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Archive for October, 2008
Last weekend I was walking home from the gym when I ran into one of my students. She told me that she was in early labor - 4 cm - and was sent to go walk around to try to get things moving. She also told me that her doctor had informed her that since her fluid levels were low, if she didn’t get things started on her own soon they would “help move her along” - meaning start Pitocin to increase the contractions and push her or “Pit her” into active labor.
Just the week before I had run across the article “Low Level of Amniotic Fluid - No Risk to Normal Birth” in Midwifery Today. Of course, I knew this was not the time to start contradicting my student’s doctor, but it made me realize how common it is for doctors to start the cascade of intervention on the basis of low fluid levels.
Here is the study from Midwifery Today:
Low Levels of Amniotic Fluid No Risk To Normal Birth
Doctors may not have to deliver a baby early if it has low levels of amniotic fluid surrounding it, Johns Hopkins obstetricians report.
In a study to be presented Feb. 7 at the annual meeting of the Society for Maternal-Fetal Medicine in San Francisco, researchers show that babies born under such conditions fared similarly to those born to women whose wombs held normal amounts of amniotic fluid. No significant differences were found in the babies’ birth weights, levels of acid in the umbilical cord blood, or lengths of stay in the hospital.
Typically, doctors have been concerned about women with low levels of amniotic fluid during the third trimester – a condition called oligohydramnios – because too little fluid can be associated with incomplete development of the lungs, poor fetal growth and complications with delivery. Amniotic fluid is measured by depth in centimeters. Normal amounts range from 5 to 25 centimeters; any amount less than 5 centimeters is considered low.
“These study results are very surprising – they go against the conventional wisdom,” says Ernest M. Graham, M.D., senior author of the study and assistant professor of gynecology and obstetrics. “Amniotic fluid stems from the baby’s urine, and the urine results from good blood flow, so if we see low fluid we assume there probably is not good blood flow and the fetus is compromised. This study shows the fluid test is not as good as we thought, and there is most likely no reason to deliver the baby early if other tests are normal.”
The researchers studied 262 women (131 with oligohydramnios and 131 with normal amounts of amniotic fluid) who gave birth at The Johns Hopkins Hospital between November 1999 and July 2002, comparing the babies’ health at birth. Patients with oligohydramnios were delivered sooner, but were less likely to need Cesarean sections. Babies born to moms with isolated low amniotic fluid were normal size and were at no increased risk of respiratory problems, immature intestines or brain disorders.
Study co-authors were Rita Driggers, Karin Blakemore and Cynthia Holcroft.
Abstract # 318: Driggers, R. et al, “Are Neonatal Outcomes Worse in Deliveries Prompted by Oligohydramnios?”
This new information may create an opening for you to discuss your options with your care provider. If diagnosed with a low amount of fluid, will your doctor give you some time to go home and hydrate (in the latter part of pregnancy, amniotic fluid is primarily baby pee) and then come back the next day for another fluid check? Or, does your provider prefer to act immediately? My experience is that most doctors allow for some time to pass. But, now is a good time to make sure you and your care provider are on the same page.
October 31st, 2008
Please enjoy this list of 10 healthful hints for pregnancy, labor and postpartum. Much of this information is gathered from friends, students, hands-on experience, mentors and teachers. I strongly believe in learning from others, so please feel free to pass this along to all your friends!
1. Olive Oil on Baby’s Bottom to Prevent the Meconium From Sticking
Vanessa, one of my recent doula clients, enlightened me to this brilliant idea. Right after your baby is born, take a few drops of olive oil and rub it onto the baby’s bottom. When your baby passes the meconium (your baby’s first poop), this dark, tar-like substance will be easy to wash off.
2. Arnica Helps Heal Tears of the Perineum After Labor
Most use the pellets rather than the cream for this type of wound. The cream is not supposed to be used on broken skin - though I have known women who have used the cream and found it to work without problems.
