|February 1, 2006|
Volume 8, Issue 3
|Midwifery Today E-News|
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Midwifery Today Conferences
Can We Have Liberty in Hospital Birth?
Attend the full-day class at our Philadelphia area conference in March 2006 and find out. Robbie Davis-Floyd, Lisa Goldstein, Marsden Wagner, Debra Pascali-Bonaro and Harriette Hartigan will teach you how to create a nurturing environment for women who are giving birth in the hospital. Go here for info.
"Soaking up Midwifery Knowledge"
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In This Week’s Issue:
Quote of the Week
"The overwhelming dominance of the obstetric paradigm has ensured the virtual silencing of dissent."
— Henci Goer
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The Art of Midwifery
Dropping a waterproof flashlight onto the bottom of the birth pool allows you to look for bleeding as well as meconium during a waterbirth. It also helps you spot floating debris so it can be removed from the water.
— Barbara Harper, Midwifery Today Issue 54
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.
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Botanical Medicine in Midwifery, by Susan Perri
Research to Remember
A University of North Carolina-Chapel Hill study of 1900 pregnant women examined the effects of the women's work schedules on pregnancy outcome. The women described work conditions such as number of hours a day they worked, how much of that time was spent standing, what shift they worked, and how often they lifted objects that weighed 25 pounds or more. The study found that pregnant women who worked a night shift at any time during their pregnancy had an increased risk of preterm birth compared with those who worked the same number of hours during the day. Those women who had worked a night shift during their first trimester increased their risk of premature birth by 50%. The researchers noted, however, that few of the women in the study had worked a night shift during their seventh or eighth month of pregnancy. The researchers speculated that working during the night may disturb the body's internal rhythm and therefore affect the usual activity of the uterus. The study also concluded that women who spend more than 30 hours a week standing or those who perform heavy lifting at least 13 times per week are at no increased risk for preterm labor or small-for-gestational-age babies.
— Obstetrics & Gynecology, December 1, 2005
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Waterbirth Tool Bag
In my tool bag as a water labor or birth labor assistant, I include extra equipment besides the standard labor assistant accoutrements:
— Judith Elaine Halek, excerpted from "Aquadurals and Douladurals Replace the Epidurals," Midwifery Today Issue 54
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The main recommendations are based on the fact that immersion in water at the temperature of the body tends to facilitate the birth process during a limited length of time (in the region of an hour or two). This simple fact is confirmed by clinical observation and by the results of a Swedish randomized controlled study suggesting that women who enter the bath at 5 cm dilation or after ("late bath group") have a short labour and a reduced need for oxytocin administration and epidural analgesia. Physiologies can offer interpretations. The common response to immersion is a redistribution of blood volume (more blood in the chest) that stimulates the release by specialized heart cells of the atrial natriuretic peptide (ANP). The inhibitory effect of ANP on the activity of the posterior pituitary gland is slow, in the region of one to two hours. When a woman is in labour this inhibitory effect is preceded by an analgesic effect that is associated with lower levels of stress hormones and increased release of oxytocin. Furthermore, it is partly via a release of oxytocin that the redistribution of blood volume stimulates the specialized heart cells.
The first practical recommendation is to give great importance to the time when the labouring woman enters the pool. Experienced midwives have many tricks at their disposal to help women be patient enough so that they can ideally wait until 5 cm dilation. A shower that more often than not implies complete privacy, is an example of what the midwife can suggest while waiting. The British Medical Journal survey (Aug 21, 1999) clearly indicates that many women stay too long in the bath (the average time was in the region of three hours for women who gave birth in water!). One reason is that many of them enter the bath long before 5 centimeters dilation.
The second recommendation is to avoid planning a birth under water. When a woman has planned a birth under water she may be the prisoner of her project; she is tempted to stay in the bath while the contractions are getting weaker, with the risk of long second and third stages. There are no such risks when a birth under water follows a short series of irresistible contractions.
The recommendations regarding the temperature should not be overlooked. It is easy to check that the water temperature is never above 37 degrees C (the temperature of the maternal body). Two cases of neonatal deaths nave been reported after immersion during labor in prolonged hot baths (39.7 degrees C in one case). The proposed interpretation was that the fetuses had reached high temperatures (the temperature of a fetus is 1 degree higher than the maternal temperature) and could not meet their increased needs in oxygen. The fetus has a problem of heat elimination.
