Portland Midwives Announce Recipe Contest!

Calling all recipes! Announcing our recipe contest to win a $50 gift certificate to Russell St Barbecue!*
*or similar restaurant - see details below

We all know that pregnant women should eat healthy food and lots of it. So should the rest of us (though…less of it). If you all are like us, no matter how many recipes you have, you get bored with them and want new ideas. Share your favorite healthy recipes with us and we will share our favorites on our blog. One lucky recipe submitter will win a $50 gift certificate to Russell St Barbecue.  

Recipe Contest Details
 1. Winner will be chosen at random, from all entries received between now and January 15, 2013. Winner will be contacted by email, and announced on our blog. You are welcome to share more than one recipe if you would like to be entered more than once. Each recipe should be submitted separately.

2. Winner will receive a $50 gift certificate to Russell St Barbecue, which is located directly below our office at Russell Street and MLK. The menu is heavy on protein and veggies, and there are vegan and gluten-free options. We love to eat there! If the winner does not live in the Portland area, or if the winner cannot eat at that restaurant due to dietary issues, the winner will then receive a $50 gift certificate to the local restaurant of their choice.

 3. Recipes must be "healthy," meaning they use mostly real, unprocessed foods in the ingredients.

4. A range of recipes from simple to intricate are welcome. Even simple salads and snack ideas are great. The idea is to post healthy food ideas that pregnant women and families with small children will actually make and enjoy.

5. Our favorite recipes will be posted on our blog, with credit given to the person who entered it.

6. To enter, submit your recipe on our website on the "contact" tab. Under "your name," put the name you want to be published if we post your recipe on our blog. To submit a recipe, enter your submission here.

7. Questions? Please email us the contact page on our website.

RhoGam Update: Risks, Benefits, New Recommendations, and Wacky Internet Myths

To review how blood types work, what it means to be Rh negative, and all the benefits of how RhoGam works, read this post from long ago.

Now for the risks: 
Disease
There is still a small, very small, risk of acquiring a disease, as is the case with any blood product. The processing standards for the shot are so good at this point, and it has been so, so, so very long since anyone has been infected with anything as the result of receiving RhoGam, that I beleive this risk is almost entirely thoeretical at this time.

Mercury
The FDA reports that there has been no mercury in RhoGam for a decade now. Some people claim that independent tests show that there IS still mercury in RhoGam. I was not able to find a source claiming this who I felt was legit enough to provide a link to on his site. Anyone who feels concern about this should be writing to the FDA and demand testing. Until such time as we can show otherwise, I personally will be taking the word of the FDA.

Aluminum
I have written to Ortho to inquire about aluminum in RhoGam.  It has been two weeks, and I have received no response.  I believe that aluminum is something we should take very seriously until such a time as we know for sure what level of risk it poses, if any.  I would encourage anyone who is concerned about this to also inquire.  If I ever hear back from Ortho, I will share their answer here.  If any of you get an answer about this, please send it to me!

Side-Effects
The product information lists possible side-effects, I have never witnessed any of these. These side-effects are known to be very rare.

New Recommendations
The old recommendations were to give a full dose of RhoGam after birth and the "mini" dose at 28 weeks, or earlier in pregnancy if indicated due to risk factors.

The new recommendations advise the full dose from 13 weeks on, and the mini dose only if there are risk factors during the first trimester, or a miscarriage or abortion prior to 13 weeks.

I predict that in time we will see the mini phased out altogether in women who are expected to remain pregnant, and used only in cases of miscarriage or abortion prior to 13 weeks.

My personal recommendation is that the risks of sensitization outweigh the risks of the shot in almost all cases, and women should carefully consider all possible outcomes of declining this shot if they choose to do so.  

Bizarre or Just Plain Wrong Internet Findings
In researching for this update, I came across some downright inaccurate information on the web (shocking!), and also some bizarre claims:  

Internet Rh Myth #1: You can test for sensitization, or check your titer, and only get rhogam if your titer is high.

 That would be backward. Once you are sensitized, it is TOO LATE for RhoGam, and there is nothing you can ever do to make yourself unsensitized. Your titer is a measure of how sensitized you are. So, if you have any titer at all, you should NOT receive Rhogam, as it will be adding useless risks (small as they may be) without any benefit whatsoever.  

Internet Rh Myth #2: With the proper diet and herbal treatments, Rh negative woman can change their blood type to Rh positive.

Um, nope, you can NOT change your blood type with those methods. You can't really change your blood type with any home method. The only way to "change" your blood type is to get a blood transfusion of a different type than you own. This would only be a temporary change, the blood cells from the transfusion would get broken down and replaced by the blood your body makes, which would be the same type it always was.

Internet Rh Myth #3: Rh negative blood is the only blood type of the aliens who landed on our planet and bred with the humans. So if you are Rh negative, this means you are the descendant of aliens, and part of the hybrid alien/human race.

While I can't actually prove this isn't true, there is not a shred of evidence that convinces me that it is. But I do miss watching the X Files.

Internet Myth #4: Prenatal RhoGam is a "big money ploy" from the pharmaceutical companies that provides no medical benefit.

There are many things that I believe that above statement is true regarding, but this isn't one of them. The risk of sensitization during pregnancy is real, and when RhoGam is given prenatally, that number drops significantly.

It is thought that the small percentage of women who get sensitized even when given RhoGam at 28 weeks and at delivery is mostly the result of "high-risk" situations prior to 28 weeks that are not recognized as such. Of the two women I have known who were sensitized after their initial bloodwork in pregnancy but before 28 weeks, they both had toddlers. Perhaps "has toddler" should be considered a risk factor for sensitization, as it is nary a toddler I know that doesn't regularly make impact on their mother's abdomen.

After many years of neglect, I am returning to work on this site. When I stopped blogging at OregonLive, I made this site as a place for those archived posts from my blog by the same name at OregonLive to live until such time as I felt like dealing with them. I made it public so that those searching for my old posts from OregonLive would have a place to find them, but I didn't really intend for this site to have the kind of traffic it has! I now am ready to both deal with the archives, and provide some more up-to-date information, as much of what is in these archives is not the advice I would give today. I will first be tackling RhoGam, as that seems to be the most visited post, and RhoGam protocols have changed significantly since I last wrote on that subject. But if there are other things that you would like to see updates on, please let me know. I also will be answering questions again, so if there is something you would like to Ask The Midwife, please click here and send me an email.

Q & A: Ultrasound Accuracy

Q: Is it possible that my scan at 5 weeks & 5 days showing nothing but a sac could really be a 8-9 week gestation? Making my 11 week scan really a
13-14 week fetus? -Rachel

A: In theory, no. In reality, I have had personal experience with the following:

- an ultrasound at 6 weeks saying that a women had a miscarriage...this woman is still pregnant today
- a first trimester ultrasound ruling out pregnancy and ectopic pregnancy....that woman later had an ectopic pregnancy that burst and she had emergency surgery
- several women who have had ultrasounds show significant anomolies or conditions in their babies...that went on to give birth to babies who did not have these conditions

Although I have not personally seen it, it is even possible to have a twin that is hiding behind it's sibling on the ultrasound be a surprise at the time of birth!

Ultrasound is a tool. It isn't perfect, but it is frequently useful, so we use it. (Did I mention it isn't perfect?)

In theory, first trimester ultrasound dates a pregnancy to an accuracy of +/- 3 days. In reality, it can be wrong.

