http://womens-health.jwatch.org/cgi/content/full/2008/710/1?q=etoc_jwwomenbe

No Need to Sweep
Whether or not women underwent membrane sweeping, overall rates of induction, postmaturity, and prelabor membrane rupture were similar.

Membrane sweeping to move the membranes off the lower pole of the uterus, routine in obstetric care, is performed to decrease the likelihood of labor induction or postmature delivery (JW Apr 11 2006). However, concerns about premature rupture of membranes and infection have led to debate about the merits of this practice. Investigators randomized 300 women to undergo membrane sweeping at 38 weeks’ gestation (with subsequent weekly sweeping) or no membrane sweeping. Participants had singleton pregnancies with cephalic presentation and anticipated vaginal delivery; women were excluded if they had indications for labor induction or cesarean delivery or had contraindications for membrane sweeping. Participants and researchers were blinded to group allocation with the understanding that this would not constitute full blinding, as patients probably would become aware of their assigned interventions.

Intention-to-treat analysis showed no significant between-group difference in occurrence of prelabor rupture of membranes (7% of women without sweeping vs. 12% of women with sweeping; P=0.19). Among women with cervical dilation 1 cm, however, 9% in the sweep group had prelabor membrane rupture versus no patients in the no-sweep group (P<0.05). Other obstetric outcomes, including cesarean delivery, spontaneous labor, induction, or postmaturity, occurred at similar rates in the two groups.

Comment: These data indicate neither great value nor great risk from membrane sweeping starting at 38 weeks. However, subgroup analysis showed that women with cervical dilation 1 cm during late pregnancy could be at risk for prelabor membrane rupture in association with sweeping, suggesting that such women might be more sensitive to the procedure. This study excluded women with multiple gestations or those with various obstetric indications. Despite these limitations, the data suggest that there is no need to sweep.

- Sandra Ann Carson, MD
Published in Journal Watch Women’s Health July 10, 2008

Related post: http://www.glorialemay.com/blog/?p=89

http://onlinemidwiferyed.blogspot.com/2011/09/midwifery-101-live-online-classes-on.html
Midwifery 101, Classes begin on Thur April 19, 2012 and continue to the end of August 2012. $150 for 20 live, online classes with Gloria Lemay, 60 mins long.

http://onlinemidwiferyed.blogspot.com/2011/09/midwifery-102-continuing-classes.html

Midwifery 102, Classes also begin on Thur April 19, 2012 and continue to the end of August 2012. $89 for 10 live, online classes with Gloria Lemay, 60 mins long.
These classes are designed for students who have completed the Midwifery 101 course.

For times and lots more information on how to join WizIq and a free sample of a class, see the links above. Feel free to share this post.

Thank you for a great series of classes. I always laugh when I watch you and have enjoyed these classes so much. I have learned a great deal about how I hope to practice. Your love of your work shines through when you teach and I admire your respect for the women you serve. Trista Tetro

one picture is worth a thousand words

What a fun idea! One of my FB friends sent me this image of Ryan Gosling. Thanks to whomever made it! I got a lot of laughs in class when I put it up on the whiteboard. Gloria

Baked Potato

Answer:

Make sure you tell the woman a baked potato or brown rice. These are slower burning carbs plus they have more minerals than the processed counterpart. It’s not just what the woman is eating that you’re interested in, it’s what she’s not eating. If you steer her towards healthier carbs, it eliminates the temptation to fill up on processed food. A little story about those 3 daily “musts”. . .

I had a new client who was a dietician for a big hotel. I gave her the diet grid to fill out everything she ate for a week and told her to eat daily:

-a baked potato or a bowl of brown rice
-large green salad
-1/2 grapefruit, orange, 2 kiwis or a red pepper

She got quite upset at me. She let me know that she ate very well and didn’t need any input from me. I asked her to just humor me and give it a try. She phoned in about 5 days and told me she couldn’t believe what an impact it had on her. By having a set list of “musts”, it helped her to prepare for the week and she didn’t snack on things in the hotel kitchen so much. She was feeling happier, stronger and more nourished by the food. Gloria

Green Mixed Salad

Things changed after that first week in high security when I was moved to a minimum security unit. This place was still like a bad summer camp but the food improved somewhat. A small team of prisoners prepared the food under the watchful eye of a Filipino woman named Anna. They seemed like a happy team and they made food that was heavy on the pasta and potatoes (women who are coming off drug addictions need a lot of carbs, plus they are cheap). Eggs were more plentiful and there was a concerted effort to make the food appetizing. There was always a table with a giant bowl of salad from which we could help ourselves and more fruit was available, too.

Four women ate at each table in the dining room and the guards ate with us. The whole group ate very rapidly as it was considered rude to dawdle over your food because there was another team of women who had to clean the tables and sweep the floor after the meal. Although this fast eating was tense, we were allowed to come back into the dining room after the cleanup crew had finished and make ourselves a tea and relax at the tables. It became my habit to bring a book or a newspaper and sit alone to enjoy a hot cup of tea for about 45 minutes after the evening meal.

One evening when I was alone in the dining room, the cook, Anna, came out of the kitchen for the first time and approached my table. She put a small paper on the table and when I took it and looked, I could see it was her photo and it was a midwifery license from the Philippines. I couldn’t quite compute it and she smiled and sat down.
She explained to me that she had come to Canada expecting to practice her profession but could never get accepted by the midwifery licensing body. She then applied for and got the cooking job in the women’s prison. She said that she just loved it. She shopped very carefully to get us the best food possible on the tight budget she was given. She knew her nutrition and wanted us all to be healthy. Her team would say a prayer over the food before beginning meal preparation. She wanted me to know that she had read about my difficulties with the licensing body in the newspapers and could understand what I was going through. Even though she couldn’t attend births in Canada, she had found a way to support women in an unlikely place and she did her work in the prison with pride and passion. I felt that my brief interaction with her was another of the miracles that I encountered within those walls. . . a midwife was watching out for me and she fed my body and soul by reaching out to me.