Friday, August 20, 2010
Becoming Midwives: Naturopathic midwifery - Part 1
Becoming Midwives: Naturopathic midwifery - Part 1: "Posted by Tatiana Naturopathic midwives make up a small minority among midwives. They are naturopathic doctors who practice midwifery eithe..."
Sunday, July 11, 2010
Wednesday, July 7, 2010
Tuesday, May 4, 2010
Sunday, March 21, 2010
Lamaze Educational Birth Videos
I have found a fantastic online reference guide and videos for expecting parents through Lamaze International's newly revised website. Lamaze has been changing its childbirth education approach to focus on the breathing, and more on the alternative natural approaches to childbirth. These videos can be used by expecting parents that are interested in a natural birth approach. I teach the Bradley Method of Natural Childbirth, and these presentations fit right in with their ideas! Just click on the link and enjoy!
Friday, March 19, 2010
Homelessness
I have been reading/following the blog of a local homeless man who is living in his car, and eating only one meal a day. I really want to change this, and help this person to at least get three meals a day. He blogged that he has been getting sick because his body is not used to eating only once. But there is no contact information for him. So I linked my blog to his as a follower, and can only hope he goes to this blog. My question to him is, how can I get three meals a day to you?
Saturday, March 13, 2010
EATING AND DRINKING IN LABOR AND IVs
Henci Goer from the Thinking Woman's Guide to Labor and Birth gives some wonderful advise that should be considered by all expecting mothers.
The idea of forbidding food during labor began in the 1940’s, when they anesthetized laboring mothers and delivered them in “Twilight Sleep” states. They began forbidding because they realized that vomiting and inhaling food particles into the lungs (aspiration) was a grave and often fatal complication of surgery. For no scientifically supported reason, this became standard practice before surgery, and during labor.
Today, changes in anesthetic and obstetric practice have made aspiration a vanishingly rare event. Less than two per 1,000,000 pregnant women in the United States between 1988 and 1990 died of any anesthesia-related complication – not just aspiration – during delivery. Better training of anesthesiologists and the modern anesthetic practice of intubation, putting a tube down the throat to protect the airway, are largely responsible for the improvement. The virtual disappearance of general anesthesia for vaginal birth and its replacement with epidural and spinal (regional) anesthesia for most cesareans has also contributed. Nonetheless, NPO in labor remains the norm at many hospitals because many doctors believe that eating and drinking in labor is risky and that IV fluids are a risk-free replacement for oral intake.
EATING AND DRINKING IN LABOR ARE SAFE!
In three large United States studies totaling 78,000 women in labor who ate and drank freely, there was not one case of aspiration. The anesthesia-related maternal mortality rate in England and Wales, where oral intake in labor is usual, is identical to the rate in the United States, where it is not. Nor is aspiration a problem in other countries that permit eating and drinking in labor, such as Japan and the Netherlands.
Doris Haire, long-time childbirth activist and writer on maternity care issues says, “I have searched back through 20 years of medical literature and there is not a single documented case of aspiration in an individual (not just pregnant women) who was properly anesthetized by today’s standards of anesthesia.”
Medical research does not support NPO or routine IV policies. Because the obstetric belief system that defines childbirth as a “medical-surgical event,” eating and drinking do not fit this model, IV’s do.
Narcotics slow stomach emptying and can cause nausea and vomiting, and relax the esophageal sphincter. Narcotics confer at least as much risk of aspiration as do eating and drinking, but no doctor suggests limiting narcotic use in labor. Narcotic medication, unlike eating and drinking, fits the medical-surgical model. Water rapidly absorbs directly through the stomach walls. Whatever possible argument could be made against food, none can be made against water. Yet many hospital policies continue to limit women to meager ice chips.
IV’s are problematic by nature. Hunger and thirst and our natural responses to them invoke complex feedback loops that maintain delicate chemical balances in both mother and child. These balances are disrupted when they are bypassed by dumping huge amounts of fluids, often over a short period of time, directly into the bloodstream. Pregnancy renders women particularly vulnerable because the physiological changes (increased amounts of fluids in the tissues, for example) cut down on the margin for error. A study that found a blood-chemistry disturbance emblematic of fluid overload in women with IVs but not in women allowed to drink clear liquids does not recommend abandoning routine IVs.
A sports-medicine physician would be horrified at the suggestion that an athlete engage in an endurance event with no food, nourishing drinks, or even water, but obstetricians and anesthesiologists are too wedded to their beliefs about labor to see it in these terms.
