all posts, eczema, parentings/things about baby and kids, women's health

on breastfeeding, breastmilk, and NPR

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I’m combining all my other blogs’ content to this site. Please bear with me as I post older content.  🙂

A while back I took a class on breastfeeding at the hospital where I planned to deliver (North Shore Medical Center Salem Hospital). Below I’ve outlined some of the notes I took as they pertain to women’s health, as well as my own thoughts.

As many people are saying, “breast is best”, it’s interesting to look into why. Studies have shown breast feeding can help women lose some of the pregnancy weight faster as you are expelling energy to produce milk. It can also help reduce your risks of ovarian cancer, breast cancer, heart disease, and type 2 diabetes, as well as it releases hormones to calm you down.

But what’s actually going on in the body when it produces milk? The glands that produce milk (alveoli) send the milk to ducts which lead to the nipple opening. The baby draws the milk out when sucking, and the more the baby drinks, the more our breasts produce. At first we only produce colostrum, which is this fatty liquid that has all kinds of goodies like antibodies and beta carotene for our babies newly-developing immune system and gut. Then the real milk comes in after about 3-5 days. When a baby started nursing each time, first (s)he will get the foremilk which is mostly composed of water, and after feeding for a few minutes (up to 10 minutes) the hindmilk (which is a lot fattier) follows. The Letdown Reflex happens each time the baby feeds and it is when the baby has latched and the breasts transition from letting out foremilk to hindmilk. Some women can feel the letdown reflex happening (described as pins and needles or some localized tightness) but many women feel nothing.

But how does breastfeeding feel? Well, apparently it is a very novel sensation to most when the baby first latches (it definitely was in my experience) and for many it is difficult to get a good latch and takes some practice! The biggest worry is that a baby who has latched poorly and is just hooked onto your nipple and so (s)he will cause the mom pain. The way to avoid this is to make sure the baby gets more of the areola in its mouth rather than just the nipple. To detach a baby from your nipple if they are incorrectly latched, you definitely don’t want to just pull them off (ouch), but instead you should insert a clean finger into their mouth to break the suction, by running your finger along their gum line.

Also leaking is normal, especially at the beginning of breastfeeding, but it usually does slow down and stop as you continue breastfeeding and your baby gets used to it. You can use nursing pads and also press your nipple/cross your arms when you feel like you are leaking to help to try and stop it.

What about your diet; how does it affect the breastmilk? What can you eat? From this class I was told you can eat and drink anything, it’s just a matter of seeing what your baby’s reaction is (if they get gassy, fussy, hiccup-y, etc after a meal, check back to see what you last eat). Obviously some things to consider are making sure things like alcohol and caffeine are out of your system before you breastfeed (I think the advice was if you have an alcoholic drink, you don’t want to feel tipsy, and you want to wait about 2 hours before you breastfeed… but don’t quote me on those hours). Also for babies that have occult blood (invisible blood in the baby’s stool), the first things a doctor may advise you to avoid are probably dairy and soy, because they are the most common culprits that irritate the babies developing gastro-intestinal system (this is what occurred in my experience). The Kelly Mom blog has a post that goes into food sensitivities in more detail.

For pumping, the advice was not to start until 3-4 weeks unless needed and to make sure you get a pump with a suction cup that is sized correctly to your breast; you don’t want your nipple squished on the sides. The other advice was to pump in the morning, or after a baby’s feeding (I believe about 30 minutes after is the recommendation).

For general nipple care, the advice was to try using your own breast milk around the inflamed area first. Then you can try lansinoh or coconut oil on tender area, and then if it’s really bad, use manuka honey (here’s a cream made with it), but wash it off before feeding the baby.

Other painful aspects about breastfeeding include:

  • Engorgement: this occurs when you don’t breastfeed enough so your breasts become swollen and hard. Regularly nursing helps prevent this, but if you need to you can also remove milk by hand (or what’s called expressing milk) you can use a pump. Just express until your breasts are no longer hard. Cold compresses can also be used after feeding to help bring down the swelling. To express, massage the breast tissue and then grab above and below the breast with your thumb and forefinger and press back towards your chest wall, then gently squeeze, moving your hand all around to help drain multiple areas.
  • Mastitis: this is the most common problem, and it is when your breast gets infected with bacteria, causing pain. You will probably have a fever or other flu-like symptoms as well. This can occur from blocked ducts, nipple injuries, or problems with breastfeeding. You want to call the doctor if you feel this has occurred. Also also make sure to wash your hands frequently to reduce infection risk.
  • Blocked ducts: this is caused by not relieving the breasts. A blocked duct will feel sore and tender. Try taking a warm shower and apply moist heat, and/or gently massage before breast feeding. Also try expressing after feedings if you still feel engorged.
  • Yeast infection: this will cause your nipples to be shiny, red, and painful. Yeast (also called thrush) can also grow in your baby’s mouth so look for cottage cheese looking stuff in their cheeks.

