|June 25, 2003|
Volume 5, Issue 13
|Midwifery Today E-News|
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In This Week’s Issue:
Quote of the Week
“One of the most important questions midwives can ask [a pregnant woman] is ‘How do you see yourself giving birth?’”
— Andrea Mietkiewicz
The Art of Midwifery
I have found an herbal combination to treat very excessive menstrual bleeding that has no estrogenic properties and has worked like a dream: Erigeron cinnamon compound. I used 20 drops in a small amt of water twice a day—the flow stopped immediately after the first dose. Red raspberry had slowed it but didn't stop it.
This compound is an old Eclectic Physician's formula. It's also great for postpartum hemorrhage. I still recommend tonifying the reproductive system and identifying the underlying cause.
— Adrienne, 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 email@example.com.
Researchers at the Hinchingbrooke Hospital, Huntingdon, England, enlisted 635 postpartum women in three groups for a blind randomized clinical trial to determine if lavender oil helps reduce perineal discomfort following birth. The first group used pure lavender oil, the second group synthetic lavender oil, and the third an inert substance as bath additives to be used daily for 10 days following normal childbirth. The study revealed no statistically significant difference between the three groups. However, the women using lavender oil had lower mean discomfort scores on the third and fifth days than did the two control groups—a time when perineal discomfort generally is high. Evidence suggests that lavender oil used in the bath may help alleviate discomfort at certain times.
— Journal of Advanced Nursing (ENGLAND) Jan 1994
DISCUSSION: What is your experience with natural remedies for postpartum perineal healing? Have you kept statistics you can share?
Windflower: Homeopathic Pulsatilla
A person who resonates with the remedy pulsatilla has a mild, yielding, emotional nature. She is affectionate to others and craves attention and affection when she is sad or hurting. Consolation, touch, massage, and emotional support help her feel better. She cries easily, and her symptoms can be temporarily relieved by a good cry. She is flexible in relationships but can be stubborn and tenacious. She is chilly, intolerant of heat, and wants to breathe fresh air. She is not thirsty. She may have sensitive digestion and report stomach pains or bowel problems.
The changeable nature of her symptoms are tricky: labor contractions are weak, then sharp, then close together, then absent. The baby's prenatal position may be stubbornly transverse; the baby may move into many problematic positions.
Pulsatilla is known in midwifery circles as a remedy for turning a baby from breech to vertex. It is useful for malpresentation of the fetus and moves the baby into an optimal birthing position. It also can turn a breech or occiput posterior if the mother and baby would be best served by an occiput anterior presentation at birth. Pulsatilla seems to work only if mother and/or baby are constitutionally pulsatilla.
Pulsatilla can balance women's hormones. It may be indicated for weak or uncoordinated labor contractions, painful after-contractions, or for postpartum hemorrhage, especially with a partially separated placenta. Its hormonal support can help with amenorrhea and dysmenorrhea.
— Excerpted and paraphrased from "Windflower: Homeopathic Pulsatilla," by Peggy Sawyer, Midwifery Today Issue 66
To read this article in its entirety, purchase Midwifery Today Issue 66 by clicking here.
While on an Indian reservation, I had studied with a shaman and observed the use of seaweed to heal burns and deep lacerations. I suggested this alternative to a couple who refused suturing of a second-degree perineal tear. The couple agreed.
I cut a piece of seaweed that was twice the length and the width of the tear, folded it in half, and moistened it with sterile water. I placed it down the center of the tear and brought the edges of the tissue together, carefully aligning them. I also covered the entire length of the tear with a second patch of moistened seaweed. Before departing, I included in my postpartum care plan instructions to replace the outer patch of seaweed each time she used the bathroom. I also instructed her to keep her legs together and to stay in bed as much as possible, caring only for herself and the baby.
Upon my arrival 24 hours later for the first postpartum check, all was well with mom and baby. Breastfeeding was going very well. When I examined the perineal area, I discovered the tissue had healed miraculously well. I could not even distinguish a separation of the tissue where the tear occurred. The mom also had virtually no pain in that area. She mentioned that the salt in the seaweed stung a little when first applied but quickly faded to a healing tingle.
Ever since that birth in 1986, I have been using seaweed patches with great success as an alternative to suturing. I have taught this technique to other midwives and apprentices.
— Excerpted from "A Natural Alternative to Suturing," by Denise Gilpin-Blake, LM, CCE, CLE and Summer Elliot, SM, RN, BSN, Midwifery Today Issue 60
To read this article in its entirety, click here.
