Low tech, non invasive ultrasound alternative

The original Baby Egg Pregnancy Countdown Calendar

The original Baby Egg Pregnancy Countdown Calendar

This is a photo of my friend, Kelly, at a prenatal clinic visit. We took her picture so she could show her friends “See, even though I’m really big, I only have one baby in here!”

I bought this Baby Egg at a Midwifery Today Conference that I attended in Eugene, Oregon. I had to own it when I saw it. I discourage routine ultrasound and recommend that dopplers and imaging devices be kept well away from the developing fetus. I like to kid around with my clients and say “Okay, today we’re going to take a picture of the baby.” They look shocked because they’ve already heard me go on and on about NOT using ultrasound. Then, I bring out the Baby Egg and they get to see their baby actual size and there’s a cute caption on the back that describes what the baby is doing at that week of gestation. I take a photo of them with the egg, like this one, so they can send it to the grandparents or post to Facebook.

The Baby Egg retails for about $16 (U.S.) through Amazon. You can see some sample illustrations on their website at http://babyeggcalendar.com/

Courage

According to the Merriam-Webster dictionary, courage is a noun meaning ‘ability to overcome fear or despair” The fear has to be present in order for courage to exist. The English word “courage” is derived from the French word for the heart, “cour”. When someone finds the heart to continue on doing the right thing in the face of great fear, everyone around her is inspired to become a nobler human being. This is the source of courage for many midwives. In ourwork, we see women and men facing their fears in birth, we ask them to have faith in the face of no evidence, we demand that they be bigger than the circumstances and, when they conquer, we get a renewed vision of how life can look when our fears don’t stop us.

The paths of parenting and midwifery push me up against my fears and despairing attitude on a daily basis. Luckily, I have found teachers and teachings that have inspired me to keep going despite a rapidly beating hummingbird heart. When my daughters were very young and I was juggling my heart’s desire to be a good parent and make a difference in childbirth, one of my friends told me to use the affirmation “My vulnerability is my strength.” I thought she was insane and argued that if I lived by that slogan my children would surely perish. I was pretty sure that my strength was my strength—and by strength I meant my ability to force and push life to suit my will. I now know that true strength is an elusive quality of being able to strengthen others. At that time, I trusted my friend and, on faith in her alone, began toying with sharing my vulnerability. I tiptoed into revealing my fears and apprehensions to a few “safe” people and slowly began to realize that what my friend had given me as an affirmation worked a lot better than my stoic, stubborn, brave warrior act.

After a few harsh lessons, I began to realize that it wasn’t up to me to conceal information that was worrying me at a birth from the parents. In fact, if I am afraid at a birth, the best thing I can do is name the fear boldly and even ask everyone else present to say what his or her fears are. One of my dear clients released her membranes at 36 weeks in her second pregnancy. Her first birth had been a beautiful, straightforward home birth and I was deeply invested in her second birth being just as great. After four days of leaking, she began having regular, intense birthing sensations and we drove to the hospital for the birth. I drove and the parents were in the back seat of my car. As we approached the hospital, my hands on the wheel were clutched into white knuckles and a ball of fear formed in my gut. I started picturing the cord being whacked off immediately and the baby being taken away from Mom. I looked in the rear view mirror and saw the father with his eyes looking terrified. I said to him “What’s your biggest fear right now, Brian?” He replied, “I am afraid we’re going to have a Cesarean.” I never imagined this would be his fear. A cesarean was not even a possibility, I explained, “Your wife is in strong birthing, she has already had one vaginal birth, the baby is small—for sure it will be born vaginally”. He asked me, then, “What are you afraid of?” I told him honestly “ I’m afraid that the baby’s cord will be cut too quickly and the baby will be taken away from Karen.” This had not occurred to him but he knew that my experience was a better barometer of things to come. He asked me what we could do to prevent this. I was able to tell him that it was very important to take the doctor aside out in the hall and tell him “It means everything to my wife and I that the cord be left to pulse and that the baby be placed on her skin until the placenta comes out.” We did a couple of “dress rehearsals” of what had to be said and then went in. The staff at the hospital respected the parents’ wishes to have the cord left intact. The birth went beautifully. I would have wished that the baby didn’t have as heavy doses of antibiotics as he was given (with resulting colic for months) but having a birth that involved no induction or anesthetics was a big accomplishment in these circumstances.

Nancy Wainer, author, midwife

Nancy Wainer, author, midwife


There was a period in my career when I was unable to divest myself of fear and dread. I wanted to have a breakthrough and so I decided to “import” some courage into my city. I thought about my heroes in the midwifery movement and asked myself “Whose the bravest person I know?” The answer was, of course, Nancy Wainer Cohen. Her book “Silent Knife” had kept my feet in the room at VBAC births where every cell in my body had been screaming “What the h— are you doing here?!!” I was pretty sure that if Nancy came and lived at my house for a few days, I could get some courage. My husband picked Nancy up at the airport and she came into my house and hugged me wracking with sobs. She cried her way through several boxes of Kleenex at the workshop she taught for my students. Her visit was four days of snot, tears and intense passion for healing birth. I learned so much about the vulnerability and strength connection. Nancy is still my hero in the courage department and she continues to live her life with her heart pinned right on her sleeve.

