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Pregnancy Induced Hypertension, Woman Heal Thyself
I have had this article from the New Statesman (a British magazine) in my files for decades. I’ve given it to many women to underline the importance of daily quality protein in pregnancy. I can’t find any reference to it on the internet and I publish it here in order to have this history preserved. Remember when reading it that no one had home computers in 1984 and there were no search engines. We had to rely on TV, magazines, newspapers and medical libraries back then. There was no email so the British postal service was the way these women contacted each other. For this young woman to undertake this project in those days is truly amazing.
The terms toxemia (spelled toxaemia by the British), and pre eclampsia have both been retired and now all these words are under the umbrella term of “Pregnancy Induced Hypertension” (PIH). Enjoy the read and leave comments. Thanks Gloria
New Statesman 6 January 1984
Health
WOMAN HEAL THYSELF
John Hargreaves on a new approach to toxaemia
FEW PROFESSIONALS care to be lectured in their own field by their clients. But when Dawn James faithfully followed her doctor’s advice during pregnancy and succumbed nevertheless to a disease which kills an average twelve women and hundreds of fetuses every year in Britain, no one could tell her why. This 27 year old woman, living in a council flat in Hackney—‘shy, and not a speaker type at all. . . from a working class background and a secondary modern school’ –determined to find out for herself.
Two years later, she was invited back by the Senior Nursing Officer to the hospital where her baby was born, to explain to the midwifery staff what she believes are the causes of toxaemia of pregnancy and how it can be prevented.
Pre-eclamptic toxaemia (a misnomer because it is now recognized that no ‘toxin in the blood’ is involved) is a condition unique to pregnancy, generally diagnosed upon appearance of two of a triad of symptoms—high blood pressure, swelling, and protein in the urine. Abdominal pains, headaches and blinding flashes of light may alert a pregnant woman that something is seriously wrong. At its extreme, the condition becomes eclampsia, the epileptic-like convulsions that can be fatal to mother and baby.
Diagnosis of pre-eclampsia is confused by the fact that all three of its cardinal symptoms may arise from other causes, many of which are entirely benign. This is often not recognized by doctors, who may begin treatment of healthy pregnant women, sometimes causing problems where none in fact existed. Even in genuine cases, standard medical treatment with bedrest, sedatives, drugs to control blood pressure, and early induction of labour does little to ameliorate the condition. Many doctors believe that the only effective treatment is to end the pregnancy.
Pre-eclampsia is still hailed as ‘the ancient enigma’ in obstetric journals, and a consultant dealing with a reader’s problem for ‘Woman’ magazine wrote recently ‘the cause of pre-eclampsia is not known. . . Because of this it is not possible to give advice on how to avoid it.’ While midwives have taken Dawn James’s findings seriously, the obstetric profession remains obdurate and aloof.
It was in the women’s magazines that Dawn James began her own search, with a request that others who had suffered pre-eclampsia write to her. She had 200 replies. She sent them a questionnaire, and compared her findings with what she had learned from the textbooks. Pre-eclampsia was supposed to be more common in twin pregnancies, overweight women and diabetics, and to run in families. None of these categories fitted Dawn James, and none was common among her correspondents. These women, anxious about their future, had invariably been reassured by their doctors that pre-eclampsia was a disease of first pregnancies only. Yet out of the 32 respondents who had undertaken another pregnancy, 23 had suffered pre-eclampsia again! With the support of many of these women, Dawn established P.E.T.S., the Pre-Eclamptic Toxaemia Society.
DAWN BEGAN a massive educational effort involving correspondence with the experts’ across the three continents and delving through the medical journals reaching back over a hundred years. But alongside continuous reportage of this work in the quarterly P.E.T.S. newsletter, Dawn kept publishing the personal experiences of her members – tragic accounts of unsuspecting women meticulously following their doctors’ orders and yet succumbing quite suddenly to convulsions and coma and having either a premature, low weight baby (with a much higher risk of mental or physical disability) or a stillbirth.
An underlying theme did begin to emerge from Dawn’s reading, and that was the supreme relevance of the mother’s diet. John Lever at Guy’s in 1843 was probably the first obstetric physician to take a dietary history, noting a single daily meal of bread and tea from a woman with puerperal convulsions. The work of Hamlin in Australia, Strauss in North Carolina and, especially, Brewer in California made a strong impression. Here was an account of the aetiology of pre-eclampsia – from inadequate nutrition, through liver dysfunction, low blood albumin and reduced blood volume—which made sense and was supported by the evidence amongst the severely undernourished subjects involved. But how could this apply in Britain in the 1980s?