Who can you call for help? Nowadays you can call your doctor, your baby’s pediatrician, and/or some hospitals also have lactation support groups (sometimes free), or lactation consultants (usually not free) that you can call to get one-on-one help.

A little more about breastmilk. In lieu of my own little own having some kind of sickness, I’ve been looking more into breastmilk’s functions. This searching led me to this internet viral photo showing how a mom’s breastmilk changed when her infant got sick. The 2013 study mentioned in that post talks about breastmilk’s immunological function and explains how when the mom or baby get sick, the number of leukocytes (aka white blood cells) in the breastmilk drastically increases to help protect them, because leukocytes help fight disease. I find that to be such a cool example of symbiosis. I personally have also noticed that breastfeeding seems to keep both me and the baby from getting some of the sicknesses that were going around (my mom, mother-in-law, and husband each got sick after the baby was born while the two moms were visiting!).

Lastly, I also read an article by NPR addressing the breastfeeding versus formula debate for poor countries.  The major points that this article made were that formula is not a godsend for impoverished countries for the following reasons:

  • formula requires water to make it, of which clean sources are not always available
  • formula causes increased risks of diarrhea and respiratory infections, and
  • formula can cost up to 30% of a families income, and subsequently families made dilute the formula to make it last longer, which reduces the amount of nutrients the baby gets per serving.

The article also talked about how it’s weird that we are constantly trying to research the benefits of breastfeeding when it’s as natural as “breathing, chewing, hearing, passing stool”. It also went on to explain that even an underfed mom can make excellent quality milk, and as for quantity, it is also enough except in the case of severe malnutrition. The latter point is interesting to me because I hear a lot of moms, including myself with babies labeled as “failure to thrive”, which essentially means our babies aren’t gaining weight at a rate that the medical professional expects. In my case, the doctor assumed I wasn’t producing enough milk and told me to supplement with formula. It turned out that my baby drank the same amount of formula as I was producing of milk, so I wasn’t the common denominator and rather my baby just drank only tiny amounts per feed. I’m curious as to why there are many medical professionals that believe many moms can’t produce enough milk when studies may be showing the contrary.

Anyway, the article ended by saying that it is up to the mom on how they want to provide for their child, however, it is important that they have accurate information to make informed decisions. This means that we would need to reform the system so doctors are never paid to handout formula samples, and on in which moms are not incentivized by free samples to use formula.

 

 

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all posts, community, eczema, women's health

why doesn’t the postpartum period include eczema care?

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I’m combining all my other blogs’ content to this site. Please bear with me as I post older content. 🙂

As you may or may not know about me, my goal in life (career-wise at least) is to create a company that cultivates support for women with chronic illnesses as they embark on becoming mothers. One of my dreams is that services provided will help to make up for the loss of midwifery-type support that towns and cities used to have, and combat the decrease of share “wise woman” spaces, but specifically in the context of helping women who have varying autoimmune or other chronic disorders.

In my dream scenario, this company I create is inspired by community and healthy social growth, devoted to bringing together all people, not just those who can pay, or who are healthy.

If I ever delved into having a physical space for the company (as opposed to being a traveling owner), the space would be free to visit (when not going to a scheduled appointment), and would have lots of nooks and tables and chairs for people to enjoy the space, and some days would have events that would have an entrance fee but it would be reasonable, and would include a free meal that my husband would make along with other perks like meet-the-community-support-team, free lectures/discussions, etc. We’d work with local hotels, bed and breakfasts, and other places that rent out rooms to make sure there were plenty of accommodations ready too, which would help bring money back into the town.

Anyway, I could go on for days, but as a result of my lofty goal, I constantly have my eyes peeled for events or opportunities that bring about that community feel, especially in women’s health. 4th Trimester Arizona is one of those awesome events I learned of after it occurred. It seemed like the perfect fusion of mixing the community members (moms, dads, grandparents, etc) with local businesses, and with health/health care professionals, allowing for support and engagement for new moms and their families. The event included workshops, panels, free wellness services, a dad track, bonding activities, and more, all with the intent of strengthening community.