The sharing other midwives have done about their fears has strengthened me to face my fears of birth One midwife wrote in Midwifery Today that “the drive to the birth with all the “what ifs” running through my head is the hard part, when I walk through the door and see the woman, all that disappears”. Another midwife told me “The scariest thing for me is the first prenatal class of a series. Meeting new people who have so much riding on my teaching is enough to give me an ulcer.” An acronym for fear is:

F= false
E= evidence
A= appearing
R= real

When I am most afraid, it is because I have forgotten the truth about how loved and blessed I am. The fear can dominate and stop me or it can be used to alert me to something to which I am deeply committed. Using a journal to write out fears in the morning helps to clear the mind. Once the fears are on paper, somehow they seem less foreboding. Being in action is another antidote to the paralysis that accompanies fear. Any action—cleaning your desk, organizing a drawer, making a phone call—will bring a new perspective and lessen the dread.

My favorite philosopher about fear and courage is the Wizard of Oz speaking to the cowardly lion “Courage is doing what’s right even though you’re afraid.” I have learned courage from birthing women and other midwives. We are there to inspire and raise the bar for each other on what’s possible in the domain of courageous action.
This article by Gloria Lemay was written in 2003 and first published in Midwifery Today, Issue 67, Autumn 2003

Questionnaire for Birth Professionals

Questionnaire for birth professionals (self awareness)

Ask yourself the question and then write down the answer(s) that pop into your head. Don’t figure it out. There are no right or wrong answers. What pops into your head may open up some awareness of your subconscious fear of birth.

1. With regard to having babies, what my mother said is_______________________________
2. With regard to having babies, what my father said is_________________________________
3. With regard to having babies, what I learned in school is _____________________________
4. With regard to my clients, what I have done that doesn’t meet my standards is ____________________________________________________________________
5. With regard to my birth practice, what I would be willing to forgive myself for is _____________________________________________________________________
6. With regard to pregnancy/birth, my biggest fear is________________________________________________________
7. How I feel when I’m standing in the lobby of a hospital is ______________________________
8. What I know about my own birth is_______________________________________________
9. If I could go back to the womb and re-create my own birth experience, I would: (write out all the elements of your fantasy ideal birth)
10. If I had beautiful, ecstatic births happening in my practice, who might be wrong? Who might be upset?
11. Some ways that I could be nicer to myself are _________________________________________

College of Midwives of B.C.

Parents, grandparents, children and birth rights activists picketed the College of Midwives offices on Nov. 28, 2012. The College of Midwives conducts secret investigations and flagging operations to undermine the alternative birth workers in the province. By sending negative press releases and spreading half-truths and innuendo, they attempt to claim a monopoly on who shall attend births in the province.

Choice of birth attendant is a woman's right

From the film “Freedom for Birth”: — “One of the home birth mothers supported by Ms Gereb (Agnes Gereb, Hungarian midwife) decided to take a stand.
When pregnant with her second child, Anna Ternovsky took her country (Hungary) to the European Court of Human Rights and won a landmark case that has major implications for childbirth around the world.

Toni Harman, one of the filmmakers says, “the “Ternovsky vs Hungary” ruling at the European Court of Human Rights in 2010 means that,. . . now in Europe, every birthing woman has the legal right to decide where and how she gives birth. . .

. . .And across the world. . ., it means that if a woman feels like her Human Rights are being violated because her birth choices are not being fully supported, she could use the power of the law to protect those rights. With the release of “Freedom For Birth”, we hope millions of women become aware of their legal rights and so our film has the potential to spark a revolution in maternity care across the world. In fact, we are calling this the Mothers’ Revolution.”

Added on June 17 2013: EUROPEAN COURT OF HUMAN RIGHTS Fact Sheet
Under Article 37 § 1(c)of the Convention
Home Birth
Ternovsky v. Hungary
(no.67545/09)
14.12.2010
The applicant complained about being denied the opportunity to give birth at home, arguing that midwives or other health professionals were effectively dissuaded by law from assisting her, because they risked being prosecuted.
(There had recently been at least one such prosecution.)
The Court found that the applicant was in effect not free to choose to give birth at home because of the permanent threat of prosecution faced by health professionals and the absence of specific and comprehensive legislation on the subject, in violation of Article 8
Right to respect for private and family life.
Source: http://www.echr.coe.int/Documents/FS_Reproductive_ENG.pdf

ADDED June 2017: A case involving a member of the College of Midwives of B.C.
MEGAN DOLSKI
VANCOUVER — The Globe and Mail
Published Sunday, Aug. 14, 2016 8:22PM EDT
Last updated Sunday, Aug. 14, 2016 8:24PM EDT

The mother of a boy who was born with severely debilitating brain injuries on Vancouver Island has settled a lawsuit against her midwife and local health authority for more than $3-million, as well as annual payments that could add millions of dollars to the cost of the case.

The annual $400,000 payments outlined in the settlement are rare, but a legal expert says if they become more common they could add an unpredictable liability to the B.C. government’s finances.

Cabe Crossman was born in December, 2011, at the Cowichan District Hospital in Duncan, located about 60 kilometres northwest of Victoria. Due to injuries suffered during the delivery, he now has severe cerebral palsy and intellectual impairment, and will require extensive care for the rest of his life.

