|January 5, 2005|
Volume 7, Issue 1
|Midwifery Today E-News|
“Alternatives for Breech Presentation”
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In This Week’s Issue:
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Quote of the Week
"A wise midwife does not pick unripe fruit."
— Gloria Lemay
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The Art of Midwifery
To turn a posterior baby: Have the woman lie on her left side with her left leg straight down and in line with her body and her right leg raised and brought up toward her face, head curled down toward knee. [I am short so having her place her knee on my shoulder is the right height and position.] During a contraction, push down and back on bottom leg and up and abducted with top leg. That seems to open pelvis and allows baby to turn with the contraction. I usually see a funny look on mom's face, and baby is on perineum immediately.
— Claudia Toms
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.
Research to Remember
An Ohio State University Medical Center study tracked stress experienced by 500 pregnant women. The researchers found that 188 women in the group who had children with autism had experienced stress levels during the 24th through 28th weeks of their pregnancy that were nearly twice those of the other study participants. The study identified life-altering events such as the death of a loved one, loss of a job, or a long-distance move as major stressors. Fetuses 24 to 28 weeks old appear to be more vulnerable to the effects of these types of maternal stress. Autism, a neurological disorder, now affects approximately one in 1000 children, and as many as one in 200 suffers from autism-related conditions.
— National Post Online, November 25, 2001
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Alternatives for Breech
Chiropractic Version: An International Chiropractic Pediatric Association (ICPA) study showed the Webster Technique was successful in resolving breech presentations 92% of the time. ICPA defines this technique as "a specific chiropractic analysis and adjustment that reduces interference to the nervous system and improves the function of the pelvic muscles and ligaments, which in turn removes constraint of the woman's uterus and allows the baby to get into the best possible position for birth." An ICPA spokesperson explains that the technique is "a means of preventing or limiting the potential of intrauterine constraint" that can prevent not only breech and transverse presentations, but also posterior and asynclitic ones. After a woman is assessed to determine sacral alignment, she turns on her back and the baby's location is determined in relation to her belly button. The trigger point for the rectus abdominus muscle is then found on the mom's left side and the chiropractors thumb is placed on this point. Pressure is exerted gradually and evenly straight down until the trigger point is found and pressure is maintained, but shifted slightly inward to isolate the broad ligament. As little as 3 to 6 ounces of pressure is often sufficient to induce relaxation of the trigger point. Pressure is maintained for a minimum of one to two minutes, more as necessary on evaluation of the trigger release, even up to 35 minutes. If little or no fetal movement is felt, some counter pressure with the opposite hand can be applied on the uterine wall opposite the side of the trigger point. Following the adjustment, the mother is again assessed for sacral alignment.
Acupuncture: A study has shown that the Zhiyin technique, which involves applying heat on an acupuncture point on the little toe, was successful 75% of the time compared with a 50% turning rate in the untreated group. The best time for this procedure is between 30 and 34 weeks gestation, although it can work as late as 36 weeks. For example, a woman at 35 weeks gestation with twins tried acupuncture needles and moxibustion (a process in which a grain-sized cone of dry, spongy substance made from mugwort is placed on the acupoints and lit with an incense stick. The burning moxa is then pinched out or taken away before it burns down to the skin.). The babies had been "everywhere but vertex—transverse and breech, breech and transverse, but after moxibustion they were lined up, heads straight down, lying next to each other." She had seen her acupuncturist about five times during a two-week period and also had had her husband burn moxa on the acupoint on her toe between appointments. She had a vaginal birth attended by midwives.
Hypnotherapy: A study at the University of Vermont College of Medicine compared 100 women with a matched comparison group and found that hypnotherapy was successful in turning a breech baby 81% of the time compared with 48% of the time in the untreated group. The intervention group had received hypnosis with general suggestions for relaxation and release of fear and anxiety. The women were asked under hypnosis why their babies were in the breech position.
Deep-Water Immersion: Susun Weed, author of Wise Woman's Herbal for the Childbearing Year, suggests finding a pool that's warm enough for total relaxation, one that is kept at a temperature higher than a regular pool. The woman gets into the pool, spends at least 15 minutes enjoying the water, then goes to a place in the pool where she can stand with her head just above water. She does five handstands in a row, ideally with a partner who can help her into the position. Simply swimming can also help the baby turn because of the stretching and crouching involved. It helps relax abdominal muscles to give the baby more room to turn.
— "Effective Alternative Treatments for Breech Presentation," by Julie Brill, CCE; Midwifery Today Issue 68
— MotherCare Canadian Birth Professionals
— Breech Birth,
by Benna Waites (Free Association Books, London, 2003)
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Web Site Update
You may now access biographies on our teachers and writers; there's a new link from the left panel of our homepage. Or you may go directly to the biographies. Includes photos and contact info on many.
This article about a Guatemalan midwife who began her midwifery career at the age of 18 is now online in Spanish. Let your Spanish-speaking friends know! If you're studying Spanish, read it alongside the English version which appears in the newest issue of Midwifery Today magazine:
I am a doula and childbirth educator and often feel "torn" when my client is 8+ cm with the urge to push at the peak of her contraction but is discouraged by the nurse for fear that the cervix will swell. This seems to go against all that I teach my clients—trust your body. I believe that nature doesn't fail when the woman is laboring normally. Does anyone have a take on this? Have any studies been done on this? Could the possibility of the "swelling cervix" come from women who get this urge early but are in bed with the baby's head pushing on one side of the cervix as opposed to a normal position?
