Tuesday, March 30, 2010

S's Birth story

S had been coming to us on the recommendation of a doula and friend of mine. She has been so much fun to get to know...and her husband's comic strips too!

She recently gave birth and shares her labor story (and it was exciting from what I hear!) on her blog.


Tuesday, March 23, 2010

Herbal Use During Pregnancy Part I

Many women are interested in a more natural approach to pregnancy, labor, and birth. This can include the use of herbal remedies to treat common problems, enhancing one's health and well being, or a desire to avoid man-made medications if possible. There are many herbs available to women, with many being safe during pregnancy. The following is NOT an all-inclusive guide to herbal use. There are so many out there that enitire books are written about herbs! I will discuss some of the more common herbs used during pregnancy as well as what to avoid. As always, you should discuss herbal use with your provider before using. Speaking with an herbalist is also a great way to get safe advice.

Herbs are made from one or more plants. It's important to remember that just because it's 'natural', doesn't mean it's safe!

The most common methods for preparing herbs are capsules, teas or infusions, tinctures or extracts, and infused oils. The standard measure for tea is 1 ounce of dried herb or 2 ounces of fresh herb with 1 pint of water. Pour the boiling water over the herb, cover, and steep for 15 minutes, strain and drink! For roots, seeds, or the hard, woody parts measure out the same proportion as the infusions, but boil in the water for 20 minutes. Then strain and drink.

Herbal Remedies (listed by problem)

  • Cystitis - corn silk thread, horsetail, or marshmallow in tea form

  • Engorgement - the leaves of a green or white cabbage leaf as a lining in the bra - change when they are limp, or grate a potato and add it to the cabbage leaf along with a small amount of hot water. Mash together and apply as a paste to the breasts. Only for engorgement as cabbage leaves are commonly used to dry up milk as well.

  • Exhaustion in Labor - infusions of fresh ginger root, alone or added to raspberry leaf tea (don't use the ginger if birth is imminent or in the first postpartum hour. Other options include an infusion of rosemary tea, or a tincture of blue cohosh root.

  • Headaches - fill a clean white sock with white rice, and add lavendar, rosemary, cloves, or combination thereof. Sew up the open end of sock and warm in the microwave or chill in the freezer. Apply to the forehead (being careful not to burn yourself!).

  • Heartburn - Teas of ginger, Iceland moss, lemon balm, chamomile, marshmallow, meadowsweet, peppermint, or spearmint. Alfalfa tablets can also be helpful and are a good source of iron as well.

  • High Blood Pressure - hawthorn and cramp bark combined in tea form.

  • Insomnia - nervine tea at bedtime.

  • Lactation - teas of comfrey, dill, milk thistle, red clover alfalfa, nettles, fenugreek, hops, and vervain. Borage, blessed thistle, and wood betony as teas act as an antidepressant and increase milk supply. fennel seeds sipped in a tea throughout the day, then chewed and swallowed, improve milk flow and are thought to decrease infant colic.

  • Mood Changes - herb baths using the flowers of roses, lavendar, borage, daisies, or chamomile. Teas of raspberry leaf alone or in combo with equal amounts of either spearmint or peppermint teas. St John's wort in capsule or tincture form. Teas of vervainherb, lemon balm, lavendar flower, borage flower, lemon verbena leaf. Fish oil or other sources of omega 3's.

  • Morning Sickness - anise, black horehound, chamomile, cinnamon bark, cloves, fennel, gentian, ginger root, hops, Iceland moss, lavendar, meadowsweet, red raspberry leaf, rosemary, spearmint or peppermint teas. Chewing or sucking slippery elm tablets or candied ginger. red raspberry capsules or tonic.

  • Muscle Aches - fill a clean white tube sock with natural buckwheat; add clove, chamomile, and lavendar herbs. Sew up the sock and warm or chill the sock. Placed on affected area.

  • Pain in Labor - motherwort in tincture form (5-10 drops mixed in a small glass of water every hour), scullcap drunk as an infusion or sipped from a glass of water to which had been added one teaspoon of the tincture, or St John's wort in an infusion, or add 23-30 drops to a glass of water. Black cohosh root in tincture form in half-teaspoon doses.Pasque flower in tea, tincture, or capsule. Basil and gotu kola teas and sage compresses.

To be continued...

Monday, March 15, 2010

Guest Post: Planning a Pregnancy

Jeanene Traynor, WHNP-BC submitted this guest post on planning a pregnancy. Jeanene works in our office, providing obstetrical care, gynecology services including preconceptional counseling, and minor procedures. Preconceptional counseling is simply a way of optimizing your chances of getting pregnant as well as improving the liklihood of a healthy pregnancy.



