Childbirth expert: Midwifery lecture in Jerusalem

Vol XXVI: Great Shape/YMCA, specialists in Pre-natal and Post-natal Health and Fitness are organizing "A DAY WITH INA MAY GASKIN" at the Jerusalem International YMCA, 26 King David Street, Jerusalem, on June 17th, 2008.

By RACHELLE OSERAN
July 3, 2007 11:09
Childbirth expert: Midwifery lecture in Jerusalem

rachelle and babies. (photo credit: )

 
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Rachelle Oseran is a Lamaze Certified Childbirth Educator with 23 years of experience working with pregnant and postpartum women. She is also a fitness professional certified by ACE (The American Council on Exercise) and a certified prenatal and postnatal exercise instructor. She co-directs Great Shape Exercise Studio at the Jerusalem YMCA. Rachelle also teaches Lamaze childbirth preparation classes and can be reached at www.childbirtheducation.co.il * * * Volumes I - IX Volumes X - XV Volumes XVI - XX * * * Vol XXVI Great Shape/YMCA, specialists in Pre-natal and Post-natal Health and Fitness are organizing "A DAY WITH INA MAY GASKIN" at the Jerusalem International YMCA, 26 King David Street, Jerusalem, on June 17th, 2008. Ina May, popularly known as "the most famous midwife in the world", has lectured at midwifery conferences and medical schools around the world. Her promotion of a low-intervention but extremely effective method for dealing with one of the most feared birth complications, shoulder dystocia, has resulted in that method being adopted by a growing number of practitioners. The "Gaskin maneuver" is the first midwifery or obstetrical technique named after a woman and is officially recognized in obstetrical literature. Ina May inspired women around the world to become midwives through her workshops and her two books, "Spiritual Midwifery" and "Ina May's Guide to Childbirth". She will share her rich experience and wealth of knowledge of practical techniques for professionals as well as means for empowering women during birth. Although the conference is geared to childbirth professionals (and anyone else in the public who wants to be inspired by Ina May), there will be a "Childbirth Expo" (companies exhibiting the latest products related to pregnancy, childbirth, the postpartum period and babies) that will be open to the public from 9.30a.m. - 1.00p.m. and 2.15p.m. - 6.00p.m. Entrance to the Childbirth Expo is free, but registration (for a fee) is required for Ina May's lectures. The program will include welcome remarks by Rachelle Oseran, Co-Director, Great Shape/YMCA and Debby Gedal-Beer, Secretary of the Israel Midwives Association. Workshops with Ina May Gaskin: Surviving Shoulder Dystocia, Sphincter Law and its Implications for Birth in the 21st Century and Sustaining Women's Inner Wisdom in Birth: The Role of the Childbirth Professional. A light lunch (Kosher L'Mehadrin, Jerusalem Rabbinate) and refreshments will be served. For more information call (02) 6258436. Vol XXV Q: I am an International Board Certified Lactation Consultant. I will be visiting Jerusalem in Sept. and I am looking for someone to help me coordinate a free Lactation Class for the prenatal & postpartum Moms in Jerusalem. Would you be able to put me in contact with someone who would help me coordinate this event? A: Thanks for your question. I know that certification by the IBCLC is very highly regarded and your willingness to share your knowledge with new mothers in Jerusalem is very generous. However, I have had a great deal of difficulty finding a suitable venue and host for this event. I, personally, will not be in the country in September and I have tried several colleagues, from independent Lactation Consultants to the La Leche League organization as well as the Association of Americans and Canadians in Israel, but have not succeeded in finding a suitable framework for your presentation. I suggest that you contact me directly at rachelle@ymca.org.il and I will give you names of colleagues you may wish to contact directly. Sorry that I couldn't be of more assistance. Rachelle. * * * Vol XXIV Q: I am 4 months pregnant, I live in Tel Aviv and am looking for any support - prenatal classes, breastfeeding classes etc in English. I am not Olah Hadasha. A: There are several English-speaking childbirth professionals in the Tel Aviv and outlying areas. Rachel Gambash (052-6710168) lives in Hod Hasharon and teaches childbirth preparation classes and breastfeeding classes in English. Paula Aji (052-8034490) lives in Tel Aviv and teaches childbirth preparation classes (modified hypnobirthing) in English as well as prenatal meditation/discussion/support for expectant couples. Camilla Isaac Elani (054-4810172) lives in Raanana and teaches parenthood preparation (in English) privately in the couple's home. Dyada pregnancy, childbirth and parenting center (www.dyada.co.il) has prenatal yoga and prenatal toning classes. Although these classes are generally conducted in Hebrew, many of the instructors speak English. I hope this helps. Q: I delivered a child in late August by cesarean. I just want to ask when can I exercise fully, like playing badminton? According to my ob-gyn, I'd be