His mother, Sarah Corrin, sued her midwife, Selina Boily, the Vancouver Island Health Authority and two unidentified nurses alleging the care she received, first from the midwife and then at the hospital, was negligent. She alleged that her labour and delivery was not properly monitored, assessed or responded to. The defendants admitted liability and a B.C. Supreme Court judge approved a settlement earlier this month.

The boy’s life expectancy could be anywhere from 12 to 30 years, according to the court ruling, meaning the final cost to the provincial government could be well over $10-million. In addition to ultimately being responsible for the health authority, the province also sponsors the Midwives Protection Program, an insurance plan unique to B.C. across the country.

The program provides midwives with legal expenses and covers claims against them alleging negligence while practising, if they pay an annual fee of $1,800 per year.

A separate liability insurance program for midwives is also used in Ontario, Saskatchewan, Manitoba and Nova Scotia. It was not immediately clear about the situation in other provinces.

The Midwives Association of B.C. says the cost of malpractice insurance was halved in 2007 by the Ministry of Health “due to the excellent record that midwives currently hold in relation to large claims,” and reduced again in 2014.

As of this year, midwives in B.C. are required to also hold commercial general liability insurance, which they can get through the insurance provider of their choice

Paul McGivern, a lawyer with Pacific Medical Law who specializes in medical malpractice and infant injury cases, said that over the past decade he has seen a trend in which settlements for obstetric cases in British Columbia have been going up – not in quantity, but in dollar value.

Mr. McGivern, who was not involved in the Corrin family’s lawsuit, has worked on many cases that have involved $3-million claims or more.

“Part of it is that the cost of care is going up. Part of it is that counsel are presenting much more sophisticated analysis of the cost of care – the evidence is getting better as to how much things cost,” he said.

However, Mr. McGivern said incremental payments in the agreement, without insurance backing, is unusual.

“It is very difficult to predict what your ongoing financial obligations are going to be,” he said.

“If you have one case or two cases, you can manage that. If you’ve got 100, 200 or 500 of those cases that build up over time, your finances can become incredibly difficult to manage and predict.”

A recurring payment in a case such as this “is not unprecedented,” said Barbara Webster-Evans, the lawyer who represented Ms. Corrin. “But it’s probably rare.”

Ms. Webster-Evans said the family requested privacy and that agreements are in place that prevent her from discussing the case in detail.

“Any of these cases when they occur are tragedies for the child as well as the family,” she said.
Source: https://www.theglobeandmail.com/news/british-columbia/vancouver-island-mother-wins-3-million-suit-against-midwife/article31403354/

Added July 11, 2017

B.C. College of Midwives demands ‘death midwives’ stop using title
College says midwife title is protected by law; death midwife says her use of it completely different
By Liam Britten, CBC News Posted: Jul 05, 2016 8:51 PM PT Last Updated: Jul 05, 2016 8:51 PM PT

Death midwife Pashta MaryMoon (far right) instructs others on a live model, how to properly wash and care for a dead body at home. The College of Midwives of British Columbia says the title “midwife” is protected by law and has sent a cease and desist letter to MaryMoon’s organization ordering them to stop using it. (Canadian Integrative Network for Death Education and Alternatives)
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The College of Midwives of British Columbia is demanding a group of “death midwives” stop using the term “midwife” when referring to their services.
The Canadian Integrative Network for Death Education and Alternatives is an organization that represents and provides awareness about “death midwives” — people who help a dying person and their loved ones with alternative funeral arrangements, often at home.
CINDEA’s webpage says they use the term “midwife” to “honour and parallel the role of a birth midwife,” but College of Midwives registrar and executive director Louise Aerts says the term is reserved under the Health Professions Act and CINDEA’s use is breaking the law.
“There can be a misperception from the public when a title is being used inappropriately,” she said.
“Part of the idea is to provide a sense to the public of what it means to be a registered health professional, and they know when those terms are being used, that there is a regulatory body overseeing the education and practices and standards of that profession.”
Even though death midwives have the “death” modifier before their title, Aerts says the potential is there for confusion.
“The public could conceive that they have the same level of training, the same level of oversight of their practice as do registrants of the college,” she said.
As a result, the college sent CINDEA a cease and desist letter this week to prevent them from using the term “midwife.”
• Death midwives offer a ‘more authentic’ funeral experience
• B.C. home funeral workshops teach loved ones to care for corpses
• Midwives call for better education and funding
Doubts about confusion
Aerts says she hadn’t heard of CINDEA until the CBC profiled the work of founder Pashta MaryMoon for a radio series.
MaryMoon says the term “death midwife” has been used for over a decade by people like herself, and she isn’t sure why it has become an issue now.
“We’re not talking about being a midwife for pregnant women,” she said. “People who are dealing with the death of a person have no confusion about what kind of midwife we are. So I don’t really see why that’s an issue.”

