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Food As Medicine Event

 

The Food As Medicine (FAM) event held in Cherry Hill, MJ was a tremendous success.

Kayla Gorrell led us in simple yoga stretches between lectures.  Michelle Aurich, cheerleader for the Eagles, described how the Plantbased diet and decreased stress helped her cure her skin disease.  A fabulous vegan breakfast and lunch were served.  Be on the lookout for our FAM event 2020 and plan to attend so you can be motivated to make changes in your life for a healthier YOU!

 

 

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The Rhombus of Michaelis

By Cathy Daub with extracts from midwife, Jean Sutton

“The Rhombus of Michaelis?” people ask, “What’s that??”  Most women giving birth have never heard of it before and yet it plays a key part in every birth.  I first heard about it from midwife Jean Sutton in New Zealand.  She went back and studied the old midwifery texts where it was described but now has been largely forgotten in our modern day technological society.

So what is the Rhombus of Michaelis and where is it?  It was identified in the literature as early as 1932 when a New Zealand obstetrician named Corkill discovered an increased space in the outlet of the pelvis during the second stage of labor.  Later, Michel Odent MD identified a possible link to the Rhombus of Michaelis when he described the fetus ejection reflex.  It might also be called the G-spot.

If you take your hand and place it vertically over the low sacrum so your fingers are pointing down towards the gluteal crease, then the flat palm of your hand is right over the Rhombus of Michaelis.  It is in the shape of a kite and includes the three lower lumbar vertebrae, the sacrum and the long ligament that reaches down from the base of the skull to the sacrum.  It is basically a plexus of nerves that serve an important function in labor.

When a pregnant woman is about to give birth, and if her baby is facing towards her spine, the baby’s head will press against the Rhombus of Michaelis nerves causing them to contract and “open her back”  slightly, with the result of hiking her left hip and angling her birth canal towards the back where babies are meant to be born.

Here is a description of the Rhombus of Michaelis as given by Jean:

This wedge-shaped area of bone moves backwards during the second stage of labor and as it moves back, it pushes the wings of the ilea out, increasing the diameters of the pelvis.  We know it’s happening when the woman’s hands reach upwards (to find something to hold onto) , her head goes back and her back arches.  It’s what Shelia Kitzinger was talking about when she recorded Jamaican midwives saying the baby will not be born ‘till the woman opens her back.’   

I’m sure that is what they mean by the ‘opening of the back.’   The reason that the woman’s arms go up is to find something to hold onto as her pelvis is going to become destabilized.  This happens as part of physiological second stage: it’s an integral part of an active normal birth.  If you’re going to have a normal birth, you need to allow the Rhombus of Michaelis to move backwards to give the baby the maximum amount of space to turn his shoulders in.  Although the Rhombus appears high in the pelvis and the lower lumbar spine when it moves backwards, it has the effect of opening the outlet as well.

When women are leaning forward, upright, or on their hands and knees, you will see a lump appear on their back, at and below waist level.  It’s much higher up than you might think; you don’t look for it near her buttocks, you look for it near her waist.  You can also feel it on the woman’s back.  It’s a curved area of tissue that moves up into your hand, or you may suddenly see the mother grasp both sides of the back of her pelvis as the ilea are pushed out and she is suddenly aware of those muscles that have never been stretched before.  Normally, the Rhombus is only out for a matter of minutes, it comes out just as second stage starts, and it’s gone back in again by the time that the baby’s feet are born, in fact, sometimes more quickly than that.

Positions that interfere with movement of the sacrum include:

  • Women lying on their backs with knees pulled up which presses their sacrum down, not allowing it to move.
  • Women with an epidural have their nerve supply interfered with so that the impulse for it to happen is obstructed.

Jean goes on to tell us what pregnant women need to know:

  • If they want a short second stage of labor and don’t want to spend a long time pushing, they need to make sure their pelvis will open to make enough space for the baby. This is perfectly safe so long as they have something to hold onto, and that the contraction of the nerve plexus (Rhombus of Michaelis) will relax as soon as their baby is born.
  • They shouldn’t allow anyone else to move their legs while they are in the second stage of labor because they can feel which way to move their body to give birth. Another person moving their legs may lower the leg in such a way that the pelvis goes back into the “wrong place” – and women in labor who are feeling their contractions will know what this means.
  • Movement of the sacrum has the effect of opening the diameters of the pelvis. Being upright the pelvis has more space in which the baby can move and a woman births with the help of gravity instead of against it.
  • Although epidurals are great for pain relief, they get in the way of a spontaneous second stage and vaginal birth. In many cases, the reason they’ve got an epidural is that the baby wasn’t in the best position when it started, and the baby in the less suitable positions needs all the space he can get to turn around in.
  • The OP (Occiput Posterior) baby needs the Rhombus of Michaelis to move backwards so he has room to turn around so he can come out as an OA (Occiput Anterior)
  • Many women fear damage to their pelvic floor but if they can be in an upright position with their weight forwards so the rhombus is free to move, very little damage is done to their internal anatomy.