If you know when you conceived, that is the best way to date a pregnancy. Otherwise, using a combination of LMP (the first day of your last period) and ultrasound is a good second best.

A Breech of Freedom

Nearly a year ago, I received a phone call one afternoon from a women who was 39 weeks pregnant. Her baby was breech. She had been planning a birth at her home 4 hours north of Portland, but due to the legal situation in Washington, although qualified to attend her breech birth, her midwife was not able to do so without fear of legal ramification. Her baby had been turned head-down several times by version, but each time had turned back. The hospital offered her only the option of Cesarean, despite the fact that she had previously given birth. And now at 39 weeks, she was running out of time.

Before I go forward, let's stop here and think for a moment: We live in a country built on freedom. Freedom of the press, freedom of religion...and, regardless of your opinion of the rightness or wrongness of it, a legal freedom for "a women's right to choose." Although she had the "right to choose" between abortion and birth (which was not at all the issue here, I am merely showing a point), she had no option in her home area when it came to the manner in which she would give birth. How on earth did we get here?

Breech babies, who come out butt first, knee first, or feet first, were once considered by all to be a variation of normal. Midwives around the world still believe this. A group of UK Midwives have a great site on the subject.

With the medical takeover of birth in this past century, more and more breech babies began to be born surgically. As this became more and more normal, less and less attendants had the opportunity to learn how to safely deliver breech babies. This cycle perpetuated itself. Then a few years ago, the widely publicized Term Breech Trial determined that Cesareans were safer for all breech babies.

But midwives were suspicious of the study: Midwives didn't have the same results with vaginal breech birth that the study claimed to! So we fought, we fought and we fought and we fought some more to keep the right to provide women with the option with the choice with the right to balance the risks for themselves and decide the manner in which they would birth their breech baby.

Let's be clear: Vaginal breech birth is not without it's risks. But neither are Cesareans.

Last month, the American Journal of Obstetrics and Gynecology updated their findings. The results? "Most cases of neonatal death and morbidity in the term breech trial cannot be attributed to the mode of delivery. Moreover, analysis of outcome after 2 years has shown no difference between vaginal and abdominal deliveries of breech babies." They then withdrew the previous recommendation of the Term Breech Trial.

This finding came last month. The baby almost a year ago? She was born vaginally, all 10 and a half pounds of her, in the presense of 3 other midwives and myself, after her mother drove 4 hours and across a state border to find a place where she had the right to choose. Her mother remains a active and vocal advocate of a women's right to choose...birth place and birth method of breech babies.

Will the new finding make vaginal breech birth offered more frequently in hospitals now? I hope for the best, but I don't expect it. Regardless of the study findings, there is still a shortage of OBs with experience in vaginal breech delivery. Those who are comfortable with it still must deal with the scrutiny and constraints of their hospital policies and malpractice insurance.

For now, midwives remain the surest bet for a vaginal breech delivery.

Q & A: Pain Relief

Q: I'm 16 weeks pregnant and I've been having sharp pains on the left side of my tail bone ever since my pregnancy started. I've never had this problem before and it usually starts after about an hour or two of continuos activity. (example: housecleaning) I don't lift heavy things or strain my self in any way, but the pain is very sharp and severe. when it starts I usually can't walk, stand, sit, or lay in any position without serious discomfort. a doctor told me it was ligaments stretching, but it doesn't feel that way. It feels more like a pinched nerve. Nobody beleives me when I describe the intensity of the pain, what is it, and what can I do about it? I hope you have the answer I'm looking for! - Marina

A: Clearly, you need to make housecleaning someone else's job. Problem solved! :) All joking aside, it is hard to be sure about weird aches and pains over email. But from what you are describing, it sounds like there is an issue with your SI joint (sacroiliac joint), a very common problem in pregnancy. The ligaments that hold the joint together get stretched by your growing uterus, at the same time your pelvis is softened by hormones (to make childbirth possible). Many of my clients have found relief from SI pain through chiropractic, accupuncture, and/or massage therapy. Hope you feel better soon!

Nature's Lotion

Upon first viewing birth videos, soon-to-be-parents who have not yet seen vernix are often perplexed and sometimes "Eww!" at the sight off the white cheesey goo covering the newborns. But vernix is nature's best lotion, and should be rubbed in, not toweled or washed off. Midwives have known this for centuries, and now there is good research to back us up! According to a new study out of Cincinnati Children's Hospital Medical Center, the benefits of this free and risk-free protectant shouldn't be wasted.

Cutting Laws

(Part 2 of Politics, Poltics...)

A brief history of EMTALA: It stands for the Emergency Medical Treatment and Active Labor Act. It was enacted in 1986 with the purpose of requiring hospitals to accept patients in active labor regardless of their insurance coverage, lack thereof, or ability to pay.

EMTALA today: The use of this anti-discrimination law has since been expanded beyond its original intent to include protection from discrimination on any grounds.

"Forced" Cesaraens: In many parts of the country, and sadly and ashamedly, in many parts of Oregon outside the metro area, practitioners and hospitals are refusing to perform VBACs (Vaginal Birth After Cesaraen). This is mostly driven by malpractice insurance, but regardless of the causes, the end result is women are being forced to have surgeries they do not want. A surgery that has even made the list of Consumer Reports' "12 Surgeries You May Be Better Off Without".

Refusal of Forced Cesaraen: If you live in a place where Cesaraens are forced and you would like to have the opportunity to have a VBAC, consider taking up temporary residence in a place that will allow them for your last months of pregnancy, such as the Portland metro area. If that is not an option for you, you do have the right to refuse a Cesaraen, regardless of what any doctor or hospital says. What you say is: "I am refusing consent for a Cesaraen Section under EMTALA and it is a violation of these rights to perform any proceedure on me without my explicit permission." Not exactly the best low-stress environment for a natural birth, but it is a right that you have.

Want to learn more about VBAC and EMTALA? Check out ICAN, the International Cesaraen Awareness Network or Birth Policy, a consumer group devoted to protecting patients and midwives legal rights.

Now my own rant: Episiotomies - why are they still so prevalent? Since the early 1990's, publications as out-there and radical as the New York Times, the Journal of the American Medical Association, and the New England Journal of Medicine have declared this proceedure to rarely be needed, and its routine use to worsen the extent of laceration. This recent JAMA study still found the same thing: Episiotomy increases the need for stitches, increases pain, increases the healing period, increases bowel incontinence, and increases pain with sex.

If some yahoo on the street came up to a woman and sliced her perineum, it would be the top news story of the night. NO ONE would consider it anything other than sexual assault. Why is it different when the assailant is wearing a white coat?

On rare, rare occasions, an episiotomy can be a life-saving proceedure on the part of the baby. Or it can be the only option other than a Cesaraen. But there is no way those situations account for the nearly half of all births that include an episiotomy.

Here's my crazy plan: Women should start asking their care provider what their episiotomy rate is. If the number is above 2 or 3%, or if their answer is "only when needed" (which translates into "at least 50%"), they should issue the following statement to their provider: If you perform an episiotomy on me without asking for and obtaining my permission, I will have my records reviewed by another provider. If the baby is not found to be in time-critical fetal distress at the time of the incision, I will press criminal charges against you for sexual assault."

Methinks it would not take long for the number of "needed" episiotomies to drop, drop, drop...

Politics, Politics...

