Monday, June 27, 2016

Use your BRAIN(ED)

In regards to modern childbirth, women have more choices than ever before in history.  We have high tech capabilities, surgical interventions, low tech labor options, pharmacological (drug) interventions, pain medications, augmentation abilities, natural remedies, and other options that can be used to help manage the various of labor and birth.

With all the options, a birthing family can get easily overwhelmed with the sheer number of options. Quality childbirth education is so important in understanding the options available to you.  Even with a solid foundation of knowledge, every family is going to have their own path to walk as they navigate their labor and birth.  How a family prioritizes their preferences and options - both for birth and for baby care - is going to be completely unique to them.

When navigating labor and birth, a mother will need to make many choices. Having a simple but effective way to weigh the risks and benefits to help navigate labor is of tremendous benefit.  So when you are faced with a decision in labor, remember to use your B.R.A.I.N.(E.D.) (Benefits, Risks, Alternatives, Intuition, Nothing, Evidence, Decision)

What does that mean, and how does it look in application?  Let’s say you are in labor and your provider suggests augmentation (speeding up labor) with the drug pitocin. You can go through this list so you can be fully aware as you move forward with your decision. Remember, each situation is going to be different, and the reasons to move forward with a decision or not are unique to you.

Benefits - What are the benefits to using this particular intervention at this time? How will it change my doctor or midwife’s approach to my care?  What outcome are we hoping to achieve with starting this intervention? What benefit will we have as a result of using this intervention that we currently are not experiencing or seeing?

Risks - What are the risks associated with using this particular option?  In his instance, explain the risks that the use of pitocin carries and its effects on both mom and baby.  

Alternatives - What can we use instead of pitocin that will give us the same effect? What are their risks and benefits? If you want to, are there natural remedies you can try first?  For example, what about nipple stimulation?  Can the mom walk around on the labor and delivery floor a while to try and move things along instead?

Intuition - Mom, what does your intuition tell you about moving forward with this course of action?  Never - NEVER - underestimate your gut feeling.  Your intuition is stronger than you think and it is prudent to heed it's warnings and follow it, especially in labor.

Nothing - What happens if we choose to do nothing? If you choose not to move forward with augmentation with pitocin, what is going to happen and are these guaranteed outcomes? As long as both mom and baby are doing fine, sometimes doing nothing is actually the safest option. This requires some patience, but many times it’s worth it.

Evidence - What does the scientific evidence say about this option?  For instance,  augmentation with pitocin is supported by evidence after a woman's water has been broken for 18 hours.  It is not supported for a woman whose progress isn’t following the Friedman's curve (1 cm / hour, which is what many hospitals still require despite its many flaws).  What reason is your provider giving for wanting to go down this particular path and is it supported by evidence?

Decision - What is your final decision?  Own it. The consequences of this decision, both good and bad, lie with you alone. If you choose to have pitocin and it leads down the common path of necessitating further intervention and possible complication, ultimately you and your baby are the ones that are going to be living with that decision.  Your doctor or midwife are not, your doula is not, and your husband or partner sometimes is not. The responsibility for the decision you make needs to be yours alone. You can move forward with as much confidence as possible after carefully and deliberately weighing all the factors at hand.

The BRAIN(ED) acronym can be applied to each decision in your pregnancy, labor, birth and postpartum time.  For instance, you can use it to decide if you want to move forward with artificial rupture of the membranes (breaking the waters), induction, cesarean, or even an epidural.  

There is no such thing as a "textbook" labor. Birth is a very individual experience for each person. Each situation is different in the way a labor progresses, the priorities that a family places on values, and the way those two things come together as a baby is being born.  There are not necessarily any wrong choices in birth - just make sure that your decisions are fully informed ones.  

Monday, June 20, 2016

The Sunshine Vitamin

Summer is here and that means most people are rejoicing at the arrival of the refreshing warm weather - particularly the sunshine! The good news? Sunshine is WONDERFUL for your health. The bad news? Most people will tell you otherwise.