Jean summarizes the importance of the Rhombus of Michaelis by saying that:

If midwives want to be assisting women to have as many normal births as possible…to be able to promise women that birth is quite manageable…that they don’t need to have the interventions…that it’s simple and it’s safe, as long as it follows the process, then having the back open is just part of that process.

References:

Sutton J (2000) Birth without active pushing and a physiological second stage of labour.  The Practicing Midwife, Vol 3, No 4. Pp 32-34.

Kitzinger S (1993) Ourselves as Mothers.  Bantam, London.

Corkill TF (1932).  Lectures on Midwifery and Infant Care.  Whitcombe-Toombs, New Zealand.

Oden M (1987) The fetus ejection reflex.  Birth, Vol 14, No 2, pp 104-5.

 

 

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The Media

by Tara Thompson,  Doula Student   BWI

I truly believe the media as a whole does a grave disservice to mothers-to-be when it comes to pregnancy and childbirth. The majority of what we see on television inaccurately portrays birth in ways that leave women feeling fearful and having unrealistic expectations of their upcoming birth. It also misleads society which effects how women are treated in pregnancy and in childbirth. Overall, normal physiological birth in its rawness is very rarely even seen in the media. I believe this has impacted medical treatment in ways that have led to more interventions, as most providers have likely never seen normal birth and have a difficult time applying the lack of familiarity to their practice. Ignorance can lead to fear of the unknown.
Growing up, I loved watching The Learning Channel “TLC” and their shows that I thought depicted real life. They had shows such as “The Baby Story” or “Maternity Ward”. Many of the episodes portrayed birth as painful and I almost always felt as if it was an emergency in need of medical interventions.  This was my first glimpse into birth, and like me, it was likely many other’s first view into “real life” birth.  It was scary!  Fortunately, I have grown to learn, through education and personal experience, that birth is not often an emergency in need of such interventions, but I often wonder how many people still believe these older shows to be a true depiction of childbirth.  How many people lack trust in their body’s and in women.  The introduction and opening credits to the show says it all.  Here is an episode of Maternity Ward:  http://vimeo.com/12675921

An older movie, The Blue Lagoon, was able to allow viewers an opportunity to see an uninterrupted birth being acted out.  Because the plot of the movie was how a boy and a girl would behave naturally without any influence from society, it was able to show that birth could happen naturally.  The film came with its harsh criticism, and or course, it was acting.  I did appreciate the idea of the human capability of giving birth uninterrupted.

The Business of Being Born made huge strides in showing the world what birth could look like.  It was a great way for mass media to reach a larger crowd on the effects of society and medical intervention on birth and its consequences.  It allowed natural birth to have the spotlight without ignoring that emergencies can happen (though not with every birth) and that modern medicine can play a positive role in birth (when it is needed and necessary).  I had already given birth to my first son before I saw this film, but I am not exaggerating by saying it was this film, paired with my instincts that changed my perception on birth.  I gave little thought to the effects of something as simple as hearing a machine beep during labor to having pitocin.  I didn’t think of the impacts of lacking skin-to-skin immediately after birth, even if my gut was telling me I wanted it.  This film put the science and facts behind what has always been instinctual to mothers.  These include being private in labor, limiting stimulation of the frontal lobe, avoiding unnecessary interventions and encouraging the body’s natural hormones to foster labor, coping with labor, and the mother/baby bond that also affects breastfeeding.  While the Business of Being Born was impactful in many ways and arguably showed birth more truthfully, the audience tended to be those who already agreed with the message.  Here is a clip from Monty Python that was used in the film:  https://www.youtube.com/watch?v=arCITMfxvEc.

I find that as a doula, I encourage women to look within for information on childbirth.  Birth is instinctive!  While the media may or may not get childbirth right, it is never beneficial to ignore one’s natural instincts and adhere to what we see on TV.  Trust your body, respect your body and listen to your body.  Most of preparing for childbirth is relearning what we already knew all along, but perhaps the media has led us astray from that.

 

 

 

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A Mothering/Fertility Slavic Textile Doll

by Yulia Welk, CCE, BWI

Crafts can serve a role of ritual, strength and healing through working with mental images, fabric and old handmade Russian tradition of making charm dolls.

I have been making Russian traditional fabric dolls for five years now, they are very numerous and unique (check my Instagram at yulia_welk).  I currently have an exhibit of 25 dolls at the local library (Drummond Public Library, Wisconsin).

A couple of them historically are devoted to the subject of fertility, pregnancy and mothering.  In the dolls, besides making the head, body and dress, we also make breasts as an important symbol of nourishment for future babies and having enough gut, energy, strength, responsibility and health for tackling those tasks.

