Do I Need a Cesarean? ACOG Says Not So Often, Many Are Preventable

You may know that the cesarean rate in the United States is over 1/3 as of 2011, and probably was even higher in 2013. Cesarean surgery, though common, is major surgery and has a number of risks. Many childbirth professionals have been concerned about this for years, and now ACOG (The American College of Obstetricians and Gynecologists) has joined the concern.

This is great news for pregnant moms who may be concerned about the possibility of having a c-section and the longer recovery time, scarring, and greater risk that c-section brings with it. ACOG developed new guidelines for obstetricians in cooperation with the Society for Maternal-Fetal Medicine regarding when cesarean surgery is needed. These guidelines expand what is considered “normal labor” in light of recent evidence so doctors do not feel the need to move to surgery as quickly. The rest of the consensus statement focuses on outlining the risks of cesareans, and exploring what the new recommendations mean for different causes of cesarean surgery.

What This Means for Expectant Couples

Hopefully, most obstetricians will try to begin following these new guidelines right away. This should mean that women are able to relax better in labor and worry less. However, as is the case with all of us, it can be hard to change old habit, so pregnant women and their labor partners may need to take some action as well.

What Can *I* Do to Reduce the Risk of Cesarean?

There are many things you can do to reduce the risk of having or needing a cesarean. The risk can never be eliminated completely, but it can be greatly reduced. Here are a few of the many available suggestions:

  • Talk to your OB or midwife about the new guidelines. Ask what he or she thinks of them. Try to find out whether or not they intend to follow them, and under what circumstances. Also ask about their cesarean rateIf they seem resistant, find another birth attendant. The original obstetric care consensus on reducing primary cesareans can be found here, and Science and Sensibility has a summary of the new ACOG guidelines for reducing c-sections that is easier to understand.
  • Get chiropractic care during pregnancy from a chiropractor trained in prenatal care and the Webster technique. They can help make sure the hips and spine are aligned in ways that not only help you stay more comfortable during pregnancy, but also helps labor go more smoothly, and can help baby move into a better position. This helps reduce the risk of having labor stop, or having baby in a position that does not work for birth. Find a pregnancy chiropractor here.
  • Eat low-glycemic. How you eat influences how baby grows. Eating slower-digesting carbohydrates, less sugar, and plenty of fiber helps even out blood sugar, and can reduce the risk of gestational diabetes and may help baby grow appropriately, instead of too quickly. Some cesareans are scheduled because baby looks “too big.” Here is a brief overview of low-glycemic eating (also called a glycemic index diet), and some information on how to start eating low-glycemic.
  • Only schedule an induction if absolutely necessary. Inductions are much more likely to end in a c-section than labors that start on their own.
  • Hire a doula, or plan to have a labor partner with you who has been trained to help you through labor. Having a trained labor partner accompany you significantly reduces the risk of cesarean.

Health Insurance Now Covers Breast Pumps in the U.S.

Loving mother breastfeeding newborn baby

Breastfeeding may be an easier option with insurance-covered pumps

Health insurance companies in the United States are now required to cover breast pumps (and lactation consultants!) for any woman who wants to breastfeed her baby. This section of Obamacare (the Affordable Care Act) went into effect for 2013.

The law states that insurance companies must cover some kind of breast pump, but not what kind. At this point (Feb., 2013), many insurance companies are only offering a manual pump. These are worked by hand, not electricity, and usually do not have any of the bells and whistles that come on higher-priced models, but still work well. Some insurance companies will only cover rentals of high-end, hospital-grade pumps, and some will cover either rentals or purchases. Some women may still want to buy or rent their own, depending on what kind of pump they would prefer to have, and what their insurance covers.

What to Know About Insurance and Breast Pumps:

  • Health insurance must cover pumps, but your company can choose what kind, and whether to cover rentals, purchases, or both.
  • Check with your insurance company to find out what type(s) of breast pumps they cover. Ask if there is a difference if baby comes prematurely, or has other medical needs.
  • Learn about the model(s) of breast pump your health insurance covers. Read manufacturer information and reviews to see if that pump could be a good fit for your situation, or to help you decide if your insurance company offers a choice.
  • Decide how much you will work, and where, for baby’s first year. If you are planning to stay home for much of that time, a basic model pump may be fine, or you may not need a pump at all. This can also be the case for working from home/telework, or even some part-time jobs. If you plan to work full time, a basic pump may also be a good fit if your company has on-site daycare or someone will be able to bring your baby to you to nurse a few times during the workday. If you will work full time far from home, you may want to invest in a higher-quality pump if your insurance company does not cover it. The more expensive pumps are generally much faster and more comfortable for frequent pumping.
  • The healthcare law specifies that breast pumps and lactation consultants should be covered without cost to the insured, so you should not pay anything.
  • Medicaid is not included under the Affordable Care Act for breastfeeding support, but most states have decided to cover some pumps. Call your Medicaid contact to see if pumps are covered in your state.
  • If you have any breastfeeding challenges, ask your insurance company to refer you to a lactation consultant they cover. Be aware that reimbursement rates for lactation consulting are low, so some excellent LCs and IBCLCs will not work with insurance companies.

What to Do to Get a Breast Pump Covered by Insurance:

  • Around 36 weeks, check with your insurance company to find out what pumps they cover.
  • When you check with your health insurance company, ask where you need to get the pump from. Different insurance plans cover different vendors.
  • Order the pump based on when you are planning to return to work. If you will be home for a few months, order the pump after baby is born.  If you will be returning to work around baby’s 6th week, order the pump before baby is born, as early as 36 weeks of pregnancy or earlier if you insurance company allows it. This way, you can be certain it will arrive before you need to return to work. Many companies are currently backed up on shipping pumps because of the high demand. Hopefully, this backlog should be resolved as companies adjust to the demand.

