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.  

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!

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 spinningbabies.com 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.

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.

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)

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.