Archive for April 2011
29
Ask A Midwife: How to Avoid Postpartum Complications
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Many postpartum complications can be avoided or reduced. There are three simple things you can do to decrease your chances of experiencing any postpartum complications.
Avoid Interventions
Every procedure or intervention increases your risk of experiencing postpartum complications. Before you are in the delivery room, determine which procedures you are willing to do with your midwife or dula and which procedures you do not want to do. Study up on the complications associated with the common procedures and interventions performed in most delivery rooms. Increasing your knowledge about the procedures that are regularly done by your doctor can give you an idea of what to possibly expect during your labor. By learning and preparing yourself to make important decisions concerning your health and the health of your baby, you may be able to ensure a positive birth experience. Research has found that negative birth experiences are linked to postpartum depression and posttraumatic stress disorder. A great way to lessen any negative effects is to choose a health-care provider that you trust.
Learn About The Process
There are so many great resources about what to expect during labor, delivery and postpartum. Take some time and learn all you can. Read childbirth books, take labor classes like Lamaze, and study about some of the different labor options available. There are many different ways to have a baby. Some mothers choose to have home births. Other mothers have water births. Regardless of which delivery you choose, study up on what to expect concerning that specific process. The more you know the less fearful you will be.
Communicate
Once you have determined your birth plan and figured out which procedures you do and do not want to experience, sit down with your health-care provider and discuss your ideas. Ask your doctor or midwife about his or her philosophy on birth and intervention, as well as how he or she will help you to avoid unnecessary or unwanted medical procedures. You should ask these questions before the third trimester so that you have time to change health-care provider’s, if you do not agree with your current health-care provider’s philosophies.
Visit Your Birthplace
Many hospitals and birth centers offer tours to expectant mothers. You should take some time to check out the facility that you will be delivering your baby in. A tour is a great way to see the facility and ask questions about their policies and procedures. Can you eat or drink during labor? Are Ivs required? Do they have lactation consultants to assist with breastfeeding?
Your birth experience will be unique and memorable. Besides mentally preparing yourself for the physical challenges of delivery you may want to understand how certain birthing experiences could affect you postpartum. Every procedure or intervention could affect you after your baby is born. Medications, Ivs, fetal monitoring devices and even the position you are in when you push your baby out can affect your ability to recovery quickly.
When creating your birthing plan you should consider how any possible interventions and medications could affect your baby and you after delivery. The following interventions or procedures are known to affect postpartum recovery. You may want to discuss these potential birth experiences with your obstetrician.
Narcotic Pain Relief
Many women worry about the pain of labor. Some women are adamant about not using any type of pain medication during labor. Other women have already told their doctor to use the biggest and most powerful pain medication available as soon as possible. What you should be aware of is that narcotic drugs like Demerol, Stadol and Nubian can make you feel spacey when your child is born. These drugs also stay in your system for several weeks and can make breastfeeding difficult.
Epidurals
There are many side effects associated with epidurals. Some women experience severe headaches, fever, pain and itching at the injection site, uneven numbing, and a serious and sudden drop in blood pressure. Women who choose to have an epidural are more likely to have a forceps delivery, episiotomy or c-section.
Antibiotics
Antibiotics are typically used during labor and birth. Unfortunately they can cause postpartum problems such as vaginal yeast infections, allergic reactions, and thrush. To reduce the impact of antibiotics on your system, eat lots of probiotic foods like yogurt, kefir, kimchi, or miso.
Fetal Monitoring
If your baby requires constant fetal monitoring you may find yourself stuck in bed. This could slow down the delivery process and increase your chances of needing an epidural or other pain medication.
An internal fetal monitoring device may also be used. This type of device requires an electrode to be placed on your baby’s scalp while inside your uterus. This type of monitoring device increases your chances of developing a yeast infection and also increases your baby’s risk for scalp infection. This type of monitoring is most effective compared to the external monitoring device.
If you are pregnant, you have probably wondered what labor will be like. Perhaps you have heard stories from your mom about your birth. You may have family members or friends who have shared their personal birthing stories with you. There are a lot of opinions about labor and delivery. Before you jump to any conclusions, here is some information from a Midwife about some common procedures that you may experience during labor.
