September 15, 2010
Volume 12, Issue 19
Midwifery Today E-News
“Prolonged Labor”
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Midwifery Today’s Prolonged Labor Handbook discusses the benefits of positioning, trusting birth, and the political ramifications of time assessment and responsibility. You’ll also learn ways to prevent prolonged labor, including herbal remedies and psychological assessment. Part of the Holistic Clinical Series, the Prolonged Labor Handbook belongs in your birthbag!
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Learn about breech birth with Ina May Gaskin, Michel Odent and Cornelia Enning

In the morning, Ina May and Michel will help you develop a variety of breech skills, including palpation and assessing fetal weight. You'll also learn about frank, footling and complete breech, as well complications that can occur. In the afternoon, Cornelia will discuss the special circumstances of breech waterbirth. Did you know that breech birth in water improves fetal oxygenation by increasing uterine blood supply during immersion? Attend this class to find out more!

This full-day Breech Workshop is part of our conference in Strasbourg, France, Sept. 29 – Oct. 3. The in-office registration deadline has passed, but you can still attend! Just plan to register at the conference. Learn more.


Gentle Birth Is a Human Rights Issue

Both mother and baby have the right to a gentle and healthy pregnancy, birth and postpartum. Come to our conference in Eugene, Oregon, March 30 – April 3, 2011 and learn more. Full program available online now.

In This Week’s Issue:


Quote of the Week

“Don't forget to bring your sense of humor to your labor.”

Ina May Gaskin


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The Art of Midwifery

Nourishing Long Labors

It’s important for the birthing woman to stay well hydrated and eat during a prolonged labor. Just a few bites and sips at a time can make a significant difference in how well the woman holds up. Miso soup with noodles makes an excellent long-labor snack, as does yogurt and fruit or honey. Popsicles made ahead of time from the juice of her choice can be appreciated, too. Recharge is a good beverage for long labors.

Excerpted from Midwifery Today’s Birth Wisdom, Tricks of the Trade, Vol. III
View table of contents / Order the book


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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News Flash

US Breastfeeding Rates Stagnate

A new Centers for Disease Control and Prevention (CDC) report shows US breastfeeding rates at 6 and 12 months have stalled and are not reaching national targets.

According to the report, among infants born in 2007, 75% were breastfed in the very early postpartum days, but six months later only 43% of babies were receiving any breast milk. By 12 months, fewer than one in four infants was being breastfed (22%). Both numbers are below national targets of 50% breastfeeding at 6 months and 25% breastfeeding at 12 months.

“High breastfeeding initiation rates show that most mothers in the U.S. want to breastfeed and are trying to do so,” the report states. “However, even from the very start, mothers may not be getting the breastfeeding support they need. Low breastfeeding rates at 3, 6 and 12 months illustrate that mothers continue to face multiple barriers to breastfeeding.”

The report slaps hospitals and birth facilities on the wrist for low levels of breastfeeding support.

“Across the US, the average level of support that birth facilities provide to mothers and babies as they get started with breastfeeding is inadequate, and hospital practices and policies that interfere with breastfeeding remain common. In the U.S., too few hospitals participate in the global program to recognize best practices in supporting breastfeeding mothers and babies, known as the Baby-Friendly Hospital Initiative.”

Among the 50 states included in the report, Idaho had the highest percentage of infants who breastfed during the early postpartum period, while Mississippi had the lowest. Oregon had the highest rate of exclusively breastfed babies at 6 months (23.7%), and Mississippi had the lowest (6.5%). To view the entire report, with a breakdown of the states’ individual ratings, visit www.cdc.gov/breastfeeding/data/reportcard.htm.


Jan’s Corner

Gauging Labor the Non-invasive Way

Who invented First Stage? Did it come about when we started putting our hands inside women? This act, of course, killed many women because doctors were doing it before they learned to wash their hands. First Stage is most likely a male invention, though perhaps midwives took it up when they experienced obstructed labors. It is helpful to delineate labor, but doing so has probably caused way more problems than it has alleviated. Michel Odent teaches us that the less we disturb the laboring woman the better. We can, most likely, slow a labor down with vaginal exams (VEs) even though women themselves often ask for one even if the midwife prefers not to do them. However, mother-leading is best. We are in partnership with women, but she is going by her thoughts, knowledge and culture. You have time to change and educate during the prenatal period, but at birth follow her lead!

I remember being at a class at a Midwifery Today conference in London, England. Jane Evans, a British independent midwife, was talking about not doing VE unless there was really a reason to do one. She was explaining how hard it often is to just sit on your hands and do nothing. Nicky Leap, another UK midwife who now lives in Australia, wrote that the less we do the more we give. How does this all add up in today’s world of protocols, where you often have to do something and record it in order to keep your certification, license or whatever? For those who can read the signs of labor, the VE often becomes a moot point. Learn all you can about the outward signs of where a woman is in her labor.

