September 28, 2005
Volume 7, Issue 20
Midwifery Today E-News
“Anemia”
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  • Impact of Childhood Sexual Abuse on the Birthing Woman, by Penny Simkin, PT (tape 932T1)
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In This Week’s Issue:


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Quote of the Week

"Do you as a midwife have the confidence, both in nature and in yourself, to do nothing? Try it at your next birth."

Vicki Penwell


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The Art of Midwifery

Every dad is different—some want to be very involved [with the birth of their baby] and some really want support. I like to ask dads two questions during the prenatal: first, What are your fears and concerns? Second, How do you see your role in [your partner's] labor? I always make a point to say, "If you see something I'm doing that you want to do, tell me." At the actual labor, most dads really appreciate being waited on a bit and cared for. Most appreciate a verbal How are you? if there is something unexpected happening. Some need reassurance and hugs.

Mary, 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 mtensubmit@midwiferytoday.com.

Research to Remember

A study that included 143 children with celiac disease* and 137 controls matched for age and gender and randomly selected sought to identify a link between duration of breastfeeding and age at which gluten is first introduced into the diet with the incidence of celiac disease. Researchers identified a 63% decreased risk for developing the disease when children were breastfed for longer than two months, compared with those who had been breastfed for less than two months. The timing of introduction of gluten into the diet had insignificant bearing on the rate of development of celiac disease.

Ann Nutr Metab, 2001, 45(4)

*Editor's Note: Celiac disease causes damage to the small intestine due to an inability to process foods containing gluten.


HypnoBirthing® Professional Labor Companion Workshop

Reno, Nevada: October 17–18, 2005

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This workshop is for HypnoBirthing Instructors who have never attended a birth, or would like more information on the mechanics of labor and birth, special circumstances, interfacing with the medical model and marketing.

Jenny West, LM, CPM, HBCE
(505) 294-4359, info@tubsntea.com, www.tubsntea.com, www.hypnobirthing.com

This workshop follows the HypnoBirthing(R) Instructor Training in Reno, NV by Aaron Aldridge 10/13–16/05; Aaron@HypnoSolution.com


Anemia

While it may seem easy to diagnose an anemic mother and prescribe a diet and supplements to bring her red blood cell level up to normal, several factors make diagnosis difficult. Determining anemia in a pregnant woman beyond her first trimester is complicated by her normally expanding blood volume. Hemoglobin and hematocrit tests show the ratio of red blood cells to volume of fluid (blood). As the blood volume increases, the number of red blood cells remains constant. The red blood cells are therefore spread thinner throughout the blood, resulting in a lower hematocrit reading. It is normal for the hematocrit reading to drop in the middle of pregnancy, an indication of increasing blood volume and stable red blood cell level.

Dr. Thomas Brewer, author of several books on nutrition during pregnancy, says that two types of women will have a low hematocrit reading at birth: women with excellent diets who have a well-expanded blood volume that shows a "false anemia," and women who are truly anemic and might also have low fluid volume. He is more concerned about a woman who is not taking iron supplements and whose hematocrit reading becomes high in her last month of pregnancy than a woman whose hematocrit reading remains low. If a woman is not taking iron supplements and has a high hematocirt reading in her last month of pregnancy, her blood volume might not be expanding enough for the birth, and this could lead to further complications. However, women living at high altitudes might have high hematocrit readings and not be suffering from anemia because the body makes more red blood cells to carry the extra oxygen needed at that altitude. Ideally, women should receive prepregnancy nutrition counseling, during which they can find out what their prepregnancy hemoglobin level is.

Iron and folic acid supplementation in combination will help increase the iron absorption rate and should help boost the iron stores of pregnant women. Unfortunately, many women have a difficult time keeping anything down, let alone hard-to-digest iron pills. Other women will have a difficult time absorbing certain types of iron supplements. Iron supplements can be changed and certain herbs can be added to the diet to enhance iron absorption. Educate women about alternative ways to get iron, including eating liver [Editor's note: organic liver], red meats, whole wheat grains, green leafy vegetables and legumes. A good diet is necessary.