Any information or links to studies would be greatly appreciated. I like to arm my clients with studies as they go into their hospital births.
— Michelle, CD, ICCE
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Question of the Week
Q: I recently had a c-section for twins because twin A was a footling breech. Unfortunately, I had to be put under general anesthesia because my platelet levels were too low to safely have an epidural. Is there any sort of homeopathic or herbal remedy that I might try to build up my platelets? My platelets generally are around 70 and have been that way for years, with 50 being the point where treatment is needed, but 100 is the cutoff to get an epidural. When I have another child, I would like to have a VBAC, but if it doesn't work, I don't want to have to be knocked out again.
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Question of the Week Responses
Q: Since giving birth, my hair has thinned to a tenth of its normal thickness. I had a normal birth, with no hemorrhage. Does anyone have suggestions how to stop my hair from falling out?
A: You have my sympathy. The same thing happened to me after each of my four pregnancies, starting at about two months postpartum. My hair fell out like male-pattern baldness—if I pulled it back in a ponytail you could clearly see the shape of a man's receding hairline. My mother told me that the same thing had happened to her. I assumed it was hormonal—maybe low estrogen from breastfeeding. After about six months it began growing back in, but it took about two years to reach its old thickness. The most frustrating thing was hearing people say, "Oh, you're just losing the extra hair you grew while you were pregnant," when it was so much more than that. I never found a solution other than patience.
A: Consider, among other things, whether you had a virus or infection recently. Scarlet fever caused me to lose more than half my hair months after I was sick. Also consider having your thyroid levels tested. Hair loss is just one of the many symptoms of a thyroid disorder. Last, if everything else is ruled out, it may be postpartum hormones. It took 18 months for my hair loss to slow down after my last baby. Taking high-quality vitamins seemed to help me.
— K. Hileman
A: When I researched and made inquiries about hair loss after my pregnancies, I learned that during pregnancy some women's individual hair strands stay attached longer. At about four months postpartum many new hair strands begin to grow, forcing the old hair to fall out. So what may seem to be a significant hair loss is actually an increase in new hair growth. It takes many months to feel that your hair is back to normal.
Another contributing factor can be a change in thyroid function and is something worth checking out if there does not seem to be an increase in new short hair coming in. I am sure other things can also cause hair loss, but most of the cases I have seen are the increase in new hair growth.
— Elaine Taylor, CPM, LDM
A: I also have had that problem, with handfuls of hair coming out after washing/brushing etc. An herbalist friend recommended nettle, which helped a little, but I found that it was just a matter of time and *really* looking after my hair [regular cuts, herbal shampoos, minimizing chemicals, etc.] that helped. Since becoming strict about shampoos has helped enormously, I have tried them all! I also regularly give myself a head/scalp massage, which also helps stimulate blood supply to the scalp.
— Joscelyn, London
A: Hair loss is a normal response postpartum, but if it is excessive in your estimation then go to a provider for a workup. At the bare minimum have your thyroid checked.
— Susan Wright, CNM, NP
A: Hair loss is very often related to low thyroid problems. I would ask several questions:
If the answers to these questions are "Yes," you are probably low thyroid. You can do a basal body temperature test to check for sure. For several weeks, take your temperature first thing in the morning before arising. It may be elevated at ovulation and your period. If your normal is 97.4 or below you are in the low thyroid range, even if it shows up as low normal on blood work. The best treatment from a natural perspective is Thytrophin PMG (3/day) and Iodomere (1/day), from Standard Process Company.
If you answer "No" to those questions and your normal body temperature is higher, one of the best things to help hair is Biotin.
— Judy, CPM
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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 73 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 if you are not already a subscriber. 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: email@example.com.
Theme for Issue No. 73: Changing Protocols
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In the birthing unit where I work we are attempting to keep birth and aftercare as a natural life event and regard our moms as well women. We ask mothers how they feel rather than rely on routine observations. However, the medical staff are now demanding that we do routine obs—T, P, and B.P., four hourly on all the women regardless of their method of birth. As we are trying to demedicalize birth I am interested to know what other maternity units do.
— Joy, Australia
In my opinion, not having been there, I would say that your midwife was correct in her assessment of the situation [Issue 6:25, Feedback]. I have had several occasions in which the cord was wrapped so tightly around that baby's neck that we had to cut it as well to facilitate the birth. Babies do not like such a quick transition, and some might need a little reminder to breathe, but in my experience there was no ill effect to the baby.
— A.M., direct-entry midwife
I was watching a birth on the Discovery Health channel in which the doctors were worried that the baby was going to have shoulder dystocia. I would like to become a midwife and have read about births and midwifery. I was appalled when the baby did get stuck, and instead of putting the birthing woman on all fours they just started to try pulling the baby by the shoulder, pushing the belly—it didn't seem too efficient. When the baby was born it had not breathed for four minutes, and they had to revive him. I wonder why they did not try the Gaskin Maneuver. Isn't it well known? Or what could be the reason?
— Stella Debiaggi
I am gathering information to write an article about twin birth. I have been getting a lot of feedback from twin mothers who were medically managed, but I need as large a sampling of homebirth/midwife managed twins as I can get for comparison. Midwives could either pass it on to their twin mothers or respond themselves, with identifying information removed (i.e., just the stats re: the questions on the survey for all the twins they've attended).
— Kim Wildner, CCE CHt, HBCE
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