Sun exposure produces vitamin D in our bodies, and that is why it is called the sunshine vitamin. Vitamin D - which is actually a hormone rather than a vitamin - is not only beneficial, it is of utmost importance for many aspects of our health and well being. Yet we as a society are told to run away from the sun, hide ourselves from exposure of any kind, and to slather our skin in sunscreen in order to protect our fragile health. When we do this, however, we are denying our bodies one of the most important tools necessary for overall health. One can supplement vitamin D through vitamin D pills, but pills do not always act the same way in the body. The purest form of vitamin D comes the natural way: through the skin.

Vitamin D is crucial to our immune function. Vitamin D decreases the incidence of viral respiratory infections. It's said, for example, to provide powerful protection against colds and flu. Some theorize that the reason “cold and flu season” takes place during the winter months is because we are not exposed to enough sunshine during that time and we are naturally vitamin D deficient.

Vitamin D is a powerful anti-cancer agent. This is contrary to modern medical thinking which says that UV exposure causes cancer. Healthy, moderate sun exposure will provide you with the cancer fighting properties of vitamin D, but it’s important not to overdo it to the point that you burn your skin.

On that note, here’s a word about sunscreen. Many sunscreens are full of known carcinogens. So when you use a regular sunscreen, you are preventing your body from getting vitamin D as well as providing your body with known cancer-causing chemicals. If you want to protect yourself from too much sun so as to not get burned, consider a natural sunscreen or moderate your exposure by covering up lightly or staying in the shade as much as possible. Avoiding conventional sunscreens is generally a good idea.

Regular sun exposure also helps regulate your hormones and sleeping cycles through the pineal gland, which is very sensitive to light. Melatonin is produced by this gland and it is an important antioxidant with cancer-fighting abilities. Daily UV exposure helps keep your pineal gland functioning optimally, providing you with the benefit of both melatonin and vitamin D.

To get enough vitamin D, you don’t need extensive time in the sun. Simply 20-30 minutes once a day in the sun while wearing shorts and a t-shirt will provide most people with the health benefits of vitamin D. During winter months, supplementation is an acceptable substitute, but as soon as you are able to get in the sun again, jump right in - and enjoy your summer in the sun!

Monday, June 13, 2016

Breech Babies

The normal way for a baby to be born is head first, and generally speaking it’s also the safest. Not all babies play by the rules, however, and many are not head down at the end of pregnancy. Babies can be in a couple different positions if they are not head down. When a baby is facing side to side, they are said to be transverse. If their bottom is down ready to come out first, this is called the breech position.

It is possible for a baby to be born breech, though most physicians are not trained in handling a vaginal breech birth. Breech birth requires specialized training and with a skilled care provider it can be perfectly fine. Most of the time however, a baby whose position is breech at the end of pregnancy will be scheduled for a cesarean.

Nobody knows why some babies turn breech. Whatever the reason, moms and those who work with pregnant women have every trick in the book for trying to turn a breech baby.

  • Some will sit in an inverted position (bottom in the air, chest on the ground) for as long as they can stand it.
  • Some will place warmth at the bottom of their bellies and ice packs at the top to encourage baby’s head to move toward the comfort of the warmth.
  • Some OB/GYNs are trained in a procedure called external version in which a doctor will attempt to manually turn a baby from the outside.
  • Chinese medicine uses a tool called moxibustion which places heat at the end of the toes on acupuncture points.
  • Some beg and plead with their babies to turn!
  • Some will simply wait for labor to start because many times babies will turn in labor.

Each method will work for someone somewhere. Some babies are committed to being breech and others are easily encouraged to turn.

An often under-utilized method of turning a breech baby is seeing the chiropractor. Chiropractic has an extremely effective method of turning breech babies and it called the Webster Technique. In short, the Webster technique releases tension in the pelvis. It gives the baby more room to have an opportunity to turn. The Webster Technique is so effective that it is said to turn babies who are either transverse or breech to a head down position in over 80% of cases. There are no risks involved so it's a perfectly healthy way to try to turn a baby.

Chiropractic care and can prevent a baby from going into a breech position. But if you find yourself in this position, you want to avoid a cesarean, and you want to turn your baby prior to birth, do all the things! And make sure you see a chiropractor that is certified in Webster Technique, such as myself.