"Kangaroo care" for premature infants of Bogota, Colombia, evolved out of necessity. Mothers of premature infants were given their babies to hold 24 hours a day. They slept with them and tucked them under their clothing as if in a kangaroo's pouch. If a baby needed oxygen, it was administered under an oxygen hood placed on the mother's chest.
Doctors who conducted a concurrent study of the kangaroo care noticed a precipitous drop in neonatal mortality. Babies were not only surviving, they were thriving. Currently in Bogota, babies who are born as early as ten weeks before their due date are going home within twenty-four hours! The criteria for these babies are that they be alive, able to breathe on their own, are pink and able to suck. However, their weight is followed closely, and they can be gavage-fed if necessary.
Dr. Susan Ludington is one of the people who have been most instrumental in bringing kangaroo care to the United States. She has been intimately involved in many research projects, and her work is having a powerful, positive impact on premature babies and their families. In the United States, the few hospitals that regularly use kangaroo care protocols have mothers or fathers "wear" their babies for two to three hours per day, skin-to-skin. The baby is naked except for a diaper, and something must cover his or her back: either the parent's clothing or a receiving blanket folded in fourths. The baby is in a mostly upright position against the parent's chest.
The benefits of kangaroo care are numerous: The baby has a stable heart rate (no bradycardia), more regular breathing (a 75 percent decrease in apneic episodes), improved oxygen saturation levels, no cold stress, longer periods of sleep, more rapid weight gain, more rapid brain development, reduction of "purposeless" activity, decreased crying, longer periods of alertness, more successful breastfeeding episodes, and earlier hospital discharge. Benefits to the parents include "closure" over having a baby in NICU; feeling close to their babies (earlier bonding); having confidence that they can care for their baby, even better than hospital staff; gaining confidence that their baby is well cared for; and feeling in control, not to mention significantly decreased cost!
— Excerpted from "Kangaroo Care: Why Does It Work?" by Holly Richardson, Midwifery Today Issue 44
To read this article in its entirety, click here.
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What is authentic midwifery? How can we move toward it? Find out what Michel Odent has to say in "The Farmer and the Obstetrician." Click here to order your copy.
What do you take with you to a birth? Anything you couldn't do without? Do you prefer oil or powder for massage?
TO SHARE YOUR THOUGHTS AND EXPERIENCE ABOUT THIS TOPIC, click here. **PLEASE DO NOT SEND YOUR RESPONSES TO E-NEWS!**
FROM THE FORUMS: Midwives' favorite words for "vagina" or words they've heard others use: daisy, pink bits, yoni, bum, crotch, bottom, vulva, bits n pieces, cha-cha. Have you used/heard others?
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Question of the Week
Q: What can be done for a broken coccyx? I am six weeks postpartum and still cannot sit without pain. I had a vaginal delivery. I have to sit on a pillow with the back cut out and it still hurts.
SEND YOUR RESPONSE to firstname.lastname@example.org with "Question of the Week" in the subject line.
Question of the Week Responses
Q: I was supposed to have a homebirth and ended up having a c-section because she was breech. When my midwife looked at the afterbirth she said the umbilical cord was short so the baby wasn't able to turn around to be born naturally at home. I'm puzzled why the cord was too short. I maintain a vegan diet. My entire pregnancy was very healthy, and my daughter weighed 8 lbs 12 oz at birth.
— Sue Gallant
A: Why does one woman's placenta develop on the right side of her uterus and another's on the left? Why is one child born with hair and another practically bald? Why does one baby prefer resting on its right side and another one on its left? Most moms want to do the most they can for their babies while they are in the womb and sometimes end up taking on too much responsibility and guilt. Not every single thing related to the development and growth of a baby can be determined and manipulated by the mom. Sometimes the best we can do is the best we can do.
— Joleen Streit, HypnoBirthing educator, doula
A: My baby had a particularly short cord of 20 cm, and I would be particularly interested in knowing if this runs in families. I had to have a c-section as my baby was breech. My waters broke and I did not go into labour after a trial.
— Rebekah Clarkson
Editor's Note: Responses to any Question of the Week may be sent to E-News at any time. Write to email@example.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.
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! www.birthlove.com/glo_doula.html
[Editor's Note: The following has been edited because of space limitations in E-News.]
New York-Presbyterian Hospital (NYPH) recently announced its decision to relieve their CNMs of delivery duties. The service was established almost 50 years ago, and as of May 1, 2003, comprised 30 nurse-midwives. These midwives provide prenatal care through private practice, the NYC Maternal Infant Care (MIC) program, and through Presbyterian's own ambulatory clinics. Births have been attended at a community hospital, the Allen Pavilion, since the late 80s, with excellent results. These midwives have not exactly lost their jobs—they will still be expected to provide prenatal and well-woman care through the clinics—but they cannot attend the births of the women who have been seeing them throughout pregnancy.
