A Goal Achieved
This fall we celebrated the completion of the long-awaited Baby Walk. It was wonderful to see you all at the Open House held on September 29, despite the rainy weather! The back yard has been transformed in to a beautiful, private and peaceful sanctuary featuring perennial gardens, the elements of water and fire, and brick walkway inlaid with engraved bricks of babies born at the Center in its days as the Molitor Maternity Hospital and more recent babies born with the help of Morning Star. It is a testament to the timelessness of birth and a celebration of the mothers and babies who have made this journey together. A few times each year, we will order more bricks and add names to the walkway, so let us know if you want to place an order for your baby or loved one! We are also pleased to announce the completion of the expanded birth suites which now feature private bathrooms and permanent, deep labor and birth tubs. About 85% of our clients are choosing to birth in the water since the birth tubs have been installed. Thank you for your patience and understanding through the long renovation! Alas, not all changes at the Birth Center have been happy this fall. Our student, Krista Cleary, has decided to step away from her midwifery training. She will be missed by her preceptor and the clients who remember her care during their pregnancy and birth. I hope you enjoy this issue of the Morning Star Newsletter. As a health care provider in practice for fourteen years, I am increasingly aware of the problems caused by lack of informed decision making and transparency in maternity care outcomes. The U.S. maternal mortality rate is increasing for the first time since 1977! Simply put, ignorance is not bliss, and health care consumers and providers need to take responsibility for knowing the facts regarding birth options, choices and treatments. Morning Star continues its mission and steadfast commitment to safe, Mother-Friendly care and education. Towards better birth, Paula Bernini Feigal, CPM, Owner/Director, Morning Star Women’s Health and Birth Center
A Fond Farewell from Krista Cleary
After many months, and many wonderful births, I am leaving Morning Star. This is a decision that weighed heavily on my heart, but I find myself at a place in my life where I need to refocus my energy. I came to my first birth at Morning Star in March of 2006. I will always be grateful to all of you who shared your births with me. It is nothing less than an honor to witness the birth of a new baby. Also, I must thank you for being my teachers - the best teacher for a midwife is a woman in labor. I have been continuously inspired by you. Everything I have learned from each one of you contributes to the foundation of my midwifery training. I don’t know how to express my gratitude to Paula for welcoming me to her practice and taking me as a student. I am a different person than I was in March of 2006. When I started, Paula said to me, “I want to train you to be a midwife - and a GOOD midwife.” When the day comes that I am officially a midwife, I hope that I am a good one, and can give credit where it is due, to Paula, for helping me in that accomplishment.
Nov/Dec 2007 Volume 3, Issue 14
Inside This Issue: Birth Announcements
News of Interest
Schedule of Events
Explore Your Maternity Care Options
Quote of the Quarter
Kristin’s Birth Story
Birth Announcements Son, Bennett Michael Gilhousen, July 18, 2007 at 5:38 pm, 7 lbs 151/2 oz. Born to Jennifer and Mike Gilhousen of Hammond, WI. Son, Ari Simon Mitchell, August 8, 2007 at 3:30 am, 9 lbs 8 oz. Born to Tessa and Troy Mitchell of Hudson, WI. Son, Ian David Afdahl, August 18, 2007 at 12:56 am, 8 lbs 1 oz. Born to Kristin and Brad Afdahl of Arkansaw, WI. Story on page 11! Son, Ilan Isaiah Anderson, August 26, 2007 at 12:34 am, 8 lbs. Born to Julie and Craig Anderson of Glenwood City, WI. Daughter, Regina Caeli Gramins, August 31, 2007 at 2:59 am, 9 lbs 3 oz. Born to Amy and Bill Gramins of Boyceville, WI. Daughter, Samira Ceaster Aleece Tubwell, September 2, 2007 at 5:50 am, 7 lbs 11/2 oz. Born to Laura and Kenny Tubwell of Eau Claire, WI. Daughter, Abigail Eva Stubbe, September 5, 2007 at 3:08 am, 10 lbs 7 oz. Born to Robyn and Brad Stubbe of Mosinee, WI.
Son, Benjamin Thormodsgaard Pike, September 27, 2007 at 7:28 pm, 9lbs 41/2 oz. Born to Nancy and Dave Pike of Rice Lake, WI Son, Evan Lyle Solberg, October 6, 2007 at 5:48 am, 8 lbs 2 oz. Born to Janelle and Chris Solberg of Eau Claire, WI. Son, Marcus Conely Endrizzi, October 7, 2007 at 11:30 am, 8 lbs 12 oz. Born to Colleen and Dan Endrizzi of W. St. Paul, MN Son, Skyler Michael Ackerman-DeMers, October 7, 2007 at 11:05 pm, 8 lbs 4oz. Parents are Steve Ackerman and Shawn De Mers of Salt Lake City, UT. Daughter, Madalyn Clarella Sonheim, October 16, 2007 at 8:00 pm, 5 lbs 9 oz. Born to Tracy and Mike Sonheim of Black River Falls, WI. Son, Caedmon David Berger, October 26, 2007 at 1:11 am, 6 lbs 15 1/2 oz. Born to Lynette and Josh Berger of Beldenville, WI. Daughter, Clara Eileen Manor, November 2, 2007 at 8.06 pm, 6 lbs 9 oz. Born to Amanda and Josh Manor of Durand, WI.
Morning Star Welcomes Our New Employees! Hi, my name is Renee Wagner. I am new to the office staff at Morning Star Birth Center. My husband Kerry and I live in Menomonie and have for most of our lives. I am the proud mother of six beautiful children ages 15 years to 2 years. They keep me very busy but I cherish every moment I spend with them. I have had the privilege of meeting some of you and I look forward to meeting all of you. Thank you for welcoming me to the Morning Star Birth Center!
