October 15, 2003
Volume 5, Issue 21
Midwifery Today E-News
“Water and Pregnancy, Part I”
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In This Week’s Issue:


Quote of the Week

"I don't practice medicine. I am a midwife."

Valerie Vickerman Runes


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The Art of Midwifery

I learned to check dilation by first measuring my index finger with a centimeter tape, then my index and middle finger together, then spread them and measured from outside to outside of each finger. Next, I applied two fingers to various objects and figured out their measurements in centimeters. Try a Cheerio, a water bottle lid, a jelly jar lid, a salsa container lid (10 cm), and so forth. Repetition is the key to learning how to measure dilation.

April
Midwifery Today Forums


Thanks so much for printing snippets of herbal wisdom that I have written—I love being able to share what I have learned with my various communities. A clarification is in order, however, about my advice in E-News Issue 5:20:

This applies to women who are not currently pregnant. Mitchella may be safely used throughout pregnancy; historically it was used as a "partus preparator" in late-pregnancy tonics. Ocotillo and dry ginger root preparations are contraindicated in pregnancy. However, fresh ginger is much less stimulating and is quite safe. Blessings...

Adrienne Leeds
Clinical Herbalist

News Flashes

Scaling and root planning, a nonsurgical dental procedure, may reduce the risk of premature birth by as much as 84% in women who are less than 35 weeks pregnant. Periodontal infections increase the levels of prostaglandin and tumor necrosis factor molecules that induce labor. The procedure entails cleaning of the tooth-root surfaces to remove plaque and tartar from periodontal pockets and smoothing the root to remove bacterial toxins.

Journal of Periodontology, August 2003


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Water and Pregnancy, Part I

According to Traditional Chinese Medicine, the water element embodies the virtue of knowledge, most importantly knowledge of the self. Balanced water relishes quiet and isolation and, in fact, needs these things to tune into the quiet inner knowing. Balanced water moves slowly and with clarity. It's described as "sitting in the lap of God," or the essence of finding comfort and strength in knowing one's life purpose. The water element can be nourished and encouraged with foods that are naturally salty and represent some connection to water, for example, seaweed. Other options include miso, tamari, kidney beans, millet and root vegetables. Keeping water in the diet and in the body can help the kidneys do their job of flushing the toxins out of the mom's system.

Dandelion (Taraxacum officinale): Use the leaves and flowers as kidney aids. They are high in potassium and will help maintain the essential balance of electrolytes while flushing out the system. The root is an excellent liver tonic. If the liver is overwhelmed or deficient, its work goes to the kidneys. Whenever there is kidney stress, it is a fine idea to also assist the liver. The whole of the dandelion plant is suitable for long-term use with total safety and no known cumulative toxicity.

Nettle (Urtica dioica): Another natural diuretic, nettle is extremely nourishing to the kidneys and adrenals. This herb is especially good for stress and depletion in the renal system. Recommended use is infusion; this is another fine choice for extensive, longer-term use.

Cornsilk (Zea Mays): cooling and demulcent in nature, cornsilk soothes irritation and inflammation, making it a valuable option in approaching cystitis. The infusion is sweet and pleasant tasting and can be used as needed.

Cleavers (Galium aparine): This herb works on the lymphatic system to stimulate immunity, and it is an effective diuretic. Fresh tincture is recommended: 20 to 30 drops, 3 to 4 times per day as needed.

Bearberry (Arctostaphylos uvaursi): Also called uva ursi, this herb is not only diuretic and demulcent, but also astringent and antiseptic. It has a remarkable action as an antibacterial in the urinary tract and is a potent, effective herb specifically for bladder infections. Emphasis is on short-term use during pregnancy. Use one cup of the infusion (leaves are the medicinal part) once in the morning and again in the evenng until all symptoms subside. Follow-up care requires continuing with one cup of the infusion daily for three days after the last symptoms disappear. Use of bearberry during pregnancy should not exceed one full week.

