Saturday, November 9, 2013

How do I Know When I am Going to go Into Labor?

How do I know when I am going to go into labor? 

Oh how I wish I could answer this question for all of you. If I had a crystal ball and could I would be rich! This is such a common question in my practice. Women in the United States have been lulled into a false sense of planning by the medical community making them believe they can detect when they go into labor. 

Here are a few things that will not detect that you will go into labor soon:

1. You are dilating. But but but. Nope. Doesn't matter. I have seen women walk around at 7 cm for a couple weeks then go on to have a normal length labor. I have seen women go from 1 cm to baby in one hour. It is not a good assessment of when you will have your baby.

2. It is your due date. See #1 below.

3. Your baby has dropped. This can happen in labor.

4. Your previous baby was born at 39 weeks (or 40, or 37). Your previous gestation amounts can play into the equation but based on 11 years of birth work I would never put money on it.

For those of you (like me) who appreciate a good check list here are a few warning signs (party signs?) that labor may be on it's way in the next week or less:

1. You are over your estimated due date. I tell every first time parent to add 8 days to their EDD based on their last period and count on baby coming no sooner that that. Make sure you share your new EDD with everyone. But what if the baby comes early you ask? You have your baby a few weeks early and no one raises an eyebrow, but go over your due date and the texts and phone calls won't stop until the baby is out. Even mom's who have had a baby before often hit their due date.

2. You have had a seriously good cry. This usually occurs as a prenatal appointment after you come in puffy and glaring at your care provider that you are still pregnant. The cry often occurs from the build up of hormones in your body preparing you for labor.

3. It has been one week since you have had a night of contractions where you were "Sure this is it."  and you almost called(or did call) your midwife.

4. You have loose bowels. You have spent most of your pregnancy more blocked up than usual thanks to iron supplements and slowed down digestion which helps with greater absorption of nutrients that is typical in pregnancy. Suddenly things change the other direction. Emptying becomes the word of the week.

5. You have lost your mucous plug although these regrow all the time and it is not uncommon to loose them a couple of times before baby comes.

6. You get up in the middle of the night to fold baby clothes. Nesting anyone?

7. Everyone in the family has gotten a really nasty cold, flu, or stomach virus and it now starting to feel better. It sounds crazy but  this almost always happens. Every one gets sick about a week before baby comes. Mom is super stressed about being sick or having sick kids while in labor. Everyone gets better and then the baby is born.

8. Your toddler has decided s/he is ready to toilet train. Completely serious. You wanted to do it all your first trimester but didn't have the stomach for it. You tried to do it your second trimester but the child wasn't ready. You had given up hope the third trimester and were sure that they would be in diapers in college. Week before the baby comes and wamo they want to use the potty and you spend a week washing pee soaked underwear.

9. Your mother-in-law who came into town to be here for the birth just caught their flight back home. Your body has a way of waiting to go into labor until it can be a private event. This can also be the sister, best friend, mother etc. I really do not have a vendetta against mother-in-laws.

10. Baby is moving less. It is very important to pay attention to baby's movements in utero as this is a positive warning sign that baby is doing well. Often right before labor there is a moment of calmness from your little one as s/he prepares for birth. They have just plain run out of room and their head is wedging deeper into your pelvis. This comment usually comes up during a prenatal appointment, but more than a handful of times I have gone to a clients home to check on things because mom was concerned that the baby wasn't moving and there was something wrong only to arrive assure her everything is fine and she is in early labor.

Regardless of everything above your baby will come when it is the right time for him or her. There is a point when almost every woman meets a point of surrender. She will be pregnant forever and she is ok with that. For now she will enjoy the joy of the baby growing with in her. Then the baby will come. The beautiful thing about birthing at home is that we get to follow the Divine plan and allow our bodies to do what they were meant to do, birth a baby perfectly.

Monday, October 28, 2013

Top 8 Supplements for Pregnancy- My Picks

The majority of women who choose to birth at home have a healthy and varied diet. If they do not feel the need to take any supplements I support them in this choice and I require none in my practice. For thousands of years women have grown healthy babies. Many others wonder what else they can or should take to help them have a healthy baby, to feel well during the pregnancy, have enough energy for birth, and to recover quickly post partum. Below you will will find the eight most common supplements I recommend to my clients.

1. Whole Food Prenatal
The two brands that I recommend are Rainbow Light Prenatal and New Chapter Perfect Prenatal.

As a general rule I recommend Rainbow Light because it is just one pill per day. I know when I was pregnant I struggled to even remember to take one pill a day never mind three. Rainbow Light does however contain Red Raspberry Leaf which some women are sensitive to so keep that in mind. New Chapter is also wonderful and easy on the stomach. It needs to be taken 3 times per day but contains no Red Raspberry Leaf.