Renee Wagner and Allison Hagen - Office Staff
Hi, my name is Allison. I am extremely excited about working here at Morning Star Birth Center. I moved to Menomonie about a year ago from Cadott and fell in love with the community. I have three beautiful children - Ryley 14, Ryan 7, and Cameron 3. They keep me very busy and bring much joy to my life. I also enjoy reading, traveling, and any outdoor activities. I look forward to meeting all of you!
HOLIDAY OPEN HOUSE!! December 1st 6-8 pm. Refreshments, music and holiday cheer, before the busyness of the season begins! Page 2
The Morning Star Newsletter - Volume 3, Issue 14
Schedule of Events l November 14th, 9-10:30 am: Siblings at Birth This class is for children ages 4-12 who are planning to attend the birth of their sibling, or for parents who just want their older children to know more about the process of birth. We talk about the birth, changes in the family’s structure and the role of the new ‘big’ brother or sister. We will watch a gentle birth video and read a special story together. l November 15th, 12-2 pm: Mother’s Tea Topic: Recipe Swap- Bring your favorite Holiday Recipe or just your favorite Recipe to pass around! FREE!
Tuesday Wednesday Thursday
29 Natural 30
Siblings at Mother’s Tea Birth 12-2 p.m. 9-10:30 a.m.
Morning Star Women’s Health & Birth Center
Web: www.MorningStarBirth.com E-mail: info@MorningStarBirth.com
Tuesday Wednesday Thursday
Holiday Open House 6-8 p.m.
Family Planning 6-8:30 p.m.
321 13th St. SE, Menomonie, WI 54751-2032
Phone: (715) 231-3100 Fax: (715) 231-3101
gdiaper starter set $
The Morning Star Newsletter - Volume 3, Issue 14
20 + tax!!!
Family Planning 6-8:30 p.m.
Schedule of Events l Natural Family Planning Class Thursday, November 29, 6-8:30 pm Thursday, December 13, 6-8:30 pm Thursday, January 10, 6-8:30 pm The course will be taught by Alice Heinzen. Couples are encouraged to attend together. The cost for the course is $100 (per person/couple) and includes materials and instruction. You may register by calling Alice at 800-255-6226 or emailing her at firstname.lastname@example.org. Class size is limited and Registration is required. l December 1, 6-8 pm: Holiday Open House A time of joyful gathering (and a time to show off your kids holiday outfits!). Join us for food, music and holiday cheer before the business of the season begins. We will be giving tours of the Birth Center and answering any questions you may have. The public is welcome to share in the festivities! Page 3
You Have A Choice!
Explore Your Maternity Care Options By Paula Bernini Feigal, CPM Around the world, midwives are recognized for their very special place in the lives and health care of women, families and communities. In 1992 I answered my calling and joined this profession. This is an organization of (mostly) women health care providers who are devoted to women's reproductive health care, increasing education of and access to birth options, midwifery care and the growth of professional midwifery. We still have a long way to go.
You Can Choose Your Birth Location Most women are vaguely aware that they have options about where to have a baby, but very few women thoroughly explore those options. Hospital birth is a relatively recent development in the history of procreation on our planet. Your grandmother was probably not born in a hospital. About 70 years ago, midwifery care became hard to find, and doctors wanted a centralized location to work in, so women started going to hospitals. In the past 30 years, midwifery has once again become a more readily accessible option for women, and so have a woman’s choices of what setting to birth in. If you want to make an educated decision on what kind of birth location in right for you, you need to visit your local hospital, Birth Center and home birth midwife and ask the right questions! There are organizations that are dedicated to helping you make informed decisions about maternity care. One is the Coalition for Improving Maternity Services (CIMS). Print a copy of CIMS “10 Questions to Ask” brochure by visiting http://www.motherfriendly.org/resources/10Q/
Midwives care about good outcomes for mother and baby, both physically and emotionally. We approach pregnancy as a normal, healthy time in a woman's life. We believe, really believe, that birth, Hospitals have OB/maternity units (sometimes mistakenly called for a healthy woman, is a time of physical, emotional and spiritual birthing centers), where women deliver. A separate nursery is availexpansion and growth. We honor her and the process with dignity, able for efficient monitoring, exams and treatment of the baby. patience and respect. We use technology with prudence. We help High-tech equipment and women find advanced care surgical facilities are on the IDEALS vs. REALITIES IN U.S. MATERNITY CARE when a pregnancy becomes ready. Today, most women in not healthy. 2004 U.S. Stats CIMS WHO our country still give birth in (4.1 million births) Suggestions Recommendations a hospital. To accommodate The Cesarean rate in our Birth Midwives 7.9% Midwives for normal Access to professional Attendants mothers who want a more (325,000) midwifery care pregnancy and birth country is over 30%! When Place of Birth natural approach to labor Hospitals 99% Out-of-Hospital you combine this with labors Where mother prefers (4.07 million) preferred and delivery, many hospitals that are started artificially Electronic Fetal No longer reported have added features like and births where a woman is Monitoring Not routine Not routine Last reported 85% labor tubs and “rooming-in”, intentionally paralyzed from Pain Relief Only for 80%* Not routine where baby spends most of the waist down (known as an Drugs in Labor complications its time in the room with epidural or spinal), or when Induction of 21.2% 10% or less 10% or less Labor mother. Doctors and mid(870,000) a vacuum or forceps are used Episiotomies wives work in hospitals. 