|July 20, 2005|
Volume 7, Issue 15
|Midwifery Today E-News|
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This full-day pre-conference class will explore the past, present and future of midwifery in this vast region. Sections include Anthropology of the Caribbean with Robbie Davis-Floyd, Birth Change in the Caribbean and Projects and Programs for Humane Women-centered Birth. Part of our conference in Nassau, Bahamas, September 22–26, 2005. Go here for info.
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In This Week’s Issue:
Quote of the Week
"Keep your hands off and keep your hands out; keep the lights dim and the talking down. Expect normalcy."
— Vicki Penwell
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The Art of Midwifery
During the first prenatal visit I tell each client how keeping a journal can serve her. I begin with a few ideas:
— Dinah Waranch, The Birthkit Issue 46
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 firstname.lastname@example.org.
Research to Remember
A study to determine the potential pain-reducing effects of ice massage applied to various acupuncture points during labor included 49 pregnant women between the ages of 16 and 38 years. Ice massage, administered by way of crushed ice in a hand towel, was applied for 20 minutes or until the fourth contraction, whichever came first, to Large Intestine 4 (LI-4), located on the hand. The women rated intensity of pain during each contraction while the ice was applied; on a scale of 1 to 5, 1 indicated mild discomfort and 5 indicated extreme pain. A postpartum questionnaire revealed that pain had been decreased by 19% after ice massage was applied to the right hand and by nearly 50% to the left hand. LI-4 is located in the webbing between thumb and index finger on the back of the hand.
— Journal of Midwifery and Women's Health 2003; 48:317–21
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An exciting new international Master's programme aimed at qualified midwives wishing to enhance their professional standing with a postgraduate qualification from a leading UK university. Conducted part-time over three years, it is entirely online, with no travel/attendance requirements. You could join the next intake, commencing September 2005. Full details: www.sheffield.ac.uk/mmid Enquiries: email@example.com
It is after the birth of the baby and before the delivery of the placenta that women have the capacity to reach the highest possible peak of oxytocin. As in any other circumstances, the release of oxytocin is highly dependent on environmental factors. It is easier if the place is very warm (so that the level of hormones of the adrenaline family is as low as possible). It is also easier if the mother has nothing else to do but look at the baby's eyes and feel contact with the baby's skin, without any distraction. To be effective, release of oxytocin must be pulsatile: the higher the frequency of pulses, the more effective this hormone is.
Oxytocin is never released in isolation. It is always part of a complex hormonal balance. That is why love has so many facets. In the particular case of the hour following birth, in physiological conditions, the high peak of oxytocin is associated with a high level of prolactin, which is also known as the "motherhood hormone." This is the most typical situation for inducing love of babies. Oxytocin and prolactin complement each other. Furthermore, estrogens activate the oxytocin and prolactin receptors. We must always think in terms of hormonal balance.
The release of morphine-like hormones during labor and delivery is now well-documented. The baby also releases its own endorphins in the birth process, and there is no doubt that for a certain time following birth both mother and baby are impregnated with opiates. The property of opiates to induce states of dependency is well-known, so it is easy to anticipate how the beginning of a "dependency" or attachment will likely develop.
Even hormones of the adrenaline family (often seen as hormones of aggression) have an obvious role to play in the interaction between mother and baby immediately after birth. During the very last contractions before birth the level of these hormones in the mother peaks. That is why, in physiological conditions, as soon as the "fetus ejection reflex" starts, women tend to be upright, full of energy, with a sudden need to grasp something or someone. They often need to drink a glass of water, just as a speaker may do in front of a large audience. One of the effects of such adrenaline release is that the mother is alert when the baby is born. Think of mammals in the wild, and we can more clearly understand how advantageous it is for the mother to have enough energy and aggressiveness to protect her newborn baby if need be. Aggressiveness is an aspect of maternal love.
It is also well-known that the baby has its own survival mechanisms during the last strong expulsive contractions and releases its own hormones of the adrenaline family. A rush of noradrenaline enables the fetus to adapt to the physiological oxygen deprivation specific to this stage of delivery. The visible effect of this hormonal release is that the baby is alert at birth, with eyes wide open and dilated pupils. Human mothers are fascinated and delighted by the gaze of their newborn babies. It is as if the baby was giving a signal, and it certainly seems that this human eye-to-eye contact is an important feature of the beginning of the mother and baby relationship among humans.
— Michel Odent, excerpted from "The First Hour Following Birth: Don't Wake the Mother!," Midwifery Today Issue 61
MIDWIFERY TODAY Back Issues are available online. Order Issue 61.
