April 30, 2003
Volume 5, Issue 9
Midwifery Today E-News
“International Midwives Day: May 5”
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In This Week’s Issue:

Quote of the Week

"The keys to understanding and helping the birth process are found all over this marvelous globe with its many cultures."

Jan Tritten


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The Art of Midwifery

Jamaican midwives make thyme tea for labouring moms. They say it makes contractions more effective—thus shortening labor—helps relax mom, and minimizes bleeding.

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News Flashes

A study from the University of California Los Angeles School of Public Health and the California Birth Defects Monitoring Program is the first to definitively link air pollution with birth defects. The two pollutants they measured were carbon monoxide and ozone. They found that the greater a woman's exposure to one of these two pollutants in the second month of pregnancy, the greater the chance that her child would have a serious cardiac birth defect: conotruncal heart defect, pulmonary artery/valve defect, or aortic artery/valve defect. No other birth defects were linked with the pollution. The study included 9,000 babies born from 1987 to 1993.

Pregnant women who were exposed to the highest levels of ozone and carbon monoxide because their homes were close to busy freeways were three times as likely to have a child with one of the heart defects as were women breathing the cleanest air. The researchers said it was not certain carbon monoxide and ozone were directly causing the defects. They could be a "marker"—something associated with the real cause. Fine particles may be to blame. Ultrafine particles correlate extremely well with carbon monoxide. The study factored in economic, ethnicity, and education variables.

— American Journal of Epidemiology, reported at
www.planetark.org/dailynewshome.cfm

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A Sampling of International Midwifery

Australian Aborigine: In traditional aboriginal society, birthing is considered "women's business" in accordance to "grandmother's law." Women birth attendants and relatives of the "right skin" care for the labouring woman in the birth camp some distance away from the main camp. A windbreak is built to provide shelter and privacy. A fire provides warmth. During childbirth the woman has total control over her birth, and the grandmother stays with her at all times. During labour the woman walks around between contractions and leans on a tree during strong contractions. Close to delivery she kneels, resting on the back of her legs, moving and rocking from side to side with each contraction. The support women talk to her and support her from behind, holding her firmly above the abdomen. The birth attendant provides massage, rubbing or pressing around the labouring woman's hips and down the abdomen toward the pelvis. During the birth the woman lifts her buttocks off the back of her legs, remaining in the kneeling position, or she assumes a squatting position. Two women help with the birth, one at the back and one at the front to catch the baby. A shallow hole is dug in the earth and lined with bark from a tree for the baby to lie in. Thus the process of "borning" takes place as the baby is born onto the ground, an important link to the land is forged.

Mavis Gaff-Smith, RM
Excerpted from "Desert Babies: Aboriginal Birthing in Central Australia," Midwifery Today, Issue 59


Costa Rica: At each antenatal visit, Dona Miriam Elizondo, a traditional comadrona, looks at the woman's belly and uses her hands to feel for the size and position of the baby. She is well-known for her special use of the traditional Costa Rican massage techniques, sobada. At every visit, she oils her hands with cooking oil or lard and gently passes them over the uterus to encourage optimal fetal positioning. She checks whether the mother's umbilicus is crooked or pulled in one direction and helps move the baby to a more central and balanced position. She says doctors, who are less skilled with their hands, sometimes call her to help turn a breech. She emphasizes keeping the baby well-positioned and suggests that women alternate sleeping sides and tie a cloth around the belly for support during the day. This will help with leg cramps and back pain and make the birth go quicker, she says. She listens to the fetal heartbeat at each visit by "putting my ear up to them. I don't use the horn or anything." At prenatal visits, she spends a lot of time talking and telling jokes and stories with the woman. "If the woman sees that you have confidence in her, she'll have confidence in you."

Rebecca Turecky
Excerpted from "Lessons from One of the Last Tica Midwives," Midwifery Today, Issue 65


Nepal: A Scottish midwife who worked in Nepal where maternal and neonatal mortality were extremely high relates how she helped make a difference in one village. One of the problems about birth in this culture was that women were looked at as dirty when they are excreting. So when they labored and exuded the juices of approaching birth, they were relegated to the barn, with the dirt and excrement of the animals all around them. When babies were born, they were considered dirtied by the juices of birth until they dried in the air. Given the harshness of the climate, many became hypothermic.

Knowing that it didn't work to tell local populations, whose cultural requirements are firmly established, how to handle birth, this midwife instead talked only with the women of her village about the needs of laboring women for basic sanitation and of newborns for warmth. The villagers discussed these new ideas for a while and then began some adaptations based on the new information. After a while, when a woman began labor, other women in the village came together and shooed all the animals out of the barn, then cleaned the barn and laid down fresh, clean straw for the mother. When the baby was born, instead of leaving it on the ground and not touching it until it dried in the air, they picked up the fresh, clean straw and dried the baby without any skin-to-skin touch, so it could go to the mother's arms much sooner. And, this Scottish midwife reported, both maternal mortality and neonatal mortality rates began dropping in the region.

