April 25, 2012
Volume 14, Issue 9
Midwifery Today E-News
“The Umbilical Cord”
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In This Week’s Issue


Quote of the Week

The parallels between making love and giving birth are clear, not only in terms of passion and love, but also because we need essentially the same conditions for both experiences: privacy and safety.

Sarah Buckley


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The Art of Midwifery

A nuchal cord is present in about a third of all deliveries and usually presents no problem. The issue, therefore, is not if the cord is present, but whether it is able to function in its delivery of blood and oxygen to the fetus during labor and delivery.

Valerie El Halta
Excerpted from “Preventing Prolonged Labor,” in Midwifery Today’s, Birth Wisdom, Tricks of the Trade, Vol. III
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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.


Send submissions, inquiries, and responses to newsletter items to: mtensubmit@midwiferytoday.com.

Jan’s Corner

Wonderfully Made

We women get to give birth if we are fertile and if we desire to. This is a gift to women that men do not get to enjoy. It is life expanding. Our body is designed by our creator to birth. This is something only half of the world’s people get to do. We worry and carry fear about the act of birth but “Fear not!” Your body is perfectly made for this, and it almost always works. The 35 percent cesarean rate and the nearly 99 percent intervention rate tell us immediately that lies are being perpetuated into the minds of pregnant women, beginning possibly with their own birth experience.

The culture gives false signals about birth from the beginning of life. It may begin with this woman’s own birth and her bad experience becomes imprinted on her mind. Women, take back your birth. Fear not. Stay away from negative people. Find a midwife who believes in you and has confidence that you can do it; if you are afraid, find someone who will convince you that you can do it. Stay away from modern tactics as the medicalization of pregnancy has overtaken this sacred time. Stay away from routine ultrasound. It does not improve outcome. Stay away from medical people who look at you and say things like, “Well, we will see if a baby can fit through there,” and other wrongful words. Words hurt and words heal. Choose the healing words of a midwife. You are not sick. You are sacred, and so is the baby inside of you. One negative sentence said to a pregnant momma can derail her confidence and her ability to birth as she was designed to. You are wonderfully made.

As Ina May Gaskin tells her moms, “Do not listen to bad birth stories or negative talk. If someone starts to tell you a negative story or thought, tell them you are pregnant and your midwife says you are not to listen to those negative words.”

Let your oxytocin flow for birth. If you are having a normal birth, stay out of the hospital for your sacred event. If you go to the hospital, get a doula. Elizabeth Davis says the midwife “needs to run on oxytocin, too.” On that note, find yourself a midwife who flows oxytocin!

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.

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News and Research

Length of Birth Then and Now

Although the modern world has been able to speed many things up, it hasn’t been able to speed up vaginal births. According to a US government study, US women are spending two to three hours more in labor than they did back in the 1960s.

On average, US moms today are different. They are older, heavier and their newborns are bigger. Katherine Laughon, lead researcher at the National Institute of Child Health and Human Development, says that even taking these factors into consideration, labor is taking longer than it used to, and doctors may need to rethink the definition of “normal” labor.

The findings were based on two government studies done decades apart. Today’s US women were far more likely to have an epidural—55 percent, compared to just four percent of counterparts 50 years ago. Oxytocin, which stimulates contractions, was given to 31 percent of mom’s in the recent study, compared to only 12 percent 50 years ago. And in the 1960s, only three percent of mothers in the study had a cesarean.

Laughon said the findings show there needs to be a redefining of “normal,” adding, “I think we need to revisit the definitions of ‘abnormal’ labor, and the timing of the interventions we use.”

— Reuters. 2012. “Childbirth takes longer now than 50 years ago, study finds.” Fox News. April 02. http://www.foxnews.com/health/2012/04/02/childbirth-takes-longer-now-than-50-years-ago-study-finds/#ixzz1qunUrmW7


Featured Article

The Cord and the Strength of Life

I have observed babies being birthed with the placenta detached and following right behind them for over 20 years. Throughout that time I have kept mental notes, observing, recording, pondering. Then one day, finally, it all added up. The explanation is a short umbilical cord, a phenomenon that requires us to allow time for the baby, the cord and the placenta to descend slowly through the birth canal, in the wisdom of nature, for a healthy and natural birth.

My first encounter with a short cord began with a false labor. The mother thought this was the day. She called me, and I stayed with her until labor ceased several hours later. The mother and baby were fine. There was no good reason to intervene, despite the fact that she was multiparous with 4 cm dilation and the baby was not engaged. I warned her of possible cord prolapse and asked her to be aware of her baby’s activity. A couple of days later she called me again. The birth was very quick and the baby was born with shoulders and body entangled in a barely pulsing cord. The newborn had some blood on his bottom because the placenta had separated at the time of birth. He required stimulation and oxygen, but it was all resolved quickly and within the realm of the normal.

