> 3) News Flashes > > A study conducted by the Department of Obstetrics and Gynecology at Cambridge University looked at 120,633 second births of singletons. Among 17,754 of these women who had delivered their first babies by cesarean section, 68 had stillbirths, or the equivalent of 239 per 10,000 per week. Among 102,870 who had birthed vaginally the first time, there were 244 stillbirths before labor, the equivalent of 144 per 10,000 women per week. The risk of unexplained stillbirth associated with previous cesarean was most significant at 34 weeks gestation. "The absolute risk of unexplained stillbirth at or after 39 weeks was 1.1 per 1000 women with previous cesarean and 0.5 per 1000 women with no previous cesarean," according to the researchers. Denver Post, Nov. 28, 2003 > > -Submitted by Patricia Kay, CNM, Olympia, WA > o=o=o=o=o=o > > > > 4) Ultrasound > > The problems with ultrasound are many. > * Unborn babies are being exposed routinely to a technology that has not conclusively been proven safe. > * Practitioners are becoming so dependent on machines that they are losing their hands-on skills. > *Machines are increasing the level of fear around birth as practitioners become less connected with the essential process. The rate of surgical birth is soaring. > * The routine use of scanning and the off-hand comment to women that the scan is being done to see "if your baby is all right" covertly and overtly implies that a scan can absolutely rule out fetal variations and defects. Women and families are led to believe that modern technology guarantees them a perfect baby. It is therefore imperative that as midwives we counter this worldwide cultural trend by being very clear about the benefits and deficiencies of ultrasound exam procedures and emphasizing that no one can guarantee anything in life or in birth. > > Parents must be told in no uncertain terms that it is unrealistic and unreasonable to expect detection of all fetal anomalies even with the most expert and through scanning, regardless of the method used and the stage of pregnancy when the exam takes place. The skill of the technician and the quality of the scanning equipment are critical to the accuracy of the exam, the degree of ultrasound to which the fetus is exposed, and whether existing problems will be detected or nonexistent ones accurately ruled out. > > -Anne Frye, Understanding Diagnostic Tests in the Childbearing Year, Labrys Press, 1997 > ==== > > TO ORDER UNDERSTANDING DIAGNOSTIC TESTS IN THE CHILDBEARING YEAR, go to: > http://www.midwiferytoday.com/redirect.asp?id=829 > > Read more of this article in the full online version of E-News at: http://www.midwiferytoday.com/enews/enews0604.asp > o=o=o=o=o=o > > > ~~~~ > Concerned about prolonged labor? > Then you need the new Prolonged Labor Handbook. > This book will show you the benefits of positioning and ways to prevent prolonged labor, including herbal remedies. You'll also discover the difference in care in hospital, clinic and home environments. > Part of the Holistic Clinical Series. > Go here to order your copy: > http://www.midwiferytoday.com/redirect.asp?id=824 > > ~~~~ > >>> > 9) Question of the Week Responses > > Q: According to my midwife and information I have from Europe, forced pushing (i.e., count to ten, hold your breath) puts a lot of stress on the pelvic floor and can damage it. But such a pushing method is not necessary. Babies get born also with a much gentler approach in which the woman pushes when her body tells her to. This method usually means that she'll hold her breath for a few seconds only (if she holds it completely at all), but several times during a contraction. What do you think? Where can I find information (online) about this approach from the United States? Or is this a well-kept secret? > > -P.L. > > A: My experience as a doula in hospitals here in the United States is that most healthcare providers encourage forced pushing - get that baby out as fast as you can. Many of them count for the mother as she holds her breath. Homebirth midwives here tend to let women push as their bodies direct. This works well for women whose bodies tell them to push. In my last birth (a HBA2C), I was complete for several hours and *never* felt the urge to push. We finally all agreed that I should just push that baby out, and I did without contractions, holding my breath only when my body felt like it. Forty minutes and he was out! > > -B.S.P. > > A: I have delivered five children and have never had a strong urge to push. My first delivery involved forced pushing because I was in the hospital, and I didn't know to argue with the doctor yet. My second son was c-section, so there was no pushing. My daughter was stillborn, and although she was very small, the doctor had me push even more than the first time in his effort to get it over with. I think he was trying to help himself more than me. Anyway, my last two sons were entirely different experiences. I had them both at home with lay midwives. I did not have an urge to push either time. This also applied to my other deliveries. The midwives were not concerned about this. Guess what? My sons were born anyway! I can tell you that not having to go through the strain of forced pushing made my deliveries much easier. I wish, as many of us do, that I was more informed before my last two sons. I have not found much information about this topic, either. However, if you are considering > > -Karen > > A: The kind of pushing you describe is advocated by The Bradley Method. I don't know about online resources, but all Bradley material, including Natural Childbirth The Bradley Way by Susan McCutcheon, discusses normalized and natural breathing patterns throughout labor. In my personal experience with hospitals, however, I'd say that this is still a well-kept secret. > > -Stacy McCarthy, AAHCC > > A: HypnoBirthing(R) - The Mongan Method emphasizes a gentle "breathing down" of the baby rather than the forceful pushing of the baby through the birth path. This technique has been espoused by Grantly Dick-Read, Bradley, and many other childbirth professionals. However, when the time comes for the baby to move down, a great many obstetricians, midwives, and doulas forget it and fall back on the "hold your breath and push." This tires the mom and decreases the chance of the baby's head and mom's body reshaping and adjusting as they need to. This in turn leads to the baby moving back up into the birth path more and also an episiotomy. To find out more about HypnoBirthing(R), go to www.hypnobirthing.com. > > -Joleen