What do you think? Will this coverage help you, and will you use it?

Breast Pumps and Insurance References:

The breast pump industry is booming, thanks to Obamacare

Breastfeeding Insurance and Reimbursement, from Medela

Breast Pumps Now Covered By Insurance, But Does It Help?

 

What to Do When Baby Is Coming And You Can’t Get to Your Doctor or Midwife – Emergency Childbirth

Woman in labor

Worrying about giving birth during a storm

With the winter storm coming to the Northeast, and all the other severe storms occurring, it sometimes happens that mom goes into labor, but can’t get to the hospital, or her midwife can’t get to her, in time for baby’s birth. This can also happen when mom has a fast labor, which is more common with second births. It is unusual, but there can be that nagging worry. Knowing how to prepare can help get rid of the worry.

So what can you do if you are due any day, and officials are warning everyone to stay off the roads? First, I’ll give tips on how to prepare for a storm if you *might* go into labor, then the steps involved in emergency birth in case mom were to find baby coming with no medical professionals around.

Please note: This information is meant ONLY for those unusual cases when mom is stuck giving birth without her attendant. It is my opinion that birth is safest with a qualified doctor or midwife present to act as lifeguard in case a problem were to arise.

If a Storm Is Coming and You’re 36 Weeks or Later

1) Relax. Chances are you will begin labor AFTER the storm has passed. Relaxing will lower your stress level, and help you be less likely to go into labor, too.

2) Get support. Make sure you will have someone staying with you during the storm just in case. Having someone you trust with you can help reduce stress, and is very helpful if labor does begin.

3) Plan ahead. If you think you might be in labor before the storm hits, or have a “hunch” you will give birth during the storm (especially if you are past 41 weeks), take a room at a hotel immediately next to your birth place. Most hospitals and birth centers have hotels a block or less away. This way, if you do get farther along in labor, getting to your birth place is much easier and safer. Again, have someone stay with you for support.

4) Prepare. Make sure you have supplies of food, water, clean towels, battery-powered lighting, blankets, a fully charged phone (preferably multiple phones, a back-up battery, or a hard line phone), and a hard copy of your birth attendant’s and birth place’s phone numbers. That way, you’re prepared in case you lose power, or are housebound for a few days.

What To Do In Case of Emergency Birth

These tips are mostly taken from “Emergency Childbirth,” by Gregory J White, MD, with a few updates from evidence-based research. These tips would come into play only when mom was already feeling an overwhelming need to push, and her support person knows getting to her birth place will not happen in time.

  1. Don’t Panic I could not resist the Hitchiker’s Guide to the Galaxy reference, and the idea is still the same. Stay calm. Birth is a normal occurrence, and most of the time it will go well.
  2. Call emergency services (911). While there is no guarantee that anyone will get to you before baby is born, calling 911 gets help on the way in case a problem were to come up, or for cutting the cord and helping deliver the placenta. Sometimes, your support person can get your doctor or another birth attendant on the phone to guide you through the birth. If so, listen to them and not these tips. :)
  3. Be in a safe place. If you are in a car, pull over to a safe location. If there is a storm, be in a safe part of the house.
  4. Go natural. Don’t take, or let anyone give you, medications or pain-relieving drugs. Instead, use comfort measures like massage, rocking, a shower, relaxation and deep breathing.
  5. Stay off the toilet once pushing. If you feel like you need to have a bowel movement, it is probably baby coming down. Once you have the urge to push, baby is down far enough to start moving through the birth canal. Get on a waterproof surface, preferably with a bit of padding underneath and some towels or newspaper on top to absorb wetness, but stay off the toilet until after birth.
  6. Wait to push. The best way to work with the pushing stage in an emergency childbirth is to wait until the urge is completely overwhelming at the beginning of the contraction and you can’t help pushing no matter how hard you try. Breathe with those early pushing contractions where the urge starts after the contraction does. Some women never get an overwhelming urge to push. It’s ok – baby will come out anyway.
  7. Use a comfortable position for birth. There are many positions in which to birth a baby, which are taught in most childbirth classes. The only thing they must include is mom keeping her legs wide apart to open the pelvis.
  8. Take it easy. Instead of pushing while holding your breath, or counting, just go with what your body tells you. This includes backing off and going gently once baby starts to crown.
  9. “Catch” baby, or let baby be born gently onto towels. Make sure baby will have support when he is born, by holding hands under him like a catcher or keeping mom’s bottom close to some towels. Baby will usually come out on his own – just provide a nice place to land.
  10. Leave the cord alone. The umbilical cord will continue to pulse for a bit after baby is born, sometimes for as long as 45 minutes. Leave it alone. Don’t try to tie or cut the cord because of the risk of infection from unsterilized instruments. Baby can safely remain attached to mom until after the placenta comes out, and even for some time after that. Let a health professional deal with the cord.
  11. Put baby skin to skin. This keeps baby warm. Most of the time, the cord is long enough to bring baby up onto mom’s belly (or at least lower abdomen) and put a blanket over baby’s back and mom’s belly.
  12. Let the placenta come naturally. Again, leave the cord alone. No pulling or yanking, just leave the cord alone, and eventually mom will have additional contractions to push out the placenta. It may take an hour or longer for this to happen. Breastfeeding baby will help. Once the placenta does come down into the birth canal, just lift it up and place it in a bowl to keep near baby until a professional cuts the cord.
  13. Give mom some juice, and a light snack. Giving birth is hard work! Mom will need to replenish her blood sugar. Some juice within 15-20 minutes of birth, and a light snack within the first hour or so will help her recover.
  14. Breastfeed baby. Being born is hard work! Baby will be hungry soon after birth, too. Breastfeeding baby within the first hour or so will help bonding with mom, get baby immune factors, and stimulate contractions to release the placenta, in addition to giving baby a blood sugar boost. If the cord is short, wait until after the placenta has been born so baby can reach without pulling on the cord.