23.7%** Systematic use not to pull the baby out, we’re Goal of 5% (667,000) justified (Vaginal Births) Pregnant women or babies talking over 80%! This is a 29.1% (1.19 million) 10-15% 10-15% Cesarean Rate who are sick are best cared staggering example of the WHO-UNICEF Breastfeeding for in a hospital. misuse of our health care 67%*** Immediately BFHI Guidelines technology and resources in After Birth WHO Recommendations - taken from a report Vol. 55, No. 1, September 29, 2006 A Birth Center is a freeour country. Are you suron the Appropriate Technology for Birth, http://www.cdc.gov/nchs/data/nvsr/nvsr55/ standing facility specifically prised to know that as interpublished by the World Health Organization nvsr55_01.pdf. designated for the care of No longer reported In revising birth certificate reportin April, 1985. vention rates increase, the ing, NCHS no longer collects this information. Last CIMS Suggestions - taken from The Motherpregnant and birthing rates of complications are reported rate (2003) is included here Friendly Childbirth Initiative from the * Listening to Mothers Report, October 2002, p. 18 women. Institutional care increasing too? Sadly, our Coalition for Improving Maternity Services ** “National Hospital Discharge Survey 2004: Advance might not be what you need (CIMS), 1996, www.motherfriendly.org. Data,” Vital Health Statistics, No. 371, May 5, 2006. country’s neonatal mortality BFHI = Baby-Friendly Hospital Initiative. *** Mothering Magazine, No. 112, May/June 2002 or want, and the Birth rate is on the rise. Maternal 2004 US Stats - most taken from Births: Final www.cfmidwifery.org 888-236-4880 Center offers a safe, comfortmortality is increasing tooData for 2004, National Vital Statistics Report able, home-like alternative to Copyright 2006 BirthNet. 215 Partridge St, Albany, NY 12203 Permission granted to freely reproduce in whole with attribution. the first time since 1977. It’s hospital care. Babies and no wonder women are afraid mothers are given continual care by the same birth team and are of birth! kept together during their stay. Birth Center care is only available to healthy, low-risk women, which can be determined with your Midwifery is the oldest healthcare ‘specialization’. Midwives still midwife. A Birth Center is equipped with emergency equipment today give care on every continent, in every country, nation and terand medication, but there are no surgical facilities. It is a place ritory on the globe! The countries that have the best outcomes have for the practice of midwifery, although some doctors work in midwives at the forefront of women’s health and maternity care. Birth Centers too. To find a Birth Center in your area, visit the Midwife care in the USA is vastly under-utilized. In our country, American Association of Birth Centers at www.birthcenters.org. the number of births attended by midwives is still under 10%. or simply check the phone book’s Yellow Pages! These numbers are slowly increasing as more and more women seek Home birth with a qualified attendant is a safe option for a gentler, more woman-centered approach to pregnancy and birth healthy, well-screened women. A midwife with the CPM credencare. Do you know what choices are available to you? Page 4
The Morning Star Newsletter - Volume 3, Issue 14
became more available (and less taboo for women) we began studytial has had specific training for at-home deliveries. Nurse-miding the sciences of anatomy and physiology. Today, there are two wives and (a few) doctors also attend home births. Usually, a types of credentialed midwife; the Certified Professional Midwife woman receives prenatal care at her midwife’s (or doctor’s) office (CPM) and the or clinic, and has © Certified Nurse made arrangements Midwife (CNM). The for a planned home The Midwives Model of Care is based on the fact that CPM is a midwife who birth. In a birth at offers complete prenahome, the mother pregnancy and birth are normal life processes. tal, birth and postparhand-selects her birth The Midwives Model of Care includes: tum care including lab team and birth care is • Monitoring the physical, psychological, and social well-being of the tests and other screengiven in the privacy ings. She is nationally and comfort of her mother throughout the childbearing cycle certified and trained to own home. Like in a • Providing the mother with individualized education, counseling, and identify risk factors and Birth Center, prenatal care, continuous hands-on assistance during labor and handle complications portable emergency that may arise. She colequipment and meddelivery, and postpartum support laborates with other ication is on site. If a • Minimizing technological interventions health care providers complication arises and refers women who during the birth, the • Identifying and referring women who require obstetrical attention become high-risk. The midwife and family have a medical backThe application of this woman-centered model of care has been proven CPMs specialty is vagiup plan established to reduce the incidence of birth injury, trauma, and cesarean section. nal birth with the lowest degree of intervention for transport to the Midwives Modelof Care- Copyright (c) 1996-2007, Midwifery Task Force, Inc., All Rights Reserved. Used with permission. possible. CPMs have the hospital. It is important to check the qualifications of your midwife when you plan to lowest C-section rates of all maternity care providers (2-5% nationwide). She has special training in out-of-hospital birth. Another type birth at home, as not all birth attendants have the same training, of midwife, the CNM has an expanded scope of practice in that she skills and experience. has the ability to write prescriptions for medications that may be There Are Different Types of Health Care Providers for Pregnant necessary during pregnancy, birth and postpartum. She has a degree and Birthing Women in nursing and additional training in midwifery. Many CNMs work in a group practice, meaning they rotate on-call days where they Many women automatically assume that when you find out you’re attend deliveries. CNM care in the hospital is often more personalpregnant; you need to find an Obstetrician/Gynecologist ized than physician care. CNMs can be employed by large medical (OB/GYN) to get your necessary lab tests and prenatal care started. practices or be in private practice. They work primarily in hospitals This is not so! An OB/GYN is a surgeon and a disease specialist for and Birth Centers, and an increasing number are offering home women who are sick or high-risk and need high-tech, interventive birth services. care. They anticipate problems during the course of pregnancy and birth. Their specialties are diseases and disorders of the female The Natural Place to Start for Women's Reproductive Health Care reproductive organs and surgery. Look for a midwife who is committed to the Midwives’ Model of Family Practice physicians are medical doctors who provide Care. They work in all settings. Education plays a central role in this whole-life care to all members of the family. Family physicians have model of care and women are expected to make educated and attended most of the deliveries in our country in the past 70 years. informed decisions about their health care. The services your midTo find a Family Practice Physician who delivers babies in your area, wife offers will depend on her scope of practice. A woman can begin call the hospital OB unit and ask for the names of family doctors using a midwife for her first gynecologic appointment and Pap test. with delivery privileges. If your pregnancy became very high-risk, A midwife may offer family planning and birth control, STD screenyour family doctor would likely refer you to an OB/GYN. ing and other lab tests. She gives pregnancy care from start to finish and can offer menopause education, resources and therapies. Midwives have been around for a long, long time. Before credentials were established, midwives learned the art and science of birth For more information visit the following websites: care through traditional methods of study. First, by watching, listenCitizens for Midwifery- www.cfmidwifery.org ing and practicing as an apprentice midwife, then, as scholarly texts Coalition for Improving Maternity Services- www.motherfriendly.org
