Friday, May 27, 2016

ACOG Induction

On May 16, the American Congress of Obstetrics and Gynecology (ACOG) met for an Annual Clinical and Scientific Meeting where they discussed several matters with regards to their practice. In this meeting, they discussed recommending routine induction at 39 weeks for all women. The birth community at large was in an uproar about several of their more controversial statements, including:

“This is a no-brainer. Why are we even having this debate?”
“39 weeks is the solution. Rescued by birth.”
“Think like a fetus. There is no benefit to staying in after 39 weeks.”
“Nature is a lousy obstetrician.”

The general conclusion was that recommending induction at 39 weeks for every woman was a good idea, though no recommendations have officially been made as a result of their discussions. Still, many in the birth community are now nervous about what may happen to the field of obstetrics and how, if this recommendation is made official, its going to change the way obstetrics is practiced.

There are a few things to note about ACOG. It is merely a private member organization, not a government entity with any authority over the practice. The recommendations that are put out by the organization can not dictate the way an OB/GYN member practices. (Hospitals and insurance companies are the ones that dictate practice). 

If a physician recommends a procedure just because ACOG recommends it, that does not mean that it is good practice. A systematic review of ACOG's policies revealed that only one third of the recommendations put out by ACOG are based in sound evidence. The other two thirds are based on either limited evidence or “consensus and opinion” (what everyone else is doing). Read here about this review of ACOG practices.

Evidence has shown over and over again that waiting until a baby is ready to be born, while carefully monitoring the pregnancy in the final weeks, is usually the safest route. In addition, a woman is not considered to be clinically “post dates” until she is 42 weeks. That means that an induction performed at 39 weeks could potentially cause a baby to be born three weeks before they were ready. This can be very dangerous for a baby. Due dates can be off, not all babies grow and develop at the same rate, and a 39 week induction could be very risky to a baby whose lungs are not yet developed. Induction itself also carries risks for both mom and baby and those are too numerous for this post.

One thing that evidence is very clear about is that a baby should gestate for at least 39 weeks. That does not mean that 39 weeks is the magic date that a baby should be forced from the womb. Stillbirth risks begin to climb after a baby has reached 42 weeks, so most care providers consider the 39 week to 41 week time frame to be an optimal window for birth. Still, even though the stillbirth risk rises, the incidence is still extremely low, and a baby may still have crucial development happening at 39 weeks and beyond.

So what is a woman to do if she finds herself with a provider that recommends induction at 39 weeks - just because?

Understand that you can always change your care provider. ALWAYS. Many women have changed doctors or midwives in the final days of pregnancy. If your care provider is not answering your questions to your satisfaction or practicing with the standard of care that you feel comfortable with, switch right away. In general, midwives tend to approach birth with a more hands off approach. They only intervene if a problem arises rather than stepping in before a potential problem could surface. Simply switching from an OB to a midwife may change the entire outcome of your birth. Study about the difference between active management and expectant management (and watch for a blog post about it) and find a provider that lines up with the one that fits you best.

You have the right to informed consent, but you also have the right to informed refusal. Informed refusal is not a term that is widely used, but it should be. Informed consent usually looks like this: “I inform you and you consent.” Informed refusal on the other hands simply asks the question, “What happens if I choose not to move forward with this plan?” That is a viable option for you.

Do your own research. Take an independent childbirth class so that you can learn about all the risks and benefits. Make the best decision for you and own it. At the end of the day, your doctor does not deal with the consequences that arise from interventions. You and your baby do. Be aware of what the risks and benefits are and move forward with what you feel is best.
Stop With The Antibiotics Already!

The news has been astir discussing the emergence of superbugs. A very real threat, they are the result of our years and years of liberal overuse of antibiotics. We have now learned the hard way that bacteria are, unfortunately, clever and they don’t like being killed off. So they have mutated to survive. And in case you missed it, that is very bad news.

Medical professionals, the CDC, and governments worldwide are urging doctors and hospitals to limit their use of antibiotics with their patients to critical situations only. Yet very little is changing in the way that medicine is being practiced. Furthermore, many patients are still demanding antibiotics for conditions where they are not needed, doctors are conceding, and the problem is getting worse.

