Is Gestational Diabetes a Problem Beyond Pregnancy?

Is Gestational Diabetes a Problem Beyond Pregnancy?

The short answer, as you may have suspected, is yes.

A recent study published in the Journal of Obstetrics and Gynaecology Research showed that over 23% of the study participants with a history of gestational diabetes were diagnosed with type 2 diabetes within 9 years, compared to about 9% of the control group. Studies in the United States have put the risk significantly higher, citing 35-60% of women with a history of gestational diabetes developing type 2 diabetes within 10-20 years. So there definitely is an increased risk.

Before you start feeling like the gestational diabetes you have during pregnancy is a sentence for eating only sugar-free desserts for the rest of your life, consider that there are a lot of ways to lower your risk. Most of them don’t even cost anything.

What to do about gestational diabetes during pregnancy:

  • Eat a low-glycemic diet (see these websites for more info onand).
  • Exercise for at least 30 minutes a day (check with your doctor or midwife first to make sure it’s ok for you).
  • Reduce stress as much as you can, to help your body be able to handle making insulin.
  • Eat plenty of essential fatty acids and protein, to provide your body with the materials needed to create hormones.
  • Ask your doctor or midwife if supplementing with cinnamon is safe for your situation, or if you can eat more foods containing cinnamon. Cinnamon has been shown in some studies to help the body to be able to process sugars better.
  • Carefully follow your doctor’s recommendations about diet, blood sugar monitoring, insulin, etc.

How to reduce your risk for type 2 diabetes postpartum/after pregnancy:

  • Continue to eat a low glycemic diet, being certain to include the nutrients necessary for creating hormones.
  • Keep a regular exercise program, preferably 30 minutes or more of aerobic activity each day.
  • Get tested for diabetes regularly, beginning within 3 months after having your baby, and every 3 years after that.
  • Pay attention to your body. Unusual amounts of fatigue, especially in the midafternoon, dizziness, moodiness, and nausea after not eating for some time can all be signs of diabetes or pre-diabetic conditions. Talk to a health care practitioner if you suspect you may be developing diabetes or pre-diabetes.
  • Consider seeing a natural health practitioner to help support the pancreas and other organs involved in the endocrine system.
  • Ask your doctor if supplementing with cinnamon is safe for you, or if you can eat more foods containing cinnamon. Cinnamon has been shown in some studies to help the body to be able to process sugars better.
  • Breastfeed. It can help reduce your baby’s risk for obesity and eventual diabetes, and because of the extra use of calories, may help you as well.
  • Achieve and maintain a healthy weight (I know – easier said than done!).

The Pocket Pregnancy Health System (due out as a website and app later in 2012) gives step-by-step guidance to help develop some of the lifestyle habits of low-glycemic eating and exercise which can help not only during your pregnancy, but reduce your risk for diabetes later in life. Until then, you can get more info to help lower your risk at the resources listed below.

A Few Resources for Women with Gestational Diabetes Reducing Risk for Type 2

Ramezani Tehrani, F., Hashemi, S., Hasheminia, M. and Azizi, F. (2012), Follow-up of women with gestational diabetes in the Tehran Lipid and Glucose Study (TLGS): A population-based cohort study. Journal of Obstetrics and Gynaecology Research, 38: 698–704. doi: 10.1111/j.1447-0756.2011.01767.x

Diabetes Risk After Gestational Diabetes PDF

National Diabetes Education Program

How to Find the Best Midwife

Once you are at your birth location, who has the most influence over how your birth turns out?

Yes, you have a lot of influence. But your OB/Gyn or midwife has an equivalent – possibly greater- amount of influence over your birth experience. This is true even if you have a birth plan, a well-trained coach, and a doula. That’s why it is very important to find an OB/gyn or midwife (also called a birth attendant) who supports the kind of birth you want to have.

When I doula births where mom wants to have a normal, natural labor, and has a doctor that is fine with letting her “try,” mom often ends up with interventions that she did not want, and that may not have been truly medically necessary. During one labor I was at, mom’s labor partner spent a good deal of the time in the hall, “talking” with the doctor. The doctor thought mom’s labor was going too slowly, but mom did not want to speed anything up. Poor dad had many quiet conversations in the hall with the doctor, declining the interventions, instead of being a constant support to his wife. Mom was healthy, had the birth experience she wanted, and got her wonderful present at the end (a healthy baby), but it was a fight. Other women are not as fortunate. I have been at births where the birth attendant was about to do a procedure such as amniotomy (breaking the bag of waters) without even telling mom what they were going to do, let alone asking consent. I had to announce the doctor or midwife’s intentions and ask mom if that was ok with her. No woman should have to spend labor wondering if something will be done to her without her knowledge, or arguing with the hospital staff to have the kind of birth she prefers. As long as you and baby are safe and healthy, a birth attendant that has similar beliefs in regard to pregnancy and birth as you have will support you in the kind of labor you want to have. That is what you are looking for.

Before you can interview birth attendants (doctors and midwives), you need to know a bit about your own desires for labor and birth. Take some time thinking about what kind of birth experience you want and where you want to have your baby. Also consider your feelings on medical procedures such as episiotomy and cesarean, and whether or not you might like to have a natural (unmedicated) birth. You can always change your mind later, but if you drastically change your desires, you may also need to change birth attendants.

Below are some interview tips, and a link to a PDF with suggested interview questions that you can print and bring with you.

What’s So Special About Breastmilk? (And how to make formula feeding more like it)

What’s So Special About Breastmilk?

(And how to make formula feeding more like it.)

As you may have heard, this first week of August has been World Breastfeeding Week. You have probably heard much of what is getting put out in the media before, about how breastmilk is the perfect food and all the benefits it has for your baby.

What you may not know is why that is. What is it about the chemical composition of breastmilk that makes it so special?  And if you decide NOT to breastfeed, is there anything you can do to give your baby more of those factors?
 
In a nutshell, breastmilk contains everything you would need in an ideal diet to be healthy. It also provides everything a new body needs to establish a great foundation for health. And, breastmilk provides all these factors in an-easy-to-digest format that lets your baby’s body become an expert at digestion without having to work too hard.

