Grand Multipara Birth

From www.nzdl.org

From www.nzdl.org

This is an online conversation that I had with a grand multip (woman who has given birth more than 5 times). There are special things about birth after the fifth baby. . . for instance, sometimes the process can be stop and start for days and, then, suddenly. . . here’s the baby. There is nothing wrong with that way of birthing but, because large families are relatively rare, many practitioners lose faith and patience and brand the woman as “failure to progress”.

Another unique thing about women carrying a fifth or more baby is that they are prone to what midwives call the “blue right leg syndrome”. It can be alarming to see how blue the right leg becomes in pregnancy but, then, the baby is out and the woman’s right leg looks just fine again. I like to read things by the midwives in the USA who serve religious groups with big families. Lots of little anecdotes like that.

CORRESPONDENCE BETWEEN GLORIA AND CAROLINE

Hi Gloria,
I am wondering if you could answer a couple things for me.
I was reading your post about the 30 Minute Third Stage, and saw your comment about the anti-bleed tea. I’m curious to know more about this.
I understood that shepherd’s purse was not to be used until after the placenta was delivered, and that it was dangerous to use it before.
I see that one of the ingredients for your anti-bleed tea is shepherd’s purse. Can you share with me how it differs in the tea, as opposed to using the tincture? Also, is this safe to use as a grand multip? This is my 10th baby, 14th pregnancy.
I tend to bleed a fair bit with my births, and I am trying to be prepared this time, (due in August) and read and research things that I could/should try to have on hand, especially in case my attendant doesn’t make it here on time. I tend to go quickly, and feel a strong need to be prepared this time.
Thank you for any input you are willing to share (smile emoticon). Caroline

TUES 22:35
Hi Caroline, One of the things with grand multips that really helps prevent bleeding is going for a 1/2 hour brisk walk. One of my clients found some research on it and it really seems to work. I don’t know why. As far as the shepherd’s purse, no one can really do studies on these herbs and their use after a birth. We worry more about after pains with grand multips. Therefore we give a cramp bark /cinnamon tea. A couple of things that I’ve seen lately that interest me for the after pains are 1. Increasing magnesium supplementation after the birth. 2. Emptying the bladder more often than you think you need to. Just get up and pee if it’s been a while and don’t wait till you feel like pee’ing. Apparently these 2 things are very helpful for cramps. Thank you for writing. I’d love you to have a smooth, relaxed birth. Gloria
06:07

Thank you so very much for your time!!
These are some very interesting points.

I’m curious for a little more information on the brisk walk. Is this something your recommend in labor? Or for the days leading up to birth?

I feel so much peace about our upcoming birth. Much more so than I’ve felt with any of the others. But I also am loving to learn as much as I can about birth as a whole, and things that could be useful for my own as well.
Thank you again. Caroline

10:30
You’re very welcome, Caroline. I mean a walking program starting NOW. I never ask women to walk when they are in the birth process. I’m afraid they will hit me! ha ha. You’ll know what you want to do when having the baby, it’s the preparation that’s important. By a walk I mean a brisk walk with no kids, no purse, flat shoes and really walking as fast as you can. Gloria

Gloria, Thank you! I will start doing that today. 😊

I am soaking up as much information as I can.

I also have to say that I love following your page and reading on your site. So much information that has been so useful.
Thank you for everything you do!!
Makes me wish I was in Canada and could meet you! Caroline

That’s very sweet of you. You are exactly the woman I am writing for, so many people just can’t “get” what I’m trying to communicate.
Gloria

I am loving the learning! I have been trying to dig as deep as I can, and find as many different ideas and perspectives as I can. I’m always thrilled when I find new perspective that makes sense!
Will you be offering your online class again in the future? I would be very interested in taking part, if you do.
Caroline

Added: Another tip I will give to grand multips. When you have lots of older children, they ALL want to hold the new baby. This gets to be a competition and a struggle and it could be a reason why the mother might bleed too much. Explain to the entire family like this: “It’s very important that Mommy has the baby on her skin for the first day of the baby’s life. That helps Mommy’s body to change over from being pregnant to being a nursing mother. If we want Mommy to stay at home and be healthy, we are ALL going to wait until the baby is 24 hours old before we take turns holding the baby.” In most families, the kids really understand this and they don’t mind so much not holding the baby as long as no one else is either.

