Articles by Month: August 2006

Perineal Massage

A recent review of trials of manual perineal massage during the last weeks of pregnancy (Kuehn 2006) has concluded that this technique can help prevent tears to the perineum in first time mothers and reduce the need for episiotomies during normal vaginal births. The reduction is not large (15%) and no doubt is also dependent on the practitioner in charge of the birth (other research has shown that midwives have a better track record than doctors in maintaining an intact perineum) but it is encouraging. Many women hope to have no stitches at the end of the birth day and it is also a goal for many midwives, who see perineal management as a key professional skill.

Of course, not all births will result in no tears, even if great care is taken. Some babies decide to arrive with a hand or arm over their heads; others rush out, leaving little time for the tissues to stretch. Anaesthetics and drugs that upset a woman’s ability to stay in touch with what is happening in her body can also make it hard to give birth slowly and gently, especially if the perineal area is numb and there is no feedback to work with.

Many women are interested in using perineal massage in the last weeks of their pregnancy. A useful place to learn more about this technique can be found on this site sponsored by the University of Michigan.

Some women find that using the Epi-No is a good way to prepare their perineal area for birth. This useful tool can also be used for strengthening the muscles after the birth, to reduce postnatal (and menopausal) incontinence problems due to poor pelvic floor muscle tine. There are more details about the Epi-no here.

Kuehn B. Massage during last weeks of pregnancy reduces episiotomies during delivery. JAMA 2006; 295:1361-1362.

Posted by andrea at 05:26 PM

Ultrasound in pregnancy - not as safe as you think?

Many years ago (1980s) questions were raised about the safety of ultrasound scans for the unborn baby. Concerns centred around an effect which had been observed when cells were bombarded with ultrasound waves at levels used for visualisation. It was noted that cells that were normally arranged in orderly rows became jumbled up and erratically organised. This led to speculation that growth may be affected - cells in the developing fetus that were. not in neat alignment may grow haphazardly, perhaps resulting in a smaller size of the baby. This proposition was reinforced by a landmark study done in Western Australia by Dr John Newnham who was investigating the effects of serial ultrasound scans during pregnancy on the baby. He found, unexpectedly, that those babies scanned more than twice were smaller than those scanned less often - not a great difference (around 30 grams) but still significant.

Another concern raised was the impact that scans might have on the ova present in unborn baby girls. These cells are fully developed in the ovary very early in pregnancy (around 8 weeks) and it was suggested that ultrasound waves that disorganised these specific cells may have later ramifications for fertility. This proposition has not been tested (to my knowledge) but makes sense from a biological perspective.

The simple fact is that there is very little evidence of the long term effects of ultrasound scans on the baby during pregnancy. It is clear that there are no major effects, since these would have shown up quite early but more subtle effects, like a tendency towards left-handedness have been demonstrated in babies who were subjected to several scans before being born. Less obvious impacts, such as smaller stature, impaired fertility etc would take considerable effort to investigate fully, and there just doesn’t seem to be enough concern or incentive (or resources) to undertake this work.

At the same time, there is an increasing market for scans and the equipment being used is becoming much more advanced and powerful. These days 3-D ultrasounds can provide a very clear picture of the baby, and to achieve this prenatal snapshot, the baby must be subjected to much higher intensities of ultrasound waves for longer periods. Shop front ultrasound stores have sprung up, encouraging expectant parents to get early pictures (even movies) for their albums, and the operators of this highly sophisticated equipment may have no medical training.

Recent articles in the British press have highlighted this development and warned parents that they may be exposing their babies to unnecessary risks and unknown consequences when they buy these images. After years of promoting ultrasound as “safe”, the medical profession is finally admitting that there are potential problems with overexposure to ultrasound waves in pregnancy. Parents don’t often realise that the hand held sonicaids and dopplers used to listen to the bay’s heartbeat also use ultrasound and that the information provided by electronic fetal monitoring, which is heavily relied on to measure fetal well being during labour is also acquired through continuous ultrasound waves beamed at the baby, often for many hours. Baby’s developing systems are therefore experiencing ultrasound waves quite frequently, adding up to a considerable level of exposure over the entire pregnancy.

Various medical bodies in the US, UK and Australia have warned of over exposure and suggested that pregnant women limit their scans to two during pregnancy. However, the seductive nature of the advertising, the natural curiosity of pregnant parents and the money making opportunities presented by ultrasound scans (for doctors and shop-front operators) are powerful influences.

As one of my colleagues noted in a wry comment on the Australian midwifery email list, “I've personally wondered if ultrasound isn't a way that will naturally limit white middle class populations. A ready built population control mechanism. One way of dealing with the crazy consumerism plague of western civilisation.” She might be onto something there!

More useful information can be found in in "Ultrasound Unsound".

Posted by andrea at 01:05 PM

New workshop for educators

I have put together a new program, on the theme of “The Essential Educator” in response to requests for a one-day program on teaching skills for childbirth educators. This workshop will focus on some of the basics and also serve as an introduction to the new teaching kits that we have developed for use in parent education programs. Those who have already purchased one of these innovative kits will be able to attend this workshop for free and those who pay will receive a voucher to the value of the workshop registration for use when they purchase one of the kits. This effectively means the workshop is free to those who will be using the new Essential Educator kits.

The feedback we have had since the launch of The Essential Educator kit last month has been wonderful. I can almost hear the sighs of relief from educators at the thought of having professionally produced handouts and materials for use in their programs and some clear guidance about facilitating group work and practical sessions.

I’ve been asked if some of the component parts are available to purchase separately and the answer to this is no. The components of the kit are integrated and need to be used collectively - this is especially true of the Birth Day panels. These magnetic boards (and their magnets) work in conjunction with several other activities (the Positions Scenarios, self-help practical sessions, Obstetric Intervention and Medication Templates and the various charts) and without these additional materials the effectiveness of the Birth Day panels will be diminished.

If you haven’t had a look at these kits in detail, check them out on the website. The full day workshops will be scheduled in various cities over the coming months, initially around the UK and Australia, but also further afield.

We are also offering some “showcase events” that basically just explain the kits and provide an opportunity for midwives and educators to see what they offer. These are free half day events and at present are only scheduled for the UK ( in September). Registration is necessary as places are limited.

The website has all the details.

Posted by andrea at 04:08 PM