Episiotomy
An episiotomy is an incision that is made through layers of tissue and muscle in the perineum. Many care providers routinely do episiotomies. Most episiotomies are considered unnecessary and may even be cause for postpartum problems. An episiotomy is very painful and can delay your healing time compared to natural tears. Research has found that natural tears heal much faster than episiotomies. There is also and increased risk of infection following an episiotomy. You should consult with your health-care provider about his or her episiotomy rates and discuss your desire not to have an episiotomy as part of your birth plan. There are several techniques that could help you to avoid having an episiotomy. They are: giving birth in an upright position; pushing when you have an urge to push and not on demand; and perineal massage while pushing.
C-sections
C-sections have become increasingly popular over the years. More and more women are choosing to deliver by c-section in order to set the exact date of birth. Many experts believe that emergency c-sections play an important role in saving lives but that too many unnecessary c-sections are being performed in the United States. Women should be aware that there is a much longer and more painful recovery time following a c-section. Women who deliver by c-section also increase their risk of infection and other short and long-term side effects.
Returning to work after delivering a baby is one of the most stressful experiences for a mother. It can be very challenging to juggle the demands of employment with the needs of a newborn and your own physical exhaustion. Many employers are beginning to offer flexible work programs that can benefit new mothers and the employers. Studies have shown that public health benefits from embracing and nurturing the mother/child dynamic regardless of bottom line. Supporting our mothers in the community pays off. Here are some options for mothers who may be returning to work soon.
Earned time is a flexible work program that uses sick leave, vacation and personal days. These days are generally grouped into one set of paid days off that a mother can use at her own discretion. This benefits the mother because she does not have to justify time off with her supervisor. This time is often earned over several years. New mothers who have accrued earned leave may be able to have a substantial amount of paid leave after childbirth. Employers find a value in offering this benefit because it promotes loyalty from their workers. Also, workers who are provided with this benefit are usually willing to work harder for their company because their personal needs are being met.
Part-time employment is a work program that allows an employee to work less than 35-40 hours a week. This type of work schedule allows mothers more time to be at home. Many part-time schedules are more flexible than full-time schedules. Providing this work option is beneficial to employers because it helps them to retain valuable employees and saves them from having to recruit and train new workers.
Job sharing is another type of work program that occurs when two workers share the responsibility and duties of one job, but both work on a part-time basis. This is beneficial for mothers who want more time at home but want to keep the same job. Employers usually offer this program because it saves them money in benefits, rehiring and training.
Phase back occurs when an employer allows workers to gradually return to a full-time work schedule over several weeks or months. This provides the mother with more time to adjust to returning to work and gives her more time with her baby. Employers generally provide this benefit because they have found that it promotes loyalty and dedication from workers.
A lactation consultant can be a valuable resource for mothers before and after their babies are born. Many hospitals and birthing clinics have lactation consultants that are available to answer questions and provide information about breast feeding and bottle feeding.
The prenatal period is a great time for mothers to discuss breastfeeding before the baby arrives. The lactation consultant can help women to understand the importance of breastfeeding and reasons for mothers to continue breastfeeding even after they return to work. The lactation consultant can provide practical strategies and encouragement.
Many mothers assume formula is a convenient way to feed their infant when they are separated from each other. A lactation consultant can help women to understand the importance of expressing breast milk for mother and baby. Some of the reasons to express instead of formula feed a baby include:
-Protecting the baby from illnesses and allergies.
-Providing comfort for the mother.
-Preventing engorgement, mastitis, and leaking from allowing the breasts to become to full because of missed feedings.
-Maintaining milk supply.
After a lactation consultant discusses the benefits of breast feeding over formula feeding, the lactation consultant can offer support and solutions to help the mother reach her breast feeding goals. This can be done by identifying breastfeeding classes in the community, which can provide information to help initiate and maintain breastfeeding, as well as hopefully create a bond of friendship with other breastfeeding mothers who can provide support to one another.
One of the biggest challenges for breast feeding mothers comes when they return to work. The lactation can help develop a plan for the mother to successfully incorporate employment with breastfeeding. This can be accomplished by helping her to maximize her maternity leave for as long as possible. The optimal amount of time is 12 weeks. Also, the consultant can provide information about job sharing; part-time employment; a gradual phase-back into a full-time schedule; or finding ways to work from home.
