May 14, 2003
Volume 5, Issue 10
Midwifery Today E-News
“Nausea during Pregnancy”
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In This Week’s Issue:


Quote of the Week

"When we birth consciously, putting our great rational mind on hold and allowing our instinctive nature to dominate, we can access the wisdom that all spiritual traditions teach: the ego is our servant, not our mistress; and our path to ecstasy and enlightenment involves surrendering our egotistical notions of control."

Sarah Buckley


The Art of Midwifery

A chiropractor told me that often preterm labor can be stopped by firm downward massage of the sacrum. Do 5–8 firm downward strokes once or twice a day every day.

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News Flashes

Researchers at University College in Dublin, Ireland, found that the rate of cell division in mice that were given an 8 megahertz ultrasound scan lasting 15 minutes was 22% lower than normal, and the rate of cell death doubled. Routine hospital scans use frequencies between 3 and 10 megahertz and can last up to 60 minutes. The study leader said the sound waves of the scans could be damaging the DNA in cells, which could delay cell division and repair, or it might be switching on p53, a tumor suppressor gene that controls cell death. Cancer occurs when damaged cells multiply uncontrollably and form tumors. Mutations in p53 are the commonest gene abnormalities seen in human cancers. The research team cautions that its results are preliminary and need further investigation.

New Scientist, 1999


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Nausea in Pregnancy

Nausea and vomiting of pregnancy (NVP) affects approximately 75% of all pregnancies (1), averaging 17.3 weeks (2). Some degree of NVP appears to protect the fetus. Brandes found a fetal loss of 86.0 per 1000 in women with no NVP, while fetal loss was 49.1 per 1000 in sick women (3). Consistent negative results are difficult to demonstrate; however, smaller infants are reported (4,5,6). Growth restriction can be mitigated by aggressive intravenous hydration, electrolyte correction, and antiemetic therapy (7).

In Australia, 20% of women had NVP until delivery (7), and in a racially mixed group of South African women, only 5% were ill until delivery (8). The latter statistic is similar to morbidity reported in the United States (9). Direct health care costs noted in a community hospital in Pennsylvania were $186,000, for an average $2,900 per woman per hospitalization (10). Nationally, an estimated $130 million in direct financial loss is assigned to NVP (11).

  1. Cziekel, A.E. et al. (1992). The effect of periconceptual multivitamin-mineral supplementation on vertigo, nausea, and vomiting in the first trimester of pregnancy. Obst Gynecol Survey 251:80–81.
  2. Tierson, F.D. et al. (1986). Nausea and vomiting of pregnancy. Am J. Obstet Gynecol 155:1017–22.
  3. Brandes, J.M. (1986). First trimester nausea and vomiting of pregnancy. Am J Obstet Gynecol 155:1017–22.
  4. Gross, S. et al. (1989). Maternal weight loss associated with hyperemesis gravidarum: a predictor of fetal outcome. An J Obstet Gynecol 160:906–9.
  5. Depue, R.H. et al. (1987.) Hyperemiesis gravidarum in relation to estradiol levels, pregnancy outcome, and other maternal factors: a sero-epidemilogical study. Am J Obstet Gynecol 156:1137–41.
  6. Godsey, R.K. et al. (1991). Hyperemesis gravidarium: a comparison of single and multiple admission. J Repro Med 36:387–90.
  7. Walters, WAV (1987). The management of nausea and vomiting during pregnancy. Med J Australia: 290–1.
  8. Walker, ARP et al. (1985). Nausea and vomiting and dietary cravings during pregnancy in South African women. Br J Obstet Gynecol 92:484–9.
  9. Gulley et al. (1993). Treatment of hyperemesis gravidarum with nasogastric feeding. Nutr Cllin Pract 8:33–35.
  10. Kousen, M. (1993). Treatment of nausea and vomiting in pregnancy. Am Fam Phys 11:1279–80.
  11. Scialli, AR (2000). Burden of the disease (abstract). Nausea and vomiting of pregnancy: what's new? Reproductive Toxicology Center, Washington, DC.

The cause of pregnancy-induced nausea is unknown, yet the theories abound. Some propose it is related to a deficiency of vitamin B, and others link nausea to changes in blood volume. In the first months of pregnancy, a woman's overall blood volume increases by 40%. Fortunately there are many options for safe, effective, natural relief of the common complaints of nausea in pregnancy. As recent clinical studies of ginger root have shown, the old remedy long used for upset stomach and nausea now has the backing of scientific research to validate its antiemetic qualities. No teratogenicity or neonatal toxicity was reported in any of these clinical studies.

Susan Perri, The Birthkit No. 36

For more information about The Birthkit Newsletter, click here.


