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|January 24, 2001
Volume 3, Issue 4
|Midwifery Today E-News
"Transverse Lie"
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Quote of the Week:
"...licensing diminishes accountability to people in favor of accountability to a licensing board."
- Fremont Women's Clinic collective,1977
The Art of Midwifery
Transverse lie is common up to 26 weeks....if the baby remains transverse after 27 weeks and is high in the uterus, listen carefully around the lower portion of the abdomen for placental sounds...to rule out placental praevia.
- Elizabeth Davis, Heart and Hands, 1997, Celestial Arts
Share your midwifery and doula arts with E-News readers!
News Flashes
A Finnish study of the long-term effects of cesarean section looked at the occurrence and outcome of the first pregnancy and first birth subsequent to cesarean section for 16,938 women. There was decreased fertility among the women who had cesareans, as well as increased spontaneous abortion. Induced abortion was increased only among women whose only previous delivery was the cesarean. There were also modestly increased numbers of ectopic pregnancies, and seriously increased numbers of abruptio placenta and placenta previa.
- Amer J of OB and Gyn, 1996, vol. 174, No. 5, 1569-74
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Transverse Lie
Editor's note: We received so many responses to the question about transverse lie [Issue 3:3] that we decided to dedicate this issue to the subject.
[In the case of a transverse lie] If precautions are not taken, when labour begins the fetal shoulder may be forced down toward the pelvis. The membranes are likely to rupture early and the cord to prolapse, while in addition the fetal arm may also prolapse. A midwife would recognize shoulder presentation by abdominal examination, and by vaginal examination, when the shoulder is recognized by feeling the fetal ribs and the hand (to be distinguished from the foot because she can 'shake hands with it'). Vaginal examination is best avoided unless placenta praevia has been excluded.... The more advanced the labour, the more difficult it is to correct the lie; after the membranes have ruptured it may be impossible.
A midwife may find...after the birth of a first twin that
the second child is lying transversely. Immediate action is necessary
and she should correct the lie by external version and rupture the second
bag of membranes, thus stabilizing the longitudinal [head-down] lie
and hastening the birth of the child.
Persistent transverse lie is much less common than breech
presentation, occurring in only 1 out of 500 term pregnancies. Anything
that prevents engagement of the head or the breech makes transverse
presentation more likely. It is also more common in multigravidas because
of the laxness of the uterine and abdominal muscles. Factors that need
to be ruled out include: placenta previa, multiple anomaly, polyhydramnios,
pelvic contraction, and uterine abnormalities. However, cases do occur
where no such associated factors are present.
Understanding and Teaching Optimal Foetal Positioning (2nd
rev ed, 1996) by Jean Sutton and Pauline Scott: A succinct and thorough
manual describing the various types of malpresentations that can interfere
with labor. Includes causes, strategies, and treatments. A must-have!
Birth Concepts, Tauranga, New Zealand. Paper, 69 pages. OFP, $12.50
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Midwifery Today's Online Forum
I recently attended a birth as an assistant where there was a moderate
hemorrhage. Since then in discussion it has been mentioned that there
may be a connection between postpartum hemorrhage and decreased milk supply.
This mom feels that she is not producing enough milk. I have seen this
with another birth about a month ago. Both moms are grand multips in their
early 40s. I wonder if anyone else has heard of this connection?
Question of the Week
Q: Has anyone had a mom who bleeds excessively? This mom has done many herbal/vitamin supplements to build her blood and still has a history of excessive bleeding prior to delivery of the placenta. As her uterus clamps down to deliver the placenta, there is a significant gush of blood. Pitocin has been the only thing her previous midwife used that was effective, but I am looking for an herbal remedy.
- Robe
Send your responses to:
Question of the Week Responses
Q: A friend is due on Feb 8 with her first baby. She is 5' 4" roughly, average weight, and her baby has been in a transverse position for the last few weeks. As far as I know there are no pelvic problems in her history. She has been doing the "lying-on-the-ironing-board" trick to try and turn baby but is looking for other techniques. She asked about moxa and acupuncture, which I didn't know enough about. She is seeing an OB who definitely has the conservative, surgical mindset. She has an appointment in two weeks where a decision will be made about scheduling a c-section. I know sometimes there are reasons that baby stays in a certain position and turning may not be the best thing to do for baby; however, I welcome any thoughts, comments or ideas that might help her have a different option other than surgical birth. She is open to alternatives, so anything is welcome.