The uterus, (or womb), is a hollow organ normally about the size and shape of a pear, except during pregnancy when it expands considerably. It is located medially within the anterior portion of the pelvic cavity, above the vagina and over the urinary bladder. the uterus is supported by the broad ligament.
The uterus provides mechanical protection and nutritional support to the developing embryo and fetus. Its superior, thick-walled portion is called the body. The fundus is the bulging upper surface of the body of the uterus where the uterine tubes enter, and the area where the fundus joins with the uterine tubes is the isthmus. The cervical canal is the region where the body of the uterus joins with the neck of the uterus called the cervix. The muscular tube of the cervix projects a short distance into the vagina, and the uterine cavity opens into the vagina at the external orifice of the cervix, also called the cervical os, where sperm are deposited during sexual intercourse. Three tissue layers make up the relatively thick uterine wall. The inner tissue layer is called the endometrium. The endometrium is composed of a thicker inner layer, called the stratum functionalis, and a deeper thinner layer, the stratum basalis. The stratum functionals is where the embryo implants. When fertilization does not occur, the stratum functionalis of the endrometrium sloughs off during menstruation. The stratum basalis provides tissue for regeneration of the stratum functionalis following menstruation. The middle layer of the uterine wall is composed of a thick layer of smooth muscle called myometrium. The muscles contract rhythmically during the process of delivery in birth. The outer tissue layer of the uterine wall is called the peritrium or serosa. It is continuous with the mesothelium of the broad ligament.
Every expectant mother at one point or another in the pregnancy is eager to deliver their baby. If you are feeling like you can’t stand to be pregnant another day, don’t worry. You are not alone. The last trimester of pregnancy is exhausting and uncomfortable. You probably aren’t sleeping very well. You may be experiencing acid reflux in the evening when you lay down to rest and your back probably aches from the added weight in your stomach. All of these discomforts would make any woman long for delivery day…with one exception. No mother wants their baby to be born prematurely. About five or six out of one hundred births in the United States are premature, meaning that the infants are born before they are physically ready to leave the womb. Premature babies are more likely to experience medical problems at birth and generally require extra medical attention and assistance immediately following delivery. A specialized pediatrician called a neonatol nurse practitioner may be called upon to assist with the baby’s care, depending on how early the baby was born. The neonatologist will determine if the baby requires any special treatment.
If your baby is born prematurely, she might weigh 5 pounds or less and depending on how early she arrives. It is very likely that your baby will not look like a full-term infant. This is because the earlier she is born the bigger her head will be in relation to her body, which will also not have as much fat as full-term babies. With less fat, a preterm baby’s skin will seem thinner and more transparent. She will probably not have any of the white, cheesy vernix protecting her at birth, because the vernix is not produced until close to the end of a full-term pregnancy.
With very little fat to keep her warm, your premature baby will probably be rushed to an enclosed bed that allows for the temperature to be adjusted keeping her warm. She will most likely be sent to a special-care nursery to be monitored until they determine that she is strong and healthy enough to be placed in the regular nursery. She may be in the special-care nursery for several weeks depending on how early she was born.
If you are a mother who breast feeds, you probably wonder how much milk your baby is consuming at each feeding and through the entire day. Mother’s who express or formula feed their infants know exactly how much their baby consumes. Mother’s who nurse exclusively can only hope that they are able to provide enough milk to satisfy their baby’s needs.
According to research done on lactation and according to lactation consultants in the United States, the mean volume of milk secreted by healthy women, whose infants exclusively breastfed, during the first 4 to 6 months is approximately 750 to 800 ml/day. In the United States, we are more familiar with ounces and this equates to approximately 25 ounces of breast milk per day. The amount of milk your baby consumes could be more or less than this. The amount of breast milk your body makes depends on your baby’s demand for it.
Research has determined that women who have twins or triplets produce more milk than women with only one nursing infant. This is because the demand from multiple infants causes the body to produce more milk to meet the need. If your baby’s feeding are supplemented with formula, it is very likely that your milk production will be less than a women who nurses exclusively.
