Counselling for positive Outcomes. Gail Hart Midwifery Today conference, Harrisberg , Pennsylvania 2012

Written by FairyDoula. Posted in Midwifery notes

Ok, so I believed that after every day at the conference I would write up my notes on my new shiny box! Not true! I totally forgot how much concentration and writing I would be doing every day not to mention running, smiling, sorting stuff and generally giving loads of energy to all of my favourite midwives and birth activists! So obviously I lunched out my homework! So now, I am about to start transporting my conference notes to blog world, I hope they are as exciting and informative to you all as they are to me!

COUNSELLING FOR POSITIVE OUTCOMES- GAIL HART

  • Every pregnant woman should be supported with all she needs when she becomes pregnant.
  • stress changes positive outcomes- life can be stressful. U.S. women are expected to do everything with minimal support
  • NUTRITIONAL ECONOMIC, SOCIAL – These are all kinds of stress- which lead to high blood pressure and then other complications.
  • Nutrition- council for positive outcomes
  • assist women to value themselves and respect themselves and their babies by eating well.
  • sit and talk, “what did you eat yesterday?”
  • you have to know where a woman is dietarily before you can positively affect her diet
  • cook for people- bring gluten-free cookies to work
  • introduce people to new foods- sprouts, houmous, stevia, seaweed
  • sometimes people know how to eat properly but can’t afford it. Assist by organising get-togethers and food shares
  • The value of prenatal care is the time spent with the woman, which gives more confidence and connection between you both, raising levels of oxytocin thereby creating better birth experiences
  • This is an exciting time for you?” use leading questions to discover where she is with her pregnancy experience.
  • Risks and fears need to be planned for but they do not need to be stated as problems to terrify women!
  • Try to keep our fears ( and adrenalin) low and the fears of our women low too!
  • All women are unique! No matter how you have been educated you need to remember that each woman experiences life differently
  • Always ask permission before touching- this creates body respect.
  • see the whole woman , use your eyes and ears, heart and hands
  • When birth experiences are bad women seem to talk of it less, with fewer details
  • Pick up the clues – get the whole story
  • Women rarely repeat their birth experience physically- most women put their experiences into perspective
  • Each birth is different- each time they change because they grow and change with the birth experience
  • Always talk calmly and remind women of the dangers of unfounded fear-mongering thru the internet and gossip.
  •  High blood pressure is not a symptom of Eclampsia or pre-eclampsia, it is a symptom that something is wrong and needs attention!
  • Only 1 out of 100 people diagnosed with pre-eclampsia actually has a seizure at birth
  • possibly calcium regulation is a factor in preeclampsia – also kidney functions are a factor.
  • MODERATION IN ALL THINGS EXCEPT COMPASSION AND LOVE
Gail Hart is a majestic midwife, her book ‘ Research updates for midwives, some thoughts on the best evidence.’ is a brilliant resource book for anyone who needs to back up their decisions and actions at a medical level. Loads of doctor speak and names to quote, makes even doctors listen and question hospital protocol!

Alternative to suturing & tear prevention – Gail Hart

Written by FairyDoula. Posted in Midwifery notes

Preparation before birth

  • exercise
  • perineal massage
  • deep breathing
  • squats
  • stretching

Strategies for second ( pushing ) stage

  • Avoid ‘coached’ pushing. Encourage her to listen to her body and to stop pushing and breathe when her baby is on the perineum.
  • A compress of hot water, olive oil, coconut oil, avocado oil, grapeseed oil, sweet almond oil or arnica oil is very helpful
  • Most stuff we know is because someone has told us from their personal experience, NOT through research
  • Standing and squatting positions create less tearing of perineum
  • Ginger increases circulation to tissues so it can stretch – it also minimises swelling and smells good
  • Comfrey activates cell rejuvenation and reduces swelling
  • 96 degrees is ideal heat for a birthing pool
  • Compression will always stem bleeding
  • Spray adrenaline onto a gauze put this on the tear to stop bleeding
  • Yunan payao seaweed helps too
  • Sugar coagulates wounds; also salt.
  • Honey is great for wound healing
  “If two pieces of vagina are in the same room, they will move together!” Gail Hart

Maternity massage – Elaine Stillerman

Written by FairyDoula. Posted in Midwifery notes

MASSAGE FOR BIRTH – ELAINE STILLERMAN

Safe, nurturing, non-judgemental, well-informed, loving, stress-reducing… THIS is the environment we want to create for massage and childbirth.