Going through a few of the speakers of 4th Trimester Arizona led me to Matrescence 4th Trimester Planning and Support, an organization started by Caitlin Green Cheney and Elizabeth Wood. They hold workshops that include how to prepare for the 4th trimester, including how to make a support system. Here is a Q&A session they did that tells a little more about their company and their backgrounds/how they got to where there are. They also encouraged me, because although they are more of a service you pay for, their intent is still to help provide education in tandem with support. I am finding that one thing most humans seem to crave in this day is more support in their endeavors; the world has gotten so big and diverse that finding a space where you feel a part of is so important. Hence my whole reason for wanting to become a postpartum advisor for women that are usually the most isolated, those who are chronically ill.

all posts, parentings/things about baby and kids, women's health

on new adventures (sleep training and postpartum doula training)

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I’m combining all my other blogs’ content to this site. Please bear with me as I post older content.  🙂

Hello again. It’s been a while since I’ve posted any content, in fact I think I haven’t posted since I was in my second trimester!

Well, I have since given birth to my beautiful little one, Fiona, and am now working through a new stage of life with her: sleep training.

It may seem a bit late as she is almost 7 months now but in reality sleep training can be initiated at any age. In my case, in her earlier months I was so worried about her weight gain (as she is small and has been consistently in the 5% quartile) and her potential food sensitivities that I was eating (she’s exclusively breastfed and she occasionally had blood in her stool), that I focused on nothing else.

As a result, Fi now appears to be in a bad holding pattern where she fluctuates between waking up twice a night to waking up every hour or so from 12pm-5am and fighting going back down to sleep unless I feed her. Her daytime naps are a total crapshoot (sometimes she sleeps like a goddess, other times she will fight it for hours but is too tired to do anything else).

So, I am working on reading through the research about various techniques to go about breaking the latter habit, looking at everything from the Ferber Method to the Sears Method. I’ll be headed to the library later today to get the official books on various methods, but in the meantime, from scouring the internet at 2am, here are a few of the suggestions (from secondary sources):

The gradual retreat/disappearing chair method

  1. place chair by crib
  2. put baby down when drowsy then sit on chair
  3. when baby cries, go to her and pat/stroke her but avoid eye contact
  4. when baby stops crying, move chair slightly further away and sit
  5. if baby cries again repeat pat/stroke and no eye contact
  6. when baby stops crying move chair further back again
  7. repeat until baby is asleep. might take 10 minutes for them to fall into deep sleep

The kissing game method

  1. put baby down when drowsy and promise to return in a minute to give a kiss
  2. return almost immediate to give another kiss
  3. take a few steps towards door then return and give another kiss
  4. promise to return in a minute to give another kiss
  5. put something away/do somethin in room, then give another kiss. 6. promise to return in a minute for another kiss
  6. pop outside room for a few seconds then return for a kiss
  7. as long as child is lying down she gets more kisses (no chat, cuddles, stories, drinks)
  8. repeat until child is asleep

The Ferber Method

  1. put baby in crib awake, turn off lights, say goodnight and leave room
  2. if baby cries, come back after predetermined time (a minute or two). Pat baby in reassuring way but don’t pick up. Leave room promptly
  3. this time stay out of the room slightly longer before returning to reassure baby
  4. continue with longer and longer periods of time
  5. if baby wakes in the middle of the night, start back over with lowest wait time at beginning of night
  6. on second night, wait a little longer than previous night (so first night try for example 3 min, 5 min, 10 min. second night try 5 min, 10 min, 12 min)

The night weaning method

  1. start gradually by nursing baby shorter periods of time or giving smaller amounts of milk in bottle, prolong time between feedings by patting baby to sleep
  2. make sure baby get plenty to eat during day (decrease distractions)
  3. offer extra feeding in evening
  4. avoid weaning during transitions (vacations, traveling, teething)
  5. have non-boob feeder comfort during night
  6. eliminate feedings one at a time. tell her she can nurse in teh morning. pat her belly/back

The pick up, put down method

  1. if baby cries when first put down, put hand on her chest with “shhh” or key phrase
  2. if that doesn’t work, pick up and repeat phase
  3. when she stops crying but is still awake, but her back down even if she starts to cry on way down
  4. if still crying, pick her up again. do until you can see signs that baby is settling (cries getting weaker)
  5. when behavior settling, don’t pick up anymore. place hand on chest and say phrase
  6. leave room
  7. if baby starts to cry, repeat process again as many times as needed until she’s asleep

The nighttime crier method

  1. put baby down when drowsy
  2. Visit baby briefly ever 5-15 min if she’s crying
  3. make visits boring, brief, but supportive
  4. do not remove child from crib (no rocking if you do). Most babies cry 30-90 min then fall asleep
  5. middle of night crying: temporary hold baby until asleep (helpful for transitions) if she cries for more than 10 min. little talking, no lights. dad is often more effective 6. give baby security object 7. phase out nighttime holding

The overall commonalities between all these methods is that you first have to have a good bedtime routine established, and that you should feel free to adjust the timings as you feel best fits your baby.