Mastectomies, VBAC's, episiotomies...whatever happened to a woman's right to choose?

BREAST POLITICS
I believe that mastectomies for breast cancer should be performed very cautiously. But, if that is what the woman chooses, she should receive full and adequate care surrounding this surgery. Lifetime Television agrees with me, and they have started an online petition to force insurance companies to pay for women to stay in the hospital for up to 48 hours after this surgery. It is a sad state of affairs when the help of a cable TV channel is needed to provide women with adequate health care coverage.

As we go forward in our fight against breast cancer, we must first take a critical look at where we have been. And remember, most lumps are found by women on self exams or by their partner.

NEXT WEEK: VBAC AND EPISIOTOMY POLITICS

RhoGam Q & A

This is old news! Please read my more recent post on RhoGam!


 Q: I am 28 weeks pregnant and I got the RhIg injection. I had a miscarriage 2 years ago and didn't know anything about this. I was wondering, is there anyway to tell if I have become Rh sensitized? - K.C.

A: Depending on how far along you were at the time of your miscarriage, you may or may not have been at risk to be sensitized. Women who have miscarriages earlier than 8 weeks are considered not at risk for sensitization. (Rh negative women who have abortions after 8 weeks gestation should also receive RhoGam injections.)

Checking for antibodies (sensitization) is a routine part of the prenatal bloodwork that I run, and likely a routine part of the bloodwork your care provider ran on you. Verify with your midwife/doc that they screened for antibodies, but most likely they already have and you didn't hear about it because no antibodies were found.

For more on RhoGam, see my more complete explanation of it from last month.

Epidural Q & A

Q: I have two children, aged 4 and 2. The first was a natural birth at a hospital with midwives. The second was a homebirth. My sister is pregnant and planning on getting an epidural as soon as labor starts. How can I tell her there is a better way?

A: The first thing to remember when talking to friends or family is that "better" is a relative term. You made the choice for natural birth and are happy with your choice. It might not be the choice she would be happy with. The fact is that over 95% of births in hospitals are medicated. Even homebirth midwives appreciate the availability of epidural for long labors, posterior babies, etc. Instead of making it your goal to show your sister the better way, make it your goal to provide her with knowledge so that she can make an educated decision about what is right for her. Kim James, a doula and childbirth educator, has done an excellent job of compiling a balanced presentation of both the risks and the benefits of epidurals .

Remember that just as your want your choice of homebirth to be respected, and you wouldn't take kindly to someone trying to talk you out of it, your sister doesn't want to be treated that way either.

RhoGam Risks - Part 2

This is old news! Please read my more recent post on RhoGam!


Why To Get RhoGam:

Simply put, RhoGam can save the life of your child. If you blood and the baby's blood mixes during pregnancy, and you get a prenatal RhoGam shot, it can prevent you from becoming sensitized and from your body attacking the baby as an Alien Invader. If blood mixes at the birth, and you get a RhoGam shot, it can save the life of a future baby in the same way.

Why To Question RhoGam:

But what if no blood mixes and you don't need RhoGam? Are there risks that could sometimes outweigh the benefits? Some people think so, especially when it comes to prenatal RhoGam given in the absense of a risk factor to cause blood mixing. While I don't believe everything this link has to say, such as I do NOT believe it is possible to change your blood type, I do believe that in the same way that vaccines should be questioned and evaluated case by case, that RhoGam given prenatally in the absense of risk factors should be questioned too.

If you are Rh- and decide that prenatal RhoGam is right for you, the shot is administered at about 28 weeks gestation. If you decide that prenatal RhoGam is not right for you, be prepared: depending on your care provider, they may have great issue with your choice.

RhoGam Risks - Part 1

Jeannine Parvati Baker, author, herbalist, midwife, and mother of 3 passed away last week. She had been very ill with Hep C, contracted from a contaminated Rhogam shot that she was given 25 years ago during the birth of her first child. In her honor, let's talk about the pros and cons of RhoGam.

Part 1: The reasons behind RhoGam

Blood Type 101: There are two major blood types that are talked about. One is the letter (O, A, B, or AB). The other is called the "Rhesus factor," or the Rh factor. That is the - or + that comes after the letter. So, O- is type O, Rh -. There are also many other minor blood factors, but they are less common and therefore less often talked about. If you are Rh+ (O+, A+, B+, or AB+), no worries. If you are Rh- (O-, A-, B-, or AB-), occasionally a situation can arise where your body views the baby inside as an alien invader that must be attacked and destroyed.

Rh Sensitization: When your body views the baby inside as an alien invader that must be attacked and destroyed, the medical and far less interesting term is that you have become "Rh sensitized." In order to become sensitized, blood must mix from a Rh+ baby with a Rh- mom. The vast majority of the time, blood does NOT mix between mom and baby at any time. But occasionally, a small amount of blood will find its way from the fetal into the maternal blood stream. It is only if that occurs that there is any risk of sensitization.

The following events will increase the likelihood of blood mixing during pregnancy:

amniocentesis
partial placental abruption (part of the placenta separates from the uterus)
car accident
domestic abuse
other trauma

The following events will increase the likelihood of blood mixing at birth:

agressive removal of the placenta - agressive cord traction or manual removal
Cesaraen birth
clamping the cord before it is done pulsing
any "traumatic" birth - forceps, vacume extractor, shoulder dystocia

Occasionally, blood will mix even at a normal birth.

After the mixing: If the blood mixes prenatally, and the mother becomes sensitized, the baby can become very sick, sometimes even die. If the blood mixes at the birth, and the mother becomes sensitized, that baby is already out and safe. But if she becomes pregnant again, and the next baby is Rh+, that baby will be attacked and possibly destroyed by the mother's immune system.

Next: Part 2 - The Why To's and Why Not's of RhoGam

IUD Pregnancy?

Q: I have an IUD in place...and a positive pregnancy test! I'm concerned for the fetus. What are the stats on babies concieved when mom has an IUD? Process of removal of IUD? Risks? Help!

A: At 99% effectiveness, IUD's (also known as IUS: Intrauterine System) are one of the most effective forms of birth control. But occasionally pregnancy happens anyway. If you have an IUD and are pregnant, you need to get an ultrasound as soon as possible. This will:

1. Rule out ectopic pregnancy.
2. Rule out a "lost" IUD - sometimes they can fall out and the lack of their presence is the cause of the pregnancy! (How one can lose such a thing and not notice is beyond me...but then again, some women make it to labor without realizing they are pregnant.)
3. Show where the IUD is and where the baby is in the uterus. Leaving the IUD in can cause miscarriage and preterm labor (no birth defects). Taking it out can also cause miscarriage! In most cases, it is safer to take the IUD out than leave it in, but that is something that will have to be determined by a doc on a case by case basis.

I've tried to find stats on which is riskier, but to no avail. If anyone out there knows where they can be found, I welcome the pointer!

Q & A: Prenatal Pelvic Exams

Q: I am ten weeks pregnant and would like to have the care of a midwife
for my entire pregnancy. I wanted to know if my wishes for not wanting to
have any internal exams throughout my pregnancy would be honored. - L

A: That depends on who you see. First, let's talk about the reasons to do these exams. Midwives and OB's offer PAP and STI (formerly known as STD) testing in pregnancy. Some providers perform these tests "routinely;" others of us offer and give the mama the choice to have the testing, not have the testing, or defer the testing to 6 weeks postpartum. Some STIs can cause miscarriages or birth defects, so catching and treating them is great. PAP tests during pregnancy are more likely to have a false positive result (the test says your cells are abnormal, but nothing is actually wrong), so some women who haven't had a history of abnormal PAPs defer those to 6 weeks postpartum. If you have a abnormal PAP result during pregnancy, current practice standards are to recommend a colposcopy, even though some research shows that repeat PAPs in some cases can be as effective as the invasive and painful colposcopy.

