Birth Rhythms: 2007

Monday, December 31, 2007

Definition of Midwife

Definition of Midwife from Midwifery Today

A midwife is a primary health care provider whose services are guided by the individual needs of each mother and baby. Her abilities and knowledge are the health, physiology and effective care of pregnancy, birth and postpartum.

She acts in a humane, receptive and flexible manner. She is willing to update her knowledge continually while maintaining a practice of meticulous care with minimum intervention.

She acquires essential knowledge from other midwives through a variety of educational routes within a formal or traditional process, as well as by assisting with mothers and babies.

A midwife shares information with mothers, families and the community that may include her model of care, alternative health services, rights and responsibilities, wellness, preventive care, bonding, breastfeeding, child rearing and family planning.

A midwife provides care and oversees the health of women and their babies during the childbearing year and assists with birth. She may provide lifelong care to women. The midwife's practice is autonomous: she may offer her services at clinical facilities and in homes.

A midwife can identify health problems, knows techniques for managing emergency situations and has a plan to refer or transport, when necessary.

A midwife is acknowledged as a primary provider of maternal health services by the members of her community or by the country in which she practices.

Tuesday, December 25, 2007

CBC News

The majority of new Canadian mothers are happy with their labour and the birth of their child, suggests new data released Tuesday by Statistics Canada, though midwife deliveries are seen in a more positive light.

http://www.cbc.ca/health/story/2007/11/27/statscan-babies.html

Wednesday, December 19, 2007

Why is there a need for Doulas in Saskatchewan?

As childbirth has moved from home to hospital, a vital element of care has been lost from the whole process. Gone are the days where a woman would have continuous support from one caregiver throughout her labour.

It used to be the case that the womenfolk within the immediate and extended family (mothers/sisters/grandmother etc...) would be on hand to provide the nurturing role for the new mother, to guide by experience and help with the practicalities that need to be performed before, during and after a woman gives birth to a baby.

The concept of the community midwife is only now being developed in Saskatchewan, but due to the immediate lack of resources, (midwives and willing Health Districts) this service will not be readily available to all women for perhaps another decade or more. Doulas fill this gap in services, by supporting women in the birth environment of their choice.

Presently, many women feel that they have no choice but to be in hospital to give birth to their baby where it is much more likely that a birth will be medically managed and intervention methods will be used.

RESEARCH has shown that having a Doula present at a birth ;
Shortens first-time labour by an average of 2 hours
Decreases the chance of caesarean section by 50%
Decreases the need for pain medication
Helps fathers participate with confidence
Increases success in breastfeeding.....

Reference: "Mothering the Mother,"
Klaus, Kennell & Klaus, 1993
A doula believes in “mothering the mother”

.....enabling a woman to have the most satisfying and empowered time that she can during pregnancy, birth and the early days as a new mum. This type of support also helps the whole family to relax and enjoy the experience.

Birth doulas are trained and experienced in childbirth, although they may or may not have given birth themselves. They have a good knowledge and awareness of female physiology BUT the Doula is not supporting the mother in a clinical role - that is the job of the midwife/medical staff.

Postnatal doulas work flexible hours to suit the family, offering practical and emotional support to the new mother and father in the home following the birth of baby. In the West today, too often mothers are rushed back into normal day-to-day activities; in many cultures women are confined to bed and rest for a period of up to 40 days.

This may be impossible in our society but with the help of a postnatal Doula, a mother can enjoy some of the benefits of a prolonged "lying in" period. This will help her bond with her baby and spend extra time with any older siblings. Our work is about empowering a family to take care of itself and we facilitate this by helping around the house and offering encouragement and suggestions.

Tuesday, December 18, 2007

Estimation of Fetal Weight

In the case of macrosomic fetuses, attempts to predict birth weight
from fetal measurements on ultrasonography have been unsuccessful in
improving clinical outcomes. Many researchers have concluded that
ultrasonographic fetal biometric assessments are no more predictive of
fetal macrosomia than clinical assessments of fetal size by means of
simple external abdominal palpation. More...

Thursday, December 06, 2007

New Canadian Book Review!

Pregnancy and Childbirth Secrets; by Gail Dahl

I have been using this book on trial as a text in my prenatal education class. It is a great hit with all of the moms!! Well written with firm reseach to BACK UP RECOMMENDATIONS...CHECK OUT THIS ARTICLE ABOUT IT: Gail Dahl

Tuesday, October 30, 2007

Newborn Care

October 2007 Journal of Family Practice

Newborn Care: 12 beliefs that shape practice (But should they?)
Common beliefs that require a second look

#1. Breast milk is a complete nutritional source for a healthy term newborn

The Evidence: Breast milk is not a complete nutritional source for heatlhy
term newborns. In fact, breast milk provides the ideal source of nutrition,
and it is almost a complete and perfect source of nutrition--with one
important exception. The AAP recommends that all breast-fed newborns
receive 200 IU/day of Vitamin D until they are getting at least 500 mL/day
of vitamin D formula or milk.

The purpose of the supplementation is to prevent vitamin D defiency and
subsequent rickets. The AAP makes no mention in its recommendation of
infant pigmentation or the expected amount of exposure to sunshine. The AAP
recommends that vitamin D supplementation begin by the time they infant is 2
months old.

#2. Supplementing with formula because the mother's milk hasn't come in yet
is a reasonable, routine practice.

The Evidence: Formula supplements are not necessary as routine practice.

Formula supplements are counterproductive, taking away the primary stimulus
for breast milk production---nursing at the breast. Infant dissatisfaction
with the initial volume of breast milk produced actually works to the
infant's advantage, driving the child to the breast more often, and thus
increasing the likelihood of successful breastfeeding. In certain
circumstances, formula supplement can be reasonable, such as when an infant
is hypoglycemic or when the baby is receiving phototherapy and experience
excessive weight loss and becomes severely dehydrated. However, formula
supplementation is not reasonable or necessary as routine practice.