I have watched vigilantly for short cords ever since. Two weeks ago, some twenty years after I noticed it for the first time, it happened again. This time it was with a mother who had had three babies. The last two had been very fast. She had always had mild contractions before going into labor, but this time she had more. As she was multiparous, I initially did not think there was a problem. About ten days after her due date I thought she was going to have her baby. Her uterus looked so low that it was “by her knees.” But it did not happen.

“Something is strange,” I thought while checking her. I sighed. The baby was floating, even though the uterus was very low. It seemed the baby ought to be engaged, but he was not. I then listened to the baby’s heart tones and found normal heart tones but with minimal decelerations. The heart tones were at 140 and descended to 126 or so in the middle of mild contractions.

I listened to the heart tones every three days. The mother was noticing movement. We decided she should try to induce herself through nipple stimulation and an enema of medicinal plants. I gave her an exam in which I stimulated the opening of the cervix. The contractions began, and she dilated another centimeter easily. The heart tones remained within normal ranges. It is important to be careful in this situation. If heart tones consistently descend to below 120 and fail to recover sufficiently, especially if the mother has been in labor for a long time, transport to a hospital facility. If all remains normal, you can continue with birth at home, although you must be alert. Have everything ready, because the birth will be very fast. This can occur because the cord itself is short or because the baby is entangled, shortening the cord.

However, everything stopped after a few hours. The mother was already at 5 cm, but the cervix remained inflexible. Although the baby’s head was in a good position, he was not engaged, and therefore was not exerting pressure. After the second attempt I sat down to think. I concluded that we were dealing with a short cord. In any other situation a vaginal exam, some nipple stimulation and an enema would have produced labor. But beyond the mother and me, the wisdom lies between the baby, the cord, the placenta and the uterus.

You can confirm that you are dealing with a short umbilical cord by observing the abdomen. During contractions, and sometimes without them, the baby appears engaged, even though a vaginal exam reveals that she is floating. It is important to avoid interventions that force the mother’s body to enter the birth process before the placenta and uterus are ready. The fundus has to descend with the baby. This process takes time. Contractions that cease despite dilation of 2–5 cm in a mother with previous fast births and no other complications indicate the possible existence of a short cord. Observation without intervention is important in these cases.

Marina Alzugaray
Excerpted from “The Cord and the Strength of Life,” Midwifery Today, Issue 70
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The Epic Women DVD Slide Show by Harriette Hartigan is a powerful affirmation of woman’s ability to give birth naturally. Choreographed to Bette Midler singing "The Rose," the 31 still photographs give witness to the strength and grace of women as they work to bring their babies into the world. Order the DVD.


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Web Site Update

Read these articles from Midwifery Today magazine now available on our Web site:

  • We Two Form a Multitude—by Lois Wilson, CPM
    Excerpt: We two form a multitude. Together we are complete. Together we are invincible. We two form a multitude. Yes, there are couplings that make us feel that strong. The mamatoto—the motherbaby—is that kind of coupling.
  • Philippines: In the Night Lorega—by Vicki Penwell
    Vicki Penwell began setting up birth centers and numerous other charity medical works in the Philippines in 1995, where to date, more than 5,000 babies have been brought into the world, for free. Lorega, where this story is located, is a typical inner-city Asian slum where the poorest of the poor live in squatter shacks and hovels, surrounded by three graveyards and a slaughterhouse.

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Birth Q&A

Q: What kinds of issues have you had with the umbilical cord at birth? How often have you seen the cord around the neck and how many loops at most? Please share what you did in these circumstances.

— Midwifery Today

A: Last year, I attended a sweet little 6 lb baby girl with a 48" cord. Her daddy said it must be her extension cord. All that cord and not one bit wrapped around anything!

— Janet Titmus Delettera

A: I had a cord break once. Baby was born to his chest, screaming his head off but wouldn’t finish coming out. I tried to see if there was a growth or tumor keeping him from coming out. I had my hand in the mom feeling along the baby’s back (she was on her hands and knees) when we heard a loud pop and the baby flew out of the mom. I caught him in midair, lowered him to the bed and noticed about three inches of cord, limp and not bleeding. The cord was only 12 inches long. Everyone but the midwife was fine—I got about 20 gray hairs that day.

— Margie Dacko

A: I had a day at the hospital where a doctor was in a cesarean. The nurse called me to stand by for the vaginal birth. I went into the room and found the mom on her back, pushing with the head crowning. She couldn’t get it any farther out. She was a multipara. I flipped her to her left side, and the head came. I then discover nuchal cord x 3, very tight. I could not slip it over the head. The nurses were getting a little worried and wanted me to clamp and cut the cord, which I would not do. Mom was on her side with the next push, with her top leg way open. I got the shoulder coming, and then somersaulted this big ol’ boy out of her. I laid the big guy on the bed and unwound him, and he started getting his blood back. He pinked up, cried, and looked great. Momma rolled back over and he went on her abdomen. We let that blood pump back into him before we cut the cord. She delivered intact.

— Vicki Gilbert Ziemer

A: I had a baby born several years ago with at least four or five wraps around the neck, diagonally around the body, leg, arm, etc. He somersaulted out just fine and spun unwrapping himself with my help. It was so fun to watch.