- Marisa White
A: I've had some success turning babies using information from an article called "Turn, Baby, Turn" published in Midwives, November 1995, pp 389-391. The article discusses turning breech babies, and illustrates exercises to try.
- Vicky, RM, RN
A: My baby remained transverse until a few weeks prior to delivery. I used the slantboard, did lots of pelvic rocks and lots of praying and talking with my baby. I let the baby know it was getting close to the time for him/her to be born and it was important for the baby to get into a good position for birth. I also manually massaged the outside of the womb in the direction the baby needed to take. The baby turned soon after. I know that talking gently to the baby was very helpful, along with the other techniques. Babies are very intelligent and understand what needs to be done.
- Robe
A: As a doctor of chiropractic specializing in pregnant moms and newborns, I have found that malposition of the baby is due to an imbalance in pelvic muscles and ligaments, causing constraint in the mother's uterus and restricting the baby's ability to get into the best possible position for birth.
I teach my colleagues specific techniques (the Webster In-utero Constraint Technique) that offer a specific chiropractic adjustment to the mother and remove constraint to the uterus. The success rate for babies turning to the vertex position is approx 90%.
Most women have a varying degree of imbalance in their pelvises, some with enough stress to the muscles and ligaments to cause malpresentation. The doctors I am instructing not only work with moms later in pregnancy when there is a malpresentation, but are now caring for women throughout pregnancy to balance pelvic muscles and ligaments early on so the uterus is not constrained.
For additional information and/ or a referral for a DC trained in this
technique in your area you may call the International Chiropractic Pediatric
Association at 1 800 670 KIDS or go to
- Jeanne Ohm DC
A: Use a pen to perform acupressure on the outside lower corner of the little toe nail. Do both sides while "doing the slant-board thing." Also start taking the homeopathic remedy pulsatilla three times a day (three or four pellets under the tongue). As soon as the baby turns head-down, STOP all treatments. Assure the baby and yourself that head down is normal and that the baby will be "held" close after he/she is out, that it is as "safe and loving" outside as it is inside. Lastly, know that this will work, know that you can say "NO" to a scheduled c-sec.
- Jennifer L. West, LM, CPM
A: Moxibustion done by a doctor of Chinese medicine or someone licensed in acupuncture is effective (at least for breech babies) around 80% of the time. I've not heard whether it will turn a transverse, but it doesn't hurt to try.
- Sharon Thornton
A: Turning a baby with a short cord may meet with little success, but a baby can't be born at all in a transverse lie, so assistance in position change is required if she wishes to avoid a c-section. Many doulas know a lot of baby-turning tricks, as do some of those who practice acupuncture, acupressure and moxibustion. Secondly, any chiropractor familiar with the Webster Technique will have a very high success rate. Known for its success at turning breeches, the technique optimizes the functioning of the uterus, which in turn helps babies assume a better position for birth. Finally, and not least significantly, mom should ask her baby what she (mom) needs to do in order for baby to turn to a vertex position in time for birth. Baby may be holding back if mom is holding back or is unresolved about something, so getting quiet and asking baby what is needed, and trusting the answer that comes, may be all that's required.
- Claire Winstone, M.A., R.C.C.
A: Have you considered an ultrasound to rule out anomalies that might affect the baby's lie? Is this a first baby? Sally Kane, CPM, LM
A: Why hasn't anyone suggested ECV (external version) before doing a section? In experienced hands it has an impressive success rate. If it were me, and maternal positioning had not helped, my next choice would be to see an experienced OB or midwife and request ECV, with the understanding that a section may still be needed.
- Jeanne Batacan
A: There is a very gentle way to encourage a baby to turn to a vertex position: use a radio or tape player with earphones. Put on some gentle soft music (classical or the like--do not use rock music), then position the earphones low on the abdomen just above the pubic bone. The baby will often move head down to listen to the music. It works well most of the time.
