Interview with OC Family

What are the benefits and risks associated with home birth? 

The benefits of midwifery care go above and beyond the setting of birth. In an ideal world, mothers would be informed and empowered throughout the pregnancy, birth, and postpartum regardless of their birth setting. I love homebirth because mothers and babies are subjected to fewer unnecessary interventions with comparable outcomes to hospital deliveries. For more information about the safety of homebirth, check out this recent study of 16,000 planned homebirths http://mana.org/blog/home-birth-safety-outcomes At home, mothers have more control over their experience. They are free to get into whatever position is comfortable, eat and drink throughout labor, and include their partner in the experience. Homebirth is wonderful for babies because they are not routinely taken from their mother, which allows for an undisturbed initiation of breastfeeding and bonding. 

Some disadvantages of any out-of-hospital setting, including home and birth center, is delayed access to emergency surgery and blood products. Midwives mitigate the need for these resources by carefully screening clients to ensure they are low-risk and therefore good candidates for out-of-hospital birth. Midwives also carry anti-hemorrhagic drugs, antibiotics, oxygen, supplies for IV therapy, and newborn resuscitation equipment for mothers and babies who require assistance. 

What considerations should you make before deciding to have a home birth?

The most important question for low-risk mothers to consider is – where will I feel safe having my baby? If the answer is ‘in a hospital,’ then she will probably have the best outcome in a hospital. If the answer is ‘at home,’ then she will likely have a more fulfilling experience at home. In the same way that a mama cat will find a dark, quiet place to have her kittens, birthing women need to have a quiet, comfortable place where they feel safe in order to fully let go and birth their babies. 

What is a home birth like? (Various options, types, etc.) Who should be in the room to help?

Birth is raw, and beautiful, and intense, and pushes women past what they ever thought was possible. This is true regardless of birth setting or the mode by which the baby leaves her mother’s body. Homebirth simply highlights these qualities because, for the most part, midwives don’t interfere with the mother, the baby, or the process. 

The question of who should be at the birth comes up a lot in consultations. It is absolutely necessary to have at least two, experienced care providers who are certified in neonatal resuscitation present for the delivery. Once the baby is born, there are two ‘patients,’ so it is important to have a caregiver for each of them. Most partners are present and supportive in one capacity or another. Some partners even catch their babies! Additionally, many women will choose to hire a doula, someone trained to provide physical and emotional support for women in labor. 

What is the most common misconception you'd like to see overcome during your time as a midwife?

One belief I would like to help foster in the general public during my career is that midwives are highly trained medical providers. My road to becoming a licensed midwife included two bachelors degrees from the University of Southern California, three years of didactic education at the Nizhoni Institute of Midwifery, thousands of clinical hours as an apprentice in both home birth and birth center practices, and a rigorous licensing examination from the Medical Board of California. We are experts in normal, physiologic birth, which means we are acutely aware when a pregnancy or labor starts to veer outside of normal. I believe that as women start to demand alternative options for maternity care, the type of exceptional, individualized care midwives provide will become more mainstream.

What motivated you to become a midwife?

When I was an undergraduate at the University of Southern California I lived in Mombasa, Kenya for a semester while I was conducting research for an honors thesis in political science. My research was on maternal and infant healthcare on the Swahili coast, specifically programs (or lack thereof) working towards UN Millennium Development Goal V (reducing maternal morality). I was fortunate enough to interview and eventually work with a Swahili midwife who let me catch a few babies while I was there. It was like a light went off in my head and I knew without a doubt that this is how I wanted to spend my life; kneeling on floors, sometimes covered in amniotic fluid, placing wet, squishy babies into mama’s waiting arms.

Three Ingredients to Beat Summer Swelling

According to Weather Underground, the temperatures in Orange County are finally lowering to more reasonable levels, but for many mamas out there, the heat has taken its toll. Can we blame El Nino for swelling? For those of us still dealing with the effects of the heat, here are some natural remedies to reduce swelling in the lower extremities during pregnancy. 

Important note: while swelling of the lower extremities is a common complaint in pregnancy, sudden swelling of the hands and/or face is not. Neither is one-sided swelling that is red and/ or hot to the touch. This information is not a substitute for medical care. It is important to contact your midwife or physician with any questions or concerns.

To understand what causes swelling, we have to have a basic understanding of the way fluids move around the body. You are made up of approximately 100 trillion cells, with each cell being unique and performing a specific task. These cells move fluids between your organs and circulatory systems through a number of different processes, namely diffusion, osmosis, filtration, or active transport (are your having flashbacks of high school biology yet?) For the purpose of our conversation about swelling, OSMOSIS is the term that we need to understand, specifically Forward Osmosis (illustrated below). 