Quadratus Lumborum

The Quadratus Lumborum is the primary muscle involved in back pain during pregnancy. For the relief of lower back pain use ‘strain, counter strain’ technique
STRAIN, COUNTER STRAIN
  •  Assist mother to lie on her side, keep knees together as much as possible when getting into position to support and protect the symphysis pubis (the cartilage join in the middle of the pelvis, above the pubic bone)
  •  Support the belly, raise the knees with pillows
  •  Find the place where there is the most strain in the muscle, by feeling and asking the client
  • When you have found the exact spot, press spot with your thumb, whilst holding other hand on the hip and pushing with a medium force forward ( this gently rotates the pelvis while you are relaxing and recalibrating the muscle with your other hand)
  • Repeat on the other side so the body is balanced!
  • HOLD THESE POSITIONS FOR 90SECS WITH EQUAL FORCE THROUGHOUT. This resets the neurons and the receptors in the body, brain and muscles and relieves the pain.

THE PSOAS

This is the muscle that reaches from the back of the hip down to the side of the knee. Pains here can be treated with muscle relaxation and strain counter strain.
MUSCLE RELAXATION
  • With the woman lying on her side supported by cushions, get her to bend her leg up towards her stomach and lift it towards the sky.
  • Practitioner stands facing the woman’s belly, assisting the lift of the leg with their right hand and giving something to push against with the left.
  • Have woman push her leg forward like she is bending her knee upwards for 5secs, then release.
  • This assists the hip to release and the leg will extend further when she straightens it out, along and back from her body.
  • Repeat this 3 to 5 times until the desired extension and pain relief has occurred.
  • Repeat on the other side so the body is balanced.
STRAIN COUNTER STRAIN
  • Have the client lie on her back with one leg straight one leg bent at right angles outwards.
  • Feel the top of her pelvis in towards the pubis until you find a sore spot.
  • Press the point with your top hand thumb, support the knee and lift gently to rotate the hip with the other hand.
  • Hold this position for 90 secs the muscle will release and reset its neurons and receptors
  • Repeat on both sides so the body is balanced!

PERIFORMIS

This is a muscle that reaches from the hip bone to bottom cheek! Pain can be relieved with the ‘strain, counter strain’ method.
STRAIN COUNTER STRAIN
  • Have the woman lay on her side supported by pillows
  • Face her belly and lift her top thigh a little upwards with your forearm
  • With your other hand feel for a sore point from top hip bone to bottom of the bottom cheek
  • When you have the place, apply thumb pressure and rotate hip for 90secs
  • The muscle will release and reset its neurons and receptors
  • Repeat on both sides so the body is balanced!
Elaine Stillerman is a brilliant massage therapist, designer of the amazing massage balls (smelly balls) and a great karaoke singer! With these techniques, she creates a calm, pain-relieving massage that uses the least amount of effort whilst creating the most amount of relief.

Haemorrhage and Third Stage difficulties – notes – Gail Hart

Written by FairyDoula. Posted in Midwifery notes

  • ‘1/3 of women die in childbirth’ IS A LIE!
Women at full term can die of
  • septic miscarriage
  • blood loss

Symptoms of haemorrhage

  • Fainting
  • Sickness
  • Mothers face pale
  • Lips blue
  • Low blood pressure
  • Rapid pulse (100, 110)
  • Convulsions

Notes on haemorrhage

  • Average blood loss is 435 cc ( 4 cups ) to 800cc (6 cups) – 1 full pad = 1/2 a cup
  • Women can lose up to a litre of blood ( 8 cups) and still survive ! – however we should be vigelant about blood loss and keep it to a minimum
  • 500cc of blood loss = 1g haemoglobin loss
  • In waterbirth, if you can see the bottom of the tub then the blood loss is normal.
  • If a woman is bleeding too much her uterus needs to be closed – if the placenta is still in it has to be removed.
  • To keep the cord intact helps the placenta trigger the separation – the whole system remains oxygenate
  • Routine use of Pitocin ( synthetic oxytocin) or oxytocic herbs to over stimulate labour can be cause of bleeding

