|October 12, 2005|
Volume 7, Issue 21
|Midwifery Today E-News|
“Alter-abled Women and Childbearing”
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Quote of the Week
"The way to prevent episiotomies is not to do them."
— Katherine Jensen
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The Art of Midwifery
If your client has hip pain during pregnancy, have her consider the following:
— Demetria, 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 firstname.lastname@example.org.
"House of Babies" New Discovery Health Series
A new 26-episode series "House of Babies," filmed at the Miami Maternity Center, will depict the joys and drama of midwife-assisted natural childbirth. Discovery Health Channel is launching previews this month.
Shari Daniels, director of the center, hopes that the series will prompt more areas to set up birth centers and encourage doctors to look at midwifery as a normal option.
The next episode, to air Saturday, October 15, is on VBAC. "Two couples are determined their first baby will be born naturally, despite fears and previous delivery complications. Nancy Jean underwent a caesarian section with her first child, but her second child was delivered VBAC—Vaginal Birth After Caesarian."
Research to Remember
Women with spinal cord injury (SCI) have been thought to have an increased prevalence of complications during pregnancy, labor, and birth. A study of 120 women with SCI revealed no significant differences between them and women without SCI in a number of significant areas: frequency of preterm labor 33% versus 22%), frequency of failure to progress (24% versus 18%), preterm delivery (29% versus 18%), or low birth weight (14% versus 15%). Of the women with SCI, 32% had autonomic hyper-reflexia, 38% had preeclampsia, 10% had gestational diabetes, 52% had bladder infections, and 29% had kidney infections. Fewer of the women with SCI (11%) had miscarriages than did able-bodied women (17%).
— Center for Research on Women with Disabilities
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Being conscious: Ask whether a woman needs assistance, rather than assume. The woman is the best expert on her abilities, her needs, and what assistance she may require. Find out as much as you can about the disability itself before meeting the woman. This will allow for maximum sensitivity in how you discuss her situation with her and also relieves her of being your teacher in this regard. You should be able to offer general information pertinent to her condition without being asked, while being open to hearing how she copes with her situation. Be honest with her about your previous experience serving women with disabilities. Don't try to pretend that the disability doesn't exist, and don't make a fuss over her because of her disability; make a fuss over her because she is pregnant and beautiful and full of all the hopes and fears and joys of motherhood, the same as any client.
If several midwives will be caring for the same woman, be sure chart review takes place consistently, that everyone takes responsibility for learning about the disability and that the disability is labeled prominently but discreetly in her records as a reminder. At the home visit, look over any adaptive equipment she may have and do some "dry-runs" for positioning and wheelchair transfers so the birth team can get a feel for what will be necessary during the birth.
Prenatal care: Women who have disabilities will need the same kind of support, information and encouragement as other women in your care. Some women may appreciate home visits for prenatals, affording them maximal accessibility and comfort for exams, etc. If a woman is paralyzed below her chest she may not feel uterine sensations; it will be important to point out how her uterus looks when a toning contraction is occurring. If she has use of her arms, she can learn to feel for both contractions and fetal movement with her hands. Similar adaptations will need to be worked out with the mother so she can experience her pregnancy as fully as possible.
Home or hospital birth? A woman with a lifelong disability may have had many painful or frightening hospital experiences; for many the idea of homebirth may carry special appeal. However, women who need major medical support or intervention to safely give birth or whose babies will need such support are best off birthing in a compassionate hospital setting. (For example, women who have cerebral palsy or spinal injuries may require drugs to relax their muscles to make yoni [vaginal] birth possible.) If the situation is borderline, get more than one opinion.
If homebirth is planned, ideally you will be able to arrange specific collaborative care with a hospital based practitioner if transport is required. The hospital staff should know of the woman's plans to birth at home and what her particular needs are regarding her disability should transport be necessary.
— Anne Frye, excerpted from Holistic Midwifery, A Comprehensive Textbook for Midwives in Homebirth Practice, Volume I: Care During Pregnancy
Because literature on childbearing with a disability is so sparse, it is difficult for midwives and health professionals to feel confident in caring for women with disabilities. A team approach using the diverse skills of a variety of health professionals can help. The woman herself is the best source of information on how to manage her specific condition. Physical therapists can assist with assessing the need for adaptations in the home for caring for a baby. And community health nurses are often aware of other women in the community who "have been through it" and who can act as a resource for the woman.
Pregnancy can be a time of disequilibrium for any woman. Women with disabling conditions may experience a double dose of it. The normal feelings of ambivalence that accompany early pregnancy may be prolonged for women who are unsure of both their physical ability and their emotional responses. They often need more time and opportunity to talk about the impact of pregnancy than "able-bodied" women do. On the other hand, some women are so excited about being able to carry out a "normal" function like childbirth that they move on very quickly in their acceptance of the pregnancy.
The fatigue of early pregnancy can be severe for women with rheumatoid arthritis, multiple sclerosis or chronic fatigue syndrome. And the feelings of dependence that so often accompany pregnancy, those feelings that allow the woman to contemplate herself and her body, are often difficult for women with disabilities. They have spent so much of their lives striving for independence that it is often very difficult for them to allow others to take care of them.
