> > 3) News Flashes > > Researchers collected data on self-reported cigarette use and urine > cotinine concentration from 1583 pregnant smokers at the time of study > enrollment--at the first or second prenatal visit regardless of > gestational age--and in the third trimester. As indicated by urine > cotinine measurement, 1349 women were actively smoking at enrollment > and 234 were not. Women who quit smoking before enrollment and those > who quit after enrollment delivered infants with the highest adjusted > mean birth weights (3492 and 3491 g, respectively). Women who reduced > their cigarette use had a mean adjusted infant birth weight 32 g > heavier compared with those who did not change their cigarette use, > but the difference was not statistically significant (p = 0.33). > Infant birth weight initially declined sharply as third-trimester > cigarette use increased. However, the decline leveled off at more than > eight cigarettes per day. -Am J Epidemiol 2001;154:694-701 > > > =PLEASE SUPPORT OUR SPONSORS!= > = > > > 4) Effects of Labor Drugs > > The risks of epidurals convert normal labor to a high-tech event. An > IV must be started to help counteract the tendency of epidurals to > cause hypotension. Electronic fetal monitoring is necessary because > epidurals can cause fetal distress, and the mother's vital signs must > be closely monitored to warn of maternal adverse reactions. If the > needle or catheter pierces a blood vessel, which is easy to do in > pregnancy because blood vessels are enlarged, or the needle goes > deeper than the epidural space, convulsions, respiratory paralysis, > and/or cardiac arrest can occur. Tests are done to confirm proper > placement before giving the full dosage, but these are not completely > preventative. Trained personnel, resuscitation equipment, and > medication must be immediately available. > > In labor, epidurals increase the need for oxytocin, instrumental > delivery, episiotomy, and bladder catheterization. The first-time > mother is more likely to have a cesarean. Temporary postpartum > complications include urinary incontinence, nerve injury causing > muscle weakness or abnormal sensation, and headache that can last for > days and is excruciatingly painful. Instrumental delivery and > episiotomy increase the probability of deep perineal tears. Backache > and headache may become chronic. In the newborn, epidurals may cause > jaundice, and there may be adverse behavioral effects. -Henci Goer, > Obtetric Myths Versus Research Realities, Bergin & Garvey 1995 > ==== > > Induction with Cytotec should never be attempted anywhere, most > especially in out-of-hospital settings. Incredibly, the American > College of Obstetricians and Gynecologists (ACOG) recently approved > Cytotec induction in spite of lack of FDA approval; in spite of a > letter to doctors from Searle, the manufacturer of Cytotec, imploring > doctors not to use it for induction; in spite of lack of approval from > the Cochrane Library (the best scientific opinion); and in spite of > the fact that it is not approved or used for induction in any country > in Western Europe. > > ACOG quotes studies of Cytotec induction, none of which have a > sufficient number of research subjects, and consequently none of the > studies quoted have sufficient statistical power to detect small but > potentially important risks such as uterine hyperstimulation and > uterine rupture. Furthermore, because published studies of Cytotec > induction have such wide methodological variability, meta-analysis is > impossible and the published attempts at such meta-analysis are > seriously flawed.... Midwives should stay as far away as possible from > such vigilante obstetrics --obstetricians taking matters into their > own hands while ignoring the recommendations of the real judges. > -excerpted from "Midwives and Cytotec: A True Story, by Marsden > Wagner, MD, Midwifery Today Issue 57 > ==== > > 7) Question of the Week (Repeated) > > Q: Does anyone have experience with pregnancy coexisting with kidney > stones? My lady had kidney stones with her first pregnancy. There has > been a recurrence with her second pregnancy. Her urologist felt it > necessary to insert a nephrostomy tube to remain in for the duration > of the pregnancy whereupon she'll probably have lithrodisropy. Her > pregnancy is normal and she wishes to have a vaginal delivery. I wish > to support her in this and am hoping there are some of my sister > midwives who've taken care of ladies like this. -Anne Walters, CNM > ==== > > Q: When you attend homebirths, what do you keep in your kit ahead of > time for those unexpected, middle-of-the-night calls? And what is the > most effective way to organize and carry your materials