allowed to play badminton after 6 months. Can I be allowed to play badminton now . . . which is 3 months after my delivery. A: There are many different types of exercise and badminton falls into the category of intense exercise. After birth, especially after a cesarean, a woman should begin with mild exercise and slowly increase the intensity. There are different recommendations for returning to exercise, based on the type. Badminton is a high impact, high intensity exercise that involves fast, sudden moves. While the hormone, relaxin, that relaxes the joints leaves the body right after birth, its effects last between 3 and 6 months after birth. I don't know if your doctor was referring to the recovery of the incision when he/she suggested waiting 6 months before playing badminton or to the potential for joint injury which is certainly possible given the ballistic nature of the sport and the joint laxity that you may still be experiencing. I suggest that you take your doctor's advice regarding badminton, but there are many other fitness activities that you can safely engage in now. Q: Hi, My wife and I recently found out we are pregnant with our third child. She took the pregnancy test and it was positive. For the past couple of weeks prior to us finding this out, my wife had a severe sore throat and was taking a full course of moxipen antibiotics and advils to sooth her pain. We've visited her doctor and he seems to think that there is no likely effect on the fetus but we're not sure. Next week my wife is going to take the blood test and on the 22, we're scheduled to do an ultrasound. Q. what are our chances that the fetus might (knock on wood) be affected by the medication that my wife took during the very first days of being pregnant? A: A teratogen is an agent, such as a drug, a virus or radiation, that causes malformation of an embryo or fetus. I suggest you contact the national teratogenic office at (02)6243663. They would have the information you are seeking and can hopefully put your minds at ease. Q: Hi there! I'm now 37 weeks pregnant and was just diagnosed with Gestational diabetes. I know many hospitals insist on a C-section at 4K. Besides a home birth, is there any way to fight for a natural delivery? I've only been here 10 weeks, and am still getting the hang of "the system" as it's so very different from America. Thanks for any help. A: The glucose tolerance test to determine high levels of blood sugar is usually performed between 24 and 28 weeks of pregnancy. However, it is often not accurate. According to midwife Ina May Gaskin in "Ina May's Guide to Childbirth" (Bantam Dell, 2003) "Between fifty and seventy percent of women, if retested, will have a different result than they got from the first test". "A Guide to Effective Care in Pregnancy and Childbirth" by Dr. Murray Enkin et al (Oxford University Press, 2000), states that "Up to 30% of mothers with an abnormal glucose tolerance test have a baby with a birthweight of more than 4000g. Clinical judgement, however, based on assessment of prepregnant weight, weight gain and a pregnancy past 42 weeks, without any reference to glucose tolerance, is more predictive of fetal macrosomia (a larger than average baby) than is the glucose tolerance test". Having a baby over 4000g in a normal pregnancy is not a reason for a cesarean, but the situation changes with gestational diabetes. Some doctors in Israel will perform a c/s on a mother with gestational diabetes if the baby weighs 4000g, while others will perform a c/s if the baby weighs over 4,500g. A crucial consideration is the estimate of the baby's weight through ultrasound, which is often unreliable, and can overestimate the size of the baby by 500g. or more. There are Ob/Gyns. who specialize in ultrasounds and are far more experienced in estimating a baby's weight than ultrasound technicians. I suggest that you discuss all of the above information with your physician before deciding how to proceed. * * * Vol XXIII Q: Hi, I was told by a security agent in the airport that it is not safe to go through metal detectors during pregnancy. Is this true? This is very hard to do in Israel where there are detectors everywhere!!! A: The low frequency electromagnetic field in the arc of a fixed frame walk through metal detector is nonionizing radiation and not x-rays. The same is true of a hand held scanner. They are different from x-rays in that they do not increase tissue temperature or cause any maternal or fetal nerve stimulation and are therefore considered safe during pregnancy. The type of low frequency electromagnetic radiation they emit is the same as our daily exposure from power lines and household appliances. The x-ray machine that scans carry-on items is well shielded so that walking past the machine does not pose any health risk to pregnant women. As with any aspect of pregnancy, you have the right to make decisions for yourself and your unborn baby. Even though these metal detectors are safe during pregnancy, if you still feel uncomfortable walking through them, you can ask to be hand-searched by a female security officer. Q: I have really enjoyed reading your column on JPost.com, and have