#3. Mothers on magnesium therapy should not breastfeed their infants.

The Evidence: Mothers on magnesium therapy may continue to breastfeed their
babies.

The misguided recommendation that mothers who are being treated with
magnesium therapy should not breastfeed is based on an unreasonable fear
that magnesium therapy can cause hypermagnesemia in breastfed newborns due
to excessive magnesium levels in the breast milk. Supplemental magnesium,
usually given intravenously to mothers with severe preeclampsia, does not
cross over into breast milk in any significant amount, even when the mother
continues to need intravenous magnesium after the birth of her baby.

#4. Mothers who are positive for hepatitis B surface antigen or who are
carriers for hepatitis C should not breastfeed.

The Evidence: Mothers who are hepatitis B surface antigen positive or
carriers for hepatitis C can safely breastfeed their newborns.

The idea that mothers who are infected with hepatitis B or C should not
breasteed their babies at first seems obvious to many who care for newborns,
as the diseases are transmitted through blood exposure, and nipple cracks
with associated blood loss are common in mothers when they begin to
breastfeed. The hepatitis B immunization protocol for infants born to
hepatits B surface antigen positive mothers takes care of the first
infectious concern. In addition, no case of hepatitis C transmission from
breast milk has evern been reported. The Centers for Disease Control and
Prevention confirms that the transmission rate of hepatitis C from infection
mothers is the same whether the babies are breast or bottle fed.

#5. Mothers who are febrile should not breastfeed.

The Evidence: In most cases, febrile mothers may safely breastfeed their
infants.

The advice for mothers not to breastfeed while febrile seems intuitively
true because of concern that the infection might pass over into the breast
milk to the baby. This rarely happens. There are only 4 contraindications
to breastfeeding during maternal fever.
a. Active, untreated maternal tuberculosis
b. Mother who are human T-cell lymphotropic virus type I or II positive
c. Mothers who are HIV-positive
(I think some newer studies have
refuted this--saying that as long as the mother EXCLUSIVELY breastfeeds and
no formula, she can safely breastfeed)

d. Mothers with a herpes simplex lesion on the breast.

#6. Mothers who smoke or drink alcohol should not breastfeed.

The Evidence: While this recommendation seems self-evident, the research
proving harmful effects to the infant is lacking.

In fact, in its most recent statement on "The Transfer of Drugs and Other
Chemicals Into Human Milk," the AAP removed nicotine from a table of drugs
for which adverse effects have been reported on infants during
breastfeeding. While it would be ideal if no breastfeeding mother smoked or
drank alcohol, the fact of the matter is that some do. In light of this,
it's wise to encourage the mother to smoke outside the home, and to change
her clothes before holding her baby. In so doing, she will avoid exposing
her baby to most of the effects of secondhand smoke. In addition, while
mothers who breastfeed their infants should, of course avoid alcohol abuse,
a singel, occasional small alcoholic drink is acceptable.

#7. Pacifiers are bad for newborns.

The Evidence: It is not clear whether pacifiers are "bad" for newborns.

The belief that newborns should not have pacifienrs cam into being for a
well-intended reason; breastfeeding advocates were concerned that newborns
would spend too much time sucking on the pacifier and too little time
sucking at the breast undermining the mother's ability to breastfeed
successfully. Consensus on the matter though is lacking. The UNICEF World
Health Organization Baby-Friendly Initiative, for instance, recommends that
pacifiers not be used. The AAP, however, advises that pacifiers can be used
once breastfeeding is well established. The research is also mixed. On the
one hand, new evidence indicates that pacifier use may decrease the
incidence of sudden infant death syndrome. On the other hand, pacifier use
for longer than 48 months has been linked to orthodontic problems and dental
caries. Thus, while prolonged pacifier use may be harmful to dental
hygiene, newer evidence allows that pacifiers may be acceptable in the first
few years during breastfeeding.

#8. Newborn emesis is an indication for a formula change.

The Evidence: No literature supports the belief that is is appropriate to
change an infant's formula in response to emesis in the first 2 weeks of
life.

The overwhelming majority of vomiting episodes in newborns have no
accompanying medical problems. A 2002 study by Miyazawa et al that looked
at more than 900 infants showed more than 47% of Japanese infants < style="color: rgb(255, 204, 51);" style="color: rgb(255, 204, 51);">(So your chances of infection are higher if your babe is born in hospital) Umbilical cord infections sometimes occur even when the cord area is kep clean and dry, so healthcare
providers must be attentive to signs of possible infection.

#10. It's easy to spot when a newborn is jaundiced.

The Evidence: Jaundice is actually difficult to detect in darkly pigmented
babies and in babies sent home within 24 hours of birth, because bilirubin
levels reach maximum levels between the third and fourth days of life.

Years ago, when infants stayed longer in the nursery, doctors had the chance
to see them when their bilirubin level was highest and when the babies were
most jaundiced. The current emphasis on early discharge does not allow this
practice. The AAP recommends clinical assessment of a newborn's state of
jauncie and that a bilirubin level be obtained whenver a physicain is in
doubt about the degree of clinical jaundice. The AAP also recommends that
physicans consider obtaining a routine screening bilirubin in all newborns
at the time of hospital discharge even if by clinicl assessment, the child
is not jaundiced. The AAP made these recommendations because of an
increasing concern that the incidence of in American is rising.

(Too much use perhapsor Vit K supplement, cutting the cord too early,
not enough time and frequency on the breast?

TABLE 1
Risk Factors for Hyperbilirubinemia in Newborns

Maternal factors
Blood type ABO or Rh incompatibility
Breastfeeding
Drugs: diazepam (Valium), oxytocin ()
Ethnicity: Asian, Native American
Maternal illness: gestational diabetes

http://www.aafp.org/afp/20020215/599.html

#11. All infants who require phototherapy need IV fluids to prevent
dehydration and enhance excretiono f bilirubin.