For more information, see “Emergency Childbirth, ” by Gregory J White, MD. Published by NAPSAC International, 1998.

Flu or prolonged fever during pregnancy increases autism risk- how to avoid flu

It seems that getting the flu or having a fever for longer than a week during pregnancy increases the risk that baby will have autism. How to reduce the risk.

New research out of Denmark seems to show a higher risk of autism in babies born to women who had the flu while pregnant, and in those babies born to women who had a fever for longer than a week during pregnancy. In the study, women who had a normal pregnancy had an autism risk of about 1%.  The study, published in Pediatrics online November 12, 2012, was done as a combination of telephone interviews and gathering diagnoses of autism from the Danish Psychiatric Central Register. Women were not tested to see if they actually had the flu, but the study results do give some reason for caution. The study included over 96,000 children born in Denmark between 1997 and 2003. While most common infections during pregnancy did not seem to have any effect on the child, mom getting the flu during pregnancy seemed to double the risk of autism, and mom having a prolonged fever (about a week or longer) seemed to triple the risk of autism.

The good news is that even the highest risk group in the study, that with fever during pregnancy lasting a week or more, still only had an autism rate of 3%. The other piece of good news is that women are able to take actions to reduce their risk of becoming ill during pregnancy.

Many experts recommend that all pregnant women get a flu shot to help reduce the risk of getting influenza. Since flu shots are most effective against the strains of flu in the shot that year, and there are many different strains of flu, some women are concerned about how effective the shot really is. There are also some concerns about the safety of the shot, including the use of thimerosal (a mercury-based preservative) in some batches of flu vaccine. While the CDC states that the small amounts of thimerosal in flu vaccines have not been shown to cause harm, some people are still concerned because of how small the developing baby is. Studies have shown that Thimerosal accumulates in brain tissue and can contribute to neurological problems. Thimerosal has been removed from all vaccines given to children in the United States because of these concerns of possible mercury toxicity. Fortunately for those who want to get a flu shot, there are shots available without mercury.

There are also many other things a woman can do to support her immune system and reduce the likelihood of getting sick during pregnancy, or to get better more quickly if she does get sick. These are great to use in case the shot does not cover all of the common strains of flu out this year, or for those women who prefer to avoid the flu shot.

If you decide to get the flu shot during pregnancy:

  • Use the flu shot, not the nasal spray vaccine. Experts recommend against pregnant women using the flu vaccine nasal spray. The nasal spray contains live virus, and live virus vaccines tend to come with a higher risk of side effects and may result in the very infection they are trying to prevent, especially in people with less-active immune systems. The natural immune suppression that occurs during pregnancy makes live-virus vaccines a bad idea.
  • Ask for a single-dose unit to avoid mercury. Influenza vaccines are packaged as multi-dose units, or single dose units. Since the single-dose unit is used once, then thrown away, it is packaged without the preservative Thimerosal.
  • Support your immune system in other ways, too. A flu shot is not a cure-all. Flu shots can help prevent the flu, but there are still other illnesses that your body will need to fight off.

To support your immune system during pregnancy and reduce risk of illness:

  • Make sure you get enough rest. Go to bed early if you need to, or even set aside time for naps during the day.
  • Eat plenty of fresh foods to get the antioxidants, enzymes and other nutrients, like vitamin C and zinc, which help support your immune system.
  • Try an immune support supplement. If your doctor or midwife says it is ok, you can also take a nutritional immune support supplement containing vitamin C, zinc and other nutrients. Supplements with echinacea may be ok, but definitely avoid goldenseal.
  • Consider taking a glyconutrient supplement to support your immune system.
  • Exercise regularly to help your lymph system to clean out toxins in your body. Even walking and stretching can help move the lymph around and clear toxins.
  • Set aside time to relax. When your body is working harder because of stress, there is less energy and resources for fighting infection. Set aside time each day to pray or meditate. These “time-outs” help your body recover somewhat without being asleep, and help calm your mind so life’s bumps are easier to handle.
  • Minimize items in your environment and diet which make your body work harder. This includes toxins, allergens, sugars, processed foods, etc.
  • Drink plenty of water to flush out wastes.

Tips for reducing the chance of getting colds or the flu are excerpted from the Pocket Pregnancy Guide: Remedies for Feeling Great While Pregnant (due to be published as an e-book in late 2012).

 

References:

Hjördis Ósk Atladóttir, MD, PhDa, Tine Brink Henriksen, MD, PhDb, Diana E. Schendel, PhDc, and Erik T. Parner, PhDd. “Autism After Infection, Febrile Episodes, and Antibiotic Use During Pregnancy: An Exploratory Study.” Pediatrics. Published online November 12, 2012 (doi: 10.1542/peds.2012-1107).

 “Echinacea.” Mayo Clinic Website. Accessed November 12, 2012 at http://www.mayoclinic.com/health/echinacea/NS_patient-echinacea/DSECTION=safety

“Echinacea preparations and Pregnancy.” Organization of Teratology Information Specialists, June, 2010. Accessed November 12, 2012 at http://www.otispregnancy.org/files/echinacea.pdf

“First Study on Safety of Echinacea During Pregnancy.” Herb World News Online (2003). Accessed November 12, 2012. http://www.herbs.org/current/echinpreg.htm

“New Study Verifies Mercury In Flu Shots Is Toxic.” March 22, 2011 /PRNewswire. Accessed 11/12/2012. http://www.prnewswire.com/news-releases/new-study-verifies-mercury-in-flu-shots-is-toxic-118432874.html

“Thimerosal and 2012-2013 Seasonal Flu Vaccines.” Centers for Disease Control and Prevention website. Accessed 11/12/2012. http://www.cdc.gov/flu/protect/vaccine/thimerosal.htm

Are Premature Babies Safer Born By Cesarean or Normal Birth?

