November 25, 2009
Volume 11, Issue 24
Midwifery Today E-News
“Doulas”
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In This Week’s Issue:


Quote of the Week

"If a doula were a drug, it would be unethical not to use it."

Dr. John H. Kennell


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The Art of Midwifery

Make a "rice sock" for heat application. Fill the sock with uncooked rice and tie a knot in the end (a tube sock will hold four cups of rice). The sock can be heated in the microwave for two to two-and-a-half minutes; the length of time depends on the power of the microwave. The sock will hold its heat for about one hour and can be reheated as needed.

The rice sock is great for round ligament pain because it can stretch along the area from inner thigh and up the groin. It can be used for heat and massage during labor, or for neck or muscular pain. It can be rolled on the lower back while the woman is doing pelvic rocks. The massager and woman can develop a rhythm of her rocks and the massager's rolls.

Smaller socks can be used for the perineum when the woman is complete and you want to apply heat. When you are finished using the sock on the perineum, throw it away.

You may need to place a sheet or thin towel on the skin if applied immediately after heating so the heat is not too intense.

At the 36 week visit, I instruct the woman to prepare a sock and put it in her suitcase. I also keep rice socks available for those who forget to bring theirs.

Evelyn Simons, CNM
Excerpted from "Tricks of the Trade," Midwifery Today, Issue 86
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Research

In a study published in June of 2008, researchers found that the continuous presence of a doula during labor decreased the chances of receiving a cesarean section and reduced the need for an epidural. Just over half of the 420 women selected to participate in the study received doula support during labor and birth. Only 13.4% of the doula-supported group required cesarean section compared to 25% of the control group, and epidural rates were also lower for the doula group (64.7% vs. 76%).

Birth 35(2): 92–97


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Being the Quiet Doula in the Corner

I delight in the enthusiasm of newer doulas I've mentored. I hear the words and the passionate tone of the voices of these beautiful, lively women.

I also remember how eager I was to "help" mothers by putting into practice all the new "tools" and "techniques" I'd just learned in the training I took. During those first births, I kept searching for the perfect word to use or the perfect suggestion to make to the laboring couple. Their looks and smiles of approval would instantly make me feel so "helpful" and, yes, my nerdy ego was hugely boosted.

What a different and wise turn my career would take. It all started with my first homebirth as a doula.

Sarah and David were a well-traveled couple I met in childbirth classes. They asked me to be their doula. I was so excited. Their midwife is a much-respected member of our local birthing community. Weeks before their due date I bought more stuff for my doula bag, which kept getting bigger and bigger. I also "refreshed" on all the tricks for turning a posterior baby, the best positions for stalled labor, best this and best that.

On a warm Saturday night David called to let me know that Sarah was in labor. I arrived at their home and we folded some laundry together. I realized that this was early labor.

I assured them that I was comfortable reading on the couch as they kept nesting around the house. Labor was progressing at a gentle pace. At each contraction they would stop and breathe together. My first observation of this couple during labor was that they only spoke in Hebrew with each other. I don't speak Hebrew. They had their own language and I stood back.

Labor kept taking its course in a beautiful and normal form. David and Sarah were as one. They found their rituals, rocking and swaying. After each contraction David would look at me with big eyes and I'd nod and smile. He would smile back.

The dance went on all night: a new noise or new behavior from Sarah, followed by David looking at me with big eyes, and then me silently nodding and smiling back at him.

In a few hours the midwife arrived and checked the water temperature of the birthing pool. Sarah went in and birthed her son. Just like that.

Very simple, easy, quiet and uneventful!

The only thing I used from my silly huge doula bag was straw for tea after the birth. The best words I could offer were none. The best advice I could give was to nod and humbly let them know that all was fine and normal.

That birth changed how I practice as a doula. It changed the way I facilitate childbirth classes. It changed the way I see birth, and it changed me as a human.

Ana Paula Markel
Excerpted from "Being the Quiet Midwife/Doula in the Corner," Midwifery Today, Issue 87
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If you attend pregnant women, you need basic knowledge of the breech delivery. In this DVD, Midwives Valerie El Halta and Rahima Baldwin Dancy share their expertise in a clear, detailed manner. You'll learn a Breech Scoring System to help evaluate risk, various positions for the mother in delivering a breech baby, the key points for diagnosing and delivering a frank breech and more. Perfect for midwifery training programs and self-study by both student and experienced midwives, Normalizing the Breech Delivery is a must-have for every birth library. Order the video.

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Web Site Update

Read these article excerpts from the most recent issue of Midwifery Today newly posted to our Web site:

  • Who Benefits from Training Traditional Midwives?—by Ann Davenport
    Davenport discusses the ramifications of training traditional midwives or skilled birth attendants based on conformity to a medical system that may or may not be in the best interest of birthing mothers.

Visit the Midwifery Today YouTube Channel

Please check out our second YouTube video, part of our Birth Essentials series:
Penny Simkin: Using Doulas for Birth Care
In this video, Penny Simkin talks about doulas in an interview at the Midwifery Today Conference in Eugene, Oregon, March 2009. The co-founder of Doulas of North America (now DONA International), Penny talks about using doulas for birth care and how the doula movement came about.

Click below to view, or you may wish to go here to download video and view without streaming interruption.


 


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Question of the Week

Q: When do you consider a woman post-date? What are your protocols for post-date clients?

Midwifery Today E-News Staff


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: How do you prevent postpartum hemorrhage?

