April 16, 2003
Volume 5, Issue 8
Midwifery Today E-News
“Fathers and Birth”
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THIS WEEK’S ISSUE

Quote of the Week

“Because the traditional midwife works in the unique setting of other people's homes, she must not rely on fixed rules but on her own ability to pay attention to the particular demands and resources of a given situation.”

Clarebeth Kassel


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The 25th Annual California Association of Midwives Conference
The Revival of Midwifery—A Rebirth in Consciousness

May 30–31 and June 1, 2003
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Speakers include: Michel Odent, MD, Rahima Baldwin, Suzanne Arms, Betty Idarius, Jeannine Parvati Baker and Laura Kaplan Shanley.

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The Art of Midwifery

If mom is having trouble with first urination after birth, I pour a couple drops of peppermint oil in the water in the toilet bowl. The fumes help the urethra open up. Or sprinkle a little peppermint oil on a cloth and put it in front of her to sniff.

Karen and April, Midwifery Today Forums


ALL BIRTH PRACTITIONERS: The techniques you've perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to mtensubmit@midwiferytoday.com.


News Flashes

Women who have preeclampsia during pregnancy are more than twice as likely to develop blood clots in legs or lungs within three years of giving birth, according to a study of 13,000 women conducted at the Ottawa Health Research Institute. Women who have unexplained swelling of a leg, chest pain and shortness of breath, which could be signs of deep vein thrombosis (DVT) or pulmonary embolism (PE), should consult their doctor. The head of the research team commented, however, that the risk is too small to warrant preventive treatment.

Other studies have shown that women with preeclampsia have genetic disorders that are associated with an increased risk of clots. Preclampsia occurs in about one in 10 pregnancies and is more common in first and twin pregnancies and in women who have a family history of the condition.

British Medical Journal

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Fathers at Birth

Does the participation of the father aid or hinder the birth?

There are many sorts of couples according to the duration of cohabitation, the degree of intimacy, and so forth. There are many sons of men: some can keep a low profile while their partner is in labor; others tend to behave like observers, or like guides, whereas others are much more like protectors. At the very time when the laboring woman needs to reduce the activity of her intellect (of her neocortex) and "to go to another planet" many men cannot stop being rational. Some look brave, but their release of high levels of adrenaline is contagious.

The double language of human beings appears as the main reason why the complexity of such issues is underestimated. There is a frequent conflict between the verbal language and the "body language" of pregnant women. With words, most modern women are adamant that they need the participation of the baby's father while they give birth; but on the day of the birth the same women can express exactly the opposite in a nonverbal way. I remember a certain number of births that were going on slowly up to the time when the father was unexpectedly obliged to get out (for example to buy something urgently before the store is closed). As soon as the man left, the laboring woman started to shout out, she went to the bathroom and the baby was born after a short series of powerful and irresistible contractions (what I call a "fetus ejection reflex").

When raising such a question one must also take into account the particularities of the different stages of labor. It is often during the third stage that many men have a sudden need for activity, at the very time when the mother should have nothing else to do than to look at her baby's eyes and to feel the contact with her baby's skin in a warm place. At this time any distraction tends to inhibit the release of oxytocin and therefore interferes with the delivery of the placenta.

Michel Odent, MD
excerpted from "Is the Participation of the Father at Birth Dangerous?"

To read this thought-provoking article in its entirety, click here.


Birth is a woman's time. The power which her body follows in order to open and let the baby emerge is a primal force of nature. What the birthing woman asks for is what she needs. Even the quietest, shyest women become unabashedly direct during the forces of labor. Your woman will tell you what she wants or doesn't want. You will be proud of the strength she displays. Your role is to dance along and love her through this magnificent process. Although it may be difficult for you to watch your partner in discomfort, remembering that your baby will arrive soon and that this is a natural and good thing helps to meet the greater goal. Birth becomes not so difficult and in fact is fun! And remember, you are vital to the process.

However, it also is important for you to find what is comfortable for you. How involved you are is your choice. In this culture we have progressed from complete exclusion of men in the birth to demanding their presence. It is between you and your partner to find what works best for you, and there is plenty of middle ground. You and your partner will only be pregnant and birthing a few precious times in this life. Enjoy and cherish these experiences. Fathering a child makes you part of a continuing evolutionary process, involving you in the production not only of your children, but your grandchildren and all generations to come.

Jill Cohen, midwife
excerpted from "A Word to Fathers"


I undertook training fathers to be advocates for their partners in relationship to the hospital staff. This was accomplished by thoroughly explaining medical procedures, informing them of their rights, and reminding them continually that it was their baby, their birth, and their choice. Some dads really got off on this! The idea of storming the hospital and fighting for what they wanted was FUN. Often I felt as though I'd created a monster. I worked hard to teach tact, diplomacy, and the fine art of negotiation. Other dads were absolutely terrified by the thought of doing battle with medical professionals. No matter how well prepared they were with information, no matter how empowered they were with choices, no matter how deeply they believed in their partner's ability to give birth, they invariably ended up paralyzed and mute in the face of unwanted intervention like deer caught in the headlights.