The Evidence: Unless the baby is clinically dehydrated, IV fluid therapy
for infants under phototherapy is not needed.

Though IV fluid therapy is commonly used to increase the excretion of
bilirubin and combat dehydration, the research tells us that IV fluids do
not bring down bilirubin levels and that even with mild dehydration, the
best fluid therapy is breast milk or formula because it inhibits the
enterohepatic circulation of bilirubin. Intravenous fluid therapy should be
reserved for jaundiced newborns with moderat to severe dehydration or those
with milk dehydration who are not able to take fluid by mouth.

#12. Breast-milk jaundice is best treated by stopping breastfeeding for
24-48 hours.

The Evidence: Breastfeeding should not be discontinued as a way to treat
breast-milk jaundice.

In fact, breastfeeding should not be discontinued for jaundice due to any
cause, as demonstrated in the opening scenario, unless you believe a bab is
at risk of requiring an exchange transfusion. The need for phototherapy
alone is not sufficient reason to discontinue breastfeeding. Breast-milk
jaundice is a common problem facing parents and physicans, but it is not a
disease and does not represent an abnormality in and of itself. Rather this
normal physiologic condition gains its importance only in that it must be
distinguished from pathological causes of newborn jaundice. Breastmilk
jaundice is believed to affect 1% to 33% of breastfed infants. One
treatment measure--to stop breastfeeding--began, in part, as a
cost-effective way to diagnose breast-milk jaundice. Rechecking the
bilirubin 24 to 48 hours after breastfeeding is discontinued would reveal a
significant drop in the bilirubin level, confirming the diagnosis of
breast-milk jaundice and obviating the need for testing for more serious
medical illness. The consequence of this misguided treatment approach,
idscontinuing breastfeeding, is that some mothers are more likely to stop
breastfeeding altogether.

What do you think?

Thursday, September 27, 2007

Vitamin D !!!!

"Take more vitamin D mothers told," Pediatricians recommend tenfold increase for pregnant and breastfeeding women.
Globe and Mail Headlines

Monday, August 27, 2007

T, Sam & the Twins (Freddies)

T, Sam & the Twins (Freddies)

Last month I met with a great couple who are expecting twins. They have set up a blog to chronicle the journey complete with photos of her gorgeous growing belly. I am very excited to share this journey with them as their Doula. Please check out the blog for updates!

believing in birth,
Lisa

Tuesday, August 07, 2007

Waterbirth of Rebekkah

On the morning of August 4 , 2007 I had the privilege of being present for the birth of a child.
Rebekkah was born into the loving arms of her parents, in her own home, in a warm pool of water. The midwives and I had sat vigil with this birthing couple for 24 hours. The mother's pace of labour was leisurely, but rhythmic and effective. She focused on her body's natural rhythms and accepted that this child would come on its own terms. I have supported many labours at home in my work as a doula, but only a couple that were planned home births. This was a very inspiring event. As a doula, I usually accompany couples into the hospital once the mother's labour is firmly established at home. The intimacy and security of the family's home environment is left behind as we enter the medical management model of birth at the hospital. Once there my energies are split between supporting the mother's physical and emotional needs and helping to navigate the medical model while still maintaining a sense of control and intimacy in a new and strange environment. My experience with this birth was very different. I was in the company of two of Saskatchewan's three midwives. Their presence set a different tone for the birth from the onset. These are truly beautiful and amazing women. Their complete TRUST in birth, quiet encouragement and hands off approach to a mother's care during labour were a breathe of fresh air. While the labouring mom and her husband spent time together and I supported them both verbally and physically when neccesary, these women kept watch. I think I will call them Birth Guardians. Their presence was barely known; floating in and out of the mother's space only when needed. Some women need alot of physical support in the way of massage during labour, others really just want to be left alone. This mom was most comforted in the arms of her husband, who held her tightly during contractions and was often heard exchanging whispers of love and adoration with her when she rested. The rest of us were there to support them and this process of birth that proceeded so perfectly. There were points during this home birth when I actually thought to myself, "This is so relaxing." They were so obviously in love and absorbed in the work of bringing this child into the world together. There were no interruptions, or interventions to distract them. They had the freedom to roam about, often going outside for walks, eating light snacks and bathing often. When the contractions would slow down, she took her body's cue to rest and would sleep for short periods of time. Upon waking she would comment on how good she felt and they would begin the 'dance' agian. This alone was wondeful to witness. Women are taught not to trust our bodies in so many ways. In the hospital this mom would have been told she was not progressing and interventions would have been initiated to force the labour into an "acceptable" pace. There is a focus on product instead of process in the medical world. The midwives kept careful records of her health throughout and of the baby's heart rate, but did not interfere with the way her body laboured. They made suggestions regarding positioning and nutrition as needed, and encouraged the mom the everything was proceeding well. You see, the range of normal becomes much wider when medical mangement parameters are lifted from labour. This woman was able to honour the process of birth and in doing so honoured herself. Her child was born so peacefully. I am not saying that one must have a home birth to have a satisfactory experience, but I will admit that the level of freedom and support for the couple while in the hands of well trained and capable midwives far exceeded any hospital experience that I have witnessed to date. I look forward to working with the midwives again and I am so excited for this new little family who have entered into relationship together in such a beautiful way. Believing in Birth, Lisa

Quote of the month

“Unfortunately, the role of obstetrics has never been to help women give birth. There is a big difference between the medical discipline we call “obstetrics” and something completely different, the art of midwifery. If we want to find safe alternatives to obstetrics, we must rediscover midwifery. To rediscover midwifery is the same as giving back childbirth to women. And imagine the future if surgical teams were at the service of the midwives and the women instead of controlling them.”

-Michael Odent, MD

Monday, August 06, 2007

Midwifery Options in Saskatchewan

Midwifery Care is available here right now!

Our current government is working towards providing funded midwifery care in our province in the next year for some health regions.