These dolls serve as visual guides for girls’ passage into womanhood.  The dress represents the ancient way of dressing for girls and women, as a collector of feminine energy that comes from the earth, being a creator, materializer, and having grounding aspects of femininity.

The second doll is called Pregnancy Doll.  She is made with colorful fabrics (red shades are important as being the charm, protective color that also represents life, blood, and energy needed for carrying the baby in the womb.   The doll has a belly with a real baby doll wrapped inside.  A woman would make a little girl or boy fabric baby, wrap it in the pink fabric, cover with the roll of birth bark and wrap in in the belly of the pregnant doll.

This doll serves as charm, protection and concentration of positive vibes for women.  Making it, women would talk about fears, concerns, birth and mothering.  The doll is publicly displayed until the baby is born.  If the outcome is a healthy happy baby this doll becomes a family, a clan female harm, that is inherited and used for future generations.  If anyone is interested in learning how to make these useful charms (we can do it online, $25 per person), please contact me through my website:  www.yulias.net or my home number 1-715-798-3175.

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Pushing in Labor??

By Horatio Daub MD, MPH  and Cathy Daub PT, CCE and CD(BWI)

A recent study in the Journal of American Medical Association1, October 9, 2018, found that delaying pushing once full cervical dilatation is reached for 60 minutes vs. immediate pushing had no significant effect on the rate of spontaneous vaginal delivery (85.9 % in the immediate group vs. 86.5% in the delayed group). However there were significant differences in the incidence of postpartum hemorrhages (2.3% in the immediate pushing group vs. 4.0% in the delayed pushing group) and chorioamnionitis  (6.7% in the in the immediate pushing group vs. 9.1% in the delayed pushing group).

This contradicts the previously held beliefs that delayed pushing results in a better chance of having a spontaneous vaginal delivery and is safer for the mother and baby.  In fact, the study was stopped early because of lack of effect of the delayed pushing on the percentage of spontaneous vaginal births and the significantly increased morbidity from higher rates of postpartum hemorrhage and increased rates of chorioamnionitis increasing the morbidity for mothers and babies. The new recommendation to not delay pushing once full cervical dilatation is achieved is supported by the findings of this study because of the significantly decreased morbidity for mothers and babies with immediate pushing.

There are some important points to consider:

  • First, regional anesthesia would confine women in labor to beds and not allow them to walk & move their bodies thus allowing easier movement of the baby down the birth canal assisted by gravity rather than fighting it when they are confined to bed in a supine position.
  • Second, this study assumes that the experience and outcomes of birth are improved with regional anesthesia numbing them to the experience of birth. There are no studies to support this hypothesis.
  • Third, the study ignores evidence that using non-pharmacological comfort measures in place of regional anesthesia reduces cesarean sections in birthing women when they are mobile, upright and free to labor in whatever place and position, works for them.
  • Fourth, the study assumes women with partially paralyzed, desensitized abdominal muscles can effectively push a baby out of the birth canal. Birthing women are basically being set up for failure by being anesthetized and partially paralyzed and being confined to the “stranded beetle” position hindering the natural progression of labor and delivery. In addition, with regional anesthesia, both motor and sensory nerves are blocked, making it impossible for her to walk or use her legs to change her position.

But what if women learn that positioning themselves in such a way that they are working with gravity instead of against it, only bearing down slightly when their body demands it at the top of a contraction, to be a less stressful and easier way to birth their babies?  Then they don’t need as much power from their abdominal muscles and they can more gently birth their babies.  They instinctively follow the cardinal movement of their babies moving and rotating through the pelvis to be born.

Reducing unnecessary cesarean sections was the topic of the recently published “Non-clinical interventions to reduce unnecessary caesarean sections by the World Health Organization (WHO). (Read more in our upcoming November Enews).   These recommendations target women, health-care professionals, and health organizations, facilities or systems. For women it addresses what they call “Psychoeducation” where childbirth preparation can help address fear of pain and labor, and explain stages of labor, hospital routines, the birth process, and pain relief among other topics.  Their recommendations include nurse-led applied relaxation training programs, and normalization of individual reactions.

Today, too few pregnant women are receiving comprehensive childbirth preparation for their upcoming births.  In BirthWorks, we advocate birth education to be very early in pregnancy or even before pregnancy.  Our program is comprehensive and integrates the mind, body, and spirit through the practice of human values.  Working with the mind means helping women to release fears and feel safe having women choose the people & environment for her birth.  For the body, it means finding optimal pelvic positions that ease movement of the baby through the birth canal, the value of mother/baby skin-to-skin contact, the physiology of birth, and more. For the spirit, it means knowing that all women are born with the knowledge about how to give birth, believing it, and having patience.