 

 

Because water is attracted to salt, water moves from less salty liquid to more salty liquid through a semipermeable membrane. The force at which this happens is proportional to the pressure on each side of the membrane. Confused yet? It gets better. This pressure is determined by the amount of protein (specifically albumin) dissolved on either side of the membrane. Now, instead of using the term “salty fluid,” I’m going to say “blood,” because that’s actually what we’re talking about. We want most of your fluid to be in your blood circulation (your plasma). However, when the interstitial tissue outside of your circulation is saltier than the blood in your circulation, fluid moves outside of the circulatory system and into your interstitial tissues by the process of forward osmosis. When you don’t have enough protein in your circulation, this happens faster. Whew! Ok, that was a lot. But what does this have to do with swelling? Fluid accumulating in your interstitial tissues IS swelling. So when you’re poking your swollen, sausage-like foot after a day in this heat, imagine that all that fluid should actually be traveling around in your capillaries. Time to tell that fluid to go home.

So how does one give this fluid the boot? Lets look at the 3 main players in the game: salt, protein, and fluid. You need to drink plenty of fluid to keep your blood volume normal. Then, you need salt in your circulation so that the fluid stays in your blood and doesn’t move out into your tissues. And finally, your need plenty of protein so that your liver can create albumin to keep the osmotic pressure normal in the whole system. In other words, you need adequate amounts of all three to keep your fluids where they should be. Together, these are known (at least at Wholistic Women’s Healthcare) as the Swelling-Saver Triad! (Too cheesy? Ok, at least I tried). 

The other common cause of swelling later in pregnancy is poor venous return from your lower legs due to the weight of your uterus. Sitting upright (like at a desk) for long periods of time will exacerbate this. A simple solution is to be sure you get up at least once an hour to walk and stretch your legs. If possible, sit on an exercise ball instead of a typical chair. Or find ways to keep your feet elevated while you work. 

What you Can do to Beat the Swelling

The Swelling-Saver Triad: be sure to drink ample water and healthy electrolytes (60-80 oz daily depending on weight and activity level), eat lots of protein-rich foods (80-100 grams daily), and salt your food to taste with a good quality salt (sea salt, Himalayan pink salt, & black salt are good options). This is the foundation of a healthy circulatory system.

Cell salts: homeopathic cell salts help your body maintain fluid balance. These can be a helpful addition to dietary changes.

Movement: a healthy pregnancy should include daily movement, whether its prenatal yoga, walking on the beach, or doing a few laps in the pool. Thirty minutes of activity will do wonders for swelling and the endorphins will make you feel good.

Elevation: lay down and prop your feet above your heart three times a day. For added benefit, have your partner massage your feet with chilled oil or aloe vera (you can add Juniper or Fennel essential oil as well)

Magnesium and Epsom salt baths: most Americans are deficient in magnesium, so add a daily supplement. I like the CALM supplement best because its tasty and you can drink it hot or cold. Epsom salt baths are another good way to absorb magnesium. Add a drop of Grapefruit or Geranium essential oil for a yummy, spa-like twist.

Parsley & Lemon: both help with circulation and lemon juice is a very mild diuretic (I do not recommend taking over the counter diuretics during pregnancy). Add them to whatever you eat and enjoy!

Dandelion tea: this liver support herb helps to keep your liver pumping out that albumin. Drink one cup daily, hot or as iced tea with lemon.

Cold cabbage: this is a go-to for any type of swelling from breast engorgement to sprained ankles to swollen feet. Chill the cabbage in the fridge beforehand, apply the leaves to your ankles, and wrap them in an Ace bandage or saran wrap to keep them in place. 

 

Ultrasound in Pregnancy

Ultrasound in America 

The use of ultrasound in obstetrics has become routine at the first prenatal office visit to establish a due date rather than using the mother’s last menstrual period date, conception date, or other clinical findings that healthcare providers relied upon before such technology was implemented. Some providers use ultrasound at each office visit to visualize the fetal heartbeat and so the mother can enjoy seeing her baby. However, this results in many healthy, low risk women having up to 10 ultrasounds in the course of their pregnancy. Since ultrasound was originally intended for high-risk clients, we should consider why ultrasound technology is routinely being used on healthy, low-risk women – how much is too much?

According to ACOG (American College of Obstetrics and Gynecologists), “in a population of women with low-risk pregnancies, neither a reduction in perinatal morbidity and mortality nor a lower rate of unnecessary interventions can be expected from routine diagnostic ultrasound. Thus ultrasound should be performed for specific indications in low-risk pregnancy.” In English, this means that routine ultrasounds don't equal better outcomes or fewer interventions. So what is the benefit you may ask? Read on. 

