September 1, 2004
Volume 6, Issue 18
Midwifery Today E-News
“Collecting Cord Blood”
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Sit Up and Take NoticeLearn effective positioning for labor and birth.

Sit Up and Take Notice: Positioning Yourself for a Better Birth, by Pauline Scott
Pelvic structure, baby's position and the exquisite engineering of the two that is designed to culminate in uneventful, natural birth


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Find out at our conference in Bad Wildbad, Germany, October 20–24, 2004. You'll learn how to create a nurturing environment for women who give birth in the hospital. Topics to be covered include:

  • Empowering Women in Hospital Births
  • Closing the Gap between Evidence and Practice
  • What Is Appropriate Technology?
  • Working under Restraint

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Honoring Our Roots, Preserving Our Future

We must honor and learn from the past while looking to and protecting our future. Discover ways this can be done at our Eugene conference in March 2005. Teachers include Ina May Gaskin, Elizabeth Davis, Robbie Davis-Floyd and Anne Frye.

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In This Week’s Issue:


Quote of the Week

"We must attempt to tell the whole truth about birth, the truth that includes transformation, mastery, satisfaction, personal power, and the difference between pain and suffering."

Cheri Van Hoover


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The Art of Midwifery

Even when a woman is feeling a little "pushy," she may be fully dilated but not really ready to actively push. In our well-meaning attempt to tell a woman when we think she is at the pushing stage of her labor, we encourage her to push way too soon. The consequence is that when a woman begins pushing before a strong and irresistible urge is present, she uses her energy to accomplish a task that her body would do more effectively on its own if she was listening to her body's cues rather than her birth attendant. Maternal exhaustion, a swollen cervix, fetal distress, and sometimes a transport for vacuum extraction or a cesarean section often follow.

Lois Wilson, Midwifery Today Issue 55


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

In a Keck School of Medicine, University of Southern California/Los Angeles study of 300 children diagnosed with asthma by age five and 400 asthma-free children, researchers found that those born to asthmatic women who had eaten oily fish several times per month were 71% less likely to develop asthma by age five. The study also showed that children born to nonasthmatic mothers did not experience similar benefits. The researchers surmise that immune response is altered by the consumption of omega-3 fatty acids in oily fish. Omega-6-containing fish such as processed fish sticks appeared to have the reverse effect: consumption by pregnant mothers resulted in offspring being twice as likely to develop asthma before age five.

http://my.webmd.com (submitted by Nancy Miller)


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Collecting Cord Blood

When the mother of a newborn baby is Rh negative and the father is Rh positive, there is a good chance that the baby will be a positive blood type. Blood in the umbilical cord and the placenta will be the baby's blood. Here are instructions on how to obtain a sample:

  1. At the time of birth do not rush the clamping and cutting of the cord. I like to see the placenta birthed (this will take approximately 30 minutes) before clamping and cutting of the cord.
  2. Take the bowl with the placenta to the kitchen and get everything together before taking your blood sample. You will need
    • 2 pairs of nonsterile gloves to protect yourself from body fluids
    • 1 container with a lid in which to put the placenta
    • 1 blue waterproof 17- by 21-inch underpad
    • 1 3-cc syringe and needle
    • 1 purple test tube with stopper (Check with your local hospital to determine what color stopper they prefer. The purple stopper tube has an anticlotting chemical in it to prevent the blood from clumping.)
  3. Before putting on your gloves, write the necessary information on the label of the test tube in very tiny printing. Remember: it is very important that blood samples not get mixed up at the hospital. You will get along well with the blood bank if you mark your samples carefully. In my area, we print the mother's full name and date of birth, the title "Cord Blood," baby's date of birth, and mother's personal health number. When you get to the blood bank, they will also want you to fill out a requisition. On that form, I put my name, pager number, the physician's name, and the mother's date of birth and personal health number. I also write for the order "Type infant cord blood for screening of Rh negative mother."
  4. Now that you have all your supplies together and the tube is labeled, take the cord blood before inspecting the placenta. Pull the placenta out of the bowl and put it on the blue pad so that it is sitting on the counter with the cord draped over the edge of the counter; the clamp is on the end of the cord. You want to keep the label of the tube clean and legible, so you may want to change your gloves or wipe blood off them on the blue pad's edge. Take the lid off the tube and hold it at the clamped end of the cord. Take off the clamp and allow the blood to run into the test tube. When a half-inch of blood has accumulated in the bottom of the tube, close the tube and rock the blood back and forth. If you can't get enough blood you may have to squeeze the blood down from higher up in the cord. Occasionally you may have to run the 3-cc needle into one of the vessels on the fetal side of the placenta, draw back on the plunger to extract the blood, and then squirt it into the test tube.
  5. Now you can do a complete inspection of the placenta and then put it away with a lid on it in the refrigerator.
  6. When you take the test tube to the lab, ask the technician to page you with the results as soon as possible. If the baby's blood is Rh negative, ask the lab to fax a copy of the record for your records. If the baby's blood is Rh positive, the lab will require a blood draw from the mother's arm. The maternal sample is taken to the lab and checked for baby's blood cells. If there are none in the mother's blood, a low dose (120 micrograms) of WinRho (Rhogam in the United States) is given. If baby cells are present in mother's blood, I have had as many as 900 micrograms prescribed. The package includes instructions on how to give the injection intramuscularly. It is given into the large muscle on the upper outer quadrant of the thigh. If you have to give more than 300 micrograms, you must give it in multiple sites. Injecting anything under the skin can cause harm, so be very careful you are sure of what you are doing and that you've had good instruction.

