Doula care: Midwifery Today interviews Penny Simpkin

postpartum perineal healing

excerpted from Midwifery Today,

...I suggest that women use ice packs for 24 hours to reduce swelling, and then switch to sitz baths several times daily using hot water with selected herbs. Nothing speeds healing faster than heat, and soaking is far superior to topical application as it more deeply stimulates circulation. Fresh ginger is a good addition to the solution; it helps relieve the itching that often occurs as stitches dissolve and the skin heals.

Here is how I recommend women take a sitz bath: Grate a 3- to 4-inch piece of ginger root into a large pot of water; simmer twenty minutes; strain and divide into two portions. Save one for later in the day, and dilute the first with water in a sitz bath. After soaking for twenty minutes, thoroughly dry the perineum and expose to air or sunlight for another 10 minutes before putting on a fresh pad (or use a hair dryer to speed the process). If the perineum feels at all sticky, use aloe vera gel to dry and soothe the tissues. Avoid vitamin E or other oil-based ointments until the skin is healed over, as these tend to keep edges from closing.

The wall-like ridge characteristic of episiotomy can be softened and relaxed with thumb or finger pressure, using a little oil (just make sure to wash your hands before handling the baby or breastfeeding). When scarring is extensive, evening primrose oil (found in health food stores) may significantly help to reduce it.

If adequately repaired and cared for, the perineum should be fully healed at six weeks no matter how extensive the damage...

— Elizabeth Davis
Excerpted from "Sex after the Baby Comes," Midwifery Today, Issue 62

doula video from Today

As expected, Dr. Nancy Schneiderman uses language repeatedly of "doctor" or "OB" & not of midwife. I found her very closed to the idea of doulas - and not a single word about statistical benefits of doulas, the many studies that show their value. Notice how she says some are very well trained - having been L&D nurses or midwives (or credentialed through DONA, as so many of us are) - but then warned that some less-well trained will create a hostile environment by giving information contrary to what the hospital staff says...that strikes me as ironic...be medically trained in order to give non-medical support!
I think so much of the tension comes from a place of defensiveness - the idea that you need your doctor's permission in order to gather the support you desire (or that you have a doctor & not a midwife!). No consideration of the idea that if you want a doula and your care provider does not then perhaps you are not well matched and should choose a different care provider. But it just doesn't have to be that way...I just do not have this tension with care providers - but I work hard to help build consensus...I doula doctors and nurses when needed!
But yes, we all know there are overzealous doulas who step over the line and are being advocates for Birth with a capital B rather than this particular birth and family - point well taken and something for doulas to be clear about.
Kind of sad that Dr. Schneiderman considers a birthing family feeling informed, cared for, physically & emotionally comfortable and having built a relationship with an integral member of her birth team as a "luxury"...

Should you wish to give Dr. Schneiderman/The Today Show feedback but do not wish to dig through the site, you can try here.

prior cesarean linked to breech presentation

from Midwifery Today...wow...yet another reason to try to avoid a cesarean:

A study to determine whether breech presentation at term is more common among women with at least one prior cesarean delivery showed a rate two times that for women who had had vaginal births. The study records of 84,688 women showed the relative risk of a breech presentation at term for women with a history of cesarean was 2.18, with no difference related to the number of cesareans. While a total of 2.46% of all women in the study had breech babies at term, 14.91% of those who had had a cesarean had a breech. The researchers took into account other factors, including gestational age, maternal age, parity, birth weight and oligohydramnios.

— Am J Obstet Gynecol, 13 Feb 2008 (10.1016/j.ajog.2007.11.009)

sleep positions & SIDS

I'm sure everyone knows "Back To Sleep" is the mantra for babies. I admit, one of my kids was very unhappy on his back & so he didn't sleep in the prescribed position sometimes...and certainly once they could roll & pick their own positions for sleep, they often ended up on their tummies. Oh, and they generally didn't sleep in a crib all that much until they were older (& maybe not even then) because they were sleeping with us.

The side-sleeping part is newer, so those of us with preschoolers may not be aware of it - not sure if I was, to be honest. But the big take-away for me was the connection to previously-used crib mattresses. So I'm posting it here in case you hadn't heard of that either.

From the new issue of Midwifery Today e-news:

...One thing not mentioned in this campaign was the SIDS risk caused by fungus and chemicals found in babies' mattresses. From 1988–1989 Barry Richardson, a British chemist, tested the mattresses of 200 babies that had died of SIDS and found all of them infected with S. brevicaulis fungus and spores and phosphorus, arsenic or antimony; and when brought to body temperature, each generated toxic gas from these chemicals. Ninety-five percent of the mattresses had been used previously by another infant, as well. This information, while published in Midwifery Today (Issue 61, Spring 2002, http://www.midwiferytoday.com/products/mt85.htm), was never made widely available in the US.

In 2005, the AAP advised parents not to place babies on their stomachs or on their sides to sleep. It seems that several studies had shown in increased risk of SIDS in relation to side- or back-sleeping*, particularly when the baby has symptoms of infection. And the wheel goes round.

Despite these well-publicized recommendations, according to an article in The New York Times (18 Oct 2005), increasing numbers of parents are letting their babies sleep on their stomachs. The article quoted an unscientific internet poll which showed that virtually equal numbers of parents put their babies to sleep on their stomachs (42%) as on their backs (43%). This is quite an increase from the 2002 statistic given by the National Center for Health Statistics (NCHS) of 11.3% of parents whose babies slept on their stomachs, but not anywhere near the 70% of babies that slept on their stomachs in the mid-1990s. So why are parents taking this risk with their babies' lives?

Parents who admit to putting their babies to sleep on the stomachs are clear on why they do so: the babies sleep better and are more likely to sleep through the night sooner. Even the Academy admits this.

Another reason that parents may be averse to always placing babies on their backs to sleep is positional plagiocephaly, or malformation of the head. According to the AAP, this issue still needs more study to determine whether a correlation exists. It is something that parents should be aware of if their baby is back-sleeping.

Interestingly, even medical professionals don't feel obligated to follow these guidelines in many cases. According to the AAP position paper, hospital personnel often place preterm babies on their sides or stomachs during hospitalization, modeling such management to parents and perhaps accustoming the babies to this position.

An interesting study from California showed that infants who were not used to sleeping on their stomachs were at greater risk when sleeping that way than those who were used to sleeping on their stomachs.

— Cheryl K. Smith
Excerpted from "Go to Sleep, Little Baby," The Birthkit, Issue 50

*must mean "stomach"