A discussion about the woman's feelings about her changing body shape will reveal whether she views those changes positively or negatively. Her response will depend largely on her comfort with herself prior to the pregnancy and on the effects of pregnancy on her comfort. For example, women with cerebral palsy or quadriplegia may have increased spasms and have difficulty maintaining their posture in the wheelchair. A wider chair may provide greater physical comfort.
Physical examination may be difficult for the woman with a disability such as vision or hearing loss or chronic illness such as cerebral palsy. The midwife should do as much of the exam as possible with the woman in the position that is most comfortable for her, or in her wheelchair if she wishes. She should be asked to bring a companion with her to the exam, one who is familiar with her transfer techniques. If the midwife is assisting the woman with transfers, time must be taken to learn the ways which are most comfortable for the woman. Braces, crutches and wheelchairs should be left close by.
Like most women, she may feel vulnerable during a breast or pelvic exam. Determine in advance what kind of draping, if any, she would prefer. The traditional lithotomy position is apt to be difficult for a woman with limited mobility. After determining the extent of a woman's abilities with respect to positioning, consider doing the pelvic exam in any of the following positions: knee-chest, diamond-shaped (on back with legs in diamond shape, no stirrups), side-lying, or modifications of these positions. If a spasm should occur during the pelvic exam, the midwife should support the limb or area in spasm and wait until it has gone away before proceeding. Spasms can be exaggerated if the woman is feeling anxious. A close presence, and thorough explanations, can decrease feelings of uncertainty.
— Elaine Carty, Tali Conine, Angela Holbrook, Lenore Riddell, excerpted from "Guidelines for Serving Disabled Women," Midwifery Today Issue 27
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Infant Attachment Experts & Baby / Birth Film Festival
November 11–12, Orange County, California
Please join the Childbirth Education Association of Orange County along with midwives, childbirth educators, lactation professionals, health care providers, doulas and parents as we come together to address current birth practices and their impact on mother/infant attachment. World-renowned presenters include Suzanne Arms, Sarah J. Buckley, MD, Wendy Anne McCarty, Marti Glenn and Mark Reiss, MD. Films showcased: "What Babies Want," "Giving Birth Challenges and Choices." November 11–12, Costa Mesa Westin. More information: www.ceaoc-conference.com (949) 300-0291
Products for Birth Professionals
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I remember someone once describing pelvic station as referring to centimeters. In other words, if a baby is at 0 station, the baby must descend 4 centimeters to reach +4 station (and be crowning). Are the stations really centimeters?
Go to our forums to share your thoughts and experience.
Question of the Week
Q: My baby was born with a tight triple cord, with red marks and bruising around neck, once born. We actually managed to get the cord over the head and free before birth. I was glad since I felt strongly that the cord shouldn't be cut early. After baby was born, the woman who managed the cord said she really believed she would not have been able make the cord slip over the baby's head if not for the watery birth environment reducing friction and sticky residue. Have other midwives found this to be true?
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II International Conference on the Humanization of Childbirth
Rio de Janeiro, Brazil
Also denominated +20+05, this event commemorates 20 years of the Conference on Appropriate Technology for Birth in 1985, and 5 years of the 1st International Conference on the Humanization of Childbirth, both accomplished by ReHuNa (Network for the Humanization of Delivery and Childbirth).
We welcome participants from Brazil and around the world who are interested in childbirth including women's organizations, consumers' organizations, educators, social scientists, administrators of health, politics, professionals, as well as pregnant women and their families.
Think about It: Convenience
Birth is not convenient. Labor is not convenient. And being a birth practitioner or a parent requires one to let go of the idea that pregnancy, labor, birth or parenting will ever be convenient. The worst of the false priorities, a desire for convenience, fuels a drive for inductions and cesarean sections with potentionally dire consequences. How many "convenience" inductions turned into labors in which a baby faced fetal distress? How many "convenience" c-sections resulted in a less-than-mature baby who had to stay in the NICU? How many "conveniently" induced or sectioned moms then had problems breastfeeding and had to use formula? Waiting for labor is inconvenient. Sometimes due dates and the weeks following fall during a scheduled vacation, but that's part of the nature of birth. It is just as bad for a midwife to strip a mom's membranes without asking or a doctor to use Cytotec to get a mom to labor before a scheduled vacation as it is for a mom to schedule an induction at 39 weeks because she's tired of being pregnant.
— Jennifer Rosenberg, excerpted from "Priorities in Birth," Midwifery Today Issue 64
MIDWIFERY TODAY Back Issues are available online. Issue 64
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.
— Cheryl K. Smith, Managing Editor, Midwifery Today
I am a young Kiwi woman, and I have just found I am due to give birth in Spain next April while my husband is there for work. It will be my first child, and I am desperate to get any information I can about the birth experience in Spain. Do readers have any contacts for midwives—preferably British—who might be able to help or any other information? I am desperate!
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