For more information regarding available midwifery services in Saskatchewan visit the Midwives Association website at: www.saskmidwives.ca

Sunday, August 05, 2007

Questions about Prenatal Ultrasound...

Contents of Article:
Autism overview
Problems with sound and heat
Elevated MAternal Temperatures cause birth defects
Autism, Genetics and Twin studies
Ultrasound Warnings Unheeded
Hottubs, Steam rooms and Maternal Fevers
Global Autism Epidemic
The Changes in Ultrasound
Increasingly Common Birth Defects
References and research suggestions

Questions about Prenatal Ultrasound and the Alarming Increase in Autism
by Caroline Rodgers© 2006 Midwifery Today, Inc. All rights reserved.
Editor's note: This article first appeared in Midwifery Today Issue 80, Winter 2006.
In May 2006, figures from the Centers for Disease Control (CDC) confirmed what too many parents and educators already knew: The incidence of autism is high, making it an "urgent public health issue," according to Dr. JoseCordero, director of the CDC's National Center on Birth Defects and Developmental Disabilities.
Only 12 years ago autism spectrum disorder (ASD)was so rare that it occurred in just one in 10,000 births.(1) Today ASD,which is characterized by a range of learning and social impairments, nowoccurs in one in 166 children (2)—with no sign of leveling off.
The steep increase in autism goes beyond the US: It is a global phenomenon,occurring in industrialized nations around the world. In the UK, teachers report one in 86 primary school children has special needs related toASD.(3)
The cause of autism has been pinned on everything from "emotionally remote"mothers (since discredited) to vaccines, genetics, immunological disorders,environmental toxins and maternal infections. Today most researcherstheorize that autism is caused by a complex interplay of genetics andenvironmental triggers. A far simpler possibility worthy of investigation isthe pervasive use of prenatal ultrasound, which can cause potentiallydangerous thermal effects.
Health practitioners involved in prenatal care have reason to be concerned about the use of ultrasound. Although proponents point out that ultrasound has been used in obstetrics for 50 years and early studies indicated it was safe for both mother and child, enough research has implicated it in neuron-developmental disorders to warrant serious attention.
At a 1982 World Health Organization (WHO) meeting sponsored by theInternational Radiation Protection Association (IRPA) and other organizations, an international group of experts reported that "[t]here are several frequently quoted studies that claim to show that exposure to ultrasound in-utero does not cause any significant abnormalities in the offspring. …However, these studies can be criticized on several grounds,including the lack of a control population and/or inadequate sample size,and exposure after the period of major or ganogenesis; this invalidates theirconclusions…."(4)
Early studies showed that subtle effects of neurological damage linked to ultrasound were implicated by an increased incidence in left-handedness in boys (a marker for brain problems when not hereditary) and speech delays.(5) Then in August 2006, Pasko Rakic, chair of Yale School of Medicine'sDepartment of Neurobiology, announced the results of a study in which pregnant mice underwent various durations of ultrasound.(6) The brains of the offspring showed damage consistent with that found in the brains of people with autism.
The research, funded by the National Institute of Neurological Disorders and Stroke, also implicated ultrasound in neurodevelopmental problems in children, such as dyslexia, epilepsy, mentalretardation and schizophrenia, and showed that damage to brain cells increased with longer exposures.(7)Dr. Rakic's study, which expanded on prior research with similar results in2004 (8), is just one of many animal experiments and human studies conductedover the years indicating that prenatal ultrasound can be harmful to babies. While some questions remain unanswered, based on available information, health practitioners must seriously consider the possible consequences of both routine and diagnostic use of ultrasound, as well as electronic fetalheart monitors, which may be neither non-invasive nor safe. If pregnant women knew all the facts, would they choose to expose their unborn children to a technology that—despite its increasingly entrenched position in modernobstetrics—has little or no proven benefit?
Problems with Sound and Heat
One challenge that ultrasound operators face is keeping the transducer positioned over the part of the fetus the operator is trying to visualize.When fetuses move away from the stream of high-frequency sound waves, they may be feeling vibrations, heat or both. As the FDA warned in 2004,"ultrasound is a form of energy, and even at low levels, laboratory studies have shown it can produce physical effect in tissue, such as jarring vibrations and a rise in temperature."(9)
This is consistent with research conducted in 2001 in which an ultrasound transducer aimed directly at a miniature hydrophone placed in a woman's uterus recorded sound "as loud as asubway train coming into the station."(10)
A rise in temperature of fetal tissue—especially since the expectant mothercannot even feel it—might not seem alarming, but temperature increases can cause significant damage to a developing fetus's central nervous system,according to research.(11) Across mammalian species, elevated maternal or fetal body temperatures have been shown to result in birth defects inoffspring.(12)
An extensive review of literature on maternal hyperthermia in a range of mammals found that "central nervous system (CNS) defects appearto be the most common consequence of hyperthermia in all species, and cell death or delay in proliferation of neuroblasts [embryonic cells that developinto nerve cells] is believed to be one major explanation for these effects."(13)
Why should neurodevelopmental defects in rats or other mammals be of concern to expecting women? Because, as Cornell University researchers proved in2001, brain development proceeds in the same manner "across many mammalian species, including human infants."(14)
The team found "95 neural developmental milestones" that helped them pinpoint the sequence of brain growth events in different species.(15) Therefore, if repeated experiments show that elevated heat caused by ultrasound damages fetal brains in rats and other mammals, one can logically assume that it can harm human brains,too.
In fact, the FDA and professional medical associations know that prenatal ultrasound can be dangerous to humans, which is why they have consistently warned against the non-medical or "keepsake" ultrasound portrait studios that have cropped up in malls throughout the country.(16)
The risks to the baby are potentially higher in commercial enterprises due to the higher acoustic output required for high-definition images, a potentially long session—as technicians hunt for suitable images—and the employment of ultrasound operators who may have no medical background or appropriate training. These variables, along with factors such as cavitation(a bubbling effect caused by ultrasound that can damage cells) and on-screen safety indicators that may be inaccurate by a factor ranging from 2–6 (17),make the impact of ultrasound uncertain even in expert hands.
Quite simply,if ultrasound can injure babies, it can cause the same damage whether done for routine, diagnostic or "entertainment" purposes.
