|October 28, 2009|
Volume 11, Issue 22
|Midwifery Today E-News|
“Massage and Touch/H1N1 Prevention”
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In This Week’s Issue:
Quote of the Week
"The body is movement. Breath is life. And the base of our being is the support of others."
— Harold Dull
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The Art of Midwifery
There a few key adjustments everyone can take to improve and maintain a healthy immune system, beyond the standard recommendations such as Vitamin C and getting good quality sleep. These remedies are more than safe for our pregnant clients, their families and us. These include:
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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Historically, alternative preventative treatment has been utilized successfully in times of epidemic flu outbreak. Although there is an option to vaccinate oneself with this new H1N1 vaccine, I would argue that the current global situation warrants a more serious search for safe, non-invasive alternatives. The inherent risks of vaccinations can serve as a reminder for midwives to return to the basics, creating and maintaining a healthy immune system.
One alternative approach being considered in countries such as India and France is nationwide homeopathic vaccination. Homeopathy as we know it today was founded by Samuel Hahnemann, although the principle dates back as far as Hippocrates. In essence, homeopathy is based on the concept that a disease can be cured by infinitesimal doses of a substance that in larger quantities mimics disease symptoms. It is governed by the principle that "like cures like"—if a substance can cause symptoms in a healthy person, then it can cure similar symptoms in a sick person. In sections 100 and 102 of his "Organon," Hahnemann describes the use of homeopathics in relation to epidemic disease.
A "Times of India" article from August 2009 explores the link between homeopathy and epidemic outbreaks, historically and today.
"Well-known Delhi-based homeopath Mukesh Batra cited the instance of the Spanish flu epidemic of 1918 in which more than 50 million people were killed worldwide. He said the mortality rate of people given allopathic treatment was 28.2 percent, while [in] those given homeopathic treatment [it] was 1.05 percent at that time." In the case of the 1918 flu, the most common homeopathic remedies were Gelsenium and Bryonia, both 30C.
Oscillococcinum was first studied in France during the 1987 flu epidemic caused by an H1N1 virus similar to the swine flu of today. This multi-center study examined the effect of Oscillococcinum (200C) on the early symptoms of flu. Results were published in the peer-reviewed "British Journal of Clinical Pharmacology." More patients in the treatment group recovered completely in the first 48 hours than the control group (17% of patients with active treatment compared to 10% of controls). More patients in the treatment group also judged the treatment as better compared to the placebo, 61% versus 49%.
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"Back labor" can slow the progress of labor, create more pain and cause the woman to experience more physical and emotional distress. Most of the pain of back labor is caused by an occiput posterior position (OPP) or occiput transverse position (OTP). The best approach is to implement measures that will encourage the baby to turn. (Editor's Note: For more information on posterior position and encouraging the baby to turn, see the numerous articles in Midwifery Today, Issue 76.)
An effective way to work with gravity is for the mother get on her hands and knees, provided she has no wrist problems. If wrist or hand problems exist, she can assume an elbows and knees position to avoid pressure on her wrists. She should rock her pelvis back and forth to encourage fetal rotation to an occiput anterior position (OAP). This is an effective way to encourage the baby to turn. In this position, with the mother's abdomen no longer pressing on her spine, the convex surface of the baby's back usually rotates and "spoons" towards the convex anterior uterus. In addition, this position provides relief from backaches since the fetal head pressure is off her sacrum. This is particularly effective if the woman's hips are higher than her head during labor. If the OPP has been identified, the expectant mother can crawl or get on her hands and knees before labor begins and hopefully prevent back labor.
For a right OPP, mother can lie on her left side (or on her right side for a left OPP) for 15–30 minutes two to three times a day. While she is side-lying, she can stroke across her abdomen in the direction that the fetal head should rotate and visualize the baby turning. Side-lying is very beneficial for those women who cannot kneel or get on their hands and knees due to physical limitations.
Lateral lunges (one leg out to the side) done slowly and purposefully widen the pelvis on the side she lunges. She should lunge toward the side the fetal back is on or in the direction of the baby's occiput. If OPP is not known to be left or right, she should lunge toward the side that brings her the greatest relief. She should hold the (supported) lunge for a count of five. This can also be done in a kneeling position as she leans over a chair or birth ball. Stair climbing is an alternative to lunges. Lunges and stair climbing can be used during early labor.
Squatting for the second stage of labor often helps the baby rotate and widens the pelvic outlet. This position straightens the pelvic (lumbar) curve, taking fetal head pressure off the sacrum. Squatting also promotes better use of gravity. Standing upright (and walking) promotes descent, which is often accompanied by fetal rotation. Visualizations accompanying all of these positions will enhance the results.
While the laboring woman is in any of these positions, the labor coach or midwife can offer physical support to alleviate her pain and encourage the baby to turn. During a contraction, counterpressure on the sacrum or area she prefers helps reduce the pain. For the support person, in order to protect your wrist and be able to hold the pressure for the entire contraction, use your fist with your wrist in a neutral position to avoid injury. For greater comfort, fold a small hand towel or dry wash cloth over your knuckles to prevent bone-on-bone pressure. Switch arms if your hand tires.