Routine IVs and NPO make no sense in modern-day obstetrics. These days, the odds are miniuscule that a laboring woman will require general anesthesia. Until such a time as we require “nothing by mouth” and IVs for downhill skiers, football players, and drivers entering the freeway – all activities where surgery under general anesthesia might also suddenly become necessary – we should not require it of laboring women.
PRO’S AND CON’S OF FORBIDDING FOOD AND DRINK IN LABOR
Pros: None. Some caregivers tell women that where go es down in labor will only come back up, so there is no use in attempting oral intake, but this is not true. Few women allowed to eat and drink as they wish will vomit.
Cons: Hunger and especially thirst cause considerable discomfort. Midwives observe that dehydration may cause fever. Dehydration and starvation are associated with longer labors, increased use of oxytocin (trade name: Pitocin or “Pit”) to stimulate stronger contractions, and instrumental delivery. In addition, during pregnancy, starvation causes a faster, sharper drop-off in blood sugar levels and an earlier switch to metabolizing body fat. Vigorous exercise, i.e., labor – accelerates this process. This is a problem when women fast in labor because metabolizing fat produces ketones. In animal studies, ketones have been shown to cross into fetal circulation, making the fetal blood more acidic (acidosis). Acidosis is a symptom of fetal distress. Also, undiluted stomach acid poses a severe hazard to lung tissue should it be aspirated.
WHAT SHOULD YOU EAT OR DRINK DURING LABOR
Fat delays digestion. Solids must be broken down into tiny bits to pass into the intestines. High concentrations of sugar and acid and either low or high concentrations of salt also slow digestion. Heavily sweetened drinks can also cause nausea and acid in the stomach, which as we have seen, should be avoided. Icy liquids empty more slowly as well.
Given these criteria, choose food and drink that you know you tolerate well, the kind you would consume if you were recovering from the stomach flu. Examples might be soft, non-acid fruits, non-fat yogurt, cooked cereal, eggs, graham crackers, toast and jam, puddings, custard, fruit smoothies made with non-acid fruits, sweetened non-caffeinated teas, non-fat milk, or non-creamy soup with noodles or rice. Eat or drink small quantities frequently rather than large quantities infrequently. One midwife recommends carbohydrates early in labor, moving to at least four ounces of calorie and electrolyte-containing fluids per hour in late labor. If you vomit, cut back to sips of clear, non-acid liquids.
WAYS TO MINIMIZE THE CHANCE OF ASPIRATION
Note that when doctors abide by these recommendations, the problem of aspiration disappears whether you eat or drink or not.
Doctors should:
- Do fewer cesareans (fewer cesareans means fewer opportunities for anesthesia
complications);
- Perform cesareans using epidural or spinal (regional) anesthesia (this has become the norm in most hospitals, but it wouldn’t hurt to ask if this is the case at yours.
- Aspiration can’t happen when you are conscious);
- Ensure that anesthesiologists use proper techniques;
- Avoid IV-fluid overload (The excess fluid causes tissue swelling and makes it hard to intubate for general anesthesia.
You should:
- Maintain some form of oral intake (The most dangerous form of aspiration is aspiration of undiluted stomach acid because it chemically burns the airways.
- Pre-surgical antacid treatment is not completely preventative);
- If you are having a narcotic, including a narcotic epidural, limit oral intake to small, frequent amounts of clear, non-acid, moderately-sweetened or salted liquids.
Narcotics cause nausea and vomiting, as well as relax the esophageal sphincter.
If there is a high probability that general anesthesia may be needed, you should:
- Limit oral intake to small, frequent amounts of clear, non-acid, moderately sweetened or salted liquids;
- Avoid narcotics.
PRO’S AND CON’S OF ROUTINE IVs
Pros: None.
Cons: IVs inhibit mobility; painful inflammation can occur at the site with time; and the punctured blood vessel may leak, causing a painful, long-lasting bruise. The main problem with IV fluids is fluid overload, which is all too common especially with rapid administration of large (bolus) amounts (one or more liters), as is done before administering an epidural or beginning a cesarean section under epidural or spinal anesthesia. This can lead to fluid in both mother’s lungs (pulmonary edema) and baby’s lungs (neonatal tachypnea). More than one author thinks bolus administration explains why babies born by cesarean fluid in the lungs. Bolus IV-fluid administration also dilutes the blood, which decreases the concentration of red blood cells (anemia). Lower red blood cell concentration means fewer oxygen-carrying cells per unit volume for the baby and the uterine muscle cells. Another problem with anemia in childbirth is that it predisposes to bleeding.