Premature baby in NICU

Premature baby on oxygen in NICU incubator

Everyone knows that premature babies are smaller and more fragile than full term babies. What does this mean about how the type of birth preemies have effects them?

A study published in the American Journal of Obstetrics and Gynecology in August, 2012 shows that it may depend on the baby’s position. In the study of over 4300 births before 32 weeks, babies that were head-down (vertex) were just as healthy if they were born vaginally (normal birth) as those who were born by cesarean surgery. Considering the other benefits that we know babies get from normal birth, it is likely that most preemies will be better off if they are born vaginally. This also helps avoid the risks that cesarean surgery holds for mom.

The story for breech (butt-down) babies was different. The study showed a large increase in mortality (death :(   ) of premature babies born by breech vaginal birth, especially among those born before 28 weeks. What we do not know is whether or not this increase is linked to the reason that labor began early. It is possible that there may be no increase in mortality in breech preemies if the cause of premature birth is premature rupture of membranes of preterm labor, but there is a danger if baby is unhealthy. Perhaps the study authors have that information and can offer additional analysis.

Remember that this study is about preterm babies born before 32 weeks, also called “very preterm.” Full term frank breech (butt-down) babies can usually have a safe, normal birth with a birth attendant skilled in vaginal breech birth. The trick is finding a practitioner who still has those skills.

What does this mean for pregnant moms?

Of course, everyone wants to have their baby full-term if possible. But spend a few minutes discussing what would happen if something went wrong and baby were to be born early. Here are some questions to ask your doctor or midwife in your second trimester in case something were to happen and baby came very prematurely.

  • How will we know what position my baby is in before birth?
  • Can I have my baby vaginally if he or she is head-down?
  • Can I use kangaroo care if I have a preemie?
  • Will there be support for pumping and feeding breastmilk to my baby, or using a supplemental nursing system?

Hopefully, we can reduce the number of preterm births and help more babies be healthy and full term. In the meantime, be informed and involved, and make sure you have a doctor or midwife you trust. :)

Resources:

Nicholas Bakalar. Vaginal Delivery Safe for Most Preterm Babies. New York Times, October 1, 2012 http://well.blogs.nytimes.com/2012/10/01/vaginal-delivery-safe-for-most-preterm-babies/?partner=rss&emc=rss

Reddy UM, Zhang J, Sun L, et al. Neonatal mortality by attempted route of delivery in early preterm birth. Am J Obstet Gynecol 2012;207:117.e1-8.

Amy Tuteur, MD. Is breech vaginal delivery safe? Science-Based Medecine, Jan. 14, 2010. Accessed Oct 2, 2012. http://www.sciencebasedmedicine.org/index.php/is-breech-vaginal-delivery-safe/

Snoring in Pregnancy May Indicate Risk of Pre-eclampsia & High Blood Pressure

New research shows a strong link between habitual snoring that begins during pregnancy, and the development of high blood pressure and pre-eclampsia. Women who snored frequently before pregnancy began did not seem to be at any higher risk of high blood pressure or pre-eclampsia.

Some things you can do to lower pregnancy risk for high blood pressure:

  • If you have noticed that you have started snoring during pregnancy (or someone tells you that you have suddenly started snoring), let your doctor or midwife know. they may have a treatment plan, or your doctor or midwife can at least monitor your blood pressure more closely to catch any developing problems earlier.
  • With your doctor or midwife’s approval, begin a moderate exercise plan including walking, swimming, or another gentle aerobic form of exercise.
  • Make sure you have the right balance of electrolytes in your body. Not getting enough, or having too much, sodium, especially in relation to potassium, can cause problems with the body’s fluid balance, leading to high blood pressure.

References:

Pregnancy-onset habitual snoring, gestational hypertension, and preeclampsia: prospective cohort study. Louise M. O’Brien, Alexandra S. Bullough, Jocelynn T. Owusu, Kimberley A. Tremblay, Cynthia A. Brincat, Mark C. Chames, John D. Kalbfleisch, Ronald D. Chervin American journal of obstetrics and gynecology, 10 September 2012 (Article in Press DOI: 10.1016/j.ajog.2012.08.034)

Pregnancy Snoring Linked to High Blood Pressure, Rachael Rettner, MyHealthNewsDaily, NBCnews.com, vitals.nbcnews.com/_news/2012/09/25/14101442-pregnancy-snoring-linked-to-high-blood-pressure . Accessed Sep. 26, 2012.

West Nile Virus and Pregnancy

This year, West Nile virus has become a serious problem in some areas of the country, such as Texas. Because there is no real treatment for West Nile virus infection, pregnant women may want to take extra care to not expose their babies to the virus.

What is West Nile virus?

West Nile virus is a virus, usually transmitted by a bite from an infected mosquito. An infection from West Nile virus can show up in a variety of ways. In most people, there will be no symptoms at all, though this does not mean that an unborn baby could not develop the infection, too. About 20% of people who are infected with West Nile virus will develop West Nile fever, which is usually mild. West Nile fever symptoms include fever, headache, and body aches, and may sometimes include a rash and/or lymph node swelling. About 1 in 150 (0.7%) infected people will develop a more serious version of the disease, either West Nile encephalitis or meningitis. These more serious symptoms include neck stiffness, muscle weakness, confusion/disorientation, tremors, convulsions, paralysis, and/or coma, in addition to a headache and a higher fever than the mild form of the disease.

At this time, there is no treatment for West Nile infection. Severe cases of infection are usually hospitalized to make sure the patient can get full-time supportive care like IV fluids, if needed, and to prevent secondary infections.

Do pregnant  and breastfeeding moms need to worry about West Nile virus?