Definitely do not schedule a c-section as babies often turn just before or in the beginning of labor. The c-section choice is always there later if truly necessary.
- Judy Jones, CPM
A: Have the mom walk on her hands at the pool in the water.
- Mimi
Coming E-News Themes
1. INTERNATIONAL MIDWIVES: Tell us about your practice, birth customs and culture in your country, arts and techniques for the birthing year, your struggles and triumphs!
2. CHARTING CAN BE AS UNIQUE AS EACH MIDWIFE'S CARE. Do you have charting methods you would like to share with E-News readers?
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QUESTION OF THE QUARTER for Midwifery Today magazine
Mamatoto: Motherbaby
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Deadline: March 31, 2001
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More on perineal massage [Issue 3:3]: for more information,
search Medline
Perineal massage in labor (especially aggressive, prolonged perineal 'ironing') *might* cause the tissue to be more susceptible to tears because it might irritate the perineum. Perineal massage prenatally *might* help prevent tearing in women with scar tissue on their perineum. Evening primrose oil has been recommended as a massage oil to help elasticize scar tissue.
Perineal massage *might not* be 'necessary' in a physiologic sense (maybe it doesn't actually stretch the tissue) but it could be helpful for some women as a tool to prepare them for the way stretching sensations will feel.
- Melissa Jones
More on essential oils:
The following list of essential oils, according to the IFA (The International
Federation of Aromatherapists), should NEVER be used [in pregnancy]: bitter
almond, boldo leaf, calamus, yellow camphor, horseradish, jaborandi leaf,
mugwort, mustard, pennyroyal, rue, sassafras, savin, southernwood, tansy,
thuja, wintergreen, wormseed, and wormwood.
- Alison
I am a midwife in Israel. I also have a website in Hebrew about birth called www.leida.co.il. One of our ladies wrote a heart-wrenching story about how she has moved to Honduras and is expecting twins and cannot find a doctor who will deliver them vaginally, even if they are both head down. Her first birth was totally natural, and she is heartbroken. She says there are no midwives there who are willing to help, and the policies are all very interventive. She would be most grateful if anyone knows of a midwife or natural-minded obstetrician who will help her deliver her babies vaginally. If any of you knows of such a person, or how to find one, please let me know via email at: email@example.com as soon as possible.
- lana Shemesh
More on home and hospital birth:
I have a hospital and homebirth practice. I work with traditional midwives in my area and have found this to be a mutually satisfying relationship. We are different, our clients are different. Much of the criticism about the medical establishment, home vs hospital, CNM vs. traditional midwifery excludes a significant variable: the clients. It is often like comparing apples and oranges. Many of my hospital clients have incredible stressors, years of poor nutrition, alcohol and tobacco abuse. These patients come to birth with a totally different package than the clients seeking homebirth. Their pregnancies, labors and births will be different than those of my midwife colleagues. One cannot be as patient about postdates with someone who has a pack of cigarettes a day habit. Bed rest, herbs and beautiful thoughts will not keep a patient with HELP syndrome from thrombocytopenia, endangering her life. I will be a more interventative with some of these clients.
It is not that I have abandoned midwifery, I am dealing with the hand I have been dealt with these particular women. So the next time we make generalized statements about the management of certain women, make sure you see the whole picture. There is room for all. There are many different kinds of women, what they want, what they need, and there are many different kinds of midwives. Our goal is finding the right fit. It is a mature, brave gesture for one midwife to acknowledge she cannot be all to everyone and help women find the right midwife.
Thanks to Anon. who recognizes that many hospital midwives not only battle the system but the women themselves who are uninterested and resistant to anything empowering [Issue 3:3]. We too have women begging for induction prior to due dates and many are skeptical that they can birth without epidurals, or at least some narcotic. The demand for ultrasound in this population is high and no matter how much a midwife talks about the lack of medical need for one, these ladies are insistent. I would love to know where the women are who want a noninterventive pregnancy and birth. We are also working with a very low socio-economic group who are not nurtured and are not able to do so themselves. So we do the best we can by caring and educating and rejoicing in that occasional young woman who, at the end exclaims, "I did it!" Judge not--you don't always know what we are working with.