By the time the next newsletter was compiled, Dawn had made the most significant step of all, by simply asking herself, as so few obstetricians have asked of their patients since John Lever, ‘what exactly had I been eating?’ ‘During the first twelve weeks of my pregnancy, I was constantly vomiting day and night and survived a few weeks mostly on bottles of lucozade. . . then, at about 5 months, I was told I had gained ‘too much’ and that I should cut down on my food. I felt really hungry all the time and would sneak a potato or some bread until my husband would remind me of the expert advice and I would go back to mostly salads. . . . When I was in hospital. . . I hardly ate at all during those two weeks prior to my induction.’
Underweight and premature
Again and again, the personal experiences indicated maternal under-nutrition, sometimes instigated by doctors setting artificial weight limits. And more scientific studies, conducted by dieticians and public health physicians rather than obstetricians were given a new prominence in P.E.T.S. They showed that pre-eclampsia could be effectively prevented by thorough nutrition counselling or diet supplementation.The obstetric profession doesn’t like this idea. ‘I would counsel that you drop any reference to Brewer’s work,’ wrote Professor Ian MacGillivray about the California champion of the nutritional thesis, ‘if you wish to have any support from research workers into this problem in the United Kingdom or for that matter, any part of the world.’
Nancy Stewart, another P.E.T.S. member and recent editor for the Association for Improvements in the Maternity Services, believes that this is inevitable given the training and role of obstetricians. ‘Prevention through good nutrition is a woman-centred approach, which means being in touch with women’s daily lives. And it has to do with health, rather than disease. This is the approach of midwives, as the guardians of normality. Obstetrics is not about health, but about diagnosing and treating disease. It is a male science, and within the political structure of maternity care it is these men, trained to approach pregnancy as a medical event, who have the power to define health care.’
Pre-eclampsia is more prevalent among unskilled working class people and teenaged, Asian and single mothers—those statistically least likely to meet the extra nutritional demands of pregnancy. How can a few informed women hope to change the system of maternity care to benefit these in greatest need? Midwives may learn eagerly from P. E. T. S., and may even recall the days when their duties included baking and delivering egg custards to get concentrated protein into poor pregnant women, but their role as independent practitioners is being rapidly diminished into one of obstetric nurses.
Perhaps P.E.T.S. can work its approach into the health care system through the back door, women taking the lead. But in the meantime as many as 15 per cent of women in pregnancy are diagnosed as pre-eclamptic, and very few of them discover in time the protective effects of sufficient high quality foods. Instead, they are categorized immediately as high risk and referred to the obstetric clinic, where sophisticated, expensive diagnostic procedures chart with scientific precision the worsening and irreversible damage to their babies.
(Transcribed by Gloria Lemay, Vancouver BC Canada from the original magazine article)
Podcast available for download
I had a great time being interviewed by Alain Desaulniers, DC, recently. Enjoy this podcast. Love, Gloria
Thanks so much for sharing about your AWESOME birth story and for your willingness to share so openly and authentically. I hope that millions are transformed through your words and message! I look forward to connecting with you soon! You rock!
I would be honoured if you would share with your circle of influence!Your Show’s link:
http://everydayrevolutions.net/022glorialemay/
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• Ranked as high as #5 in iTunes Health, #1 in iTunes Fitness & Nutrition, #2 in iTunes New & Noteworthy, #77 in iTunes Overall.Thank you for giving back,
AlainDr. Alain Desaulniers
Family Chiropractor, Everyday Revolutions Podcast Host, Educator, Keynote SpeakerSubscribe to the Everyday Revolutions podcast on iTunes, Sticher Radio or Soundcloud
MIDWIFERY CARE FOR THE VBAC WOMAN
Midwifery Care for the VBAC Woman
by Gloria Lemay
© 2001 Midwifery Today, Inc. All rights reserved.
[This article first appeared in Midwifery Today Issue 57, Spring 2001.]
Someone asked me recently what things are done differently with vaginal births after cesarean (VBAC) as opposed to a first baby. Midwives usually reply to this question with a reassuring, “Oh, we treat you normally,” but there are differences in the two situations that can be distinguished in midwifery practice.