With the pellets, the you can put 2-3 in your peri bottle before you fill it with water, and use that solution when you pee. You can also take it orally (2 pellets) whenever you remember to. Try to avoid taking it around meals or touching the pellets with your hands. As you start to feel better you will naturally start taking it less often. Any dosage you can get will be helpful, but I think the stronger the better for this.
3. “The Midwive’s Pitocin”
Make a bowl of oatmeal, honey and nuts during labor and graze on it as you desire. If you break down the ingredients, you will find the perfect balance of complex carbohydrates, protein and natural sugar.
4. Hard Candy to Help Boost You During Labor
Because so many hospitals restrict eating during labor, it is possible for mom to get a little low in the energy department. I always bring hard honey candies with me to labors. This can give the laboring mom a bit of energy, and it dissolves in the mouth so it does not count as eating food, should any one ask.
5 Apple Cider Vinegar for Acid Reflux
Drink one tablespoon of apple cider vinegar in the morning, before eating. Theoretically, it works because the stomach is fooled into producing less acid. (Midwifery Today Winter 2007)
6. Cold Maxi-Pads with Witchhazel, Lavender and Vaseline
Before you head to the hospital, take several maxi pads and pour witch hazel and several drops of lavender on them, and then place them in the freezer. Not only will this small science experiment feel good on your sore bottom, it also promotes healing.
One of my students recently passed on the idea of smearing some Vaseline on the pad to prevent any stitches you might have needed from sticking to the pad.
7. Breastmilk for Cracked Nipples
It is not uncommon for women to experience sore or cracked nipples while breastfeeding. It is usually a sign that your baby is not latching correctly. One treatment for helping heal your nipples is to express a small amount of breast milk or colostrum onto the nipple and allow it to air-dry.
8. EAT YOUR GREENS!!!
Dark leafy greens, such as kale, collard greens, spinach, arugula, beet greens and dandelion are packed full of vitamins and minerals, and they can alleviate many pregnancy-related discomforts. Studies have shown increasing your iron intake can help relieve restless leg syndrome. A lack of calcium and magnesium (both found in dark leafy greens) can help rid you of middle-of-the-night calf cramps. For those that suffer from constipation, the fiber in these vegetables will help get things moving along!
These dark greens are also rich in vitamin K. Insufficient Vitamin K can contribute to postpartum hemorrhaging.
9. Coconut Water for Electrolytes, Edema and Constipation
Tender coconut water (elaneer/nariyal pani) is one of the richest sources of electrolytes. It is high in chlorides, potassium and magnesium and has a moderate amount of sugar, sodium and protein. Potassium helps regulate blood pressure and heart function. Coconut water is also a good source of dietary fibre, manganese, calcium, riboflavin and Vitamin C.
Coconut water is also a natural diuretic, which will help prevent urinary tract infections as well as relieve constipation.
10. Check Out the Wonders of Nettles: A Safe, Wonderful Herb for Pregnancy and After
The use of herbs may be a very new concept for some, but I would like to introduce you to the nettle leaf. There are no contraindications to the use of this leaf during or after pregnancy. (Holistic Midwifery, Anne Frye) And the benefits are bountiful!
*Vitamins A, C, D and K, calcium, potassium, phosphorous, iron and sulphur are particularly abundant in nettles.
*Increasing fertility in women and men.
* Nourishing mother and fetus.
* Easing leg cramps and other spasms.
* Diminishing pain during and after birth. The high calcium content, which is readily assimilated, helps diminish muscle pains in the uterus, in the legs and elsewhere.
* Preventing hemorrhage after birth. Nettle is a superb source of vitamin K, and increases available hemoglobin, both of which decrease the likelihood of postpartum hemorrhage. Fresh Nettle Juice, in teaspoon doses, slows postpartum bleeding.
* Reducing hemorrhoids. Nettle’s mild astringency and general nourishing action tightens and strengthens blood vessels, helps maintain arterial elasticity and improves venous resilience.
* Increasing the richness and amount of breast milk.