Elevated Maternal Temperatures Cause Birth Defects
Understanding what happens when the fetus's temperature increases, whether caused by an elevation in maternal core temperature or by the more local effect of ultrasound, is the key to appreciating prenatal ultrasound risks. An individual's body temperature varies throughout the day due to various factors such as circadian rhythms, hormone fluctuations and physical exertion. While people may have up to 1.5° F in each direction of what is considered a "normal" core temperature, the overall average among people is 98.6° F. An increase of only 1.4° F to 100° F can cause headaches, body aches and fatigue, enough to get the individual excused from work. A temperature of 107 F can cause brain damage or death. A core temperature of about 98.6° F is important because that is the point at which many important enzyme reactions occur. Temperature affects the actual shape of the proteins that create enzymes, and improperly shaped proteins are unable to do their jobs correctly.
As factors such as the amount of heat or duration of exposure increase, enzyme reactions become less efficient until they are permanently inactivated, unable to function correctly even if the temperature returns to normal.(18) Because temperature is critical to proper enzyme reactions, the body has built-in methods to regulate its core temperature. For instance, when it is too low, shivering warms it up; when it is too high, sweating wicks off the heat. For obvious reasons, fetuses cannot cool off by sweating. However,they have another defense against temperature increases: Each cell contains something called heat shock (HS) proteins that temporarily stop the formation of enzymes when temperatures reach dangerously high levels.(19)
Complicating the issue is the fact that ultrasound heats bone at a different rate than muscle, soft tissue or amniotic fluid.(20) Further, as bones calcify, they absorb and retain more heat. During the third trimester, the baby's skull can heat up 50 times faster than its surrounding tissue (21),subjecting parts of the brain that are close to the skull to secondary heatthat can continue after the ultrasound exam has concluded. Elevated temperatures that might only temporarily affect the mother can have devastating effects on a developing embryo.
A 1998 article in the medical journal, Cell Stress & Chaperones, reported that "the HS response is inducible in early embryonic life but it fails to protect embryos against damage at certain stages of development." The authors noted, "With activation of the HS response, normal protein synthesis is suspended…but survival is achieved at the expense of normal development."(22)
Autism, Genetics and Twin Studies
What does elevated body temperature have to do with autism?
Geneticists are trying to crack the DNA mysteries behind ASD. Recently researchers linked two mutations of the same X chromosome gene to autism in two unrelated families, although they do not yet understand at what stage these genes were damaged.(23)
Because sibling and twin studies show a higher prevalence of autism among children in families with one autistic child, geneticists expected to find inherited factors, but despite millions of dollars invested in the search, no clear explanation indicates that ASD is inherited.
Perhaps scientists need look no further than at the thermal effects of ultrasound for many answers. If prenatal ultrasound is responsible for some cases of autism, it stands to reason that if one twin were autistic, the other would have a high probability of being affected, since both would have been exposed to ultrasound at the same time. In both identical and fraternal twins, one twin could be more severely affected than the other if he or she happened to take the brunt of the heat or sound waves. In the case of fraternal twins, since autism strikes males between three to five times more often than females, the sex of the twins also could make a difference in outcome.
A 2002 study showed that simply being a twin substantially increased the likelihood of autism, making twinning a risk factor.(24) Could this increased twin risk factor have to do with the practice of giving mothers with multiple gestations more ultrasounds than those expecting singlebirths? While not discounting the role genetics may play in autism, the possible impact of prenatal ultrasound deserves serious consideration.
Ultrasound Warnings Unheeded
The idea that a prenatal ultrasound can be hazardous is not new. The previously mentioned 1982 WHO report, in its summary "Effects of Ultrasoundon Biological Systems," stated that
"…animal studies suggest that neurological, behavioral, developmental, immunological, haematological changes and reduced fetal weight can result from exposure to ultrasound."(25)
Two years later, when the National Institutes of Health (NIH) held a conference assessing ultrasound risks, it reported that when birth defects occurred, the acoustic output was usually high enough to cause considerable heat.(26). Although the NIH has since stated that the report "is no longerviewed…as guidance for current medical practice," the facts remain unchanged.
Despite the findings of these two major scientific gatherings, in 1993 theFDA approved an eight-fold increase in the potential acoustical output of ultrasound equipment (27), greatly increasing the possibility of disastrous pregnancy outcomes caused by overheating. Can the fact that this increase inpotential thermal effects happened during the same period of time the incidence of autism increased nearly 60-fold be merely coincidental?
Hot Tubs, Steam Rooms, Saunas and Maternal Fevers
If the culprit is heat, then what about other situations in which heat impacts pregnancy?
A 2003 study titled, "A report of heat on embryos and fetuses" in the International Journal of Hyperthermia states, "hyperthermia during pregnancy can cause embryonic death, abortion, growth retardation and developmental defects."(28) It further states, "An elevation of maternal body temperature by 2 degrees Centigrade [3.6 degrees Fahrenheit] for at least 24 hours during fever can cause a range of developmental defects."(29) The report noted that necessary data to draw conclusions on exposure timesless than 24 hours were lacking (30), leaving open the possibility that elevated maternal temperatures for shorter periods may adversely affect fetuses.
A study reported in the Journal of the American Medical Association (JAMA)found that "women who used hot tubs or saunas during early pregnancy face up to triple the risk of bearing babies with spina bifida or brain defects."(31). Hot tubs and baths present greater dangers than other heat therapies such as saunas and steam rooms because the immersion in waterfoils the body's attempt to cool off via perspiration, in much the same way fetuses cannot escape elevated temperatures in the womb. All of this taken together establishes the fact that heat, whether caused by elevated maternal temperature or by an ultrasound transducer that remained over one area too long, can set into motion damaging changes in a developing baby. Using common sense, why would anyone think that intruding upon the continuous, seamless development of the fetus, which has for millions of years completed its work without assistance, be without consequences?
Vaccine and Thimerosal Controversy
Despite long-standing evidence that ultrasound induces thermal effects and that thermal effects can harm fetal brain development, the cause of autism has remained so elusive to researchers that many autism societies use a puzzle piece as part of their logos.