One can anticipate that, if a small number of simple recommendations are taken into account, the use of water during labor will seriously compete with epidural anesthesia. Then helping women to be patient enough and enter the pool at the right time will appear as a new aspect of the art of midwifery.
— Michel Odent, MD, excerpted from "A Landmark in the History of Birthing Pools," Midwifery Today Issue 54
The temperature of the water is very important; it must stay between 86 and 95 degrees F. Ideally, it should be between 92 and 94 degrees F for late labor, 86 degrees F for placental delivery, and then warmed back up to the low 90s for breastfeeding. Under these circumstances, the following benefits accrue:
The mother must be in the water for at least thirty minutes before maximum effects are realized. After two to three hours, benefits as per hormone stimulation diminish. Advise her to stay flexible, and see how she feels about being in the water as labor progresses. Never put a cold cloth on her forehead to cool her if she gets too hot: cool the water down or have her come out. If she gets claustrophobic in the tub, or feels like she cannot get enough leverage to bear down, she should get out immediately.
… It is best to avoid touching the baby as it is born. If the mother is undisturbed, she will touch the head herself, and the baby will spiral out (literally pushing itself out with its feet) and turn to face her. It may expel fluid from its lungs (seen getting into the water), and may reach one arm toward her with the other bent, as if swimming (the asymmetric tonic reflex). Mom and baby will then make eye contact, and she and her partner can lift it and bring it to her chest.
— Elizabeth Davis, excerpted from Heart and Hands: A Midwife's Guide to Pregnancy and Birth,
MIDWIFERY TODAY Back Issues are available online: Issue 54
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Web Site Update
The entire program and registration form is now online for our conference in the spa town Bad Wilbad, Germany, October 2006.
The dates for the Eugene 2007 conference have changed to March 14–18, 2007. For our domestic conferences we are switching to the Wednesday–Sunday format of our International conferences. Watch for more information about upcoming conferences here.
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[Two friends and I recently miscarried.] The hospitals here insist on a D&C. Is it necessary? Better? Some say if they want to get pregnant again it might be better if they start with a clean canvas? We are all very healthy young women, two of us were RH-, but did have RhoGAM after our first. Information?
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Question of the Week
Q: What do you do to encourage women to trust birth?
— E-News staff
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. Write to email@example.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.
Think about It
When a midwife attends a birth, legally she is required to intervene. Although the law varies from state to state and country to country, generally it is safe to say that midwives must time contractions and measure dilation. If a labor is not progressing at the speed that some government officials have arbitrarily decided it should be, a midwife must choose between breaking the law and transporting the woman to the hospital. Even if a woman manages to give birth within the government's timeframe, there are restrictions on how soon after the birth the placenta must be delivered. … Most midwives will agree that the fear of prosecution is always in the back of their minds to at least some degree.
— Laura Shanley, excerpted from "What Some Women Don't Want," Midwifery Today Issue 63
Lots of women say they want to be midwives to be advocates for women and their right to choose how, when, where and with whom they give birth—but are those rights really the first thing midwives are concerned with? In this litigious time, I think not. The bureaucracy stands in the way of pure attended birth. To me, it is not desirable to have someone present in my home who is ultimately concerned with preserving her license. Part of that motivation to preserve the license may mandate things like fetal monitoring, vaginal exams and time limits—all things that have proven disruptive to the process.
— A.C., quoted from "What Some Women Don't Want," Midwifery Today Issue 63
Readers, what do you think? E-mail your thoughts to E-News at: firstname.lastname@example.org Letters sent to ANY OTHER e-mail addresses will not be considered. Enter the words "Think about It" in the Subject line.
MIDWIFERY TODAY Back Issues are available online. Issue 63
The Association of Texas Midwives annual conference "Trust in Birth" May 4–6, 2006 in San Antonio, TX. Presenting Marsden Wagner, Anne Frye, Barbara Harper, Penny Simkin and more! Visit www.texasmidwives.com for additional information.
CAM 2006 Annual Conference—Midwifery: Teaching Trust, Changing Stories. Come join us May 19–21, 2006, in Occidental, California for a magical weekend in the Redwoods. For more information, contact: Fawn Gilbride (707) 738-8747 or www.californiamidwives.org
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