Normal birth= normal placenta delivery

  • Let the uterus expel the baby- assist the baby and mother to skin-to-skin contact
  • To watch the physiological stages of separation means to assist the true way of expulsion
  • Placental expulsion can take from 30 mins to 6 hrs!
  • To pull on the cord when the womb is not contracting will only cause problems
  • Hold the cord, feel the womb, feel the slack – DO NOT TUG!
  • Watch, Wait, Allow physiology to progress – be like the animal and let nature take its course
  • Shepherds purse herb can stop bleeding and contract the uterus
  • You can also use your hands to contract the uterus- rub the mama’s belly flat-handed, support under the uterus and push from above – you are trapping those blood cells and stopping the bleeding.
  • Also, nipple stimulation and breastfeeding can help
  • A thumbnail piece of placenta in the mother’s mouth activates uterus contractions in 20 seconds!
  • Getting upright and blowing in a bottle can help the placenta to separate
  • Get the mama to cough or sneeze this can also help
  • The best way is to not disturb the natural bonding space of mother and baby- leave the room for 20 mins*  make yourself invisible – leave the woman to birth her placenta herself with no fuss!
*hi lara, you take great notes, but I need to post a correction there. I probably mispoke something in the class. “I” was not the midwife who said to leave the room for 20 minutes to give the mother privacy to birth her own placenta. I said I know of this teaching and assisted a midwife once who followed this. I don’t personally do this or advocate it; I just know of some who do, but I’m personally not comfortable with leaving her. I always stay with the woman, nearby but as much out of her way as possible, so I can observe her and her baby and help if needed. But I try to stay quiet and pretty invisible and unintrusive. I could be on a chair nearby, or perhaps just by the door, but I don’t leave. About using your hands to stop bleeding: The hands are the best and most effective tool. Faster than medications. About placenta — it is a very effective emergency treatment, and the knowledge should be reclaimed. It used to be known throughout the world but has been forgotten in many on haemorrhage and third stage difficulties – Gail Hart

A Midwives’ Healthy relationship with Fear – Elizabeth Davis

Written by FairyDoula. Posted in Midwifery notes

  • To work with fear is a way to be active and alert in a situation where most are frozen and inactive .
  • Women’s healthcare providers – ‘Midwives’ have always been here
  • It is an honourable position , respected and powerful.
  • However our fear is grounded in a history of persecution since ‘ The Burning Times’
  •  To repress and attack midwives is to deny the power of women
  • In any patriarchal society, midwives will always be seen as troublemakers because they care for the health and rights of women
  • “At this time, no one is more dangerous to the state and church than the midwives.”  The Spanish inquisition for the Catholic church  – six million women died!
  • These ‘Burning times’ created a pain body for all the women who came after – the line of the story was broken- now we are beginning to re-weave  the storylines
  • FEEL YOUR FEAR – It keeps you alert and assists you to be aware and watch your back, it helps to keep you safe!
  • TO MEET FEAR OPENLY INSTEAD OF CLENCHING AND FREEZING MEANS WE CAN OPENLY RECOGNIZE IT  AND OPEN OURSELVES TO THE POSSIBILITIES OF OVERCOMING IT!
  •  To cleanse yourself of the fear that is felt is a very important tool, then you do not bring every fearful event to each moment of fear.
  • To cleanse and heal gives us the opportunity to work with our fears and grow past them.
  • Fear, anger, jealousy – are all from the primal part of the brain
  • DANGER! – creates adrenaline – enables us to respond – as conscious beings, we can choose how we respond.
  • ADRENALINE – frozen, closedness, hate, fear, or
  • OXYTOCIN – Love, Compassion, caring, openness
  • A woman giving birth runs a 100 times more Oxytocin than at any other time
  • When we run oxytocin at a birth we entrain to the birthing woman and we learn how to be in LOVE   – our brain waves drop through ALPHA- BETA – THETA – Theta waves – being the place where time becomes elastic and brainwaves open so that experiences can be rewritten
  • BE IN LOVE!

Second Stage Difficulties – The Pushing part – Ina May Gaskin

Written by FairyDoula. Posted in Midwifery notes

  • Once the inner mouth opens – the cervix is dilated
  • Tired – take a nap – TO REST IS NOT DANGEROUS!
  • Hot – drink cool water – rest
  • Cold – use a blanket, do some exercise
  • Nipple stimulation can always be benieficial to birth progression
  • A woman’s instincts are the primary answer to what is needed during the 2nd stage
  • ASSIST HER TO LISTEN TO HERSELF BY LISTENING TO HER
  • Food can be instantly benificial to the womans laboring capabilities
  • When the birthing womans experience is longer than the midwives endurance , HAVE A PARTNER!
  • ITS GOOD TO HAVE SUPPORT AND FRIENDS! NEVER BE TOO PROUD TO STEP ASIDE!
  • Toilet seats, birth stools, showers- all these assist in the progress of labor
  • Facial expressions are important during labour – scrunched up face = clenched uterus – relaxed face = relaxed uterus
  • Make the sphincter happy! – quiet , relaxing, dim light, gentle music, sexual attention, sweet smells , warm water
  • Release all tension in the body and brain
  • Sometimes the dimensions of the pelvis need to change to assist the downward movement of the OP ( Occiput- back of babies head- Posterior – facing mothers bottom), high position baby
  • Get the mother to stand upright , a person on each side of he mother places hand s on the top of the hip bones and together they push inwards thus creating a scissor movement in the pelvis making the bottom bones open wider.- or in the words of my 9 year olds son Jake ” If the baby is stuck push on the top sides of the mummies bottom and the baby will come out of the bottom of the mummies bottom! “