Another reason to do a pelvic exam is to see how big your uterus is, as this is a tool for determining when you are due.

Another reason to do a pelvic exam is to perform "pelvimitry." This is measuring with the midwife/doc's hands to see how big your pelvis is. This information is of moderate usefulness: Hormones at the end of pregnancy, and particularly once labor starts, will make the pelvis more flexible and better able to expand. Also, even if your pelvis is "too small," the only way to test it is to go into labor and see if it progresses! If you have had a vaginal birth before, you have what is called a "proven pelvis."

Vaginal exams can also tell the midwife/doc (and you!) if you are showing any signs of going into labor...which can be a good or bad thing, depending on how many weeks you are.

For my personal practice, and that of many midwives I know, these reasons are explained and then the mother chooses if and when she wants exams. There may be waivers that need to be signed, but it isn't a really big deal. Other provider types may consider these exams "required." As with everything else, if this is important to you, ask your provider how they feel about this before or at your first appointment. If your provider is not comfortable with your choice on this issue, there are plenty of others around who will be.

Ultrasound Feedback

Dear Jesica,

Here's another useful 1st trimester u/s application. I'll be 35 when I deliver this spring, technically "advanced maternal age" (ha!), so my midwife at UCSF in SF recommended this new diagnostic
test that can be done earlier and is non-invasive when compared with
the standard CVS and amnio tests.

I personally prefer to have as few ultrasounds as possible, but having
one early on with the end result of avoiding the CVS and/or amnio test
was well worth it in my book.

But I definitely don't understand the OBs who do them everytime a woman
comes in for a routine appointment, just so they can "see" the baby.
That just seems excessive to say the least! Love your blog by the way! - JJ

Dear JJ -

This type of ultrasound is a screening tool that is a definite improvement over the Quad Screen - it is more accurate and can be done earlier.

However, it is important to remember that this type of ultrasound is still a screening test, not a diagnostic test. An accuracy rate of 87% means that 13% of Downs babies still will not show with this test. Likewise, the 5% false positive rate means that out of 100 mothers who this test indicates Downs for their babies, 5 of those babies will not have Downs.

The only way to know for sure is still amniocentesis...and it still carries the 1 in 300 risk of miscarriage. Both screening and diagnostic tests can be great tools if the mothers choosing to have them 1) want the information, 2) understand the limits of the information they will receive, and 3) understand the risks or possible risks with obtaining that information.

Thanks for the article!

PS - The blog loves you too! :)

Ultrasound: Part 2

Although we no longer use X-Rays in the shoe store to check shoe size, it is still the best way to determine if a bone is broken. While ultrasound is not a toy, it is a tool with useful applications in obtaining medical information.

ULTRASOUND IN THE FIRST TRIMESTER

Ultrasound imaging done in the first trimester can determine:

1. the presence of more than one fetus
2. if a miscarriage is happening
3. if the pregnancy is ectopic
4. your due date, to an accuracy of +/- 3 days

If you are very unsure of your dates, you may wish to have a first trimester ultrasound. Dating a pregnancy can also be done as the pregnancy progresses by checking fundal measurement (the length from your pubic bone to the top of your uterus) or by later ultrasound (see below). You and your midwife/doc can discuss what you feel is best for you should any of these situations arise.

ULTRASOUND TESTING AT 18-20 WEEKS

Ultrasound testing done at this time can determine:

1. the presence of more that one fetus
2. the presence of physical abnormalities in the baby better than at any other time
3. cervical length (can be a sign of preterm labor)
4. placental placement (placentas that are across or near the cervix can be noted and monitored)
5. the gender of the baby
6. your due date, to an accuracy of +/- 7 days

If you would like to get one ultrasound during pregnancy to see that “all is well,” this is the best time to do it. All of the baby’s major physical structures have formed by this point. After this point, as the baby becomes more crowded, it becomes harder to view all the structures as well. If your placenta is found to be near or over the cervix, a follow-up ultrasound later in pregnancy will be indicated to make sure the placenta has “moved up” (they usually do). Please note that the accuracy of the due date at this time is +/- 7 days. That means there is a 2 week period in which your baby could be due.

ULTRASOUND TESTING IN THE 3RD TRIMESTER

Ultrasound testing done at this time can determine:

1. if the baby is head-down vs. breech, should that be a concern
2. if you are past your due date, it can confirm that the baby is still doing well and that there is enough amniotic fluid to wait for you to go into labor naturally
3. the presence of more that one fetus
4. the presence of some physical abnormalities in the baby
5. cervical length
6. placental placement and health (making sure it is still working well)
7. your due date, to an accuracy of +/- 3 weeks (a six week range!)

So, if you have one of these reasons listed above, the small risks of ultrasound may be outweighed by the valuable knowledge that can be gained by it.

Remember: Ultrasound is a tool. It is not absolute truth. You can have ultrasound to asure you that all is well, and still have a baby that has an anomoly not found by ultrasound. Conversely, ultrasound can indicate there is a problem when there is none. This is seen most often with estimated size of the baby: It may say the baby is significantly larger or smaller than it actually is.

Ultrasound information is a piece of the puzzle. It is not the whole picture.

Ultrasound: Not A Toy?

PART 1

"What about those 3-D ultrasounds?"

I hear it so often. They're fun - they're cute! They aren't medically informative. And the FDA warns against them.

Even routine medical ultrasounds, which is a common practice (even offered by yours truely!), isn't recommended by respected organizations. The National Institutes of Health notes that "the data on clinical efficacy and safety do not allow recommendation for routine screening at this time; there is a need for multidisciplinary randomized controlled clinical trials for an adequate assessment." The World Health Organization (WHO) has a similar statement: "Ultrasound screening during pregnancy is now in widespread use without sufficient evaluation. Research has demonstrated its efficacy for certain complications of pregnancy but the published material does not justify the routine use of ultrasound in pregnant women."

In a 1999 study, six scientists at University College Dublin found that ultrasound creates changes in cells. The researchers gave 12 mice an eight megahertz scan lasting for 15 minutes. Hospital scans can last for up to an hour, using frequencies of between three and 10 megahertz. Two significant changes in the cells of the small intestine were detected in scanned mice compared with unscanned mice. Four and a half hours after exposure, the rate of cell division had reduced by 22 per cent and the rate of programmed cell death had approximately doubled. The researchers believe there may be similar effects in humans. However, he stressed that the implications for human health were uncertain. Further evidence that ultrasound has an effect on cells is indicated in recent research that shows a higher-than-average rate of left-handedness in boys exposed to ultrasound in utero.

So why, despite these warnings, is "everybody doing it?" You'll just have to read tomorrow...

Flu Shots In Pregnancy?

The official word from the CDC on flu shots in pregnancy is that they are safe after the 13th week of gestation. (The nasal spray is a live virus and is NEVER safe during pregnancy.)