and supplies? > -B.H. > > 9) Switchboard > In response to the link between obstetric drug use and future > substance abuse in the baby: This possibility is explored in Michel > Odent's video "Midwives, Lullabies, and Mother Earth." A doctor > presented a graph, presumably of his data, showing how the baby's risk > of later drug use jumped with each dose of meds given. > -Melissa Schuppe > Virginia > ==== > > For midwives interested in the long-term effects of drugs in the pre- > and perinatal period (including drugs in labour) I refer them to the > writing of Stanislav Grof. He refers to studies and his own work in > Holotropic Breathwork on the effects of birth trauma, drugs etc. in > these and other of his books: > > -Psychology of the Future: Lessons from Modern Consciousness Studies, > State University of New York Press, 2000. > -The Holotropic Mind, (with Hal Zina Bennett), Harper, San Francisco, > 1990. > -The Stormy Search for The Self, Thorsons, 1991 (with his wife > Christina Grof). > > I have found Grof's work and transpersonal psychology to be a very > useful theoretical framework in which to capture the essence of many > birth experiences I have shared with women and their babies. > > I am an independent midwife in Canberra, Australia, and have been > attending homebirths here for 14 years. At present, > homebirth/independent midwives are having difficulty obtaining > professional indemnity insurance so I have closed my practice for a > while. > -Emma Baldock > ==== > > In regard to Claire's letter about the relationship between use of > epidurals in labor and later drug dependency in the children (Issue > 3:47) and the letters from Melissa Jonas and Natalie Bjorkland > disputing this (Issue 3:48), I offer the following research study > reported in Epidemiology 2000;11:715-716. > > Maternal Medication During Labor May Affect Offspring's Drug > Dependency > > Women who wish to lower their offspring's risk of drug abuse may > decide to forego some of their own drug use during labor and delivery, > according to the results of a prospective study. Dr. Karin Nyberg, of > the University of Goteborg in Sweden, and associates evaluated data > collected on children born between 1959 and 1966. Of the 693 subjects > ages 18 to 27 years who were interviewed, 69 met DSM-III diagnostic > criteria for drug abuse and/or dependence on cocaine, hallucinogens, > narcotics or other drugs. Thirty-three non-drug abusing siblings > served as controls. > > Multiple doses of strong pain medication were used during labor > preceding the birth of 23% of the drug abusers and 6% of the controls. > The researchers estimated an unadjusted odds ratio of 4.7 for drug > dependency in offspring whose mothers received at least three doses of > opiates or barbiturates within 10 hours of birth. The occurrence of > meconium-stained amniotic fluid was also associated with an elevated > risk of drug dependence, but this was confounded by prenatal drug > exposure in 5 of 17 cases. Other potential factors - prolonged labor, > asphyxia, birth order, and low birthweight - were similar among cases > and controls. Dr. Nyberg and her colleagues report that their results > replicate previous findings in humans and animals regarding prenatal > exposure to high doses of medications at birth and adult offspring's > drug dependence. > > Additionally, Beverly Lawrence Beech wrote to this topic in her paper > "Drugs in Labor: What Effects Do They Have Twenty Years Hence?" > > "...In a well-designed case control study at the Karolinska Institute > in Stockholm in 1990, researchers compared children exposed to > pain-relieving drugs in labor with those who were not and discovered > an increased risk of drug addiction later in life (Jacobson et al., > 1990). In 1988 they showed that when nitrous oxide was given to the > mother, the child was five and a half times more likely to become an > amphetamine addict than a brother or sister born to the same parents. > In their paper in the British Medical Journal (1990), patients who had > died from opiate addiction were compared with brothers and sisters; > the researchers found that if the mothers had been given opiates or > barbiturates or larger doses of nitrous oxide the risk of opiate > addiction to the child in later life was increased 4.7 times. In a > further study, researchers discovered that the risk of drug addiction > was related to the hospital in which they were born. In other words, > the likelihood of a child developing drug addiction in later life > depended on the labor ward policies of the hospital the mother chose > for the birth, and I quote: "For the amphetamine addicts, hospital of > birth was found to be an important risk factor even after