Lois Wilson, midwife
excerpted from "A Note to Fathers: It's You She Wants"


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Web Site Updates

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Forum Talk

Soon I will attend my first birth in the hospital. I'm curious and concerned to know how you handle a situation in which the doctor really thinks an episiotomy is necessary, but the mother really does not want one.

Jamie R.


To share your thoughts and experience about this topic, go to Midwifery Today's Forums. PLEASE DO NOT SEND YOUR RESPONSES BY E-MAIL!


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Question of the Week

Q: A plus-sized woman who has mild cerebral palsy (CP) wonders how the CP will affect her pregnancy and birth. She is concerned she might have a cesarean because of mobility and flexibility issues. She is also concerned that she or the baby might be more prone to complications because of CP. Do readers have experience, information, resources, or hints for women with CP and their births?

— Anon.


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


Question of the Week Responses

Q: What do you consider to be the true beginning of first stage? Why?

A: Onset of labor cannot truly be labeled until the baby is born. The variety of patterns and signals is so great that it is best determined after the fact. I encourage women to tune into their bodies and be aware of changes. Most of the time a woman knows that something is different. For many mamas, the signals aren't dramatic but rather build over time. My first labor began in the waiting room of the doctor's office. At the time I wasn't sure, but in retrospect I know it was the beginning and precipitated by my OB's recommendation that we use prostaglandin gel to induce me since it was my due date!

It really pushes my buttons to hear women tell me their labor began at the time they arrived at the hospital—because it's not REAL until she arrives at the hospital.

It's important to include early first stage labor that culminates in birth into the total time. This would help families preparing for labor to have a longer, more accurate range of normal.

— Glenda

A: First stage labor begins when mom is having regular contractions that are consistently getting closer together and stronger and are not affected by walking, rest, food, drink, or relaxation. It doesn't matter how long they last or how far apart they are. That can vary greatly with every woman.

— Lara Miller


Re: VBAC [Issue 5:07]:

Read, read, and read some more. Silent Knife is an excellent source. I was so lucky it came out soon after my section. I also became involved in Cesarean Prevention Movement (CPM), now ICAN (International Cesarean Awareness Network). They were wonderful and provided lots of information. Seek out others with similar experiences that have had successful VBACs. I did not personally know anyone who had done it before me but was fortunate enough to have a wonderfully supportive midwife.

Even if a VBAC doesn't go well, there can still be emotional healing. I had an awful first birth in hospital and then an unnecessary section for my second son. I planned a homebirth for my first VBAC, but because the baby died and labor did not start, I had to have labor induced and I delivered in the hospital again. As terrible an experience as my daughter's birth was, I was still healed in other ways. My last two pregnancies resulted in fine healthy baby boys born at home. It is well worth the time to do the research and find supportive care from a source that can assure you when you have doubts and support you in your decision. Read everything you can find and surround yourself with supportive people.

Karen

The risk assessed to VBACs has always interested me because of my previous surgery and scarring. During the seventh month of my first pregnancy, intestinal blockage required exploratory surgery. My uterus was moved far to the side to allow for the blockage to be found and the repair done. I was stitched and taped and left the hospital three days later with an incision about 5–6 inches long.

Because of IV fluids and hydration, my abdomen was two times larger than when I went into the hospital. At no point was the incision or scar tissue mentioned following the surgery or during labor. I went on to have an unmedicated vaginal birth of a 7 lb 14 oz baby girl. I have to wonder, how can a previous c-section years before the subsequent birth be any more of a risk than major abdominal surgery three months before birth?

On that note, a woman I know has had seven c-secs and plans to have more. How is carrying so many babies and having so many c-secs approved of by a doctor? The reasoning just doesn't seem to make any sense in our current medical policies.

Chantel Haynes


EDITOR'S NOTE: Responses to any Question of the Week may be sent to mtensubmit@midwiferytoday.com at any time. Please indicate the topic of discussion in the subject line or in the message.


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Birth Works National Conference

birthworks

Clarion Hotel Conference Center in Cherry Hill, NJ
Featuring, Jean Sutton, Cathy Daub, Michel Odent, Lewis Mehl-Madrona, and Suzanne Arms

For a complete listing of workshop topics and speakers visit www.birthworks.net/conference2003.html

THANK YOU!


With Woman

by Gloria Lemay, compiled by Leilah McCracken

Gravida and Parity

Gravida ("to bear"): A pregnant woman. Any pregnancy including the present one.
Para ("to give birth"): A woman who has given birth. Includes any birth after 22 weeks, whether live or dead.
Nulligravida: A woman who has never been pregnant.
Primigravida: A woman who is pregnant for the first time.
Multigravida: A woman who has been pregnant more than once; she may not have given birth to a child of viable age.
Nullipara: A woman who has never given birth to a child over 22 weeks gestation.
Primipara: A woman who is giving birth for the first time.
Multipara: A woman who has given birth more than once at more than 22 weeks gestation.
Grand multipara: A woman who has given birth to five or more children at more than 22 weeks gestation.
Term: birth that occurs between 38–42 weeks of pregnancy.
Preterm: birth that occurs between 22–37 weeks of pregnancy.
Postterm: birth that occurs after 42 weeks of pregnancy.