Now, that is the official word. The other side is that the flu shot DOES contain Thimerosol, the mercury-based preservative that has gotten a bad rap for causing autism. Now, some people are convinced that vaccinations cause autism, some are convinced they don't. I think we don't really know yet, and that people need to come to their own conclusions on what is best for them and their children. Even if not accepted by the CDC, there is quite a bit of concern from other sources.

Basically, this is a decision that you need to decide for yourself. If you choose to get a flu shot, that is certainly within the CDC's current recommendations. If you choose not to get a flu shot, there is a lot of evidence to support that choice as well. Regardless, if you like saurerkraut, it sounds like that is a safe bet.

Q & A: Who's The Daddy?

Q: I'm pregnant! My last period was the first week of October. Me and my boyfriend have been together since the 10th of October - is this his baby?

A: The most common way to date a pregnancy is to consider conception to be 14 days after the 1st day of your last period. For example, if the first day of your last period was October 1st, then you probably conceived around the 14th of October. Or, if the first day of your last period was October 10th, then your conception date is probably around the 24th of October.

However, this is only a probably. Most people ovulate 14 days after the start of their period, but not everyone! You may ovulate 20 days after your period starts, or even 5 days after the start of your period.

To avoid math, use this online due date calculator. The luteal phase is the length of time from when you ovulate until the first day of your period. If you don't know when you ovulate, leave the luteal phase at the default setting of 14 days.

It is also possible to have a period AFTER you are pregnant. Usually these are lighter and shorter than normal periods, but occasionally they can be just like a regular period.

Your current boyfriend is probably the father, but as your pregnancy progresses and other signs (and ultrasound, if you choose to get one) confirm your due date, you can be more certain who the biological father is. The only way to be absolutly 100% certain is if the baby and the father (and often you as well) have a paternity test after the baby is born. If you want to do that, blood can be taken from the umbilical cord at the time of the birth so that the baby doesn't have to be poked. (Prenatal paternity testing is available, but not entirely accurate last I checked.)

Believe it or not, this situation isn't all that infrequent. Talk with your midwife or doctor about the question of paternity so they can be sensitive to the issue. (If they aren't sensitive to the issue, get rid of them and see someone who is!)

Is Thimerosal By Any Other Name Still Thimerosal?

Synonyms/Components of Thimerosal:

Mercurochrome®
Merzonin
Merthiolate®
Mertorgan
Sodium ethylmercurithiosalicylate
Ethyl (2-mercaptobenzoato-S) mercury sodium salt
Mercurothiolate
Merfamin
Thiomersalate
Thiomersal
Thiomersalan
[(o-carboxyphenyl)thio] Ethylmercury sodium salt

I also found this site. I think the some of the info is out dated but
it list synonyms and chemical property of it.
http://www.hgtech.com/Information/Thimerosal.htm

http://www.safeminds.org/research/docs/Hviid_et_alJAMA-SafeMindsAnalysis.pdf

Q & A: Crampbark While Breastfeeding?

Q: I was wondering if it is ok to take Cramp Bark while nursing? - Mark

A: Yes! Crampback (Viburnum) is an herb that has been used safely and effectively for centuries to reduce afterpains. Afterpains are the sometimes very painful contractions that occur in the days and weeks after childbirth. These contractions cause the uterus to shrink down to size and prevent the mother from bleeding to death. So long as bleeding is not excessive, crampbark can be used to calm the contractions a bit when they become unbearable. Afterpains tend to increase in severity with each child. They also tend to become stronger during breastfeeding, as that triggers oxytocin production, the hormone that is responsible for the contractions. Crampbark is easiest to take in tincture form - there is a tea, but the taste is terrible, and I don't think it is quite as effective.

I like KellyMom's list of dangerous herbs while breastfeeding, but I am less fond of her list farther up on the page about herbs that can interfere with milk production. I think both Lemon Balm and Peppermint are no problem while breastfeeding. In fact, Lemon Balm tea is a great way to assist with postpartum depression.

For more information on herbal use, my favorite author on the subject is Rosemary Gladstar.

The Never-Ending SIDS Story

SIDS is a mystery. SIDS is just an official sounding term for "the baby died and we don't know why."

Here's what we do know:

Babies sleeping on their backs are less likely to die. But we don't know why. There are also a few holes in this theory, as discussed by the SIDS Alliance Of The Carolinas.

A couple weeks ago, the American Academy of Pediatrics came out with new recommendations. The most controversial parts of these recommendations are that babies should be given pacifiers as a routine prevention of SIDS, and that the aren't too keen on co-sleeping. Backlash against these recommendations has been severe, as seen in USA Today, Le Leche League's offical recommendation against the AAP position, and co-sleeping advocates.

I'm still wondering what happened to all the research about the chemicals in baby bedding contributing to this mysterious illness. It made it into the British Medical Journal - which has very strict standards for publication - why can't it make it into mainstream US media? While I don't promote it as the sole cause of SIDS, it makes sense to me that arsenic might possibly be bad for babies. Just maybe.

They didn't have rice cereal in 500 AD?

Two recent recommendations from the American Academy of Pediatricians made the news last week while I was on holiday. This one I like, the one I'll comment on later has some good points, but the main message is (how do I say this nicely?) idiotic. But for today, just the good one!

New guidelines for introducing solid food have discovered that powdered rice cereal is not used in most of the world, was not available until recent times, and babies thrive on other foods! We have realized that adults should eat a wide variety of foods, and simple carbohydrates aren't high in nutrition. The same logic has finally come round for babies.

What I have to add in my recommendations for solid food are:

1. Breastmilk-only is still the best food until 6 months.
2. Despite what they say about throwing all the rules out the window, try to avoid foods on the most allergenic list in large quantities until after a year or later.
3. Experimenting is great - if your baby shows interest in a food on your plate, let them have a bite. BUT, try to limit the number of new foods introduced per day so if a problem does occur, it will be easier to figure out which item is to blame.

I wonder how long it will take Gerber to jump on the bandwagon: Anyone for pureed Artichoke and Summer Squash Lasagna?

Q & A: Varicose Veins

Q: I'm almost 18 weeks pregnant now and my varicose veins are very angry! They are painful some days and big (and ugly!). In fact, my midwife
admitted in a nice way that they are the worst she's seen! Spider veins are developing and seem to be associated with the varicosities. Had them for my first pregnancy too but not this bad. My midwife also said that I take the
best care of myself of many of her clients (I exercise regularly, eat
well, am slim, etc.) Those faulty genetics! Anyway, I am taking rutin
three times a day but don't know what else to do. I tried compression
stockings with the last pregnancy and didn't love them. Any ideas? :)

A: Yes, much of which you are already doing. Good food, exercise, and Rutin are all good, so are compression stockings. You said you didn't love them, but you didn't say whether you wore them anyway and found them helpful or not! Most women find them very helpful, most women hate them, never met one that loved them. If you truely can't stand to wear them, at least be sure to elevate your feet as much as possible.

This is one area where a significant amount of research has been conducted on natural remedies, although the only one listed on that link with which I have personal experience is Butcher's Broom. I agree with the research that Butcher's Broom is effective in reducing the symtoms of varicose veins. Be sure to talk with your midwife before taking any of the remedies.

Finally, you may want to consider surgical removal of the misbehaving vessels after the baby is born.

Q & A: Why Do I Have To Eat So Much Protein?

Q: Why is it so important to consume high levels of protein while
pregnant? Alos, is it safer and or healthier to eat plant protein versus
animal?