- Elenie Smith, CNM
More on VBAC and cesarean incisions:
I spent time in a Bolivian maternity clinic operated by Canadian missionary nurses. No doctor was available and the closest hospital was a rough 2-hour drive away. To send the moms in there was as good as signing their death certificate. Due to the combination of circumstances, few women were sent in to the hospital. We usually didn't see these women until they came to the clinic in late labor. At that time lower segment, transverse incisions were never done. Classical incisions were the only form done in area hospitals. We could not send someone in to the hospital just because they presented in labor with a previous classical incision. So VBACs with classical incisions were not uncommon and were taken in stride. In all the history of the clinic, there had never been any kind of complication due to classical incision! These moms labored and successfully gave birth as though there had never even been an incision.
Another non-statistic: My aunt was a missionary midwife in Africa for 36 years. She retired in 1975 after nearly 12,000 births. She too worked without a doctor or hospital closer than 100 miles away. Of course she had never seen the lower segment, transverse incision. I asked her specifically about the "dangers" of VBAC and she just chuckled and said a VBAC was a very safe option. Of course in her experience, VBAC wasn't considered an "option"--there was no other choice.
I am not advocating doing something simply because it has been done under such circumstances. Wisdom is still in order. We do not have to set out to prove our theories at the expense of a mom/baby. But judging by both of the above situations, I would say VBAC with any kind of incision is not only possible, but probably very safe and efficient. Of course in neither of these situations did attendants do anything as foolish as inducing labor in a VBAC mom, and there was little if any intervention of any sort in either situation. Labor and birth just proceeded as simply, safely and efficiently and as God planned that it should, and therefore it was also successful.
- Elaine, midwife, CBE, doula
I had a c-sec with my first baby in 1993 (footling breech discovered after my water broke). Since then, I've had three wonderful homebirths and am planning another in August 2001. My c-sec led to an interest in natural birth, becoming a doula and a childbirth educator. Recently, in Washington state, and I'm assuming across the country, the birth community has become very freaked out again about uterine rupture in VBAC women. I am becoming nervous that if I have any more children, I will not be able to find an attendant to support a homebirth or even a vaginal birth because midwives are pulling out of doing VBACs. A woman in my area who was not a VBAC ruptured, the baby died and mom barely survived. I've seen a rupture at a birth I attended (lots of Pitocin). Also recently in our area, two VBAC women in the hospital ruptured without augmentation.
I would like to see more information on any studies currently being done with VBAC women, and basically any information I can find on VBAC and homebirth. I'm not afraid to have a homebirth, but it saddens me that women, even in the hospital, would again be convinced that a c-sec is the "safer" option for themselves and their babies. I don't believe that's true.
- Teresa
I truly look forward to each installment of the E-News as it maintains sanity in the medical world in which I practice. I am blessed with the opportunity to deliver my first grandchild in June, and am curious to hear from other midwives who have had a similar opportunity. I feel confident about working with my daughter, but am being exposed to much negativity from my co-professionals, even the midwives. Help!
- Nona McNatt
I have recently been accepted into the nurse-midwifery specialty of the
Master of Science in Nursing program at Vanderbilt University's School
of Nursing. It is a specialized, accelerated program called the "bridge
program" because it allows students with bachelor's degrees to receive
their RN licensure after the first year and then join the rest of the
MSN students the second year in the specialty of their choice. My bachelor's
degree is in biology. I am currently researching financial aid options
and wonder if anyone has any advice or knows of any aid available to nurse-midwifery
graduate students. I am on my own with this (my mother does not approve
of my chosen career and refuses to help me) and I do not belong to a minority
group or any particular religious affiliation, so any scholarships from
those sources are unavailable to me. There are not any assistantships
or stipends available and federal aid is limited and will not be enough
to cover tuition. Any suggestions would be sincerely appreciated. I am
- Victoria Harris
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Midwifery Today: Each One Teach One!


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Editor's note: This market commentary is provided by the Dairy Division at FCStone/Downes-O'Neill in Chicago, Ill.