* To birth easily*

  •  Watch the partners! if they need to wee and are holding on they will be influencing their woman’s ability to let go.
  •  Tell stories -‘ How I learned to enjoy pooping in labour’, ‘ The princess and the Poo’, ‘ The mole who knew it was none of his business’
  • Make the room smell nice
  • Most fears are just social inhibitions we need to be practical to overcome them
  • ASSIST MOTHERS TO REWIRE THEIR MINDS TO CELEBRATE POOPING AND FARTING TO CREATE POSITIVE BIRTH STORIES!
  • We need to laugh more in labour- it gives us neuro endorphins and oxytocin ( the birthing love hormone) it also softens the pelvis and allows the baby to come down
  • Meconium is not poo! It is intestine packing ! It is not nasty!
  • If there is meconium and the heart tones are good there is no need to worry
  • Heart decelerations are common panic moments but if the baby recovers immediately then it has enough oxygen and there is no need to fear.
  •  Dad is good as furniture and bad as a cameraman
LAUGH MORE LOVE MORE! Ina May Gaskin is an amazing woman – a midwife, author and international birth activist, her books ‘Spiritual Midwifery , Ina May’s guide to childbirth ‘ and ‘A Midwives’ manifesto’ are compelling, enlightening reading. if you haven’t already read them, I advise you to do so! In this session, she also advised that ‘ The Court Midwife’ by Justine Siegermunden was an interesting read.

First Stage Difficulties (the opening phase) – notes – Gail Hart

Written by FairyDoula. Posted in Midwifery notes

PROLONGED LABOUR RISKS

  • Infection, maternal exhaustion, postpartum haemorrhage, fetal distress, fetal injury or asphyxia, low APGAR scores, separation of mother/baby, difficult recovery, postpartum depression, caregiver exhaustion leading to poor decisions.

* To reduce the risk of infection*

  • Preserve membranes
  • Limit internal exams
  • Avoid internal devices
  • Keep mother hydrated and rested
  • Maintain a clean enviroment

* Risk of distress created by*

  •  Stimulated labour
  •  Artificial rupture of membranes( water bag)
  • Maternal low blood sugar
  • FEAR > TENSION > PAIN!
  • Maternal supine ( laying down) position
  • Coached pushing acidosis
  • Manual extraction ( forceps, suction cup)

* Reduce the risks by*

  • Monitor carefully and unobtrusively
  • Listen to baby> You can hear with your ear from the back as well as the front.
  • Augment labour conservatively
  • Assist all involved to be patient
  • Encourage intact membranes
  • Avoid maternal supine position ( lying down)
  •  Encourage active upright positions and side-lying ( Simms or left lateral)
  •  detect and correct malpositions early
  • Maintain maternal blood sugar with food , liquid or sugar
LOVE > RELAXATION > JOY!

* Assess mother and baby*

DONT DO AN INTERNAL EXAM FOR NO REASON – IF YOU DO ONE , DO A GOOD ONE!

  • Monitor closely for signs or symptoms of infection
  • Elevated maternal temperature
  • Rising pulse
  • Increased uterine or abdominal tenderness
  • Exhaustion
  • Signs of true maternal exhaustion
  • Rising pulse and temperature
  • Is there progress?
  • There must be progress even if there is slow progress
  • Mother and baby must remain in a good position
  • Detect heart decelerations
  • Know when to quit*
  • Signs of disproportion between head and pelvis
  • High head – head not engaged and cant be made to engage
  • Asynclitism ( head off to the side not aligned to the bone of the pelvis) – especially increasing degrees
  • Strong contractions ( rushes, surges) without progress or dilatation( cervix opening)
  • Failure of head to flex and descend with strong contractions and good pushing
  • Large and growing caput ( swelling formed on the baby’s head by pressure from the dilating cervix) but with no descent when measured above the pubic bone

*Signs of potential Uterine ( womb) rupture*

  •  A thinning lower uterine segment( may feel like a balloon
  •  Full bladder
  • Rising contraction ring
  • Formation of Bandl’s Ring ( extreme thickening of the ring of normal labour when labour is obstructed. It is able to be felt with the hands as a hard ridge across the tummy)
* DONT EVER LET THINGS GET THIS FAR! * BE PRUDENT, GET HELP * RULE OUT OBSTRUCTED LABOUR!