A: Proteins are a basic building block of humans - both moms and babies. Some of their uses during pregnancy are: formation of hormones, enzymes, and antibodies; maintainance of the body's ph levels; building new blood (the amount of blood in your body increases by half during pregnancy!); and...there was something else....oh!....building the baby. :) There is also a belief by some, myself included, that sufficient protein can prevent pre-ecclampsia (scroll down to August 23rd for more on that).

I suggest that women consume whatever works for them during the first trimester, as many are battling morning sickness and food aversions. Once that phase has past, I recommend 60-80 grams of protein per day until around 20 weeks. At 20 weeks, I then recommend 80-100 grams per day till the baby is born.

The question of plant vs. animal is a tricky one. Plant is certainly safer...there is no Mad Soybean Disease. However, the chances of getting any of the diseases from animal food are statistically very low when compared with the risks we take on a daily basis, such as riding a bike or driving a car.

Concentrations of mercury in fish can cause serious fetal damage, as mercury easily crosses the placenta. The link will give the details, but the general rules are: 1. The bigger the fish, the more time it will have had to absorb mercury, and the higher the concentration will be. 2. Moderation is the key.

Of the amino acids needed by the body through food, plant sources are often deficient in one or two. By combining plant sources, you can easily get everything needed. And don't let the word combine lead you astray - the combination need not take place at the same meal.

Part 2: Mad About the Chicken Pox Vaccine!

See part 1 for my views on vaccines in general...

Here's why I don't like it:

1. Prior to widespread vaccination, 90% of Americans were immune by age 20. Prior to this age, the disease is benign. In adulthood, it can be very dangerous, even deadly. In pregnancy, it can cause horrible complications for the unborn baby. Children who are vaccinated will become non-immune at some point in adulthood, unless they receive booster shots. These facts and more are available in this easily navigatable report from a little school called Harvard University. Most children have health insurance. Many adults in America do not, and therefore do not receive non-emergency medical care, such as booster shots. So, without the shot, 90% of Americans will be immune in adulthood, when chickenpox is dangerous. With the vaccination, how many will still be immune in adulthood? I don't know, but I know it will be less. So what is the real motivation for the widespread use of this vaccine? That parents will miss less days from work!

2. According to a report by the American Academy of Pediatrics, pediatricians with more patients in managed care (ie: with private health insurance) were markedly more likely to recommend the vaccine than peds with more patients on state health assistance programs.

3. And to top it all off, this new study now indicates that because of the vaccine for this generally harmless childhood disease, there are now increased rates of shingles, an illness related to chickenpox, which is extraordinarily painful for about 6 - 8 weeks, and a very serious disease.

If parents want to immunize their kids against chickpox to keep from missing work, fine. That is absolutly their right as a parent. But let's not mandate that every child receive this vaccine, and let's not pretend medical science supports it.

Part 1: Back To School Vaccines

Like all medications, there are benefits and risks to vaccination. Among other more common and less severe risks, a certain number of people given vaccines will die from the vaccine itself. And, a certain number of people who get the illness, will die of the illness. This risk, along with the more common and less severe ones, can be weighed for each child to determine what is best for that specific child.

For most vaccines, I can see the logic to vaccinate, the logic to not, and the logic to do something in the middle (delayed schedule, etc). I get mad when parents are made to feel guilty about researching and choosing not to vaccinate, and I get equally mad when people who do choose to vaccinate are made to feel guilty by the non-vaccinating. For some of the reasons parents choose not to vaccinate, read this article from Mothering Magazine. The American Academy of Pediatrics provides reasons some parents choose to vaccinate.

If you would like to attend a class that gives a balanced view on the reasons to and not to choose each vaccine individually, Dr. Ed Hoffman-Smith holds monthly classes on the subject at The Natural Childbirth & Family Clinic. I know the classes give a balanced view, because the parents I have sent to them have chosen a variety of options afterwards!

If you have chosen not to vaccinate your child, and are confused on what to do at the start of this school year, fear not! It is very easy - there is a place to sign at the bottom of the form that they give you.

VBAC DISCUSSION IN USA TODAY

VBAC's, Vaginal Birth After Cesaraen, has become a hot topic. In a recent article in USA Today, they explore the issue of why a private medical decision has become so controverisal.

As a follow-up, professionals and patients have added their opinions in Letters to the Editor. The first of these letters is from Katherine Prown, a mother-turned-activist who I had the pleasure of meeting at a conference last year.

Coming soon: Portland Cesarean and VBAC stats, and this midwife's opinion of all of it.

When The Kids Drive You Crazy:

Part 2 of Mental Health for Mom and Dad

Parenting is the hardest job there is. The image of child abuse is often of a cruel parent who is torturing their children for entertainment. The reality of child abuse is that happens, but it is the minority. MOST child abuse happens when parents who want to be good parents are pushed over the limit with stress. Proper support of parents can significantly reduce child abuse.

If you are a parent who is feeling unable to treat your children the way you want to, Parents Anonymous is the place for you. The focus is on giving parents the tools and support they need to become better parents, without blame and guilt.

This article by Dr. Marty Tashman gives great tips on how to reduce parenting stress.

Mental Health For Moms and Dads

Part 1: Postpartum Help

Parenting is the hardest job on earth. Add to that all the stresses of daily life, and it is no wonder we end up with so much postpartum depression.

The best cure is prevention. Organize friends and family to bring meals and help with household chores in the immediate weeks after birth, join a mama-baby group of any sort, and talk with your partner before the birth about parental roles and responsibilities so that you two have a plan of how things will work. Eat healthy food and consider a little Lemon Balm tea (available loose at Limbo, or is many brands of packaged "postpartum tea" - just read the label).

A little "blues" is normal after birth, as it is with any emotional life change. If the feelings last longer than a week, are precluding you from doing normal daily activities, or are turning into fleeting thoughts of causing harm to yourself or your child, that is NOT normal, and intervention is needed. A good place to start is the Baby Blues Connection. If you find yourself needing more professional help, or if you have feelings of causing harm, you need to see someone experinced in both the perinatal period and mental health. Many nurse midwives are also psychiatric nurse practitioners - a wonderful combo for the postpartum mama! Here is the finder for Nurse Practitioners in Oregon. There are also many Psychiatrists, Therapist and Counselors who aren't CNM's but who specialize in portpartum depression.

Q & A - Pre-eclampsia: The Big Bag Ugly

See below for the Q & A posted August 15th on when protein in the urine was not a cause of worry. Today we'll discuss when it is.

If significant protein in your urine is found, especially later in pregnancy, and especially if your blood pressure exceeds 140/90 OR has increased significantly, you may have pre-eclampsia. To diagnose pre-eclampsia, blood will be drawn to run a panel on your liver function, and you may have to collect all of your urine for a 24 hours in a special Orange Pee Jug (that's the official medical term for it).

Pre-eclampsia can remain mild for weeks on end, or it can progress quickly and, in most severe cases, put both the mother and baby's life at risk. For this reason, no one likes it, and it must be taken very seriously.

Theories on what causes pre-eclampsia range from a defect in the placenta to anaphylactic reaction to the father's genetic contribution. I believe that it is likely an assortment of contributing factors.