Antibiotics are prescribed in many instances where they are of  absolutely no use, and can even cause some harm. Not only is this unnecessary and irresponsible, it is now dangerous. Many times a physician will still prescribe a course of antibiotics for a person who has a virus because “the virus could become something more serious.” They are given prophylactically (in advance of a potential threat) where no threat currently exists.

Antibiotics are not risk free. They strip the body of all bacteria - the good and the bad. Many times the body has a difficult time regenerating its lost gut flora and it can take weeks or years after a single course of antibiotics for the gut and immune system to regain a balance to function optimally. A fifth of all hospital visits are related to antibiotic problems including allergic reactions and other adverse events.

The CDC says that antibiotics should never be given for:
  • Viruses (including the common cold, flu, bronchitis, etc)
  • Many sinus and ear infections (Yes - ear infections. Get your ears adjusted instead!)
  • Sore throat

They may still be useful in cases of:
  • Strep throat (but not always)
  • UTIs (urinary tract infections)

So, if you’re going to try to avoid antibiotics, What can you do to stay healthy?

The first thing to note is that our definition of health should not be “feeling good” or “absence of disease”. Disease happens in our bodies and we are well designed to manage it. Furthermore, one can “feel good” but be secretly and unknowingly growing cancer in their body. They are sick - but they don’t “feel” like it. Instead, our definition of health should look something like this:

My body is well equipped to handle whatever comes at it, and it is operating efficiently.

When you look at it that way, perspective changes a bit. For instance, if you come down with the flu and your temp is 103, your body aches, and you are fatigued, you are not sick… you are perfectly healthy! Your body is effectively fighting a nasty virus! Imagine what that virus would do to you if your body temperature did NOT raise to fight the infection. See? You are actually healthy because your body is properly taking care of itself.

You can also support your immune system.
  • Eat whole, unprocessed foods as much as possible. Cut out the processed (boxed) foods from your diet.
  • Take probiotics. The gut is 80% of the immune system so treat it right and it will take care of you.
  • Get adjusted. A single chiropractic adjustment increases immune response by 200%. When the body can properly communicate within itself it functions at an optimal level.
  • Cut out sugar. Sugar cuts the effectiveness of the immune system drastically for several hours after consumption.
  • Consider taking immune supporting supplements. At least consider vitamins C and D. Make sure you are buying plant based vitamins that your body can absorb and use.
  • Reduce your stress. See my post about deliberate breathing.

Consider also that these superbugs are largely living in hospitals where antibiotics and antibacterial cleaning methods are being used all the time. Most cases of people contracting these dangerous superbug infections start when a person visits the hospital and they become exposed to antibiotic resistant bacteria. So, stay away from the hospital as much as possible. If you are not sick, do not go there - including to give birth. (Birth is not an illness and it is the only time in your life that you’ll be admitted to the hospital when you are perfectly healthy. You can choose to protect yourself and your baby from superbugs at the hospital by considering birthing at home or at a birth center.)

It’s time to change our perspective a bit. We are risking a lot when we jump to the prescription pad for every little thing that ails us. Limit your use of antibiotics to only when a real threat presents itself, support your immune system, and trust your body’s design for managing sickness.

Thursday, May 26, 2016

Relaxin Is Not So Relaxing…..

Pregnancy brings with it many equally wonderful and irritating things. Baby kicks, but heartburn. Growing new life, but morning sickness. Lots of attention, but relaxin.

Oh, the relaxin. 

Relaxin (not to be confused with relaxING) is one of many reasons pregnant women need a chiropractor, and desperately. See, relaxin is responsible for many important things during pregnancy and birth. Its primary function is to loosen the joints of the pelvis to allow the baby adequate passage space. Relaxin, as it is a hormone, does not work on solely the pelvis, however. It affects all joints.

So by the end of pregnancy, when relaxin is at its highest, you rather feel a bit like a marionette, which is why you need a chiropractor to put you back together.

