Hands off my Vagina

The term episiotomy means to cut the skin between the vagina and anus in an attempt to widen the vaginal opening for childbirth. Many years ago this was done routinely on every woman giving birth under the notion that a cut would be easier to repair than a jagged laceration when a woman tore on her own. Episiotomies are no longer recommended and can even do more harm than good. Here's why:

• A cut weakens the tissue of the perineum making it easier to tear into the rectum during childbirth
• Increased risk of infection
• Some women may not tear at all, so why not give them the opportunity to not need stitches
• Studies show that women with episiotomies have a longer recovery and more long term pain with intercourse.

If your doctor reaches for the scissors during your birth, make sure you tell them "Hand's off my vagina!".

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To VBAC or Not?

VBAC is the term used to refer to a women who successfully gives birth vaginally after a previous c-section. A TOLAC (trial of labor after cesarean) is the term used for women who are trying to have a vaginal birth after cesarean.

60-80% of women attempting a VBAC will be successful (ACOG, 2010).

Benefits:
Lower risk of hemorrhage and infection
Faster recovery
Decreases risks associated with multiple cesareans such as injury to bowel, bladder, hysterectomy, and abnormal placenta placement
Less breathing problems with baby


The most common risk associated with a TOLAC is a uterine rupture, where the pressure from contractions causes the c-section scar to break open. This can rapidly cause hemorrhage or loss of oxygen to the baby and could result in a hysterectomy or death to mother, infant, or both. It sounds scary doesn't it? The actual risk of something like this happening is very low and it does depend on certain factors like how many previous c-sections you have had, whether or not your doctor is using pitocin to stimulate your contractions, etc. With one prior c-section the risk of a uterine rupture is less than 1% which means that only 1-10 out of 1000 women who are attempting a VBAC will have a uterine rupture. With high tech hospital facilities other subsequent complications such as hysterectomy and death are even more rare occurances.

There are also risks with considering an elective repeat cesarean and this may seem like a safer option but consider the risks:

Increased risk of breathing problems with baby call respiratory distress syndrome
Hemorrhage
Injury to bowel or bladder
Infection
Readmission to the hospital with complications
Increased risk of hysterectomy in future pregnancies due to abnormal placental locations
Increased risk of death compared to a vaginal delivery.

Midwives are known for low cesarean section rates and are the perfect choice for women considering TOLAC.

Great Resources: International Cesarean Awareness Network http://www.ican-online.org/

Stand and Deliver: My birth plan

Check out this edited version of a birth plan at the blog Stand and Deliver:


Stand and Deliver: My birth plan

The First Few Moments…

All of your hard work during labor has finally paid off. You hear the first cry from your newborn baby and it is the most perfect moment of your existence. Many new mothers do not know about the importance of skin to skin contact during the first hours after birth and often find themselves caught up in rigid hospital routines that enable nurses to whisk their newborn babies away to a nursery. Weighing the baby and giving medications can be postponed until after the first hour and an assessment to make sure baby is doing well can be performed with the baby on your chest. Baby can also be placed skin to skin with the mother during a cesarean section or on the father chest if the mother is unable. Placing your baby on your chest immediately after birth (also called Kangaroo care) is proven to have many benefits for both mom and baby. Most experts recommend keeping baby skin to skin with you for at least 1 hour. Skin to skin care helps to:

• Stabilize your new baby's temperature, heart rate, and blood sugar which are very important for newborns
  
• Make latching on to the breast easier for breastfeeding because baby is most awake during the first hour.
  
• Studies show that babies held skin to skin at birth breastfeed more months after going home
  
• Your baby may cry less and be soothed by the smell of your skin
  
• Promotes bonding
  
• Stimulates the uterus to contract with the release of oxytocin helping you to have less vaginal bleeding
  
• Helps distract you from pain if you will need stitches
  
• Placing your baby skin to skin during breastfeeding also helps to stimulate milk production
  

 

Favorite Birth Quotes

"Just as a woman's heart knows how and when to pump, her lungs to inhale, and her hand to pull back from fire, so she knows when and how to give birth"  --Virginia Di Orio

 

"Mothers need to know that their care and their choices won't be compromised by birth politics." --Jennifer Rosenberg

"Giving birth should be your greatest achievement not your greatest fear" -- Jane Weideman

 

