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