For a woman to become pregnant, one of her eggs must unite with a man's sperm at just the right time. The egg will be released from the ovary and travel through the fallopian tube. The man's sperm should join the egg during this journey. This means that during intercourse, he will ejaculate and his sperm will travel up through the vagina, cervix, uterus to the fallopian tube, where the egg and sperm unite. The fertilized egg continues to travel, attaching itself to the inside of the uterus. Here the fertilized egg will embed, and continue to grow.

Lifestyle changes for women that will improve pregnancy outcomes include a healthy diet, some form of exercise and eliminating unhealthy lifestyle habits, such as tobacco, alcohol, illegal drugs and some prescribed medications.

Each month, a woman having regular intercourse has a 20 - 25% chance of pregnancy. Most couples conceive within one year of unprotected, regular intercourse.

If you are planning to become pregnant, it is good to be up to date on your gynecologic exams and immunizations. A pre-conception appointment is always a good idea; lifestyle changes, medications and nutrition can be discussed at this appointment. Prenatal vitamins can be started three months or so before a pregnancy is planned.

Wednesday, March 10, 2010

Wordless Wednesday

Vaginal Births After Cesareans: New Insights

The NIH summit on VBAC safety comes to a close today. A report has been issued and low and behold.....

VBACs are ok and the cesarean rates need to drop. I'm dumbfounded at this shocking noise. Do you detect a touch of sarcasm there?

It's absolutely wonderful that this topic has been brought to the attention of the public and media. But to those of us in the know - doesn't really seem to be anything new or shocking. Here's a copied excerpt from the abstract summary...

Results: We identified 3,134 citations and reviewed 963 papers for inclusion, of which 203 papers met inclusion and were quality rated. Studies of maternal and infant outcomes reported data based upon actual rather than intended router of delivery. The range for TOL and VBAC rates was large (28-82 percent and 49-87 percent, respectively) with the highest rates being reported in studies outside of the U.S. Predictors of women having a TOL were having a prior vaginal delivery and settings of higher-level care (e.g., tertiary care centers). TOL rates in U.S. studies declined in studies initiated after 1996 from 63 to 47 percent, but the VBAC rate remained unimproved. Hispanic and African American women were less likely than their white counterparts to have a vaginal delivery. Overall rates of maternal harms were low for both TOL and ERCD.

While rare for both TOL and ERCD, maternal mortality was significantly increased for ERCD at 13.4 per 100,000 versus 3.8 per 100,000 for TOL. The rates of maternal hysterectomy, hemorrhage, and transfusions did not differ significantly between TOL and ERCD. The rate of uterine rupture for all women with prior cesarean is 300 per 1,000 and the risk was significantly increased with TOL (47/1,000 versus 3/1,000 ERCD). Six percent of uterine ruptures were associated with perinatal death. No models have been able to accurately predict women who are more likely to deliver by VBAC or to rupture.

Women with a prior cesarean delivery had a statistically significant increased risk of placenta previa compared with women with no prior cesarean, at a rate of 12 per 1,000 and risk increasing with the number of cesareans. Compared with previa patients without a prior cesarean delivery, women with one prior cesarean and previa had a statistically significant increased risk of blood transfusion (15 versus 32.2 percent), hysterectomy (0.7 to 4 percent versus 10 percent), and composite maternal morbidity (15 versus 23-30 percent). Perinatal mortality was significantly increased for TOL at 1.3 per 1,000 versus 0.5 per 1,000 for ERCD. Insufficient data were found on nonmedical factors such as medical liability, economics, hospital staffing, structure and setting, which all appear to be important drivers for VBAC.

Conclusions: Each year 1.5 million childbearing women have cesarean deliveries, and this population continues to increase. This report adds stronger evidence that VBAC is a reasonable and safe choice for the majority of women with prior cesarean. Moreover, there is emerging evidence of serious harms relating to multiple cesareans. Relatively unexamined contextual factors such as medical liability, economics, hospital structure, and staffing may need to be addressed to prioritize VBAC services. There is still no evidence to inform patients, clinicians, or policymakers about the outcomes of intended route of delivery because the evidence is based largely on the actual route of delivery. This inception cohort is the equivalent of intention to treat for randomized controlled trials and this gap in information is critical. A list of future research considerations as prioritized by national experts is also highlighted in this report.

Sunday, March 7, 2010

Nutrition Corner: Minerals

We've covered vitamins so let's move on to minerals now. During pregnancy, minerals are typically obtained in adequate numbers between dietary intake and your prenatal vitamin. Let's look at the minerals in detail...