Particularly confounding is the fact that ASD plagues the children of high-income, well-educated families whohave the best obstetrical care money can buy. Why would women who took theirprenatal vitamins, observed healthy diets, refrained from smoking ordrinking and attended all regularly scheduled prenatal visits bear children with profound neurologically based problems?
Some believe that childhood vaccines, at first available only to those who could afford them, cause autism. Many vaccines contained thimerosal, a mercury-based preservative, which was thought to have a cumulative neurotoxic effect on children, especially as the number of childhood vaccines increased during the same period of years that the prevalence of autism increased. However, after an exhaustive review in 1999, the FDA found no evidence of harm in the use of thimerosal in childhood vaccines.(32)Despite those findings, that same year the FDA, NIH, CDC, Health Resourcesand Services Administration (HRSA) and American Academy of Pediatrics (AAP)together urged vaccine manufacturers to reduce or eliminate thimerosal inchildhood vaccines.(33) Pharmaceutical companies complied, and ultimately reduced the infant thimerosal exposure by 98%.(34)
Interestingly, not only did autism rates fail to decrease, they continued to increase. ASD increases are between 10 to 17 percent every year, according to the Autism Society of America (35), indicating that thimerosal is not to blame.Thimerosal was not the only area of concern in the vaccine-autism controversy. Many people believed that a correlation existed between the triple vaccine MMR (mumps, measles and rubella) and ASD. However, a large,retrospective epidemiological study of more than 30,000 children in Japan between 1988 and 1996 found that the autism rate continued to climb after the vaccine was withdrawn.(36) Those results were no different than the outcome of a 1999 study published in The Lancet, that showed no corresponding jump in autism in the UK after the introduction of the MMRvaccine.(37)
A 2001 study published in JAMA examining California autism and MMR vaccination rates said the results did "not suggest an association between MMR immunization among young people and an increase in autism occurrence."(38) While concerns about vaccines and mercury exposure shouldnot be dismissed, evidence to date does not implicate either one as a major factor in the explosion of ASD cases.
Global Autism Epidemic
Statistics on the increase of autism worldwide among industrialized nationsshow that it has emerged in just the last few decades across vastly different environments and cultures. What do countries and regions with climates, diets and exposure to known toxins as disparate as the US, Japan,Scandinavia, Australia, India and the UK have in common? No common factor in the water, air, local pesticides, diet or even building materials and clothing can explain the emergence and relentless increase in this serious, life-long neuro-developmental disorder. What all industrial countries do have in common is the quiet yet pervasive change in obstetrical care:
All of them use routine prenatal ultrasound on pregnant women.In countries with nationalized healthcare, where virtually all pregnant women are exposed to ultrasound, the autism rates are even higher than in the US, where due to disparities in income and health insurance, some 30 percent of pregnant women do not yet under go ultrasound scanning.
The Changes in Ultrasound
In considering initial studies indicating that prenatal ultrasound is safe,one must factor in the ways in which the technology and its applications have continually changed and how that has altered the potential exposure o funborn children. Besides the huge increase in allowable acoustic output inthe early 1990s, the following changes have made the field of prenatal ultrasound riskier than ever:
The number of ultrasound scans conducted during each pregnancy has increased, with women often receiving two or more scans even in low-risk situations.(39)
Women in "high-risk" situations may receive many more scans—which, ironically, may raise their risk. The range of time within an embryo or fetus's development when ultrasound is performed has extended to very early in the first trimester and continues into the third trimester, right up to delivery. Fetal heart monitors that are used prior to delivery—sometimes for hours—have not been shown to reduce neurological problems and may increase them.(40)
The development of the vaginal probe, which positions the beam of sound much closer to the embryo or fetus, may put it at higher risk. The use of Doppler ultrasound, which is used to study blood flow or tomonitor the baby's heartbeat, has increased. According to the 2006 Cochrane Database of Systematic Reviews, "routine Doppler ultrasound in pregnancy does not have health benefits for women or babies and may do some harm."(41)
Increasingly Common Birth Defects
Dr. Rakic's research team, cited earlier in this article for its recent study on mouse brains and ultrasound, pointed out that "the probe was held stationary for up to 35 minutes, meaning that essentially the entire fetal mouse brain would have been continually exposed to the ultrasound for 35minutes…in sharp contrast to the duration and volume of the human fetal brain exposed by ultrasound which will typically not linger on a given tissue volume for greater than one minute."(42)
This is an excellent point, which is worth pursuing. One of the most popular non-medical uses of ultrasound, which can extend a medically indicated session, is to determine the sex of the baby. Could this have a connection to the increase in birth defects involving the genitals and urinary tract? The March of Dimes says that these types of birth defects affect "as many as 1 in 10 babies," adding that "specific causes of most of these conditions is unknown."(43)
Following this line of thought, consider what other parts of the body are scrutinized by ultrasound technicians, such as the heart, where serious defects have soared nearly 250 percent between 1989 and 1996.(44) The list of unexplained birth defects is not a short one, and in light of what is emerging about prenatal ultrasound, scientists should take another look at all recent trends, as well as the baffling 30% increase in premature births since 1981, now affecting one in every eight children (45), with many showing subsequent neurological damage.(46)
Although many claim that ultrasound benefits outweigh the risks, that statement has no basis and much evidence is to the contrary. A large randomized trial of 15,151 pregnant women, conducted by the RADIUS StudyGroup, found that in low-risk cases, high-risk subgroups and even in cases of multiple gestations or major anomalies, the use of ultrasound did not result in improved outcome in the pregnancies.(47)
The argument that ultrasound is either reassuring to the parents or provides an early opportunity for bonding pales in the face of the possible risks that are emerging as new data become available. Parents and health practitioners may not be able to easily turn away from this window on the womb and resume more traditional practices in obstetrics and midwifery. However, with the disturbing trend in autism and other equally troubling, unexplained birth-related trends, it does not make sense to blindly employ a technology that is not reliably safe for unborn babies.
Caroline RodgersEditor's Note: Read more about ultrasound on our Web site: http://www.midwiferytoday.com/