The Midwives Model of Care
When we ponder the nature of being human ~ as spirit embodied in matter When we honor the strength and knowing of every mother-baby And protect their tenderness & vulnerability Then, we birth a better future and a happier, healthier & more peaceful world ~Suzanne Arms
The Morning Star Newsletter - Volume 3, Issue 14
Quote of the Quarter
News of Interest Drugs Often Used in Birth Not FDA Approved Listed here are several commonly used drugs used in U.S. hospitals today. Many have not been approved by the FDA and have not undergone any or adequate testing to be used on laboring or lactating women or their neonates. It is wise not to be too cavalier about the common practice of “off-label” use. Administering some of these drugs is actually “anti-label”. Fully informed consent should be obtained in writing. “Off label” use of many obstetrical drugs is common, but that doesn’t always make it OK or wise. It wouldn’t hurt for doctors or nurses to grab a PDR and read up on the drugs they are administering to mothers and babies. They might be more inclined to press for policy change and urge informed consent in writing. Midwives, childbirth educators and doulas can help close this information gap by having this information readily available to their clients just in case informed consent is not practiced in their birthing facility. This is part of being ethical and Mother-Friendly. First, Do No Harm Some of the Commonly Used Obstetric Drugs (Many are not approved by the FDA) : Terbutaline BRETHINE (terbutaline sulfate) Mnfr: Novartis Pharmaceuticals Not FDA approved for pregnancy, labor, delivery or lactation. Commonly used “off-label” although no adequate studies have been done to prove efficacy. Terbutaline sulfate has not been approved by the FDA and should not be used for tocolysis (to stop or slow contractions) and warns “Serious adverse reactions may occur after administration of terbutaline sulfate to women in labor”. “Increased fetal heart rate and neonatal hypoglycemia may occur as a result of maternal administration.” For more information from the manufacturer call or write: Novartis Consumer Health, Inc. 560 Morris Avenue, Summit, NJ 07901 Direct inquiries to: (800) 635-2801 Toradol TORADOL (ketorolac tromethamine) Mnfr: Roche Pharmaceuticals Not FDA approved for pregnancy, labor, delivery or lactation. The use of toradol is contraindicated in labor and delivery because through its prostaglandin synthesis inhibitory effect, it may adversely affect fetal circulation and inhibit uterine contractions, thus increasing the risk of uterine hemorrhage. For more information from the manufacturer call or write: Roche Pharmaceuticals 340 Kingsland Street, Nutley, NJ 07110 Direct inquiries to: (800) 526-6367 Cytotec CYTOTEC (misoprostol), Mnfr: G.D. Searle & Co. Not FDA approved for pregnancy, labor, delivery or lactation. Another popular drug where “off-label” experimentation is done to women despite clear warnings to providers about the potentially fatal risks. The Company warns that Cytotec should not be used by pregnant women. In 2000 the FDA and the manufacturer of Cytotec have Page 6
issued warnings to health care providers that Cytotec is not approved by the FDA for the induction of labor and delivery or abortion. Under the heading of Labor and Delivery the package insert of Cytotec (misoprostol) warns: “Cytotec is not approved for the induction of labor and delivery or abortion. Cytotec is a synthetic analog of prostaglandin E1, and as such can induce or augment uterine contractions. Cytotec has been used outside of its (FDA) approved indication, as a cervical ripening agent for the induction of labor or abortion, in spite of specific contraindications to its use during pregnancy.” Serious adverse events reported following off-label use of Cytotec for cervical ripening and/or induction of labor include maternal and fetal death; uterine hyperstimulation, perforation, or rupture requiring uterine surgical repair, hysterectomy or salpingo-oophorectomy (excision of a uterine tube and ovary); amniotic fluid embolism; severe vaginal bleeding; retained placenta; shock; fetal bradycardia; and pelvic pain. There is an increased risk of uterine rupture when Cytotec is used in patients who have had prior Cesarean delivery or major uterine surgery. For more information from the manufacturer call or write: G.D. Searle & Co. Chicago, Illinois 60680-5110 Direct inquiries to: (800) 323-1603 Fentanyl ACTIQ (fentanyl citrate), Mnfr: Anesta Corp Not FDA approved for pregnancy, labor, delivery or lactation. Actiq is approved by the FDA only for the treatment of persistent cancer pain. See package insert for Black Box warning. For more information from the manufacturer call or write: Anesta Corp. 4745 Wiley Post Way, Salt Lake City, UT 84116 Dilaudid DILAUDID (hydromorphone HCl), Mnfr: Abbott Laboratories Not FDA approved for use in pregnancy, labor, delivery, or lactation. Hydromorphone, a hydrogenated ketone of morphine, is a narcotic analgesic. It is believed to relate to the existence of opiate receptors in the central nervous system. Like morphine, adequate doses will relieve even the most severe pain. Nausea and vomiting occur infrequently. Dilaudid affects brain centers that control respiratory rhythm, and may produce irregular and periodic breathing. Limitations are imposed by the adverse effects of the drug resulting from high doses. Dilaudid is contraindicated in the presence of an intracranial lesion associated with increase intracranial pressure and when ever ventilatory function is depressed. For more information from the manufacturer call or write: Abbott laboratories, Pharmaceutical Products Division N. Chicago, IL 60064 Direct inquiries to: (800) 633-9110 Nubain NUBAIN (nalbuphine hydrochloride), Mnfr. Endo Pharmaceuticals FDA approved for labor and delivery. When used in labor and delivery, fetal bradycardia (with permanent neurological damage), respiratory distress at birth, apnea, (continued on next page) The Morning Star Newsletter - Volume 3, Issue 14