Regardless of the cause, I have seen good diet prevent and even turn around pre-eclampsia. The diet suggested by Dr. Tom Brewer is actually good for all pregnant women. If you have a history of liver or kidney problems, or are concerned about developing pre-eclampsia, you can start the diet before symptoms develop. It certainly won't hurt you, and it just might help! I don't believe this diet will 100% prevent or cure pre-eclampsia, but I have literally seen it turn bad lab values into good ones.

Q & A: Protein in Urine

Q: We are approx. 9 weeks into our second pregnancy. We had our first
midwife appt. for this new pregnancy last week. When we used the urine test strip, I had protein in my urine. My midwife wasn't concerned and thought it was maybe that I'm not getting enough calories. Do you have any more information on what could cause protein in the urine so early in the pregnancy? My blood pressure is very low, I walk, am slim, drink lots of water, etc. Thanks for any advice you have!!!

A: Protein in the urine is common during pregnancy, and the causes range from benign to life-threatening. According to Anne Frye, one of the best authors on midwifery, protein in the urine can be caused by: dehydration, contamination from blood, contamination from vaginal secretions, contamination from semen, a urinary tract injection, a normal sign of normal kidney strain during pregnancy, strenuous exercise (including labor!) and, of course, the big bad ugly: pre-eclampsia/toxemia. I'll talk about pre-eclampsia later this week - that doesn't appear until at least 28 weeks (except in extraordinary circumstances). But since you are far from 28 weeks, that wouldn't be you.

Although Anne doesn't mention it, I have also seen protein spilled in people who have a history of eating disorders, which makes sense, because their kidneys and liver are more likely to have been stressed in the past. But unless you have a history of eating disorders or other liver/kidney problems, then that wouldn't be you either.

Urinary tract infections (UTI's) will have other signs - pain on urination, low back pain, etc., along with the presense of other things on the urine "dipstick."

Most midwives (as do doctors) check urine with a dipstick as a routine part of each prenatal. If they find something concerning, they will then proceed to have the pregnant woman do a "clean catch," which involves an acrobatic series of events with wipes and sterile cups and starting peeing before catching, and doing the hokie-pokie as you turn yourself around. If you had a large amount of protein in your urine, your midwife would probably proceed with a clean catch. But if it was just a small amount, they likely wouldn't worry about it. If it wasn't a clean catch, which it probably wasn't, then the likely suspects are the blood (even trace amounts that you can't see), vaginal washdown, or residual semen, which are all normal. Almost all women have a small amount of protein show on their dipstick at some point during pregnancy - some women have a low level show throughout the whole pregnancy!

As with any issue, if you feel concerned about the protein in your urine, talk with your midwife. If you still feel concerned, it's ok to ask to do a clean catch. Then you'll know if the protein is really in your urine, or from another source.

When Breast Isn't Best

Let me first start with this disclaimer: I believe that breastmilk is the most perfect food in existance for babies. I believe it is best if it is their only food for the first 6 months, and has benefits as a major part of an infant's diet for long after that.

According to this MSNBC Article, 62% of women are breastfeeding at one week, but only 14% at six months. The American Academy of Pediatrics, the World Health Organization, and every other authority on infant health, have made it quite clear for some time now that the best thing for all babies is to be solely breastfed for the first six months. So why isn't is happening?

The first, and perhaps largest reason, is the return to work. Pumping is hard, pumping is time-consuming, and pumping doesn't always work, even in the most supportive of workplaces. And many workplaces aren't supportive, even though the law says they have to be. Sort of. If you work for the State of Oregon, it's quite clear cut, thanks to Govenor Kitzhaber. If you want to get your workplace breastfeeding friendly, start with this packet from the Oregon Department of Health Services.

Q & A: Midwives, Nurses and Doulas - Oh My!

I've been asked a few questions now related to what type of midwife I am, the different types there are, etc.

I could explain about the different types of midwives, but the Oregon Midwifery Council has already done a fine job of that. In addition to what they have to say, I will add that most CNM's practice in hospitals, but there are a couple in the area who do homebirths; and LDM's and DEM's attend home and birth center births. To further complicate matters, although the OMC site does not mention them, Naturopathic Doctors (ND's) can also get a special endorsement in Obstetrics and attend births in homes and birth centers. Also, some DEM's are also Registered Nurses, some CNM's are also Licensed Accupuncturists, some ND's are also CNM's, etc.

Originally, I set out to be a CNM, but switched horses midstream. Because homebirth and working in birth centers was my goal, it didn't seem the right thing for me to train in a hospital (for me! for me! not for all!). So I attended Birthingway College, which for me was a great fit. Class size is small - my class had 12, they now accept 15 students per year - and tests are long (25-30 pages, and no multiple choice), and it was exactly the type of education I needed. Now, due mostly to frustration with dealing with insurance companies, I am toying with the idea of going back to school to become a CNM. Of course, being a CNM would not stop my frustration with dealing with them, only change the reasons why I would be frusted.

Another type of birth attendant is a Doula. Doula's do NOT provide any sort of medical care, they provide emotional support and comfort measures during labor. Free doulas are available through Birthingway College. They are student doulas, many of which are also in the midwifery program. (Now, this is all about labor doulas - there is also such a thing as a postpartum doula, which is a whole different topic.)

Q & A: Group Beta Strep (Part 2 of 2)

So, you have GBS, along with 30-50% of other women (rates vary around the country, it seems to me about half my clients have had it). You of course have the option of getting IV antibiotics if you so choose, but only if you are having your baby in a hospital. (Side note: If you are giving birth in a hospital, and are GBS positive or GBS status unknown, ask your provider if not getting antibiotics is even an option. It has been my experience that most hospitals have a very strict policy of requiring the IV antibiotics, or rather, their malpractice insurance companies do. But that is a whole other topic.)

If you choose to give birth at home or a birth center, you will not have the option of IV antibiotics. Your options are:

1. Other forms of antibiotics: If you have read the literature and decided that you want antibiotics, you can have your doctor prescribe oral antibiotics that you would start taking at about 37 weeks. You can also get an IM dose (an IntraMuscular injection), which is effective for 10 days and then must be repeated. The effectiveness of these treatments have not been evaluated. Some of the severe risks of the IV antibiotics are lessened, but the more commonplace problems (vaginal yeast infections, thrush leading to breastfeeding problems) still exist.

2. Hibiclense douche: This is the standard of care for GBS treatment in many European countries (that have infant mortality rates better than ours). At the beginning of labor, you douche with chlorhexidine gluconate (brand name: Hibiclense). This product is available over the counter at the drugstore. For more info, read this study from Norway's Aker Hospital, or this study from Italy that found it to be equally effective as IV antibiotics! Of course, not all the studies showed it to be as effective.

3. Herbal Treatments: These vary far and wide; I have heard great success stories from using herbal vaginal suppositories, but have not personally had great success with this treatment. It's not that I believe they aren't working for others, I just don't think they are all created equal, and I haven't found the right one. (If you have, let me know!) I think the problem is that the vaginal suppositories need to have boric acid in them to be effective - and boric acid burns, so many don't include that ingredient anymore. What I have seen is a reduction in the colony level (ie: bacteria still there, but less of `um) from herbal treatments, which is a good thing. If you want to try these herbal treatments you can do at home, they likely won't completely rid you of GBS, but they will generally improve your immunity and perhaps lower the number of bacteria. (Of course, talk to your care provider first.)

4. Risk Factor based care: If you develop a risk factor, you transfer care to the hospital and get IV antibiotics. If you don't develop any risk factors, you proceed with your out-of-hospital birth.