2. Vitamin D
There are many symptoms associated to low vitamin D levels that are often attributed to pregnancy. 
These are common issues from low vitamin D levels:
  • Fatigue
  • General muscle pain and weakness
  • Muscle cramps
  • Joint pain
  • Chronic pain
  • Weight gain
  • High blood pressure
  • Restless sleep
  • Poor concentration
  • Headaches
  • Bladder problems
  • Constipation or diarrhea
 Sunscreen, lack of foods high in vitamin D and lack of time spent outside contribute to our issues with not making enough vitamin D. Egg yolk, many types of oily fish and cod liver oil are good natural sources of vitamin D. Low vitamin D has also recently been linked in pregnancy to gestational diabetes, preeclampsia, and low birth rate.

3. Omega-3- fatty acids
These good fats are very depleted from the mother during pregnancy because they are used in fetal eye and brain development. Depletion in the mom often leaves her feeling low on energy, depressed and nutrient starved.

4. Probiotic

Probiotics are live microorganisms, good bacteria, and by the millions they live naturally in the intestines. They are introduced to our bodies during birth and with out the we would be prone to infection, vitamin and mineral deficiencies and a weakened immune system. When the gut has enough good bacteria is prevents bad bacteria and helps protect us from infections. Studies show that mothers who increase their probiotic intake during pregnancy reduce their child's risk of allergies  They also loose their baby weight faster and have fewer yeast and thrush infections.

5. Chew-able Papaya Enzymes
Heartburn and indigestion is a common ailment during pregnancy. A raw enzyme in papaya can help. The Papain enzyme may assist in breaking down food in the stomach which may reduce heartburn, acid reflux and other gastrointestinal conditions.

6. Floridix
Anemia is common in pregnancy. Floradix contains an herbal based iron supplament which is easily absorbed and less likely to cause constimation that synthetic iron. Having a low hemoglobin count can leave you feeling tired and lethargic during pregnancy and can affect how you feel after loosing blood during your birth.

7. Chlorophyll
Consuming liquid chlorophyll during pregnancy, labor and postpartum can affect your energy levels, milk supply, safe detoxification, constipation and much more. Let's face it who doesn't need more greens in their diet. The mint flavor tastes great.

8. Red Raspberry Tea
Red raspberry leaf helps to tone and contract the uterus. Strengthening the uterine muscle to prepare for childbirth. It has a mild taste.

All of these supplements are included in my all inclusive midwifery package. Contact me to find out more about this option.

Wednesday, May 22, 2013

Haiti Days 6 and Days 7

Day 6- Tuesday
Woke up early and had breakfast. They prepared eggs with onions and peppers and pineapple. I skipped the eggs because peppers make my throat have issues. I had a piece of bread instead and a Luna bar. Midwifery meeting had me doing prenatals and being available for a birth if it came in with Marie as second. It was a very busy morning.  No labors came in so we just hung around the rest of the afternoon. A lunch of rice and beans and spaghetti for dinner.  We saw about 30 prenatals and 14 postpartums. I slept well outside again.

Below are the native staff midwives. 

Day 7- Wednesday
I woke up at 5 am to rooster crowing and the power was on so I moved to my indoor bed under a fan and slept two more hours.

 Claudin woke me up at 7 to say a labor was here. It was Mediline, the woman who was here last week with false labor and bleeding. We  sent her home with orders for a HIV and syphilis test, these are free, and an ultrasound. She was back with her ultrasound orders, was 4 cm and in labor but still no test results. The ultrasound showed low amniotic fluid, a low reactant and small baby and a mystery as far as where the bleeding came from. Still no test results and she still had syphilitic type sores all over her body. We asked her why she didn't get her tests done and she said she didn't want to.  Marie, Mary, and I discussed all of the options and mostly due to the fact that she was non compliant we  decided to transport her. We started an IV and her friends came to be her support at the hospital. They were really upset that we were taking her but calmed down after we shared the reasons and nodded their head in agreement. They got into the MBH ambulance and headed out.

 Only 18 prenatals this morning.  I saw two interesting cases today. The day I arrived they had just transported a mom in preterm labor at 30 weeks.  She showed up today for her regular prenatal. They gave her some mystery pills to take daily and sent her home. They told her to come back if she needed to push or to come to MBH. She was complaining the mystery pills gave her heart problems. We didn’t know what she was on and so had no advice for her. It was really difficult to not know what to do do help. It made me thankful for being back home where co-care exists and is just a phone call away.  I sent her home with magnesium and calcium for her irritable uterus and told her to come back every week. 

Another mom was breech and engaged at 35 weeks and a transverse baby at 36 weeks. A second time mom came in measuring 47 cm at 40 weeks. Major polyhydraminous confirmed by ultrasound with a small for gestational age baby. We referred her to the hospital for an induction. 

