|April 23, 2008|
Volume 10, Issue 9
|Midwifery Today E-News|
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Read this book to discover how sexual abuse affects women during pregnancy and childbirth and what you can do to help. You'll learn from the experiences of 81 women and find suggestions for working together during maternity care and beyond. The book includes resources and information from current research. Suitable for both caregivers and pregnant survivors, Survivor Moms will help anyone whose life has been touched by sexual abuse. Published by Motherbaby Press, a division of Midwifery Today.
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Midwifery Today Conferences
If you're thinking about becoming a midwife…
…you need to attend the full-day Beginning Midwifery class at our conference in Ann Arbor, Michigan, this May. This is your day to learn about midwifery and decide if it is the profession for you. You'll learn both the challenges and the joys of this calling, so you'll be able to make an informed decision. Segments include The Art of Midwifery, Prenatal Care, Normal Labor Physiology, Emotional Issues in Labor and Anatomy of a Birth Bag.
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Come to our conference in Bad Wildbad, Germany, October 2008. You'll learn about midwifery and birth from a variety of teachers, including Gail Hart, Mary Zwart, Michel Odent, Cornelia Enning, Ina May Gaskin, Suzanne Colson, Elizabeth Davis and Debra Pascali-Bonaro. Plan now to attend! Learn more about the Bad Wildbad, Germany, conference and get a complete program.
In This Week’s Issue:
Quote of the Week
"I wish I had a twin, so I could know what I'd look like without plastic surgery."
— Joan Rivers
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The Art of Midwifery
The most prevalent danger in multiple gestations is prematurity and corresponding complications, such as respiratory distress syndrome and intestinal problems such as necrotizing enterocolitis. With insistence on excellent nutrition, encouragement and abundant social support, midwives help many women carry twins to term. Experienced, well-educated and fully-equipped midwives, with refined palpation and gentle version skills, can bring important elements to the pregnancy, if not also to the birth. Finally, enveloping the mother in optimism, love, patience and prayer is tremendously powerful "medicine" that results in outcomes the shiniest knives and fanciest machinery cannot hope to match.
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 email@example.com.
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Research to Remember
A study by an obstetrician specializing in multiple-birth pregnancies showed that taller women are more likely to have twins. The cause is believed to be a protein called insulin-like growth factor, which increases the sensitivity of the ovaries to follicle-stimulating hormone and has previously been linked to greater stature. The study looked at 129 women who had twins or triplets and found that on average they were taller than the average woman in the US.
— Journal of Reproductive Medicine, September 2006
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Pregnancy Management for Twins
Fetal mortality is increased in twin pregnancy to four times that of singletons, and the major cause of death is prematurity. Birth weight is an important factor and twins born after 36 weeks gestation have a several times higher rate of survival. Ultrasound has not been proven to reduce perinatal mortality in multiple pregnancies. In her book Having Twins, Elizabeth Noble states that "making a decision about whether to have a test or about which test is appropriate may require a second and [even] a third opinion. Women expect a test to reassure them, but sometimes it provokes more anxiety if the outcome is not clear or further testing is necessary. It is much better to prevent complications by availing yourself of good health care and [healthful] nutrition."
Data from my practice of 300 births show that prematurity is rare with continuity of midwifery care at home. I support Dr. Tom Brewer's recommendations for a high protein diet with a balance of fresh whole unprocessed foods. Women with twins may need to eat small, frequent meals. I do not routinely advocate extra vitamins or supplements. We know that a drop in hemoglobin in the second trimester is evidence of normal healthy hemo-dilution, and this is more pronounced with multiple pregnancy.
Pregnancy discomforts are usually increased in women carrying more than one baby. If a woman goes into premature labor, having her rest and drink three to four glasses of water will dilute the level of oxytocin in her bloodstream. In one woman's experience, premature contractions at 33 weeks stopped and she carried her babies to term.
Women expecting twins will need to arrange for help at home before and after the birth. Contacting a diaper service…, and planning for home help are important components of preparing for the busy postpartum period. Wholistic care also includes dealing with emotional and relationship issues. Regular home visits are beneficial because the midwife can assess the home environment and determine how to best support the family during the perinatal period. It can also be very stressful for a woman carrying twins, who has other children, to travel to prenatal visits, especially late in the pregnancy.
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ICM Conference Update from Jan
One of the most exciting elements of the International Confederation of Midwives Triennial conference, besides the rich array of leading edge papers and classes, is the midwives themselves. There will be midwives from ALL over the world who will attend the conference in Glasgow, 1-5 June 2008. Be sure to take your notebook to collect names, addresses and phone numbers of all the new friends you will make from all over the world. If you have a business card take a lot of them with you. You will be able to learn about what is going on in midwifery and birth from Africa, Japan and a hundred other countries. Midwifery Today will be there as well gleaning exciting information. I will share this with you in both Midwifery Today Magazine and Midwifery Today E-News.
Toward Better Birth,
For more information: http://www.midwives2008.org/home.htm
Products for Birth Professionals
The number of live births in twin deliveries rose one percent between 2004 and 2005 to 133,122 births, for a rate of 32.2 twins per 1000 births. The actual number of live twin births has doubled since 1980 (from 68,339).
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Midwifery Today is interested in promoting international networking among childbirth practitioners. Our goal is to strengthen the international community by establishing country contacts in every country of the world. To see which countries have a Midwifery Today country contact, please click on the flag/country name in the panel on the right side of our main international page.