Smoking in Pregnancy Unborn babies who are exposed to cigarette smoking by their mothers may have damage to developing organs or adverse effects on the immune system. Whatever the effect, babies, both born and unborn, may be predisposed to a variety of diseases. In a 2001 retrospective study of 25,102 singleton children of pregnant women in Denmark -of whom 30% smoked- scheduled to deliver between September 1989 to August 1996, exposure to cigarette smoke was associated with a higher risk of death both in utero and within the first year of birth. After adjusting for other factors, including alcohol and caffeine intake, they found these results the same: an increased risk of stillbirth and rate of infant mortality twice that of nonsmokers. Of note was the fact that women who stopped smoking during the first trimester had stillbirth and infant mortality rates comparable to those of women who did not smoke during pregnancy. The authors reported that approximately 25% of all stillbirths and 20% of all infant deaths in a population with 30% pregnant smokers could be avoided if all pregnant smokers stopped smoking by the sixteenth week of gestation. - Am Journal Epidemiol 154(4): 322-27, 2001
hood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis. For maternal outcomes, a history of lactation was associated with a reduced risk of type 2 diabetes, breast, and ovarian cancer. Early cessation of breastfeeding or not breastfeeding was associated with an increased risk of maternal postpartum depression.
Somebodyâ€™s listening A news article forwarded by Susan Hodges (Citizens for Midwifery) reports that women in New South Wales (NSW), Australia, will no longer be able to demand cesareans for non-medical reasons. Under new policy, they are informed about benefits and risks of cesareans versus vaginal deliveries, including the adverse outcomes associated with subsequent pregnancies. This changed policy came about in part as a result of a US study that showed that babies born by cesareans-on-demand were almost three times as likely to die as those born vaginally. Now if only US hospitals will follow their lead.
Two new reviews regarding the health benefits of breastfeeding have recently been published. To establish the impact of long term breastfeeding, the World Health Organisation commissioned a review of the evidence available in the form of a series of systematic reviews. The available evidence suggests that breastfeeding may have long-term benefits. Subjects who were breastfed experienced lower mean blood pressure and total cholesterol, as well as higher performance in intelligence tests. Furthermore, the prevalence of overweight/obesity and type-2 diabetes was lower among breastfed subjects. A review from the USA investigated the effects of breastfeeding in developed countries. This is a particularly important piece of work as it reviews only those studies carried out in the developed world and therefore adds weight to the arguments that breastfeeding is vitally important for healthy outcomes outside of the developing world. The reviewers concluded that a history of breastfeeding was associated with a reduction in the risk of acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, child-
Our understanding of birth physiology is based on the simple fact that adrenaline (the emergency hormone mammals release when they are scared, when they are cold or when they feel observed) and oxytocin are antagonistic. In other words, when human beings release adrenaline, they cannot release oxytocin. This indicates the main role of the midwife: to protect the laboring woman against any situation associated with a rising level of adrenaline. This is an art because it involves the personality, the way of being, the background, the experience and the intuition of the birth attendant. Since adrenaline release is highly contagious, one of the main preoccupations of the birth attendant is maintaining her own level of adrenaline as low as possible. Midwives often use tricks to keep their stress levels low. One of these is to engage in a repetitive task, such as knitting. Avoiding useless stimulation of the maternal neocortex, which is the source of powerful inhibitions, is a real art. Remaining silent when verbal language is not absolutely necessary is an art. Escaping notice while, at the same time, being able to detect whether something is wrong is an art. Adapting to every particular case and to every particular situation is also an art. - Michel Odent, MD excerpted from â€œCan the Art of Midwifery Survive Protocols?â€? Midwifery Today Issue 73
(continued from previous page) cyanosis, hypotonia have been observed. Data suggests that Nubain is excreted in maternal milk. Caution should be exercised when Nubian is administered to a nursing woman. Stadol STADOL (butorphanol tartrate), Mnfr. Bristol-Myers Squibb Company FDA approved for labor and delivery. Stadol is an analgesic, forty times more potent that Demerol. The analgesia provided by 2 mg of Stadol NS is equivalent to 10 mg of morphine, 40 mg pentazocine and 80 mg meperidine. When administered to the woman during labor the drug crosses the placenta and enters the blood, brain and other fetal organs within minutes. The central nervous system effects include depression of spontaneous respiratory activity and cough reflex, stimulation of the emetic center affecting nausea, and sedation. Other effects of Stadol include alterations in cardiovascular and lung function, and alterations in gastrointestinal, motor, and bladder sphincter activity. Stadol, like other mixed agonist-
antagonists with a high affinity for the K-receptor, may produce unpleasant psychotic-like effects. Two mg of butorphanol IV and 10 mg of morphine sulfate IV depress respiration to a comparable degree. The label points out that 2 mg of butorphanol IV and 10 mg of morphine sulfate IV depressed respiration to the same degree in individuals without significant respiratory dysfunction. The duration of action of Stadol injection was 3-4 hours. The manufacturer advises the user that neurobehavioral testing of infants exposed to Stadol injection during labor showed no significant differences from infants in other drug treatment groups 18.6 hours after birth. The label does not mention the type of test used to evaluate the neurologic state of the infants. No information given as to how the infants in the Stadol group compared with infants that were not exposed to an epidural block. For more information from the manufacturer call or write: Bristol-Myers Squibb Company 345 Park Avenue, New York, New York 10154 Direct Inquiries to: (800) 468-7746