Streit, MA, CHt, HBCE, CD(DONA), New Mexico > ==== > > Read more answers to this question in the full online version of E-News at > http://www.midwiferytoday.com/enews/enews0604.asp > > EDITOR'S NOTE: Responses to any Question of the Week may be sent to E-News at any time. Write to [EMAIL PROTECTED] Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message. > o=o=o=o=o=o > > 10) Feedback > > I am extremely disappointed in your article about premature labor [Issue 6:03]. I am a mother of six children, one of whom was born at 29 weeks after a very difficult and dangerous pregnancy. Before you suppose that I don't know anything but the obey-your-doctor mode of thinking, let me tell you that my preemie was my fourth child, born after an OB-attended birth, a midwife-attended homebirth, and a midwife-attended birthing center birth. I am widely read on natural childbirth and healthy pregnancy. I went into my fourth pregnancy expecting a normal and excellent pregnancy and birth. In fact, my husband and I were planning to have either a midwife-attended homebirth or an unassisted birth. However, problems started early on, and we got on the high-risk pregnancy track before we knew it. > > I had a large placental abruption, but we did not know it at that time. I was bleeding every day for months. I spent seven weeks on bed rest. I can tell you without a doubt that when you are on bed rest you are much less likely to aggravate an abrupted placenta, and you bleed less. I can tell you that magnesium sulfate stopped labor when I was hemmorhaging three different times. I can tell you that I am thankful for every single extra day we were able to keep my baby within my womb! The interventions we went through were definitely highly valuable! > > I am deeply saddened to read your ignorant article which would lead readers to believe that nothing a doctor has to offer is going to help in a premature labor situation. Guess what? You are dead wrong. Thankfully I did not listen to articles like this when I was in need of information about this subject. If I had, I doubt that my days would be graced with the presence of my healthy, happy, nearly 4-year-old son Isaac! > > Certainly these interventions can and do have undesirable side effects. At times it was truly hellish to go through what I did. However, there were no alternatives, and interestingly, this little portion of your article offers no substitutions. So, I suppose the author would prefer that all women in premature labor just carry on as usual and hope for the best. No thanks! > > The idea that cerclage has little or no proven benefit is also outrageous. Tell that to a woman who has suddenly lost her early-second-trimester baby because her cervix suddenly opened up! I will tell you, those women are very thankful to have a cerclage and bed rest the next time around so they get to end up with a baby in arms at the end of their pregnancy instead of a heart full of grief. What would your author suggest for a woman with an "incompetent cervix"? > > I truly wonder what the point is of articles like this. It seems to me that this is a huge plank in the eye of natural childbirth advocates: They love to point out all the supposedly bad and worthless interventions available in an allopathic model of care, but they have no real solutions or alternatives to offer. Guess what? Sometimes things go wrong, and we need and benefit from interventions! Certainly we do not want these interventions to be handed out without good reason. My experience was that I had very attentive high-risk specialists who wanted to maximize the benefit and minimize the negative aspects of the treatments I got. Is it possible that some things were done that were not completely helpful? Yes. Unfortunately, that is the paradox that goes along with a situation like the one I was in. I had to do the best I could with the information I had to help my baby. Which, interestingly, there was *nothing* from the all-natural crew! Guess what - All Natural Mommas sometimes r > > If you have information to offer women in premature labor situations that would help them have healthy babies and avoid the rigors of bed rest, monitoring, and medications, please offer them! But no more worthless articles pointing ignorant fingers at the things we do have available to help! Your article does a great disservice to all women struggling with premature labor. > -Erica Johns, Kentucky, USA > ==== > > Ed. note: Readers, any further discussion? > > EDITOR'S NOTE: Only letters sent to the E-News official e-mail address, [EMAIL PROTECTED], will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will not be considered. > o=o=o=o=o=o > > EDITOR'S NOTE: Only letters sent to the E-News official e-mail address, [EMAIL PROTECTED], will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will not be considered. > o=o=o=o=o=o > >> Midwifery Today E-News is published electronically every other Wednesday. We invite your questions, comments and submissions. We'd love to hear from you! Write to us at: [EMAIL PROTECTED] Please send submissions in the body of your message and not as attachments. > > This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment. > > This publication and any information provided are not intended to constitute the practice of, or furnishing of, medical, nursing or professional health care advice, diagnosis, consultation, treatment or services in any jurisdiction. Always seek the advice of your midwife, physician, nurse or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding any medical condition. > > (c) 2004 Midwifery Today, Inc. All Rights Reserved. > o=o=o > > Copyright Notice > The content of E-News is copyrighted by Midwifery Today, Inc., and, occasionally, other rights holders. You may forward E-News by e-mail an unlimited number of times, provided you do not alter the content in any way and that you include all applicable notices and disclaimers. You may print a single copy of each issue of E-News for applicable notices and disclaimers. Any other use of the content is strictly prohibited without the prior written permission of Midwifery Today, Inc., and any other applicable rights holders. > o=o=o > > Remember to share this newsletter. You may forward it to as many friends and colleagues as you wish--it's free! > > Need to subscribe, unsubscribe, or otherwise change your E-News subscription? Then please visit our easy-to-use subscription management page: > http://www.midwiferytoday.com/redirect.asp?id=199 > >
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