Prenatal Care to create a positive birth, the Midwives’ role – Gail Hart

Written by FairyDoula. Posted in Midwifery notes

  • Humans believe what they see, they also see what they believe
  • Whatever you do the baby will grow and progress
  • Get women to log the baby’s movements, time, duration, then they will begin to know their own normal and will be able to gauge when things change. ” call me if things change”
  • keep your ego in check! The woman, the hospital, the midwife, the doula all work together as a team to create a positive birth
  •  Let women know that routine ultrasounds have not been proven beneficial to birth outcomes
  • Prevention is better than cure, DIET, EXERCISE, HEALTHFUL LIVING all create positive birth experiences
  • Bacterial Vaginosis ( BV) and Group B Strep (GBS) are both considered causes of preterm birth
  • BV overgrowth is allowed by lack of lactobacilli
  • BV and GBS prefer an alkaline environment
  • Nurture the good guys to reduce the bad guys- a good cup of lactobaccili can protect against BV and GBS, yeast, e.coli, and anaerobes
  • Prepare the soil- raise acidity- vinegar rinse- 2tbsp to 1 pint water
  • Plant the seeds- probiotic yogurt- use directly as a cream
  • Slow down the weeds- practice good hygiene- wash your partner! sex can spread BV and GBS
BE ACTIVELY AWARE SUPPORT CONSCIOUS PREGNANCY!

The Initial Interview – Carol Gautschi

Written by FairyDoula. Posted in Midwifery notes

Notes taken from a talk by Carol Gautschi, CPM LM

Before the first interview

Make sure that the woman knows who you are and how you work- you need to be sure that you are a good match. Having a website can help with this, some details on your website could be

  • How I became a midwife
  • Birth classes I teach
  • How and when I conduct interviews
  • Apprenticeships
  • Herbal birth aids
  • Disclosure- what I offer
  • Recommendations- herbal and dietary
Ask women who call you to visit your website and note down any questions that they have to bring to their initial interview
  • It’s good to work on your perceptive skills, look in their eyes, read their body language.
  • We assist women to own their births- Midwifery is deeply spiritual and the ultimate feminine experience, women together are a tribe.
  • TRUTH , HONESTY AND REALITY CREATE RESPECT!
  • Pregnancy is a path of discovery and we are there to assist and support women on their journey.
  •  If you have no confidence in the woman to birth then get over yourself and pass her on to someone else
  • Assist her to be able to refuse your care – give her the option to finish your relationship
  • Take all women to a ‘Designer Birth’ level of her care – MIDWIFERY IS AN ARTFORM!
  • Do your best to not speak in absolutes-‘ Never’ is not as good as ‘seldom’
  • Continuity of care is really important, it allows the midwife to build a unique relationship with the mother that is filled with LOVE and the more love there is the more oxytocin there is so the better the birth experience will be.

Questions to ask during the interview

  • How is your nutrition?
  • Do you have a homebirth consent form and is it signed?
  • Do you know the risks and benefits of homebirth?
  • What is your and your families birth history
  • How do you deal with pain?
  • Why do you want to have a homebirth?
  • Help the woman and the family to become self-empowered
  • Assist the family to create their own birth experience
  • Be ATTENTIVE, OBSERVENT AND SUPPORTIVE 
  • Become invisible but still assist
  • Give recommendations but release them to make their own choices

Carols Birth Infusion

  • take a handful of organic herbs: 2parts raspberry leaves, 2 parts nettle leaves, 1 part alfalfa, 1 part oatstraw
  • get a litre jug and put the herbs into the bottom of the jug
  • pour boiling water over the herbs
  • cover tightly and let stand overnight
  • strain the mixture and press the juice from the herbs
  • drink freely throughout the day
  • repeat at night                       
MIDWIFERY IS MORE SPIRITUAL THAN MONETARY!

Carol Gautschi is a midwife who speaks so passionately about her art and craft of midwifery that she makes me cry and goose pimples rise on my skin! If you want to know more about her, check out her website – http://gentlebirths.net/ – big fairy love, Lara xxxxxxxxxxxxx

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