Midwifery Today E-News Staff

A: There is a concept in Chinese medicine which is based upon the symbol of yin and yang. Simplistically speaking, one can say that yin stands for water, and yang for fire. If you take that one step further, since yin is fluid, one can also say that yin is blood. Since yang is also seen as energy, one can say that yang is qi. Having said that, let's let the basic symbol of yin and yang remain, and instead of seeing it as yin and yang, or water and fire, see it as blood and qi. It is important to understand that these two aspects of yin and yang are mutually interdependent, meaning that one depends upon the other, transforms into the other, and that there is no absolute separation between them. An example of this is the transformation of night into day, or yin into yang.

Traditional Chinese theory teaches us that blood is the mother of qi, and that qi is the motivator of blood. Mother to motivator to mother to motivator, and on and on, just as yin transforms into yang or night transforms into day, showing us a total interdependence, transformation, and a reality that the two compose one. To simplistically go further into Traditional Chinese thinking, one of the numerous properties of qi is to "hold things in place," such as blood in the vessels. Qi also warms, since it is an aspect of yang, or fire.

When a woman is in labor too long, or when she has spent her qi/energy, then that property of "holding" is no longer one that can be relied upon. This can even happen if a woman labors for too long in a hot bath, as can be seen by noticing that a woman who is too hot, or hot for too long, will collapse into exhaustion while in the heat or once she has left the source of heat. A good non-labor example of this is when one sits on a sunny beach all day and when home, collapses into exhaustion.

In preventing postpartum hemorrhage, an old saying that I found from the 18th-century midwifery books from Europe (before we had a midwifery book in North America) is that "the sun should not set twice on a laboring woman." Of course when I was a young woman I had to challenge this, but in due time I learned that this lesson has great merit. I learned that when a woman went too long in an active labor and got to a point of exhaustion, that she was very likely to bleed in the immediate postpartum/third stage of labor. Once I better understood the concept and the properties of qi, I was able to see that with exhaustion in labor, a woman may no longer be able to have enough qi to "hold the blood in place." This will result in a predisposition to losing blood. In any given labor, the loss of one night of sleep is normal, but to lose more than that does not allow a woman to restore or replenish her qi through the normal channels of rest, and as a result, hemorrhage is more likely to occur.

Lastly, Chinese medicine greatly relies on the many pulses found in each wrist to evaluate the state of health, strength, etc in any given person. Again, simplistically speaking, there are the qi pulses and the blood pulses. When the qi pulses (which are found on the left radial pulse) are deep, hard to find or only palpable with pressure, it is an ominous sign. These pulses tell us that the yang properties are less than desirable or possibly altogether gone, and as a result, unless the woman's qi is restored prior to birth, she will likely bleed.

Also, as day transforms into night, or yang into yin, if a woman gets too hot for too long she will surely cool down (yang into yin) and if this is not monitored carefully and the yang restored or what is left of it contained, she will likely go into a state of feeling chilled, seen as shaking as if cold. This is not a good sign and speaks of the qi having been reduced or lost. The thoughtful and nourishing tradition of wrapping an immediate postpartum woman in a warm blanket is one that allows the yang to be saved from further loss. This wrapping warms the body externally. Aside from it being a humane ritual and one that women have always loved, it has great physiological implications. A warming drink is also able to contain the remaining yang by warming the body internally. So warmth, both externally and internally, will aid a woman in holding onto the remaining yang after the delivery of a baby, thus preventing postpartum hemorrhage.

Therefore, four simple measures to check relative to preventing postpartum hemorrhage are:

  1. Do not lose the Qi.
  2. Do not use up one's fire.
  3. Do not let the pulses found on the left wrist lose strength.
  4. Warm the body externally and internally immediately after birth.

By embracing these ancient concepts and precepts of Traditional Chinese Medicine, these simple guidelines can be cultivated for any practitioner wanting to prevent postpartum hemorrhage.

— Raven Lang, OMD, LAc


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.


Think about It

The always wonderful Dr. Christiane Northrup is asking American women to "Reclaim Your Right to Birth Right," in a Huffington Post article by the same name. She says:

"As an obstetrician/gynecologist, I have spent the last 30 years educating women about the wisdom of their bodies, including their innate ability to birth normally. Yet our so-called healthcare system, which is a direct reflection of the beliefs of our culture, sees the female body and its processes (like labor) as an accident waiting to happen. Media images of birth as an emergency play right into this. The truth is that labor and birth need not be the emergencies we think they are. And the medicalization of birth actually does more harm than good."

Appearing as it does on a well-read and fairly mainstream Web site, the more than 400 comments that follow the article are almost as educational as the article itself.

Read the full article and comments at: http://www.huffingtonpost.com/christiane-northrup/c-section-or-natural-birt_b_323422.html


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Letters

During the last five years I have been supporting women during pregnancy and birth—many kinds of women, many kinds of births; each woman with her own way of going through this amazing and challenging passage.

My other great love is music. I have sung and played music ever since I was a child. In September 2009 I released a CD of the music I wrote and composed during the last 10 years (visit my Web site at www.dassi.co.il). I often am inspired to write songs during a birth, and many times when I come back home after supporting a labour I sit and write.

One of my dreams is to collect birth songs and chants from different cultures and in different languages—songs written by women, supporting women; songs written in order to help bring divine presence into the birth space. My plan is to collect these songs, sing them together with other doulas and midwives, and record them into a CD. These songs will be used to support pregnant women and bring the massage of prayer into labour.

Any help with collecting these songs and chants will be so much appreciated!

My goal is clear: to help women deliver their babies happily and peacefully. I hope you will join me on this journey!

Dassi Elad
dassi@dassi.co.il


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