How breastmilk compares to formula:

(Chart from “Comparison of Human Milk and Formula,” at AskDrSears.com. The formatting is better on the original site)

NUTRIENT FACTOR

BREAST MILK CONTAINS

FORMULA CONTAINS

COMMENT

Fats

-Rich in brain-building omega 3s, namely DHA and AA
-Automatically adjusts to infant’s needs; levels decline as baby gets older
-Rich in cholesterol
-Nearly completely absorbed
-Contains fat-digesting enzyme, lipase

-No DHA
-Doesn’t adjust to infant’s needs
-No cholesterol
-Not completely absorbed
-No lipase

Fat is the most important nutrient in breastmilk; the absence of cholesterol and DHA, vital nutrients for growing brains and bodies, may predispose a child to adult heart and central nervous system diseases. Leftover, unabsorbed fat accounts for unpleasant smelling stools in formula-fed babies.

Protein

-Soft, easily-digestible whey
-More completely absorbed; higher in the milk of mothers who deliver preterm
-Lactoferrin for intestinal health
-Lysozyme, an antimicrobial
-Rich in brain-and-body- building protein components
-Rich in growth factors
-Contains sleep-inducing proteins

-Harder-to-digest casein curds
-Not completely absorbed, more waste, harder on kidneys
-No lactoferrin, or only a trace
-No lysozyme
-Deficient or low in some brain-and body-building proteins
-Deficient in growth factors
-Does not contain as many sleep-inducing proteins.

Infants aren’t typically allergic to human milk protein.

Carbohdrates

-Rich in lactose
-Rich in oligosaccharides, which promote intestinal health

-No lactose in some formulas
-Deficient in oligosaccharides

Lactose is considered an important carbohydrate for brain development. Studies show the level of lactose in the milk of a species correlates with the size of the brain of that species.

Immune Boosters

-Rich in living white blood cells, millions per feeding
-Rich in immunoglobulins

-No live white blood cells-or any other cells. Dead food has less immunological benefit.
-Few immunoglobulins and most are the wrong kind

When mother is exposed to a germ, she makes antibodies to that germ and gives these antibodies to her infant via her milk.

Vitamins and Minerals

-Better absorbed, especially iron, zinc, and calcium
-Iron is 50 to 75 percent absorbed.
-Contains more selenium (an antioxidant)

-Not absorbed as well
-Iron is 5 to 10 percent absorbed
-Contains less selenium (an antioxidant)

Vitamins and minerals in breast milk enjoy a higher bioavailability-that is, a greater percentage is absorbed. To compensate, more is added to formula, which makes it harder to digest.

Enzymes and Hormones

-Rich in digestive enzymes, such as lipase and amylase
-Rich in many hormones: thyroid, prolactin, oxytocin, and more than fifteen others
-Varies with mother’s diet

-Processing kills digestive enzymes
-Processing kills hormones, which are not human to begin with
-Always tastes the same

Digestive enzymes promote intestinal health. Hormones contribute to the overall biochemical balance and well- being of baby.
By taking on the flavor of mother’s diet, breastmilk shapes the tastes of the child to family foods.

The comparison chart above is not an exhaustive list, but hits on some of the most important distinctions. Another good resource can be found here: Poster of breastmilk and formula ingredients.

What if I can’t breastfeed?

First, I would question that assumption. Almost every woman can breastfeed at least partially with the right education and support. Second, even if you are deciding not to breastfeed long term, consider breastfeeding for the first month or 2, or even just the first week or so. Every little bit will help your baby. That short time breastfeeding might be hard, but breastfeeding gets considerably easier after the first few weeks. So don’t think that the way it starts out is the way it will always be if you were to decide to continue.
 
But, if you are truly not able to breastfeed or choose not to, try to ensure that your baby is getting as closely as possible what they would be getting out of breastmilk.

How to make formula more like breastmilk

Obviously, you can’t replace all the components of breastmilk when feeding your baby formula. But, these few tips will help formula feeding moms give their babies more of the benefits of breastfeeding, so baby is healthier. The links to specific products below are affiliate links to Amazon or other sites. I would appreciate it if you buy using the links, but you are welcome to go find the products and purchase them without the links. Whole Foods and other health food stores tend to carry similar products, if not these specific ones.

  • Get close, skin to skin contact time with your baby. We humans are designed to crave connection and skin-to-skin contact. The effect of this contact is most obvious in babies, and it helps them grow and develop more quickly.
  • Supplement Essential Fatty Acids like DHA if they are not in the formula you are using. Essential fatty acids (EFAs) are used in many essential body processes, such as brain and hormonal development, but not all formulas contain them yet. Both of these are good EFA supplements: Nordic Naturals Baby’s Dha, 2 fl Ounce and Nordic Naturals Baby’s DHA (Vegetarian).
  • Use an infant probiotic supplement. If baby is not getting the good bacteria for their digestive system from breastmilk, you can buy a powder to mix with baby’s formula. Here are some high-quality options in different price ranges:
    ProBiota Infant PowderJarrow Baby’s Jarro Dophilus or the liquid version: Baby’s Jarr-Dophilus Drops, or Udo’s Choice Infant’s Blend Probiotic.
  • Consider adding glyconutrients to baby’s formula. Glyconutrients are the 8 sugars necessary for many body processes. They are included under “oligosaccharides” in the chart above.
  • Around 4 months old, introduce small amounts of an allergen-introduction powder.  In breastmilk, the mother eating a variety of foods helps introduce baby to tiny amounts of these substances and reduces the incidence of food allergies.  With formula, small amounts of potentially allergenic foods can be added with a powder such as SpoonfulOne or  Ready, Set, Food!
  • Add additional nutrients with a liquid multivitamin. Most formulas are missing some nutrients. An infant multivitamin supplement like this one (Child Life Multi Vitamin and Mineral) can help fill in the gaps. An additional iron supplement might be necessary, since the iron in formula is not as easily absorbed.
If you want additional help, just ask! I and so many other people are more than happy to help you find the best way to feed your baby, and to support you during that process. La Leche League is a great place to start if you are considering breastfeeding.
 
Have you found anything else in breastmilk that is missing from formula, or a way to replace those ingredients?

West Nile Virus and Pregnancy

West Nile Virus and Pregnancy

Learn how you can reduce your exposure to the West Nile Virus.