Ultrasound: Weighing the Propaganda Against the Facts - by Beverley LawrenceBeech
Ultrasound: More Harm than Good? - by Marsden Wagner
Search more about ultrasound.
References:"National Autism Treatment Plan for Excellence in IDEA" Petition to thePresident of the United States.www.petitiononline.com/natpidea/petition.html. Accessed 23 Sep 2006.
"How Common Are Autism Spectrum Disorders (ASD)?" Centers for DiseaseControl and Prevention. www.cdc.gov/ncbddd/autism/asd_common.htm. Accessed23 Sep 2006.
"Autism in schools: Crisis or challenge?" The National Autistic Society.www.nas.org.uk/nas/jsp/polopoly.jsp?d=160&a=3464. Accessed 23 Sep 2006.
"International Programme on Chemical Safety. Environmental Health Criteria22. Ultrasound." 1982. United Nations Environment Programme, InternationalLabour Organisation and International Radiation Protection Association.www.inchem.org/documents/ehc/ehc/ehc22.htm. Accessed 22 May 2006.Keiler, H., et al. 2001. Sinistrality—a side-effect of prenatal sonography:A comparative study of young men. Epidemiology 12(6): 618–23; Campbell,J.D., et al. 1993. Case-controlled study of prenatal ultrasonographyexposure in children with delayed speech. Can Med Assoc J 149: 10, 1435–40.
"Ultrasound Can Affect Brain Development." Truth Out Issues.www.truthout.org/issues_06/080806HA.shtml. Accessed 25 Sep 2006.Ibid.Eugenius, S., et al. 2006. Prenatal exposure to ultrasound waves impactsneuronal migration in mice. PNAS 103(34): 12903–10.www.pnas.org/cgi/content/abstract/103/34/12903?maxtoshow. Accessed 11 Aug2006.Rados, Carol. 2004.
FDA Cautions Against Ultrasound "Keepsake" Images. FDAConsumer Magazine. www.fda.gov/fdac/features/2004/104_images.html. Accessed11 Sep 2005.Samuel, Eugenie. 2001.
Fetuses can hear ultrasound examinations. NewScientist.www.newscientist.com/article/dn1639-fetuses-can-hear-ultrasound-examinations-.html. Accessed 11 May 2006.Miller, M.W., et al. 2002. Hyperthermic teratogenicity, thermal dose anddiagnostic ultrasound during pregnancy: implications of new standards ontissue heating. Int J Hyperthermia 18(5): 361–84.Ibid.Graham, Jr., M., M.J. Edwards and M.J. Edwards. 1998. Teratogen Update:
Gestational Effects of Maternal Hyperthermia Due to Febrile Illnesses andResultant Patterns of Defects in Humans. Teratology 58: 209–21.Clancy, B., R.B. Darlington and B.L. Finlay. 2001. Translating developmentaltime across mammalian species. Neuroscience 105(1): 7–17.Ibid.See note 9 above.See note 13 above.Wilson, D.E. 2004.
"Body Function Dependent On Body Temperature." InWilson's Temperature Syndrome—A Reversible Low Temperature Problem. eBook.www.wilsonsthyroidsyndrome.com/eBook/Chapters/02Temp.cfm. Accessed 19 Sep2006."How enzymes work." Biotopics. www.biotopics.co.uk/other/enzyme.html.Accessed 19 Sep 2006.
"The ultrasound procedure: Physical effects and research." Birth.www.birth.com.au/class.asp?class=6610&page=5. Accessed 23 Sept 2006.Barnett, S.B.
"Can diagnostic ultrasound heat tissue and cause biologicaleffects?" In S.B. Barnett and G. Kossoff, eds. 1998. Safety of DiagnosticUltrasound. Carnforth, UK: Parthenon Publishing.Edwards, M.J. 1998. Apoptosis, the heat shock response, hyperthermia, birthdefects, disease and cancer. Where are the common links? Cell StressChaperones 3(4): 213–20.Klauck, S.M., et al. 2006. Mutations in the ribosomal protein gene RPL10suggest a novel modulating disease mechanism for autism. Mol Psychiatry.advance online publication 29 August 2006. doi:10.1038/sj.mp.4001883.Betancur, C., M. Leboyer and C. Gillberg. 2002. Increased Rate of Twinsamong Affected Sibling Pairs with Autism. Am J Hum Genet 70: 1381–83.See note 4 above.
"Diagnostic Ultrasound Imaging in Pregnancy." National Institutes of HealthConsensus Statement Online. 5(1): 1–16.See note 16 above.Edwards, M.J., R.D. Saunders and K. Shiota. 2003.
Effects of heat on embryosand foetuses. Int J Hyperthermia. 19 (3): 295–324.Ibid.Ibid.Milunsky, A., et al. 1992. Maternal heat exposure and neural tube defects.JAMA 268(7): 882–85.
"Thimerosal in Vaccines." U.S. Food and Drug Administration.www.fda.gov/cber/vaccine/thimerosal.htm. Accessed 21 Sep 2006.Ibid.
"Thimerosal and Vaccines." Centers for Disease Control.www.cdc.gov/nip/vacsafe/concerns/thimerosal/faqs-thimerosal.htm#3. Accessed27 Sep 2006."Facts and Statistics
." Autism Society of America.www.autism-society.org/site/PageServer?pagename=FactsStats. Accessed 21 Sep2006.Honda, H., Y. Shimizu and M. Rutter. 2005.
No effect of MMR withdrawal onthe incidence of autism: a total population study. J Child PsycholPsychiatry 46(6): 572–79.Taylor, B, et al. 1999. Autism and measles, mumps, and rubella vaccine: noepidemiological evidence for a causal association. Lancet 353(9169):2026–29.Dales, L., S.J. Hammer and N.J. Smith. 2001.
Time Trends in Autism and inMMR Immunization Coverage in California. JAMA 285(22): 1183–85.Stephens, M.B. 2000. American Family Physician Conference Highlights:Majority of Pregnant Women Want Prenatal Ultrasound. Am Fam Physician(62)12: 2665.Wagner, M., and M.G. Wagner. 1994.
Pursuing the Birth Machine, 1st ed.French's Forest, Australia: James Bennett Pty Ltd.Bricker, L., and J.P. Neilson. 2006. "Routine Doppler ultrasound inpregnancy." The Cochrane Collaboration 3.www.cochrane.org/reviews/en/ab001450.html. Accessed 23 Sep 2006.Smith, M. 2006.
"Ultrasound Affects Development of Murine Brains." MedpageToday. www.medpagetoday.com/Radiology/GeneralRadiology/tb/3882. Accessed 13Aug 2006.
"Genital and Urinary Tract Defects." March of Dimes.www.marchofdimes.com/printableArticles/4439_1215.asp. Accessed 27 Aug 2006.
"Healthy from the Start." 1999. The Pew Charitable Trusts (EnvironmentalHealth Commission). www.pewtrusts.com/pdf/hhs_healthy_from_start.pdf.Accessed 25 Sep 2006.Behrman, R.E., and A.B. Stith, eds. 2006. Preterm Birth: Causes,Consequences, and Prevention. Washington, D.C.: National Academies Press.http://newton.nap.edu/catalog/11622.html. Accessed 20 Sep 2006.
"New research offers clues to prevent brain damage in premature babies."2006. Medical News Today.www.medicalnewstoday.com/medicalnews.php?newsid=28786. Accessed 25 Sep 2006.Ewigman, B.G., et al. 1993. Effect of Prenatal Ultrasound Screening onPerinatal Outcome. N Engl J Med 329(12):821–27.
Editor's Note:
We are interested in anecdotal evidence to support or refute this theory of ASD. Midwives or other individuals who know of cases of autism in which the mother didn't have an ultrasound are asked to contactCheryl Smith at mgeditor@midwiferytoday.com or by writing to us.----------------------------------------------------------