BABIES BORN IN THE CHRISTMAS SEASON–KEEP THEM HEALTHY

It’s a special thing to have a baby in North America at Christmas time. Photos of the new baby under the tree with the gifts, extra time off from work, a time of holiness joy and good cheer, . . . you would think it would be the ideal time to give birth. Unfortunately, many little newborns end up in hospital at this time due to the timing of their arrival.

No Finer Gift

No Finer Gift

Photo credit http://www.gracemogadamphotography.com/2015/05/08/newton-newborn-photography-william/

1. This is sugar time. The chocolate, cookies and candies are everywhere you look and sugar undermines the immune systems of the family members leading to colds and flu.
2. Staying up late. Parties given by neighbours, school, church, etc., tend to go late and the older kids in the family are affected and can get sick at this time by the late nights AND THE SUGAR.
3. The pregnant parent is either nesting in with the new baby or is hugely pregnant and doesn’t want to go to events, so the other parent takes the bigger kids and doesn’t pay close enough attention to the sugar or the late hours.
4. The children at school tend to be getting coughs, colds, flu and they spread it to the siblings of the new baby. Those older siblings sneezing or coughing on the new baby leads to trouble.
5. Christmas travel. A lot of pressure can be put on the family of a new baby to drive 100 miles (or more) for Christmas day family dinners. No matter how much the family thinks this is a good idea, IT IS NOT. The newborn should be kept warm and cozy at home because those long car trips are exhausting, no matter how much planning happens in advance. The nursing parent has to take care of her breasts/breast milk supply. All this is best done at home.
If the breast feeding gets thrown off at this season of the year, it can result in the newborn baby failing to thrive and/or the nursing parent getting mastitis, sore cracked nipples or a diminished production of milk.

What can you do to make sure that your new baby stays out of the hospital during this season?

1. Screen all visitors by asking them “Are you sure you are completely well? We don’t want any bugs around the new baby.”
2. Buy lots of grapefruit, kiwi fruit and oranges and make them the whole family’s dessert through this time. Keep a big bowl of this healthy Vitamin C-packed fruit out and visible. Keep stocking it up. Don’t bring sugar-y foods into the house.
3. If you have older kids in school, pay close attention to their diet and sleep. Keep them healthy. Both parents need to be responsible and communicate with each other about this.
4. Both parents need to watch their own health. Stay away from alcohol, take your vitamins, keep your schedule calm, have afternoon naps, avoid annoying people, etc.
4. Take a year off from the hype and pretend you’re in a stable with cattle lowing. In the big scheme of things, you’ll be glad you did. Have a really peaceful Christmas giving thanks for the miracle of your very own healthy newborn Christ child.Christmas warmth

The Herbal Bath

This is something I have had in my files for many years. I’m posting it for those who are interested. The only time I have prepared all these herbs, we had them “cooking” while the woman was in the birth process. She didn’t like the smell so we had to interrupt the process, take the big pot outside and get the house cleared of the smell. So, lesson learned, don’t do this during the birth. I’m not in agreement about the idea of getting a woman into a bath to stop excessive bleeding or the idea of opening the labia and swooshing bath water into a post partum vulva. Actually, there are lots of ideas in here that I don’t go along with but I thought you might like to read this handout from around 1985.

I’m sorry I don’t know the source of this to credit the author. Gloria Lemay

Beginning of the quote:

THE HERBAL BATH
This bath mixture should be prepared, strained and put together in a large container ready for the bath. Remember, this bath is also used as treatment for heavy bleeding, and must be ready for immediate use if necessary. A quart or two of strong shepherd’s purse and extra comfrey (fresh if possible) should be set aside for internal use and for adding to the bath if needed.

¼ C sea salt
1 ounce Uva Ursi
1-2 ounces Comfrey
½ – 1 ounce Shepherd’s Purse
1 large bulb fresh garlic

Have ready for emergency use:
2 quarts strong shepherd’s purse tea
2 quarts strong comfrey (fresh if possible)
1 qt. alum root tea, or alum crystals

Simmer the tea and let set for some time before straining. Simmer the tea leaves again to get their full benefit. If you have garden fresh comfrey, do not simmer—use raw. Whiz it in the blender, strain and add to the tea mixture in a large container. Whiz the fresh garlic, add this and the sea salt to the mixture. Cover, label and set aside. Add to the warm bath water when needed.