— Elaine Stillerman
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Question of the Week
Q: How do you prevent postpartum hemorrhage?
— Midwifery Today 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.
Question of the Week Responses
Q: How do you feel about the Obama health care plan? Do you think it's likely that midwives and doulas will be included in this plan?
— Midwifery Today editors
A: I feel that Barack Obama's heart is in the right place and that he is making and will continue to make practical and caring decisions re: health care, to the best of his ability. He listens and gathers information so that he can make the best decisions for the people of the US and the world, and has done so much already.
I hope this move on health care will include having midwives serve in their rightful place within the health care system, allowing them the autonomy they deserve.
— Consie Kunst
Q: [From E-News 7:6] I was blessed with a wonderful homebirth under the watchful eyes and in the warm hands of two local midwives in the state of Illinois. This was my fourth homebirth and sixth pregnancy. The birth of my 8 lb 4 oz baby went beautifully. It was not until I got out of the birthing pool and onto the birthing stool to release our placenta that my uterus prolapsed. My midwives did their best and gave me all the information they knew about uterine prolapse. I am reaching out to the bigger midwife community for additional advice about how to treat a prolapsed uterus and maintain uterine health through the rest of my life. I am only 24, and who knows what is in the future. If we choose to have another baby, what will likely happen? Your support, knowledge, and resources would be greatly appreciated.
A: I agree wholeheartedly with the Standard Process [supplements, from a response in E-News 11:19] for nutritional support. Since you are 24 and relatively healthy, yoga practice could be beneficial; specifically Downward Dog in proper position. Combine this position with 10 Kegal exercises, rest, then repeat. I'm sure your midwives encouraged Kegals, which should begin soon after birth for all women—do them in a reclined or prone position—for up to six weeks. "10 Kegals with each diaper change" was how my midwife encouraged me. Of course, slowing them down and pretending your yoni (vagina) is an elevator and squeezing up the various floors helps. The pelvic muscles are very stretched shortly after birth and doing Kegals upright isn't recommended until the muscles have had a chance to heal (six weeks postpartum on average). Once a woman is back to her exercise routine (which is usually around six weeks), yoga can begin. Never do an "upside down" posture while menstruating.
To do Downward Dog, first get on all fours (Cat position). Then, placing most of your weight into your arms, press upward until your glutes are pointing high and you make a V with your body. Your knees can be bent so that your arms and back are straight and your pelvis (glutes) points up to the ceiling. Once you are comfortable and relaxed in this position, do 10 Kegals. Then come out of Downward Dog position, into Cat postition, and rest. Build up to doing this for about 10 repetitions, which would be 100 Kegals total. The upward/downward motion repositions the uterus before you do the Kegals.
If you are completely unfamiliar with yoga, Downward Dog is a common yoga position and Yoga Zone includes Downward Dog in several of their videos/DVDs, such as "Power Yoga." They don't include the Kegal information. I have shared this information with the MDs I work with.
— Sandra Stine Tallbear, CNM
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
Touch is a basic need in the lives of beings. We depend on touch to survive at many levels. Humans and animals—we all crave it, need it, appreciate it and use it effectively for our benefit. At least, when we are babies and at the very beginnings of our lives, we are intimately connected to our mothers and rely on touch, smell and physical closeness for not only our survival, but also for the optimization of our health and well-being. It is later in life that some cultures have a tendency to move away from physical touch, but this is not necessarily due to the lack of a need for it, but rather as a curbing and civilizing of our animal instincts, which humans have been considering in the last centuries mostly as "lowly" or as “far away from ‘godly.’”
It is through touch that energy can be shared, uplifted, rooted, moved and used as fuel, as we give it and receive it. This is why touch and massage for pregnancy and birth can be especially important, as women in labor need to move a lot of energy through themselves, give themselves into a lot of energy, and allow a great many changes in their souls and bodies in order to open up to give birth.
— Naolí Vinaver
The IX ICM Regional Asia-Pacific Midwives Conference will be hosted by the Academy for Nursing Studies and Women's Empowerment Research Studies (ANSWERS) and the Society of Midwives-India (SOMI), and is scheduled to be held from November 19–22, 2009, at the Hotel Marriott in Hyderabad, India. This Regional Conference of the International Confederation of Midwives (ICM) will bring together 500 midwives from different countries of the Asia-Pacific region to deliberate on maternal and child care.
This landmark conference, to be held for the first time in India, will give a platform to nurse-midwives to present research papers, participate in scientific sessions, and discuss, share and find solutions to common birth-related problems in the developing socioeconomic scenario of the Asia-Pacific region. One of the highlights of the Conference is a Skill Hall, where skill practice will be guided by experienced obstetricians, midwives and pediatricians during the three days. Our partners in this Conference: UNICEF, UNFPA, SIDA, Ipas, and PATH.
For last minute or on-the-spot registrations, please send us an e-mail at: firstname.lastname@example.org
— Raji Nair
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