|January 31, 2007|
Volume 9, Issue 3
|Midwifery Today E-News|
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In This Week’s Issue:
Quote of the Week
"Integrity commits itself to character over personal gain, to people over things, to service over power, to principle over convenience, to the long view over the immediate."
— John C. Maxwell
The Art of Midwifery
Due to overharvesting and habitat destruction, many of our community's best-loved herbs are at risk of disappearing forever. A study conducted by over 16 organizations over the course of 20 years found that almost one-third of the plant species of North America are now so rare that they may become extinct within the next few decades. Many of these plants are medicinal herbs that are being wild-crafted to death.
If you feel you must continue using plants that are threatened in the wild, purchase only cultivated sources. Read labels and refuse to buy at-risk plants that have been wild-crafted. Let your herb suppliers know you won't buy endangered species and would like organically grown sources of your favorite herbs. If you wild-craft your own plants, carefully watch the impact of your harvesting over the course of several years. Stop gathering plants from populations that fail to recover quickly after harvesting.
— Mary Lou Singleton
If you would like to learn more about endangered herbs and what you can do to help solve the problem, order this issue of Midwifery Today.
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.
Passionate Midwifery Education
Elizabeth Davis, Part III
In her education seminar, Elizabeth Davis talked a lot about the circle of women and its importance. Explaining how women think, she said that women in a stress response, as you may know, tend and befriend. The circle is needed to keep the community healthy. Women need female circles. We mirror beauty and love from friends. Students are asked to give an overview of what midwifery is, what it looks like and how we respond. In the circle we reward not only academic learning, but the ability to see and draw out our value. We continually check in. What a wonderful addition to learning midwifery these circles can be.
The main ground rule is confidentiality. Another is that each member has the right to pass rather than speak. The overall idea of the circle is: Healer, heal thyself. We work to keep alive the passion in our calling.
Elizabeth spoke of "educating dragons." The reference is to people we have to deal with throughout life such as a head nurse or difficult doctor, and even at times a sister midwife. She says a midwife needs to "run oxytocin" herself. In other words, calm breeds calm.
"We want our students to learn a foreign language—the medical model world." She has students learn how something feels by role playing. She teaches compassion by having students role play each person in the room: doctor, midwife, dad, mom, pediatrician, nurse. These drama scenarios are great learning experiences.
Wisdom is a hard quality to calibrate; it resides within every woman. See if your training program will institute student circles. The wisdom passed and shared will be a passion producing fuel for learning.
— love, Jan
To read all installments of our column on midwifery education, go to our Better Birth and Babies Blog.
Natural Labor Induction
Before considering artificial induction, women may choose to investigate natural, non-invasive methods of encouraging labor when forty to forty-three weeks pregnant.
The simple act of lovemaking before or during labor facilitates a quicker birth and can trigger the onset of labor. When a woman is sexually stimulated, oxytocin flows through her system causing her uterus to contract, either in the form of orgasms or labor contractions.
Pulsatilla is a common remedy used in labor. It can ease the pains of pre-labor (also called false labor) if taken in 200C potency every two hours for a maximum of three doses. If a woman is ready for labor, her contractions will become consistent and more powerful; if she is not ready, the contractions will cease.
Evening primrose oil aids the ripening or softening of the cervix, preparing it to dilate. It softens the cervical tissue, which is very useful, when there is scar tissue from a previous surgery, abortion or damage from contraceptives (such as IUDs). It can be taken orally in a dose of three to six capsules per day and, like male seminal fluid, helps lengthen the pelvic ligaments so the baby's head can engage properly in the pelvis. This will aid the process of dilation and can contribute to a quicker, less painful birth.
Using evening primrose oil may be a wise course of action for women who have had previous c-sections for failure to progress or who have labor that starts and stops.
— Marnie Ko, excerpted from "Natural Alternatives to Induction," The Birthkit Issue 22
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Research to Remember
A qualitative study of 27 women in BC, Canada, 20 of whom experienced some pregnancy-induced nausea, investigated the use of three herbs for their anti-emetic properties. All three of the herbs—ginger, peppermint and Cannabis—have been found to be clinically effective against nausea and vomiting in other medical contexts, e.g., chemotherapy. Despite safety concerns expressed in the medical literature, this small study failed to find clinical evidence of harm in their use by pregnant women.