This year, West Nile virus has become a serious problem in some areas of the country, such as Texas. Because there is no real treatment for West Nile virus infection, pregnant women may want to take extra care to not expose their babies to the virus.

What is West Nile virus?

West Nile virus is a virus, usually transmitted by a bite from an infected mosquito. An infection from West Nile virus can show up in a variety of ways. In most people, there will be no symptoms at all, though this does not mean that an unborn baby could not develop the infection, too. About 20% of people who are infected with West Nile virus will develop West Nile fever, which is usually mild. West Nile fever symptoms include fever, headache, and body aches, and may sometimes include a rash and/or lymph node swelling. About 1 in 150 (0.7%) infected people will develop a more serious version of the disease, either West Nile encephalitis or meningitis. These more serious symptoms include neck stiffness, muscle weakness, confusion/disorientation, tremors, convulsions, paralysis, and/or coma, in addition to a headache and a higher fever than the mild form of the disease.

At this time, there is no treatment for West Nile infection. Severe cases of infection are usually hospitalized to make sure the patient can get full-time supportive care like IV fluids, if needed, and to prevent secondary infections.

Do pregnant and breastfeeding moms need to worry about West Nile virus?

At this point, no one knows how often a pregnant or breastfeeding woman who gets infected with West Nile virus would pass it to her baby. It is also unknown how often the virus would cause problems for baby, even if it is passed on. Experts recommend that pregnant women in areas known to have infected mosquitoes take precautions to reduce their exposure (listed below). If a mom who is breastfeeding develops symptoms of West Nile infection, at this point the recommendation is to continue to do so. The benefits of breastfeeding for baby are well known and very important, and the rate of transmission of West Nile virus through breastmilk is unknown, if it exists. It seems unlikely that there is any transmission through breastmilk, since West Nile virus is NOT transmitted by touching, kissing, or from health care workers who have treated infected patients.

How can I reduce my exposure to West Nile Virus?

The best way to reduce your exposure to West Nile virus, is to reduce your chance of being bitten by mosquitoes.

  • Reduce mosquito breeding places around your home. Eliminate standing water in plant pots, low places, clogged gutters, dips in children’s toys, etc. If you have standing water that you want to keep (such as a birdbath), add a substance to break the surface tension. Commercial ones are available at nurseries, or you can use a drop or 2 of a natural, phosphate-free, biodegradable liquid soap.
  • Reduce mosquito hiding places around your home. Mosquitoes love to hide on the undersides of ivy leaves and similar plants. If you have a lot of ivy around your home, consider using a safe garlic spray or other safe spray to help keep them away.
  • Wear protective clothing.When you go into areas where you are likely to encounter mosquitoes, wear clothes they can not bite through. Light-colored, loose-fitting clothes will work best.
  • Wear insect repellent. Many experts recommend wearing bug spray with DEET whenever you go outside. While DEET is officially safe for pregnant women to wear, if you are hesitant to use a bug spray containing DEET (I personally try not to touch the stuff), there are other effective alternatives. A chemical called picaridin is as effective as DEET, but is odorless and approved for use in children 2 months old and up. For those who want a natural insect repellent, the CDC says those natural repellants containing oil of lemon eucalyptus are the most effective.
  • Make your body less attractive to mosquitoes. Much of what attracts mosquitoes is said to be genetic. Other known attractants include sweating, breathing out more carbon dioxide, movement, heat, having type O blood, being pregnant (darn!), and being overweight. There are many people that claim that what you eat effects how many mosquitoes will bite. Unfortunately, it seems that none of these things have yet to be proven true. But, since eating raw garlic or foods rich in B-vitamins such as Brewer’s yeast is unlikely to cause harm (other than to your breath!), they are something to try.
  • Try to plan outdoor activities during full daylight. Mosquitoes are more active at dawn and dusk, so try to stay inside (or do the above tips) during early morning or twilight hours.

References:

West Nile Virus Questions Answered. WebMD. Reviewed July 4, 2012. Accessed Aug 23, 2012. http://www.webmd.com/a-to-z-guides/west-nile-virus-faq

Mosquito Mythbusting: Will the Real Repellents Please Stand Up? ABC News.com Accessed Aug. 23, 2012 http://abcnews.go.com/Technology/mosquito-mythbusting-real-repellents-stand/story?id=10543307#.UDZ826PAETB

Mosquito Bites. Mayo Clinic website. April 30, 2011. Accessed Aug. 23, 2012. http://www.mayoclinic.com/health/mosquito-bites/DS01075

Are You a Mosquito Magnet? WebMD. Reviewed January 31, 2012. Accessed Aug. 23, 2012. http://www.webmd.com/allergies/features/are-you-mosquito-magnet

Natural childbirth causes PTSD in some moms? A closer look

Natural childbirth causes PTSD in some moms? A closer look

It’s not just unmedicated birth – and you can reduce your risk.

Note: If you just want to know the risk factors for developing PTSD after giving birth, and what you can do to possibly prevent childbirth causing PTSD, scroll down to the end. 

If you already gave birth and suspect that you might have birth trauma or PTSD, please get help and support! Here are a few resources that may help:
https://www.solaceformothers.org/resources/
https://www.birthtraumaassociation.org.uk/for-parents/ (UK)
https://www.postpartum.net/

As you may know, I taught natural childbirth classes for many years, and had both of my children naturally, without any pain medication. So when I found this article in Skygrid that mentioned natural childbirth causing PTSD in some women, I was very curious.

Can childbirth cause PTSD? YES, but why?

I have no doubt that, in some cases, giving birth can be a traumatic experience that can lead to PTSD (post-traumatic stress disorder). I have been at a couple of births as a doula that I would definitely call traumatic for the mom, and possibly for other family in the room, too. What was intriguing to me about this article, however, was the claim that a much higher percentage of women who had natural births went on to show signs of PTSD than those who had epidurals.

Now, you might be thinking, “of COURSE natural births are going to cause more PTSD, don’t they hurt more?” But you have to remember my background. As a natural childbirth educator and doula, I know a LOT of women who have given birth without medication. Very few, if any, of them described their birth as anything approaching traumatic, so I do not imagine natural births causing PTSD more often than medicated ones. I have, however, spoken with many women who were looking for classes for their second or subsequent baby and had experienced a traumatic natural birth previously. In general, they either had a normal (unmedicated) birth by accident – there was just no time for the anesthesiologist to arrive and place the epidural – or they were not trained to cope well with labor contractions, did not have enough support, or were confined to bed and unable to labor as they needed to.  Many of these women came to my classes and had an untraumatic, even empowering, natural birth the second time, after having prepared.