During pregnancy, iron is needed for the manufacture of hemoglobin in both mom and baby's red blood cells (RBCs). The baby will draw iron from momma, so mom needs to keep her iron levels up. Iron is better absorbed from dietary sources than from supplements. The RDA is 30mg. Most prenatal vitamins contain around 27-35mg. But again, iron is better absorbed by the body if it comes from dietary sources. So, try eating foods such as lean or organ meats, enriched grains, green leafy veggies or dried fruits, and egg yolks.


This mineral is important for bones, muscles, and regulatory functions in cells and blood. Again, the baby will draw calcium from momma to help with skeletal growth. Pregnant women need about 1200mg of calcium a day. Good food sources for calcium include milk, cheese, whole grains, leafy veggies, and egg yolks. Tip: if you find yourself having frequent 'charley horses', or leg cramps, try getting more calcium in the form of a supplement or dietary. This usually takes care of those pesky leg cramps!


Phosphorus works closely with calcium, with the body maintaining a careful ratio in the blood. Our diets in the US are typically very high in this mineral. Typically foods that are high in phosphorus contain only small amounts of calcium. The RDA is 1200mg during pregnancy. Foods high in phorphorus include lean meats, milk, cheese, processed meats, snack foods, and carbonated beverages. No supplementation is needed on this one!


Much of this mineral is stored in the bones, similar to calcium and phosphorus. Active magnesium is found in the nerve and muscular cells. This mineral can also be taken as a supplement to decrease leg cramps, however does not cause any change in blood levels of the mineral. The RDA is 320mg. Dietary sources include green veggies, nuts, wheat bran, soybeans, and wheat germ.


Iodine is important for preventing many mental deficiencies in the developing baby's brain. The RDA is 22o micrograms. The source is idodized salt and seafood. It is rare to have a deficiency in this mineral in the US.


This mineral is a component of insulin so has an active role in metabolism. The zinc RDA is 15mg. Zinc supplements are not recommended at this time due to lack of evidence that shows a benefit. Foods rich in zinc include oysters, shellfish, Brewer's yeast, wheat germ, wheat bran, pine nuts, bran cereals, and pecan nuts. Other sources that also have zinc include liver, cashew nuts, fish, eggs, and parmesan cheese.


This trace mineral is typically ingested in adequate amounts from food sources so supplementatation is not necessary. The mineral plays a role in the formation of bones and cells. The RDA is 2.6mg. Food sources include:

1 cup raisin bran cereal: 1.9 mg
1 cup cooked brown rice: 1.8 mg
1 cup cooked oatmeal: 1.3 mg
1 ounce (19 halves) pecans: 1.3 mg
1 ounce English walnuts (14 halves): 1.0 mg
1/2 cup pineapple chunks: 0.9 mg
1/2 cup boiled spinach: 0.9 mg
1/2 cup black beans: 0.4 mg
1 ounce (23 whole kernels) almonds: 0.6 mg
1 slice whole wheat bread: 0.6 mg1 cup black tea: 0.5 mg
1/2 cup raspberries: 0.4 mg
1/2 cup sliced strawberries: 0.3 mg

Thursday, March 4, 2010

Breastfeeding Corner: Time Management

In its most wonderful sense, breastfeeding provides a time honored bridge into motherhood. The time spent with a baby at her breast is an opportunity for a brand new mom to learn all about her brand new baby, every little detail! For the baby, the time spent at mom's breast eases the adjustment to "life on the outside" with the warmth and comfort of mom's body as the new habitat and the best restaurant in town. This time spent together also provides a new mother with a window of time in which to rest, heal from childbirth, and build a healthy milk supply. It's a responsive relationship where the physical and emotional needs of both mother and baby complement one another and can result in a strong bond that becomes the foundation for a lifetime of growth and trust.

There are many resources for new mothers to tap into when it comes to the common challenges of breastfeeding. A little time spent learning a new skill, patience, knowledgeable help and perseverance can overcome the great majority of breastfeeding challenges. Just ask, and you will be able to find the kind of help you need.

Enter another culprit among breastfeeding challenges: the time management crunch of the 21st century. The speed at which we live our lives, and the instantaneous-ness that has become a built-in part of our cultural expectations seem to be a major hurdle for more and more new mothers to overcome. We can google just about any question and have an answer in a snap. How can it be that it may take several attempts for a baby to latch on, and then the combination of nutritive nursing and non-nutritive/comfort sucking can add up to HOURS in the daily life of a newborn?! The process of breastfeeding requires the time spent with your baby. Time that should not be resented, but enjoyed. This is NORMAL -- but what if your expectations have not adjusted to allow you and your baby to thrive during this relatively short chapter in life? How will you ever adjust to this new reality?

