February 4, 2009
Volume 11, Issue 3
Midwifery Today E-News
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Learn how sexual abuse affects women during pregnancy and childbirth and what you can do to help.

Survivor MomsSurvivor Moms: Women's Stories of Birthing, Mothering and Healing after Sexual Abuse was written to help break down the isolation pregnant women and their caregivers often feel—as though they were the only ones having to cope with these challenges. You'll be able to read excerpts from 81 women's stories of birthing, mothering and healing after childhood sexual abuse. The book also includes some complete narratives, discussion of implications of women's experiences for their care, suggestions for working together during maternity care and beyond, resources to consult, and information from current research.

Suitable for both caregivers and pregnant survivors, Survivor Moms will help anyone whose life has been touched by sexual abuse. Published by Motherbaby Press, an imprint of Midwifery Today. Get the book.

This issue of Midwifery Today E-News is brought to you by:

Look below for more info!

Midwifery Today Conferences

Bring Massage into Your Midwifery Practice

Attend the full-day Massage for Prenatal, Labor and Postpartum Care class with Elaine Stillerman and learn Swedish and support massage strokes for prenatal, labor and postpartum care. You'll also discover how to use these techniques in a variety of positions including on the floor and in a tub. This is a whole mini massage course, so plan now to attend! Part of our conference in Eugene, Oregon, March 2009. Learn more about the Eugene conference and get a complete program.

Be Prepared for Breech Babies

Attend the full day Breech Workshop with Michel Odent, Ina May Gaskin and Cornelia Enning. First, you'll learn about the many research studies that have been done on breech birth. Then Michel and Ina May will help you develop your breech skills. You'll be shown techniques to turn breech babies and strategies for what to do if the baby won't turn. Finally, Cornelia will show you how to work with breeches in water. This is an important class for any midwife. Part of our conference in Copenhagen, Denmark, May 2009. Learn more about the Denmark conference and get a complete program.

In This Week’s Issue:

Quote of the Week

"The most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing we ever give each other is our attention.... A loving silence often has far more power to heal and to connect than the most well-intentioned words."

Rachel Naomi Remen

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The Art of Midwifery

If midwives can ensure that they communicate effectively with each pregnant woman, and can negotiate with her an acceptable and realistic plan of management for her pregnancy, then it will be much easier to deal with any complications that arise.

— Tingle, J., J. Wilson and A. Symon
Clinical Risk Management in Midwifery, p. 157

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.

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A small study of women's encounters with a midwife during childbirth, with data collected by tape-recorded interviews two to four days after delivery, found that "presence" by the midwife was the most important factor in a good experience. This included the need to be seen as an individual, a trusting relationship—obtained by good communication and proficient behavior, and supporting the women on their own terms by providing a sense of control.

Midwifery 12(1): 11–15, 1996

Please support our advertisers!

Consider chiropractic care for safer, easier births.

Our doctors offer special care for pregnant women and infants. Specialties include the Webster technique for optimal fetal positioning and gentle cranial and spinal techniques for your baby. Visit www.icpa4kids.org.

Electronic Communication

As a devoted and sensitive health care provider, you've undoubtedly mastered the subtle nuances of interpersonal communication. But how well does your business communicate with the world at large?

Whether you are a midwife, doula or childbirth educator, it is essential that you stay in touch with current clients, past clients and prospects. An electronic newsletter is often a fast, inexpensive, and effective way to do this. The benefits of your own newsletter are not to be understated. It allows you to:

  1. Upgrade your professional image and boost your credibility.
  2. Educate current clients and nurture those relationships.
  3. Stay in touch with past clients who might refer new business by passing your newsletter on to a friend.
  4. Educate potential clients, reinforce your value, and help you convert them into paying clients.

This last point, about using electronic communication to help convert prospects to clients, can make or break your business. Prospect e-mail addresses are some of your most important business assets. When prospects call you about your services, you must get their e-mail address. They are very interested in your service. They really want to get a chance to know you. They want to make sure that you have the abilities to help them. They want to know your personality. They want to know how you can help them. Twice a week, send them articles that will help in pregnancy, labor, or after the birth.

Sending your prospect a newsletter will have one of three results:

  1. The prospect unsubscribes and continues to look for someone who is a better fit for her.
  2. The prospect will continue to be educated by your expertise but doesn't take any action to hire you.
  3. The prospect realizes that you know what you are doing, enjoys the e-mail from you, and hires you.

Sheri Menelli
Excerpted from "Save Time and Effort—and Make More Money—with Electronic Communication," Midwifery Today, Issue 82
View table of contents / Order the back issue

Products for Birth Professionals

Valentine's Day Gifts!