We saw several postpartum moms. 
 A good number of them birth at the hospital or at home but come here for care as neither the hospital or the TBA do postpartum care. I saw two different mothers. The first was there with her 8th child. A beautiful little girl. They were both healthy but I did some cord care. The TBA's and the hospital just tie off the cord, cut them keeping them very long usually between 3 and 6 inches, and stick a piece of cloth to them. They are often stinky and infected from being pulled on and not having enough air circulation after a few days. Traditionally women wrap their baby’s bellies to keep them strong and from having big bellies. They have a fear of large distended abdomens in children as this is a sign of malnutrition. The only real problem it causes is lack of circulation for the umbilical stump and over heating so we try to discourage it.  They also don't use waterproof diaper covers so the babies always feel wet. The second mom had a listless one month old. She said he, although he was dressed in a pink dress, hadn't nursed in over 24 hours. We took mom to a private room and had her strip off her shirt as well as stripping the baby to his diaper. He nursed right away and continued for the next hour. Mom complained that her breasts were too full and she couldn’t get him to nurse in the morning. We talked about nursing 8 to 12 times a day and hand expressing to help the baby latch on. I finally figured out after quite a few discussions that nursing 8-12 times a day means nothing to most people who do not have a watch. So much to my interpreters aggravation I got in the habit of saying
 "Nurse first thing in the morning, nurse after you gather water, nurse after your first meal, nurse after the baby sleeps, nurse before you make another meal, nurse when it is getting dark, nurse when it is completely dark, nurse when you need to get up to pee at night. Repeat, repeat, repeat."
 I think she just wanted formula and felt too tired, hot and sweaty to nurse her baby. I truthfully didn't blame her. It was hot. We asked her to return tomorrow so we could check on him. We were done early around noon. Martha and I have gotten pretty good at working together and sharing an interpreter. In the afternoon we walked to the gas station for snacks. This bottle of vodka cost half as much as a Snickers bar. Made me chuckle.

 I got chocolate of course, two snickers bars. I put one in the freezer and it disappeared. I was pretty sure it was one of the workers children who took it. I didn't make a big deal about it because really I didn't need two Snickers bars and that child really did. When I was at MBH the only thefts that had occurred were food. Laptops and Ipods lying around go untouched but a candy bar in the fridge is fair game. Lunch was quinoa and black beans dinner rice with beans and sausage. We sat around and joked and talked then headed to bed.

Thursday, May 16, 2013

Haiti-Day 5

Day 5- Monday
I woke up early as usual and took a shower, a real one the power was on, and it was cold but in Haiti that is a marvelous thing. I was trying not to wake up my late riser roommates but I was unsuccessful. Breakfast was delicious French toast with peanut butter and syrup and bananas. Ironically a banana in Creole is "Pini" and a pineapple in "anana". As far as my Creole is coming I feel like the only words I can remember are foods and labor words like push, shower, baby and urinate. :) Midwife meeting at 8 we talked about who would be doing initial prenatals for moms coming for the first time to the clinic and who would be on call for births. I was going to be doing prenatals and be second for Martha who was going to do her first catch in Haiti. I was very excited for her!  

At 9 am Marie started the prenatal classes at 9 explaining about how the baby grows, nutrition, body parts and labor. At 10 prenatals began. We had to do a full initial exam and questionnaire so it took a lot longer especially through an interpreter. I got mostly through with one when Mary came and told me a laboring mom, Sebine, was here and her bulging bag was hanging between her legs. I finished up quickly. Almost every mom complained of a UTI and vaginal itching. Haitian people are very clean but UTI's are common due to not drinking enough water and not having toilet paper.  They go home with probiotics and cranberry pills. About half were married, another 25% in a relationship and the rest the dad split when the pregnancy was announced. These statistics are about the same as the clients I serve at home. Even in a conservative state like Utah. When asked if they ever felt sad as part of a depression screening all but one of the 12 I interviewed said yes. When asked why, the answer was usually "I look at my life and the status of Haiti and feel sad". One said she felt sad because she couldn't return to school pregnant and other was sad because her mother wouldn't stop yelling at her about getting pregnant. The interesting thing is that I get similar answers from many of my moms in the United States. Unhappy about the relationship with the father, unhappy about the state of the country. So are people just generally unhappy even if hey have enough food to eat??? 

When I finished the one prenatal I joined Mary and Martha in the birth room. Sure enough mom was on the bed with a softball sized bag of waters between her legs. Mary ruptured it with an amnicot and checked mom to find her complete but baby was still high. She walked stairs for the next 3 hours while we finished prenatals. After a while she felt like pushing and Martha got into position with Mary and I guiding her she delivered the baby. I did pit, charting, mom care and baby APGAR. Mary left right after the birth to check on another labor so I showed Martha how to do gentle fundal massage to expel clots and do a newborn exam. The baby was beautiful. Dressed in a cute white and blue dress.