So, in trying to figure out why this study found that more women having unmedicated births were developing PTSD symptoms, I traced the news story back to the press release about 1/3 of postpartum women developing PTSD symptoms, and the original study on Postpartum Post-Traumatic Stress Disorder symptoms.

The study was completed with 89 women who had given birth in Israel. Of these, 3 were determined to have developed full PTSD, 7 partial PTSD, and an additional 15 had some PTSD symptoms, but could not be considered a true diagnosis. The study does not make it clear how many mothers gave birth without pain medication. They do state that “A significantly smaller number of women who developed PTSD symptoms received analgesia during delivery
compared to the control group,” but that precise percentage is not revealed. The authors have a chart that splits all of the study participants into categories: “Natural,” “Elective Cesarean,” “Emergency Cesarean, and “Instrumental.” since this chart does not include a category for “vaginal with anagesia” or “epidural,” we can not assume that all of the women either had a cesarean, an instrumental delivery, or had no medication at all. It seems that the study authors use “natural” to mean “vaginal, without vacuum or forceps, ” not a normal vaginal birth without pain medication. Ah, now I think I understand.

If you combine the information in this study with what we already know about PTSD, and about PTSD and childbirth, from other studies, we can conclude that there are a number of risk factors. Here are the factors that were more often associated with the development of PTSD after giving birth:

  • “Very uncomfortable” with being unclothed during labor (80% of those who developed PTSD, vs. 27.7% of non-PTSD group).
  • Previous birth was considered “traumatic” (60% of PTSD group, vs. 15.5% of control group.
  • History of depressive symptoms or seeking mental help. 50% of the PTSD group had sought out help from a mental health care practitioner after a previous birth, while only 8.3% of the control group did. Also, 80% of the PTSD group reported sadness or anxiety during or after the previous pregnancy, vs. 33% of the control group. In the current pregnancy, 80% of the PTSD group felt that they had at least one emotional crisis, vs. 23.8% of the control group.
  • Pregnancy complications were reported by 80% of the PTSD group, but only 28.6% of the controls.
  • A high fear of birth itself was reported by 80% of those women who developed PTSD, but only 30% of those who did not develop PTSD.
  • 71.4% of the women who developed PTSD reported feeling like their life or health was in danger during labor, vs. 20.7% of the controls. Additionally, 40% of the PTSD group felt as if their baby was in danger at some point during labor, while only 3.6% of the controls felt this way.
  • The PTSD group used significantly fewer birth methods to prepare for labor than did the control group (0.4 methods vs. 1.5). The PTSD group also had less confidence in their ability to ability to cope with labor.

Strangely, having a doula or other support person did not influence the development of PTSD in this study, but that may be due to the small size of this study.  The control group did more reading and birth preparation, but this was not considered significant. Again, this value could reach significance in a larger study.

Overall, this study has some problems. It has a very small sample size and some of the terms are used in confusing or non-conventional ways. In addition, the press release and media articles make a questionable conclusion the headline.

Does this mean that childbirth does NOT cause PTSD? No, childbirth can definitely cause PTSD. Let’s look more closely at the circumstances under which women have developed PTSD after giving birth in the past.

In a 2008 study by Zaers, et. al. on depressive symptoms and PTSD after childbirth 6-15% of women reported clinically significant PTSD symptoms 6 weeks and 6 months, respectively, following labor. In the Zaers study, they found the factor most strongly associated with developing PTSD symptoms was women experiencing anxiety in late pregnancy.

According to the Mayo Clinic, the risk factors for anyone for developing PTSD include:

  • Being female
  • Experiencing intense or long-lasting trauma
  • Having experienced other trauma earlier in life
  • Having other mental health problems, such as anxiety or depression
  • Lacking a good support system of family and friends
  • Having first-degree relatives with mental health problems, including PTSD
  • Having first-degree relatives with depression
  • Having been abused or neglected as a child

This may seem to doom certain women to developing PTSD after giving birth no matter what, especially those who have or have had anxiety or depression. However, I think there are some trends that may point to preventive measures women can take to reduce their risk of developing PTSD as a result of giving birth. My thoughts are below.

What to do when pregnant that may help reduce the risk of PTSD after giving birth:

  • Seek help from a mental health professional to help process any previous traumas. You may have experienced a Trauma (a single traumatic event), such as a car accident, rape, natural disaster, previous traumatic birth, etc., or it may have been recurring trauma (a series of smaller events that created an atmosphere of fear and danger), such as an abusive parent, school bullying, being in combat, a chronic illness, etc. An especially effective form of treatment for processing trauma of any kind is Eye Movement Desensitization and Reprocessing (EMDR). This treatment is approved by the VA for use in helping veterans process combat trauma and improve symptoms of PTSD. Logically, it can help with other types of trauma, too. You can find a certified EMDR practitioner at www.emdr.com or www.emdria.org
  • Get support for you during this pregnancy. Talk with friends, family, other pregnant moms, and professionals, if necessary, about how you are doing during your pregnancy. Make sure you take time to pamper yourself. Enlist your partner and friends to help make sure you take time out for yourself, and to check in to see how you are feeling.
  • Work on reducing any pregnancy fears that you have. Sometimes just talking about them helps, sometimes making preparations to help in case something did go wrong is a good answer, and sometimes you need to put some focused effort into just processing the fear. There are many ways to uncover and process birth fears in the classes and book Birthing from Within, by Pam England.
  • Get plenty of sleep. Everything is harder when you are not well rested. There is a list of many ways to get better sleep during pregnancy in the Pocket Pregnancy Guide to Feeling Great While Pregnant, available in early September, 2012 where e-books are sold.
  • Eat omega-3 essential fatty acids. Essential fatty acids are needed by the body to create hormones and enzymes. These hormones help your body keep baby in until the right time, know when to start labor, help your baby develop, help you sleep, and even help determine your mood.
  • Get enough protein. Like essential fatty acids, your body needs the amino acids in protein to create hormones, including those we need to feel happy and sleep well. Many experts recommend that pregnant women eat at least 80 grams of protein a day, or over 100 grams daily if carrying twins or triplets.
  • Exercise at least 4 days a week, preferably daily. Exercise releases endorphins (feel-good hormones), and has been shown to reduce symptoms of depression. Depression symptoms are a risk factor for developing PTSD.
  • Learn and practice meditation and other stress-reducing techniques. Reducing overall stress can help with coping with events better so they are less likely to create the negative mental loops that exist in anxiety and depression and breaking up negative loops already in process.
  • Decide how you would prefer your labor and birth to go, and prepare for it. Understanding how your body works during labor, the procedures to expect, and how your birth attendant would deal with possible problems that come up can help reduce any fear about birth so you are more comfortable letting nature take its course. Whether you decide that you want to have a normal (unmedicated, low-intervention) birth or that you want an epidural as soon as you can get one, learn about the possible interventions that might be needed, and how to work with labor contractions to feel more comfortable. Just knowing that you and your support team can handle just about anything that comes up will help you have a much better, more emotionally relaxed birth experience overall, no matter what happens.
  • If you think you will be uncomfortable with wearing a hospital gown or being unclothed during labor, ask if you can bring a nightgown. Many birth attendants and hospitals are fine with you wearing your own clothes, as long as it opens completely in the front. They do need to have access to checking the baby’s heart rate and catching him or her, after all. 🙂 Make sure whatever you bring is something you don’t mind throwing away afterwards, because it could get stained.
Overall, pregnancy and giving birth is a natural process, but it can be intense.  Preparing, having a support system in place, and having a doctor or midwife who is respectful of your needs can help reduce the risk of experiencing birth as traumatic, but (just as in birth itself) there are no guarantees.  If, after giving birth, you find that you can’t think about it without feeling upset, or it keeps replaying in your mind, or any other reason you think your response may not be healthy, talk to a therapist or use one of these links to get help.

Resources

Childbirth can cause PTSD, study finds

One in Three Postpartum Women Suffers PTSD symptoms After Giving Birth, American Friends of Tel-Aviv University, Wed. Aug 8. 2012. http://www.aftau.org/site/News2?page=NewsArticle&id=17059

Inbal Shlomi Polachek MD, Liat Huller Harari MD, Micha Baum MD and Rael D. Strous MD. Postpartum Post-Traumatic Stress Disorder symptoms: The Uninvited Birth Companion. IMAJ, VOL 14: June 2012, pp. 347-353.

Post-Traumatic Stress Disorder (PTSD) Following Childbirth, MGH Center for Women’s Mental Health, Harvard Medical School, Posted October 8, 2008. http://www.womensmentalhealth.org/posts/post-traumatic-stress-disorder-ptsd-following-childbirth/ Accessed August 13, 2012.

Post-Traumatic Stress Disorder: Risk Factors. Mayo Clinic website. Accessed Aug. 13, 2012. http://www.mayoclinic.com/health/post-traumatic-stress-disorder/ds00246/dsection=risk-factors

Zaers S, Waschke M, Ehlert U. Depressive symptoms and symptoms of post-traumatic stress disorder in women after childbirth. J Psychosom Obstet Gynaecol. 2008 Mar;29(1):61-71.

EMDR therapist groups, http://emdria.org/ or www.emdr.com

Moms with gestational diabetes DO appear to have a higher cesarean risk

Moms with gestational diabetes DO appear to have a higher cesarean risk

Many childbirth educators and other childbirth professionals have suspected it for a long time, but now there is peer-reviewed proof (if there was not any already): just having the label of having gestational diabetes mellitus (GDM) raises a woman’s risk of having a cesarean section.

In the study, “Gestational diabetes mellitus: A risk factor for non-elective cesarean section,” which has been published in the online version of the Journal of Obstetrics and Gynaecology Research from the Japan Society of Obstetrics and Gynecology, researchers showed that even though the rate of cesarean indicators was not significantly different, mothers with GDM had a statistically significant higher rate of non-elective cesarean. The study authors think it may be knowledge of the diabetes itself influencing doctors.

You could argue that these are Japanese doctors in the study, not American, so the results don’t apply in this country. I think it is reasonable to use caution here (and around the world), because human nature is pretty much an international language. 

The best thing is always to try to reduce your risk of getting complications such as gestational diabetes (or as it is now sometimes called, “gestational glucose intolerance”). If you do have or end up with GD/GDM, talk with your birth attendant. Find out his or her parameters for when they would consider cesarean or other interventions necessary in your case. Ask for the doctor’s cesarean rate to see how it compares to other doctors, hospitals, and areas. If you don’t like what you find, it’s ok to switch practices. You may want to consider using a midwife, as they tend to treat pregnancy and birth as more of a normal occurence than a disease. Additionally, do what you can to keep the gestational diabetes under control with low-glycemic eating, regular exercise, and any other recommendations made by your health care professionals. Having well-controlled diabetes gives you a lot more options.

So what can you do if you are pregnant and would prefer to avoid cesarean?

The best thing is always to try to reduce your risk of getting complications such as gestational diabetes (or as it is now sometimes called, “gestational glucose intolerance”). If you do have or end up with GD/GDM, talk with your birth attendant. Find out his or her parameters for when they would consider cesarean or other interventions necessary in your case. Ask for the doctor’s cesarean rate to see how it compares to other doctors, hospitals, and areas. If you don’t like what you find, it’s ok to switch practices.

You may want to consider using a midwife, as they tend to treat pregnancy and birth as more of a normal occurence than a disease. Additionally, do what you can to keep the gestational diabetes under control with low-glycemic eating, regular exercise, and any other recommendations made by your health care professionals. Having well-controlled diabetes gives you a lot more options.

References

Gorgal, R., Gonçalves, E., Barros, M., Namora, G., Magalhães, Â., Rodrigues, T. and Montenegro, N. (2011), Gestational diabetes mellitus: A risk factor for non-elective cesarean section. Journal of Obstetrics and Gynaecology Research. doi: 10.1111/j.1447-0756.2011.01659.x

How to Find the Best OB or Midwife for You

How to Find the Best OB or Midwife for You

You have a say on your birth plan.