New evidence of the health benefits of breastfeeding
The Morning Star Newsletter - Volume 3, Issue 14
Special Article Pelvic Pain By Kristin Afdahl Pelvic pain: something that just comes with pregnancy. This is what I was told with my first baby. It’s normal, and it’ll go away after the baby is born. Well, it didn’t and I’d like to share my story with you so you don't have to deal with the pain for years like I did. My first birth was a traditional hospital birth, no drugs, but laying on my back and my baby was pulled out with a vacuum suction. After the birth I thought it normal to feel pain while walking, putting on my clothes or even just simple things like getting my legs into bed. At my 6 week post-partum checkup my doctor sent me home with Ibuprofen and told me to come back in a few weeks if things weren’t better. I went in at 10 weeks because I was still feeling extreme pain in my pelvis. It even hurt to touch. He said this was normal, to continue taking the ibuprofen. Well, this answer wasn’t good enough for me so I started doing some research on the internet and found my problem. The pain disappeared 2 months before conceiving again. I thought I was in the clear until about my 7th month of pregnancy when my one hip started to really hurt or get “locked” out of place. In my 9th month of pregnancy pain got significantly worse and moved into my pelvis. With my knowledge of this problem and help from Paula and Dr. Emily Smith, I can say I’m pain free today. It’s called Symphysis Pubis Dysfunction (SPD). The two halves of your pelvis are connected at the front by a stiff joint called the symphysis pubis. This joint is strengthened by a dense network of ligaments which means that under normal conditions, very little movement occurs. In order to make your baby's passage through your pelvis as easy as possible, your body produces a hormone called relaxin, which softens the ligaments in your pelvis. As a result, these joints move more during and just after pregnancy. They do not know exactly what causes SPD, but current thinking indicates that if one side of the pelvis moves more than the other when you walk or move your legs it can lead to pain and inflammation at the symphysis pubis.
Recipe Italian Pumpkin Strata Dense and creamy this vegetable-filled strata employs bread, cheese, milk, pumpkin and eggs to create a moist and delicious casserole you can cut into squares or wedges and serve with a platter of fresh fruit for a smashing brunch! 1 tablespoon vegetable oil 1 pound sweet Italian sausage, casing removed 1 small onion, chopped 1 /2 cup chopped green bell pepper 1 /2 cup chopped red bell pepper 2 cloves garlic, minced 1 pound loaf Italian or French bread, cut into 11/2 -inch cubes 2 cups (8-ounces) shredded mozzarella cheese 2 (12-ounce) cans Evaporated Milk 1 (15-ounce) can Pumpkin 4 large eggs 1 /2 teaspoon crushed, dried oregano Page 8
When does it happen? SPD can occur towards the end of the first trimester or after delivery. Many women notice their symptoms for the first time around the middle of their pregnancy. If you experience SPD in one pregnancy, it’s more likely that it will reoccur in your next pregnancy. The symptoms may also come on earlier and progress faster. What are the symptoms? Pain in the pubic area and groin are the most common. You may also suffer from back pain, pelvic girdle pain or hip pain. It’s common to feel a grinding or clicking in your pubic area and the pain may travel down the inside of the thighs or between your legs. The pain is usually made worse by separating your legs, walking, going up or down stairs or moving around in bed. It is often much worse at night and can stop you from getting much sleep. Getting up to go to the bathroom in the middle of the night can be especially painful. How it is treated and self help tips: I feel the first step to treatment is to self-diagnose and realize what the problem is, then check with someone who knows about this problem. Paula recommended some exercises to me to strengthen my pelvic muscles and also a pelvic support belt. Hydrotherapy or acupuncture can sometimes be useful. When dressing, sit down when putting your clothing on. Avoid separating your legs and making straddling movements such as when getting in and out of the car or bath. A chiropractor can help if they are knowledgeable of this problem also. Women may experience pain of some degree during pregnancy in their pelvis and it can be very frustrating. Just know that there is help out there and that many other women experience this pain too. Even just talking about it and knowing someone is out there with the same thing helps! It can be treated in some form and know that if treated sooner than later it won’t be a permanent problem. Info from: www.babycentre.co.uk
For those of you looking for glass baby bottles, you know how hard they are to find! You can purchase glass baby bottles at www.newbornfree.com. Thanks to Hannah McClelland for passing on the information! 1
/2 teaspoon crushed, dried basil /2 teaspoon crushed, dried marjoram
Preheat oven to 350°F (175°C). Grease 13 x 9-inch baking pan. Heat oil in large skillet over medium-high heat. Add sausage, onion, bell peppers and garlic. Cook, stirring to break up sausage, for 7 to 10 minutes or until sausage is no longer pink; drain. Combine bread cubes, cheese and sausage mixture in a large bowl. Beat evaporated milk, pumpkin, eggs, salt, pepper, oregano, basil and marjoram in medium bowl. Pour over bread mixture, stirring gently to moisten bread milk mixture. Pour into prepared baking pan. Bake for 30 to 35 minutes or until set. Serve warm. Season with salt and ground black pepper. Makes 12 servings. The Morning Star Newsletter - Volume 3, Issue 14
