February 28, 2007
Volume 9, Issue 5
Midwifery Today E-News
“Urinary Tract Infections”
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This quarterly newsletter has the same kind of information as Midwifery Today magazine and the same focus on safe, gentle birth, but is more relaxed and informal. This makes it perfect to pack in your birth bag or purse to read when you have a few minutes spare time, or to put in your waiting room to share with your clients. Back issues


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Attend two full-day sessions on Traditional Midwifery and discover what our sisters from Central America have to teach us. You'll learn traditional techniques for dealing with shoulder dystocia, hemorrhage, posterior, postpartum care and more. You'll also participate in a discussion about ways to preserve and strengthen midwifery, and ways to institute birth change when needed. Go here for more information and a complete program.


Send submissions, inquiries, and responses to newsletter items to: mtensubmit@midwiferytoday.com.

In This Week’s Issue:


Quote of the Week

"Lysol-loyal hospital staff are worried about the germs your children carry with them, but it is the germs carried by staff and ever present in the infectious hospital that are truly to be feared."

Jock Doubleday


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The Art of Midwifery

When we consider perfect trust in birth, we must be careful not to ask for perfection in birth. Some babies will die. We will never be able to force some of these babies to live. I'm not saying we shouldn't learn preventive healing or use medical assistance to ward off problems before they get worse. I'm simply saying that, as a midwife or birth assistant, a day will probably come when you encounter death. As difficult as it is to acknowledge, we would be wise to accept from the beginning that the entire process of birth is a miracle of immense proportions, and that although our bodies are able to undertake it, sometimes that miracle takes its own path.

— Karen Salt, Midwifery Today Issue 44


Midwifery Today Issue 44 can be purchased.

For another take on trusting birth, see "Trusting Birth Even More" by Carla Hartley in the upcoming issue of Midwifery Today (Issue 81, Spring 2007). Subscribe and make sure you receive this issue.

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.


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Urinary Tract Infections - Helpful Hints

While pregnant, it is possible to have a UTI with little or no symptoms. If not treated, a urinary tract infection can be dangerous to you and your baby during pregnancy. Pregnant women should heed the following suggestions to minimize the risk of acquiring a UTI.

First things first, after you've gone to the bathroom, pay attention! Do you wipe from the back to the front? If you do, you are wiping bacteria from around your rectum into the vaginal area. This can cause vaginal infections or irritations and/or urinary tract infections. Learn to wipe front to back.

Secondly, do you hold your urine when you feel you need to go? Research has determined it is unsafe to hold your pee. If you feel the need to pee, do so. Holding it can cause an accumulation of bacteria in the bladder which increases one's risk of acquiring a UTI.

— Lisa Goldstein, excerpted from "Urinary Tract Infections—Helpful Hints," The Birthkit; back issues


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Research to Remember

A review of studies regarding the use of cranberry juice in the treatment and prevention of urinary tract infections (UTI) suggests that it works by preventing bacterial adherence to cell surface membranes. Although no trials support its effectiveness in the treatment of UTI, recent randomized controlled trials show that it can be effective in preventing UTI. In addition, the authors pointed out that it is "a safe well-tolerated herbal supplement that does not have significant drug interactions."

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Read Gentle Birth, Gentle Mothering by Dr. Sarah J. Buckley for information that will help you make intelligent, informed choices. Dr. Buckley combines the best medical evidence with her experience as a mother of four to give you advice and information that will help you have a safe, natural birth and start you on the road to gentle parenthood. Topics covered include epidurals, Caesareans, ultrasound, prenatal diagnosis, attachment parenting, extended breastfeeding, co-sleeping, doing without diapers, yoga and gentle discipline. Order the book.

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Midwifery Today Magazine Issue 68Want the whole story? Subscribe to Midwifery Today magazine and four times a year you'll receive 72 pages filled with complete articles, birth stories, stunning birth photography and more. Midwifery Today E-News is just a taste of what you'll find in Midwifery Today magazine. Subscribe.



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Question of the Week

Q: I will be getting pregnant soon, and I want to treat my contracted pelvis condition before getting pregnant, to avoid the dangers of dystocia. It got contracted while doing a series of seated bent leg poses, and I know my pelvis can open up again. Any advice on how to proceed?

— Pascha


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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Question of the Week Responses

Q: I need some advice in dealing with/assisting a private client. She is prone to premature births, hyperemesis gravidarum (HG) and pre-eclampsia, and has celiac disease (she cannot eat wheat). (I am aware that the pre-eclampsia is a result of the hyperemesis and malnutrition, and was attempting to help prevent it.) However, I noticed she has a history of eating disorders and is exercising 1–1/2 to 2 hours a day.