controlling > for residential area" (Nyberg, 1993). Jacobson and Nyberg's research > suggests that the use of opiates, barbiturates and nitrous oxide in > labor causes imprinting in the babies, and we are now reaping the > whirlwind...." > > She quoted the following studies as her references: > > Jacobson, B. et al. (1990). Opiate addiction in adult offspring > through possible imprinting after obstetric treatment. British Medical > Journal, 301:1067-1070. > Nyberg, K. et al. (1993). Obstetric medication versus residential area > as perinatal risk factors for subsequent adult drug addiction in > offspring. Pediatric and Perinatal Epidemiology, 7: 2332. > > Are we sure we can separate the effects of different pain-relieving > drugs from the effects of epidurals? Is it truly worth taking the > risk? There should always be a weighing of the risk-benefit factors. I > believe there is a time when an epidural is worth the risk - but I > know they are much overused in the United States and I have serious > questions about the ethics of encouraging mothers to sign up in > advance for their epidurals during their childbirth education classes. > I assist at both hospital and homebirths where moms are supported > through their labors with no drugs whatsoever and have beautiful > drug-free birth experiences! Of the 31 vaginal births I've attended, > 24 moms have elected not to have an epidural (or other drugs) - 77% - > and 5 of the 7 who elected to have epidurals had labors exceeding 18 > hours. Someone said recently that you can't control birth, but you can > make an impact on how it will be by your thoughts and feelings. That's > an awesome responsibility for doulas and midwives! > -Helen Moore, CD(DONA) > [EMAIL PROTECTED] > ==== > > I was homebirthed but I feel some of the symptoms Claire mentioned, > i.e., "feeling disconnected from their bodies, fuzzy thinking when > under stress, feeling inadequate and incapable of completing things > they start" so I didn't give these symptoms much credence and almost > skipped the rest of her piece. In the end, I did like what she said > about making sure that the mother is informed of the possible risks of > any intervention. This is so important. > > I had read about the risk of epidural and increased incidence of > substance abuse in an issue of Mothering magazine (No. 99 Mar/Apr > 2000). The article by Beverley Lawrence Beech cites studies that found > an increase risk of substance abuse for those babies delivered > anesthetized [see above]. > > In another article in the same issue, Penny Simkin writes that an > epidural puts the baby at the risk of the following: bradycardia and > hypoxia; tachycardia and fever; subtle changes in newborn reflexes and > neurobehavior, including suckling; more difficulty in self-soothing or > being consoled. She lists a few references in her article. > - Colleen Morris > ==== > > Regarding the tummy exercises mentioned in Issue 3:47 for diastasis of > the rectus abdominii: It is important to EXHALE your breath while > flexing; that is, breathe out when you pull yourself up into the > crunch and flex the abdominal muscles. The exercises are much more > effective that way. > > I was taught a low stress/high result version of the exercise: lying > on back on firm surface with hands behind head, pelvis tilted, then > exhale and raise your head and shoulders just a little while pulling > your abdominal muscles in toward the spine. Then inhale while > relaxing. Do this several times per day for as many repetitions as you > find comfortable. Remembering an ounce of prevention, we might add > the exercises prenatally and before pregnancy, as well, along with our > Kegels. > -Julia Swart > ==== > ==== > > For separated abdominal muscles: You may want to consider some herbs > not only to help your muscles heal but also to help you recover from > your pregnancy. Astragalus and Cordyceps would be great for you. A > formula called Bu Zhong Yi Qi Tang (Ginseng and Astragalus Combination > - it usually doesn't contain ginseng) would probably benefit your > muscles and help your energy. Cordyceps is a great herb to help > nourish your primal energy, which women lose during childbirth. There > are many herbs that can do this. > > It would be best if readers see a licensed acupuncturist or Chinese > herbalist for the herbs. As every person is individual, it is > difficult to say what would be the best dose. Also, every herb company > will have different recommended doses for their formulas so it is best > to follow manufacturer suggested doses unless otherwise advised. Doses > are usually 6-12 grams boiled in 2 - 3 cups of water. > -Colleen Morris, L.Ac > ==== > > >
-- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