The red line is an excellent, non-invasive gauge of labor’s progression. When you learn how to read the red line, you’ll know how many centimeters dilated a mother is. In an article (“Primips: Women Having Their First Babies”) originally printed in Midwifery Today magazine, Issue 55 (Winter 2000), Gloria Lemay tells us how to read that red line: “Watch her rectum. The rectum will tell you a good deal about where the baby’s forehead is located and how the dilation is going. If there is no rectal flaring or distention with the grunting, there is still more dilating to do. A dark red line extends straight up from the rectum between the bum cheeks when full dilation happens. To observe all this, of course, the mother must be in hands and knees or side-lying position.”

Labor is for bringing the baby down and out. If we are going in and up, we are reversing the natural order. Let us try to find the most optimal ways of working with the natural process of birth. It cannot be improved upon in 90–95% of cases. Discerning the 5–10% is the hard part. With good prenatal care and careful attention to our reactions, we can probably come close.

Jan Tritten, mother of Midwifery Today

Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.

Jan’s blog: community.midwiferytoday.com/blogs/jan/default.aspx
Jan on Twitter: twitter.com/jantritten
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International Alliance of Midwives on Facebook: facebook.com/IAMbirth


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Research

ACOG: Moderate Caffeine Consumption Does Not Cause Miscarriage, Preterm Birth

Moderate caffeine consumption does not appear to cause miscarriage or preterm birth, according to a recent report conducted by the American College of Obstetricians and Gynecologists (ACOG) and published in the August 2010 edition of the journal Obstetrics & Gynecology.

The ACOG committee said women who consume less than 200 mg of caffeine per day—the equivalent of a 12-ounce cup of brewed coffee—are not at increased risk for miscarriage or preterm birth. However, ACOG “remains unclear whether high levels of caffeine consumption have any link to miscarriage.”

— American College of Obstetricians and Gynecologists. 2010. Committee Opinion No. 462: Moderate Caffeine Consumption During Pregnancy. Obstet Gynecol 116(2): 467–68.


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Prolonged Labor: Past & Present

Labor marathons are often rooted in emotional discord. Fostering loving trust and loyal, determined commitment will usually see you through. As long as nutrition and hydration are offered freely, and vital signs remain reassuring, labor may take as long as it need to. I don’t believe there is a time limit. Families know we will only turn toward surgical options in cases of absolute need.

Unfortunately, caregiver fatigue, physician distress or boredom also leads to surgical interventions. The midwife transports because she is exhausted or inadequately prepared; the doctor proposes surgery out of his own burden of fear and expected role as deliverer. Tired and fed up with the whole mess, the family goes along with anything just to get it over with. Interventions at these times are not medically necessary, but under the duress of the situation, it seems like the best choice. This sort of decision is one many later regret.

Our jobs are to blend diligent overseeing with sincere encouragement, massage, herbs or homeopathy, hydrotherapy, supported ambulation, music, prayer and rest. Studies validate these complementary modalities. When we have tried everything, we may still bring in fresh attendants or call for advice. We don’t throw in the towel until we’ve tried absolutely everything and maybe even try something new. Only then will we know that we gave it our very best, so if something is really wrong, we will be grateful for that medical miracle.

A skillful midwife is more than a friendly handmaiden with monitoring tools and an ability to call 911. While I find infatuation with automated birthing repugnant, neither do I want to be the limited midwife of the past. Solidly grounded in contemporary knowledge and appropriate technology, I thrill at using new research to outwit complications, sharing methods with sister midwives around the world, finessing botanical combinations to surpass antibiotics’ effectiveness and by refining manual approaches to problems to which others apply scalpels.

Judy Edmunds
Excerpted from "Prolonged Labor: Past & Present," Midwifery Today, Issue 46
View table of contents / Order the back issue


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Read this editorial by Jan Tritten from the brand-new issue of Midwifery Today, Autumn 2010:

  • From Russia with Love
    “When the lovely young couple who publish Home Child magazine in Russia joined us last year at our Copenhagen conference, I had no idea that this meeting would birth such amazing ideas and start to shake up the birth movement on an international level. Since meeting Katerina Perkhova and her husband, Philip Perkhov, I have been so blessed, I am almost without words.”