For the past few decades, neonatal resuscitation doctrine has directed us to flood the lungs with high concentrations of oxygen instead of air in order to speed recovery from asphyxia. However, too much oxygen is a poison, and the body takes steps to protect itself. Putting 100% oxygen into a newborn baby's lungs is not the same as filling them with air. The body reacts to the difference. Tiny blood vessels spasm. The breathing center shuts down. The body responds by breathing more slowly and less deeply, or not at all. The hope that fueled the proponents of oxygen therapy has been that the extra oxygen will work so quickly it will short-circuit those reflexes. Oxygen resuscitation became accepted as standard of care in many regions, even though it was controversial.
The Resuscitation with Air (RESAIR) study first tested room-air resuscitation (RAR) on tiny newborns who were unlikely to survive regardless of whether they received oxygen. They then began to carefully test RAR on larger babies, always ready to switch to oxygen if needed. Preliminary results in 1993 showed no advantage in the group resuscitated with oxygen. The time of ventilation was shorter in the RAR babies, as was the time to first cry. Apgars and blood gases were the same.
Results of RESAIR 2, published in 1998, showed that first week mortality was 12.2% in the RAR group and 15.0% in the oxygen group. Neonatal mortality (28 days) was 13.9% in the RAR group versus 19.0% in the oxygen group. Death within seven days of birth and/or moderate or severe hypoxic-ischemic encephalopathy (primary outcome measure) was seen in 21.2% in the room air group and 23.7% in the oxygen group. Heart rates were the same among both groups at all times. Apgar scores at one minute were significantly higher in the room air group (5 v. 4). Apgar at five minutes averaged higher in the room air group (8 v. 7). There were more one-minute Apgar scores under 4 in the oxygen group (44.4%) than in the room air group (32.3%). More infants with five-minute Apgar scores under 7 were found in the oxygen group (31.8%) than in the room air group (24.8%). Acid base status was the same at all points. Average minutes to spontaneous breathing were less in the RAR group than in the oxygen group (1.1 v. 1/5). Average time to the first cry was shorter in the RAR group. RESAIR 2 concluded that asphyxiated newborn infants can be resuscitated with room air as efficiently as with pure oxygen. In fact, time to first breath and first cry was significantly shorter in room-air- versus oxygen-resuscitated infants. Resuscitation with 100% oxygen may depress ventilation and therefore delay the first breath.
Later data have shown that over-saturation with oxygen (introducing 100% oxygen into the lungs) reduced breathing efforts in all air-breathing creatures. Chemical receptors—markers for oxidative stress—can be detected in the baby's blood for weeks. Spontaneous breathing was delayed after oxygen resuscitation compared with room air. Oxidative stress was still detectable four weeks after birth in infants exposed to oxygen at birth, compared with the RAR babies. The oxygen group showed evidence of hyperoxemia during resuscitation. Researchers concluded that increased oxidative stress might have long-term effects on brain growth and development.
— Gail Hart, excerpted from "The Air We Breathe" Midwifery Today Issue 73
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The following herbs for common postpartum problems support mother in a holistic fashion. If she has been given any type of drug, properly research the drug and herb combination.
Mom will need extra nutrition postpartum, and this tea is a staple in my herbal and doula practice. It is rich in nervines, vitamins and minerals.
You Rock! Mamma Tea and Infusion
All hemorrhage mixtures should be made ahead of time.
If a woman is hemorrhaging, follow proper protocols and seek appropriate medical attention. Transport to hospital if the herbs are having no effect.
— Demetria Clark, excerpted from "Herbs for Mother's Care Postpartum" in The Birthkit Issue 44
ORDER THE BIRTHKIT Issue 44.
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Web Site Update
Don't miss the July 25 early registration deadline for our conference in the Bahamas in September. With this early registration, you may take a discount on conference prices.
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Does anyone use cord banders, and if so, what do you think of them? Ninety dollars is a big initial output, but I can't get metal clamps anymore and I hate the plastic clamps. The bander looks a lot more comfortable to the baby, and the latex thrown away is negligible compared to the plastic clamps. Thoughts?
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Question of the Week
Q: (Repeated) What experiences have midwife readers had with shoulder dystocia and brachial plexus injuries? What techniques have you used successfully and unsuccessfully to relieve shoulder dystocia? Have you ever seen a brachial plexus injury where there was no shoulder dystocia, the delivery was textbook, but still an injury?
SEND YOUR RESPONSE to firstname.lastname@example.org with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message. Responses to any Question of the Week may be sent to E-News at any time.
A few months ago I read that having the mom put her heels together (like frog legs) during pushing was an effective way to bring baby down. I used this method while birthing my youngest child, but didn't really remember that until reading your article. I am a doula and while attending a birth this week I suggested to the nurse this position. She said she would try anything once. Mom brought the baby down in just a couple of pushes. She pushed her first baby out in just a little less than 40 minutes. We used the "frog legs" position until crowning.
— Shelley Bailey, doula, Uniontown, Ohio
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