Glucose-containing IV fluids, also called “dextrose” IVs, can raise maternal and fetal blood glucose levels to diabetic levels (hyperglycemia). Hyperglycemia in the baby increases production of lactic acid, a metabolic byproduct when there is insufficient oxygen. This additional source of lactic acid can add to the stress of a baby already experiencing difficulties; in fact, animal studies show that excess glucose renders the fetal brain more vulnerable to injury during periods of oxygen deprivation. Excess glucose in the baby’s circulation causes the baby to pour out insulin in response. After the birth, the baby is abruptly cut off from the source of glucose. The excess insulin can then cause a precipitous and sometimes dangerous drop in the baby’s blood sugar levels (hypoglycemia). Monitoring a newborn’s blood glucose levels means one or more painful heal sticks and possibly a bottle feeding with sugar water or formula, which can interfere with establishing breastfeeding.
CONCLUSIONS FROM MEDICAL LITERATURE
We don’t know what the normal biochemistry of laboring women and newborns is like because almost universally, all control groups were kept NPO and usually had an IV too. There are no studies during labor other than one published study of the effects of eating and drinking on nausea and vomiting and a small unpublished study of their effects on labor.
- Fasting during labor causes a rise in maternal ketone levels, which may have adverse effects on the labor.
- Fasting does not guarantee an empty stomach.
- Hunger and especially thirst are a source of considerable discomfort in laboring women.
- Eating and drinking in labor does not increase the risk of vomiting, avoids the hazards of IV-fluid overload, and may have beneficial effects on labor progress.
- Caregivers may commonly overdose IV fluids.
- IV fluids can cause problems related to fluid overload, problems that are greatly exacerbated by giving large amounts of IV fluids rapidly or fluids that don’t contain salts.
- Glucose IVs can cause high blood sugar in the baby before birth and low blood sugar after the birth, both of which can cause problems.
The idea of forbidding food during labor began in the 1940’s, when they anesthetized laboring mothers and delivered them in “Twilight Sleep” states. They began forbidding because they realized that vomiting and inhaling food particles into the lungs (aspiration) was a grave and often fatal complication of surgery. For no scientifically supported reason, this became standard practice before surgery, and during labor.
Today, changes in anesthetic and obstetric practice have made aspiration a vanishingly rare event. Less than two per 1,000,000 pregnant women in the United States between 1988 and 1990 died of any anesthesia-related complication – not just aspiration – during delivery. Better training of anesthesiologists and the modern anesthetic practice of intubation, putting a tube down the throat to protect the airway, are largely responsible for the improvement. The virtual disappearance of general anesthesia for vaginal birth and its replacement with epidural and spinal (regional) anesthesia for most cesareans has also contributed. Nonetheless, NPO in labor remains the norm at many hospitals because many doctors believe that eating and drinking in labor is risky and that IV fluids are a risk-free replacement for oral intake.
EATING AND DRINKING IN LABOR ARE SAFE!
In three large United States studies totaling 78,000 women in labor who ate and drank freely, there was not one case of aspiration. The anesthesia-related maternal mortality rate in England and Wales, where oral intake in labor is usual, is identical to the rate in the United States, where it is not. Nor is aspiration a problem in other countries that permit eating and drinking in labor, such as Japan and the Netherlands.
Doris Haire, long-time childbirth activist and writer on maternity care issues says, “I have searched back through 20 years of medical literature and there is not a single documented case of aspiration in an individual (not just pregnant women) who was properly anesthetized by today’s standards of anesthesia.”
Medical research does not support NPO or routine IV policies. Because the obstetric belief system that defines childbirth as a “medical-surgical event,” eating and drinking do not fit this model, IV’s do.
Narcotics slow stomach emptying and can cause nausea and vomiting, and relax the esophageal sphincter. Narcotics confer at least as much risk of aspiration as do eating and drinking, but no doctor suggests limiting narcotic use in labor. Narcotic medication, unlike eating and drinking, fits the medical-surgical model. Water rapidly absorbs directly through the stomach walls. Whatever possible argument could be made against food, none can be made against water. Yet many hospital policies continue to limit women to meager ice chips.
IV’s are problematic by nature. Hunger and thirst and our natural responses to them invoke complex feedback loops that maintain delicate chemical balances in both mother and child. These balances are disrupted when they are bypassed by dumping huge amounts of fluids, often over a short period of time, directly into the bloodstream. Pregnancy renders women particularly vulnerable because the physiological changes (increased amounts of fluids in the tissues, for example) cut down on the margin for error. A study that found a blood-chemistry disturbance emblematic of fluid overload in women with IVs but not in women allowed to drink clear liquids does not recommend abandoning routine IVs.