Vitamin K and vitamin C, taken together, may provide relief of symptoms for some women. In one study, 91% of women who took 5 mg of vitamin K and 25 mg of vitamin C per day reported the complete disappearance of morning sickness within three days. However, most doctors use higher amounts of vitamin C (500 to 1,000 mg per day).

www.mycustompak.com/healthNotes/Concern/Morning_Sickness.htm


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Forum Talk

I am looking for information about how having myoma or fibroid on the uterus affects labor. Is there anything special about preparing the body for labour? I have a client (as a doula) who has this condition; she is now 29 weeks pregnant, and so far everything is fine.

Lena


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Question of the Week

Q: I am currently pregnant with twins, my third and fourth children. I have had two previous vaginal births with little complication. We are planning a homebirth with two experienced midwives. What special care should be taken with a multiple pregnancy, labor, and delivery? I would love to hear from others about this subject. As a doula and childbirth educator, I have a lot of book knowledge about the subject but would like to hear from those who have experienced or taken care of women in a multiple birth situation.

— Jonelle


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Question of the Week Responses

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

A: *Avoid fat in the diet. *Don't allow your stomach to become empty: eat small amounts frequently, and if you throw up, eat something else immediately. *Eat anything that will stay down, even if it doesn't seem like optimal nutrition (ANY nutrition is better than NO nutrition). *Avoid strong odors if they turn your stomach. *Get enough rest.

— Anon.

A: Through both my pregnancies I had continuous nausea for the first three months, 24 hours a day. Three things really helped:

  1. Sniffing ginger oil or drinking hot water with fresh ginger grated into it.
  2. Eating a thin vegetable or meat soup continuously through the day. I ate a small bowl every time the nausea started and it would go away for 2–3 hours at a time.
  3. Reflexology by a trained pregnancy reflexologist. It was amazing how the nausea and fatigue would go away for days after just one session!

— Maria, doula

A: This is what helped me personally when I experienced nausea (not just in the morning) in pregnancy: vitamin B-6, ginger (I usually took it in tea form), and small high-protein meals/snacks. Also, try not to let your stomach be completely empty. For nausea in the morning, keep a small cooler with cubes of cheese or peanut butter and crackers near your bed. Before getting up, eat a little bit. Try not to drink liquids at the same time as foods: eat first, then drink. Whenever anyone has asked, these are the things I tell them to try. It usually works. I have given birth three times, and during the second pregnancy I experienced no nausea at all.

— Wanda Lea O'Keefe, prenatal, labor, and postpartum doula

A: Seaband and acupuncture! Studies show very good effect.

— Marietta, RN/midwife

A: The following Web sites may be helpful:

— Ellen Baumann
Dallas, TX

A: I do not know how proven it is but—EAT, EAT, EAT. I am 6 weeks pregnant. I eat a well-balanced organic primarily macrobiotic diet. I do not know why it is called morning sickness because morning is when I feel best. I have nausea all day on and off and sometimes worse in the evening when I am tired and cooking dinner. The best thing I have found is to nibble all day. Plain almonds and raisins, fresh pineapple on cottage cheese, cherry tomatoes, celery sticks and carrots, boiled eggs, waffles with almond or peanut butter, a piece of fruit like an apple or grapefruit—it seems to help.

It also helps to simply accept the nausea as a positive sign that your baby is there and growing. The nausea should pass around the 12th week.

— Traci B. Mueller

A: I experienced this in my own pregnancy and have seen it a lot. There seems to be a direct connection between low blood sugar and nausea, particularly the "morning sickness" of early pregnancy. The body's needs change radically from day to day, particularly at the beginning, and I discovered that eating some protein before going to sleep, and having emergency food—protein or complex carbohydrates—available at a moment's notice forestalled nausea. You have to catch it while you're hungry but before nausea sets in. Otherwise it's too late—food won't help.

Once labor begins, low blood sugar can cause a complication too. No matter what you do, there's sometimes vomiting, but if she's been well-nourished just beforehand, it might be minimized. It's just something to be aware of.

In the postpartum stage, it's very easy for the new mother to forget to eat. Some sort of protein-vitamin drink that's always available in the refrigerator is helpful. Anytime the baby eats, the mother has a glassful of this drink. That seems to cut down on postpartum depression, I find.

— Suzanne Fremon, hypnodoula

A: I was taking a natural herbal, iron supplement and this made me very sick. Sometimes the iron in the prenatal vitamins can make the nausea a lot worse. I stopped taking the supplement and the nausea was improved considerably. Since then, I have been drinking a smoothie every morning consisting of a banana, 5 strawberries, 1/2 cup fruit yogurt, silken tofu (150 g), a drizzle of real maple syrup, and lots of milk. I find it easier to drink if its consistency isn't too thick. I drink two goblets of this first thing in the morning, and I feel great all day. I did miss making it one day and I was very nauseated and 'gaggy' all day. I think it's the protein of the tofu that makes the difference.