Prenatal Preparation
The full history of the events leading to the cesarean is very important. With a VBAC client, ask her to get her operative record, nurse’s notes, anesthetist’s report, pediatric report—get all the records and go over them thoroughly. Often the couple did not get full or accurate information about what was going on. Sometimes there’s a little “clue” as to what went wrong that could help to prevent a cesarean from recurring. Sometimes there is a big chunk of information that didn’t get communicated. I saw one set of records where the only indication for the cesarean was the note from the obstetrician that “this woman is a natural childbirth fanatic.” Another set of cesarean records had no indicator whatsoever of why the woman received abdominal surgery when she had given birth at l9 years old. When she told her parents that the midwife was perplexed and could see no reason for the surgery, her father admitted to her that he had stayed in the visitor’s lounge all day and had been verbally threatening to the doctor: “If anything happens to my daughter, I’ll sue you!” This helped the daughter to understand what had happened to her and also helped her to be firm with her father that he was to be nowhere near her VBAC birth.
With VBAC births it is important for the midwife to work with the dad prenatally. A VBAC father is in a horrible position because, despite the fact that his wife had an operation and a long recovery, he still got a live wife and baby at the end of it all. VBAC dads are often “fantasy bonded” to the medical system and terrified of childbirth in general.
The good thing is that they listen very carefully and really know when the care is better and more thorough and when the practitioner is authentically on their team. I find that if the midwife talks to them very honestly, they can trust and be fully supportive when the birth time arrives.
If the woman has dilated past five centimeters in the first birth, I plan for it to be fairly fast—like any second baby. If the woman has not gone into the birth process or not dilated past five the first time, that’s all right, she’ll still give birth vaginally, but we have extra midwives on call to bring fresh energy if the others get discouraged or tired. We plan for it to be like going to two births in a row. The point that the woman reached in her first birth is often a psychological hurdle for her. If she dilated to six centimeters the first time, the news that she is seven or eight will be a relief and a breakthrough. One of our clients, a minister’s wife, said over and over again in her pregnancy: “I just want to feel what pushing is. If I only get to push, I’ll be happy. I just want to know what other women mean when they say they had to push.” She’d had a Bandl’s ring in the first birth process and the cesarean was done at five centimeters. We were praying that the complication wouldn’t repeat. She dilated smoothly and began to push. With each push she would exclaim “Thank you Jesus, thank you Jesus!” What a wonder it was to watch her push out the baby, a girl whom she named Faith.
All humans have a certain propensity to self-sabotage, and the VBAC woman must be on guard against her own defeating patterns. The midwife must be bold in pointing out ways that the woman is repeating dumb moves—there’s no place for us being “nice” if it will mean another cesarean. An example of this: If the woman had a cesarean with five support people, she will be cautioned to keep her VBAC private.
Privacy and quiet are a must, and we will be very forceful about setting up logistics before the birth so that the woman can birth in peace. In short, the VBAC is high priority because this woman’s whole obstetrical future rides on its success.
Keeping a VBAC normal
We show the couple lots of videos of beautiful VBAC births because one video is worth a thousand words. If you don’t have your own, purchase a copy of my dvd “Birth with Gloria Lemay” which shows a beautiful VBAC waterbirth. Art therapy is helpful in creating the environment before the birth day. I place a big sheet of drawing paper in front of the father and mother with lots of colored pencils and instruct them to, “Draw your birth cave” or, “Color your birth.” When they are finished, I write the date on the two drawings and put them away in my files. After the birth, we take them out and are amazed at the details that were drawn weeks before and later manifested in the actual birth.
I schedule longer appointments with VBAC women because they seem to need to obsess. I don’t have solutions to many of their fears but it seems to help to just be able to talk to someone who cares and understands. I usually also ask them to, “Tell me how you know that this time you’re going to have a vaginal birth?” The answers always amaze me. One woman said, “Because this time I’m not depending on my doctor or my midwives—me and my husband are going to have this baby.” I suggested that she give up depending on her husband, too. She looked terrified at that idea but I could see that she understood; she looked me in the eye and said, “Right!” That was the moment I knew she would do it. She’s had three water homebirth VBACs since then, and after each birth her first words were, “I did it.”
VBAC women are so grateful for the opportunity to birth normally that they are often shy to ask for the extra things that make a birth beautiful, such as a Blessingway ceremony or a waterbirth. The midwife must remember to offer and encourage the mother to think “really beautiful birth” rather than “bare minimum birth.” I find it helpful to ask, “This is the only second baby you will ever have—what would make it really special?”
The Day of the Birth
In my practice, no one gets induced in any way or gets pain medication. This policy is very important for all women but especially for VBAC women. If there is a small chance of uterine rupture, we must have everything on our side to prevent it (the rate of VBAC uterine rupture without induction is 0.4 percent or less than one in 200*). It is beyond my comprehension how anyone could give a VBAC woman misoprostol (Cytotec), oxytocin or castor oil or strip the membranes or use any other form of induction when that would triple her chance of having a uterine rupture.