Pashta MaryMoon, seen here practising on a live model, says using the term “death midwife” has “nothing to do with being equally credible as birth midwives.” (Canadian Integrative Network for Death Education and Alternatives)
MaryMoon questions whether the College has the legal standing to stop death midwives from using the title, but admits CINDEA has no legal representation.
She also says CINDEA’s use of the title is not about claiming the legitimacy of midwifery.
“What we’re doing is reclaiming the ancient word and the ancient practice. It has nothing to do with being equally credible as birth midwives,” she said.
“It has to do with bringing back the original practice of caring for your own dead and the people who would support the families to do that, who were the midwives.”
MaryMoon said on Tuesday she wasn’t sure what CINDEA’s next steps would be besides consulting other group members and similar practitioners in the United States.

View story online (with photos) here:
http://www.cbc.ca/news/canada/british-columbia/college-of-midwives-death-midwives-1.3666406

Birth without borders

I’ve been on a bit of a rant lately about “Keep those damn hats off babies”, “Take off those wet sports bras”, “Get everyone skin-to-skin, dark, private” and I get told that “We have to choose our battles”, “It’s important to meet people where they are and not overwhelm them with picky details”, and other variations of advice to STOP IT!

These things are HUUUUUGE to me. I only want to speak into the ears of those who want perfect births. I had a perfect birth. What is a perfect birth? It’s a birth that you look back on when your child is 30 years old and you wouldn’t change a single thing about it. . . every smell, touch, taste, word spoken and beam of light goes to the grave with you as a top of the mountain of life experience. It’s an experience that makes up for so much of the day to day b.s. that is part of living in a human body. It helps to salve the losses and the heartaches and gives you a glimpse of the bliss that’s possible when all the stars align on a really, really good day. That’s what I want for every birthing woman. When I saw this little video clip (I think it’s from Russia), it made my heart sing as I prayed that no one would enter the frame and interfere with this woman’s bliss (no one does). Unfortunately the sound is missing but I love it that someone turns off the lights so baby could transition to this bright world in a slow way. I also love it that the toddler comes in with questioning eyes to see what the heck is happening in his world and looks to the Dad with questioning eyes and is reassured that “Yes, this is different but it’s all good, sweetie.” I just made that up but I love my own version of things. Enjoy.

Group B Strep: what you need to know

We are told that the concern about Strep B involves two groups at high risk of infection:
1. Premature infants under 37 weeks gestation
2. Any infant in utero with membranes released longer than 18 hours

Contractions are a possible indicator of infection, but this situation is a concern in weeks 0-36. After 36 weeks, Braxton Hicks are normal and a good sign of a healthy toned uterus getting ready to push a baby out.

A culture that shows Strep B in the vagina is not necessarily illness related. Just as we commonly have Strep A in our throats on a swab and have no sore throat symptoms (no strep throat), from one day to the next we can all culture positive for Strep B without any symptoms or danger to our unborn babies. This is why many practitioners refuse to test for it and simply wait to test until such time as the above two “at-risk infant scenarios” show up. One day a woman might test positive and the next be negative. To treat with antibiotics before labour would NOT be recommended. Why?
The woman’s body could build up a resistance to the antibiotics and so could her baby’s body. Then if either got a more serious infection after the birth, the antibiotics might be ineffective.

Taking antibiotics can also lead to thrush, vaginal yeast and severe colic in the months after birth. There is some indication that antibiotic use can lead to Vitamin K deficiencies in the baby.

I would advise pregnant women to do as many things as possible to minimize their risk of ANY infections and maximize their immune systems. Some safe suggestions:

1. Boost vitamin C in your diet—e.g., eat 2 grapefruit per day. Other good sources of Vitamin C are red peppers, oranges, kiwi fruit.

orange, grapefruit, kiwi

Boost Your Vitamin C

2. Drink a cup of echinacea tea or take 2 capsules of echinacea every day.

3. Get extra sleep before midnight. Slow down your schedule.

4. Take 1 tsp colloidal silver per day. Take it between meals. Hold the liquid in your mouth a few minutes before swallowing. Colloidal silver can be purchased in most health food stores. It is silver suspended in water. It is antibiotic in nature and safe in pregnancy if you limit the daily intake to 3 tsps or less. Do not take more because there is a danger of turning your skin permanently blue by overdosing.

5. Plan ahead for extra warmth after the birth for both the mother and baby. Hot water bottles, heating pads, hot packs, big towels dried in a hot dryer during the pushing phase all help keep the mamatoto extra toasty after birth and reduce stress. Have a friend or family member assigned to be in charge of the mother/baby warmth team. Colostrum is the best antibiotic treatment the baby could ever get.

6. Other good prevention tips: Keep vaginal exams to a minimum — 0 is best. Do not allow membrane stripping to start the birth (a.k.a. membrane sweeping). Do not permit artificial rupture of the membranes. Do not allow children of other families to visit the new baby for the first three weeks. Keep the older kids healthy so they are not sneezing and coughing on the new baby.