Throughout pregnancy, the body goes through massive changes. A woman’s center of gravity is shifting, her hormones are changing, and her physiology changes to accommodate the growing babe. The most significant changes to the woman’s joints, bones, and support structure occur in the second half of pregnancy - when the baby grows the most.

The effects of relaxin rather compound on each other. If a woman is not being regularly adjusted, that back ache she’s getting will only get worse. Her hips will only be exposed to more relaxin (and a growing babe!) until birth. Regular adjustments during pregnancy will help keep a pregnant body as comfortable as possible until the birth. At the end of pregnancy, a chiropractor can get the mother’s body as ready as possible for labor by manipulating her pelvis and spine in an optimal position for birth.

In addition, chiropractic can come in very handy during the actual labor to help with the baby’s position in the pelvis. Most pregnancy care providers are only concerned with whether the baby is head down or not. If the baby is head down, that’s great - but that’s not the only position that matters during labor. The way that a baby is facing during birth makes a huge difference in the length of labor, the pain of the contractions, the contraction patterns, and ultimately whether or not a mother will have a cesarean.

In short, a baby should be facing to either side of the mother’s body. Baby should be looking at either the left hip or the right hip. If the baby is facing forward, then the back of the baby’s head pushes on the mother’s lower back during contractions - and this is what we call back labor - where contractions are felt very strongly in the back. It is miserable.

There are many positioning maneuvers that can be done to help encourage a baby to turn properly, but if the water is broken and that little noggin is tightly engaged, it’s time to call the chiropractor. Many a babies have been born via cesarean simply because they were “sunny side up,” “malpositioned,” or “OP” (occiput posterior). Many of those babies did not need to be surgically born - they just needed expert hands to encourage them to turn to a more favorable position.

Furthermore, a baby’s head should be STRAIGHT down. If a head is acynclitic - tilted toward the side - the baby may not come down. A chiropractor can help straighten out a baby’s head as well.

After the birth, relaxin is still in a woman’s body for about 4 months. If the pregnancy left a woman’s hips, back, and spine misaligned, those things are not going to heal themselves just because the relaxin is no longer present. They need special attention by a master of skeletal manipulation...

...which is a chiropractor.

Moral of the story: a chiropractor is a must for women in pregnancy.

“As soon as my client tells me she’s starting to feel achy, I immediately send her straight to the chiropractor. Never once has a single woman come back to me after a pregnancy chiropractic adjustment with anything but immense relief. Chiropractic is a must for pregnancy care and comfort - and it is crucial during labor in some situations. I love chiropractors for my clients - every pregnant woman needs a chiropractor.”
- Rachel Madrigal CLD, CCCE (Birth Doula and Childbirth Educator)

Tuesday, May 17, 2016

Deliberate Breathing
It seems rather silly to tell a person to focus on their breathing. After all, it’s the one thing we are going to unconsciously do from the moment of birth until the day we die. You’re going to do it anyways. So of all the things you could possibly give your attention to, why breathing?
Let’s to go back to high school anatomy and physiology for a moment to briefly discuss the profound effect that deep breathing can have on your health. The short version is this: there are two states that the human nervous system can exist in. They are called the sympathetic nervous system and the parasympathetic nervous system.
Long words, I know… but stay with me…..
The sympathetic nervous system is what we refer to as the “fight or flight” state. Its purpose is to get the body immediately prepared to manage a threat - by fighting or fleeing (flight). It spikes adrenaline, dilates pupils, raises blood pressure, sends blood to the extremities in preparation for handling opposition, heightens the senses, and it speeds up both the heartbeat and the breath. It is very useful - when you are in extreme danger - and that is what it is meant to protect you from.
We are only meant to use the sympathetic nervous system for 3%- 5% of the entirety of our lives.
The problem is that most people in the modern world live with this as their normal, ongoing state of being. Especially women. Their adrenaline is always high, their blood pressure is responding to stress, the internal organs aren’t getting as much blood as the extremities, etc. The long term, continuous activation of the sympathetic nervous system wreaks havoc on the body. It stores fat, increases stress, depletes the thyroid and adrenals, and disrupts our sleep.
The moral of this story: only use it when you need to.
Instead, what should the body be doing? In a healthy body, the parasympathetic nervous system will dominate. When the parasympathetic nervous system dominates, the body is in a state of calm. The blood pressure lowers, stress decreases, and the body no longer needs to store away extra fat.
The sympathetic and parasympathetic nervous systems exist rather on a spectrum. Sympathetic functions keep us alive, so parts of them are activated all the time. (For instance, we need SOME blood pressure!) But long term heightened activation causes problems. How do we swing the pendulum the other way?
Go back to the top of this article: deep breathing. The lower part of the lungs activates the parasympathetic nervous system. Most people are very shallow breathers as a result of their ever activated sympathetic nervous system, so reaching the lower cavity of the lungs takes deliberate, conscious effort.
I realize that I just added one more thing to your to do list, which likely further activated your sympathetic nervous system, but follow me for just one more moment.
Here’s how to do this: take daily breathers. Start with 5 long, deep breaths, twice a day. Do it now. Yes - stop reading - I’ll wait.
See? Not hard.
Your health will thank you.
You’re welcome.