This herbal bath is highly recommended for every woman following childbirth. There is absolutely no danger of introducing an infection, if the baths are done correctly. The garlic and sea salt make the bath solution aseptic. Uva Ursi is a specific for healing a woman’s reproductive organs. Comfrey contains alantoin, a cell proliferant, which causes the edges of wounds to grow together. It is very healing and soothing. Shepherd’s purse is excellent for preventing and controlling excessive bleeding.

The bath should be taken shortly after the birth. If the placenta has not been expelled, and you would like to get in the bath, you may do so. When you feel a contraction coming on –squat over a bowl and push it out.

A warm bath to soothe after the birth.

A warm bath to soothe after the birth.


The water should be comfortably warm, but not hot. The water should be about hip level. Lie back, spread your legs and swoosh the healing waters up inside the birth canal. Thirty minutes should be the minimum time in the bath. You will find the bath very soothing, relaxing and rejuvenating.
The baby should be put in this bath with you. The herb bath will start the healing process of the cord stump, and it may drop off as early as 3 days. In this bath, your baby will become mellow, and may even smile. He will unfold, stretch and float in the lovely weightless, warmness of the water. It’s wonderful to watch his pure joy at finding something so familiar and enjoyable in this new world. Caress and speak softly to him. He will love this communication, and will respond by total eye contact and facial expressions. When the infant is taken out of the bath, he should be patted dry, not rubbed. Dress him in soft, warm things. Put him to bed with you and let him cuddle up next to your warm body.

End of quoted material.

Birthing the Placenta in the early days of Canada

I’m a little hesitant to post the following because of the undertones of colonial disdain but I’m going to go ahead because this is the source of my conviction about the 30 Minute Third Stage. If this story can be used as a cautionary tale for midwives and physicians, I think it’s important to share it. Please read it with a sympathetic view to the time and place.

From CBC Radio “Ideas” program “Doctoring the Family
By David Cayley and Jutta Mason

(beginning of excerpt) David Cayley (announcer): It is clear that pre-medical birth cultures, both Native and non-Native, had many resources to deal with difficulties, but the picture is naturally not without its shadows and isolated cases of shocking cases of incompetence are easy enough to find. Rita Dobois, for example, recalls that although native midwives were usually very cautious about manual extraction of the placenta, she did encounter one very striking exception.

Rita Dobois: The placenta, they didn’t like to pull on it. Now, there was another case here in Manitoba that one of my friends went to and they did a terrible job there. Now, that midwife was known in the community as not being a very good midwife, and she did a delivery on a young woman, a woman who was about 19-20 years old and it was her first baby, and the placenta did not come away fast enough for her liking, and she went in after the placenta. It was very strange, I was quite surprised that she apparently took the placenta and whatever she got and put it into a cloth and put it on the lady’s abdomen and sent the patient in to Norway House, to the doctor, because she was still bleeding. When the doctor opened the cloth, he almost died of shock because there was the uterus, the cervix, the bladder and part of the bowel. She had taken everything out. She had yanked it all out—everything. And that was something that we could not understand, because we had never seen this happen.

So, this nurse said that she was sent in there for the next period. It was freeze up in the fall. She said there were two babies delivered and this midwife insisted that she do the delivery. So she thought well, I’m going to be there, I’m going to see this thing. And so she was there for the delivery and she said it was really an amazing thing because she had never heard a midwife or seen a midwife do this. As soon as the baby was born, I mean just as fast as a wink, her hand was going in to pull out the placenta because the woman was going to die if the placenta wasn’t out. And at one point, the nurse said to her, if you don’t take your hands away from there I’m going to hit you over the head right now and knock you out, because you’re going to kill this lady. And this woman got really upset because she thought that what she was doing was really the right thing to do. And so they got a clock and they sat there and watched the clock. And this nurse kept saying to her, take your hands away, it’s not 30 minutes yet, it’s not 30 minutes. And so finally in 30 minutes, the placenta separated and delivered by itself, and this woman was absolutely amazed.