A sports-medicine physician would be horrified at the suggestion that an athlete engage in an endurance event with no food, nourishing drinks, or even water, but obstetricians and anesthesiologists are too wedded to their beliefs about labor to see it in these terms.
Routine IVs and NPO make no sense in modern-day obstetrics. These days, the odds are miniuscule that a laboring woman will require general anesthesia. Until such a time as we require “nothing by mouth” and IVs for downhill skiers, football players, and drivers entering the freeway – all activities where surgery under general anesthesia might also suddenly become necessary – we should not require it of laboring women.
PRO’S AND CON’S OF FORBIDDING FOOD AND DRINK IN LABOR
Pros: None. Some caregivers tell women that where go es down in labor will only come back up, so there is no use in attempting oral intake, but this is not true. Few women allowed to eat and drink as they wish will vomit.
Cons: Hunger and especially thirst cause considerable discomfort. Midwives observe that dehydration may cause fever. Dehydration and starvation are associated with longer labors, increased use of oxytocin (trade name: Pitocin or “Pit”) to stimulate stronger contractions, and instrumental delivery. In addition, during pregnancy, starvation causes a faster, sharper drop-off in blood sugar levels and an earlier switch to metabolizing body fat. Vigorous exercise, i.e., labor – accelerates this process. This is a problem when women fast in labor because metabolizing fat produces ketones. In animal studies, ketones have been shown to cross into fetal circulation, making the fetal blood more acidic (acidosis). Acidosis is a symptom of fetal distress. Also, undiluted stomach acid poses a severe hazard to lung tissue should it be aspirated.
WHAT SHOULD YOU EAT OR DRINK DURING LABOR
Fat delays digestion. Solids must be broken down into tiny bits to pass into the intestines. High concentrations of sugar and acid and either low or high concentrations of salt also slow digestion. Heavily sweetened drinks can also cause nausea and acid in the stomach, which as we have seen, should be avoided. Icy liquids empty more slowly as well.
Given these criteria, choose food and drink that you know you tolerate well, the kind you would consume if you were recovering from the stomach flu. Examples might be soft, non-acid fruits, non-fat yogurt, cooked cereal, eggs, graham crackers, toast and jam, puddings, custard, fruit smoothies made with non-acid fruits, sweetened non-caffeinated teas, non-fat milk, or non-creamy soup with noodles or rice. Eat or drink small quantities frequently rather than large quantities infrequently. One midwife recommends carbohydrates early in labor, moving to at least four ounces of calorie and electrolyte-containing fluids per hour in late labor. If you vomit, cut back to sips of clear, non-acid liquids.
WAYS TO MINIMIZE THE CHANCE OF ASPIRATION
Note that when doctors abide by these recommendations, the problem of aspiration disappears whether you eat or drink or not.
Doctors should:
- Do fewer cesareans (fewer cesareans means fewer opportunities for anesthesia
complications);
- Perform cesareans using epidural or spinal (regional) anesthesia (this has become the norm in most hospitals, but it wouldn’t hurt to ask if this is the case at yours.
- Aspiration can’t happen when you are conscious);
- Ensure that anesthesiologists use proper techniques;
- Avoid IV-fluid overload (The excess fluid causes tissue swelling and makes it hard to intubate for general anesthesia.
You should:
- Maintain some form of oral intake (The most dangerous form of aspiration is aspiration of undiluted stomach acid because it chemically burns the airways.
- Pre-surgical antacid treatment is not completely preventative);
- If you are having a narcotic, including a narcotic epidural, limit oral intake to small, frequent amounts of clear, non-acid, moderately-sweetened or salted liquids.
Narcotics cause nausea and vomiting, as well as relax the esophageal sphincter.
If there is a high probability that general anesthesia may be needed, you should:
- Limit oral intake to small, frequent amounts of clear, non-acid, moderately sweetened or salted liquids;
- Avoid narcotics.
PRO’S AND CON’S OF ROUTINE IVs
Pros: None.
Cons: IVs inhibit mobility; painful inflammation can occur at the site with time; and the punctured blood vessel may leak, causing a painful, long-lasting bruise. The main problem with IV fluids is fluid overload, which is all too common especially with rapid administration of large (bolus) amounts (one or more liters), as is done before administering an epidural or beginning a cesarean section under epidural or spinal anesthesia. This can lead to fluid in both mother’s lungs (pulmonary edema) and baby’s lungs (neonatal tachypnea). More than one author thinks bolus administration explains why babies born by cesarean fluid in the lungs. Bolus IV-fluid administration also dilutes the blood, which decreases the concentration of red blood cells (anemia). Lower red blood cell concentration means fewer oxygen-carrying cells per unit volume for the baby and the uterine muscle cells. Another problem with anemia in childbirth is that it predisposes to bleeding.