So far we’ve attempted sleep training once with Fiona (last night in fact), and it took hours to get her down. Jake had to do it because she got ragingly upset if I tried to and me attending to her didn’t result in her getting fed. I am handling the nap version of this today (so far unsuccessfully) and then we’ll see how tonight fares.

Speaking of how things fare, that brings me to my other adventure. I have finally gone and signed up for a postpartum doula course and will be working my way through that in the coming months. I might just skip ahead to do the reading that pertains to sleep habits and use the material to help inform my ongoing real life experience. I’ll be taking the little one to the library next to where we live to stock up on the necessary books and then I’ll come home and work through them with her.

More to come about my course and in depth sleep training experimenting with Fiona soon!

all posts, eczema, women's health

on biomechanics and katy bowman

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I’m combining all my other blogs’ content to this site. Please bear with me as I post older content.  🙂

I haven’t posted in a while because “times [but mostly things in my life] they are a-changing”. What I mean by that is that I have a bunch of exciting things I’m trying to get involved with that are still centered around my various beloved themes, including:

  • community
  • women’s health… and now, a throwback,
  • biomechanics!

Let me catch you up. Once upon a time I was a confused undergraduate trying to narrow down the vast world of supposed choices to figure out my next step post-college. I knew I had splashes of talent in various areas, but that I was also relatively unskilled overall in a whole larger host of things, making me not a great candidate for any job (at least that was the opinion I had of myself). I remember I came to a point where I narrowed the choice down to two respective options:

  1. go to graduate school for biomechanics. Specifically comparative (non-human) biomechanics, but with the desire to see if I could follow in the footsteps of those inspiring people who learn from nature and then connect that learning to something in the human world (e.g. the tensile strength of sharks’ skin as a model for bulletproof vests, or the boxfish’s shape as a model for the most aerodynamically stable (and ugly) car), or
  2. go to physical therapy school. Essentially PTs are the biomechanists of the medical world (so in this analogy an orthopedic surgeon would be more like a biomechanical engineer). This therapy path would allow me a more direct way to give back to the people and help others.

As you may know, I ultimately chose physical therapy, and then ended up leaving it about halfway through the program because the physical contact (manual therapy, measurements, etc) with patients was not conducive with my skin condition. This  ultimately made physical therapy less than an ideal career for me.

So then, the deluge. How am I full circling back to the idea of biomechanics (though not necessarily comparative this time)? Well, first I started working in the field of women’s health a little over two years ago, which has since led me to undertaking the process for a prenatal and postnatal coaching certification (I actually just finished this past week and am officially a certified prenatal and postnatal coach!). I am also tying that field of knowledge to a few other movement-related initiatives, including the current co-creation of a course for single mothers of color (but I’ll go into more on that when it’s further along). I also am in the process of figuring out if I have the time to set up and lead stroller/carrier friendly walks in a local nature reservation.

While in the midst of these various endeavors, I also ended up finding Katy Bowman, a biomechanist and movement educator known for her Nutritious Movement company, which builds on her nature-based movement ideologies/passions. She believes in modifying our every day human environments (along with many movements we do) to better promote health and wellness, because movement-optimized environments require us to move better by their very nature. An example she gives is not having a couch in your home. This then requires you to do more squats (if you end up sitting on the floor, or chairs of lower heights), and forces you to move your hip, knee, and ankle joints in greater ranges of motion. The no-couch life also facilitates less sitting time by virtue of there not being any comfy furniture to sit upon, thus increasing your NEAT which helps your body even at the cellular level.

As I delved more into her material, I realized I had found someone that encompassed that overlap in my interests that I didn’t know existed; she is not a practitioner of health or medicine therefore not subject to the insurance whims, nor is she just an academic  stuck talking only to other academics/writing scholarly papers while being removed from the direct societal implementation. Bowman also intersects nature with the manmade world, bridging the choice I was stuck between (loving the idea of physical rehabilitation and the like while having a passion for being involved in natural environments, but unsure of how to make either a thing). Even more excitingly, after some light searching I discovered she too has a masters (in health studies, while I’m health sciences, but close enough) so I know it’s possible to straddle the academic world even in a health-esque field while not being a PhD or MD.

This is endlessly inspiring to me because now I’m starting to think it isn’t impossible to focus on prenatal and postpartum women and work with them and their babies/ young children to create lifestyle changes and increase our movement, while doing it all in nature. Though I’m not fully sure of the direction I’m going to end up going to get it started, all in all, things are looking to be very promising in the near future.