What is ultrasound?

Ultrasound is a form of high-frequency energy (approximately 100 times the frequency of normal sound waves) that forms an image of the baby by reflecting waves off the baby’s tissues and onto a receptor probe. The contact of ultrasound waves compresses tissue. The result of the tissues absorbing ultrasound energy and of being compressed is a temperature increase on the cellular level. The increase in temperature combined with pressure may result in cavitation (the forming of gas bubbles) and implosion of cell membranes. It is important to remember that no well-controlled scientific investigations are currently being done or have ever been done to determine the long-term risks of ultrasound use.

Ultrasound.jpg

Medical vs non-medical ultrasound

It is important to distinguish between ultrasounds that are used to ascertain medical information and those that are performed for the entertainment of the parent(s).  In cases of medical necessity, the information gained from ultrasound can be invaluable in decision-making.  There are many medically pertinent reasons to have an ultrasound during your pregnancy, including:

  • Calculating gestational age in the first trimester when last menstrual period date is not known and other methods are uncertain. The dating ability of ultrasound becomes less accurate as the pregnancy progresses
  • Examining the fetus for abnormalities
  • Screening for certain genetic conditions, such as Downs syndrome, Trisomy 18, and others
  • Locating the position of the placenta and determining the type of umbilical cord insertion
  • Determining fetal position if palpation is inconclusive
  • Follow up for screen positive findings 

Reasons for ultrasound that are not considered medically necessary include:

  • Determining the sex of the baby
  • Seeing what the baby looks like
  • 4D “keepsake” videos

 The most recent statement from the FDA regarding “keepsake ultrasound” is as follows:

“The long-term effects of tissue heating and of the formation of partial vacuums in a liquid by high-intensity sound waves (cavitation) are not known. When the product (keepsake ultrasound) is purchased over the counter and used without prior consultation with a health care professional, there is no oversight of how the device is used and little or no medical benefit derived from the exposure. The number of sessions or the length of a session to which a fetus is exposed is uncontrolled, thus raising the potential for harm to the fetus.”

In other words, please don't get keepsake ultrasounds. (I'm sure I'm making a lot of friends with all the ultrasound boutiques right about now)

  Medical Indications for ultrasound by trimester

First trimester

  • Confirm intrauterine pregnancy, presence of the gestational sac and embryo
  • Assess number of embryos
  • Determine the presence of cardiac activity
  • Confirm gestational age by measuring crown-rump length and looking for anatomical markers
  • Diagnose a fetal demise
  • Nuchal translucency marker to screen for genetic disorders

Second trimester

  • Examine fetus for abnormalities - which may reveal conditions that are inconsistent with life outside the womb and only detectable by ultrasound. Ultrasound may also reveal a life-threatening abnormality that could only be corrected with immediate access to hospital resources.
  • Assess fetal lung maturity
  • Determine cervical length
  • Locate placenta
  • Assess amniotic fluid volume

Third trimester

  • Follow up monitoring of placental position
  • Assess amniotic fluid volume
  • Assess fetal growth
  • As part of a non-stress test or biophysical profile
  • Determine fetal position if palpation is inconclusive 

What do you do with the information?

Ultrasound gives valuable information to parents and providers as they proceed with a plan of care. As with many of the tests and screens offered in the course of your pregnancy, it is important to consider what you would do with the information gained via ultrasound. Would seeing your healthy baby give you a peace of mind that you would otherwise be without? Would knowing your baby has a condition change your plans for your pregnancy and birth time? The answers to these questions and others may help determine the timing of and the purpose for the ultrasounds you want. 

Please note that the information above is intended to be informative and not a replacement for medical care. Please contact your care provider if you have any questions or concerns regarding ultrasound or fetal monitoring. 

 

Pregnancy Recipes

What do I eat when I'm pregnant?

Nutrition is one of the main focuses of midwifery care. Every prenatal appointment with your midwife includes a discussion about the importance of eating real foods that are rich in protein, fat, and essential nutrients. Supporting pregnant mothers as they make positive changes to their diet is one of the most important things we do as midwives. By using food as medicine, we hope to lessen the chance that our mamas will have complications such as gestational diabetes or pre-eclampsia in their pregnancy. Everyone agrees it is important to have optimal nutrition while growing a baby. The question is - what should you eat?

In an effort to answer this question, Wholistic Women's Healthcare will start adding weekly recipes to our blog! Mama friendly, midwife approved meals that are nutritious, easy to prepare, and won't break the bank. Read, set, go!