— Pamela Golliet

A: This is a family story: My husband was born with his cord wrapped four times round his neck, then once around his feet. To this day he will NOT wear a tie. We’ve been married 38 years and no, not even for our wedding! He hates anything around his neck.

— Patricia Edmonds

A: [Response to the above comment] That’s so funny because my daughter was born with the cord around her neck and she loves having anything and everything around her neck. We really have to watch her.

— Adele Chlebeck

A: One baby I caught had such a short cord that she had to stay between mum’s legs until the placenta delivered—it was most odd to see. Another had an amazingly long cord wrapped around the neck, across the abdomen and around one leg, but because it was so long and wasn’t affecting the baby’s ability to maneuver in the birth canal, the birth was not complicated. My advice is to reflect on each birth and see if, in hindsight, you can understand how that particular birth unfolded. I often notice something during the birth, and then once the baby arrives, it all makes sense.

— Sally Kelly


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Wisdom from the Web

When a human baby is born it needs to begin breathing air into its lungs in order to survive. However, it would be a mistake to imagine that a baby’s first breath contains their body’s first experience of life-giving oxygen. Oxygen is provided for the fetus throughout the entire pregnancy by the mother, through the placenta. Following birth the placenta continues to provide oxygen for approximately five minutes while blood pumps, to and fro, through the umbilical cord. This is part of an ingenious plan of God’s (or nature’s) to allow the newborn time to “unfold” his/her lungs and to gently make the switch from living underwater to breathing air through the lungs. Remember, the infant is not receiving “placental” blood or even the mother’s blood through the umbilical cord. The baby is retrieving its own blood supply from one of its own functioning organs that just happens to be inside its mother’s body.

— Echo Child’s Play; Green parenting for non-toxic-healthy homes
http://ecochildsplay.com/2010/01/06/natural-childbirth-delayed-cord-clamping/


After your baby’s natural childbirth, the umbilical cord does not just lie limp not functioning. For several minutes after birth, the cord is still very much alive and active, still pumping blood and oxygen into your baby. You should not cut the cord until it has completely stopped pulsating. Changes in the cord’s Wharton’s jelly then produce a natural internal clamping within 10–20 minutes after birth. But as long as it is still beating, it is still benefiting your baby.

— April Asorson, childbirth educator
http://mynaturalchildbirth.org/natural-childbirth-cord-cutting/

Its richness in stem cells is probably what makes Wharton’s jelly most interesting to scientists. But the great thing about this substance is that it essentially provides a physiological cord clamp. It reacts to changes in temperature, and ensures that the internal structure of the baby’s cord collapses. Of course, childbirth is exactly that event that caused those changes in temperature. After the cord stops pulsing, it turns limp and white. Wharton’s jelly is the substance that means that clamping the umbilical cord is not necessary. The human body does this all by itself!

— Olivia, blogger and journalist
http://www.writeaboutbirth.com/index.php/whartons-jelly-the-natural-umbilical-cord-clamp/birth/


If you’d like to share a bit of wisdom from the Web, please send a 4–5 sentence excerpt, accompanied by a link, to mtensubmit@midwiferytoday.com.


Conference Chatter

Welcome to Germany

I hope we will see many of you from around the world at the conference in Bad Wildbad, Germany. This is truly an international event where you can meet midwives from many countries and exchange ideas and make friends. At one of our Germany conferences, we had midwives and doulas from 43 different countries! The venue is fabulous, with its spas where we go after the conference to relax, tell birth stories and just enjoy the water and each other. The little town of Bad Wildbad loves the midwives and rolls out the red carpet for us. There are places to stay for every budget. As always, it is our hope that you will gain ideas, insights and a new strength to carry out your calling for motherbaby.

We also want you to save money! If you register by June 5, 2012, you get the most reduced price. Subscribers of Midwifery Today save even more—if you aren’t a subscriber yet, you can become one when you register. You get the most benefit by being a subscriber, because not only do you get a cheaper conference, but you also get all the great articles written by our teachers and other great authors from around the world. Midwifery Today really is a great magazine that brings you both the heart and the science of midwifery and birth. Students also save 20 percent on three or more days. We really want students to start off their career with knowledge gained from all over the world—knowledge that is seldom taught in schools! There will be a lot of hands-on care taught at this spectacular event that will enrich us all!

You can learn more about the Germany conference here: http://www.midwiferytoday.com/conferences/Germany2012/

— Jan Tritten


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Expanding your personal library?

How about expanding your local library with books that encourage natural and instinctual birth? How much information about natural and instinctive birth is at your library? As a patron of a library, you have a say about what books they carry. Let your library know you want natural birth and midwifery materials to be available. Your library is your resource. Use it.



Stories

I was at a birth last year where the mama reached between her legs to touch her baby girl as she was being born. The baby reached out and grabbed hold of the mom’s finger and held it until she was all the way out. The mama kept saying, “My baby! My baby! My baby is holding my finger!” It was beautiful—I still get teary-eyed when I think about it.

— Beth Murch


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