I have also used Bowman as an entry into foot health (using her book Whole Body Barefoot), subsequently contemplating the health of my own feet on a more regular basis. Since I left the category of a nulliparous woman (a woman who has never given birth), I’ve been thinking about how my body alignment changed during pregnancy and how now I still often feel joint laxity and generally less in-tune with my body. This has resulted in me walking more duck-footed than I had previously. I am testing out her suggestions to improve my foot (and global postural) health presently, but honestly ,uch of her program is just good practice for regaining balance and better alignment generally (like doing calf stretches and one leg standing balance exercises). I’m already noticing that I am more able to abduct my pinky toes further since starting. My personal goal is to retrain my feet to be able to wear minimalist shoes (or shoes that alter the natural foot mechanics the least). This includes working my way to comfortably wearing shoes with no heel lift (which normal even sneakers and many types of sandals have).

Before that book, I also read Bowman’s book called Diastasis Recti: The Whole Body Solution to Abdominal Weakness and Separation. Though the content is obviously useful for postpartum moms, the condition of diastasis recti (DR) can impact men and nulliparous women too.

In this book Bowman talks about how our modern lifestyles put a lot more pressure (force) on our cavities (diaphragmatic, stomach, and pelvic) and so to combat that we need to make environmental changes in our lifestyle. This includes actions like sitting less in the day and returning to using our bodies to move more (rather than always having appliances and tools to help us).

The point isn’t to remove all modern conveniences entirely if it’s not possible in our lives, but to balance out those convenient factors so our bodies have a chance to regain better mobility and functional strength while we continue to go about our daily lives.

The most crucial exercise Bowman suggests as a takeaway from her book is better rib engagement. This is done by drawing our ribs down and back without just sucking in our stomachs. We need to get our ribcage muscles and joint attachments to be less stiff because it impacts our ability to use our arms in their full range, and can cause issues if we move our pelvises with our ribcages all the time. Anyway, the book is definitely worth checking out to hear Bowman explain all of this (she does a much much better job).

The last thing I read by Bowman was a paper she put out about Movement Ecology. She addresses movement in multiple avenues, highlighting how we as a species gravitate towards decreased movement, which means more than just decreased exercise. She investigates movement as a broader topic, looking at how our daily activities and the environment around us help move and change our bodies in multiple ways, including at the cellular level (e.g. literally deforming our cells as when we lay on an object and our cells flatten). It’s cool stuff!

The fun thing about Bowman’s work (and I’m just talking about the books/papers I referenced in this post, so foot health techniques, diastasis recti prevention, and movement ecology practices), you can already come up with a fairly comprehensive program for prenatal and postpartum mothers to help them stave off lifestyle-related aches and pains, and regain more function respectively, while building foundational blocks of strength and mobility. And that’s what I’ll be playing around with next with my own routines.

On a tangent, I wonder how much of the severity of my topical steroid withdrawal would be alleviated  if I moved more?

all posts, parentings/things about baby and kids, women's health

prepared childbirth: the skin plan

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I’m combining all my other blogs’ content to this site. Please bear with me as I post older content. 🙂

In April of 2018, my husband and I attended a 6-hour class on childbirth preparation. I’ll go into a few details about specifics we learned, though it is important to keep in mind, different hospitals and different OBs may have different practices than what we were told.

The whole view around labor now, is that modern medicine is more than capable of helping pregnant folk with the pain. The thing they can’t fix is if we get fatigued. Fatigue is the biggest predictor of if there will be a need for an unplanned Cesarian section because if we laboring women wear ourselves out before we are in the pushing stage, we won’t be able to physically get the baby out into the world. This becomes even more important to note when the pregnant mama-to-be is already battling eczema and it’s host of fatigue-induced symptoms like sleep deprivation.

The first topic the educator went into were ways to conserve energy, aka ways to relax. Physiologically and mentally, giving birth is draining. Mentally, there is pain, so she explained the options our specific hospital has to allow women to cope.

  • Analgesics – I can’t remember the specific names of the two that are put into the IVs but essentially, all of the analgesic options help take the edge off. They don’t make the pain of contractions disappear, but they chemically help to relax the muscles, which allows for us to perceive less pain. How it works is that it helps us waste less energy reacting to pain, decreasing how much we stiffen up from feeling pain or how we can’t relax between contractions. The two analgesics mentioned in the class do cross the placenta, and thus can affect the baby, so the educator advised that if we want these ones to request them before we are 9cm dilated so that there is more of a chance of it getting out of the baby’s system before the baby is born. Otherwise the baby will also get some of that chemical relaxation affect and may then score poorly on the APGAR test (because they will be unfocused and floppy). The third type of analgesic mentioned was nitrous oxide (aka NO, or that’s right, laughing gas!). It does not cross the placenta nor affect the baby but its catch is that only the mom herself can administer this drug. She has to be able to hold the mask to her own face and breathe and then remove it on her own (for legal reasons). Now how do these chemicals affect the skin of someone with eczema?
  • Epidurals – There are two types used: the local or the full. The local (which has gotten the misleading name of “the walking epidural”) numbs the woman’s body from basically her chest to her groin. Though theoretically her legs would still have feeling, if you can’t feel your abdominals or other stabilizing core muscles, you really can’t walk. The full epidural numbs all the way down to the feet, and it is administered when you have to go into an unplanned C-section. When you get a local epidural you have to go in to the C-position on the bed (or that position we see women giving birth in in movies all the time), and you will have to be cued of when to push because the epidural numbs you from feeling any pain of the contractions at all. Supposedly you will still feel something, but most often it is described as a distant pressure.