Thursday, August 02, 2007

Why Breastfeeding In The First Hour Of Life Is Important

http://www.medicalnewstoday.com/articles/78485.php

A news article from this morning

Sunday, May 20, 2007

Postpartum Depression

Today in Emotional Health
Prevent Postpartum Depression
Up to 10 percent of new moms develop postpartum depression, but with a little advance planning you can reduce the risk of it happening to you.
Get tips on preventing postpartum depression.

Tuesday, March 20, 2007

Midwifery In Saskatchewan!

HOLISTIC PREGNANCY AND CHILDBIRTH:MIDWIFERY IN SASKATCHEWAN

Presented By
DR. HEATHER FOX PhD, DAc, ND, RMT, SATHE WESTERN ACADEMY OF MIDWIFERY & SONYA DUFFEE, TRADITIONAL MIDWIFE, Cert. DOULA TRAINER

Midwifery is traditionally holistic, combining an understanding of the social, emotional,cultural, spiritual, psychological and physical aspects of a woman's reproductiveexperience. Midwives promote wellness in women, babies and families. Learn how youand your family can have the healthiest and most positive experience possible.

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Saturday, January 06, 2007

Doulas: Bridging the Gap

By, Robyn Cuthbert-Adair
mother of 4 & a Saskatoon Doula

The entry to motherhood is a unique and sacred passage to be honoured and cherished by women and those supporting them. A doula (Greek term which has come to mean “mothering the mother") is a support person or facilitator for women and their partners as they make that journey to welcome new life.

Human beings are social by nature and require a tangible sense of community support, especially during times of transition. The journey through pregnancy, labour, and birth exposes this need in women. Historically, the members within rural community readily supported one another as people freely gave and depended upon the strength of others, enabling the community to thrive and flourish as a whole. Mothers had their families near and, therefore, were able to interact with several generations of women, drawing wisdom and support through the dynamics of life; this included the support given to one another while crossing the threshold into motherhood.

Prior to industrialization, humanity’s need for social structure and interdependence gave insight to the development of basic technologies to aide with daily living tasks(shelter, clothing, tools). However, the mass growth and influence of sophisticated 20th century technology coupled with large scale urbanization has redirected the course of human interdependence toward individualism and a dependency on technology; a trend with potential to leave people isolated, unsupported, and without a social standard through the changes of life. Thus, women entering motherhood can feel alone, afraid, and vulnerable to the bombardment of information, advice, and a growing list of ”do’s and don’ts” regarding every aspect of pregnancy, birth and parenting.

Doulas endeavour to fill this gap for birthing women and their partners through birth education and continuous support during pregnancy, labour and birth, and the immediate postpartum period. Essentially, a doula encourages a woman to discover her inner strength, ability, and instinct to birth, and to surrender to that primal knowledge rather than relying on external sources to inform her birthing process. Doulas also offer information and resources relating to hospital procedure (patient rights, routine admittance tests, drug options, etc.), as well as, to alternative therapies and practices for birth (massage, aromatherapy, acupressure, etc.).

This information enables women and their partners to make informed decisions while remaining open to the experience of their unique birth journey. When women are supported in birth they feel safer and more enabled to be in control of their own experience.

If women are allowed to trust their bodies and birth according to their wishes the more confidence they will take into the mothering journey. A doula can offer this much needed support, and in doing so reclaims the traditional roots of women helping women.

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