Tina Raymond, excerpted from "Anemia: Diagnosis, Treatment and Prevention," Midwifery Today Issue 10


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Anemia is a common issue for pregnant women. It occurs when a lack of the vital nutrients vitamin B12, folic acid and especially iron causes a breakdown of blood cell membranes. Healthy and resilient cell membranes ensure that more nutrients go in and more waste gets out, in addition to protecting the cell from invasion by unfriendly microorganisms. The result is significant fatigue, lethargy, intolerance to cold temperatures, increased susceptibility to illness and dark circles beneath the eyes. The breakdown of blood cell membranes in anemia means the cells cannot do their important work of delivering oxygen throughout the body. This disrupts energy production and transport cycles, in addition to the natural means of defense from infection.

Iron, vitamin B12 and folic acid are readily available in supplement form. Following are some herbal options for boosting iron to nourish and rebuild the blood.

Single Herbs Rich in Iron:

  • Yellow dock root (Rumex crispus)
  • Dandelion leaf (Taraxacum officinale)
  • Stinging nettle (Urtica dioica)

Use these herbs in tincture form, 1 to 2 droppersful twice daily. Yellow dock and dandelion leaf have distinct flavors that may be too strong as a tea for some people, but nettle herb makes a wonderful infusion. Long-term use of nettle infusion is deeply nourishing and is an excellent ally for women who struggle with low iron and all types of anemia.

Deep Vitality Cordial (Iron Syrup)

  • ½ c blackberries
  • ½ c raspberries
  • ½ c rosehips (fresh or dried)
  • ½ oz yellow dock root
  • 1 oz dandelion leaf tincture
  • 1 oz nettle tincture
  • 3 c water
  • ½ c blackstrap molasses
  • ¼ c maple syrup

Boil the water, add berries and yellow dock, gently simmer for 20–30 minutes or until the liquid is reduced by half. Line a sieve with cheesecloth or muslin and place it securely over a large glass bowl. Pour the hot berry juice through the lined sieve, catching the strained juice in the glass bowl. Set hot berry mash aside and allow it to cool. Meanwhile add the sweeteners to the hot liquid and whisk until well blended. When this liquid has cooled, add the tinctures and remaining juice, which can be wrung from the mash through the cloth.

Store the syrup in a clean glass bottle and refrigerate. The molasses and alcohol from the tinctures act as natural preservatives. Take one tablespoon once or twice daily as needed.

Susan Perri, "The Importance of Iron and How to Correct Anemia" in The Birthkit Issue 34


Copper is involved in the absorption and transportation of iron and the synthesis of RNA, a substance essential to the reproduction of cells. Copper deficiency can interfere with the production of red blood cells. The anemia caused by copper deficiency causes small pale red blood cells, just like iron deficiency anemia—making the two deficiencies hard to distinguish, which can be very frustrating and perplexing to the client and prenatal care provider.

Because copper is abundant in the same foods that naturally contain plenty of iron, the client who is not getting enough iron from food sources will probably not be getting enough copper. Further, the anemic client who is sent home with a bottle of iron supplements and little or no information about dietary changes may well remain anemic. This is because most iron supplements and iron fortified foods do not address the fact that if a client's diet has been deficient in iron to the degree that anemia is apparent, the diet almost inevitably has been deficient in copper as well.

Foods high in copper: legumes (dried beans such as lentils and kidney beans), seaweeds, shellfish, salmon, organ meats, whole grains, wheat germ, rice bran, wheat bran, nuts and seeds, tomato juice, potatoes, avocados, currants, dried coconut, molasses and brewer's yeast.

Organically grown crops will tend to have a higher copper content than chemically fertilized crops.

Nutrients are interdependent; deficiencies or large supplemental doses of any one nutrient can often have a harmful effect on several other nutrients. Large does of zinc, vitamin C and iron can cause a deficiency of copper. Large supplemental doses of copper, on the other hand, can interfere with the absorption of zinc.

If a client chooses to use nutritional supplements, the copper content should be about 2.5 mg per day.