The rub with all these options for medical pain killers (analgesics and epidurals) is that they can have the unintended consequence of slowing down the labor. If they cause you to be too relaxed, particularly your uterus, you run the risk of the doctor then needing to give you something to “get you back on track”. What this means is that they will add pitocin (a manmade version of oxytocin) to stimulate stronger contractions. The catch-22 of pitocin is that, unlike oxytocin which is made naturally by your body and will gradually increase your contractions to some extent, pitocin is more of a 0-to-60-in-no-time kind of drug, and often times women report that it makes contractions much more painful. It definitely did in my case.

If you have a scheduled C-section, you will be given a spinal tap, which is when the medication is administered so it goes into your spinal fluid. You will then lay down and a tarp will cover you from the chest down (though you can request a see-through one if you want to watch the procedure) and your arms will be tied in a T shape so that one can have constantly blood pressure monitoring, and the other can have the IV in place. Afterwards, depending on the hospital, you may be able to have the baby wrapped up against your body after they have taken the baby for cleaning and screenings, or you can have your partner do skin-to-skin contact if you are too tired/out of it.

Which brings me back to mentioning induction. A hospital can have a few reasons to induce, and I think it can vary by hospital/practice. One reason is if your baby may be late. Apparently, it is common to induce around week 39 now because it allows for an extra week in utero so that if the due date was off by 7 days, you are at least on week 38 (week 38-42 is deemed the safe range for a baby to be born and be totally developed but also still get enough nutrients from the placenta).

Fun fact: did you know they figure out the age of the baby, and whether they were right or not at their predictions, by the placenta? Apparently, it ages and you can figure out when it formed by its coloration!).

Back to induction; so what normally causes labor to start? Scientists and doctors have no idea what triggers the chemical to be released at that specific time, but they do know that prostaglandin is the chemical that sets it all in motion. This is because prostaglandin cause the cervix to soften. Many women when seeing a OB/GYN probably learned that the cervix feels like “the cartilage at the tip of your nose” or something like that. Well when we are going into labor, we want it to soften so that it can then efface (or thin out) and make way for the baby. So first, if you need to be induced, they will add prostaglandin to you (either via an IV or through a suppository inserted in your vagina that has to dissolve). If that works and your cervix softens, then you are given pitocin to make the uterus contract. Then if all goes well, you’ll quickly ramp up in contractions and soon progress to the pushing stage.

So what happens during this first stage, the contractions? Well, like I mentioned before, the focus is on controlling pain so that you don’t tire yourself out. That’s really it. As your body works on the contractions and starts to dilate your cervix to 10 cm, you aren’t really an active participant, so you just have to find ways to bear the pain/discomfort without wasting your energy staying balled up or tiring yourself out. Unmedicated suggestions they mention are (and again this depends on the hospital you are at) using a hospital bath/whirlpool to relax the muscles, sitting on a PT ball, moving around and changing position (if you didn’t get an epidural), taking deep breathing (always need to keep breathing and never hold your breathe- it makes you tight/wastes energy), visualizing something calming, etc. The educator also mentioned how if you are “stalling” or your contractions aren’t going at the speed the doctor thinks they should, and he/she feels they may need to give you pitocin, that you should request an extra 30 minutes and do everything from listen to music, 6th grade slow dancing with your partner, cuddle, kiss, or get up and move around (if you didn’t have an epidural). This is because all these actions can help release more oxytocin, which helps force those contractions to continue.

Then when you’ve finally reached 10 cm dilation, the pushing stage can begin. There are many ways one can go about the breathing during the pushing stage, but the advice was that you want to push when having a contraction (more force) and that at that point you generally tuck your chin to your chest to help exert more downward pressure. If the contractions are going for 60 seconds, you want to take 2 deep breaths right before it starts and then breathe out while pushing, take a smaller breath in (you don’t want to take a deep breathe in because the baby is kind of yo-yoing inside of you and you want to make sure you are pushing it down faster during the contractions), and then breathe out while you squeeze out. After the contraction, relax. If the doctor tells you not to push during a contraction, bring your chin up high and try to resist the urge. A reason a doctor might tell you not to push is to adjust the cord around your baby.