It was an interesting start to the week as prices found strong support early in the day and the gains did not relent throughout the session. Prices saw double-digit increases pre spot session and, despite a lack of any action during the spot market, prices continued to trade firm.
The main reason for gains seemingly the discount on futures relative to the spot cheese prices. We calculate current spot values near a 21.50 Class III equivalent vs. futures coming into the day sub $21.00. There also seemed to be notable spread trading with Nov closing up just 10 cents while Dec through March futures gained 15 to 32 cents on the day. Current trade sentiment seems to mostly favor price movement quieting down for a period of time with the anticipation being that any sizeable move likely to favor the downside. While this may be the general consensus, we continue to hear of strong and stronger-than-expected domestic sales.
Grain futures traded mixed but mostly lower as continued pressure during yesterday's session likely came as a result of the bearish estimates from Informa on Friday.
The market is getting increasingly mixed signals with a tight carryout seemingly growing larger according to private estimates (INTL FCStone/Informa); however, average trade estimates for Thursday morning's reports are projecting far smaller total production than those private numbers. It seems headed into Thursday's report equilibrium on corn is just below the $7.50 mark, while soybeans seem to be looking at $15.50 equilibrium. Difficult to say which side the majority of the risk lies on headed into the report, but given the lower production estimates we'd think the risk of the big move is likely to the downside should USDA's production number come nearer the private estimates. Should the market break toward the $7.25 mark, as it was heading into the stocks report, we would be looking to purchase additional physical bushels and buy puts below the market for downside participation should a sizeable drop occur.
Look for corn to open 3 to 5 cents higher and for beans to open 17 to 20 higher.
Block cheese: $2.10 (unchanged)
Barrel cheese $2.06 (unchanged)
Butter: $1.925 (up 6.5 cents)
Grade A NFDM: $1.66 (unchanged)
These data and comments are provided for information purposes only and are not intended to be used for specific trading strategies. Commodity trading is risky and FCStone Group, Inc., INTL FCStone Inc., and their affiliates assume no liability for the use of any information contained herein. Although all information is believed to be reliable, we cannot guarantee its accuracy and completeness. Past financial results are not necessarily indicative of future performance. Any examples given are strictly hypothetical and no representation is being made that any person will or is likely to achieve profits or losses similar to those examples. References to and discussions of exchange traded products are made solely on behalf of FCStone, LLC. References to and discussions of OTC products are made solely on behalf of INTL Hanley, LLC, and OTC products are only available to eligible counterparties.

subset: commoncrawl


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Logan set for rehab outing at Triple-A
DENVER -- Hope and frustration will collide when Rockies left-hander Boone Logan pitches for Triple-A Colorado Springs on an injury rehab assignment Monday.
Logan was eligible Sunday to return from the 15-day disabled list, where he has been placed because of diverticulitis (a digestive ailment). It's part of a frustrating season for Logan, who signed a three-year, $16.5 million deal with the club during the offseason but has been on the DL twice because of elbow issues and now because of the digestive ailment.
At the end of last season with the Yankees, Logan (2-1, 6.11 ERA in 25 games) underwent surgery to remove bone chips and shave a bone spur in the elbow, so it was possible that he would struggle with elbow issues. Still, the interruptions for that and the digestive problem have been difficult.
"I haven't been on the DL my whole career and I sign a nice three-year deal to help the team, but get hurt the first year," Logan said. "It's very frustrating. It kills me even more because I get paid to pitch and I'm not pitching."
The digestive ailment flared in a strange manner. Logan was unavailable in Pittsburgh last weekend because of neck stiffness. But when the digestive ailment was discovered, Logan said doctors told him that ailments on one side of the midsection often lead to pain in the opposite neck-shoulder area.
For what it's worth, the benefit is that Logan's arm is rested.
"My arm feels the best it's felt in as long as I can remember," Logan said. "What makes it real frustrating is I'm on the DL for a couple of weeks with something else. You want to perform and help out your team."
Logan said after he pitches Monday, he will campaign to be activated immediately, but he doesn't know the team's plans. Manager Walt Weiss did not rule out bringing Logan back Tuesday, depending on how Monday goes.