I believe that VBAC women have longer, gentler births because Nature is compensating for the scar. There is no hurrying. I would be terrified to induce a VBAC woman but feel safe to attend her at home if her body is pacing itself naturally. We keep it in the back of our heads that the signs of rupture are stabbing pain, unusual bleeding, decels of the baby’s heart, or a peculiar shape of the abdomen but we don’t look for problems if they don’t exist.
We are especially careful with the birth of the placenta in a VBAC because there is a slightly increased chance that the placenta might be adhered to the scar, and we do not want to have a uterine prolapse caused by pulling.
Postpartum Differences
After the birth, VBAC women need to be told that they can walk upright. They can’t believe that they can straighten at the waist right after giving birth. Then, they can’t believe it when we ask them to do sit-ups and leg raises on day one. Usually by day three when we go to visit, their husbands say, “Oh, she’s gone to the gym.” With VBAC women, the complaints are very few in the postpartum period because they are comparing to post-surgery pain and any minor scrapes and bruises seem like nothing.
In the years following the birth, these women and men send us more clients than anyone else, and if we’re in legal trouble, they’ll be at all the rallies, raise money, stamp the envelopes, write letters to legislators, and be our true friends for life. A VBAC is an amazing experience for the birth attendants as well as the family. Very Beautiful And Courageous (VBAC).
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Q & A: VBAC
Two Types of Pelvises
by Gloria Lemay
Q: From a midwife: A great many Asian women are very small and small-footed, yet I hear that many of them birth vaginally. Would you comment on pelvic size?
A: When I get a VBAC client and she is endlessly self-psychoanalyzing and beating herself up for having a c-section, I usually say, “Look you made two big mistakes! First you were born in the wrong country, and second you were born in the wrong century—if you’d been born and raised l00 years ago in France, for instance, you would have given birth vaginally.” When I teach my workshops, I tell the students there are two types of pelvises in allopathic medicine: l) contracted, and 2) adequate. In midwifery, there are two types of pelvises as well: l) roomy, ample, and 2) you could get a pony through there!
Gloria Lemay is a Private Birth Attendant in Vancouver, British Columbia, Canada and a frequent contributor to Midwifery Today and The Birthkit.
“Birth with Gloria Lemay” the film
This is the kind of delightful feedback I receive about the DVD. Gloria
From Donna Reicks:
“Gloria, I just have to tell you…..I loaned out your DVD “Birth with Gloria Lemay” as I do to any “English” ladies I serve. These are 1st time parents (after 7 years of trying!) and she loved your DVD and commented her favorite part was the extra features on circumcision!! They were on the fence if they had a boy. Now, their decision is made. Thanks Gloria!! Keep up the good work! Much love to you!”From Gloria Lemay: “When I made the DVD, it was easy to add a few “extras” besides the footage of 9 home water births. One of the “extras” is a Director’s Cut-type film with me explaining what is going on in the film. The strange thing for me is how many women say, “After watching the version with you explaining what’s going on, my husband is now comfortable with the idea of birthing at home and he feels confident.” The conclusion I’ve come to is that I must have been talking to the back of the sound technician (a man) and that’s why the words seem to affect men. Completely inadvertent but I like it.
Then, there were 2 really good videos that really taught me a lot about the importance of the male foreskin so I requested the use of them from the owners. They were both thrilled to give me their material. Again, so much of the feedback that I get is that those two features have such an impact on people. Both of those intact penis features are available for anyone to watch online but, it seems, a couple sitting on their couch watching a DVD will keep going right to the end of the DVD and THAT has put the information in a lot of people’s hands. It’s so gratifying to know that those DVDs are all over the world. If you have one, don’t leave it on your shelf—get it out and show it or lend it to pregnant families!”
“Birth with Gloria Lemay”
To order the film and download to a thumb drive go to this link
https://birthwithglorialemay.vhx.tv/products/birth-with-gloria-lemay
Placenta Bowl, a family tradition
Lightened photo shows detail on the underside of the bowl.
The birth of a baby is a time to really consider what family traditions should be kept and what family traditions should be discarded. It can be a time to get creative and design rituals that truly nourish the heart. This wooden placenta bowl was commissioned by a family and carved by a B.C. artist. It is now being used at the second generation of homeborn babies in the family and will be passed on for years to come.
Shared with the kind permission of the family.