So, when the nurse asked around the community, you know, how much experience this woman had, they said not a lot, but they thought that she wasn’t that bad. So then when they had the second delivery, Lenore said to this woman, well, you’re going to do the delivery, but there’s the clock and I’m telling you, if you touch that woman before 30 minutes I’m going to really sock you a good one. And so she said the woman just sat there and waited and watched the clock and watched the nurse for fear that she was going to get a clobbering. And in 30 minutes, the placenta separated and came away nicely, and this woman was amazed. She said, you’ve got magical powers. She said no, but she said I bought this clock and it’s yours, and you watch it. And she said, the next time there’s a delivery, even if I’m not here, you expect me to clobber you if you touch her before 30 minutes. And this woman was really amazed, she just couldn’t believe that 30 minutes was like a magic number. Because to her, as soon as the feet were out, you had to go in there and pull out the placenta, right away, quick. . . There was this terrible fear of losing the patient to hemorrhage. We’ve never seen that anywhere else. (end of excerpt)

Related link: 30 Minute Third Stage

Skin to skin, above all else

I’m sharing below an e-mail conversation with a Midwife/Lactation Consultant from Israel. Gloria

From: Leslie Wolff, Israel

Subject: Lactation Consultants in the labor & delivery room

I was a midwife in the labor/delivery ward for 14 years – and am now a IBCLC for the past four years – working as the coordinator of breastfeeding at my hospital, which means getting to Labor and Delivery also…mostly when the midwives ask me if I can give some help…

I have a few of my own beliefs about breastfeeding immediately after delivery. I feel that skin to skin after birth for the first two hours is SO important -more important than making a big effort to get that baby to breastfeed.. MAINLY because I realize that it helps the diad – mother and baby – to recover from the birth experience, is a Win Win situation that requires no effort , there is nothing to “succeed” in – it is just a “being” situation that is beautiful for Mom and baby. And if the baby goes for the breast – great..and if not, or the breast is offered and the baby doesn’t GO FOR IT – that’s fine. .I also truly don’t like to give “instructions/ advice” during those first two special hours..I know that proper latching is important, but that mother JUST GAVE BIRTH – I could never see myself “instructing her” – maybe a little helping the baby get the nipple farther into the mouth , maybe a word here or there – there is plenty of time to help her when she is in Postpartum ward – those first two hours after birth seems like a special, quiet , almost holistic time ( having nothing to do with the fact that the baby had a natural or very intervened-with ( is there such a word?) birth, maybe even a C-Section…..I know that babies are “supposed to” “immediately” start breastfeeding beautifully – but I see so many mothers and babies that are SO content just lying there Skin to Skin, relaxing, bonding in their own special way. In the past, before I discovered the beauty of Skin to Skin ,I remember many frustrated Moms and babies doing their best to breastfeed, because Mom and Dad both knew that was the best thing to do immediately after birth…)

I’m glad that you brought the subject up – because I too am interested in how others ” do it” during that first period after birth labor/delivery ward, and am interested in any comments about what I wrote..

Close to the Heart

Leslie Wolff, Israel

—————————————————————————————————————————————-

Leslie, may I have permission to put your wise words on my blog. I attend only homebirths and have the same attitude. It’s the skin to skin contact and little (or big) noises of the baby that cause the uterus to contract powerfully post partum. It is a sacred time right after birth that can never be recaptured. When the mother and baby have warmth and privacy they will “discover” each other and fall madly in love. This is the best child protection method both in the short and long term. We are mammals. We must sniff, lick, coo, cuddle, look at and hear our young. In turn, the baby does many “pre-nursing behaviours”-climbing, licking, looking, hearing, sniffing. . . who knows what they are doing because it’s dark and private, remember? How do I know this? Because I had it with my own 2 homebirths. Just like sex, it has to be experienced to be believed. My mission in life is to learn how to take my interference away from the mammatoto. Gloria Lemay, Vancouver, BC
—————————————————————————————-

Dear Gloria – it is my honor and pleasure to be quoted on your blog!
Tomorrow I am giving a power point presentation – two lectures – one on Skin to Skin for the Healthy Newborn and the second : Kangaroo Care for the Premature – for nurses and midwives and a few doctors at a breastfeeding course in Tel Aviv ( an acknowledged course for IBCLC). For the first time I am going to take a firm stand on my thoughts about those first two hours , with the support of the feedback I got from you and others.

