> > > 1) Quote of the Week > > "The best way to avoid a cesarean is to stay out of the hospital." > -Brooke Sanders Purves > o=o=o=o=o=o > > > 2) The Art of Midwifery > > Pelvic Press: Use this technique during second stage if there is a > delay in descent or caput forming due to malposition or cephalopelvic > disproportion. It also is helpful in occiput posterior babies, deep > transverse arrest or a tight fit. It increases mid-pelvic and outlet > dimensions to make room for fetal rotation and descent. The woman is > in a squatting position, the partner or caregiver kneels behind her; > during a contraction this person locates the iliac crests and presses > them firmly toward each other. When combined with squatting, movement > in rotation or descent should be visible in three to four > contractions. > >From "Labor Progress Handbook" by Ruth Ancheta & Penny Simkin; > submitted by KarieAnn Zeinert, doula > ==== > > ALL BIRTH PRACTITIONERS: We encourage you to continue to send in your > favorite tricks of your trade! > o=o=o=o=o=o > > > 3) News Flashes > > A University of California at Davis School of Medicine study found > that extending breastfeeding from four months to six months after > birth greatly reduced the number of respiratory infections. The study > of 2,277 children between the ages of 6 and 24 months identified five > groups: formula-fed only, full breastfeeding for less than one month, > full breastfeeding from one to four months, full breastfeeding from > four to less than six months and full breastfeeding for six months or > more. Researchers found that the chance of contracting pneumonia was > reduced fivefold with two added months of full breastfeeding, and the > risk of recurrent ear infections was reduced twofold. This is one of > the first studies to show that breastfeeding longer adds to its > benefits. The U.S. Department of Health and Human Services plans a > campaign starting in 2003 to encourage breastfeeding. In the United > States, 64% of women breastfeed their newborns but only 29% continue > for at least six months. > -The Sacramento Bee, May 6, 2002, page B1 > > > > > > > 4) Premature Rupture of Membranes (PROM) > > Detection > Question the mother about the following: > * the amount of fluid that was lost > * degree of inability to control the leakage > * time of rupture > * color of fluid > * odor of fluid > * last sexual intercourse or use of vaginally inserted products. > > Laboratory tests can confirm the presence of amniotic fluid: > * nitrazine test > * vaginal pH determination > * nile blue sulfate staining > * amniotic fluid arborization (fern test). > > Midwifery Parameters of Safety > Midwives who adhere to a preventive philosophy and encourage their > clients to do the same decrease the number of incidences of PROM. By > educating their clients to eat a good diet and maintain good hygiene, > avoid smoking and drugs, and clear up any vaginal infections, fewer > cases of PROM occur. > Many midwives, after having dispensed the appropriate precautions to > their client, will wait up to two weeks for labor to commence. Women > who are 37 weeks or more may be encouraged to stimulate labor by > various methods. > > PROM and the Preterm Fetus > Thirty to fifty percent of preterm labors occur after PROM. Women with > preterm (before 37 weeks) PROM should have white blood cell counts, > with differentials, done every other day. They should be compared to > counts taken earlier in the pregnancy. > For very early PROM, most women will be given the usual precautions: > bed rest and a tocolytic drug such as ritodrine. For those closer to > term (35-36 wks), precautions will be given and the preferred > treatment is waiting. Fetal lung maturity accelerates after membranes > rupture and most healthy babies if larger than 2,550 grams will be > good candidates for a homebirth. > > Risks and Complications > An unengaged fetal head can cause cord prolapse if the amniotic fluid > rushes by, taking the cord with it. A small or premature baby may have > a cord prolapse because there is enough room for the cord to pass. > > Infection > A woman with prenatal infections such as Gardnerella or Beta strep is > at increased risk of PROM. Infections may predispose a woman to PROM > by weakening the bag. > A study by Dr. Lewis Mehl in California showed that infections > dramatically increased after the fourth day. Another study in the > Netherlands of 6,014 pregnancies found no increased risk of infection > for PROM if no vaginal exams were done and delivery exceeded 24 hours > from PROM. > > Signs and Symptoms of Infection > Chorioamnionitis occurs when the two layers of the placental > membranes, the chorion and amnion, become infected or inflamed. No one > sign or symptom should be used as the only criterium for diagnosing > infection. Some indications of infection are: maternal fever, seen in > 85-100% of infected women; fetal tachycardia, 180 or more; chills; > uterine pain and tenderness; foul vaginal discharge; low blood > pressure and increased pulse; vaginal walls unusually warm to the > touch; elevated white blood cell count. > > Testing for Infection > Check white blood cell count with differential every other day. > Gram staining of the amniotic fluid can identify infection in up to > 80% of women when the level of organisms has reached or exceeded 105. > However, the presence of