a question for you. How many ultrasounds are safe for a baby? Has there been any real research on the effects in this area? I've heard Israel does many ultrasounds comparatively, and would like to gather more information before going along with all the doctor says. Thank you so much for your help! SS A: : Thank you for asking this important question. Ultrasounds are ultra-high frequency sound waves emitted by a transducer that is moved over the mother's abdomen, producing a picture of the baby in the uterus. In Israel this diagnostic test is done routinely 2 - 4 times during the pregnancy, though some doctors (almost always those who have ultrasound equipment in their offices) perform ultrasounds at every prenatal visit. Most ultrasound machines use pulses of ultrasound that last a fraction of a second. The time between the pulses is used to interpret the scan that returns to the machine. Doppler techniques used in specialized scans and fetal monitors use continuous waves of ultrasound. The World Health Organization maintains that routine ultrasound testing has not been sufficiently evaluated to let the practice go unquestioned. The primary concern is the effect of ultrasound waves on fetal brains. The Federal Drug Administration (FDA) of the USA states, "Ultrasound is a form of energy and, even at low levels, laboratory studies have shown it can produce physical effects in the tissue, such as jarring vibrations and a rise in temperature." They maintain that prenatal ultrasounds can't be considered completely innocuous. It is important to differentiate between selective and routine use of ultrasound. The time taken to do the scan, the type of equipment used and the experience of the technician also need to be examined. Ultrasounds can provide important information in specific clinical situations, such as if a fetus is alive or dead, to predict whether a pregnancy will continue after a threatened miscarriage and gestational age (particularly when this is done in the first or early second trimesters). Ultrasounds can also often diagnose a malformation and can be used with additional testing such as amniocentesis or chorion villus sampling and are used to assist procedures such as a cervical cerclage or external cephalic version (turning a breech baby). It can assess fetal growth in the second half of the pregnancy and can locate the position and health (grade) of the placenta. It can be used to confirm a suspected multiple pregnancy, assess the amount of amniotic fluid (this can vary based on the time of day and the amount of fluid ingested) and determine the fetal position (this can be assessed manually by a skilled practitioner). Ultrasound waves affect the tissues in two ways. Firstly, the sonar beam heats the highlighted area and, secondly, the small pockets of gas that exist in the tissue being scanned vibrate and then collapse (an effect known as cavitation). Many animal studies have indicated that the effects of ultrasound waves can be harmful to the central nervous system. Human studies have shown that ultrasound testing during pregnancy shows possible adverse effects including "premature ovulation, miscarriage or pre-term labor, low birth weight, poorer condition at birth, perinatal death, dyslexia, delayed speech development and less right-handedness. Non right-handedness (left-handedness and ambidexterity) is a consistent finding in many studies and is, in other circumstances, seen as a marker of damage to the developing brain." ("Gentle Birth, Gentle Mothering" by Dr. Sarah J. Buckley, One Moon Press, 2005). Many physicians claim that the benefits of ultrasound outweigh the risks, but a large randomized trial of 15,151 pregnant women, conducted by the RADIUS Study Group, found that in low-risk pregnancies, 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 (Ewigman, B.G. et al 1993 "Effect of Prenatal Ultrasound Screening on Perinatal Outcome" N. Engl. J. Med. 329 (12); 821-27). Some suggestion has even been made connecting frequent use of ultrasound in pregnancy with the steep increase in autism ("Questions about Prenatal Ultrasound and the Alarming Increase in Autism" by Caroline Rodgers in Midwifery Today, Winter 2006, # 80). An important consideration in the decision to have ultrasound testing in pregnancy is the mother's emotional attitude. Some women are eager to "see" their babies in utero and are more relaxed knowing that the baby is developing normally. This is often a positive step in developing the bond between the mother and her baby. Other women, however, feel that ultrasound is an invasion of the baby's privacy and feel that the magical nature of the pregnancy is being medicalized. Another consideration is what you plan to do with the information provided by the ultrasound. When used for diagnostic purposes, ultrasounds can lead to life-saving fetal surgery or can prepare specialists to be on hand at the birth to provide immediate care for a specific problem. However, when used routinely, ultrasounds can often be a cause for unnecessary anxiety without any benefit. Ultrasounds often pick up inconclusive abnormalities in late pregnancies when nothing can be done about them and