Once you are at your birth location, who has the most influence over how your birth turns out?

Yes, you have a lot of influence. But your OB/Gyn or midwife has an equivalent – possibly greater- amount of influence over your birth experience. This is true even if you have a birth plan, a well-trained coach, and a doula. That’s why it is very important to find an OB/gyn or midwife (also called a birth attendant) who supports the kind of birth you want to have.

When I doula births where mom wants to have a normal, natural labor, and has a doctor that is fine with letting her “try,” mom often ends up with interventions that she did not want, and that may not have been truly medically necessary. During one labor I was at, mom’s labor partner spent a good deal of the time in the hall, “talking” with the doctor. The doctor thought mom’s labor was going too slowly, but mom did not want to speed anything up. Poor dad had many quiet conversations in the hall with the doctor, declining the interventions, instead of being a constant support to his wife. Mom was healthy, had the birth experience she wanted, and got her wonderful present at the end (a healthy baby), but it was a fight. Other women are not as fortunate. I have been at births where the birth attendant was about to do a procedure such as amniotomy (breaking the bag of waters) without even telling mom what they were going to do, let alone asking consent. I had to announce the doctor or midwife’s intentions and ask mom if that was ok with her. No woman should have to spend labor wondering if something will be done to her without her knowledge, or arguing with the hospital staff to have the kind of birth she prefers. As long as you and baby are safe and healthy, a birth attendant that has similar beliefs in regard to pregnancy and birth as you have will support you in the kind of labor you want to have. That is what you are looking for.

Before you can interview birth attendants (doctors and midwives), you need to know a bit about your own desires for labor and birth. Take some time thinking about what kind of birth experience you want and where you want to have your baby. Also consider your feelings on medical procedures such as episiotomy and cesarean, and whether or not you might like to have a natural (unmedicated) birth. You can always change your mind later, but if you drastically change your desires, you may also need to change birth attendants.

Below are some interview tips, and a link to a PDF with suggested interview questions that you can print and bring with you.

But I Already Have a Doctor or Midwife!

If you already have a midwife or OB/Gyn, you can still interview them! Take some time to get clear on what you want, and follow the interview tips using the questions in the PDF. You may want to skip the more basic questions, and just ask a few of the more specific questions that are important to you. Hopefully, you will get answers that agree with your birth wishes, and you will feel more confident in your birth attendant. If not, the earlier you find out, the easier it is to find a doctor or midwife that you will be happy with and switch to their practice.

How To Decide Who to Interview

There are many birth attendants in most communities. To find out where to start, ask people who have similar feelings about birth who they would recommend. Sometimes asking on an online pregnancy board can work, but you need to make sure you find out about the preferences of the person making the recommendation, and specifically what they liked about the doctor or midwife.

If you think you want a natural birth, you can find great birth attendants by asking someone who gave birth naturally, or ask local doulas or natural childbirth educators. If you want someone who will help you have a good scheduled birth when your family will be in town visiting, ask other women who were induced. If you want a great, family-centered cesarean since you need one for medical reasons, ask other women who had c-sections.

How to Conduct an Interview

  1.  Call and ask as many questions over the phone as you can. This will probably help you thin your list down to just a few practitioners to visit on face-to-face interviews. When calling a doctor or midwife’s office, ask their staff standard questions such as whether or not they take your insurance, office hours, and so on. Then, instead of asking about the practitioner’s birth philosophy, ask something like, “what do you think patients like best about ___________ (doctor or midwife’s name)?” This may give you an insight into the philosophy of this birth attendant which may or may not appeal to you.

“Once my students were aware of the connection … those who made some changes … found that their symptoms improved.”

    1. Make use of “meet the professional” events. Many obstetric practices (and pediatricians!) hold regular “Meet the Midwives” or “Meet the Doctors” events. These can be low-risk and low-stress way to see if a particular practitioner’s style fits well with your needs, desires, and style. Hearing other parents’ questions can be very helpful, too.
    2. When asking what someone thinks about an issue or procedure, ask open-ended questions. Asking someone, “How do you feel about epidurals?” will get you a much more honest and complete answer than, “I want to have a natural birth, will you support me?”
    3. Before going into an interview, memorize the most important topics and questions you want to discuss. Many medical professionals feel somewhat defensive when someone comes in with a written set of questions and takes notes. (Think of how you feel when someone takes notes in a job interview.) Conversely, since doulas are more laid back and expect you to interview several before choosing, many are fine with you taking notes. Just ask first.
    4. Try not to write notes while in a personal interview. Remember your feelings and impressions as well as you can and write notes as soon as you’re out of the office. If you really want to have your written list with you, ask the professional first if they mind if you take notes. Of course, you can take notes on the phone all you want.

“Taking notes during an interview can make a doctor or midwife feel like they are on trial, which is not the best way to build rapport.”

    1. Go with your gut. If you meet with someone that seems to meet all of your other criteria, but you just don’t really like them for some reason, trust that response. You want to feel completely confident and safe with anyone on your birth or healthcare team. If you are not comfortable with someone, you may frequently second-guess their judgment. That does not help you get the best care in a timely manner, and may cause stress and more problems in labor.

Questions to Ask an OB or Midwife

You are probably wondering what specific questions would be good to ask when interviewing. I have put together a list of suggested questions to ask when interviewing an OB or midwife into this PDF. It is a single page, and you are welcome to print it, share it, or put it into Evernote to view it more easily as long as the copyright and contact info at the bottom remain intact.

Download the PDF of suggested interview questions here.

What do you think?

What did you feel was a helpful question you asked or thing you did to choose your doctor or midwife? Please tell me in the comments below!

Health Insurance Now Covers Breast Pumps in the U.S.

Health Insurance Now Covers Breast Pumps in the U.S.

Check with your insurance company to find out what pumps they cover.

Health insurance companies in the United States are now required to cover breast pumps (and lactation consultants!) for any woman who wants to breastfeed her baby. This section of Obamacare (the Affordable Care Act) went into effect for 2013.

The law states that insurance companies must cover some kind of breast pump, but not what kind. At this point (Feb., 2013), many insurance companies are only offering a manual pump. These are worked by hand, not electricity, and usually do not have any of the bells and whistles that come on higher-priced models, but still work well. Some insurance companies will only cover rentals of high-end, hospital-grade pumps, and some will cover either rentals or purchases. Some women may still want to buy or rent their own, depending on what kind of pump they would prefer to have, and what their insurance covers.