At this point, no one knows how often a pregnant or breastfeeding woman who gets infected with West Nile virus would pass it to her baby. It is also unknown how often the virus would cause problems for baby, even if it is passed on. Experts recommend that pregnant women in areas known to have infected mosquitoes take precautions to reduce their exposure (listed below). If a mom who is breastfeeding develops symptoms of West Nile infection, at this point the recommendation is to continue to do so. The benefits of breastfeeding for baby are well known and very important, and the rate of transmission of West Nile virus through breastmilk is unknown, if it exists. It seems unlikely that there is any transmission through breastmilk, since West Nile virus is NOT transmitted by touching, kissing, or from health care workers who have treated infected patients.

How can I reduce my exposure to West Nile Virus?

The best way to reduce your exposure to West Nile virus, is to reduce your chance of being bitten by mosquitoes.

  • Reduce mosquito breeding places around your home. Eliminate standing water in plant pots, low places, clogged gutters, dips in children’s toys, etc. If you have standing water that you want to keep (such as a birdbath), add a substance to break the surface tension. Commercial ones are available at nurseries, or you can use a drop or 2 of a natural, phosphate-free, biodegradable liquid soap.
  • Reduce mosquito hiding places around your home. Mosquitoes love to hide on the undersides of ivy leaves and similar plants. If you have a lot of ivy around your home, consider using a safe garlic spray or other safe spray to help keep them away.
  • Wear protective clothing.When you go into areas where you are likely to encounter mosquitoes, wear clothes they can not bite through. Light-colored, loose-fitting clothes will work best.
  • Wear insect repellent. Many experts recommend wearing bug spray with DEET whenever you go outside. While DEET is officially safe for pregnant women to wear, if you are hesitant to use a bug spray containing DEET (I personally try not to touch the stuff), there are other effective alternatives. A chemical called picaridin is as effective as DEET, but is odorless and approved for use in children 2 months old and up. For those who want a natural insect repellent, the CDC says those natural repellants containing oil of lemon eucalyptus are the most effective.
  • Make your body less attractive to mosquitoes. Much of what attracts mosquitoes is said to be genetic. Other known attractants include sweating, breathing out more carbon dioxide, movement, heat, having type O blood, being pregnant (darn!), and being overweight. There are many people that claim that what you eat effects how many mosquitoes will bite. Unfortunately, it seems that none of these things have yet to be proven true. But, since eating raw garlic or foods rich in B-vitamins such as Brewer’s yeast is unlikely to cause harm (other than to your breath!), they are something to try.
  • Try to plan outdoor activities during full daylight. Mosquitoes are more active at dawn and dusk, so try to stay inside (or do the above tips) during early morning or twilight hours.

References:

West Nile Virus Questions Answered. WebMD. Reviewed July 4, 2012. Accessed Aug 23, 2012. http://www.webmd.com/a-to-z-guides/west-nile-virus-faq

Mosquito Mythbusting: Will the Real Repellents Please Stand Up? ABC News.com Accessed Aug. 23, 2012 http://abcnews.go.com/Technology/mosquito-mythbusting-real-repellents-stand/story?id=10543307#.UDZ826PAETB

Mosquito Bites. Mayo Clinic website. April 30, 2011. Accessed Aug. 23, 2012. http://www.mayoclinic.com/health/mosquito-bites/DS01075

Are You a Mosquito Magnet? WebMD. Reviewed January 31, 2012. Accessed Aug. 23, 2012. http://www.webmd.com/allergies/features/are-you-mosquito-magnet

Natural childbirth causes PTSD in some moms? A closer look

women can develop PTSD after giving birth

Like postpartum depression, PTSD from childbirth is often not treated.
© Mcpics | Dreamstime.com

Note: If you just want to know the risk factors for developing PTSD after giving birth, and what you can do to possibly prevent childbirth causing PTSD, scroll down to the end. :)

As you may know, I taught natural childbirth classes for many years, and had both of my children naturally, without any pain medication. So when I found this article in Skygrid that mentioned natural childbirth causing PTSD in some women, I was very curious.

Can childbirth cause PTSD? YES, but why?

I have no doubt that, in some cases, giving birth can be a traumatic experience that can lead to PTSD (post-traumatic stress disorder). I have been at a couple of births as a doula that I would definitely call traumatic for the mom, and possibly for other family in the room, too. What was intriguing to me about this article, however, was the claim that a much higher percentage of women who had natural births went on to show signs of PTSD than those who had epidurals.

Now, you might be thinking, “of COURSE natural births are going to cause more PTSD, don’t they hurt more?” But you have to remember my background. As a natural childbirth educator and doula, I know a LOT of women who have given birth without medication. Very few, if any, of them described their birth as anything approaching traumatic, so I do not imagine natural births causing PTSD more often than medicated ones. I have, however, spoken with many women who were looking for classes for their second or subsequent baby and had experienced a traumatic natural birth previously. In general, they either had a normal (unmedicated) birth by accident – there was just no time for the anesthesiologist to arrive and place the epidural – or they were not trained to cope well with labor contractions, did not have enough support, or were confined to bed and unable to labor as they needed to.  Many of these women came to my classes and had an untraumatic, even empowering, natural birth the second time, after having prepared.

So, in trying to figure out why this study found that more women having unmedicated births were developing PTSD symptoms, I traced the news story back to the press release about 1/3 of postpartum women developing PTSD symptoms, and the original study on Postpartum Post-Traumatic Stress Disorder symptoms.