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The benefits of nettles listed above are an excerpt from Wise Woman Herbal for the Childbearing Year by Susun Weed
October 23rd, 2008
It is a given that in a yoga class we will likely do downward facing dog, warrior two and savasana. But one exercise that is unique to a prenatal or postnatal yoga class is a round or two of pelvic floor exercises, also know as “Kegels”.
I am often surprised how many women do not know about the importance of a healthy pelvic floor. I would think their doctor might have enlightened them about this. Each time we do Kegels in class, I ask the students, “Who is practicing their Kegels at home?” Usually this brings about a few smirks, sheepish looks and a few nods. (These nods often come from the all-knowing second time mothers who know what happens when you don’t do your Kegels! You can read this as “Depends adult diaper anyone??” )
The strength and flexibility of the pelvic floor is especially important to address during and after pregnancy, when the healthy function of the pelvic floor is really tested. Because of the hormones relaxin and progestrone and the weight of the growing fetus, the pelvic floor can become weak and vulnerable. Over time if a woman does not maintain a strong, flexible and healthy pelvic floor she can suffer prolapsed bladder, prolapsed uterus, prolapsed anus, urinary incontinence, back pain and pelvic pain. Even if a woman gives birth by Cesarean section, she will still have carried the weight of her baby for an average of 40 weeks, and the pelvic floor will have experienced some weakening.
Besides the obvious reason to do your Kegels, (not peeing yourself would be that obvious reason), you will gain greater sensitivity and circulation in that area, making sex more enjoyable for both you and your partner. You will lessen your chances of tearing when your baby’s head is crowning, since a toned muscle will stretch more effectively than a weak one, and should you tear, you will likely heal more quickly. You will experience more support for your body, leading to less back pain, you will minimize your chance of getting hemorrhoids and you may experience a shorter second stage of labor - PUSHING!!!
It is a misconception that it is only important to focus on the strengthening aspect of the pelvic floor. It is equally important to remind the students to learn how to relax the pelvic floor. When a woman is in the second stage of labor (the pushing stage) she needs to access the ability to let these muscles relax and let her baby out. If she goes into labor never having familiarized herself with her muscles way down there, how can she expect to know how they work?
One way I like to teach students to relax the pelvic floor is have them focus on the “letting go” of the pelvic floor during Kegel exercises. For example, I ask the students to do an “elevator” Kegel, by imagining there are four floors at the base of the body and that they are to slowly engage and lift the pelvic floor up all four floors, and then slowly release the muscles floor by floor. (Typically, most women say they cannot control the descent of the muscles. They drop from the fourth floor straight down to the bottom.) This type of exercise uses the slow muscle twitch fibers, which make up 70% of the muscles of the pelvic floor, and asks the woman to be more aware of what it is like to consciously relax the pelvic floor muscles. To focus on the fast muscle twitch fibers, I would ask the students to pulse the muscles, quickly engaging and releasing.
If you are brand new to Kegels and are unfamiliar with how to access the pelvic floor muscles, you can practice on the toilet. Try stopping the flow of urine mid-stream - this is a good start. But don’t practice that way too often, since you don’t want to inadvertently give yourself a urinary tract infection. Once you feel comfortable with focusing on the front of the pelvic floor, you can include some of the muscles to the back of the pelvic floor. One of my students, a physical therapist, said you should “engage your rectum as if you were trying not to pass gas in public. But don’t tighten your butt muscles”.
Without getting into a whole anatomy lesson, the muscles that we focus on when practicing Kegels are part of the superficial layer of the pelvic floor, which resembles a figure eight. The bulbospongious muscle is the front loop of the figure eight, which runs from the clitoris to the central tendon (the perineum), and the anal sphincter is the back loop of the figure eight. Here is a link to a picture of the superficial pelvic floor muscles.
Now that you are a little bit more familiar with the workings of your pelvic floor, Kegels will not be such a mystery. Happy Kegeling!
October 6th, 2008