Glucose-containing IV fluids, also called “dextrose” IVs, can raise maternal and fetal blood glucose levels to diabetic levels (hyperglycemia). Hyperglycemia in the baby increases production of lactic acid, a metabolic byproduct when there is insufficient oxygen. This additional source of lactic acid can add to the stress of a baby already experiencing difficulties; in fact, animal studies show that excess glucose renders the fetal brain more vulnerable to injury during periods of oxygen deprivation. Excess glucose in the baby’s circulation causes the baby to pour out insulin in response. After the birth, the baby is abruptly cut off from the source of glucose. The excess insulin can then cause a precipitous and sometimes dangerous drop in the baby’s blood sugar levels (hypoglycemia). Monitoring a newborn’s blood glucose levels means one or more painful heal sticks and possibly a bottle feeding with sugar water or formula, which can interfere with establishing breastfeeding.
CONCLUSIONS FROM MEDICAL LITERATURE
We don’t know what the normal biochemistry of laboring women and newborns is like because almost universally, all control groups were kept NPO and usually had an IV too. There are no studies during labor other than one published study of the effects of eating and drinking on nausea and vomiting and a small unpublished study of their effects on labor.
- Fasting during labor causes a rise in maternal ketone levels, which may have adverse effects on the labor.
- Fasting does not guarantee an empty stomach.
- Hunger and especially thirst are a source of considerable discomfort in laboring women.
- Eating and drinking in labor does not increase the risk of vomiting, avoids the hazards of IV-fluid overload, and may have beneficial effects on labor progress.
- Caregivers may commonly overdose IV fluids.
- IV fluids can cause problems related to fluid overload, problems that are greatly exacerbated by giving large amounts of IV fluids rapidly or fluids that don’t contain salts.
- Glucose IVs can cause high blood sugar in the baby before birth and low blood sugar after the birth, both of which can cause problems.
Thursday, January 21, 2010
This is a very important letter relevant to any midwives who would like to mission in Haiti. This was posted on another midwife's facebook page, and she requested that everyone post it so all can see. If you are looking to help those in Haiti for a short-term mission trip, this may be for you.
To see the letter go to my facebook page.
To see the letter go to my facebook page.
Tuesday, January 19, 2010
Today I received my dopplar!
I am both excited and ambivalent, but today I received my dopplar. I wonder how many mamas will want to use this instrument in a home birth? In the hospital they strap you up with the fetal heart monitor, and after studying about ultrasound in my childbirth education training classes, I have always wondered if the dopplar would affect the baby in the same way. I bought this instrument because of my difficulty in using the fetoscope. My ears with age are not the same as they used to be, and hearing on the fetoscope has been very difficult. I guess I will just have to tell the mamas that I take care of that I will need to use the dopplar for their births. Still, I feel like I have taken one step forward to having my own practice! Very exciting!!!
Saturday, January 2, 2010
Wise Woman. Proverbs 31, verses 10-31
Wise WomanWho can find a virtuous wife?
For her worth is far above rubies.
The heart of her husband safely trusts her;
So he will have no lack of gain.
She does him good and not evil
All the days of her life.
She seeks wool and flax,
And willingly works with her hands.
She is like the merchant ships,
She brings her food from afar.
She also rises while it is yet night,
And provides food for her household,
And a portion for her maidservants.
She considers a field and buys it;
From her profits she plants a vineyard.
She girds herself with strength,
And strengthens her arms.
She perceives that her merchandise is good,
And her lamp does not go out by night.
She stretches out her hands to the distaff,
And her hand holds the spindle.
She extends her hand to the poor,
Yes, she reaches out her hands to the needy.
She is not afraid of snow for her household,
For all her household is clothed with scarlet.
She makes tapestry for herself;
Her clothing is fine linen and purple.
Her husband is known in the gates.
When he sits among the elders of the land.
She makes linen garments and sells them,
and supplies sashes for the merchants.
Strength and honor are her clothing;
She shall rejoice in time to come.
She opens her mouth with wisdom,
And on her tongue is the law of kindness.
She watches over the ways of her household,
And does not eat the bread of idleness.
Her children rise up and call her blessed;
Her husband also, and he praises her;
"Many daughters have done well,
But you excel them all."
Charm is deceitful and beauty is vain,
But a woman who fears the Lord, she
shall be praised.
Give her of the fruit of her hands,
And let her own works praise her in the gates.
Proverbs 31, verses 10-31.
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