Childbirth Education: Fetal Monitoring During Labor and Delivery

Posted: 1458 days ago in Pregnancy

Ultrasounds: Pretty as a Picture?

Posted: 1549 days ago in Pregnancy

ultrasounds

Ultrasounds. Sonograms. Whatever you call them, they are the grainy black and white pictures that many women get of their unborn babies.

Ultrasounds were traditionally taken if there was a suspected problem with a woman’s baby, or perhaps to see if there was more than one kid in there.

91584560Then, they started being used routinely to ‘confirm’ or ‘date’ a pregnancy.

And seemingly all of sudden, women are having multiple ultrasounds to check if baby is ‘too big’ (btw – what’s too big?), or just to have another photo to add to the picture album.

Does any of this improve outcomes for mom or baby? Not so much.

Before you start screaming at me, please know that I think an ultrasound is a great tool to use if there is a suspected or known complication of pregnancy. For sure. However, the vast majority of pregnant moms are ‘no’ or ‘low-risk’.

Not to mention, ultrasounds in fact do a really poor job of determining the size of baby in utero. How many of you know someone (or are someone!) who had their baby induced early because an ultrasound estimated that he or she was getting ‘too big’ to deliver vaginally, only to have a petite 6 pounder? And again, what the heck is too big? A 4’11” friend of mine had a 12 pound baby. At home. With no drugs.   No problem!

And let’s not get into the false positives that happen all too often. I was in the room when a good friend had an ultrasound.  She was told that her baby would have one leg that was significantly shorter than the other. It’s no surprise that she was a nervous wreck for months before the baby was born – perfectly healthy, with no leg issues. Or my friend who was told in no uncertain terms that her baby had multiple physical deformities – to the point where they considered termination of the pregnancy – only to delivery a healthy baby.

My advice to you? Ask questions and be an informed consumer.

  • “What is the indication for this test?”
  • “What will you do differently with the information gained from this test?”
  • “What are the side effects?”

To this last question, I’m quite sure most doctors will say there are no negative side effects. However, I will leave you with this direct quote from the National Institutes of Health: “Despite widespread application of ultrasound imaging and Doppler blood flow studies, the effects of their frequent and repeated use in pregnancy have not been evaluated in controlled trials.”

I’ll pass, thank you very much.

The Myth of the Due Date

Posted: 1555 days ago in Pregnancy

duedate

If you are pregnant, fuggedabout your due date.

It’s a myth. Mmm-hmmmm, you heard me right. Due dates don’t really mean anything.

Think of how unique each of us are; we are many different combinations of height, weight, hair and eye color. No two noses look exactly alike, and let’s not even get into how different Kim Kardashian’s rear end is from Chelsea Handler’s.

So why do we think that each and every baby should be born exactly 280 days from the onset of their mom’s last period? That, my friends, is the myth of the due date.

There is, in fact, a window of 4-5 weeks in which babies can be expected to come and be considered full-term, with no complications.

Why babies come when they do is a little-understood science. Some theorize that when a baby’s lungs are mature, this triggers a hormone that starts labor. Others say that since those last weeks are when baby shows the most growth, they come when they are at their peak survival time – fat stores, brain growth and reflexes are ready for the outside world.

So if most babies will be born healthy and happy between 38-42 weeks, why do so many doctors start talking induction 38 weeks (or earlier!)?

I dunno, but I can guess.  

An induced labor is a controlled labor. There is no mystery about when, where or how labor will start. It’s all nice and tidy, tied up in a package of hospital gowns, Pitocin and a 9-to-5 work day. Nice for the doctor, but is it good for the baby or mama? I think not.

The contractions stimulated by Pitocin are waaaaay stronger and more painful than those you would have had if labor had started naturally. The use of Pitocin also necessitates that you have other interventions like an IV and constant fetal monitoring, not to mention it increases the likelihood of the need for a C-section.

Not. Cool.

Who are we to think we know better than nature about when a baby should be born? In a complicated, high-risk pregnancy, perhaps yes. But in the vast majority of healthy pregnancies? Step away from the induction, please!

Our belly buttons may pop out toward the end of pregnancy, but alas, it’s not the same as the turkey thermometer. There is no “done” button.

Only Mother Nature knows when the time is right for your baby to come. So, Listen to your mother, ya hear?

Nursing 103: “The Football Hold”

Posted: 1566 days ago in Parenting Pregnancy

Successful Nursing Tips

Posted: 1567 days ago in Parenting Pregnancy

nursing-tips

Successful nursing starts before the cord is cut.