The Mother Goddess Clay SculptureThe Mother Goddess Clay Sculpture is a reminder that we can look to the Earth for inspiration about mothering our children and ourselves. The 2-inch mother and her round removable baby make a warm and loving gift for a new mother. Get the sculpture here.

The Mother Milk Clay SculptureShe'll also love the Mother's Milk Clay Sculpture, a warm reminder of the special nourishing bond between mother and baby. The 2-inch tall sculpture was inspired and designed by a nursing mom. Get the sculpture here.

Are you ready for birth emergencies?

As a home or birth center midwife, you may rarely encounter emergencies, but when they do happen, you need to know what to do. Birth Emergency Skills Training: Manual for Out-of-Hospital Midwives gives you the information you need. It takes you from the initial steps of intervention though definitive care, balancing a friendly tone and visual appeal with authoritative and clinically useful information. This book belongs on the shelf of every practicing midwife. To Order

Birth Emergency Skills Training

What is Midwifery Today magazine?

A 72-page quarterly print publication filled with in-depth articles, birth stories from around the world, stunning birth photography, news, reviews and more. Subscribe. Midwifery Today Magazine

Cook delicious and wholesome meals for your whole family.

Whole Family RecipesWhole Family Recipes—For the Childbearing Year & Beyond highlights foods that are especially needed by pregnant women, breastfeeding mothers and their growing children. Taking a non-dogmatic and down-to-earth tone, the book focuses on incorporating vitamin- and mineral-rich foods and good quality fats into the diet. If you're an expectant mom or new parent this book belongs in your kitchen. If you work with pregnant women, have copies in your library to share with your clients. Recipes include Cheesy Potato Pie, Baked Lentils and Oat and Dried Berry Bars. To Order

Belly Love in Clay

Celebrate the beauty of the pregnant body!

The Belly Love in Clay pendant comes in an earthy turquoise glaze and hangs from a cord of fine Greek leather. Makes a delightful gift for your midwife or doula.

Web Site Update

Read this review from Midwifery Today, Spring 2007, newly posted on our Web site:

  • Having Faith: An Ecologist's Journey to Motherhood by Sandra Steingraber
    What do you get when you cross a poet, a scientist and a mother? You get the author of this outstanding book! I have to be honest. If you told me that there was a book about how the environment affects pregnancy, birth and breastfeeding, I wouldn't necessarily run out and get it. But I happened across this one on the library shelf and opened it in the middle. I discovered a fascinating narrative of Sandra Steingraber's experience of becoming a mother, entwined with her personal exploration of the impact of the modern world on our babies.

Read this review from Midwifery Today, Summer 2007, newly posted on our Web site:

  • A Midwife's Tale: The Life of Martha Ballard, Based on Her Diary, 1785–1812 by Laurel Thatcher Ulrich
    Painstaking research by historian Laurel Thatcher Ulrich has produced this Pulitzer Prize winner—a captivating investigation into the life of a Maine midwife. Martha Ballard's diary records not only her midwifery activities, but such mundane undertakings as weaving, washing clothes, visiting neighbors and entertaining guests. With help from other historical documents of the period, Ulrich has gleaned revealing insights from what other historians termed "trivia."

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With options ranging from classified ads to full page graphics, there is an option that is just right for your business. Ask about packages designed to fit your needs. [ Learn More ] or contact ads@midwiferytoday.com

Advertise at Midwifery Today's Copenhagen, Denmark, conference

Reach a targeted, international market by advertising at Midwifery Today's conference in Copenhagen, Denmark. By advertising at "Preserving the Spirit of Midwifery" you will reach an audience passionate about birth. [ Learn More ]

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Use our spring online coupon page to pass savings on to your customers. [ Take a peek ]

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Question of the Week

Q: Why do some women develop swollen feet and hands in the first trimester of pregnancy?

— Anonymous

SEND YOUR RESPONSE to mtensubmit@midwiferytoday.com with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.

ed page graphicLearn about midwifery education!

Are you an aspiring midwife who's looking for the right school? Are you a practicing midwife who would like learn more? Visit our Education Opportunities page to discover ways to start or continue your education.

Question of the Week Responses

Q: I am a Lamaze Certified Childbirth Educator and had learned many years ago that pain in childbirth is caused by the muscular contractions of the uterus. The theory: When the uterus contracts, a percentage of oxygen is cut off. When this is accompanied by fear, tension and holding one's breath, there is less oxygen for the uterus. I was told that a hard-working uterus needs all the oxygen it can get to help minimize pain.