As a mom of four, I've felt that my to do list and calendar have frequently required me to use a shoehorn to make all the "stuff" fit. I have done this for longer than I care to admit, but then what could be more important than meeting the needs of growing children? Time spent is an investment in both their well-being and in my enjoyment of them. I've come to appreciate that the time spent breastfeeding also can assist with the mental adjustment to motherhood. So, how can a new mother cope?

Step 1: Set Priorities
First, decide what is most important to you. Breastfeeding takes time -- and you save money, so it's not a bad trade-off! The time spent when babies are small and vulnerable doesn't last very long: needs change, babies grow and nurse more efficiently, your uncertainties will diminish as you learn more. The initial "work" of breastfeeding lessens considerably after several weeks when life begins to have more of a routine to it and you establish some balance and the "new normal" in your life. My favorite coping tool for stressful times like these is: simplify. Decide what has to be done and what you can live without while you attend to time spent breastfeeding. Your satisfaction and well-being are important here, so honor what you NEED. Simplify the rest.

Step 2: Get Help
Delegating, also known as "asking for help" is the next step in honoring what you and your baby need: time spent with each other. Dismiss the thought that you can or should do it all at the same time. You are someone's mother, not Super Woman! Surprise your friends and family who offer to help by actually telling them how than can. They will enjoy the satisfaction they feel when you actually ask them to shop for your groceries, fold a load of laundry, load your dishwasher, sweep the floor, or put a meal in your crockpot. Many household tasks can be delegated, but nursing your baby is NOT one of them!

Step 3: Surround Yourself with Supportive People
Without support, nursing can be a lonely endeavor. Too many questions can go unanswered, and your uncertainties can influence your enjoyment of the process. Family and friends who are willing to take care of you while you take care of your baby are priceless! Getting to know other mothers who are sharing a similar experience will do wonders for your social life and your sense of well-being. Stop by our Nursing Mothers Group on Wednesday morning if you don't know anyone who is breastfeeding.

Above all, amidst the busy-ness of life, don't forget to enjoy your baby as you ease into motherhood! This busy 21st century will surely survive while you take care of your baby and adjust to the "new normal" in your life. Don't let the sudden shift in your priorities surprise you. It is not uncommon for things that were once "so important" to become less so. Embrace that change. Re-prioritize your life to include the time spent breastfeeding, simplify according to your circumstances, delegate what others are able to do, and surround yourself with supportive family and friends. And, then the time spent breastfeeding becomes a mothering skill and a very sweet memory as your baby grows.

Sharon Olson IBCLC

Monday, March 1, 2010

Gretchen's Story - Her Perspective

Focus, breath, focus, breath, is all I could think to myself on the long bumpy car ride to Phoenix Baptist. Coming from Goodyear it seemed as though I would never make it. Arriving at the hospital at 12:00 p.m., still focusing and still breathing, my contractions were only getting worse. Speaking to anyone would break my concentration of relaxed breathing.

Triage was the first step to seeing my baby boy! Dilation check at 4cm kept me thinking, only 6cm to go! This being my third time to the hospital only made me more anxious because they were actually going to keep me.

Being asked over and over again by the triage nurse, “Would you like an epidural for the pain,” really made me want one. The suggestion from my midwife (Tiffany) to sit in the tub was the best advice I have ever taken. While sitting in the tub I was able to use mental imagery to clear my mind of the contractions that were taking place. After sitting in warm water for about 40 minutes, I was ready to move to my bed. With each contraction getting stronger and closer I kept increasing my water intake, since I chose not to have any IVs; I wanted to make sure I was hydrated for the hard work that lie ahead. Still breathing calmly I wanted a gentle lower back rub. While my husband and Tiffany took turns, I continued to stay as comfortable as possible.

“I need to push!”, I kept telling Tiffany, this led to my final dilation check. At a 9 with bag still intact was a bummer. As the dilation check approached its end my bag broke! It was officially time for me to push! Whew, was I already sweating the first minute into pushing. I knew the hardest part was yet to come, this was just the beginning. Lying on my side was starting to become uncomfortable. It was time to move to my back…….this wasn’t working….back to the side. With my husband holding my leg, Tiffany coaching, and me concentrating and pushing, he finally crowned. A few more hard exhausting pushes and his head was out. The burning was intense but as I kept calm I knew it would be over soon. After feeling like I was going to turn inside-out and a couple more strong pushes, my baby was here!

Bradyn, weighing in at 7lbs 12oz, born at 6:06p.m was a Bradley baby! My labor/delivery could not have gone any better. Everything was perfect! I never imagined that it could be such an amazing experience.