"The effort to seperate the physical experience of childbirth from the mental, emotional, and spiritual aspects of this event has served to disempower and violate women" --Mary Rucklos Hamptom

A Common Reality: Postpartum Depression

Bringing home a baby is supposed to be a joyous experience. At least this is the expectation that most of us have, but what happens when the harsh reality of late night feedings, exhaustion, and a screaming baby become part of your everyday life. Instead of finding happiness in cuddling your new bundle of joy, you are tearful and overwhelmed by the experience of becoming a mother. The truth is that these types of feelings are shared by many women that are home for the first few weeks after having a new baby. Hormonal changes from pregnancy and still returning to normal making it easier to feel overwhelmed and cry at any moment. For most women this gets better within two weeks of having your baby.

Occasionally, these emotions do not get better and may last longer than two weeks. Women may continue to experience episodes of crying and of being overwhelmed. Symptoms may progress to feelings of depression such as hopelessness, loss of interest in enjoyable activities, sleeping all the time, not taking care of yourself or the baby, not eating, and withdrawing from friends and family . It may also be common for women to have feelings that they are not bonding well with the baby and even have feelings of hurting themselves or their baby. It is important to know that you are not alone. It is not something that you should feel embarrassed or ashamed about. An estimated 5-25% of women experience postpartum depression and it can start at any time during the first year after the birth of a baby. There is hope and it is important to talk to your health care provider about treatment options. Your health care provider may prescribe depression medication to help regulate your hormones until they return to pre-pregnancy levels. Mental health professionals that specialize in postpartum depression can also be a good source of hope and support.

I recently came across a new book called "Why I Jumped: My True Story of Postpartum Depression, Dramatic Rescue & Return to Hope" by Tina Zahn. This amazing story is the true story of a woman who suffered with postpartum depression after the birth of her child. Her depression became so severe that she completely isolated herself from her family, friends, and new baby. She compares her feelings during that time in her life as losing all hope. At her lowest point, Zahn drove her car to a large bridge in Green Bay, Wisconsin intending to take her own life by jumping over the edge. In a life changing moment, a state trooper held on to Zahn at the last minute after she jumped over the edge. This heroic act saved her life and she has since recovered and dedicated her life to helping other women with postpartum depression. It is a brilliant story to give women suffering with postpartum depression hope again.
Here is the video of her actual suicide attempt recorded by the state troopers camera that saved her life.

Steps to Breastfeeding Success

Positioning:

            Finding the best position for nursing will depend on what works best for both you and your baby as well as what is most comfortable.  It is recommended that you experiment with different breastfeeding positions so that you can find the best position to fit your needs. Start out by finding a comfortable position for you. Use pillows to support your arms and back. Position your baby so that the baby’s mouth and nose are directly in front of your nipple and so that the baby doesn’t have to turn towards your breast. Several common positions to try are:

Cradle

This is one of the most common positions for breastfeeding. Baby is positioned with the head in the nook of the elbow and laid across the lap. Baby should be positioned with the body toward the breast. Using a pillow to support the baby or your elbow will make this position more comfortable.

Cross Cradle

This position is similar to the cradle hold. Instead of positioning baby’s head in the inside of your elbow, use the opposite hand to support the baby’s head and guide the infant to your breast. Use the other hand to support your breast making a C with your fingers around your nipple.

Side Lying

This position is useful at night or when you are tired. While lying on your side, place the infant against your body so that the baby is lying on its side even with your breast. Use one arm and hand to support the baby and the other to support your breast. This position is useful for mothers who have had a C-section to prevent putting pressure on the incision.

Football Hold

Sitting in an upright position, turn the baby facing up toward your breast. Use one hand to support the baby’s neck and guide the baby to your breast. The other hand can be used to support the breast. This position is also useful for mom’s who have had a C-section or mothers who are breastfeeding multiples.

Rooting

New babies have many reflexes that are natural and common at birth. One of these is called the rooting reflex and it is essential to breastfeeding. You stimulate the rooting reflex when you rub your nipple along your baby’s bottom lip to encourage the baby’s mouth to open wide.

Latch On

Position the fingers in a U or C shape around the nipple. Guide the breast close to baby’s mouth. You can tickle the baby’s bottom lip with the nipple or bring the baby’s chin into contact with the breast. This action should stimulate the infant to open wide like a big yawn. This is your signal to place the entire nipple in the infant’s mouth. Make sure at least ½ of breast around the nipple is in your baby’s mouth.