Best circumstances, you’re going to have the baby on your chest as soon as he/she is born, and while the cord is still pulsating. Unfortunately in a hospital birth, they take the baby after the cord is cut to be cleaned up. So an unmedicated – natural birth – can be in the hospital, but you will need to request that the baby is placed on your chest immediately following the birth. I also suggest requesting to let the cord naturally stop pulsating before it’s cut.

If you don’t believe me when I tell you how miraculous this process is – then watch this breastcrawl video (so long as you’re not faint of heart). It’s of a baby working its way up momma’s chest directly after giving birth. Babies have a rooting reflex where if their cheek and mouth is stimulated, and they feel the nipple, they will move toward it; it’s a natural reflex. Babies are hard wired to nurse, it’s us momma’s that need some training.

Here are some training tips.

  1. Baby positioning is really important – baby’s chest to mom’s breast is the mantra/visual to have when nursing your baby. Many moms make the mistake of holding their baby in a traditional cradle hold (face up in arms) – necessitating that baby should turn its head to nurse. Have you ever tried to swallow with your head turned to one side? It’s pretty hard to do. Position your baby where his or her head is in a neutral position when latching on. For a visual on this, watch the video below.
  1. Make sure that baby’s mouth is really wide open, and literally shove as much of your breast as you can into their mouth. A lot of moms make the mistake of just trying to pry the nipple into the mouth, when really the whole areola  should go into the baby’s mouth.
  2. I’m a big fan of letting the baby nurse on demand in general, but definitely in the first week. The more baby sucks, the more your body stimulates the production of milk – you cannot spoil baby at this age.
  3. Rooming in – i.e. keeping baby close to you is critical for getting to know your baby’s signs, especially those signs telling you that they want to nurse. That’s why I’m not a big fan of babies being in the nursery down the hospital, or being in their own room the first few weeks.breastfeeding
  4. I would avoid giving a bottle at all cost, it creates nipple confusion. A baby has to work in order to get milk from a breast, and has instant gratification of high volumes of milk from a bottle. They will definitely boycott the breast if a bottle is introduced too quickly. Eventually I love the idea of pumping, and letting dad feed but I would hold off for at least 6 weeks or more before bringing a bottle into the picture.
  5. A lot of women feel pressured to supplement with “formula” because they’re told that they are not producing enough milk, or their baby is losing weight. It is very normal for a baby to lose up to 10% of its body weight after birth when nursing. As long as baby is wetting his/her diaper, you should be fine. If you have a serious concern, consult with your doctor.

If you have any other questions, comments, or concerns – I’m happy to help.

Good luck to all the new moms!

Nursing 102: “Chest to Breast”

Posted: 1594 days ago in Parenting Pregnancy

Nursing 101: Supporting Baby

Posted: 1598 days ago in Parenting Pregnancy

Does Your Baby Have Good Posture?

Posted: 1632 days ago in Parenting Pregnancy

baby-posture

Wait. What?

How does a baby have good posture? They barely sit or stand yet!

Well guess what – if your baby doesn’t start out with good posture from the get-go, he or she will surely NOT have good posture when it comes time to sit and stand! Here’s what I mean…

Does your baby’s head always end up in the same position while they sleep, even if you turn it a different way?

Does it flop or turn to one side?

Do they cry when you attempt to put them in a certain position, over and over?

Do they refuse to nurse on one side?

These are all signs that your baby may have structural misalignments, or what we call “poor posture” in adults.

How does that happen???

467588149Believe it or not, poor posture can start in-utero! If a baby is in a breech or transverse position, his or her head does not enjoy the “key-in-lock” relationship that happens when the head is vertex (head down). If baby is in a less than ideal position long enough, this can result in minor postural deviations at the least, and torticollis (‘wryneck’) if it’s really bad.

Even if baby is in a perfect position in-utero, the birth process can be incredibly traumatic for him or her, especially if interventions like Pitocin, epidural, vacuum extraction or C-sections are utilized. Their tiny joints and ligaments can be sprained and strained just like an adults can. Ultimately, if left uncorrected, this can often lead to postural changes, pain, and even health issues like ear infections and colic.

The ability to move freely is really important for development of normal spinal curves and muscle formation. “Tummy time” develops the very important “C” curves of the neck and back. However, spending too much time in an infant carrier can also force baby’s spine into unnatural positions, so you’ll want to watch for that.