"Collecting Cord Blood: Guide for Student Midwives," by Gloria Lemay, The Birthkit Issue 35


YOU CAN PURCHASE BACK ISSUE 35 of The Birthkit, Midwifery Today's between-issues newsletter! Go here.


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Web Site Update

The advertising opportunities flyer for the conference in Germany is now online in PDF form.

Read these reviews of important books about birth newly posted online:


Forum Talk

I am setting up a group practice next year and am keen to hear how others have structured their practice to enable a better life/midwife balance. This has come about after watching many good friends burn out or develop major health problems whilst struggling to provide one-to-one midwifery care. 24/7/365 on call is simply too much, and no other profession calls for it. I am hoping to establish two teams of two in which each team has a number of women to provide care for and each member has one week of P/N and A/N and evenings/weekends off, whilst the other team member is on call for births, backed up by the on-call of the other team, if that makes sense. It would mean that once a fortnight you would have a long weekend and seven nights in your own bed, uninterrupted, yet still be able to practise midwifery.

Megan


Go to our forums to share your thoughts and experience.


Question of the Week (Repeated)

Q: I am 36 years old and the mother of an 11-month-old boy. I was induced twice for his birth because I was late by two weeks, and he was born by c-section. I think I have conceived again. Will the baby and I be okay? Is it too soon after a cesarean to be pregnant again? Might I have any complications (problems)? At times I have backaches.

— Jane


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

Regarding episiotomy [Issue 6:17]:

A: I am a midwife with 10 years experience currently working in a tertiary hospital in England. Until recently I was an independent midwife in New Zealand where I had practiced for seven years. My philosophy is to promote normal birth and to use minimal intervention.

I very rarely cut an episiotomy, and when I do I use the smallest cut—as long as the opening is such that the baby is born with the next contraction. The times when I have felt an episiotomy necessary have been in the case of fetal distress and also in cases where the perineum has been very rigid and ungiving. Usually you can tell this when there is no progress when the head is on the perineum and the perineum will not stretch while the woman is pushing. If you feel the perineum when the woman is pushing there is no give or stretching of the perineum and a lot of pressure is building up from the head wanting to come through.

I attended a birth recently where this was the case but chose to wait a little longer to see if the perineum would stretch. It was against my intuition but I thought not to cut, and wait. The baby was born with the next few contractions, but as the baby crowned I could see the perineum just tear. There was also some bleeding just prior to the head crowning that came from the top of the perineum. After the baby was born the woman proceeded to haemorrage from a paraurethral tear and had to go to theatre to repair a third-degree tear. The blood loss was more than 2000 mL, and the damage to the urethral and clitoris area was extensive. The woman was Asian. A colleague says that with Indian and Asian women an episiotomy is often necessary as they seem to have tight perineums. I had not worked with many Asian or Indian women in the past so had no experience of this.

So for that woman it would have been better practice to cut an episiotomy when I felt to and trusted my intuition instead of feeling the midwifery thing to do was not to cut. It would have saved the damage to the perineum as well as the blood loss that resulted.

For me it was a lesson in trusting my experience and intuition as a midwife and doing the best for the woman and baby. As midwives we never stop learning and growing in our practice. I think we should always be reflecting and practicing according to what we have experienced and what we know is the best practice.