A sister for her big brother. We moved her to postpartum. All moms stay at least 4 hours but if we have the beds they often stay overnight. They are in a clean environment away from other children and they are fed three meals a day.  Lunch was beans and millet with sauce. I almost always skip the sauce which has a mismatch of different foods in it usually onions and peppers plus some sort of meat or fish or crab. It would be heaven for my husband who loves spicy, highly flavored foods and a surprise. Harder for me who eats almost the same thing every day. The food is always delicious though and there is always enough.

 Another labor came in the middle of the day. A 5th time mom who was 29 weeks was complaining that she had been having contractions for 24 hours and she felt like she needed to push. Mary did an exam and found her closed at -3 station. She continued to have contraction like pain. After some discussion she claimed she had not had any food for 3 days since she had none, she had 4 children to feed and her husband had left her. She complained of being dizzy with no energy. We gave her some food and kept her to monitor for several hours. She still complained of pain. We suspected a UTI so we did an IV to hydrate her well and cranberry and kept her overnight and fed her, and fed her, and fed her.

 Martha and I walked to the gas station a few blocks away for some ice cream. It was heaven! I am drinking 4-5 quarts of water a day. I fill it up and I swear someone else is drinking my water. When sweat runs down my face into my mouth, which is all the time, it just tastes like water. I constantly carry a washcloth with me to wipe my face other wise I drip on the patients. It is actually embarrassing  I am used to heat. Where I live it is always above 100 degrees in the summer often 110, but we have 0% humidity. Haiti is hot and humid which is why it is so beautifully green contrasted to the amazing red desert I come from. After a birth it is the worst. I am dripping sweat everywhere and the native staff midwife always jokes that I had "douche" shower, in my "rad" clothes. And she was right, that is exactly what I looked like. As soon as clinic was over every day I would change out of my scrubs, bucket shower and dress in a pair of capri length goucho pants and a t-shirt. We came home and picked up trash that had blown into the yard before eating a dinner of fried plantains, potatoes, hot dogs  and bread fruit. I took a bucket shower and prepared for bed. It started to rain so I had to move in my beloved outside bed, At 11 it had stopped so I moved it back out again.

Thursday, May 2, 2013

Family Forum May-Baby Wearing

Come join us for this months family forum event on baby wearing. 

My wonderful husband wearing our third child while home on a lunch break. He decided to let me take a nap and he did the dishes. Now that is an amazing man!

Benefits of baby wearing per

Benefits of Babywearing

Medical professionals agree that infants thrive through touch; “wearing” your baby is another way to meet this need. But the benefits of babywearing don’t end there … babywearing offers many other advantages, some of which include:

• Happy Babies. It’s true … carried babies cry less! In a study published in the journal Pediatrics, researchers found that babywearing for three hours a day reduced infant crying by 43 percent overall and 54 percent during evening hours. (1)
• Healthy Babies. Premature babies and babies with special needs often enter the world with fragile nervous systems. When a baby rides in a sling attached to his mother, he is in tune with the rhythm of her breathing, the sound of her heartbeat, and the movements his mother makes—walking, bending, and reaching. This stimulation helps him to regulate his own physical responses. Research has even shown that premature babies who are touched and held gain weight faster and are healthier than babies who are not. (2)
• Confident Parents. A large part of feeling confident as a parent is the ability to read our babies’ cues successfully. Holding our babies close in a sling allows us to become finely attuned to their movements, gestures, and facial expressions. Every time a baby is able to let us know that she is hungry, bored, or wet without having to cry, her trust in us is increased, her learning is enhanced, and our own confidence is reinforced. This cycle of positive interaction deepens the mutual attachment between parent and child, and is especially beneficial for mothers who are at risk for or suffering from postpartum depression. (3) (4)
• Loving Caregivers. Baby carriers are a great bonding tool for fathers, grandparents, adoptive parents, babysitters, and other caregivers. Imagine a new father going for a walk with his baby in a sling. The baby isbecoming used to his voice, heartbeat, movements, and facial expressions, and the two are forging a strong attachment of their own. Baby carriers are beneficial for every adult in a baby’s life. Cuddling up close in the sling is a wonderful way to get to know the baby in your life, and for the baby to get to know you!
•Comfort and Convenience. With the help of a good carrier, you can take care of older children or do chores without frequent interruptions from an anxious or distressed infant—which helps to reduce sibling rivalry. Baby carriers are also wonderful to use with older babies and toddlers; you can save those arms and go where strollers can’t. Climbing stairs, hiking, and navigating crowded airports all can be done with ease when you use a well-designed baby carrier!

I will have many different types of carriers to try out plus babies of all different ages. You won't believe how much happier and content your baby is if they are worn regularly. Free up your hands!

Thursday May 9th at 7pm. Partners and kids are welcome. Bring a snack to share if you would like and any carriers you have. 
See you there and contact me at for more information or for directions.