the mother remains anxious until and frequently even after the birth which can adversely affect her bond with her baby. Doctors sometimes suggest that, based on an ultrasound in late pregnancy, the baby appears large and suggests induction before the due date to prevent a "difficult labor". In such cases, it is important to understand that the ultrasound can miscalculate the baby's weight by half a kg. and induced labor usually results in a more "difficult labor". If you are concerned about having unnecessary ultrasounds, I suggest you discuss your concerns with your doctor. Dr. Sarah Buckley also suggests having the technician or doctor sign a paper stating the reason for the ultrasound, the type of equipment used, the duration of exposure and any other pertinent information to raise awareness of the ultrasound dosage on your baby. Also make sure to ask for the shortest exposure time possible. * * * Vol XXII Q: Hi. My baby has been in the breech position (feet down) - I thought it had turned as felt strong movement under my ribs but now think it has turned back again. Is there still plenty of time for it to turn into the head down position naturally - I am 31 weeks and this is my first pregnancy. Any tips for getting the baby to turn? Thanks. A: Babies usually settle into their birth position by the 34th or 35th week. After that there is less room for the baby to turn, though it is still possible for the baby to turn at the end of the pregnancy. Before you begin any of the natural/alternative/medical techniques to try to turn a breech baby, it is imperative that you establish the position of your baby. If your baby has turned to a vertex presentation (head down), then you shouldn't try any of these methods as the baby could then turn back to a breech position. Look at this website to see if you can determine the position of your baby. This should, however, be verified with a doctor or midwife. If the baby is still breech, around the 36th week you could try to turn the baby using positioning, acupuncture or moxibustion (Chinese medicine). A detailed explanation of these methods can be found on the website www.birthinternational.com Click on "Articles" and then scroll down to "If your baby is breech". If none of these methods helps, you should find a doctor who has a high success rate in turning the baby manually. This is known as External Cephalic Version and should only be attempted at 38 weeks. If the baby remains in a breech position, there is often a very good reason why the baby won't turn which might have something to do with the placenta or the umbilical cord. You may find doctors or midwives in England who are experienced with vaginal breech births, assuming that the baby is in a position that is deliverable vaginally. Good luck, Rachelle. Vol XXI Q: I am 8 1/2 months pregnant, and have been told that to do the perineum massage 3-4 times a week can help reduce tearing. I have also been told that it can cause an infection. What is your suggestion? A: Prenatal perineal massage is, indeed, recommended for reducing perineal trauma during childbirth. The Cochrane Database reviewed studies that included 2,434 women. They state: "Most women are keen to give birth without perineal tears, cuts and stitches, as these often cause pain and discomfort afterwards, and this can impact negatively on sexual functioning. Perineal massage during the last month of pregnancy has been suggested as a possible way of enabling the perineal tissue to expand more easily during birth. The review of trials showed that perineal massage, undertaken by the woman or her partner (for as little as once or twice a week from 35 weeks), reduced the likelihood of perineal trauma (mainly episiotomies) and ongoing perineal pain. The impact was clear for women who had not given birth vaginally before, but was less clear for women who had. There were no randomized trials on the use of massage devices. Women should be informed about the benefits of antenatal perineal massage." (Beckmann MM, Garrett AJ, 2007). I have never heard of perineal massage causing an infection. To verify this, I did a Medline search and read through 59 research studies on prenatal perineal massage. I didn't find any reports of perineal massage causing an infection, though it's possible that this has happened in isolated cases. To reduce the chances of causing an infection, whoever is doing the massage (you or your partner) should have clean hands and should not touch the urethra, as urinary tract infections are common during pregnancy. There are a variety of methods of massaging the perineum. Your childbirth educator, doula or midwife can give you advice on technique. The most effective preparation is when your partner does the massage and holds the peak stretch while you focus, relax and concentrate on releasing this area. Your partner may then be able to take the stretch a little further, repeating this technique each time. Good luck. * * * Cafe Oleh experts have been chosen for their knowledge and reputation. Cafe Oleh does not take responsibility for any advice they offer. Send your questions for Rachelle


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