The study was completed with 89 women who had given birth in Israel. Of these, 3 were determined to have developed full PTSD, 7 partial PTSD, and an additional 15 had some PTSD symptoms, but could not be considered a true diagnosis. The study does not make it clear how many mothers gave birth without pain medication. They do state that “A significantly smaller number of women who developed PTSD symptoms received analgesia during delivery
compared to the control group,” but that precise percentage is not revealed. The authors have a chart that splits all of the study participants into categories: “Natural,” “Elective Cesarean,” “Emergency Cesarean, and “Instrumental.” since this chart does not include a category for “vaginal with anagesia” or “epidural,” we can not assume that all of the women either had a cesarean, an instrumental delivery, or had no medication at all. It seems that the study authors use “natural” to mean “vaginal, without vacuum or forceps, ” not a normal vaginal birth without pain medication. Ah, now I think I understand.

If you combine the information in this study with what we already know about PTSD, and about PTSD and childbirth, from other studies, we can conclude that there are a number of risk factors. Here are the factors that were more often associated with the development of PTSD after giving birth:

  •  “Very uncomfortable” with being unclothed during labor (80% of those who developed PTSD, vs. 27.7% of non-PTSD group).
  • Previous birth was considered “traumatic” (60% of PTSD group, vs. 15.5% of control group.
  • History of depressive symptoms or seeking mental help. 50% of the PTSD group had sought out help from a mental health care practitioner after a previous birth, while only 8.3% of the control group did. Also, 80% of the PTSD group reported sadness or anxiety during or after the previous pregnancy, vs. 33% of the control group. In the current pregnancy, 80% of the PTSD group felt that they had at least one emotional crisis, vs. 23.8% of the control group.
  • Pregnancy complications were reported by 80% of the PTSD group, but only 28.6% of the controls.
  • A high fear of birth itself was reported by 80% of those women who developed PTSD, but only 30% of those who did not develop PTSD.
  • 71.4% of the women who developed PTSD reported feeling like their life or health was in danger during labor, vs. 20.7% of the controls. Additionally, 40% of the PTSD group felt as if their baby was in danger at some point during labor, while only 3.6% of the controls felt this way.
  • The PTSD group used significantly fewer birth methods to prepare for labor than did the control group (0.4 methods vs. 1.5). The PTSD group also had less confidence in their ability to ability to cope with labor.

Strangely, having a doula or other support person did not influence the development of PTSD in this study, but that may be due to the small size of this study.  The control group did more reading and birth preparation, but this was not considered significant. Again, this value could reach significance in a larger study.

Overall, this study has some problems. It has a very small sample size and some of the terms are used in confusing or non-conventional ways. In addition, the press release and media articles make a questionable conclusion the headline.

Does this mean that childbirth does NOT cause PTSD? No, childbirth can cause PTSD. Let’s look more closely at the circumstances under which women have developed PTSD after giving birth in the past.

In a 2008 study by Zaers, et. al. on depressive symptoms and PTSD after childbirth 6-15% of women reported clinically significant PTSD symptoms 6 weeks and 6 months, respectively, following labor. In the Zaers study, they found the factor most strongly associated with developing PTSD symptoms was women experiencing anxiety in late pregnancy.

According to the Mayo Clinic, the risk factors for anyone for developing PTSD include:

  • Being female
  • Experiencing intense or long-lasting trauma
  • Having experienced other trauma earlier in life
  • Having other mental health problems, such as anxiety or depression
  • Lacking a good support system of family and friends
  • Having first-degree relatives with mental health problems, including PTSD
  • Having first-degree relatives with depression
  • Having been abused or neglected as a child

This may seem to doom certain women to developing PTSD after giving birth no matter what, especially those who have or have had anxiety or depression. However, I think there are some trends that may point to preventive measures women can take to reduce their risk of developing PTSD as a result of giving birth. My thoughts are below.

What to do when pregnant that may help reduce the risk of PTSD after giving birth:

  •  Seek help from a mental health professional to help process any previous traumas. You may have experienced a Trauma (a single traumatic event), such as a car accident, rape, natural disaster, previous traumatic birth, etc., or it may have been trauma (a series of smaller events that created an atmosphere of fear and danger), such as an abusive parent, school bullying, being in combat, a chronic illness, etc. An especially effective form of treatment for processing trauma of any kind is Eye Movement Desensitization and Reprocessing (EMDR). This treatment is approved by the VA for use in helping veterans process combat trauma and improve symptoms of PTSD. Logically, it can help with other types of trauma, too. You can find a certified EMDR practitioner at www.emdr.com or www.emdria.org
  • Get support for you during this pregnancy. Talk with friends, family, other pregnant moms, and professionals, if necessary, about how you are doing during your pregnancy. Make sure you take time to pamper yourself. Enlist your partner and friends to help make sure you take time out for yourself, and to check in to see how you are feeling.
  • Work on reducing any pregnancy fears that you have. Sometimes just talking about them helps, sometimes making preparations to help in case something did go wrong is a good answer, and sometimes you need to put some focused effort into just processing the fear. There are many ways to uncover and process birth fears in the classes and book Birthing from Within, by Pam England.
  • Get plenty of sleep. Everything is harder when you are not well rested. There is a list of many ways to get better sleep during pregnancy in the Pocket Pregnancy Guide to Feeling Great While Pregnant, available in early September, 2012 where e-books are sold.
  • Eat omega-3 essential fatty acids. Essential fatty acids are needed by the body to create hormones and enzymes. These hormones help your body keep baby in until the right time, know when to start labor, help your baby develop, help you sleep, and even help determine your mood.
  • Get enough protein. Like essential fatty acids, your body needs the amino acids in protein to create hormones, including those we need to feel happy and sleep well. Many experts recommend that pregnant women eat at least 80 grams of protein a day, or over 100 grams daily if carrying twins or triplets.
  • Exercise at least 4 days a week, preferably daily. Exercise releases endorphins (feel-good hormones), and has been shown to reduce symptoms of depression. Depression symptoms are a risk factor for developing PTSD.
  • Learn and practice meditation and other stress-reducing techniques. Reducing overall stress can help with coping with events better so they are less likely to create the negative mental loops that exist in anxiety and depression and breaking up negative loops already in process.
  • Decide how you would prefer your labor and birth to go, and prepare for it. Understanding how your body works during labor, the procedures to expect, and how your birth attendant would deal with possible problems that come up can help reduce any fear about birth so you are more comfortable letting nature take its course. Whether you decide that you want to have a normal (unmedicated, low-intervention) birth or that you want an epidural as soon as you can get one, learn about the possible interventions that might be needed, and how to work with labor contractions to feel more comfortable. Just knowing that you and your support team can handle just about anything that comes up will help you have a much better, more emotionally relaxed birth experience overall, no matter what happens.
  • If you think you will be uncomfortable with wearing a hospital gown or being unclothed during labor, ask if you can bring a nightgown. Many birth attendants and hospitals are fine with you wearing your own clothes, as long as it opens completely in the front. They do need to have access to checking the baby’s heart rate and catching him or her, after all. :) Make sure whatever you bring is something you don’t mind throwing away afterwards, because it will probably get rather stained. :)