Echinacea root (Rvhinsvrs suhudyigolis, purpurea): A well-known antibiotic alternative, Echinacea acts by boosting liver and immune system function to fight infection. This medicinal root is a good one to try if these other options prove unsuccessful. Recommended use is a tincture dose of half the individual's body weight in drops every three hours. With a bladder infection, it is important to continue treatment even after the symptoms subside to safeguard against reinfection, because bacteria can linger in the system for a few days.

From "The Water Element: Why It's Important to Help Mothers Keep Water in Their Diet,"
by Susan Perri, The Birthkit Issue 35


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Forum Talk

For about the past six weeks a client who is 39 weeks pregnant has had joint pain (mostly in her fingers) when she wakes up in the morning, very stiff too. She doesn't have edema in her hands, just the joint pain and stiffness. Overall she is very healthy. Any ideas why this is happening or how to resolve it (other than giving birth!)?

Kiran


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Question of the Week

Q: It seems I read theory after theory about what causes preeclampsia and how to deal with it and get the mom back on track. What do E-News readers have to say about this problem?

— C.J.


SEND YOUR RESPONSE to mtensubmit@midwiferytoday.com with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.


Question of the Week Responses

Cytotec

Q: I am 26 years old. About two years ago I was 42 weeks pregnant and desperate. I had been having contractions for weeks but had not dilated at all, so my midwife scheduled me for an induction. I arrived at the hospital early in the morning and was given Cytotec (not knowing anything about its experimental use), and within hours I was in extremely hard labor. My contractions were seconds apart for 5–6 hours, and I felt like I couldn't move or breathe. The intensity of the contractions was beyond anything I had ever imagined. Luckily I delivered a healthy baby boy, and aside from a heart murmur, which is gone now, he is very healthy. I on the other hand have had numerous health challenges. When my fertility returned after ceasing breastfeeding I became very nauseated and sick. I took several home pregnancy tests; all were negative. A couple of days passed and I started having extremely sharp pains in my lower abdomen. A nurse practitioner did another pregnancy test, which was negative, and sent me home. Later that day I started bleeding and didn't stop for about 10 days. Ever since then I have had terrible cramping throughout my cycle with and without my period. I have hot flashes, extreme mood swings, and episodes of nausea and dizziness, all of which I had never experienced before giving birth. Has anyone else had a similar experience to mine?

I feel the use of Cytotec is a very grave injustice to women who have been, without their knowledge or consent, subjected to the experimental use of a very powerful and potentially very dangerous drug. I would be most interested to hear from readers who have anything to say about the effects of Cytotec, long or short-term.

— Shannon

A: I recently suffered a miscarriage in my fourth month. I miscarried at home, alone, and was followed up by a physician afterward. I had no drugs whatsoever, but I am experiencing the same effects you describe: mood swings, hot flashes, painful cramping during and well before my period. I have also begun to have a much longer cycle length. We are trying to conceive again, and it is difficult with the various cycle lengths, intense cramping, and my bad moods!

— Lora

A: You should know that big warnings have been sent to doctors' offices about the use of Cytotec. Nonetheless, it is used without heed even in VBACs! This is a grave injustice and breach of protection of the public's health.

— Chris Hafner-Eaton, PhD, MPH, CHES, NDc, retired LLLL and IBCLC

A: I was not given Cytotec, I was given Pitocin, and I have experienced the same symptoms and a lot more. I suggest that you have your hormone levels checked with a saliva test (more accurate than blood testing). If the level is not where it should be for you it can cause a lot of problems. I went to a holistic health care practitioner because doctor after doctor told me there was nothing wrong with me, while my symptoms were worsening. I was diagnosed with premenopause (not perimenopause, because the symptoms of premenopause can be experienced as early as 20 years before the onset of menopause). As a result I ended up with sleep apnea, adrenal fatigue, and hypothyroidism. I was a mess! Finally I have balanced my health by changing my diet, using natural hormone replacement therapy, getting the right vitamins and minerals (including Immunocal and Xtra Sharp), and changing my exercise routine. I think you could benefit from one or more of these same changes.