Book Review Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First by Marsden Wagner, MD As reviewed by Angelo P. Giardino, MD, PhD, MPH Dr. Marsden Wagner’s book, Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First, offers strong criticism of a number of shortfalls in the current maternity care system in the United States. However, the book does more that just hurl condemnation at the professional culture led primarily by obstetricians; it also provides a cogent set of recommendations and a road map of sorts toward a more woman- and child-centered healthcare delivery system. The audience of the book is potentially broad and would include healthcare providers, policy makers, public health officials, and all who would advocate for a more patient- or person-centered healthcare delivery system. The writing is clear, succinct, and easy to grasp. Physicians, however, will find the book a difficult read because of the level of criticism lobbed at their profession. Dr. Wagner decries the medicalization of maternity care; he is sure to offend many with statements, such as “Hospitals are highly symbolic of the medical model of birth -- twenty-first century cathedrals with priests in white robes” (pg 187). Physicians tend to see themselves as well-trained professionals who care for patients through the application of education and technology, and Dr. Wagner’s allusion to them as “priests” of a cult of science runs counter to that view; the comment comes off as a sarcastic criticism of doctors and hospitals in general. However, despite the tendency toward inflammatory comments and phraseology, the book does contain a tremendous amount of information related to the maternity care system in America, as well as international comparisons and solid referencing (as evidenced by 31 pages of endnotes). Dr. Wagner is eminently qualified to write about the maternity care system in the United States. He is a pediatrician and perinatologist, a former full-time faculty member at UCLA, and a former director of Maternal and Child Health for the California State Health Department. For 15 years, he also served as the World Health Organization’s director of Women’s and Children’s Health. Now an independent consultant, he has written many scholarly papers and chapters, as well as authored over a dozen books all drawing upon his extensive clinical and scientific experience in perinatology and perinatal epidemiology. Dr. Wagner is not shy about how he frames the issues surrounding the inadequacies that he sees as existing in the American maternity care system. He specifically states that the purpose of the book is to further an understanding of problems in the system with an eye toward ultimately moving beyond defining the issues and toward suggesting solutions. In the preface, we begin to get a sense of how strong the opinions to come will be as we read. Dr. Wagner writes, “I believe that an important part of the struggle for control of maternity care described in this book is gender-specific -- that there has been a paternalistic takeover of territory that rightly belongs to women and that did belong to women until relatively recently” (pg ix). The Morning Star Newsletter - Volume 3, Issue 14
The arguments are exquisitely framed by the author’s stated support for the underlying principles promulgated by the Coalition for Improving Maternity Services (CMIS). These principles are provided below because they give a snapshot of the author’s own passionate views of wellness and the need to demedicalize and humanize the childbirth process: Normalcy: Treat birth as a natural, healthy process Empowerment: Provide the birthing woman and her family with supportive, sensitive, and respectful care Autonomy: Enable women to make decisions that are based on accurate information and provide access to the full range of options for care First, do no harm: Avoid the routine use of tests, procedures, drugs, and restrictions Responsibility: Give evidence-based care solely for the needs and in the interests of mothers and infants (pgs 11-12, 182). After reading about the “crisis” in maternity care, the subsequent chapters provide discussions of what might be expected in the future, such as efforts to control cesarean section rates and the debate about malpractice litigation. Dr. Wagner’s detailed knowledge of the issues surrounding the off/against labeled use of the medication misoprostol (Cytotec) to induce labor comes into clear focus as well; the largely anecdotal evidence behind the off-label prescribing of misoprostol is described in terms of being the issue that pushed the author over the edge and made him into a medical whistleblower of sorts. The comprehensive information from court cases and scientific investigation into the issues surrounding the use of misoprostol is in and of itself an illuminating study of how medical practices may become established with little to no evidence to support them. Additionally, Dr. Wagner also spends a considerable amount of time discussing the positive influence of midwives on maternity care, especially around the routine childbirth. Owing primarily to his extensive international experience with World Health Organization (WHO), where he saw how midwives have had a profound health and wellness impact on the women that they serve, Dr. Wagner does a thorough job at making their value clear. One gets the idea that his recommendations for fixing the American maternity care system will have midwives playing a significant role -- a departure from the current “paternalistic” system that Wagner decries in the Preface. Finally, prior to offering his solutions, Dr. Wagner takes aim at hospitals as well and criticizes the professional attitude among many in the healthcare industry, which almost seems to criminalize the notion of a home birth, while at the same time almost sanctifying the in-hospital birth process. To his credit, Dr. Wagner, whose scientific training and experience are impeccable, consistently offers up the literature that he is using and the rationale behind his analysis and conclusions. The last 2 chapters are well worth the read because if one gets beyond Wagner's negativity toward the US healthcare system, the presentation of guiding principles, practical changes, and intended (continued on page 10) Page 9
Recent Improvements at Morning Star
Come to our Holiday Open House on December 1st from 6-8 p.m. to see our new birth suites and all of the wonderful enhancements that we have done! Book Review (continued from page 9) outcomes from the reforms that he proposes is masterfully done. The vision presented is one that is rooted in the value of a national health system that would universally provide care to all pregnant women, not just those with some sort of public or private healthcare coverage. Other aspects to the vision include: 1. Promotion of at-home deliveries, especially for low-risk births 2. Increased use of midwives for low-risk births 3. Access to obstetricians for high-risk maternity care with a shared responsibility with midwives for the routine aspects of the care, even for the high-risk maternity patient 4. Increased scrutiny, transparency, and accountability of the healthcare delivery system Page 10