I often think we must have had a lot of women who were Strep B positive in the 1000 plus births I have attended. We do not test unless we have long rupture of membranes and/or a preemie. Once the baby is born, we keep all women warm and baby skin-to-skin with the cord intact and, of course, all our mothers breastfeed. I have never had a baby sick with Strep B in thirty years. Unfortunately, the use of high dose antibiotics on so many pregnant women has resulted in an increase in infant deaths due to E Coli. *Group B strep/antibiotics

Prevent the diagnosis of positive for GBS: If your care provider wants you to go for GBS testing to comply with their protocols, read this article by a Certified Nurse Midwife about the use of garlic in the vagina to knock out bacteria. Do this regimen prior to testing.
http://www.midwiferytoday.com/articles/garlic.asp

Be sure to check out Lisa Barrett’s blogpost (and the comments) about the Cochrane Review regarding GBS and Antibiotics at http://www.homebirth.net.au/2009/07/gbs-cochrane-report.html
*References:
(1.) E. M. Levine et al., “Intrapartum Antibiotic Prophylaxis Increases the Incidence of Gram Negative Neonatal Sepsis,” Infectious Disease Obstetric Gynecology 7, no. 4 (1999): 210-213.
(2.) C. V. Towers and G. G. Briggs, “Antepartum Use of Antibiotics and Early-Onset Neonatal Sepsis: The Next Four Years,” American Journal of Obstetric Gynecology 187, no. 2 (2002): 495-500.
(3.) C. V. Towers et al., “Potential Consequences of Widespread Antepartal Use of Ampicillin,” American Journal of Obstetric Gynecology 179, no. 4 (1998): 879-883.
(4.) R. S. McDuffie Jr. et al., “Adverse Perinatal Outcome and Resistant Enterobacteriaceae after Antibiotic Usage for Premature Rupture of Membranes and Group B Streptococcus Carriage,” Obstetric Gynecology 82, no. 4, pt. 1 (1993): 487-489.
(5.) T. B. Hyde ct al., “Trends in Incidence and Antimicrobial Resistance of Early-Onset Sepsis: Population-Based Surveillance in San Francisco and Atlanta,” Pediatrics 110, no. 4 (2002): 690-695.
(6.) M. L. Bland et al., “Antibiotic Resistance Patterns of Group B Streptococci in Late Third Trimester Rectovaginal Cultures,” American Journal of Obstetric Gynecology 184. no, 6 (2001): 1125-1126.
(7.) M. Dabrowska-Szponar and J. Galinski. “Drug Resistance of Group 9 Streptococci,” Pol Merkuriusz Lek 10, no. 60(2001): 442-444.
(8.) R. K. Edwards et al., “Intrapartum Antibiotic Prophylaxis 2: Positive Predictive Value Antenatal Group B Streptococci Cultures and Antibiotic Susceptibility of Clinical Isolates,” Obstetric Gynecology 100, no. 3 (2002): 540-544.
(9.) S. D. Manning et al., “Correlates of Antibiotic-Resistant Group B Streptococcus Isolated from Pregnant Women,” Obstetric Gynecology 101, no. 1 (2003): 74-79
(10.)Cochrane Database: Jan. 2013 “Maternal colonization with group B streptococcus (GBS) during pregnancy increases the risk of neonatal infection by vertical transmission. Administration of intrapartum antibiotic prophylaxis (IAP) during labor has been associated with a reduction in early onset GBS disease (EOGBSD). However, treating all colonized women during labor exposes a large number of women and infants to possible adverse effects without benefit.”
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007467.pub3/abstract

UPDATE: Cochrane Library, June 10, 2014
Intrapartum antibiotics for known maternal Group B streptococcal colonization
Women, men and children of all ages can be colonized with Group B streptococcus (GBS) bacteria without having any symptoms. Group B streptococcus are particularly found in the gastrointestinal tract, vagina and urethra. This is the situation in both developed and developing countries. About one in 2000 newborn babies have GBS bacterial infections, usually evident as respiratory disease, general sepsis, or meningitis within the first week. The baby contracts the infection from the mother during labor. Giving the mother an antibiotic directly into a vein during labor causes bacterial counts to fall rapidly, which suggests possible benefits but pregnant women need to be screened. Many countries have guidelines on screening for GBS in pregnancy and treatment with antibiotics. Some risk factors for an affected baby are preterm and low birthweight; prolonged labor; prolonged rupture of the membranes (more than 12 hours); severe changes in fetal heart rate during the first stage of labor; and gestational diabetes. Very few of the women in labor who are GBS positive give birth to babies who are infected with GBS and antibiotics can have harmful effects such as severe maternal allergic reactions, increase in drug-resistant organisms and exposure of newborn infants to resistant bacteria, and postnatal maternal and neonatal yeast infections.

This review finds that giving antibiotics is not supported by conclusive evidence. The review identified four trials involving 852 GBS positive women. Three trials, which were more than 20 years old, compared ampicillin or penicillin to no treatment and found no clear differences in newborn deaths although the occurrence of early GBS infection in the newborn was reduced with antibiotics. The antibiotics ampicillin and penicillin were no different from each other in one trial with 352 GBS positive women. All cases of perinatal GBS infections are unlikely to be prevented even if an effective vaccine is developed.
Source: http://summaries.cochrane.org/CD007467/intrapartum-antibiotics-for-known-maternal-group-b-streptococcal-colonization

UPDATE April 2016: From the (30th Anniversary Special) copy of Midwifery Today Magazine. Quote: “Unlike the US, the UK does not recommend universal screening because, while GBS disease is the most common cause of infection in full-term newborns, it is statistically still quite rare.(Wickham discusses these numbers in depth.) The Royal College of Obstetricians and Gynecologists (RCOG) firmly states that it will not support routine screening for GBS “until it is clear that antenatal screening for GBS carriage does more good than harm and that the benefits are cost effective” –two factors that have yet to be affirmed in any research done to date.” End Quote

This was part of a book review in Midwifery Today Magazine, Spring 2016 for “Group B Strep Explained” by Sarah Wickham, Midwife, 2014, paperback, pub’d by AIMS

Hold that hat!