Anonymous
Excerpted from "Midwives Away From Home," Midwifery Today, Issue 62


South Africa: At the Linkwood Clinic at the eastern edge of Johannesburg, all facets of pregnancy and birth care are incorporated under one roof. In addition to the midwives, two obstetricians maintain consulting offices in the clinic building but apart from the birthing unit. They conduct deliveries in the birthing unit for the occasional mother who prefers not to have a hospital birth but feels more comfortable with a doctor attending. The birthing unit itself includes seven private rooms, all equipped with normal beds and beautiful tubs for laboring and birthing. When a mother is admitted in labor, she will stay in the same room for the entire length of her labor, birth, and postpartum, which can be anywhere from a one- to four-day stay. The rooms are homey, comfortable, and low tech, with nothing to intimidate mom or family. Most midwives bring a small birth kit into the room and leave a cart of emergency supplies outside the room. Linkwood has one major downfall: the kind of care it offers is not more accessible to the general public. It is a private clinic and therefore only covered by private insurance or paid out of pocket by those who can afford it.

Jana Anderson
Excerpted from "Midwifery in South Africa," Midwifery Today, Issue 63


Nigeria: Gentle Birth Education Centre Nigeria (GBECN) is a nonprofit educational organization pioneering gentle birth education and waterbirth resources and research in Benin City, Nigeria. Our programs serve as alternatives to interventionist medical birth and to reduce maternal/infant mortality. I became a midwife after an eight-year apprenticeship with my grandmother, a renowned traditional midwife. I spent my childhood with my her, observing firsthand what natural birth can be!

Poverty, lack of childbirth education and modern facilities, and shortage of trained orthodox midwives to serve in the rural areas and urban cities make birth far more dangerous than it should be. All this prompted me to start my organization. GBECN aims to help couples have the best possible transition into parenthood by providing a qualitative birth education and information that will enable them to make informed choices about their babies and place of birth.

Remarkable changes have started taking place, largely due to our centre's decision to include some female church leaders in arranging free seminars and workshops on childbirth education. We recently concluded an arrangement with some local government areas to train health and social workers to work with midwives and nurses to educate and provide useful information to rural women. GBECN has successfully encouraged people to discover the joy and satisfaction of a gentle birth followed by gentle parenting. Our centre was founded to show people what happens when homebirth is considered the standard of normal birth and midwifery care is the standard of care.

Andrew I. Ewere
Excerpted from "Improving Birth in Nigeria," Midwifery Today, Issue 65

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Forum Talk

Midwifery Today is interested in hearing about your plans for International Midwives Day. Tell us what you've planned, how the event went, what you might do differently next year, and so on.

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Question of the Week

Q: I know there are a host of answers for this, but what are some *proven* and doable ways to minimize effects of nausea during pregnancy?

— Sarah Stevens, aspiring CNM
Pensacola, FL


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


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Question of the Week Responses

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.

A: As a physical therapist, I have worked with people affected by CP. I would specifically want to know what her physical limitations are and how she feels about them. There are many different types of CP with many different presentations. How she is specifically affected will dictate how she should proceed.

— Wendee Whittaker Bartness, MPT, BHS, BS

A: CP, whether a minor or a major re-ability, may have had a physical effect on the development of the pelvis as it responds to the stressors of growth combined with activity, especially in adolescence. Physical activity during pregnancy can help the relaxin effect. It is always a test (final exam?) to see if a specific baby's size, presentation, attitude, resilience plus the mom's emotional resources added to her uterus' powers will allow him/her through to a vaginal birth.

Otherwise relax; any normal shaking-type neurological responses should become magnified. The families I've worked with found it to be a source of great humor in labor and offered extra arms immediately after birth in order for mom not to drop her baby!

— Anon.

Re: VBAC [Issue 5:07]:

I have not had a VBAC, but I did have a c-section. I had a very valuable experience during my pregnancy due to the presence of a large fibroid in an inconvenient place in my uterus, blocking the cervix. The experience unfolded during my nine months of intense inner work, as well as alternative therapies to achieve a vaginal birth anyway. I did go into labor spontaneously, but the baby wouldn't come out after more than 38 hours. All thought my experience had an apparently "negative" outcome. I learned something very precious in life and in birth. The most important work is that which deepens your knowledge of yourself, of your strengths and of your weaknesses. This way you can gather confidence from the strengths and work on improving the weaknesses. I had a very beautiful labor, full of love, and absent of pain. The overall experience is a memory of colors, love, faith, and hope; there is only a very small part of sadness. Our daughter is a very calm and happy baby now.

Go into your pregnancy and birth with courage, faith, love, and confidence. Work hard at creating the most positive situation you can, and go for it! No matter what the outcome is, you will know that you gave it your all.

Aiyana Gregori
Chile


EDITOR'S NOTE: Responses to any Question of the Week may be sent to E-News at any time. Please indicate the topic of discussion in the subject line or in the message.