— Julie Keon CD (DONA), CBC
Ottawa, Canada

A: Ginger tea. Drinking tea made from slices of fresh ginger with sugar in hot water reduces nausea greatly. This is an old Indian remedy. In India the traditional "chai" contains slices of fresh ginger along with other ingredients such as cinnamon, cardamon, and black pepper mixed with a black tea and hot milk, which assists digestion. The main ingredient is ginger, which when drunk alone as tea tastes good and helps prevent and reduce nausea.

— Barbara Ben-Ami
Israel


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With Woman

by Gloria Lemay, compiled by Leilah McCracken

Intimacy of Water in Birth

When you are called to attend a birth, the simple act of cleaning the woman's bathtub, drawing her a deep warm bath, putting in a couple of drops of lavender oil, and lighting a small candle may be the biggest contribution you will make. I have found that even those women who had been disinterested in having a waterbirth will be drawn to the sound of a bath running and appreciate the option of water immersion when the sensations of birth are strong.

Waterbirth does not necessarily mean that the baby emerges into water. It could mean that the mother uses water immersion before, during, or after the birth. Like all aspects of the birth process, it is not about performance and rules; it's about possibilities and the unique experience of each birth. Once the birthing woman is in the tub, in the dim light, and she has a drink beside her, leave the room and keep everyone (including dad and kids) out until she requests company. Being alone in the water has a very good effect on the part of the human brain that controls dilation. Let go of your own temptation to "support" and "be helpful"—these things have an adverse effect on the part of the human brain that controls dilation.

The woman who is in darkness and alone will feel safer to massage her vulva and vagina, change positions, make odd facial expressions, curl up, stretch out, fart, pee, smile— do any of the things that a human being does when completely private. Knowing that people who love her are within calling distance is all that is needed.


BirthLove, where private birth attendant Gloria Lemay is a Contributing Expert, has an extensive waterbirth collection—birth stories, photos and articles: www.birthlove.com/pages/stories/waterbirth.html
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.


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Midwifery Today Magazine Question of the Quarter

Theme for Issue No. 67: Fear in Midwifery and Birth
Question of the Quarter:
What do you do to overcome your fears in midwifery and/or birth?

Please submit your response by June 15, 2003 to mgeditor@midwiferytoday.com. (All responses are subject to editing for space and style.)


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Feedback

A question was brought up today during a discussion I was having with someone. During pregnancy is it true that the mother's blood and the baby's blood never mix or ever has any contact? If this true, how can that be? Why would a child have the same blood type as a mother and not a father?

Charlene

Episiotomy [Issue 5:09]:

My first child was born after many hours in labour and resulted in an episiotomy which was repaired badly. A year after my son was born I had it refashioned and was very glad that I did. However the fear remained that I would have problems with delivering more children, especially as other people told me that after one episiotomy I would need to have further ones to be able to give birth without tearing. When I fell pregnant with my second child the fear grew worse, but my midwife reassured me that everything would be fine, I wouldn't need an episiotomy, and there was no real reason why I should tear. At antenatal classes the teacher gave my husband and myself a sheet with instructions for perineal massage. We did the massage from about 26 weeks gestation right up until the birth. On 14th August 2002 I gave birth to my 8 lb 10 oz daughter (2 lb 4 oz heavier than my son) at home in the birthing pool with no tearing whatsoever. I don't know if it was the massage or the combination of water and massage, but it is possible to have a "normal" birth after an episiotomy.

Sarah Dunn
England

Regarding your issue about fathers attending the births of their children [Issue 5:08], I found the tone of the excerpts presented lacking a balanced representation. Certainly that is the opinion of the three professionals quoted, but my observations and experiences have differed with regard to dads at births.

Dr. Robert Bradley brought fathers into the birthing room because he felt who better to support a laboring woman than her lover and life partner. Women are constantly telling me they choose Bradley Childbirth classes BECAUSE it includes the dad.

I find that even when a father feels he is not up to the task of acting as primary labor assistant, he and his partner still benefit from having him well-educated. A father who is not well-informed and trained may inadvertently bring ignorance and fear into the labor room, and interfere with the process. When he is educated and trained he knows not only what is happening and why, what is normal and what is not, but how to help and when to ask for help. I encourage all the families who attend my classes to train or hire a secondary labor assistant (who is a woman) to act as backup for the dad. This way he has a choice, and the mom has all the support she needs. As a matter of fact I have heard complaints from the doulas that the family didn't really need them!

I think we need to look at the presence and role of the dad at births according to each individual family. We can't judge who should or shouldn't be there—it is really up to the mom and her family's individual personalities and circumstances.

Amy V. Haas, BCCE

Does anyone have an English version of the legislation regulating midwifery practice in The Netherlands? Also maternal morbidity and mortality statistics for The Netherlands?


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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