The doctor will give you updates about the baby’s location relative to your pelvis. If they are lined up with the ischial tuberosities, they are at ground 0 and you will see the head soon. If they are not there yet and are still higher up, you’ll get a positive number (of centimeters), and if their head is already visible, you will get a negative number and will probably be seeing that baby very soon.

Then we have to talk about episiotomies. So at my hospital the rate is very low (under 2%), and they will only do it if they think the vaginal tissue is going to rip towards the urethra, in which case they will cut the perineum down a little bit (in the direction towards the rectum). If it doesn’t seem like the vaginal tissue is going to rip in that upward direction (which is determined if the tissue turns white, indicating it has stretched to its max and there is no more blood flowing through it), then instead they will apply a warm compress to the rectal area to help try to warm those muscles and tissues up to get them to relax and stretch a bit more. If they do need to cut you, they will give you a local anesthesia and then do a quick incision.

Also another thing to keep in mind if you are going to a hospital is what are the state laws. In my state, it is mandatory that the baby get antibiotic drops in their eyes, and I think the TB shot before they leave. They also will prick the baby’s foot to take blood for genetic screenings. It’s important to understand what procedures are required like that, so that way you don’t find yourself fighting a state law after you’ve given birth. Also, my hospital will put antibiotics in our IV’s during labor if the mom was positive for group strep B culture during a vaginal/rectal swap between week 35-37. Other than that, if a mom comes in dehydrated, she will also automatically be given an IV for her labor.

A big emphasis that the educator couldn’t say enough was that when you have your new baby, you really want to do skin-to-skin contact. It helps warm the baby up but also is an amazing bonding experience and helps calm both the mom and the baby down. Obviously this can be challenging as a mom with eczema. I found personally that I could hold my baby skin to skin right after the birth (but also note I had been on antibiotics during the birth), and then later when home would struggle with skin to skin, where as soon as my baby was asleep and I’d put her down for a nap, I’d need to scratch like crazy.

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on racial differences in maternal care

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Photo by Nicholas Githiri on Pexels.com

I’m combining all my other blogs’ content to this site. Please bear with me as I post older content. 🙂

Way back a few months, Fi and I visited my parents, and as a result she got her fill of dog exposure. Studies are still looking into the impact of early dog exposure (e.g. the first year of a baby’s life) on the child’s risk of asthma, allergies, and eczema later in life, and preliminary data seems to suggest that dogs have a positive effect in decreasing the risk of all three.

One study even found a higher correlation of eczema reduction for black children as opposed to white children from dog exposure, which could be useful as black people statistically have a higher risk for eczema (especially women).

These kinds of studies highlight the need for analysis of subgroups (e.g. race, gender, type of birth) to really understand who is being affected specifically. However, subgrouping is only useful so long as the studies are done through non-biased non-reductionist lenses. If accomplished, such specificity would allow for more applicable research to come out that could help promote better health, wellness, and medical decisions.

Which reminds me, I also listened to a webinar from the Black Mamas Matter Alliance. It covered a lot of material, but there was one particular point that stuck out to me (besides the need for a lot of policy reform across the country). It was the need for doulas, particularly those who live in the communities they serve (called community-based doulas).

Doulas act as support people for mothers, providing nonjudgmental (and non-medical) advice to moms from pregnancy to postpartum, making sure moms understand their rights and options. A doula from one’s own community would invaluable as they would understand the dynamics behind the community, as well as having firsthand experience with how the medical/clinical facilities are.

The webinar also talked about the need for insurance coverage for doulas (especially under Medicare), so that more mothers can afford them. I couldn’t agree more, especially as doulas correlate with better outcomes and statistics for the mothers overall.

The webinar is up on the BMMA site if you want to listen to it.

And lastly, I also read a book by a black midwife called Listen to Me Good, which was a book about a less well known figure in women’s history named Margaret Charles Smith. She was a midwife in Alabama who worked from the 40s to the 80s.

She never thought she’d become a lay midwife, as the hours were terrible and the pay even worse, especially for a black woman in the south. She learned traditions of birth and postpartum care through her grandmother and other “wise women”, and then later got standardized training through the nearest hospital, which allowed her to assist more women in a systemically recognized and medically approved fashion. She still continued to serve women as best she could without putting her neck on the line (she also helped deliver white women’s babies, which was a contentious point at the time).

The book also reflects on the various struggles black women faced in trying to work as midwives in Alabama, first due to explicit racism, but in later years, also due to systemic racism and prejudice through the worlds of healthcare and medicine, as doctors sought to get rid of lay midwifery (and devalued nurse-midwifery too in some areas). Many women, like Miss Smith, continued to try to care for women regardless, as they were the only option for hundreds of miles, and because white doctors were generally not interested in making the trip to aid poor black women give birth.