Linda Smith wrote me, when I mentioned to her that the words of the 4th Step of Baby Friendly put more emphasis on breastfeeding than skin to skin, and I think it should be the opposite):

From Linda Smith: “Take a look at how Step 4 is currently interpreted:

http://whqlibdoc.who.int/publications/2009/9789241594967_eng.pdf

Step 4: Help mothers initiate breastfeeding within a half-hour of birth.
Place all babies in skin-to-skin contact with their mothers immediately following birth for at least an hour. Encourage mothers who have chosen to breastfeed to recognize when their babies are ready to breastfeed, offering help if needed. Offer mothers who are HIV positive and have chosen not to breastfeed help in keeping their infants from accessing their breasts.

It’s very clear from this interpretation that getting babies ONTO their mother’s bodies after birth is the point. What they DO once they’re touching mom’s body is up to the baby and mother. Some will latch quickly; others will take longer. Letting the mother & baby follow their instincts is key.
Our role is to STOP INTERFERING.

This is WAY more than your beliefs – the science on this is very clear!
Linda J. Smith, BSE, FACCE, IBCLC, FILCA Bright Future Lactation Resource Centre, Ltd.

So these past letters – yours and others – have come for me just at a perfect time – and I appreciate your feedback very much…
CLOSE TO THE HEART and MIDWIFERY IN PEACE
Leslie

The Undervalued Therapeutic Power of Rest

I developed very sore nipples when my youngest daughter (now 28 years old) was about 8 months old. I was working as a midwife at the time and I was completely perplexed and dismayed to be having sore nipples for, what I thought was, no reason at all. I called the La Leche League to see if they had any ideas about cause or cure and the first response on the other end of the phone was “Have you been getting your rest?” Oh, how I hated those words. . . I wanted a much fancier diagnosis than “you’re tired, dear”. The truth was that I’d just come off a very long birth and had been up two nights in a row. I was rushing around trying to pull my own household together and do postpartum care for the new family, too. That LaLeche League Leader gave me such a gift by causing me to pause and see that I wasn’t taking care of myself and my nipples were a first alert that things were falling apart.

I notice that my clients have the same dismayed reaction when I bring up rest. Isn’t there another way? Isn’t it possible to have those 3 birthday parties I have scheduled for my 4 year old? Can’t I pick someone up at the airport, go to the library and cook dinner for six in my first week after giving birth? Whaaaaaaaaa.

We live in a culture that has no value or respect for rest. If you’re resting, you’re lazy and incorrigible. We have been raised on Tampax ads that say “Go play tennis, golf and volleyball when you’re having your moon time. An active woman is an attractive woman.” I love the Orthodox Jewish practice of giving women a bed of their own from when their period starts to 12 days later and arranging a complete day of rest from all household duties on Saturday. We would all be well advised to adopt these customs.

Some of the problems that are cured by rest in bed:
-breast problems of all kinds in nursing mothers
-heavy or prolonged vaginal bleeding in post partum or perimenopause
-general crabbiness or depression

RECIPE FOR A POSTPARTUM BABYMOON

For building up milk production, go to bed with the baby for 24 hours. Mother should wear only panties, baby only a diaper. A tray with fluids, magazines and flowers beside the bed for the mother and all diaper changing needs for the baby close at hand. Another adult woman in the house brings meals to the mother. After 24 hours of this bed rest, the milk will be abundant. (I’ve had one client who said it didn’t work. When I went through what she had done, it turned out that instead of following these instructions exactly, she went to her cousin’s place for the day and lay on her couch.) No, no, no. The naked skin and privacy are a big part of this “Babymoon” formula. Don’t modify. Probably, when you read this, you thought “This would be a luxury for a new mother.” It’s actually very basic and pays huge dividends for the family and larger community. Some cultures understand this and make sure the new mother is given a 40 day period of rest/care when she has a baby.

Baby and mother skin to skin in bed.

Baby and mother skin to skin in bed.