Resources:

Childbirth can cause PTSD, study finds

One in Three Postpartum Women Suffers PTSD symptoms After Giving Birth, American Friends of Tel-Aviv University, Wed. Aug 8. 2012. http://www.aftau.org/site/News2?page=NewsArticle&id=17059

Inbal Shlomi Polachek MD, Liat Huller Harari MD, Micha Baum MD and Rael D. Strous MD. Postpartum Post-Traumatic Stress Disorder symptoms: The Uninvited Birth Companion. IMAJ, VOL 14: June 2012, pp. 347-353.

Post-Traumatic Stress Disorder (PTSD) Following Childbirth, MGH Center for Women’s Mental Health, Harvard Medical School, Posted October 8, 2008. http://www.womensmentalhealth.org/posts/post-traumatic-stress-disorder-ptsd-following-childbirth/ Accessed August 13, 2012.

Post-Traumatic Stress Disorder: Risk Factors. Mayo Clinic website. Accessed Aug. 13, 2012. http://www.mayoclinic.com/health/post-traumatic-stress-disorder/ds00246/dsection=risk-factors

Zaers S, Waschke M, Ehlert U. Depressive symptoms and symptoms of post-traumatic stress disorder in women after childbirth. J Psychosom Obstet Gynaecol. 2008 Mar;29(1):61-71.

EMDR therapist groups, http://emdria.org/ or www.emdr.com

Safe Pregnancy in Hot Summer

Tips for a Safe Pregnancy in Summer

Safe Pregnancy in Summer Tips. Feel free to share!

2012 is proving to be one of the hottest summers ever, at least in the United States. When they say that “sensitive populations” need to be careful, that includes pregnant moms.

Getting too hot or becoming dehydrated are both dangerous conditions for your baby.

Here are a few tips to help have a healthy and enjoyable summer.

  • Drink a LOT of water and drinks to help replenish your electrolytes. Try for an 8-ounce glass of water each hour, or more if you are exercising.
  • Exercise indoors in air conditioning if possible, or exercise outdoors in the morning while it is still cooler.
  • Stay indoors during hottest part of  day in air conditioning or a cool basement, especially if the temperature reaches over 90 degrees. Look for “cooling centers” or hang out at a friend’s house if you do not have either of these available. If you plan to be outdoors, wading or standing in a pool with a hat on, using a battery-powered misting fan, or using a cooling cloth on your neck can help keep your core body temperature down.
  • Watch for signs of dehydration. Early warning signs include dark-colored urine, frequent urination of very small amounts, and dry skin. More serious dehydration can result in fatigue, fever, and more. If you notice any mild symptoms, drink more hydrating beverages. If the symptoms are severe, you may not be able to drink, but may be able to suck on a popsicle or ice chips/cube. If there are severe dehydration symptoms, call your birth attendant or 911 right away.
  • Try to have someone with you who can watch for signs of heat exhaustion & heat stroke. People who are developing heat illnesses often do not realize anything is wrong. Symptoms include: heavy sweating (sweating may stop eventually if the person is not cooled off), fatigue, headache, pale, clammy skin, thirst (may be extreme), rapid heartbeat, dizziness, fainting, nausea or vomiting, muscle  cramps, and/or mild fever. If you or someone else develops symptoms of heat exhaustion, get them to the coolest area possible, give them a drink of cool water or sports drink, and get them cooled off right away.
  • If you notice contractions (pains in your abdomen), immediately drink 1 liter (about four 8-ounce glasses) of water or electrolyte drink and call your doctor or midwife.

Summer can be an enjoyable time during pregnancy (swimming is wonderful). Just take that little bit of extra care to stay safe, and enjoy!

Read more about heat exhaustion: http://www.umm.edu/altmed/articles/heat-exhaustion-000075.htm#ixzz23RxMXw4n

Is Alcohol Safe to Drink During Pregnancy?

We have all heard it on the news recently: a study was released showing that moms drinking up to 8 alcoholic drinks a week during pregnancy does not effect her baby.

Or does it?

Is alcohol really safe to drink in pregnancy?

The study everyone is discussing can be found here:
The effects of low to moderate alcohol consumption and binge drinking in early pregnancy on selective and sustained attention in 5-year-old children

(http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2012.03396.x/abstract)

Before we can really answer the question of whether or not drinking is safe in pregnancy, we need to decide what do we mean by “safe.” To me, for something to be safe it should have a minimal risk of causing harm under normal circumstances, when reasonable precautions are taken. Under that definition, I can consider driving a car to be “safe,” as long as I am a trained driver who is well rested and paying attention. Something could always happen in spite of that, but generally speaking a well-prepared trip in a car is “safe.” :) I can not call smoking “safe,” because even though there may be no visible harm the first, second, or even the 100th time I were to smoke, I know that small amounts of damage are being done each and every time someone smokes. Of course, different people have different definitions of “minimal risk,” and of “causing harm.” To me, something that puts an unnecessary strain on my body, especially during pregnancy, and is thus causing my body to work harder and be more likely to get sick is “causing harm” over time, much like smoking. That may not be your opinion.