Althea Sever, excerpted from "Persistent Anemia: Copper's Role," Midwifery Today Issue 18


You can order these back issues:

MIDWIFERY TODAY Issue 10
THE BIRTHKIT Issue 34


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Web Site Update

The special subscription offer for students comes down from our Web site on Friday, September 30. Act NOW to get this subscription discount described here.

This article about the traditional Mesoamerican sweat bath and its perinatal uses is now online. Let your Spanish-speaking friends know! If you're studying Spanish, read it alongside the English version which appeared in Midwifery Today Issue 74:

Want more tricks of the trade? Read this review:


Forum Talk

I am a student midwife and currently seven weeks pregnant. I know that taking bioflavonoids helps make a strong water bag and placenta and prevents tearing and stretch marks. Is it possible to take too many? I am considering taking at least 900 mg a day along with 500–1000 mg vitamin C. Does anyone see that there would be a problem with this?

Moline


Go to our forums to share your thoughts and experience.


Question of the Week

Q: I am a mom of six and would like to find out how most midwives deal with GBS-positive mothers. Are there herbal remedies or are they destined to a hospital birth and IV antibiotics?

— Anon.


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.


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This is an international conference and all are welcome! Register on-line at www.blackmidwives.org or call 1-866-531-5981.


Question of the Week Responses

Q: I recently assisted a mom with a beautiful normal labor until she reached eight centimeters. Then her cervix began thickening and swelling all around. The baby was left occiput transverse (LOT), and mom adopted leaning-forward positions naturally throughout her labor. At the peak of contractions when at eight centimeters, she began some uncontrollable grunting/pushing, which I am sure contributed to the swelling more. We tried open knee chest and Trendellenburg while panting to get the baby off of the cervix, but nothing seemed to work. What other things have worked for others to reduce cervical swelling and the urge to push too early?

— Mary Callender, birth and postpartum doula, Richmond, Virginia

A: Put her in the water! Allowing her to float in a tub relaxes her, may help her dilate, and she's buoyant with less pressure on her rectum.

— Anon.

A: Try about 30 ml (medicine cup) of crushed ice. Put it into the tips of your two gloved examining fingers. Apply the ice lightly to the cervix that is swollen. Within a minute or two, the ice will melt. Then remove your fingers and continue your position changes and coaching mom. I have used this technique numerous times for a swelling anterior lip that will not reduce. As soon as the ice has melted, I am able to reduce the anterior lip, and the mother does not have to wait to push anymore.

Whenever we have a swollen injury somewhere else on our body, we use ice to reduce it. What amazes me is how quickly it seems to work on the cervical tissues.

— Lana Bernat, RN, BSN, MS


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.


Direct-entry Midwifery Program Info Sought

Do you know of or are you involved with a Direct Entry Midwifery program/school? We are updating our list of programs for Issue 77 of Midwifery Today. If you are involved in a midwifery program that began or moved in 2002 or later, please send us the name of the program, address, phone number, e-mail, other contact info and Web site. Please send your information to: mgeditor@midwiferytoday.com.


Feedback

In response to Issue 7:18 (theme, Cesarean Prevention):

We live in a world full of knowledge and scientific discoveries, and there is still no way to improve on what God originally made. No amount of money or pressure should force a doctor to pretend otherwise. It is sad to hear of people demanding or requesting c-sections and medical persons being at ease with that. It's about time we educate women that they are not ill and they chose to be pregnant!

Anon.

Recently I was doing some research and came across the following Web site for an organization that uses the same acronym as the International Cesarean Awareness Network (ICAN):
http://www.constipation.net/Chapters/4_CS_prevent.html

I was thoroughly horrified by the garbage I found there about vaginal birth and wonder if you are aware of this site. I have contacted ICAN and it is likely they will send something, but I would really like this Web site to be flooded with messages contradicting the doctor's bogus viewpoint.

Natalya Lukin, CPM, LM

Marsden Wagner is so right! Many women today seem not to know what is the endpoint of their pregnancy. From my experience the most frequent reason for asking for c-section is fear of pain, impatience to go through the process of birth and lack of knowledge. Because they did not prepare for the birth they expect the medical providers to act against their better judgment, and the doctors play into their hands fearing litigation.