I hear many dramatic stories from midwives and nurses about women who had to be operated on after giving birth because they were bleeding heavily and had “retained pieces of placenta” or “retained clots”. My personal experience is that ALL post birth bleeding is remedied by resting in bed. The lochia is red for the first two days, changes to pink and serumy around the third day, and then proceeds to being brownish and quite smelly for about two weeks. If it turns red again after going through the pink and brownish stages, it means the mother is doing too much. She needs to follow the “BabyMoon” lie-in instructions above. Remember, THIS IS NOT A LUXURY, IT’S BASIC. The family needs to be told that, if they don’t help the mother to rest in bed, they will end up visiting her in hospital.
We need to give up the notion of supermom. Do whatever it takes to get your rest time after the birth and then you will be back to your busy life sooner. When women have homebirths, they usually feel so well that they want to get up and “prove” to the world that they can do anything. Be mindful of the Zen maxim “If you have something to prove, you have nothing to discover.” The really smart women don’t even get dressed for weeks after the birth. If you’re all perky in a track suit, people will expect you to run . . . therefore, find the nastiest old nightie possible and wear that to convince family and friends that you need their assistance.

If you can’t figure out how to ask for help in the early weeks with a new baby, photocopy 20 copies of this list and hand out freely.

Rest, high protein meals, and lots of skin to skin time in bed with baby . . . these are the basics of getting motherhood off to a good start.

After the Birth, what a family needs


“Let me know if I can help you in any way when the baby is born.” … “Just let me know if you need a hand.” … “Anything I can do, just give me a call.”

Most pregnant women get these statements from friends and family but shy away from making requests when they are up to their ears in dirty laundry, unmade beds, dust bunnies and countertops crowded with dirty dishes. The myth of “I’m fine, I’m doing great, new motherhood is wonderful, I can cope and my partner is the Rock of Gibraltar” is pervasive in postpartum land. If you’re too shy to ask for help and make straight requests of people, I suggest sending the following list out to your friends and family. These are the things I have found to be missing in every house with a new baby. It’s actually easy and fun for outsiders to remedy these problems for the new parents but there seems to be a lot of confusion about what’s wanted and needed…

1. Buy us toilet paper, milk and beautiful whole grain bread.

2. Buy us a new garbage can with a swing top lid and 6 pairs of black cotton underpants (women’s size____).

3. Make us a big supper salad with feta cheese, black Kalamata olives, toasted almonds, organic green crispy things and a nice homemade dressing on the side. Drop it off and leave right away. Or, buy us frozen lasagna, garlic bread, a bag of salad, a big jug of juice, and maybe some cookies to have for dessert. Drop it off and leave right away.
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Delicious Dinner Salad

4. Come over about 2 in the afternoon, hold the baby while I have a hot shower, put me to bed with the baby and then fold all the piles of laundry that have been dumped on the couch, beds or in the room corners. If there’s no laundry to fold yet, do some.

5. Come over at l0 a.m., make me eggs, toast and a 1/2 grapefruit. Clean my fridge and throw out everything you are in doubt about. Don’t ask me about anything; just use your best judgment.

6. Put a sign on my door saying “Dear Friends and Family, Mom and baby need extra rest right now. Please come back in 7 days but phone first. All donations of casserole dinners would be most welcome. Thank you for caring about this family.”

7. Come over in your work clothes and vacuum and dust my house and then leave quietly. It’s tiring for me to chat and have tea with visitors but it will renew my soul to get some rest knowing I will wake up to clean, organized space.

8. Take my older kids for a really fun-filled afternoon to a park, zoo or Science World and feed them healthy food.

9. Come over and give my partner a two hour break to go out to a coffee shop, pub, hockey rink or some other r & r that will be a delight. Fold more laundry.

10. Make me a giant pot of vegetable soup and clean the kitchen completely afterwards. Take a big garbage bag and empty every trash basket in the house and reline with fresh bags.

These are the kindnesses that new families remember and appreciate forever. It’s easy to spend money on gifts but the things that really make a difference are the services for the body and soul described above. Most of your friends and family members don’t know what they can do that won’t be an intrusion. They also can’t devote 40 hours to supporting you but they would be thrilled to devote 4 hours. If you let 10 people help you out for 4 hours, you will have the 40 hours of rested, adult support you really need with a newborn in the house. There’s magic in the little prayer “I need help.”

    First posted online August 2001