Pediatric chiropractors do a great job of treating obvious spinal issues like head tilt and torticollis. More importantly, they can detect subtle shifts before they become even bigger problems. It’s a great idea to get your kids checked preventatively, much like you have a dentist check their teeth as soon as they get them.

After all, ‘An ounce of prevention…’ and all that.

Mastitis

Posted: 1693 days ago in Pregnancy

mastitis

Unless you are or know someone who has nursed a baby, you may think mastitis is something that has to do with a sailboat. If only that were so.

Mastitis is an inflammation in one or more mammary glands in the breast, usually caused by a clogged or infected milk duct. And it hurts like hell.

Imagine the biggest, reddest zit that you’ve ever had. Now imagine it about 10 times bigger, on your boob, and so sensitive that even the lightest touch from a baby’s hand or brush of a shirt has you cringing. Oh yeah, and you’ll probably have a fever and flu-like symptoms, too.  

Lucky you, am I right?

Treatment may include antibiotic therapy, which is not great for a breastfeeding mom, so you’ll want to do all you can to avoid it. If left untreated, mastitis can lead to an abscess, which may even need surgical intervention. Though sometimes it’ll get you even if you do everything right, there are a few things you can do to minimize the chances that you’ll get mastitis.

They include:

Breastfeeding in different positions. There are many milk ducts that lead to the nipple. If baby only nurses in one position, he or she may only be draining certain ducts, making it more likely that other ducts go stagnant and get clogged. Moving baby around will give you the best chances of avoiding this.

Allowing baby to fully empty one breast before moving on to the other. Milk retained in one breast, especially the rich hindmilk(the secondary milk that comes in after the foremilk that typically has a higher concentration of lactose) — is the milk you need to worry about. If baby gets full on the foremilk (which typically happens), he or she may have trouble digesting all of the rich hindmilk, and if you don’t go back so baby can finish before going to the other breast, it can become a serious milk-duct-clogging culpri

Wearing supportive (though not tight) undergarments. Heavy lactating breasts require a little extra support, but squeezing them into a bra that’s too small may contribute to mastitis.

If all fails and you end up with mastitis, please remember to visit your healthcare provider, pronto-stat!

Much love, my new mommy bunch!

Epidurals: Worth the Trip?

Posted: 1706 days ago in Pregnancy

epiduralsdivider2Epidurals are not all that they are cracked up to be.

Yeah sure, they are great for pain management in childbirth. But how many of you realize that there are A LOT of potential downsides to epidurals many of them serious and long-lasting – for an upside of short-term pain management?

For instance, did you know that an epidural increases your need for interventions like vacuum extraction and forceps to be used during childbirth?forceps 

And how about the increased likelihood that you will end up with a C-section? Had you heard of that one?

It can also cause long-term back pain and nerve damage – we see this a lot in our practice!

Oh! And let’s not forget about fetal heart rate changes and potentially dangerous drops in blood pressure – scary stuff!

Those are just a few. For a more comprehensive list of pros and cons, check this out: http://www.epidural.net/prosandcons.html

There is even some talk that when you have an epidural, you rob your baby of endorphins to protect them against the stress and pain of childbirth. Let me explain: when you or I have a painful stimulus, our bodies secret endorphins to help manage that pain (which is why sharkbite or accident victims often report not feeling pain at first). Those endorphins flow throughout our body, and allow baby to benefit from them as well.

If we artificially numb that pain with anesthesia, we no longer secrete endorphins. So though we don’t feel pain, the anesthesia does not numb baby, so he or she does feel pain.

vaccuumIn my article Natural Childbirth, I talk about how cool it really is to have an active part in your birth. And to be honest with you, though my two unmedicated births were, uh, not particularly comfortable – it was very transient, and very manageable pain with a purpose.

And for you guys? Let me give you an example of why epidurals might not be a good idea. Let’s say you’re constipated. Really, really constipated, and you’re determined that today is the day – you’re going to finally poop. Let’s put you in bed, on your back, with your feet up in the air. And, yeah, let’s numb you from the waist down.

How successful do you think you’ll be? Not. At. All.

Which is why it makes no sense at all to me that we would put a pregnant woman on her back, numb her from the waist down, and expect her to push out a baby. Which is ultimately why this one intervention often leads to many others.

So in answer to my question, is an epidural worth the trip? No way in hell.

But thanks for coming!