Checking Your Own Cervix
How to Check Your Own Cervix- “it’s not rocket science”
“I think it’s a good and empowering thing for a woman to check her own cervix for dilation. This is not rocket science, and you hardly need a medical degree or years of training to do it. Your vagina is a lot like your nose- other people may do harm if they put fingers or instruments up there but you have a greater sensitivity and will not do yourself any harm. Clean your hands well and make sure your fingernails are trimmed and rounded.
“The best way to do it when hugely pregnant is to sit on the toilet with one foot on the floor and one up on the seat of the toilet (or if that yoga is too difficult, put one foot up on the bathtub or a stool with your knee bent).
Put two fingers in and go back towards your bum. The cervix in a pregnant woman feels like your lips puckered up into a kiss. On a non-pregnant woman it feels like the end of your nose. When it is dilating, one finger slips into the middle of the cervix easily (just like you could slide your finger into your mouth easily if you are puckered up for a kiss). As the dilation progresses the inside of that hole becomes more like a taught elastic band and by 5 cms dilated (5 fingerwidths) it is a perfect rubbery circle like one of those Mason jar rings that you use for canning, and about that thick.
“What’s in the centre of that opening space is the membranes (bag of waters) that are covering the baby’s head and feel like a latex balloon filled with water. If you push on them a bit you’ll feel the baby’s head like a hard ball (as in baseball). If the waters have released you’ll feel the babe’s head directly.
“It is time for women to take back ownership of their bodies.”
-Gloria Lemay, Vancouver, BC
http://www.gentlebirth.org/archives/birth.html#Self-Checking
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Update
One birthing woman who checked her own cervix described it like this: “I could feel my bag of water bulging down and then later the baby’s head once the waters broke- so cool.”
“How did I do it? I just reached up in all the way to the back and felt. It’s sort of awkward/difficult to reach but if you are familiar with what your cervix normally feels like, sort of like the tip of your nose, it gets shorter and stretchy. I felt it at like maybe 2 cm, about 6, which is when I could feel the bag, and then when it was time for baby to come. When the contractions were getting super intense I pushed a bit and that was enough to break my waters. Babe came shortly after.”
(shared with permission) 2014
“An Unnecessary Cut”, 20 min video on Hospital VBAC
This video is timely and a valuable resource for birth workers. It’s a good length (20 mins) and it addresses that large number of women who are not ready for a home birth for a VBAC. It’s also a very good promotion for hiring a doula. Chileshe Nkonde-Price, a cardiologist at the University of Pennsylvania, wants to avoid an unnecessary Cesarean. This is the last week of her pregnancy. Enjoy and tell me what you think of it. Gloria
An Unnecessary Cut? How the C-section Became America’s Most Common Major Surgery – The New Yorker
Producer: Sky Dylan-Robbins
Cytotec (misoprostol) injuries or death? Medical records needed.
Hyper Stimulation of the Uterus cuts off Oxygen to fetus.
- From Jette Aaroe Clausen
I am engaged in the public discussion on induction of labor and misoprostol in Denmark. I and a colleague, Eva Rydahl, have addressed the Health committee in the Danish parliament. They have not banned cytotec but they have announced that they will do more monitoring of this and they issued a new circular making it mandatory for midwives and doctors to report side effects to off-label medication.
Eva and I strive to learn more about hyper stimulation and the way cytotec works. To do so we need patient records. We will of course treat them in confidence and not reveal any names. We will be grateful if we can be allowed to read any medical notes from patients (or their families) who have had adverse reactions to Cytotec (misoprostol). Fetal monitor tracings are especially useful to us. My colleague, Eva Rydahl (who is also on facebook), will also be happy to correspond with families. My e-mail address is jecl@phmetropol.dk I work at the Danish midwifery education in Copenhagen. I am an Assoc Prof of Midwifery and a researcher. Jette Aaroe Clausen, May 21, 2014
Giving birth is another elimination process
It feels so much better when it’s all done.
Why do I say that birth is an elimination process? Something large is within a body cavity and it must come out. When it’s time, it will come out. It will come out no matter where you are, no matter how smart/dumb you are, no matter if you want it to or not. Even if you want to call the whole thing off and come back to it another day, it will still come out. You’ll be very uncomfortable when the body messages say “It’s time“. You’ll get the right information from the messages of that discomfort and you’ll know exactly what to do. When you’re done, you’ll feel a lot better!
(Now, go back and read what I’ve said and apply it to vomiting, pee-ing, poop-ing or birthing and see how it fits.)