    Signs of a good latch:

      Baby’s lips are turned out like fish lips

      You hear sucking and swallowing

      Ears or temple will wiggle

      You feel tugging at your breast, but not burning or pain

   Knowing when to feed your baby

Generally breastfed babies will eat every 2-4 hours. There are visual cues to look for so that you can know when your baby is hungry. Babies who are ready to breastfeed generally exhibit these signs and symptoms:

Signs of Hunger:

EARLIEST

Wiggling around, moving the arms and legs

Rooting (sucking on fingers, licking, turning head to the side)

LATER

Fussiness or making squeaky noises

Restless, intermittent crying

LATEST

Full crying, screaming, infant becomes red

Breaking the Suction
Babies will usually stop automatically when he or she is satisfied and has gotten enough breast milk. Occasionally if breastfeeding is uncomfortable or you need to reposition baby you may need to break the seal between baby’s mouth and your breast. To release the suction place one finger in between your baby’s mouth against the gums and your nipple to break the seal.

Place Bid - BiddingForGood Fundraising Auction

Place Bid - BiddingForGood Fundraising Auction

Help support the Frontier School of Midwifery and Family Nursing by bidding on this one of a kind Mary Breckenridge stamp collection.

A Healthy You Means a Healthy Baby

 Things to avoid:

       Alcohol, drugs, and tobacco products

       “Empty” calorie foods like potato chips, soda, fast food (these have little nutritional value)

       Avoid high doses of Vitamin A including liver.

       Fish that contain high levels of mercury: swordfish, shark, king mackerel, tilefish.

       Deli or processed meats (hot dogs) can have bacteria that can make you sick with Listeria.

       Raw sprouts can have salmonella or e-coli bacteria

       Consuming large amounts of ice or craving other non-food items (notify your healthcare provider immediately because this could indicate that you are anemic)

How much weight should I gain?

Overall:

       25-35 lbs if you are already a normal weight

       11-20 lbs if you are overweight

       28-40 lbs if you are underweight

By Trimester:

       2.2-5.5 pounds during your first trimester (weeks 1-12)

       1 lb every week  during your second and third trimester (week 13-40)

Most important nutrients that you need during pregnancy:

      Iron

      Folic Acid

      Protein

      Vitamin C

      Extra Calories

      Water

How much do I need?

Iron-27mg per day

Folic Acid-0.4mg per day

Protein-70-75g a day

Vitamin C-85mg/day

An additional 300 calories per day. (You should already be getting at least 2200 calories a day if you are not pregnant)

Water-Drink at least 8-10 glasses a day

Why do I need these nutrients?

Iron-prevents anemia which is easier to get when you are pregnant. Helps to make sure you have high enough iron levels in your body to combat the blood lost at the birth of your baby.

Folic Acid—Prevents anemia and reduces the chance that your baby will develop spina bifida or other neural tube defects (issues with the spinal cord)

Protein—Helps your baby grow and develop. Babies of mothers who eat enough protein are a healthy weight at birth and usually have less

problems.

Vitamin C-to help you absorb iron from foods better and reduce the risk of anemia.

Extra calories—Needed to meet the extra demands of your baby. Extra calories

prevent you from becoming malnourished.

Water-drinking enough water decreases your risk of dehydration which can cause preterm labor, reduced fluid around the baby, and urinary tract infections.

Coping with Morning Sickness and other First Trimester Annoyances

So you're pregnant! You may be overjoyed to hear the news or like many women may feel ambivalent and not be sure how you feel about being pregnant. On top of all these emotions you end up throwing up every morning and most of the day making the thought of being pregnant even harder to deal with. Not to mention you are tired all the time, your breasts hurt, and you are peeing every five minutes.  Here is a breakdown of what all these symptoms mean and why you have to go through them:

Nausea and vomiting -- This is caused by the high levels of hCG (Human Chorionic Gonadotropin). This is the pregnancy hormone. The good news is all that morning sickness means that your hormone levels are right on track to keep you pregnant and studies show that women who have nausea and/or vomiting are less likely to miscarry.

Being tired -- The cause of this is unknown but is thought to be caused by the change in hormones in your body. Some women may also experience some shortness of breath during this time which is normal.