— Complement Ther Nurs Midwifery 10(1):30–36. Feb 2004.
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Question of the Week
Q: Women being discharged from hospital receive almost universal postpartum instructions to avoid tub baths. I suspect that long ago some OB thought this sounded reasonable and it was repeated from generation to generation till it became etched in stone ("common" sense?).
I rather think this is hogwash but have no evidence one way or the other. Apart from the studies cited about women in labor with ruptured membranes NOT having increased infections caused by tub baths in labor, does anyone know of any evidence supporting or discrediting the theory that bath water gets up into the vagina (postpartum or otherwise)?
— Susan Robinson
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Question of the Week Responses
Q: What do you recommend for pregnant moms who are dealing with mild depression, mood swings and blues?
A: I would recommend that the mother supplement with an omega-3 fish oil. Not flax or walnut oil, but fish oil from a pure and sufficient source. www.innatechoice.com or Carlson Labs both make quality products.
The human body can't make enough EPA/DHA from plant sources like flax seeds. It is crucial for mom and baby to be getting enough because it is a fat required for developing brains and nervous systems.
Moms get the short end of the stick because they transfer a large portion of their omega three's to the baby—hello, depression and the blues. Start supplementing (1000mg EPA/DHA) each day for mom and the baby will get it through the breast milk.
— Dr. Drew Kaminski
A: If a new mom has mild depression, mood swings and the blues, first a full evaluation is important. Many free brief screening tools like PHQ9, Edinburgh PP depression scale, and Zung and Hamilton can be used to evaluate level of depression. Also the practitioner should always rule out a physiologic cause like hypothyroid or other endocrine imbalance. What about anemia? If her H&H are low she may need a nutritional evaluation to supply necessary nutrients. Please evaluate for suicidal thoughts, intention and plan. Document all of your findings.
For mild and transient symptoms, 30 minutes or more of exercise a day helps. A brisk walk with or without the baby is a great way to begin. If weather is a problem seek a nearby school, gym or mall for walking.
Social support is essential. If a new mom is able to identify a supportive person who she can share her feelings (truthfully) about new motherhood it can be an enormous relief. New mothers are under much pressure to have life in order quickly and many are overwhelmed.
Evaluate sleep. If the new mom is not getting adequate sleep, she may experience mild depression, mood swings and the blues. Have family members, etc., provide support so that she can get adequate rest. A light box will often help people who have seasonal affective disorder so this is an option to consider.
If the above interventions do not work and the new mom is amenable, some herbal interventions like St. John's wort and/or rhodiola may be helpful. I would have the new mom consult with a knowledgeable midwife/herbalist to assure proper dosing and evaluation if she is breastfeeding. Try to avoid SSRIs for mild symptoms!
— Lorraine B. Sanders, CNM, APRN, BC, DNSc
A: I recommend a couple of sessions of Cranio Sacral Therapy (visit www.upledger.com). It helps to relax, to fill the body needs and to restore harmony in the body structure and expression of the emotions surrounding birth and postpartum.
— Laura Cao-Romero
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
The powers that be recommend active management of third stage (cord cutting and placental delivery) where Pitocin is given, the cord is clamped and cut immediately (within two minutes of birth), and the placenta is delivered immediately. This is done out of fear of polycythemia, jaundice and hemorrhage.
Babies also are commonly given a prophylactic shot of vitamin K after birth to prevent hemorrhagic disease, because they have naturally low levels of vitamin K after birth. (Note: Vitamin K is produced in the gut once the baby has received adequate breast milk.)
Polycythemia is essentially an excess of red blood cells (RBCs). High numbers of red cells increase the blood's viscosity. Blood flow to organs is reduced and, in rare cases, blood clots can form.
So, what if the whole reason that babies are low in vitamin K, is because polycythemia is normal after birth? In other words, perhaps the human system was designed so vitamin K should be low naturally to counteract the excessive RBCs. Are we creating new problems by altering the normal physiological balance of the mother/baby disconnection?
Perhaps the reason active management works, to a certain extent, is that prophylactic vitamin K is given. So if we have a natural physiological third stage, would we then be creating additional problems by giving vitamin K? OR should we develop new rules that say if you are doing active management of third stage—yes, you need vitamin K; conversely, if you are practicing a natural third stage then there is no need for additional vitamin K?
Feedback is welcome!
— Amy V. Haas, BCCE
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