Image

Someone on Facebook is doing a survey of what birth workers think about putting knit toques on newborn heads.

We have to ask ourselves about the way this hat thing got going. Babies were not doing well after being born to medicated women and immediate cord clamping. The baby who has started off at such a deficit will lose body heat and be in very rough shape. Helping keep in heat by a hat might be a matter of life and death in this instance where the body is so weakened.

Contrast that to a baby born spontaneously and placed on his mother’s body. . . both of them wrapped together in a warmed blanket skin to skin. The cord is intact, the placenta continues its work of transferring just the right amount of blood back and forth to the baby while he/she adjusts to life in an air environment in a leisurely fashion.

Then, the baby and the mother lock in a gaze; the mother recognizing that this is her own; she buries her nose in the wet head and drinks in the smell of her young; she locks the imprint of that child’s whole being into her vision and she would not ever confuse her baby with someone else’s. Later, she chooses the clothing SHE wants her child to wear; she dresses and grooms her own baby. . . she is in charge and has been born as the mother. No one and no article of clothing has come between her and her total impressions of that baby. Through skin, mouth, nose, eyes and heart she has claimed the baby as her own and the bond is strong.

eliskintoskin

Bringing medical birth practices to a natural birth is a sign that we lost so much knowledge in the dark years when homebirth/midwifery was wiped out. Now, we can look again at these things and lay them aside as foolish for well women and their infants.

http://www.normalfed.com/starting/hat/ Article by a Lactation Consultant

YOU’RE NOT IN LABOUR

425pregnant.jpgYOU’RE NOT IN LABOUR

These are difficult words for birth attendants to say; I would say they are right up there with “I’m sorry, I’ve made a mistake.” They are, also, difficult for the birthing woman to hear. I’ve been on the receiving and giving ends of those words.

RECEIVING END
During my first home birth (second baby, 12 years after my first birth), I “laboured” all day (5 minute apart sensations that I thought “really hurt”) and at 8 p.m., my mw did a pelvic and said “you’re only 3 cms., you’re not in labour. I suggest you send all these people home, stop entertaining, go to bed, get some rest and I have to go help some other midwives at another birth.” I remember (a) wanting to kill her  (b) knowing somewhere inside that she was right but not liking it and (c) going into the bathroom and crying my heart out. I did as she told me, went to bed and about midnight it swung into a whole different level of intensity. I could see what she meant that I hadn’t been actively having a baby during the day. I gave birth to my baby at 2 a.m. after about 4 hours of very high gear birth sensations.

What did my midwife do for me by “giving it to me straight”?

1. She gave me the benefit of her experience which was what I paid for.
2. She respected me enough to know that I could deal with the truth and she didn’t have to candy coat it for me.
3. She opened up the possibility that, yes, things could get harder but I could manage it.
4. She provided a model for me to give to other women.

At the time, I didn’t know that I would be attending births in my future but many of the things I learned from that birth now benefit the women I attend and those I teach.

At times, it’s tricky to know the woman who is “not in labour”. (I actually don’t use the term “labour”; I would use the term “not in the birth process” so I’ll change to that language now.)

A PRIMIP CASE

I was looking at a film this weekend of a 3 day marathon birth process. The birthing woman was having strong back to back sensations, feeling hot, in immense pain. She had a very good doula attending her plus her male partner. After three days of tiring birth process, she went to see her midwife at the birth centre and she was only 1 cm dilated. As I watched it (granted you can’t tell anything from a short film clip), I wondered if she might have scarring on the cervix from previous laser surgery. The other possibility is that she was scared to death and couldn’t dilate (it was a planned hospital birth centre birth with CNMs). At 1 cm she was given an epidural to get some rest and, the next day, “some manual help to get dilation going” (breaking up scar tissue, perhaps?) and she went on to birth her baby vaginally.

ANOTHER PRIMIP SITUATION

I was asked to help out at a birth for a midwife’s daughter. The grandmother thought the birth was imminent and wanted me to come over and provide support, camera operation, and rested after care person. When I arrived, sure enough, the daughter was in high gear and I proceeded to boil up the instruments and get things ready for the birth. Between the highly intense sensations, the birthing woman said to me, “Gloria, I like your running shoes.” At that moment, I realized that she wasn’t really in the birth process. (If a woman is really having a baby, I could be naked and she wouldn’t notice). I think this birthing mother had seen so many birth videos in her childhood that she was acting out the whole scenario rather than experiencing it. Needless to say, it was another 48 hours before that baby was born. Telling my friend who is a very experienced midwife that her daughter wasn’t even close to having a baby was not easy but it had to be done. With our own family members it’s often difficult to be objective.