Chicken-feta-salad

Ingredients:

  • 1/2 head of organic hydroponic butter lettuce
  • 1 organic heirloom tomato
  • 1/2 organic red bell pepper
  • 1/4 cup roasted pecans
  • 1/2 cup artichoke hearts
  • 1/2 organic chicken breast 
  • 2 tbsp organic, pasteurized feta 
  • 2 tbsp dressing (equal parts organic extra virgin olive oil & balsamic vinegar)
  • High quality salt (sea salt or pink salt work well) & pepper to taste 

Nutritional Breakdown:

Protein: 36 grams

Fat: 34 grams (unsaturated fats, which are good for you and your baby)

Sugar: 4 grams (naturally occurring in tomato and bell pepper)

Vitamins and minerals:  (Lettuce) manganesepotassiumbiotin, vitamin B1, vitamin B6, vitamin B12, copper, iron, vitamin C, omega-3 fatty aids, phosphorus, chromium, magnesium, calcium, and pantothenic acid. (Tomato) vitamin C, biotin, vitamin K, copper, potassium, manganese, vitamin A, vitamin B6, folate, niacin, vitamin E, and phosphorus. (Red bell pepper) vitamin A, vitamin C, vitamin B2, vitamin B6, pantothenic acid, niacin, potassium, folate, vitamin E, and molybdenum.  (Pecans) vitamin A, vitamin B, vitamin E, folic acid, calcium, magnesium, phosphorus, potassium, and zinc. (Artichoke hearts) niacin, magnesium, phosphorus, potassium, copper, vitamin C, vitamin K, folate, and manganese. 

Cost: $3.75

All vegetables from local CSA (Community Supported Agriculture) 

Pecans, feta, and Himalayan pink salt from Trader Joe's

Artichoke hearts, organic chicken, olive oil, and balsamic vinegar from Costco 

 

 

20 Questions to Ask in a Midwife Consultation

The process of hiring a midwife is a journey that usually includes a few consultations. I recommend meeting with two or three different midwives before making your final decision, just to be sure you have found a good fit. Because women's choice is so important to most midwives, these consultations are generally free of charge. 

The first thing to be aware of when you start to look for a provider is that there are two different midwifery licenses in California: the Licensed Midwife (LM) and the Certified Nurse Midwife (CNM). LMs are licensed by the Medical Board of California, the same board that licenses physicians. They are independent healthcare practitioners who specialize in out-of-hospital births. CNMs are licensed by the Board of Nursing and generally work in hospitals or birth centers, although some have home birth practices as well. Certified Professional Midwives (CPMs) hold an international credential in out-of-hospital birth but cannot practice legally in California without one of the aforementioned licenses. 

Going on consultations may feel overwhelming at first. Rest assured that most midwives go out of their way to make it an enjoyable and informing experience. I have compiled a list of some of my favorite questions to get you started - I hope you find them helpful. Remember that there are no questions too silly or embarrassing (believe me, we've heard it all). Blessings on your journey! 

Twenty questions to ask in your midwifery consultation:

  1. What kind of training and experience do you have? 
  2. Why did you become a midwife?
  3. Are you certified or licensed by any professional organizations?
  4. How many births have you attended in an out-of-hospital setting?
  5. What is your fee for maternity care and what does that include? When is it due?
  6. Do you work with insurance?
  7. How do I reach you in an emergency? For an urgent question? For a non-urgent question?
  8. What happens if two births are happening at the same time?
  9. Who do you take with you to births as an assistant?
  10. What kind of equipment, medications, and supplies do you bring to the birth?
  11. Are you certified in neonatal resuscitation (NRP) ?
  12. What is your transport rate? What are the most common reasons for transport?
  13. If we transported to the hospital, which one would we go to? Would you stay at the hospital with us?
  14. For what types of issues in pregnancy would I get "risked out" of care? 
  15. How do you handle emergencies such as shoulder dystocia, hemorrhage, or a baby in respiratory distress?
  16. How do you handle common complications such as nuchal cord (cord wrapped around baby's neck), sub-optimal fetal position, or long labors?
  17. What kind of postpartum care do you offer? Do you offer newborn care?
  18. Do you work with doulas and birth photographers?
  19. Can I or my partner "catch" my own baby?
  20. Why do you support out-of-hospital birth?

For more questions to ask your midwife, check out the Birth Without Fear Blog at http://birthwithoutfearblog.com/2013/01/01/44-questions-for-your-midwife/ 

To set up a consultation with Wholistic Women's Healthcare, please visit our Contact page.