Peeing ALOT -- This is also due to the changes in hormones during your first trimester (later on in pregnancy as the baby gets bigger your uterus presses on your bladder causing more trips to the bathroom)

Breast tenderness -- This is caused by the changes in your breast that occur to prepare your body for breastfeeding and producing milk. Your breast start to become larger and are more sensitive.

So what can I do to get some relief you say??

The good news is that for most women these annoying symptoms do get better around 12-14 weeks when you begin to enter your second trimester of pregnancy. Here are some helpful tips to get you through the next month or two.

The nausea and vomiting is usually what interferes with normal daily life. So getting that under control is usually the most important thing to many women. Starting with simple measures like keeping something in your stomach at all times and avoiding the extremes of having nothing in your stomach and being too full. This is when many women become nauseous.

• Keep crackers at the bedside and try to eat a few before getting out of bed in the morning.
•  Avoid being around any heavy odors when you feel like you might lose it at any moment. 
• You can also try any type of ginger product. Ginger has been shown to reduce nausea in many studies. Many health food stores carry ginger tea, ginger chews or candy, ginger ale, etc. Make sure these are made with real ginger. 
• Vitamin B6 50mg at bedtime and if needed in the morning is also a natural alternative to decreasing nausea. 

There is probably little that you can do to reduce the tiredness that you feel. Again rest assured that this will also get better soon. For now, take frequent rest periods, eat healthy, and do some mild low impact exercise. It will get better!!

To avoid being up all night going to the bathroom, try to limit how much fluid you drink right before bedtime. Remember you need at least 8-10 glasses of water each day now that your pregnant.

Breast soreness can be decreased by wearing a supportive bra and avoiding stimulation if it is uncomfortable.

I hope this information helps to make your first trimester a little more comfortable.
Congratulations on beginning your journey to motherhood!

Midwives are not just for home birth

Inevitably, when I mention that I am going to school to be a "midwife" to another person while out in public I get this blank look and usually the response, "you want to do home births?" and then I have to go into my discussion about the historical progression of midwives since the 1970's. Yes, it is true that some midwives do attend home births, but the majority of midwives (about 95%) deliver babies in hospitals because that is where most women nowadays choose to give birth.  In fact, nurse midwives meet rigorous educational and licensure standards to ensure that they are competent.The present day midwife can practice in a variety of settings including home births, birth centers, and hospitals. Nurse midwives have evolved into primary care practitioners that serve women throughout all aspects of their lifespan. Midwives now function to take care of women during adolescence, pregnancy, middle adulthood, and menopause. Midwives can offer women gynecological care, prenatal care, family planning and contraception, and post menopausal care just to name a few. Midwives are able to prescribe medication to the women they serve, which means yes ladies you can have that epidural if you need it. Nurse midwives are trained in low risk care and emergencies. Nurse midwives have the backup support of a physician and can transfer care to them if high risk care or a cesarean section becomes a necessity. 

Here is where the confusion about midwives comes in. There have been several different types of midwives throughout history.

Midwifery education varies based on their credentials and it is important to choose someone based on both their education and experience as well as someone who shares the same values that you do.

Certified Nurse Midwife (CNM)

This type of midwife has gone to nursing school and received a bachelor’s degree in nursing. They have most likely had at least a year working as a registered nurse in a labor and delivery setting. CNM’s must have at least a master’s degree (the equivalent of 6+ years of higher education). CNM’s are required to take a national exam to be licensed. CNM’s are able to write prescriptions, have hospital privileges, and assist with cesarean sections if there patient needs one.

Certified Professional Midwife (CPM or CM)

This midwife has attended an educational program in midwifery. Educational length may vary. Many deliver babies in a home setting or birth center. They are not required to have been a nurse before, but are required to take the same national licensure exam as a certified nurse midwife to practice. They do not have privileges to practice at hospitals and cannot prescribe medication.

Lay Midwife

This midwife usually obtains experience through an apprenticeship with another midwife and delivers babies in a home setting. They do not have any formal education and have not taken a national licensing exam to ensure competency.

Many women that choose a midwife for their birth experience and very satisfied with the care that they receive.A midwife will be there to support whatever choice you decide during your pregnancy and birth. Midwives offer personalized, holistic care that focuses on empowering women to be involved in their own health care. Every woman should have the option to be cared for by a midwife!