— Michelle

A: It sounds like endometriosis. I have no idea if Cytotec would cause or contribute to this, but it wouldn't hurt to do a little reading. A doctor friend found a great book called "Endometriosis: A Key to Healing Through Nutrition," by Dian Shepperson Mills, MA, and Michael Vernon, PhD, HCLD. It was extremely helpful in controlling/curing her endometriosis. I found the information fascinating.

— Amy V. Haas, BCCE
www.healthybirth.net


Retained Placenta

Q: We have a client who in her first birth had a retained placenta. Retrieving was complicated by a vagal response. She ended up needing to be transported, and the placenta was removed while she was under anesthesia. We are trying to collect data about incidence of repeat retained placentas and any suggestions for reducing its incidence. We are aware of the possible role of vitamin E, and she is minimizing her intake in this pregnancy.

— SC

A: We had a mother who had several births ending in a transport to the hospital for the removal of the placenta. She did not require a D&C. For her last birth she did not take vitamin E and took selenium the last 6–8 weeks. She did fine. I also believe in prayer and asking God to bless each birth with a good outcome.

— R.Y.

A: I can find no data supporting any connection between vitamin E intake and retained placenta, although there is some showing that women deficient in vitamin E may be at higher risk of early miscarriage or spontaneous abortion. Adequate amounts of vitamin E are essential for reproduction.

Women with a history of adherent placenta do not usually repeat, but they may if they still have the same risk factors—abnormal shape of uterus; history of surgical abortion and/or repeated D&Cs; they are DES daughters; endometriosis; uterine surgery, including cesarean section; and adherent placenta caused by implantation disorders (placenta accreta, increta, etc).

A placenta may be "retained" simply because it is delayed—either because separation is delayed by far-spaced contractions or because there is separation but not expulsion. As long as the uterus is well contracted and not bleeding, then time is the usual cure. Sometimes a separated placenta is caught in a contracted cervix or is mechanically caught because of full membranes. In these cases traction or manual expulsion or manual extraction might be needed (although sometimes a change in position will do the job). These conditions are not likely to repeat.

An abnormally adherent placenta may come free with intra-uterine manipulation, or it may require being surgically removed with instruments (curretage—a surgical "scraping"). An adherent placenta may repeat since the conditions that caused the last one may still exist in the next pregnancy. Did this woman require surgical removal of the placenta? Was the placenta adherent, or was it a case of a separated but "trapped" placenta? If the former, then she should be cautious of a repeat, otherwise she is at the same—or only a little more—risk than usual.

— Gail Hart

A: As a second student midwife in New Zealand I have not heard of diet and drinks influencing the outcome of a retained placenta. However, it is vital that your midwife fully explains what is involved in CCT (controlled cord traction). If and when this is required, (because in NZ we prefer to use physiological, which is the way Mother Nature intended) it is important that your midwife supports your uterus and gently guides your placenta out.

In a recent experience when unfortunately the placenta was retained, it was very important that the woman knew what to look for, e.g., size of the clots, smelly discharge, etc. Luckily only a small percentage of membranes were retained, and she passed these while still in the hospital.

I am unsure what the hospital protocol is in the United Kingdom or United States, but it would be interesting to know if anyone would like to get back to me. My e-mail address is g_stringsj@hotmail.com.

— S.N.


Editor's Note: Responses to any Question of the Week may be sent to E-News at any time. Write to mgeditor@midwiferytoday.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.