According to an American College of Nurse-Midwives (ACNM) spokesperson, the announcement explained that the Allen Pavilion patients are "not appropriate for midwifery care" and applied to midwives bringing private patients to this hospital. An assessment of risk status determined that only 17% of women presenting at the Allen Pavilion were eligible for midwifery care. She stated that increasing use of Pitocin and rising cesarean section as well as age and medical co-factors led to her decision to terminate any labor management by midwives as of October 1, 2003. No data supporting this justification have been presented to the midwives despite multiple requests. Following the midwives' request for a multi-disciplinary task force evaluation the midwives were told, No discussion, no compromise.
The action may involve significant Medicaid fraud charges brought against Columbia University and New York-Presbyterian Hospital stemming from the practice of billing Medicaid for births attended by CNMs as if they had been attended by obstetricians who were not present, complete with economic incentives for obstetricians to sign the charts as if they were present.
ACNM's executive director states, "The 30 midwives employed at NYPH are currently delivering 1500 newborns, assisting physicians and nurses with the care of many more women in labor, and providing over 25,000 prenatal and family planning visits per year. The published literature on pregnancy outcomes for women who receive care by nurse-midwives, even those whose socio-economic status place them at increased risk for poor outcomes, is filled with evidence that nurse-midwives provide a safe model of care."
As few as six or seven obstetrician gynecologists may be hired to take the place of 30 midwives. One result is loss of continuity of care from clinic to hospital. All women will be considered high risk when they are admitted.
Please speak out on behalf of the women in Washington Heights and Inwood in New York City, women like you who deserve to have the option of midwifery care in labor and birth.
— Susan Hodges, "gatekeeper"
A cystocele occurs when the bladder (cyst) prolapses (falls) into the vagina. In the traditional birth position (either flat or semisitting) the bladder blocks the birth canal, making pushing ineffective, not to mention extremely painful! A woman with a cystocele needs to get into the hands and knees (H&K) position upon full dilation to let the bladder fall forward and unblock the birth canal. Once the baby's head is past the bladder, she may then stay on her H&K or assume any other position of choice for the actual delivery.
I gave birth almost four weeks ago in a hospital. My doctor is surprisingly noninterventionist. He believes that medical procedures are there for emergency cases only and not for routine use. I had planned to avoid epidural and induction that are so common in hospital births.
My contractions began on Saturday evening but were not intense or frequent until Monday evening. I was admitted to the hospital at that point and stayed overnight. Despite staying active and being upright a good amount of the time, I did not dilate any more all night, so I was given the option in the morning to be induced or go home. The doctor offered to rupture my membranes to see whether labour would progress, and if it didn't, I would have to be induced. I declined and went home.
I returned to the hospital on Tuesday evening. A vaginal exam showed that I had not dilated further all day (I had been at 3 cm dilation since Monday evening). I was sent home again.
On Wednesday afternoon I went to my doctor's private office, and he found that I was approximately 7 cm dilated. He recommended I go home, eat something, and meet him at the hospital a little later.
At 5:30 pm he arrived at the hospital and ruptured my membranes. Labour seemed to be going well until my contractions started becoming less frequent. In the end, I had to be induced, and the pain of the more intense contractions, combined with my physical exhaustion, required an epidural. Luckily, it wore off before the final pushing stage, so I was able to feel the actual birth of my daughter. Even during the epidural I could feel the pressure of the contractions, so I knew when to breathe and when to push.
After I delivered my baby, my uterus never contracted again. I had to push the placenta out myself, and then I began to hemorrhage. I required a final large shot of oxytocin to stop the bleeding. At that point I was glad I already had an IV in place.
What causes the "prolonged latency" stage I experienced, and what could I have done to avoid this situation? What would have happened if I had not been at a hospital, but at home with a midwife? Would I have been one of the very rare casualties? I am 23 years old, was in fantastic shape before and through my pregnancy, watched my diet carefully, took vitamin and mineral supplements as well as essential fatty acids (evening primrose oil). What should I do differently next time?
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.
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Michigan School of Traditional Midwifery 6th annual Midwifery Skills Workshop August 17-20, 2003. Early registration discount extended through June 1, 2003: $335.00, $395 thereafter. Registration includes lodging, meals, workshop materials. For more information visit www.traditionalmidwife.com or call 989-736-6583.
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