However, I recently read a brief article in Fit Pregnancy (Oct/Nov 2008) that states: "Labor pain evidently comes mainly from the cervix, not the uterus, a Swedish researcher says. In non-pregnant women, the uterus contains pain-sensitive fibers, but for reasons unknown, those fibers disappear almost completely during pregnancy. Experts' best guess is that this is an evolutionary adaptation; if the nerve fibers remained, birth would be too painful—as would pregnancy. The findings could lead to more effective labor pain treatment." ~ From S.R. Karolinska Institute

I'd appreciate any input you might have on this subject and, if possible, referral to another possible source.

— Elly Rakowitz, LCCE

A: I don't have any other sources for you but I do have some input. Labour is a spiritual experience, it's physical and emotional as we know and the best way to help women birth their babies is to help them embrace all of that. They need to know they can do it, believe their body knows what it is doing, trust, breath, relax, open, and welcome it and the power of being the centre of the universe.

Too much naming stops the flow. I don't think knowing exactly where the most pain is coming from matters...are you looking for a labour pain treatment, some certain way to make all women comfortable with scientific knowledge of just where exactly their discomfort originates? Tell them they are amazing, whisper "open" in their ears, help them visualize where the baby is in their bodies, and the breath is certainly key, those babies do love their oxygen... Every birth is as different as every person you know and I can't help but believe that we all feel it in our own way, our own rhythm. It's got to be an ever changing, ever flowing and deeply personal passage with totally different "nerve fibres" coming into play at any time. I think it is impossible to focus on one set of nerves, one place that is the source.

— Donna Harnett

A: Hi Elly, In response to your question regarding the source of pain in childbirth, I would like to refer you to Grantly Dick-Read's book Childbirth without Fear. It is an incredible insight into the causes for pain in birth, and points out that pain is likely caused by fear during birth. It is referred to as the "Fear-Tension-Pain Syndrome." He references several women whom he witnessed give birth and were obviously without pain and each of these women had in common the lack of fear of childbirth. He also cites physiological reasons why our bodies are not capable of inflicting pain on us during childbirth. He actually states that it is the fear that causes blood to leave the uterus, and thus the uterus was without oxygen (blood goes to other parts of the body necessary for fight or flight responses) and thus women feel pain. So by his theory it is not the work of the uterus itself that causes pain, but extraneous (namely psychological) factors. It is quite an insightful and eye-opening book. I personally have experienced a virtually pain-free birth, and the only time I felt pain was for a short time (15 minutes) when I also felt afraid. Later I went on to read his book and it shed a light on what I personally experienced.

— Martha Basham

A: I believe Grantly Dick-Read in Childbirth without Fear addresses this question and perhaps provides an explanation.

From Chapter 4, Anatomy and Physiology: The muscle layers of the uterus and nerves of the uterus:
The uterus is composed of three types of muscles.
The muscles in the outer layer are mainly longitudinal, are expulsive, and are controlled by the parasympathetic nervous system or the mammalian brain.
The muscles in the middle layer run in all directions, including in figure eights, are constrictive, and are controlled by the sympathetic nervous system or neocortex.
The muscles in the inner layer are mainly circular, are concentrated in the lower half of the uterus and near the neck, are constrictive, and are controlled by the sympathetic nervous system or neocortex. They are sphincter muscles, in effect.
From Chapter 5, The Pain of Labor
The uterus does not contain pain receivers or nociceptors for many types of pain. It "can be burned, cauterized, handled and moved without sensation of discomfort to the patient." It does contain nociceptors, however, for "excessive tension or laceration."
In other words, if fear (via neocortical stimulation) causes the circular muscles to constrict, while the longitudinal muscles continue to expel, the uterus will experience excessive tension that will be perceived as pain.

— Susan Planck

Responses to any Question of the Week may be sent to E-News at any time. Write to mtensubmit@midwiferytoday.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.

Think about It

How to avoid e-mail communication problems

Write clearly and briefly. Proofread, wait, proofread again and then send it. If you are having trouble communicating with a person by e-mail, call them on the telephone or meet them face-to-face rather than continuing the e-mail discussion.

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Re: Monitoring FHR in presence of meconium (E-News 11:2, Feedback)

I would like to dispute the recommendations by Sandra Ebanks regarding monitoring the FHR in the presence of meconium. Monitoring per the NICE guidelines, which she states are to monitor FHR in low-risk pregnancies for one minute following a contraction and not during or before. I would like to know how a person monitoring only after a contraction can accurately determine the FHR baseline. There may be a late deceleration or prolonged deceleration that lasts for more than the one minute timeframe. You cannot determine the baseline via this method, therefore you cannot accurately determine if there is a late deceleration or if you are monitoring a baseline change or prolonged deceleration. You have nothing to compare it to. ACOG's guideline is to listen to the FHR for 30 seconds prior to, during, and after a contraction in order to determine baseline and if decelerations or accelerations may be occurring. [One] needs to know baseline in order to make such determination.

Tanya Jennison, RN

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