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Shoulder Dystocia II—Tricks of the Trade
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Question of the Week

Q: I have just learned that I am pregnant with our second child. At three weeks postpartum with my first child (after a beautiful homebirth) I suddenly developed severe and very painful hemorrhoids that lasted until about four months postpartum. I went to the doctor in extreme pain and after examining me, he could find nothing noticeably wrong. I have since learned of two other women who experienced the same situation—no issues until three weeks postpartum and then severe pain that lasted until four months postpartum. At first I thought it could be related to the position I/we labored/gave birth in, but one of the three women had a scheduled cesarean. Could it be related to a drop in hormone levels? I had a very healthy and uneventful pregnancy and birth, and recovered quickly in every other way. I am looking for any information that can help me prevent this in my next postpartum period. Thank you!

— Danae Schonberg


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: Do you induce labor with herbs, homeopathy or other natural remedies in your practice? If you do induce, what are the reasons for the induction?

— Midwifery Today staff

A: I am a childbirth educator and doula, so I don’t make the decisions for when my clients are induced. I do prepare them fully to take care of their bodies by eating an optimal diet and exercising to prevent the need for a medically indicated induction. The most common reason for an induction is going to 42 weeks. I am often contacted for “ways to get the labor started” right around the due date. I do not encourage my clients to do “natural techniques,” which insinuates the body isn’t working properly, especially prior to 41 weeks. Instead, I try to get them to relax and enjoy the end of their pregnancy. If mom gets near the 42-week point, my main suggestions are: for suspected fetal malpositioning I recommend a chiropractor. For stress, anxiety, fear, or emotional issues I recommend acupuncture and/or homeopathy. Along with preparing my mothers to take charge of their health prenatally and utilizing these techniques nearing 42 weeks, induction is a very rare occurrence.

— Michelle McClafferty, CD, ICCE

A: Induction—with herbs, homeopathy, natural remedies or drugs—is still an induction. I trust birth, and babies’ wisdom in the process. As the research now suspects that a fetal lung protein, once released into the amniotic fluid, may be responsible for initiating labor, one may question induction.

Seeing the risks of prematurity, one may want to sincerely question induction once again, as it is responsible for life-lasting consequences for babies born everyday around the world. Of course, everyone knows at least one woman who “lost her baby because of postdates,” yet one can never really predict who that will be, or if the baby was going to make it if labor had been provoked. I believe in the wisdom of babies, mothers and the creator. I also strongly discourage the use of castor oil, as it is a laxative that may cross the placental barrier and could potentially result in the baby having a bowel movement too. Why introduce a risk for the sake of ... what? Who are we inducing mothers for, again?

— Paule Bezaire, CLD, midwifery student


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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Letters

Dear Midwifery Today,

Mother Health International (MHI) is seeking midwives to volunteer in our clinic in Jacmel, Haiti.

Midwives must have five or more years experience as a primary midwife, have caught 30 or more babies in the last 24 months, be available to volunteer three or more weeks at the MHI birth clinic, and be willing to pay for their travel to and from Jacmel, Haiti. If you are interested in volunteering at our clinic in Jacmel, please download and submit the application located at http://www.motherhealthinternational.org and click on Volunteers. All applications can be returned to info@motherhealthinternational.org

MHI is not accepting student midwives at this time; however, preparations are underway to make this possible in the near future. Located on Haiti’s southern coast, Jacmel suffered extensive causalities and was left littered with crumbled buildings and destruction after the January 12, 2010, 7.0 earthquake.

MHI founding members were part of a first-responder team of seven medics, midwives and support staff who traveled to Jacmel, Haiti, on January 28, 2010, via Santa Domingo, Dominican Republic, to offer disaster relief to women and children. With the help from private donations, NGOs, nonprofit organizations and government organizations, the team was able to provide emergency medical aid, water and food to the women and children who survived the earthquake. Shortly after arriving in Jacmel, the founders of MHI recognized the greater need beyond disaster and emergency aid and began the process to build a holistic Maternal Birth Clinic in the heart of one of the most under served areas in Haiti, St. Helen Parish. On March 10, 2010, MHI officially opened our doors to pregnant women and started prenatal evaluations immediately. Today nearly 100 babies have been born at our birth center and thousands of prenatal visits have been preformed. The MHI birth clinic is modeled after the Midwifery Model of Care. Our birth center is housed in a 44-foot dome structure (1,500 square feet) on a piece of land with a small house in front of it that serves as our home for volunteers. Midwives come from around the world to donate their time to serve the mothers of Jacmel.

Renée Bisnaire
volunteer coordinator, Mother Health International renee@motherhealthinternational.org


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Volunteer Midwives Needed: Mother Health International’s birth clinic in Jacmel, Haiti, is seeking volunteer midwives to donate three or more weeks of their time in 2010. For more information: http://www.motherhealthinternational.org


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