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With Woman

by Gloria Lemay

The Cervix and Assessing Dilation in Centimeters

The cervix in a pregnant woman feels like your lips puckered up into a kiss. On a nonpregnant woman it feels like the end of your nose. When it is dilating, one finger slips into the middle of the cervix easily. As the dilation progresses the inside of that hole becomes more like a taut elastic band, and by 5 cm dilated (5 finger widths) it is a perfect rubbery circle, like one of those Mason jar rings that you use for canning, and about that thick.

If you take a dressmaking tape measure and start measuring circles (the top of your shampoo bottle, the bottom of a coffee mug, etc.), you'll get familiar with the diameters in centimetres. One centimetre (about half an inch) is the diameter of your fingertip. Therefore, if you can insert one finger in the opening of the cervix, you're 1 cm dilated. Two fingers loosely together is approx 3 cm, 5 cm is the two fingers parted and the outer edge touching the rubbery edges of the cervix, 9 cm you just have a small band of the rubbery edge around the baby's descending head, 10 cm is no cervix felt along the edges.

Get practise by finding a rosebush and looking at the blooms. The tight buds are a closed (0 cm) cervix; fully bloomed roses are 10 cm from edge to edge when you make your fingers do "the splits." I especially think it's a good and empowering thing for a woman to check her own cervix for dilation. This is not rocket science, and you hardly need a medical degree or years of training to do it. Your vagina is a lot like your nose—other people may do harm if they put fingers or instruments up there, but you have a greater sensitivity and will not do yourself any harm.


Midwifery teacher Gloria Lemay runs BirthLove's Doula Course. It is free for all site members. See www.birthlove.com/glo_doula.html.


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Feedback

To Chloe [Feedback, E-News 5:19], I would certainly go through with the pregnancy. Olive leaf extract has been used to treat herpes. Gy-Na-Tren (www.natren.com ) is a probiotic vaginal insert that works wonders. www.blisscream.com has a product called Intimate Joy Cream that has worked well.

Joy


This is my third pregnancy, and I am due the middle of February. Both my previous births were vaginal and went just fine. The first was in a hospital and my second was at home with a midwife.

In February 2002 I was standing in the kitchen and began experiencing what I thought was gas. The pain worsened, and I climbed into bed. I figured it was stomach flu and bore it for a while, then went to a stat care center. They could do nothing for me and suggested I go to the emergency room (ER). I did not go. The pain came and went, and I figured I would get over it. After two days I awoke during the night with rather severe abdominal pain and had to go to the ER. After multiple testing and confused looks from everyone, they called a specialist. He could only guess that I had a ruptured ovarian cyst that was causing my problem. During surgery it was discovered that I had no cysts, but a branch of my uterine artery had torn. I had lost about 5 pints of blood at this point in my abdominal cavity. Also, they discovered that on either side of my uterus in my broad ligaments, I have/had a hole thru which my ovaries and bowel could freely move. The doctor could not determine any etiology for either the internal bleeding or the holes. He fixed the artery but left the holes because he wanted to do more investigating to see if he could find a similar case. In May of last year I was supposed to go back for surgery to fix the holes. I was very torn as to whether or not I needed the surgery. It was discovered that I was pregnant, maybe just 2–3 weeks along, and surgery was postponed. I took this as a sign that the surgery was not needed, and I never rescheduled. I started my period about 2–3 weeks later. My youngest is 3 so I do not think that this is related to a pregnancy.

I am now in my 5th month of pregnancy. I have assumed it would be safer to be in the hospital because no one knows what happened to me or if I will be safe or what to expect. But I passionately hate doctors and hospitals, and I think this will be a problem for me. I really want to be at home with my midwife. I have not talked to her because I just recently made my decision. I have not even talked to my husband about my concerns yet. I need some guidance, but I do not know what anyone can offer me, thus my fears are all my own right now.

Is there is research available that I could present to my husband and midwife to put them at ease? I was able to find the short article "Broad Ligament Tear an Indication for C-Section," and that made me feel a bit at ease. I have yet to find an article about "broad ligament tear." Whatever you could offer would be tremendously appreciated.

Melissa


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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