Some mothers claim that they are not able to produce enough milk to satisfy their baby’s hunger. Research has still not determined why some women seem to produce milk easier than other women. Caloric intake does not seem to affect milk production. There are several home remedies that claim to help stimulate lactation. However, no research has been done to prove or disprove any remedies.
If you are concerned about whether your baby is getting enough milk from breast feeding exclusively, be patient and observant. Pay attention to how long your baby nurses at each breast. How many feeding she has in a day and how your breasts feel. Are they fuller in the morning and more depleted in the evening? Also pay attention to how you feel. Are you stressed during feedings? Do you relax or are you rushing to get other things accomplished? Are you getting enough rest? Eating nutritious foods and drinking enough water? Improving your diet, drinking more water and reducing stress may be able to help your milk production.
If you are still concerned, consult with your pediatrician before supplementing your baby’s feedings with formula.
Routine vaginal deliveries can occur in several different positions. Generally most people think vaginal deliveries occur with the mother lying on her back. Although this is a common position, there are several other positions that are used to help speed the delivery of the baby. Regardless of the delivery position, most vaginal deliveries are very similar.
Once the baby’s head is delivered, the certified midwife or doctor will likely suction the nose and mouth. This helps to remove any fluid that may be blocking the airway to allow your baby to take his first breath. Many babies quietly breath and do not cry so do not be worried if you do not hear your baby cry initially.
The rest of the baby’s body is usually easier to push out with much less difficulty. Once the baby is completely delivered, the midwife or doctor will more thoroughly suction the baby’s nose and mouth before being handed to you to hold for the first time.
You will notice that your baby is covered with a white cheesy substance called vernix. This is a protective coat that is produced toward the end of pregnancy by the sebaceous glands in his skin. He will be wet from the amniotic fluid in your uterus and may have some of your own blood on him if you experienced an episiotomy or vaginal tear during delivery.
This first interaction with your baby is priceless. Enjoy this moment and pay attention to how your baby’s skin feels. Enjoy this skin-to-skin contact and take advantage of his attentiveness, which will probably only last for a few short hours. Your baby’s skin tone may appear blue at first. This is normal and your baby will gradually turn more pink as your his breathing becomes more regular.
Over the next few days your newborn’s breathing may seem irregular. This is normal. Your newborn may take as many as 60 breaths per minute and may alternate with short, shallow breaths and long pauses between breaths.
Your babies head may be elongated. This is because his head had to adapt to the contour of the passageway in order to squeeze through. Do not worry. Your baby’s head will return to its normal oval shape after several days.
The first two weeks after your baby is born can be the most joyful and painful two weeks since delivery. Although you will be thrilled to finally hold your baby in your arms, the pain of nursing can often take your breath away during these first weeks home. This is especially true if your baby is not positioned properly or does not latch on well when you start breastfeeding. The result is usually cracked or sore nipples.
Cracked nipples are almost always the result of incorrect positioning of the baby at the breast. The first and most important part of breastfeeding is positioning the baby correctly. There are several nursing positions that a lactation consultant can discuss with you to help you prevent any discomfort. If your baby is not able to latch on to the breast properly your nipple may become traumatized. This often results in severe pain to the nipple or other areas of the breast.
There are some simple tips you can follow to help minimize your discomfort. Wash the breasts only with water, not soap. Soap can be drying to the sensitive areas of the breast and cause cracking. Applying creams and lotions will not help and may agitate the problem more. Using a different nursing position at each feeding can help to prevent one area of the breast from feeling raw. Also, limit the length of feedings to five or ten minutes. If you limit the feedings, you should add more feedings to the schedule.
If you live in a humid climate, the best way to treat cracked nipples is to allow your breasts to dry out any moisture. Do not wear plastic breast shields or plastic-lined nursing pads. When possible, expose your breasts to the air as much as possible. A hair dryer, set at a low setting and kept safely away from the skin, can be an effective tool at keeping the breasts dry. After nursing, rinse the nipples to remove the baby’s saliva and try to express a little milk from your breasts and allow the milk to dry on the nipples. Dried milk can help with the healing process.
Dry climates will require the application of ointments or purified hypoallergenic lanolin on the nipples. Lanolin is a safe choice for you and baby. Be careful when applying other ointments. Ensure that they are safe for consumption by your baby.