Thomas Harding is a reporter for MLB.com. Read his blog, Hardball in the Rockies, and follow him on Twitter @harding_at_mlb This story was not subject to the approval of Major League Baseball or its clubs.


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Solano Land Trust will host a Public Interest Session for Rockville Trails from 5 to 7 p.m. on Wednesday, Feb. 27 at the Downtown Theatre in Fairfield, 1035 Texas Street.
The information gathered through public comment will help the trust prepare the management plan for the property.
The public is welcome to the event to share comments and ideas regarding the future of the Rockville Trails property. There will be stations set up around the room focused on security, traffic, facility improvements (trails, parking, bathrooms, and structures), and the plants and animals that are on this property. Solano Land Trust representatives will be present at each station to receive public comments. Comment cards will be provided. This information will be used by Solano Land Trust staff and the Rockville Trails subcommittee to understand the public's view of the future of this new natural park. The subcommittee is comprised of Solano Land Trust Board Members and other volunteers from the community.
Rockville Trails Frequently Asked Questions and a Timeline about the property are available at www.solanolandtrust.org. Those who cannot attend the Public Interest Session but would like to comment are encouraged to view the Frequently Asked Questions and take the Online Comment Survey at www.solanolandtrust.org. Comments will be accepted until March 15.
Solano Land Trust plans to offer docent-led tours in the Spring of 2013 but cannot open the park to the public until the California Environmental Quality Act, or CEQA, requirement is complete and facilities are constructed. CEQA requires an analysis of all potential impacts of this project.
Solano Land Trust's Rockville Trails is located between Green Valley and Suisun Valley Roads, across from the city of Fairfield's Rockville Hills Regional Park on Rockville Road. olano Land Trust has permanently protected 22,161 acres of working farms and natural areas in Solano County.
For more information call, 432-0150.


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SWINDON Town chairman Lee Power asked a High Court courtroom why he would plough £2m into something he didn't believe he owned, this morning.
Power appeared bullish and refreshed on the second day of the hearing to determine who owns the football club, as he stood his ground under questioning from the defence counsel.
It was put to the chairman by Charles Douthwaite, defence counsel for Jed McCrory, he neither believed he was the owner of the club nor did he believe an agreement still existed, whereby he could make himself the majority shareholder.
Power said: "Why would I put £2m into the football club if I didn't think I was the owner?
"The finances improved during the audit (October 2013) because I'm putting money in and selling players for them.
"Without my money the club would've fallen over in March (2013).
"Without me we wouldn't even be sitting here now.
"Everyone in the courtroom knows that, especially the gentleman in the back row who's supporting the football club."
In his evidence, Power also elaborated on the alleged accusations thrown at him by McCrory on the day he stepped down as chairman in December.
He said: "The match-fixing was something that Jed brought up when we decided to part.
"It was something he felt he needed to say when he knew he'd been found out with stealing money from the football club.
"Straight away, me and Sangita rang the Football League and the FA about these accusations.
"He (Jed) even said the manager was in on it. The match we fixed changed four times and we won all the games we're supposed to have fixed."


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Canada has always been a progressive nation open to bold new ideas. Our Parliament has produced cornerstones of our Canadian identity such as enshrining our Charter of Rights and Freedoms and creating our public health care system.
Stephen Harper's secretive regime is now blocking Canadians from knowing what happens in committees and even provides misleading information to Canadians and to Parliament.
The Liberal Party of Canada believes that Parliament should belong to the people instead of the Prime Minister. Liberals are committed to exploring Parliamentary and Electoral reform in order to realign our institutions with democratic principles and to ensure more meaningful and effective representation.
On January 29, 2014, Liberal Leader Justin Trudeau released all 32 Liberal Senators from their partisan responsibilities, making them Independent Senators. As a result, only elected Members of the House of Commons will serve as members of the Liberal Caucus. He also committed to appointing independent senators only, through an open, transparent and public process for appointing and confirming Senators.
This statement is inspired by policy resolutions submitted and voted on by Party members. 2012 Resolution References: ON-19, ON-21, SK-79, SLC-90