5. Watching and waiting: Proceed with out-of-hospital birth, and if the baby shows signs of infection, admit the baby immediately for early treatment. Many GBS cases can be treated if caught early, but not all can be caught and treated in time.

All births, regardless of GBS status or choice of birthplace, carry some risk. Risks can never be eliminated - it is simply a matter of choosing which risks you feel most comfortable with.

Q & A: Group Beta Strep (GBS) - Part 1 of 2

Question: I had a question about home birth. My husband and I are considering home birth for our next child. My last pregnancy I had tested positive for Group b strep. I was wanting to know how safe it is to give birth
at home being a carrier of this? I was also curious of how commom this
is and the dangers that may come from the baby contracting this from
me? Thank you, Angela

Answer: First, let's start with a brief history of medicine and how progress is made. 1. We realize something bad is happening. 2. We try to find a way to prevent it from happening or cure it once it happens, usually with a lot of trial and error. Eventually, we find a way to prevent or cure. 3. If it's a prevention, we often start applying that prevention to everyone. (After all, if we can stop something bad from happening, why wouldn't we?) 4. We evaluate the prevention technique: Is it working? It is causing other problems?

Now, let's apply that to GBS:

Step 1: Out of every 10,000 babies, 2 are so severly ill that they often die from an infection found to be caused by Group Beta Strep.

Step 2: The source of this infection was from the mothers - depending on the area of the country you live in, between 25% and 50% of women have this bacteria present in their vaginas. Aside from an occasional urinary tract infection, the bacteria presents no problem in the mothers. It is not an STD, it is just part of what is normal flora for that woman. But sometimes this bacteria is passed on to the babies. And of those babies, every once in a while, one gets sick. And a baby who is sick from GBS is REALLY sick.

Step 3: In the 1990's, doctors in the US started administering IV antibiotics during labor to all women who were found to have GBS present in their vaginas during the third trimester.

Step 4: According to the CDC, for every 2 babies we are saving from a death due to GBS, we are running the risk of killing one mother. We are also exposing 25% to 50% of all babies born to antibiotics they likely don't need. This is contributing to the widespread problem of antibiotic resistant infection.

So, what are the alternatives? I'll tell you on Monday!

Morning Sickness: Pills, Pills, Pills

When you've tried all the easy fixes, it might be time to start popping some pills. These fall into 3 catagoris: Vitamins, OTC Meds, and prescriptions.

Whatever catagory you try next, the same principal applies: Use the smallest dose you can to elicit the desired response. Start with a quarter of the recommended dose - if that works, try an eigth the next day. If it doesn't work, try half the recommended dose. Each day, if it works, try half the amount the next day; if it doesn't work, try double the amount the next day, until you reach the recommended dose. Do not, of course, exceed the recommended dose without consulting your healthcare provider.

Vitamin B6 (pyridoxine): Recommended dose is 10-25mg, 3 times per day.
Vitamin 12: Injections from an N.D. or M.D., once weekly.
Vitamin K and Vitamin C: There is a "study done my midwives in the UK" that I've heard a lot about, but I have searched and searched and never found the actual study. If anyone can send me a link to it, please do! The study is famed to be based on 5 mg per day of Vitamin K and 25 mg per day of Vitamin C. However, that is an extraordinary amount of Vitamin K to be taking daily, and a wimpy amount of Vitamin C. My friend Karli found results with 100mcg of Vit K per day - which is equal to only 0.1 mg! If you want to try this, I would recommend starting with 100 mcg/day of Vitamin K and 500 mg per day of Vitamin C.

Unisom TABLETS (doxylamine): Recommended dosage is 25 mg per day, but I have seen as little as a quarter tablet work. Best results are when used in conjunction with Vitamin B6. This is available at any drugstore.

Presciption medications: If you've tried everything else, it may be time to move to the hard stuff. The most common presciption drug is called Phenergan (promethazine), which is an anti-histamine that also works well for nausea. I have seen one baby who had seizures (that were annoying and frightening but not dangerous), and the mother thinks it was from the Phenergan she took in early pregnancy, but we don't know. No major infant problems have been attributed to it's use; but mothers often find themselves so drowsy from it that all they can do is sleep. For a complete list of available presciption drugs, their side effects, etc., click here. For an article that remembers the thalidomide babies, click here. In the end, no one really knows the risks of most medications in pregnancy. You must balance for yourself the potential risks versus the reality of a mother who can't keep food down. To be a mother is to make the best choices you can with the information you have, and without the benefit of knowing what the future will hold.

Morning Sickness: The Easy Fixes

Despite the benefits of morning sickness (see below), most women say they want it gone. Actually, they rarely tell me they want it gone...it's usually more of a cry, plead, whine, beg, or frustrated shout.

Remedies abound, but different ones work for different women and for different pregnancies. I always advise women to start with the ones that have no adverse side effects (or even beneficial side effects), and go from there. The other end of spectrum is using prescription anti-nausea drugs, which for some women do become necessary.

Try these things first:
1. Eat small, frequent meals. Never go more than two hours without having a bite of something.
2. When you go to bed at night, leave crackers or nuts on your nightstand. Set your alarm for an hour before you need to get up. Eat a few bites, go back to sleep. When you awake, your stomach won't be empty.
3. Stop taking your prenatal vitamins, especially if they are high in iron. You can start again when you have your morning sickness under control. Your baby will be fine in the meantime.
4. Click on this checklist of things to try for morning sickness. Print it out and check the remedies off as you try them...you may be surprised at what works!
5. Try herbal teas: red raspberry leaf (make sure you are not buying raspberry flavored tea), nettle, peppermint, and ginger teas all can be effective on morning sickness. In a clinical trial published in the medical journal Obstetrics and Gynecology, ginger was found to be very effective. Red Raspberry Leaf, Woman To Be, Pregnancy Tea, and Ginger tea can be found at local health food stores, the nutrition center at Fred Meyer's, or online at this website. Nettle tea is harder to come by, but has the "side effects" of being high in iron and one of the best herbs there are for pregnancy. It is easiest to buy in bulk at Limbo.

And if these things don't work? Part 3 will have Pills, Pills, Pills.

Morning Sickness? It's so GOOD for you!

No one likes vomiting. And really, nothing will change that - but understanding the reasons why it is a good thing can make those urgent trips to worship to the porcelin goddess a bit more sensible.

The Good:
1. In a not-so-recent, but very good, study, Cornell University researchers found that morning sickness is nature's way of protecting the baby.
2. Morning sickness indicates high hCG (IE: main early pregnancy hormone) levels, which means you are less likely to miscarriage.
3. It will pass: By 12 weeks, most women find their symptoms decreasing in frequency and intensity. By 16-18 weeks, very few women have any symptoms left at all. (Those who do may have a condition called hyperemesis gravidarum.)

"Great," you say, "so it's good for me. But I want it GONE."

For that, stay turned tomorrow for Part 2...

Welcome!

Why the move from OregonLive? OregonLive really wants at least 4 posts a week, if not more. My schedule just doesn't accommodate that. They have been very nice about letting me get away with less - often WAY less - but it isn't really how they want things. Why now? OregonLive was switching their blog software, and it would be a lot of effort on both their part and mine to switch my database over. I figured I might as well just switch it elsewhere, since that would probably be happening someday anyway.