A VBAC BIRTH THAT FOOLED ME

One of my VBAC clients called me to say she was having regular sensations. She seemed to be in the early stages of birth so I settled in to just wait it out. About 10 p.m. at night, things picked up dramatically so I decided to do a dilation check (this was 20 years ago). To my surprise and delight, she was 7 cms dilated. (that should have been a clue that I was making a mistake. When the external world doesn’t match the internal exam, check more carefully). I held her and massaged her all night long while the others slept. By morning, everything had petered out and I couldn’t figure out why she wasn’t actively pushing by that time. She had been snoozing between her sensations through the night but I’d had her on the toilet, walking around, in the shower, etc. I did another exam only to realize, at that point, that I had completely blown it, she was only 2 cms dilated and wasn’t even in the birth process yet. That was one of those awful moments when you have to say BOTH of the top two difficult things at once. I said “Theresa, I’m sorry I’ve made a mistake. Last night when I checked you it wasn’t accurate. Right now, you are 2 cms dilated and you’re not in the birth process yet. I shouldn’t have been encouraging you all night that you’d be having the baby soon. Right now, the only way that this will work is if you’re willing to begin anew. Cancel everything we’ve done so far and get back to the very beginning. You need to eat, get some sleep, downplay this early stuff, relax. Everything is normal and healthy but I have made a huge blunder and I’m sorry.” The worst thing I could have done in this situation is to lie to this woman and tell her that she had gone backwards in her dilation—yes, many practitioners do this. It’s so unfair to a woman who already thinks her body might fail her. Not only that, but I think somewhere in the woman’s own “knowing” place, she realizes that she has not really been in the birth process.

This amazing woman did begin anew. She and her husband forgave me for my mistake, rested, ate, relaxed, summoned their patience and had a home VBAC for their baby. I will be grateful to them forever.

MULTIPS CAN HAVE THIS, TOO

Even though a woman has given birth before, each birth is different. We got a call from a woman who lives out in the country that she was in the birth process. Usually one attendant goes first to scope things out and the other gets called when the birth is close. In this case, I picked up my trusty partner, Mary, because it was a second baby and the drive was long. When we arrived, the mother seemed to be having a lot of pain and I went into “we’re going to have a baby mode” getting the pool inflated and supplies ready. On one of my sprints through the kitchen, I noticed that Mary was sitting at the table reading. I said “What are you doing?, the baby’s coming.” Mary looked up and said “She’s not in labour, Gloria, you’d better check her before you get too excited.” Ewwwwww! I hated hearing that, but, of course, she was right and I knew it even without checking. Her membranes were intact, so I suggested checking dilation and the woman was more than willing (another sign it’s very early). Sure enough, no dilation at all.

We reassured the birthing woman that things would get more intense and she definitely would have her baby. To give her and her husband some privacy, we went over to the local mall and told her to call us when the sensations picked up. She never called us so, after we’d spent all our money at the mall (only time I ever shop is when I’m waiting on babies), we drove home. She called back two weeks later and, this time, she was really in the birth process and pushed her baby out two hours after we arrived!

Added December 2014. Quote from Gail Hart, Midwife in Oregon.

We all need to remember that Prodromal Labor is NOT LABOR.. Prodromal is symptoms which occur BEFORE LABOR BEGINS and are similar to the condition of PreMenstrual Syndrome.
We should help women recognize this is normal. It is not labor. it is not a sign in anyway of anything being wrong. It is not a symptom of malposition. It is normal.

She just is not ready to be in labor — the hormones are not quite there. These women can be ‘not yet in labor’ for days, sometimes weeks. They should understand this as normal ‘discomforts of late pregnancy’ and use remedies if they need it — baths, distractions, sleep aids etc.

The contractions they are having are preparatory — preparing for labor — and women with a lot of PreLabor SYmptoms frequently have easier labors because their uterus is nicely primed for labor when it does begin.
It is not relevant to know how frequently they contract — but the length and strength of the contractions will tell us (and mom) whe she is finally tipping into Labor. Contractions which are less than a minute long are not likely to be true labor.

Added December 10, 2016: From Gloria Lemay: Many women do things to “get their birth going”. This can range from a 4 hour brisk hike, to acupuncture, to eating spicy food, castor oil, etc etc etc. When the body isn’t ready to give birth, all these things do is just drag out a ‘pretend’ birth process.
Another big pitfall, wasting the early period of the birth process by staying awake, chatting, texting, and socializing. In modern times, we don’t seem to have the older, wiser women to tell the younger women to “chill out” and ignore the early phase. When the woman stays up all night in early birthing, she basically works a graveyard shift. Then, her circadian rhythms are thrown off. No other mammal does this. Electric lights are no friend to a birthing woman. So, don’t blame the woman’s body or the baby’s size when a birth is not moving along. Look to the powers i.e. the strength of the uterus. There are things that the woman can do to get the birth off to a good start beginning with waiting till the baby is really ready. Then, guarding her privacy and being in the dark will help her pituitary to work effectively in producing birth hormones.

What’s a Poor Midwife To Do?