It really puts into perspective that even today, black women in America are still three to four times more likely to die during childbirth (or the first week immediately after) than white women. Food for thought.

One thing that could help bridge this increasing gap is better sensitivity training and education for medical practitioners. I was curious about different traditional practices and beliefs around postpartum care which led me to some interesting studies. One such study covered a few Central American countries and their beliefs around both the perinatal and postpartum periods.

I do think it’s important to know of the different roots behind postpartum treatments to help understand why a family may act/react the way they do to particular medical practices in western birth facilities (like hospitals). This is the way, in my opinion, to create a culture of care that uses a mom’s background/culture along with the medical evidence based practice to put the best interests of moms first, rather than of healthcare premiums.

 

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on polycystic ovarian syndrome (pcos)

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photo source: what does it mean to have a diminished ovarian reserve?

I’m combining all my other blogs’ content to this site. Please bear with me as I post older content. 🙂

A while back I stumbled upon a briefing in my email that led me to this study, which indicated that women with polycystic ovarian syndrome (PCOS) have an increased risk for developing type 2 diabetes. As a woman who was diagnosed with PCOS as a 17 year old (and as a woman with an egregious sweet tooth), this news alarmed me, but not just for the risk mentioned.

First off, PCOS is a reproductive hormonal condition that can impact fertility. With PCOS woman is thought to have at least two of the following: high levels of androgen, increased facial hair, multiple cysts in her ovaries, and/or infrequent periods. The risk of PCOS is also greater when a woman is obese.

When I was first diagnosed with PCOS, I was around 17, and went to the Ob/Gyn because I hadn’t had my period in 6 months despite not being sexually active. The doctor inquired on my lifestyle, and when he discovered I played on two soccer teams and ran track on the off season, he quickly decided that my period’s absence must be due to my high level of physical activity. For some reason, he still decided to do an ultrasound, and then proclaimed that I had cysts in my ovaries. He retroactively mentioned that they might be the reason for my errant hairs on my chin and below my belly button (as PCOS is known for causing hormonal fluctuates that result in increased androgen). He then had me get a blood test, the results of which showed that I had slightly lower levels of estrogen than is “the norm”. He prescribed me birth control pills to balance out my hormones and sent me on my way. And so I began my journey on “the pill” for about 3 or 4 years.

After that, every time I subsequently went to see a Ob/Gyn, in college and after, I dutifully marked down that I had PCOS on the medical intake forms. It was never remarked upon again as my body weight was normal, which at the time was the big red flag with PCOS. It wasn’t until I started going through what we later found to be topical steroid withdrawal that my PCOS became a problem. Because my skin was so bad, doctors believed it may have had something to due with my hormones, and so I had a gamut of tests, from blood and saliva draws, to MRIs. They found that my cortisol levels were high and decided it would be worth it to see if taking me off the pill alleviated said result (it was also discovered that I had a pituitary adenoma, which led to me having to see a neurologist, and in following years having to get an annual check-up MRI. This continued until one doctor said they weren’t sure I ever had the adenoma, but instead perhaps the imaging had been read incorrectly the first time. Such is the way with imaging readings, I’ve learned).

When I was pregnant, I dutifully told my new Ob/Gyn about my PCOS diagnosis, and he replied that many women were given the diagnosis of PCOS when they were young without it truly being the case. Rather, he elaborated, it was more likely the case that I was young and my body was still adjusting to its hormonal changes. So maybe I had a cyst or two temporarily but it was not the same thing as PCOS. He furthered that the diagnostic signs for PCOS are a bit outdated, a statement of which newer studies seem to agree.

With the uncertainty around correct diagnoses, how then would one know if they are at more risk for type 2 diabetes or not? After I pondered this for a while, and my mind wandered down such avenues of questions, I inevitably came to the same conclusion where I always end up. Does it really matter? Or are most of these conditions still the product of lifestyle? Is the answer still then to eat more vegetables, cut down on sugar and processed foods, don’t consume excessive calories, sit less and move more?

Whenever I get to this conclusion I start to wonder what cultures still follow these stipulations more closely, and if said cultures have been studied for their rates of lifestyle diseases. But that’s a post for another day.

 

REFERENCES

Dewailly D. Diagnostic criteria for PCOS: Is there a need for a rethink? Best Practice & Research Clinical Obstetrics & Gynecology. 2016 Nov; 37: 5-11.

Kakoly NS, Earnest A, Teede HJ, Moran LJ, Joham AE. The Impact of Obesity on the Incidence of Type 2 Diabetes Among Women With Polycystic Ovary Syndrome. Diabetes Care. 2019 Jan.

Polycystic Ovary Syndrome. Office on Women’s Health. https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome.