|November 10, 2010|
Volume 12, Issue 23
|Midwifery Today E-News|
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Quote of the Week
“The protocols in the world of animal husbandry to protect an offspring at the time of birth—no strangers, dimmed lights, freedom of movement, familiar environment, unlimited nourishment, respectful quiet, no disruptions—are done without hesitation because to do otherwise invites “unexplained distress” or sudden demise of the offspring.”
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The Art of Midwifery
A Need to Suction?
I do not suction my babies routinely; I feel this procedure is a man-made thing. When I birth my babies, I turn them over onto their stomachs with their heads down and brush up their backs and they will spit up what they need to. With suctioning of any kind mucus, as well as meconium, is forced down the throat. Unless you plan to intubate and suction with a vacuum tube, like in the hospital, the only meconium you will be suctioning will be down the esophagus. This is traumatic to the baby and throws him into the vagal response, which increases his respiration and heart rate at a critical time when he should be stabilizing.
I find that most of the meconium that babies will spit up is in a large mucus plug, tinged with the meconium, within the first six to eight hours after birth. If baby’s respiration is slightly elevated above normal, a small amount of sterile water can be given to him, and he will soon spit up a large mucus plug and be just fine. If you are concerned that baby may have aspirated meconium, about the only thing you can do is watch for signs of infection if you do not plan to intubate and suction.
Jan’s Corner: Guest Column by Joy Paley
Traumatic Birth and the Request for a Cesarean
As you already know, birth is a powerful experience, one that has the potential to be either incredibly uplifting and fulfilling or psychologically and physically damaging. Midwives are intent on making the experience the former by providing loving, individualized care. But what about women who have already had a traumatic birth?
There are many different aspects of a birth—use of forceps, unrelieved pain, c-section, or a perceived loss of control during the birth for example—that may cause a mother to classify her birth as “traumatic.” Research has shown that once a woman has undergone a traumatic birth, she is more likely to request a cesarean for the birth of her next baby.(1) In one Hong Kong study, 24% of women chose elective cesarean after their first birth and a quarter of these women reported “intense fear of vaginal birth” as their reason for electing to have a cesarean.
Midwives have a special place in reaching out to and educating women who have experienced a traumatic first birth. Patti Gardner, CNM, wrote in the Journal of Perinatal Education about what can be done to help these mothers have a fulfilling, normal subsequent birth.(2) Gardner noted that counseling can have dramatic effects for women who have had a previous traumatic birth and are planning to deliver by cesarean. After short-term talk-therapy, many of these women change their minds and choose to deliver vaginally. Midwives involved in education or prenatal care should keep this in mind.
Letting women remember and grieve over their first, traumatic birth experiences in a private setting with someone she trusts is key to helping her move forward, and midwives can provide this type of support. Education also is important. Some women may be under the impression that a cesarean is safer than vaginal birth. Others do not fully understand what a cesarean entails or realize that a c-section is a major surgery that poses dangers to the birthing woman as well as her baby. Once women are informed about the reality of cesarean birth, many will choose the safer route and birth their babies vaginally.
However, many of these women may never come into contact with a midwife. Most have birthed their babies in a hospital setting, choosing obstetricians over midwives. It is important for doctors whose patients are requesting cesarean surgeries to recognize that this request may belie a deeper psychological trauma associated with giving birth. Obstetricians need to refer these women to a counselor or, even better, to a midwife. After all, studies have shown that women who give birth in hospitals with a midwife have lower rates of intervention than those who birth with an obstetrician, with the same safety for baby and less trauma for mom.(3)
— Joy Paley blogs for An Apple a Day (http://emersonmerrick.blogspot.com) and writes about nursing school choices for the Guide to Healthcare Schools. Joy graduated from Stanford University in 2010 with a bachelor’s degree in science, technology and society. She also was selected as a 2010 Levinthal fellow, which honors Stanford undergraduates for exceptional work in fiction or poetry. When she’s not reading or writing, Joy likes to work on crafty projects or spend time outside. She is currently living in Berkeley, California.
— 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
Psychological Abuse Linked to Postpartum Depression
A study recently published in The Lancet shows a link between postpartum depression and domestic violence, particularly psychological violence by intimate partners, during pregnancy. Researchers followed 1,000 Brazilian women from their third trimester through their early postpartum weeks. The women who reported that their intimate partners had physically or sexually abused them during pregnancy were more than three times more likely to have postpartum depression. Women who had experienced psychological violence, such as intimidation or humiliation, were even more likely to suffer from postpartum depression.
— Ludermir, Ana B., et al. 2010. Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study. Lancet 376(9744): 903–10.
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Sandy was a small Appaloosa bred to a large Tennessee Walking Horse. The birth took longer than usual due to the size of the foal, but we felt that giving her lots of space and time to work it out on her own was best, despite the suspected dystocia. The only real “assistance” she needed (if any) was having the amniotic sac removed from the foal’s face when his head crowned and presented. He began breathing right away, 30–40 minutes before the birth of the rest of his body, so I felt justified in that action.
Sandy labored long on the ground and began to birth the foal while lying down. I found the situation extremely interesting in so many ways, watching her movements and seeing her really working with the birth, shifting her position with contractions and staying calmmmmm. She didn’t fight, resist or panic at the difficulty of her task; she simply worked with the birth as instinct guided her.
Three of us were there, quietly, quietly: Marion and John—my adult children—and I, trusting birth and feeling like guardians of the moment. We frequently exchanged knowing glances, awed by the miracle and honored that she allowed us to be there. Horses seldom birth when people are around, preferring the safety of solitude to the perils of intervention. We have always been fortunate to have unique trusting relationships with the animals on our farm. This was one of those times, and though typical to our lives, it was nonetheless a uniquely remarkable event that seemed almost suspended in time. It was perfect in so many ways, until interference nearly spoiled it.
A woman who was driving by erroneously saw the situation as an emergency. Answering an unsolicited (but well-intended?) call to duty, she brought her car to a screeching halt and ran toward us in hysterical panic. To our amazement (and dismay!) she covered five acres with Olympic speed, scaling an electric fence without noticing the voltage, yelling at jet engine decibels with an auctioneer’s aggravating articulation—completely shattering serenity. She was clearly disturbed and overwrought by what she was seeing us not doing and anxious to remedy the entire situation with her obviously needed expert opinions.
“Do something! Aren’t you going to do something? Why aren’t you doing something?! The baby is stuck, can’t you see that? Hurry—call the vet—he’s going to die! You’ve got to grab hold and pull him out! Don’t you have a winch?”
Sadly, her reaction was not unexpected or uncommon, so none of us was critically surprised. Due to poor education regarding the normal nature of birth, people often panic for want of a more educated and calm point of view. Our uninvited visitor was no exception and we understood her typical “reasons” for fear, though we did not share them ourselves.
Serene in Marion’s comforting and trusted company, Sandy hardly noticed the disturbance. She continued working and after some time, she finally stood up. She employed gravity and allowed the weight of the foal’s body to help her help him to emerge; and he did, beautifully. The foal was safely birthed and we all felt emotionally charged.
Mexican Art Expresses the Joy of Birth
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Question of the Week
Q: A Midwifery Today author, Beth Barbeau, recently noted that we have “safer birth in a barn,” stating that humans often take a decisively “hands-off” approach when it comes to animal birth, allowing animals to birth in privacy and serenity. But when it comes to human birth, the opposite seems true and interventions are the norm. Have we reached a point where we do indeed have “safer birth in a barn”? Share your thoughts with us.
— Midwifery Today staff
Read the article online “Safer Birth in a Barn?
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: 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
A: Last month I experienced incredible rectal pain and intestinal cramping at one week postpartum with my second child after a smooth labor. I was impacted and having difficulty pooping. I started to get small hemorrhoids, which I treated with extra fluids, Vitamin E capsules, juice and fruit puree. I also went to see my chiropractor and physical therapist as soon as possible. The chiropractor adjusted and released a great deal in my lower back, which immediately made a huge difference and eliminated the pain. My physical therapist specializes in women’s health and pelvic floor dysfunction, and worked externally on my pelvic floor. I believe that it is a skeletal/muscular issue that occurs after carrying a baby. A friend developed a rectal fissure at three weeks postpartum with her first child, and had severe pain for months. After my experience last month, she now believes that her fissure could have been resolved (or prevented) with early chiropractic and/or physical therapy care.
— Sylva, RN, CLC
A: I am not sure what caused your hemorrhoid pain three weeks later, but one possibility is irritation from yeast. This is quite common. The way to prevent it is using water to wash off the rectum after every bowel movement and then applying white diaper rash creme.
— Judy Slome Cohain, CNM
A: I am wondering, since no hemorrhoid could be located, if it was actually a rectal tear you experienced? Rectal tears are not really noticeable, yet they are excruciatingly painful during the bowel movement itself. They are treated similarly, with daily stool softeners to help things pass smoothly. It takes a while for them to heal. They don’t necessarily happen due to the birth itself.
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.
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Periglow, the best to support the perineum after birth. Periglow is a ready-to-use Swiss compress to promote healing the first weeks after giving birth. As a soak or bath. http://www.periglow.com
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