This question came in to my blog in response to my archived post on the use of Castor Oil. Since it is a subject I seem to deal with daily, I’ve answered it where everyone can join in the discussion. Gloria

QUESTION

Hi Gloria! I am a student midwife, and in my state, women must be transferred to an OB if they have not given birth by 42 weeks. The local midwives (my preceptors) use castor oil as a last resort induction method. They don’t like doing it, from what they tell me, but they feel that, if after nothing else works (walking, sex, black and blue cohosh), it would be better to try castor oil and breaking the woman’s water, than to have a perfectly healthy woman transferred to the hospital.

What is your opinion on this? If you were faced with a similar situation (I should mention that midwifery licensing is strict in Florida, and midwives may lose their license if they do not follow the “rules”), what would you recommend? I do not plan on practicing here in Florida when I graduate from midwifery school, but I’d like to pass along some information to the midwives that I work with. Florida Student

RESPONSE

I am faced with a similar situation in my province. We have registered, government paid midwives who have to play nice with the doctors in order to have hospital privileges, a government salary, and publicly funded malpractise insurance. They have the same complaint “We hate to induce naturally but it’s better than what they are going to get in hospital. . . .” We also have the same mess here in B.C. as the rest of North America. Those membrane stripping, castor oil, acupuncture, herbal inductions don’t work because the woman isn’t ready to have the baby and, then, she gets on the prostaglandin/pitocin intervention-cascade train and the midwife feels so bad. . . but, hey, what could she do?

Canadian midwife with client

Canadian midwife with client

Every day, I thank my lucky stars that they used me as an example to the government of what a “renegade” midwife was. Midwives in my province could only become a professional body if they proved there was a “danger to the public” by NOT having a profession. I got to be the designated “danger” because I had proven for years that I would not lie down with the doctors and side with them against my clients. Obviously, the midwives organization would never have given me a license, even if I applied, so I didn’t have to bother applying. A few of my friends did and they were bankrupted and humiliated by the “professional” body. As soon as the government registrations were issued, we saw these inductions start. So many women in my community have been fooled by this cruel trick.

When the local midwives first obtained registration, there was a lot of righteous conversation about “evidence based” midwifery. The large multi centre trial about 41 week inductions conducted by Mary Hannah of Toronto (1) was pointed to by midwives to frighten women into being induced at 41 weeks. We had never seen this in our province prior to regulation. We had twenty years of experience as lay midwives with many post dates women and had not seen any problems but that experience was set aside in favour of the “evidence base”. Even though the midwifery empirical knowledge did not support Ms Hannah’s conclusions and even though the midwives were extremely conflicted and frustrated by the results of their labour inductions, they still obeyed the medical “evidence”. Then, the “evidence” was shown to be without merit. In 2002, Hall and Menticoglou published a paper in the British Journal of Obstetrics and Gynecology proving that Hannah’s study was wrong (2). Has that meant that midwives in my province are now encouraging women to relax up to and past 42 weeks gestation? Oh no, because now the doctors have kept on with their aggressive policies of inducing everyone at 41 weeks and, evidence- be- damned, they’ll make the midwives do the same thing. Science is trumped by community “standard of care” which basically means “we’ll all follow like sheep and hope the wolf doesn’t catch us”. Now, I don’t hear too much rhetoric about “evidence based practice” among local midwives. There is still a lot of lamenting about “how bad they feel” but the inductions continue unabated. Of course, the midwives don’t feel even 1/100th as bad as the woman who has had major abdominal surgery thanks to their aggressive policies.

I’ll post a link here to the B.C. Government Vital Statistics chart (click on Item 11) which shows that, prior to regulating midwives in 1998, there was an up and down pattern to cesarean rates and the rates remained below 25%. For the last reported year (2011) the rate was over 30%. This means that, since midwifery regulated on January 1, 1998 the cesarean rate has risen and the pattern has been a steadily upward climb. The cesarean rate is the score card of what is happening in obstetrics in any given jurisdiction. We’re obviously not doing so well here in B.C. When the registered midwives were soliciting the government for a professional designation, one of the cornerstones of their bid was that they would save the government money by preventing cesareans.

Cesarean Rates in British Columbia Before and After Midwifery Regulation

Cesarean Rates in British Columbia Before and After Midwifery Regulation

So, in answer to your questions: a)What is your opinion on this? I think it is disgusting that midwives are so cowardly and turn perfectly healthy pregnant women into wounded mothers. And (2) If you were faced with a similar situation (I should mention that midwifery licensing is strict in Florida, and midwives may lose their license if they do not follow the “rules”), what would you recommend? I will not be faced with a similar situation because I would not join an organization where I was made to go against my conscience, my common sense and my promise to my clients. If I was in such an organization and realized that I could not do my work with integrity, I would not be complaining about these ridiculous “protocols” I’d be changing them or resigning in protest.

(1) Hannah ME et al. Postterm pregnancy: putting the merits of a policy of induction of labor into perspective. Birth 1996;23(1):13-9.
(2) Menticoglou SM and Hall PF. Routine induction of labour at 41 weeks gestation:
nonsensus consensus. BJOG 2002;109:485-91.

related post: Castor Oil Inductions
This post was updated on Sept 5, 2014 to reflect B.C. Vital Statistics to 2011
Updated Dec 30, 2014 to include link to “Nonsensus Consensus”