— Julie Watson

A: As a midwife, one day you will know it is time to do an episiotomy and you can do it. I was once told this by a midwife of more than 30 years those exact same words. I too stated that I don't think I could do that. Little did I know, a week later, I would be eating those words and doing exactly as I stated I could never do. In my particular situation, mom had been pushing for about 2 to 2-1/2 hours. We tried every position there was, including squatting, toilet, bed side, lithotomy—every way there was. No prior perineal massage was performed despite extensive counseling to do so. I was working with her perineum as much as possible, trying to get it to stretch as the head was crowning. Her perineum was bulged out as big as the baby's head and still was not giving. Heart tones were no longer palpable due to the descent. Baby's color was a deep, deep purple/blue. It was at this time that we decided to cut as it was quite evident the baby was lacking oxygen and going into distress. Had the baby not been going into distress, I would have continued to try to get her to stretch. When you see the baby in distress and not coming, you know it is time to cut and you will be able to do it. The baby's life is in your hands by that point. Mom was on a very strict soy diet, and I often wondered if that kept her perineum so healthy that it just would not give. I had prior to this always said that those perineums will stretch when given time and gentle care.

— Lorrie Stanley, CPM

A: Whenever I hear stories like this, the first thing I wonder is, Why was the mother pushing for four hours? Was her body itself initiating and taking on the work of the pushing, or was she bearing down purposely because the midwife told her it was time to? Then I wonder, Was there something (e.g., inhibition, vaginal exams, perineal massage/support, verbal coaching, etc.) interfering with the body's ability to release the hormones that would have allowed the perineum to stretch?

— Linda Hessel


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


Think about It: ACOG

Marsden Wagner, speaking at the 2001 ICAN conference, said that the American College of Obstetricians and Gynecologists (ACOG) is really a trade union. As such, its primary goal was protecting the interests and income of its members. If that happened to coincide with what was best for mothers and babies, well and good. If it didn't, it was mothers and children overboard.

In the 1990s ACOG's leaders woke up to the conflict of interest between promoting evidence-based care and ACOG's prime directive: benefiting OB/GYNs. They then deliberately changed course to wield ACOG's clout and credibility on behalf of OB/GYNs and to hell with evidence-based care.

Wagner went on to say that we shouldn't be allowing ACOG to regulate maternity care any more than we allow the auto workers' union to regulate car safety. I would take his thought further.

As regards safety, an even better parallel than the AFL-CIO would be if tobacco companies had their scientists conduct research on cigarettes, they published studies concluding that smoking has benefits, they buried studies showing that smoking had hazards, and then they wrote the rules that governed their liability in lawsuits. The situation is actually worse. Unlike what would be the case with tobacco companies, no one suspects ACOG or its academically credentialed obstetricians of an ulterior motive. Anything ACOG or its minions say is uncritically swallowed whole. It's a sweet arrangement, although not, of course, for women and children.

Henci Goer, excerpted from "The Assault on Normal Birth: The OB Disinformation Campaign," Midwifery Today Issue 63


Question of the Quarter for Midwifery Today Print Magazine

We hope you'll take a minute to consider the Question of the Quarter for Issue 72 of Midwifery Today. In fact, if you send us a response and we use it, we will send you a free copy of the next issue. Responses are subject to editing for space and style. Try to keep the word count at less than 400. E-mail responses, along with your mailing address, to: mgeditor@midwiferytoday.com.

Theme for Issue No. 72: Prematurity and Postmaturity
Question of the Quarter: Do you do anything to prevent preterm and/or post-term pregnancies? If so, what? If not, why not?
Deadline for submission: September 15, 2004.

Question of the Quarter is a feature of Midwifery Today magazine, E-News's parent publication. Responses will be printed in Midwifery Today magazine. Subscribe.

Write to us! (See writer's guidelines.) We love hearing from you!


Feedback

Regarding high-protein diet and conception [News Flashes, Issue 6:17]:

Generally, I find yours to be a very reputable publication. This being the case, I was surprised to find this item presented as news. The only animals the results of this study can possibly matter to are mice and other herbivores. The researchers were extremely sloppy in using this study to draw conclusions about the omnivorous animal known as the human being. In fact, higher protein diets such as Atkins have even been shown to aid conception in folks with certain health problems. As example, I conceived with no problem at all while on the Atkins Diet, conceiving the very first try.

H.J.

Just a note: This falls under the category of fad diets such as Atkins and backs up the research that balanced protein/carb diets are best for moms. The Brewer diet falls under the balanced diet category. Remember, it is not just protein!

Amy V. Haas, BCCE


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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