Non-pharmacologic methods to ease labor pain and reduce cesarean section are well known but underutilized.  These include relaxing in warm water, moving in labor, keeping upright positions as much as possible, having the presence of a doula to help a woman in labor to feel safe, and having early childbirth preparation. The way to decrease cesarean sections is not to have women lying on their backs with regional anesthesia, unable to move out of bed, but rather allowing women to move and assume the positions that work for their birth.

Why not concentrate instead on ways to help pregnant women develop a new paradigm about birth- one that includes being upright, walking, having comprehensive childbirth preparation that offers both an academic and emotional preparation for birth, finding a safe place to birth, and the value of a doula.

Given the fact that most women in the USA give birth with epidural anesthesia, the researchers were trying to develop strategies to improve the percentage of spontaneous vaginal birth .  Not surprisingly, they found no improvement with pushing early or late in labor in this outcome.  They did find that immediate pushing decreased postpartum bleeding and infections.  In order to make significant decreases in cesarean section and instrumental deliveries, we believe the logical conclusion is to decrease the numbers of women who are anesthetized for their births in the first place.

We recommend that allowing women to use movement and gravity to assist their births along with other non-pharmacologic measures, is what will improve outcomes  for women and babies and decrease cesarean rates the most effectively.

  1. Sperling JD, Gossett DR. Immediate vs Delayed PushingDuring the Second Stage of Labor. JAMA. 2018 Oct 9;320(14):1439-1440. doi: 10.1001/jama.2018.12877. No abstract available. PMID:30304414
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Tips for Sleeping Through the Night During Pregnancy

 

After announcing your pregnancy, one of the first pieces of advice veteran-parents will likely give you is to “get as much sleep as you can now because once the baby comes, you’ll be missing it”.

Unfortunately, it’s not that simple. According to an study published in Sleep Medicine, women experience “short sleep duration, poor sleep quality, [and/or] insomnia” throughout all three trimesters. The study went on to find a direct correlation between sleep quality and stress, and looked at how sleep impacts pregnancy as a whole. Sleep deprivation has a significant impact on cognitive abilities, such as reaction time, alertness, general performance, and even emotion (as if pregnancy by itself doesn’t make managing emotion hard enough).

The good news is that there are a number of ways to help promote quality sleep throughout pregnancy – and even sleep through the night. It may take a little trial and error, though, as there are a number of factors that may be contributing to restless nights.

One reason for poor sleep during pregnancy is general discomfort. As your pregnancy progresses, your body shape changes, making it difficult to find a comfortable position to sleep in. If you are typically a stomach or back sleeper, you may feel particularly miserable, and even unnatural, trying to sleep on your side. To remedy this, try putting a pillow between your knees to help align your hips. You may also find some relief by putting a soft pillow under your growing belly to help support some of the weight. If you’re lacking in extra pillows around the house, there are a variety of “pregnancy pillows” designed specifically for this purpose.

As your baby (and belly) grows, there will be more and more pressure on your bladder – resulting in more and more trips to the bathroom. This is particularly frustrating after you’ve finally fallen asleep (and gets increasingly more frustrating each subsequent time after). Unfortunately, there aren’t any miracle cure-alls for this one, but you can be strategic about hydration. Try to load up on water as much as possible during the morning and mid-day, and then by the evening start to taper off your liquid intake (of course, don’t risk dehydration just to avoid that 12 am wake up).

Stress is another common reason for poor sleep quality for anyone – but even more so for pregnant women. A 2014 study examined stress hormone levels in pregnant women and found that as gestation progressed, the hormone levels increased incrementally. Pregnancy is stressful as it is, there is a lot to worry about (especially if you’re a first-time mom) so the added hormone levels only make it worse. If you’re experiencing insomnia as a result of a racing mind, try using a sleep-focused guided meditation app on your phone to help you fall asleep. Consider investing in a mouth guard if you find yourself clenching or grinding your teeth due to tension. Finally, if the stress is so bad that you still feel exhausted despite getting a full night’s rest, try implementing (appropriate) moderate physical activity, changing up your diet, or limiting your social commitments to allow you to get more rest. Always remember to consult your healthcare provider if the stress, or exhaustion, is overwhelming.

Sleep is essential to a healthy pregnancy, but don’t be too discouraged if you’re not getting as much sleep as you did before pregnancy. The best thing you can do is give yourself some grace and permission to rest during this time, even if that means saying no to a few social events or taking a midday nap to make up for those frequent overnight bathroom trips.

Sarah Johnson

sjohnson@tuck.com

Tuck is a community devoted to improving sleep hygiene, health and wellness through the creation and dissemination of comprehensive, unbiased, free web-based resources. Tuck has been featured on NBC News, NPR, Lifehacker, and Radiolab and is referenced by many colleges/universities and sleep organizations across the web.