A multiple pregnancy is considered as one pregnancy; the number of births is counted as the babies birthed. Abortions, both spontaneous or induced, are counted as gravida. After 22 weeks, all are counted as para, including stillbirths. The current pregnancy is counted as gravida until the time of birth.

Gloria Lemay is a private birth attendant in Vancouver, BC, and is a contributing expert at BirthLove, www.birthlove.com
Read more from Gloria on Midwifery Today's website: “Pushing for First-Time Moms”
Note: This article is also published online in French and Spanish.


Exclusively on the BirthLove Site

Gloria Lemay, celebrated midwife and teacher, is offering advanced online doula education. She covers a vast amount of topics that today's doulas and student midwives need to know: herpes simplex II, medical terminology, pediatric exam of the newborn, prenatal diagnostic tests, business and professionalism, pregnancy-induced hypertension, gestational diabetes and so much more. The course is free for all BirthLove members. Check it out!


Feedback

I am a graduate student researching the stories of lesbian birth mothers. I read a small study by an undergraduate student who interviewed a midwife who claims that lesbians have a higher cesarean section rate (about 50%!). Has anyone else heard this? Also, have you noticed that lesbians have a higher home-to-hospital transfer rate for planned homebirths?

Heather Richard

Re: bachelor of midwifery course, Australia [Issue 5:07]:

This course is offered by Australian Catholic University, Monash University Peninsula Campus, and University of Victoria, St. Albans campus. Together they make up the "Werna Naloo Bachelor of Midwifery Consortium." The course is three years, full-time. Eighteen of the 24 units are specific to midwifery. At least 11 units are available online from members of the consortium. This allows some time flexibility. There is a large practice component to meet the requirements of ACMI for registration. Application is via VTAC. There are huge waiting lists each year. For further information see university sites and go to courses. I am in the first semester of the course. It's really enjoyable but a lot of work.

Andrea
Melbourne

I live in Adelaide and have completed the two-year part-time BA of Midwifery at University of South Australia. I am a general nurse, hence why the course was only two years part-time. I have just commenced my graduate midwife programme at a public hospital, and for someone who did not know if I wanted to do midwifery after I completed the course, I am having a ball! The course had four subjects, and I worked from reproductive medicine, antenatal, postnatal, special care nursery and delivery suite. In South Australia, you only have to witness three natural births, assist with four, and complete at least 10 births independently. You also have to care for 20 other women in labour. I know in the eastern states and Queensland the number is higher so registration with the Nurses Board in each state can occur. If you are not a registered nurse, a three-year full-time degree has commenced, and you achieve a BA of Midwifery and can practice as a midwife. A one-year "bridging" course to register as a RN is being brought in with this degree if you want a double degree. I found the course to be a good grounding for midwifery but is complemented with a graduate programme once you have completed the degree.

Lisa

Do you have information about Arab cultures and their practices regarding pregnancy and birth? I am a nursing student, and I am doing an oral presentation about this subject. Although I have a friend whose family is Arabic, I am looking for additional info.

Tiffany Dotson

I am a nurse-midwifery student presently studying at a community college. Do readers have information about the evolution of midwifery, how it has progressed, ethical issues in midwifery practice?

Sharon Norbal, R.N.

I experienced the beautiful birth of my first child with a midwife. However, my second child was born in a hospital because of location. I was allowed to go over 42 weeks gestation, thus I gave birth to a LGA baby. She had shoulder dystocia. I was forced to get off my hands and knees and on to my back for delivery. It was a nightmare. I was given an episiotomy that was not repaired correctly. I left the hospital without stitches. The doc assured me I would "fill in." I am recovering physically, but I am scared to death to deliver another baby. The doc told me I would never deliver another baby vaginally. My husband, who is a nurse, thinks I have post-traumatic stress disorder. Is there a support group for stressful birth experiences? Can readers recommend reading that could help me? How does one recover from a "mangled episiotomy repair"? I know I could do an episiotomy revision, but is that necessary? Will the discomfort ever lessen? I would love to have another child and trust my body again.

Nanette Stark

Can readers guide me about myeloproliferative syndrome disease—remedies, natural food diet, and supplements to control the situation? Can someone recommend Internet sites?

Bharat Sheth
India
ameets@bom7.vnl.net.in

I am trying to get some information about mucus plugs and their role in pregnancy and labor. After recently losing a baby at 31 weeks I am looking for many answers.

D.


EDITOR'S NOTE: Only letters sent to the E-News official e-mail address, mtensubmit@midwiferytoday.com, will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will not be considered.


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