5. Continued education of maternity care providers 6. A focus on public education on maternity care. True to his advocacy purpose, Dr. Wagner then concludes the book with a 10-part action plan that he suggests as a road map for those in the audience who would choose to fight for the CMIS principles articulated above. Regardless of the readerâ€™s agreement or disagreement with Dr. Wagner's assessment and vision, the road map is sound; from an advocacy perspective it would make sense if one were interested to take up the cause for a demedicalized and more humane childbirth process. For those who have reflected on the shortfalls in our nationâ€™s maternity care system, Marsden Wagnerâ€™s Born in the USA certainly offers a challenging perspective by someone who knows a lot about what has and what has not worked. The Morning Star Newsletter - Volume 3, Issue 14
My Birth Story: A Dream Come True by Kristin Afdahl I always felt birth to be a natural occurrence. Something intimately made between you and your partner. And then the birth of the being you made together to be natural and private. My first experience with our son Bo, now almost 3, was not exactly my dream story. Not bad in any means, actually very common in today’s world. Hospital birth, dry birth lying on my back, vacuum extracted baby, tiring hospital stay, postpartum depression, and 2 years of terrible pelvic pain. My experience at the birth center was quite the opposite and exactly what I’ve always wanted and dreamed in my child’s birth and my health. After dealing with my pelvic pain for quite some time through pregnancy and postpartum for 2 years, I’d had enough. The doctor at the hospital couldn’t figure it out, “everything is healed, there should be no pain” he told me. I ended up doing research on my own and found the condition to be called symphysis pubis dysfunction (SPD). It most commonly happens in women who produce too much of the hormone relaxin- the hormone responsible for relaxing your pelvis so it moves for the baby. Symptoms include pain in pelvic or hip area, difficulty walking up stairs, putting your pants or socks on, pain turning in bed, clicking sounds while walking and the feeling that your entire uterus ought to fall right out at any time. I had e-mailed Paula just to see if she had ever heard of this condition, desperate for someone to help me out. I was interested in having another baby and really scared that this condition would worsen. She had heard of it and said she can help, that there are less stressful ways of having a baby to help protect your pelvis i.e., water birth, squatting, letting your baby come on it’s own rather than pulling it out. Two months later I was pregnant and signed up to give birth at the birth center after meeting Paula and knowing that this was the best decision for me and my family. My pregnancy and birth care was perfect [in all stages]. My pelvic pain really started to get bad around month 7. Paula helped me find a pelvic belt, which helped a little but the only real thing to help was to have the baby so the pressure wasn’t on my pelvis anymore and I’d stop producing the hormone relaxin. I couldn’t wait... My first contraction was at 9:30 pm Friday, August 17th. It was a terrible pain that woke me out of sleep. The diarrhea instantly started and I didn’t know if it was because I was so nervous that this might be it or beginning labor. But after timing the contractions and finding them to be 2 min. apart I knew this was the “real thing”. We called Brad’s mom to come and take care of Bo our 3 year old. She arrived at 11 pm and by then the contractions were really painful. I couldn’t The Morning Star Newsletter - Volume 3, Issue 14
walk or talk through them. We arrived at the birth center around 12 am. What a perfect setting, the lights were dimmed and all was calm. Paula said the blue room was ready and the bath was drawn. I felt like it was a bed and breakfast! Paula checked my cervix and I was dilated to a 4. I then got in the tub - talk about heaven!- until another contraction started anyway. But between the contractions I was able to relax with the warm water, the lights in the tub, and my husband right there at the edge of the tub. Things went very fast from there. I then felt the overwhelming need to push. I asked Paula if this could be happening so soon - I had only been there about 30 minutes! She said to listen to my body and if I needed to push to push. Sure enough I was ready. She said to reach down and feel my baby. I felt the bag of water and that broke in my hand. I then felt my baby’s head and with one more push he was out. I reached down and brought him out of the water onto my chest. He was just beautiful and what a perfect experience. (I can say that now that I have forgotten how much it hurt - amazing how that works!) What a great team - Paula with her calm and reassuring voice, Krista with her constant encouragement, and even though Erin was ill (and wearing a mask) at the time, she even helped by fanning me every time I said I was dizzy. They all worked together yet I don’t recall ever actually hearing them talk. They kept the environment very calm for me and did what they had to do in monitoring and caring for me and my baby. I can’t thank them enough for this perfect experience such an intimate experience shared with them all - and most of all with my husband. It felt like it was just us two in the room alone just like I wanted. They will always have a special place in my heart. As for today, 3 weeks postpartum, I feel great. Knowing the pain that SPD can cause weeks or even years after a birth I opted to take charge of my pelvic health this time and am working with chiropractor Dr. Emily Smith who is very knowledgeable with a woman’s body pre- and post-partum. She has helped me so much. I feel so great taking charge of my pelvic health this time around choosing to give birth in the water, squatting, letting my baby come naturally, and choosing to work with a chiropractor immediately after delivery. Another huge difference this time around has been taking Omega 3 Fish Oil which was recommended by Paula at my first meeting with her. I believe it has significantly helped with the baby blues. I’ve only had one day of the blues compared to the 2 weeks with my previous pregnancy.
The emotional and physical care has been beyond my expectations. I’ll never be able to thank the birth team enough for making this a great journey. This is how a pregnancy and birth should be- natural and with the woman in control. After this experience I feel entirely different about being a woman. I know now that we as women have total control of our bodies and that the mind/body connection is very strong and important to know. I feel so empowered to do anything in life now! Thank you to the birth center for everything. Page 11
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Morning Star Birth Center November-December (Winter) 2007 Newsletter. Learn about your maternity care options as well as drugs often used i...