Chava Alkalay

Saying that having a baby by planned cesarean is just another way to give birth is like saying that a colonectomy is just another way to have a bowel movement.

Amy V. Haas, BCCE

I have a feeling that in order to make the hospital's shareholders happy, few demands for sections will be refused. If there is a bad outcome and someone tries to hold the doc liable for unnecessary surgery, the lawyers will correctly say, "He/she did all they could—they operated!" Cesareans bring in so much money for the hospitals, most would be happy to see an 80% or more section rate—more if the clientele is covered well by insurance.

So this feeds a dirty pool—those like me who believe in less intervention are seen as neglectful or worse, and those who are doing the most harm are seen as the "saviors." This is so wrong. I think the ones who feel they are being "forced" into vaginal births will be the ones for whom there is no financial or research advantage for the institution. And those clients should be thanking God!

Cathi, aspiring midwife, doula, mother

I agree that c-sections are often unnecessary, but I also think that telling women how they can give birth is the beginning of a slippery slope on the issue of reproductive rights. If we say that a woman can't have an elective cesarean, then perhaps next we will say that a woman can't choose to abstain from prenatal vitamins or in fact do anything that her doctor or midwife does not advise. Education about the possible harmful side effects of c-sections is a better answer than blocking the medical option.

Isis, mother, student, future midwife

An elective cesarean is along the lines of a tummy tuck or breast augmentation. Certainly not all the medical care in the United States as well as internationally requires a medical indication. So, I do oppose a ban on elective surgery. However, I do think insurance companies that do not cover other cosmetic procedures, or even elective treatments that may have a significant impact on one's health (weight loss procedures, for example), should also decline to cover the cost of elective cesareans. It is also important that videoed and written explicit informed consent about the dangers to subsequent pregnancies (placental implantation over the scar resulting in placenta accreta, increased risk of prenatal uterine rupture, increasing unavailability of VBAC) as well as the dangers to the baby (increased incidence of respiratory distress) and mom (various risks of any major surgery and anesthesia) be required.

Fran Wilson, CNM, Kennewick, Washington


In response to Joy Hearn in Issue 7:18:

I have not had someone in my care present with the symptoms you are listing, specifically tightening of the chest, head and neck with onset of preterm contractions. In our practice, we would provide constitutional homeopathic care for someone in your condition. Your symptoms are rare and "peculiar," which would make a great case for homeopathy. While you may still have the tendency to birth your babies early, your unusual symptoms could be relieved and your overall state of health for both you and the unborn baby would be improved.

Andrea Mietkiewicz, RN, midwife, homeopath, Old Town, Maine


I am a midwife in France. I have been practising midwifery in hospital for eight years and attended my second homebirth a few days ago with another midwife with several years of experience in homebirth. The labor (second baby) went well, a little slow to start but went from 7 cm to delivery in 1 hour 20 minutes. The baby was 4460 g and came out occiput posterior (OP). The mother ended having a third degree tear, bad enough for us to transfer her to hospital for suturing—not a pleasant way to end a homebirth! Mother and baby are well today.

For her first baby she had had forceps and a large episiotomy, which healed with difficulties. Her first baby weighed 3600 g. This time she never suffered from back labor and did the end of her labor bending forward on her knees. Then she began pushing sitting on the toilet where she felt more comfortable, and then gave birth sitting on a birth stool. Did the sitting position encourage tearing?

We basically let her do what she felt like doing, taking the positions she wanted to take. The less we intervene, the better it is.

But maybe in this case I should have tried more actively to turn the baby. I expected a 4000 g baby, and while she was pushing as I saw the head crowning slowly and weirdly, I thought it might come out OP. As she was sitting I couldn't hold the perineum very well, and I encouraged her to push gently to help the baby crown very slowly. Should I have had her lie back to have a better view of the perineum?

I am ready to hear some technical advice from more experienced midwives.

Sabine


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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