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Feedback

Arab birth traditions [Issue 5:08]: "Transcultural Health Care—A Culturally Competent Approach" by Larry Purnell and Betty Paulanks provides information in the book and on disk for 27 various cultural groups. I really enjoyed this book/disk.

Robin Jones, CNM


Episiotomy [Issue 5:08]: I sympathize with you in your concern about episiotomy. If the woman doesn't want one, and before she goes into labor the doctor believes it is a necessity, it is best to find a different care provider.

Lynda Indiana


I had an 11 lb 3 oz baby boy and a 3rd degree tear that healed terribly, with pain for a year, unbelievably painful bowel movements for about 3 months (I cried each time and drank gallons of prune juice), and even after healing a tender spot that was painful during sex. This all ended with my second birth of a 9.5 lb son who ripped out all the old work. After being put back together, sitz baths four times a day with baking soda and starting on day four, vitamin E oil on the forming scar tissue for 8 weeks, my perineum was restored to normal!

Have another baby! Have him/her at home, and don't be scared to tear. Have a midwife who is skilled at putting a body back together right. Yes, birth hurts—lots of burning because of scar tissue, but I am so looking forward to my third birth—I have no recognizable scar tissue, a far cry from that stiff lumpy uncomfortable mess I was left with the first time.

Catherine


The deadline is quickly approaching for taking a case to the Supreme Court that has far-reaching implications not only for midwives, but also for a long list of professionals and nonprofessionals who provide health education, health promotion, etc. The Illinois Supreme Court has interpreted the Illinois Nursing and Advanced Practice Nursing Act to mean that anyone providing even basic health education is required to be a licensed nurse.

Legal help is needed as soon as possible: Do you have or do you know anyone who has experience before the Supreme Court? Anyone with experience before the US Supreme Court is encouraged to assist the counsel with the case. Please e-mail Steve Cochran at SteveCochran@HealthFreedom.us or call 540-745-6708 to volunteer or to provide contact information if you know someone with this experience.

For more info (including a summary and the full text of the ruling), go to www.HealthFreedom.us. You can also make financial donations to the case at this site.

Susan Hodges


Lesbian birth mothers [Issue 5:08]: I am a bisexual woman partnered with another woman for the past 12 years. We conceived our two boys by donor insemination. We planned two homebirths. For the first (1997) I labored at home for 48+ hours. My midwife then required us to transport to the hospital (labored another 8 hours and then was told we needed a c-section). For the second (2002)I labored at home for 26 hours, asked to transport, labored in the hospital for another 5 hours and had a c-section when the baby suddenly went into distress. That gives me a 100% c-section rate! In both labors my babies were posterior, had head circumferences in the 95 percentile and above. In both labors I stayed at 9 cm for five to six hours. With the first birth, it was clear that my midwife had some assumptions about how my being a lesbian was affecting my labor. With the second birth, my midwife was wonderful, and held no assumptions, but my MD (who was very OK with homebirth and vbac/hbac supportive) made some assumptions about my sexual history that were invalid.

I'm not sure my example can lead to any statistically valid conclusions. However, my experience has led me to believe that the mind-set of caregivers can really affect the progress of labor, and if caregivers believe that a woman is not up to the job of giving birth because of her sexual identification, then that is going to affect, even on a very subconscious level, how a woman experiences labor. For the record, of my lesbian friends who have borne children in the past five years, four of the five births were natural.

Anon.


Evolution of midwifery [Issue 5:08]: You may find Midwifery and Childbirth in America by Judith Pence Rooks helpful.

Robin Jones, CNM


My 30-year-old daughter is expecting her first baby. She is 7 months along. The baby's heart skips a beat about every ten seconds or so, and this has us very worried. The doctor says not to worry, but he's having her come in every week so he can check it, and he's ordered several sonograms of the baby's heart. Is this normal? My daughter is also having severe heart palpitations, which they are also monitoring. Have you heard if irregular heart beats could be caused by a magnesium deficiency?

Sonja Hald


Recommended reading after a traumatic delivery [Issue 5:08]: I definitely had post-traumatic stress syndrome after being forced into what was probably an unnecessary c-section by an angry doctor, and going through it with my epidural NOT working for pain relief during the surgery. (That is just the tip of the iceberg!) Two books I found most helpful were:

  "Rebounding from Childbirth toward Emotional Recovery" by Lynn Madsen (This is the better of the two, in my opinion)
  "Birth as a Healing Experience" by Lois Haizel Freedman, MEd

I am now pregnant (after seven years—took me that long!) with my third child. While I have some fears, I've gotten counseling and will be keeping in touch with my counselor throughout the pregnancy. I'm looking forward to a better experience with a doctor who seems to be truly dedicated to caring for what is best for women—not just what is most convenient for her.

Hope Anne Dueck


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.


Classified

The 25th Annual California Association of Midwives Conference May 30–31 and June 1, 2003 Speakers include: Michel Odent, MD, Rahima Baldwin, Suzanne Arms, and Laura Kaplan Shanley.
Web: www.californiamidwives.org/news.html
E-mail: midwife7@xprs.net


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