Wednesday, May 4, 2016

The Real Dangers of Sugar
Dr Harold W. Harper, M.D,
How You Can Beat the Killer Diseases
“The major addiction problem in the United States and, to a large extent, in the Western world, has nothing to do with opiates, uppers, and downers, or even alcohol or tobacco. The number one addiction today is sugar.”
It's positively maddening to try and understand how to eat healthy today. Proponents of all kinds of varying diets shout at each other over the interwebs, citing research to support their stance, leaving the neutral health seeking person at a loss. Paleo, low-carb, raw food, vegan, juicing, vegetarian, gluten free, grain free, keto, organic, non-GMO....

They all, however, have at least one thing in common. They all desperately try to educate the general public about the dangers of sugar. Specifically, refined sugar, or unnatural sugars such as high fructose corn syrup.

They are all right to do so. Let’s talk about sugar.

The more we know about it, the worse it gets. We know its evils. Sugar causes everything from chronic inflammation to tooth decay to obesity. It contributes to depression, ADHD, insulin resistance, diabetes, metabolic dysfunction, fatty liver, cancer, and hormone imbalances. Despite our valiant efforts to come off of it, we are relentlessly caught in its addictive, tasty clutches. Sugar is in everything. EVERYTHING! It’s in sushi. It’s in bread. It’s in many dairy products. Coffee creamer. Peanut butter.

The quest to avoid sugar becomes further complicated when we find that sugar is even in “health foods” – those that are designed to appeal to the very population that is trying to be healthy and lose weight!

Weight loss is a herculean effort these days that is many times destroyed by even moderate sugar consumption, so let’s talk briefly about what makes you fat. Insulin is the fat producing hormone. That means anything that goes into your body interacts with your biology in such a way that it causes insulin to rise, produces fat.

What is the primary cause of insulin spikes? Sugar.

To lose weight and be healthy, you decide you’re going to stay away from sugar.  Be aware: this may prove to be a bit more difficult than you may think.  Not only is sugar difficult to avoid in most foods found at the grocery store, it is highly addictive, as mentioned in the quote at the top of this post.  ( )

To aid in many healing many health conditions, and of course to lose weight, many recommend a sugar detox of some kind. There is no “safe” or “innocent” amount of sugar, period.  At the very least, cutting down on sugar intake significantly will go a long way toward reducing those incessant cravings, and it will greatly improve the state of your health.  

It is not at all uncommon to experience detox symptoms as you cut out sugar, since it has addictive qualities. Having a detox buddy if possible will keep you accountable.  I have accountability groups starting every month.  AND/OR you can ask a friend, spouse, or partner to do it with you.    

Focus on what you CAN eat rather than what you CAN’T.  If your goal is to be healthy, a paradigm shift toward the way you approach food is a good way to start. Eat to live rather than live to eat. Remember, you can be skinny and unhealthy.  

Finally, if you decide to detox from sugar and you slip up, pick yourself up by your bootstraps and let the next decision you make THAT DAY be a better one. Health is an ongoing process, not a one-time deal.