So what are the known risks of drinking alcohol during pregnancy?

According to the March of Dimes, the risks of drinking alcohol during pregnancy include an increased risk of:

  • miscarriage,
  • premature birth,
  • stillbirth (tentative connection),
  • intellectual disabilities,
  • behavioral problems,
  • learning disabilities,
  • emotional problems,
  • heart defects,
  • defects of the liver, kidneys, and/or bones,
  • facial defects/altered features,
  • hyperactivity,
  • attention issues,
  • psychological disorders,
  • difficulties with memory and problem-solving,
  • and speech and language delays.

The risks above often occur grouped as one of many Fetal Alcohol Spectrum Disorders (FASDs). While the commonly known and relatively severe Fetal Alcohol Syndrome (FAS) has a fairly specific set of the above defects present, other FASDs can show a wide variety of combinations of the above risks.

The study that was recently published examined the differences in attention between 5-year-old children whose mothers drank varying amounts during pregnancy. While attention is important, and can be an indicator of overall brain function (though most attention-deficit people I know are extraordinarily intelligent), problems with attention is only one of the 15 risks listed above, and may not be present in all cases of FASDs. In fact, I know people with FASD (what they used to call “Fetal Alcohol Effects,” a milder form of the disorder), who seem to be just fine in regard to attention, and are quite intelligent. Their challenges are mostly in the emotional and behavioral (i.e., societal norms of social behavior) category.

What to do when pregnant is ultimately your decision, but it seems that drinking alcoholic beverages during pregnancy may still not be a good way way to have a healthy baby. In addition to the Fetal Alcohol Spectrum Disorders symptoms listed above, here is why I think consistent (or any) drinking when pregnant is a bad idea.

I look at it this way. A lot of alcohol causes problems – health problems for adults, and birth defects, etc. in unborn babies. I would not consider serving my toddler a sippy cup full of beer or vodka, so I prefer not to do it before they are born, when one drink for me would equal 10, 15 or even 20 drinks (based on body weight) for my baby. Any adult that drank that many servings of alcohol that often would have liver and other problems in a hurry. I think we all want our babies to have a better start than that.

Ironically, this line of reasoning (if we give the body a lot of this potential toxin and it shows problems in a short time, then just a little bit of exposure must be bad, too, especially over a long period of time) is the same way that many studies look at certain health effects. In an article posted recently on Time magazine’s website, they cited a study showing that air pollution (specifically ozone) causes damaging effects on the heart with as little as 2 hours of exposure while exercising. The amount of ozone they used in the controlled environment was higher than that found in any city in the US (it’s the peak level for the world’s most polluted cities such as Mexico City and Beijing). At that level, there were more inflammation-causing compounds and a lowered ability to break blood clots. The conclusion? “The results show that ozone can have potentially harmful, and even deadly effects on the heart, say the authors.”

What does this have to do with pregnancy? Nothing directly, though we can draw a few conclusions. First, if it is reasonable for us to measure high exposure in a short time causing high risk, then conclude that lower exposure over longer time also causing risk in this situation, why can we not apply that same idea to drinking during pregnancy? Or coffee? Why is it that we assume that 7 cups of coffee a day must be harmless, but 8 cups or more a day is not because of a greatly increased risk of stillbirth? Why not be safe and lower the amount of coffee considered safe to 2 or 3 cups a day, or even none? The fact is that a pregnant mom can decide where she wants to draw that line. Anywhere at or below 7 cups of coffee a day is most likely fine in the short term in regard to stillbirth. Many women may want to drink less because of the effects that are still unknown, or not wanting the effects to build up. The same likely holds true for alcohol. Remember that the researchers in the study did not find no effect on attention with less than 9 drinks a week, it just was not significant.

So, while this study may be good news that an occasional cocktail during pregnancy (or even a LOT of cocktails) is not going to cause ADHD or other attention problems in baby, I can understand why so many doctors and midwives are still recommending that women avoid alcohol completely during pregnancy.

References:

Underbjerg, M., Kesmodel, U., Landrø, N., Bakketeig, L., Grove, J., Wimberley, T., Kilburn, T., Sværke, C., Thorsen, P. and Mortensen, E. (2012), The effects of low to moderate alcohol consumption and binge drinking in early pregnancy on selective and sustained attention in 5-year-old children. BJOG: An International Journal of Obstetrics & Gynaecology. doi: 10.1111/j.1471-0528.2012.03396.x

Drinking Alcohol During Pregnancy, March of Dimes. http://www.marchofdimes.com/pregnancy/alcohol_indepth.html Accessed 6/26/2012

Alice Park. Ozone Can Harm the Heart in as Little as Two Hours. Time, June 26, 2012 http://healthland.time.com/2012/06/26/ozone-can-harm-the-heart-in-as-little-as-two-hours/ Accessed June 26, 2012.

Alice Park. Exposure to Air Pollution in Utero Can Increase Kids’ Behavior Problems. Time, March 23, 2012.
http://healthland.time.com/2012/03/23/moms-exposure-to-air-pollution-can-increase-kids-behavior-problems/ Accessed 6/27/2012

Alice Park. Exposure to Air Pollution in Pregnancy May Boost chances of Obesity in Kids. Time, April 17, 2012. http://healthland.time.com/2012/04/17/exposure-to-air-pollution-in-pregnancy-may-boost-chances-of-obese-kids/ Accessed 6/27/2012