bacteria is suggestive and positive results > should not be interpreted as confirmation of infection. Acridine > orange staining may be used if gram staining yields a positive result > because it can also detect mycoplasmas. > Gas-liquid chromatography is a reliable test. Others include > C-reactive protein, leukocyte esterase test strip, and glucose levels > in the fluid, although these tests have been reported to have > questionable value. > > Cesarean Section > The cesarean rate is 30-50% for women who are induced to deliver > within 24 hours of PROM. Because most women will spontaneously go into > labor within this time frame, the patient and wise birth attendant > will wait. > > Causes > Suspected causes of PROM include polyhydramnios, fetal > malpresentation, multiple gestation and prenatal maternal genital > infections. Repeated vaginal exams during pregnancy may predispose > some women to early rupture. Some maternal genital infections that may > predispose a woman to PROM are Gardnerella vaginalis, herpes, > ureaplasma urealyticum, mycoplasma hominis, Bacteroides bivivus, group > B strep and E. coli. > -Yvonne Lapp Cryns, PROM by the Book, > in Wisdom of the Midwives: Tricks of the Trade Vol. 2, a Midwifery > Today book > o=o=o=o=o=o > > > > > > 9) Question of the Week Responses: Cholestasis > > Q: At 30 weeks gestation, G2P0, my sister is experiencing cholestasis > of pregnancy. She has high bile acid levels and an unrelenting itch. > They have tried solu-medrol pack, Questran rx, all to no avail. Any > ideas for treating this condition? What about the baby? > -Ellen Haynes, RN ICCE > ==== > > A: Gentle choleretic/cholagogue herbs that are safe for pregnancy > include burdock root, dandelion whole plant and yellow dock root. Both > move bile through the gallbladder (choleretic) and stimulate the liver > to produce more bile (cholagogue). The herbs can be combined and made > into a tea, perhaps 2-4 cups sipped throughout the day. Alternately, > tinctures are used either as simples or a mixture: one dropperful in a > little warm water four times per day. In addition, use dandelion whole > plant tincture as a bitter tonic by placing 5-10 drops on the tongue > before meals and snacks. Bitters help set things up by stimulating the > secretion of digestive juices all along the GI tract. > > To help cope with unpleasant itching, scullcap tincture is my > favorite. If your sister is brave she can drink the very bitter tea, > which would also support her liver. I wonder if a relaxing oatmeal > bath would also soothe her? > > Your sister may be tempted to avoid fats right now. Even so, after a > week or two on the herbs, I would recommend that she ingest some fish > oil daily. The essential omega 3 fatty acids found in fish oil are > major components of breast milk and the rapidly developing fetal > nervous system. They also decrease the inflammation around the bile > ducts that occurs in cholestasis. > -Adrienne Leeds, herbalist and midwifery student > ==== > > A: You will find an underlying problem of a stressed liver. I would > address this by immediate use of dandelion tea: begin with one cup on > day one, two on day two, and three on the third day and until birth, > plus a few weeks beyond. I would expect my client to feel better > within several days. > -Molly Germash, CPM > Dallas/Ft. Worth, TX > ==== > > A: I am a CPM and graduate RN. I recently worked with a primip who had > cholestasis. Repeated attempts were made in the hospital to induce her > beginning around 38 weeks -- they were unsuccessful. Her bile salts > were high but not too far above the high end of normal. (Really high > levels are cause for more concern.) She was managed by CNMs with > Ob-Gyn consultation. The management style adopted was watchful > waiting, but no one was alarmist. Finally she was given the option to > go home and wait a few days before attempting induction again, with > daily nonstress tests in the plan. The baby was reactive and great all > along, which helped allay concerns. The parents were alarmed by dire > information they had picked up on the Internet. With reassurance they > were happy for respite from induction. Mom ended up going into labor > spontaneously around 41 weeks and labored well but ended up with a > cesarean due to persistent OP presentation. More research must be done > about this condition and appropriate management. The itching is severe > at first, but should subside. > -Jennifer McGeorge, CPM > ==== > > A: This happened to me too, but it resolved on its own after about one > week without medications. > -Anonymous > o=o=o=o=o=o > > The BirthLove Web site has helped many women grow trust in birth and > in their bodies. It has helped women resist Cytotec, find good > midwives and stop believing everything their doctors say. There are > hundreds of homebirth stories: unassisted VBAC, fathers' stories, twin > (and triplet home VBAC!) stories, breech stories -- for things that > people get sectioned for daily, there are homebirth stories on the > site. Marsden Wagner, MD, is a contributing expert, as is Sarah > Buckley, MD, Gloria Lemay and Gretchen Humphries. BirthLove has > changed and saved lives through education, communication and love. > Become a member of BirthLove today and be inspired! > http://www.birthlove.com > o=o=o=o=o=o > >
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