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Read these article excerpts from the most recent issue of Midwifery Today newly posted to our Web site:
Read this article from Issue 84 of Midwifery Today newly posted to our Web site:
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Question of the Week
Q: One of our clients recently discovered that she has twins. They each have their own placenta, and she has reached 21 weeks in very good health and is extremely determined about birthing at home! This is her second birth. We totally support her decisions and plan to attend her homebirth. However, with the increasing hospitalisation, it has been more than 20 years since there was a planned homebirth of twins here in Denmark. We only have hospital experience with twin births, and it is just so overly medicalised and regarded as high-risk with all the machinery and medicine close at hand and "the works"…. We are SO keen to learn more from midwives with twin-homebirth experience. Please share with me EVERYTHING that comes to mind!
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.
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Question of the Week Responses
Q: How long can a baby be on breast milk only, with the addition of no solid food or liquids? I don't want to feed my baby anything but breast milk until I have to, but am not clear whether there is a maximum after which it becomes less healthy to do so.
A: My son refused to eat until age 2-1/2; he maybe would have a bite of something here and there, but preferred to breastfeed. Slowly he began to eat more as he decreased nursing until he stopped at age 3-1/2. I worried endlessly that I was doing something wrong.
Now, at age 17, he is a varsity athlete winning awards for all-district, all-conference and all-area.
A: I breastfed my first son until he weaned himself at 38 months, and I am currently nursing my 31-month-old son. Both of them nursed exclusively until they were a year old with no ill effects. They are active and healthy. I also think this helps my cycles not to return until later than most of the women I know - 21 months with the first and 19 with my second. I hope this helps you.
— Laura Reiboldt
Q: I have a girl in class who has expressed a lot of fear and anxiety regarding her upcoming birth, from lots of surgeries (urogenital) as a baby/child. She remembers "things being done to her, no control, no choice, no voice, doctors talking at her, not to her, bloody surgeries, pain, etc., and "having to be strong and brave." She mentions already feeling some resentment toward baby for "having to endure labor/birth pain." She does not want her experience to prevent her from bonding and loving her baby.
This realization of fears is a huge step. It's much harder when they arise during labor and no one is prepared or knows what they stem from or what to do with them! I suggested she discuss with her midwives so they are aware and can help her during labor. We discussed the significance of having an unmedicated labor vs. having a labor where she feels safe, protected, unviolated, where she has some control of choices and that does not produce emotional trauma for her.
I welcome a discussion of whatever you can think of that may be helpful. I think they are considering hiring me as a doula, so also anything from that standpoint would be appreciated.
A: There is a wonderful book called When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women, by Penny Simkin. I often recommend this book to my clients. I also like the book Mind over Labor: A Breakthrough Guide to Giving Birth, by Carl Jones, Marian Thompson and Emmett E. Miller. Both books are helpful when working through fears and anxieties in labor.
I encourage you to have her speak with her midwives and if their practice is not responsive to her needs then I would look for one that is. Also encourage her to seek out a professional therapist. If she is unwilling at this time, then have some names and numbers ready for her in case she needs them later. She needs to verbalize with you and her partner and anyone who will listen about her fears and concerns. The more she acknowledges them the more control of them she has.
Most importantly, I would remind her and you that she is normal. What she is feeling is normal for someone who has had similar experiences. The biggest difference this time is that she is in control. She has the option of choosing her provider and type of birth experience. She can pick her level of participation and awareness. By participating and being aware of the birth, she is participating in her child's birth and she should bond better and heal through the experience. Birth can be healing for the mother. It was for me and many of my clients.
A: I think it's important to emphasize to this woman that it is fine and normal for her to have these feelings AND that regardless of these feelings, she will still give birth to her baby. It's rarely possible to stop yourself from having an emotion, but you can refuse to allow it to get in the way of what you have to do. Birth doesn't require bravery, instead it requires letting go, being in the moment and letting your body do what it needs to do. While you'll probably have a nicer birth experience if you are able to resolve your fears and resentments, countless millions of scared, overwhelmed women have birthed before you, and you can too.
— Erika Peterson Bartlog
A: In this particular case, an epidural is probably the best for the woman. She has already been through enough pain and surgeries as a child, and the labor process does not have to be like that. If she has a doula for support, she should encourage this option, as many hospitals have patient-controlled epidurals and she can relax in the fact that she has control in this process. She can feel as little or as much as she wants and enjoy and appreciate her baby afterwards, instead of feeling angry at the child for putting her through an otherwise agonizing process.
A: I have supported women in labour with similar issues and in my experience the best approach is for the midwives and caregivers to be fully aware of the woman's past medical and psychological encounters. That way they can work together and approach labour as "positive pain," which is something that I as a midwife target during antenatal classes. Having someone they trust during labour is vital and, as you already have a good rapport building with this woman, then acting as a doula would be most beneficial. It's good that she has voiced her fears and anxieties, as many women don't.
— MR, UK midwife
A: As a doula and previous HypnoBirthing Childbirth Educator, I found Emotional Freedom Techniques (EFT) to be immensely helpful to alleviate the energy around negative memories such as described in the question. You can find a trained practitioner at www.emofree.com or take the training by video yourself for little cost. There are wonderful articles on its use during pregnancy and birth on the site, as well. Anyone can use this surprisingly simple technique, even the mother herself.
— Jan Bennett-Collier
Editor's Note: Survivor Moms: Women's Stories of Birthing, Mothering and Healing after Sexual Abuse is now available from Motherbaby Press, a division of Midwifery Today.
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