What to Know About Insurance and Breast Pumps:

  • Health insurance must cover pumps, but your company can choose what kind, and whether to cover rentals, purchases, or both.
  • Check with your insurance company to find out what type(s) of breast pumps they cover. Ask if there is a difference if baby comes prematurely, or has other medical needs.
  • Learn about the model(s) of breast pump your health insurance covers. Read manufacturer information and reviews to see if that pump could be a good fit for your situation, or to help you decide if your insurance company offers a choice.
  • Decide how much you will work, and where, for baby’s first year. If you are planning to stay home for much of that time, a basic model pump may be fine, or you may not need a pump at all. This can also be the case for working from home/telework, or even some part-time jobs. If you plan to work full time, a basic pump may also be a good fit if your company has on-site daycare or someone will be able to bring your baby to you to nurse a few times during the workday. If you will work full time far from home, you may want to invest in a higher-quality pump if your insurance company does not cover it. The more expensive pumps are generally much faster and more comfortable for frequent pumping.
  • The healthcare law specifies that breast pumps and lactation consultants should be covered without cost to the insured, so you should not pay anything.
  • Medicaid is not included under the Affordable Care Act for breastfeeding support, but most states have decided to cover some pumps. Call your Medicaid contact to see if pumps are covered in your state.
  • If you have any breastfeeding challenges, ask your insurance company to refer you to a lactation consultant they cover. Be aware that reimbursement rates for lactation consulting are low, so some excellent LCs and IBCLCs will not work with insurance companies.

What to Do to Get a Breast Pump Covered by Insurance:

  • Around 36 weeks, check with your insurance company to find out what pumps they cover.
  • When you check with your health insurance company, ask where you need to get the pump from. Different insurance plans cover different vendors.
  • Order the pump based on when you are planning to return to work. If you will be home for a few months, order the pump after baby is born.  If you will be returning to work around baby’s 6th week, order the pump before baby is born, as early as 36 weeks of pregnancy or earlier if you insurance company allows it. This way, you can be certain it will arrive before you need to return to work. Many companies are currently backed up on shipping pumps because of the high demand. Hopefully, this backlog should be resolved as companies adjust to the demand.

What do you think? Will this coverage help you, and will you use it?

Flu or prolonged fever during pregnancy increases autism risk

Flu or prolonged fever during pregnancy increases autism risk

It seems that getting the flu or having a fever for longer than a week during pregnancy increases the risk that baby will have autism. How to reduce the risk.

New research out of Denmark seems to show a higher risk of autism in babies born to women who had the flu while pregnant, and in those babies born to women who had a fever for longer than a week during pregnancy. In the study, women who had a normal pregnancy had an autism risk of about 1%.  The study, published in Pediatrics online November 12, 2012, was done as a combination of telephone interviews and gathering diagnoses of autism from the Danish Psychiatric Central Register. Women were not tested to see if they actually had the flu, but the study results do give some reason for caution. The study included over 96,000 children born in Denmark between 1997 and 2003. While most common infections during pregnancy did not seem to have any effect on the child, mom getting the flu during pregnancy seemed to double the risk of autism, and mom having a prolonged fever (about a week or longer) seemed to triple the risk of autism.

The good news is that even the highest risk group in the study, that with fever during pregnancy lasting a week or more, still only had an autism rate of 3%. The other piece of good news is that women are able to take actions to reduce their risk of becoming ill during pregnancy.

Many experts recommend that all pregnant women get a flu shot to help reduce the risk of getting influenza. Since flu shots are most effective against the strains of flu in the shot that year, and there are many different strains of flu, some women are concerned about how effective the shot really is. There are also some concerns about the safety of the shot, including the use of thimerosal (a mercury-based preservative) in some batches of flu vaccine. While the CDC states that the small amounts of thimerosal in flu vaccines have not been shown to cause harm, some people are still concerned because of how small the developing baby is. Studies have shown that Thimerosal accumulates in brain tissue and can contribute to neurological problems. Thimerosal has been removed from all vaccines given to children in the United States because of these concerns of possible mercury toxicity. Fortunately for those who want to get a flu shot, there are shots available without mercury.

There are also many other things a woman can do to support her immune system and reduce the likelihood of getting sick during pregnancy, or to get better more quickly if she does get sick. These are great to use in case the shot does not cover all of the common strains of flu out this year, or for those women who prefer to avoid the flu shot.

If you decide to get the flu shot during pregnancy:

  • Use the flu shot, not the nasal spray vaccine. Experts recommend against pregnant women using the flu vaccine nasal spray. The nasal spray contains live virus, and live virus vaccines tend to come with a higher risk of side effects and may result in the very infection they are trying to prevent, especially in people with less-active immune systems. The natural immune suppression that occurs during pregnancy makes live-virus vaccines a bad idea.
  • Ask for a single-dose unit to avoid mercury. Influenza vaccines are packaged as multi-dose units, or single dose units. Since the single-dose unit is used once, then thrown away, it is packaged without the preservative Thimerosal.
  • Support your immune system in other ways, too. A flu shot is not a cure-all. Flu shots can help prevent the flu, but there are still other illnesses that your body will need to fight off.

To support your immune system during pregnancy and reduce risk of illness:

  • Make sure you get enough rest. Go to bed early if you need to, or even set aside time for naps during the day.
  • Eat plenty of fresh foods to get the antioxidants, enzymes and other nutrients, like vitamin C and zinc, which help support your immune system.
  • Try an immune support supplement. If your doctor or midwife says it is ok, you can also take a nutritional immune support supplement containing vitamin C, zinc and other nutrients. Supplements with echinacea may be ok, but definitely avoid goldenseal.
  • Consider taking a glyconutrient supplement to support your immune system.
  • Exercise regularly to help your lymph system to clean out toxins in your body. Even walking and stretching can help move the lymph around and clear toxins.
  • Set aside time to relax. When your body is working harder because of stress, there is less energy and resources for fighting infection. Set aside time each day to pray or meditate. These “time-outs” help your body recover somewhat without being asleep, and help calm your mind so life’s bumps are easier to handle.
  • Minimize items in your environment and diet which make your body work harder. This includes toxins, allergens, sugars, processed foods, etc.
  • Drink plenty of water to flush out wastes.