Alarm bells have started to ring in my head as I read about how debilitating HG can be. If she is that sick now, how can she keep going? She refuses to be hospitalized, although she spends at least one day a week there being tested. I suggested she cut her cardio down to 30 minutes a day (rather than an hour and a half!), and substitute Tai Chi or yoga. Everything the doctors have tried has seemed not to work (including Zofran). When she started forcing herself to eat regularly her vomiting increased from five times a day to 15. I've done quite a bit of research on the disease and ways to help, but apparently nothing I or anyone else has suggested works or helps in the least. Any thoughts or suggestions? I'm stumped with this one.

— Amy Haas

A: I have a friend going through a similar situation. This is her second pregnancy with HG. During her first, a central line was placed because of frequent hydration and she was hospitalized at least monthly without weight gain. This pregnancy has seen only one visit to the ER, but a lot more medication, social support and new coping strategies that seem to be helping.

Hyperemesis has been linked to unresolved emotional issues and many times these emotional issues control our lives during highly emotional periods, such as pregnancy. Severe nausea and vomiting during pregnancy can leave the mother feeling helpless and unfit, leading to further attempts to control both her body and environment.

Recent research has indicated that the use of antidepressants in cases of severe HG can be extremely helpful. The following link has multiple sites for information gathering: http://www.helpher.org/hyperemesis-gravidarum/impact-hyperemesis/index.php

There is a link between postpartum depression and HG, which may mean that treating the psychiatric symptoms of HG can reduce the incidence or severity of PPD, however this is still under investigation.

Within my search, the most poignant stance seems to be that of support and not contradiction. To these women, regardless of cause, their symptoms are serious and deserve compassion and relative medical treatment.

Is it possible that this client may benefit from specialty care such as a perinatologist instead; and that this care coupled with emotional support and possible counseling would help her in empowering herself?

— Chantel Haynes, Doula
Minnesota

A: Your client doesn't have history of an eating disorder, she has an eating disorder! It was present before she got pregnant. She needs counseling around body image issues and healthful eating. She may also have some ambivalence about being pregnant. Anyone who is not a professional athlete who is doing that much cardio while pregnant has some kind of mental/body image disorder. And even a professional athlete would not do that. She is endangering her health and most likely that of her baby. Not eating well while pregnant and nursing is a sure way to get severe osteoporosis! Get her to counseling fast.

— Kathleen Metzler, RN
Supporter of homebirth and midwives

Follow-up: Thank you to all of the wonderful people out there who contacted me with information on my client with hyperemesis gravidarum. As expected the woman gave birth at 34.5 weeks to a 5 lb baby boy, due to PROM and infection. The mom went home almost immediately, and the baby was in the hospital for about a week. He is now home on an apnea monitor, but otherwise doing well. I was able to visit with them and assist the mom with some breast feeding issues.

Sadly, I believe this woman may actually have had not hyperemesis, but bulimia. There were quite a few clues, including the absence of that debilitating fatigue so common in hyperemesis, excessive exercising, the inability to keep down water, along with her past history and personality profile. I think it's important that all care providers take a thorough history, and really look at each woman as a whole, as opposed to assuming the most common answer. Unfortunately, not only did she come to me late in the game, but all the counseling in the world about proper nutrition would not make a difference if the bulimia was not addressed.

I wonder how common eating disorders are during pregnancy? All the literature I saw speaks of it as a past problem.

Thank you!

— Amy V. Haas


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.


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Think about It

Risk assessment is an integral component of midwifery care. As long as I've been in practice, some sort of form has been in use to determine a pregnant client's "risk" for complications. If a client scores under a certain number, she is "low risk." If she scores over a certain number, she is "high-risk." There is nothing in between. From my perspective, the "nothing in between" makes this system fundamentally incorrect.

— Katherine Jensen, excerpted from "Reconsidering Risk," Midwifery Today Issue 74


MIDWIFERY TODAY ISSUE 74 can be purchased.


Feedback

I send my blessings to the mamas who burn out the lights with labor, to the mamas who push their babes out onto the floor and scoop them up, to the mamas who pound their fists with every contraction and refuse to push without the natural urge, to the mamas who hear their babe's first noise when only halfway born, to the mamas who only share the time with their babes on the inside and to the mamas who see their births getting better and better every time.

I encourage you all to share your stories and to seek the positive moments and spread them far and wide. Our culture truly depends on it.

I encourage everyone to see the video Birth as We Know It and share it with others. Elena Tonetti-Vladimirova tells a story of children watching butterflies hatch out of their cocoons. The children saw how hard it was for the first butterfly to emerge. When the second butterfly began to emerge they decided to make it easier and cut the cocoon open. The special fluids were unable to push out into the wings and the butterfly did not squeeze through the small opening. That butterfly never learned to fly. Birth is important in nature!

Patricia Couch
Lane County Birth Network
Eugene, Oregon


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This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.

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