. It has helped women resist Cytotec, find good midwives and stop believing everything their doctors say. There are hundreds of homebirth stories: unassisted VBAC, fathers' stories, twin (and triplet home VBAC!) stories, breech stories -- for things that people get sectioned for daily, there are homebirth stories on the site. Marsden Wagner, MD, is a contributing expert, as is Sarah Buckley, MD, Gloria Lemay and Gretchen Humphries. BirthLove has changed and saved lives through education, communication and love. Become a member of BirthLove today and be inspired!
Question of the Quarter, Midwifery Today magazine
Issue 64, Unity
Is unity possible in this diverse midwifery community? Can we stand up for and support one another when there is such a range of philosophical approaches to training and practice?
Please submit your response by Sept. 30, 2002, to email@example.com.
All responses subject to editing for content and style. Sorry, but we cannot reply to each individual submission
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A reason for long labours [Issue 4:29] could be the position of the baby. If the babies were posterior or had a slightly asynclitic head, it would affect how the head was pushing on your cervix and therefore the dilation. I have read that babies whose occiput and back hang out on the right side of the mom's belly during the last part of pregnancy as opposed to the left side have a potentially slower labour (among other things).
- Pam, doula
In response to the question about unassisted birth in the UK [Issue 4:29]:
This is what was sent to me by Beverly Beech recently:
No, people are not being fined for unassisted homebirth. The position in the UK is this: There is no legal requirement in the UK for a woman to call either a midwife or a doctor when she is in labour. A woman cannot be prosecuted for delivering her own baby. She may be unwise, but it is not illegal. However, it is illegal for anyone to represent themselves as a qualified midwife or doctor. Two men were prosecuted under this act for helping their wives deliver their own babies. Women are often told that if they do not call a midwife they will be prosecuted. A new Act is going through that includes a proposal to raise the fine to 5,000 pounds. The Act refers to those who pretend to be qualified, but it is this Act that parents are threatened with if they do not call a midwife. Of course, if the woman calls the midwife and gives birth before she arrives her husband (or whoever attends her) cannot be prosecuted.
- Laura Shanley
In reference to a letter in Issue 4:29 about overpopulation [Responses edited for length.]:
Is it our responsibility as midwives to ensure that women are informed and take action by using birth control, or ought we to respect their privacy and not intrude into such a personal area unless they inquire? Is this not the heart of midwifery—to respect the woman's privacy and desires rather than try to control her? For those women who do inquire about family planning, a midwife is responsible to fully inform the woman of the mode of action, benefits and any harmful side effects of various unnatural forms of birth control.
Many people have the wrong impression of large families, and children in general. I have four homebirthed babies. We eat from our garden, pick up after ourselves, try to conserve wherever possible. We plant trees. Children are a blessing, and if we stop having children out of fear, we who try our hardest to instill goodness and principles in our children, what will future generations be like? I will continue to have however many children I am blessed with, and I will not fear.
- Laurie Price
Family planning is between a husband, wife and God. The birthing community has no place interfering with anyone's family planning choices. I always felt it was ridiculous that at a six-week postpartum check-up, while I held a beautiful bundle of joy that I was asked about whether or not I wanted birth control pills. It is almost like the practitioner was saying, "We wouldn't want that (meaning the baby) to happen again!"
Overpopulation is a myth. Have you traveled across the United States and seen the vast, wide expanses of land? To research more in depth on the myth of overpopulation, visit the Couple to Couple League Web site.
As for teen pregnancy, the root of the problem is that strong family units have disintegrated. Once the teen is already pregnant, the only thing to do is to help her have the baby. It is not the time to teach about contraceptives. Contraceptives don't help teen boys or girls gain self worth and respect—they only give permission to act inappropriately. If we are to be free of the tragedy of teen pregnancy, we need intact families where fathers preside and teach and mothers raise their own children, not send them to childcare while they pursue a career. How can children learn our values if we are not there to teach them?
- Laura Grout, AAHCC, CD (DONA)
It is not the job of midwives to force their opinions about overpopulation or birth control on their clients. A woman should not have reservations about enlisting the services of a midwife for fear that she is going to be lectured about overpopulation, whether she is having her third baby or her twelfth baby. If she wanted that kind of concern, she could go to an obstetrician. A woman who has educated herself about birth to the point that she is choosing a midwife is probably smart enough to decide for herself how many children she would like to have and how frequently she would like to have them. Midwives should offer the option of providing birth control information to their clients; beyond that it is the very personal decision of the couple whether to accept it or not. If they turn it down, it would behoove the midwife to bite her tongue and keep her opinions about overpopulation and other highly debatable and controversial issues to herself.
I have longed to become a midwife since reading Ina May's book in high school and now hope to become a homebirth OBGYN. I am a trained doula. I am ardently pro-choice and want to support women's healthcare, including safe, legal abortion. Sheila Kitzinger's Complete Book of Pregnancy and Childbirth is the only one I have seen with a compassionate discussion of past abortions. I know of several women who don't include all of their abortions in their medical history because they are afraid of the response.
After examining options, abortion may be the best for the family. It may be an agonizing experience; it may need to be done again with a subsequent unplanned pregnancy. A woman is also no less of a mother or compassionate soul if she aborts with no qualms whatever. Regardless of my feelings about my own experience, I now understand not necessarily how or why one might need to abort, but simply that one sometimes does. But where is the unity between childbirth and the rest of the reproductive, sexual life of the woman? Why should the caregivers for these different aspects also be segregated?
When we seek to empower women yet do not counsel them about the advantages of population control and smaller families, when we create an environment in which women do not feel comfortable sharing their reproductive history, how are we achieving this empowerment?
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!
EDITOR'S NOTE: Only letters sent to the E-News official e-mail address, firstname.lastname@example.org, will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will not be considered.
The International School of Traditional Midwifery in Ashland, Oregon is accepting enrollment for Fall 2002 classes. Contact us at 541-488-8254 or visit us at www.globalmidwives.org
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