Tips for reducing the chance of getting colds or the flu are excerpted from the Pocket Pregnancy Guide: Remedies so You Feel Great While Pregnant (due to be published as an e-book in late 2015).

References:

What to Do When Baby Is Coming And You Can’t Get to Your Doctor or Midwife – Emergency Childbirth

What to Do When Baby Is Coming And You Can’t Get to Your Doctor or Midwife – Emergency Childbirth

Knowing how to prepare can help get rid of the worry.

With the winter storm coming to the Northeast, and all the other severe storms occurring, it sometimes happens that mom goes into labor, but can’t get to the hospital, or her midwife can’t get to her, in time for baby’s birth. This can also happen when mom has a fast labor, which is more common with second births. It is unusual, but there can be that nagging worry. Knowing how to prepare can help get rid of the worry.

So what can you do if you are due any day, and officials are warning everyone to stay off the roads? First, I’ll give tips on how to prepare for a storm if you *might* go into labor, then the steps involved in emergency birth in case mom were to find baby coming with no medical professionals around.

Please note: This information is meant ONLY for those unusual cases when mom is stuck giving birth without her attendant. It is my opinion that birth is safest with a qualified doctor or midwife present to act as lifeguard in case a problem were to arise.

If a Storm Is Coming and You’re 36 Weeks or Later

1) Relax. Chances are you will begin labor AFTER the storm has passed. Relaxing will lower your stress level, and help you be less likely to go into labor, too.

2) Get support. Make sure you will have someone staying with you during the storm just in case. Having someone you trust with you can help reduce stress, and is very helpful if labor does begin.

3) Plan ahead. If you think you might be in labor before the storm hits, or have a “hunch” you will give birth during the storm (especially if you are past 41 weeks), take a room at a hotel immediately next to your birth place. Most hospitals and birth centers have hotels a block or less away. This way, if you do get farther along in labor, getting to your birth place is much easier and safer. Again, have someone stay with you for support.

4) Prepare. Make sure you have supplies of food, water, clean towels, battery-powered lighting, blankets, a fully charged phone (preferably multiple phones, a back-up battery, or a hard line phone), and a hard copy of your birth attendant’s and birth place’s phone numbers. That way, you’re prepared in case you lose power, or are housebound for a few days.

What To Do In Case of Emergency Birth

These tips are mostly taken from “Emergency Childbirth,” by Gregory J White, MD, with a few updates from evidence-based research. These tips would come into play only when mom was already feeling an overwhelming need to push, and her support person knows getting to her birth place will not happen in time.

  1. Don’t Panic I could not resist the Hitchiker’s Guide to the Galaxy reference, and the idea is still the same. Stay calm. Birth is a normal occurrence, and most of the time it will go well.
  2. Call emergency services (911). While there is no guarantee that anyone will get to you before baby is born, calling 911 gets help on the way in case a problem were to come up, or for cutting the cord and helping deliver the placenta. Sometimes, your support person can get your doctor or another birth attendant on the phone to guide you through the birth. If so, listen to them and not these tips. 🙂
  3. Be in a safe place. If you are in a car, pull over to a safe location. If there is a storm, be in a safe part of the house.
  4. Go natural. Don’t take, or let anyone give you, medications or pain-relieving drugs. Instead, use comfort measures like massage, rocking, a shower, relaxation and deep breathing.
  5. Stay off the toilet once pushing. If you feel like you need to have a bowel movement, it is probably baby coming down. Once you have the urge to push, baby is down far enough to start moving through the birth canal. Get on a waterproof surface, preferably with a bit of padding underneath and some towels or newspaper on top to absorb wetness, but stay off the toilet until after birth.
  6. Wait to push. The best way to work with the pushing stage in an emergency childbirth is to wait until the urge is completely overwhelming at the beginning of the contraction and you can’t help pushing no matter how hard you try. Breathe with those early pushing contractions where the urge starts after the contraction does. Some women never get an overwhelming urge to push. It’s ok – baby will come out anyway.
  7. Use a comfortable position for birth. There are many positions in which to birth a baby, which are taught in most childbirth classes. The only thing a position must include is mom keeping her legs wide apart to open the pelvis.
  8. Take it easy. Instead of pushing while holding your breath, or counting, just go with what your body tells you. This includes backing off and going gently once baby starts to crown.
  9. “Catch” baby, or let baby be born gently onto towels or whatever soft, cleanable surface you have available. Make sure baby will have support when he is born, by holding hands under him like a catcher or keeping mom’s bottom close to the surface. Baby will usually come out on his own – just provide a nice place to land.
  10. Leave the cord alone. The umbilical cord will continue to pulse for a bit after baby is born, sometimes for as long as 45 minutes. Leave it alone. Don’t try to tie or cut the cord because of the risk of infection from unsterilized instruments. Baby can safely remain attached to mom until after the placenta comes out, and even for some time after that. Let a health professional deal with the cord.
  11. Put baby skin to skin. This keeps baby warm. Most of the time, the cord is long enough to bring baby up onto mom’s belly (or at least lower abdomen) and put a blanket over baby’s back and mom’s belly.
  12. Let the placenta come naturally. Again, leave the cord alone. No pulling or yanking, just leave the cord alone, and eventually mom will have additional contractions to push out the placenta. It may take an hour or longer for this to happen. Breastfeeding baby will help. Once the placenta does come down into the birth canal, just lift it up and place it in a bowl to keep near baby until a professional cuts the cord.
  13. Give mom some juice, and a light snack. Giving birth is hard work! Mom will need to replenish her blood sugar. Some juice within 15-20 minutes of birth, and a light snack within the first hour or so will help her recover.
  14. Breastfeed baby. Being born is hard work! Baby will be hungry soon after birth, too. Breastfeeding baby within the first hour or so will help bonding with mom, get baby immune factors, and stimulate contractions to release the placenta, in addition to giving baby a blood sugar boost. If the cord is short, wait until after the placenta has been born so baby can reach without pulling on the cord.

For more information, see “Emergency Childbirth, ” by Gregory J White, MD. Published by NAPSAC International, 1998.