How to know when to go?

This post is in regards to all the new mama’s that are approaching their due date and feeling overwhelmed with excitement and anticipation of the birth, and anxiety over when it will happen or “how will I know if I’m in labor.” Some signs of impending labor (not real labor just yet!) include:

-increased vaginal discharge: this discharge is usually clear or white-ish, and may be tainted with blood, indicating bloody show. This is totally normal, and it does not mean you are in labor. As our bodies instinctively prepare for birth, we experience increased secretions of vaginal fluid that helps to sort of “cleanse” the birth canal and attempt to “wash away” any harmful pathogens. This discharge is usually scant in amount and will come and go. My preceptor recommends to use a regular period pad, and if you soak through more than one pad an hour, you should notify your healthcare provider.

That being said, if it is obvious that your water broke (ruptured membranes), evidenced by a gush of fluid, persistent draining from the vagina, or soaking through more than a pad an hour, first remember to stay calm! The media is forever portraying water breaking as this huge stat emergency that they need to get to the hospital as soon as possible. Not usually the case. If you are ruptured and go to the hospital, they will sit you in triage, perform a speculum exam, hook you up to the monitor, test the fluid to make sure its amniotic (IT IS NOT UNCOMMON TO UNKNOWINGLY PEE ON YOURSELF!!) There is a lot of pressure down there, and lots of different sensations, and yes, many people come in swearing their water broke, because they would know if they peed themselves, and when all is said in done, it turns out its just urine. So before you get all crazy about  your baby coming, here is some advice we give:

Meconium stained amniotic fluid

1. If the gush of fluid is clear, and baby is moving as usual, take a breather. Have a small meal, take a shower, brush your hair, call your best friends, and gather what you need to bring for the hospital. Don’t wait all day obviously, but 1-2 hours give or take is probably ok.

2. If the fluid is green, brown, or any other funky color, this is probably an uh-oh moment…just go right on up to the maternity unit.

-Some women will start experiencing uterine contractions within a few weeks of their due date. Most people may have heard the referred to as Braxton-Hicks contractions.

Credits to Mark Parisi

Even if they start getting more uncomfortable, especially in addition to all the other discomforts going on around this time, it is important to remain calm, and not let your anxiety/excitement get to you. If you start feeling contractions that are annoying and uncomfortable, relax a minute and take a time out to think. Literally. If you have been up on your feet getting things ready for the baby or just running around aimlessly because you cant think of anything else to do, go sit or lay down in a nice quiet, comfortable area. Put your feet up. Drink a bottle of water or two. If its night, take a benadryl or a tylenol PM, and just try to get some rest. Conversely some women may feel more discomfort when resting, and it may help to get up and walk around. If any of these methods work for you and make the contractions even a little bit better, then you are most likely not in real labor. That being said, do be weary about potential urinary tract infections, as these frequently present with the same discomforts associated with false/early labor, and often go undiagnosed; notify your provider if you have any [abnormal] increases in urination or urgency (well, duh, if you’re pregnant thats a no brainer), if there is any burning, or bleeding with urination, any local irritation, or dull persistent lower abdominal or flank pain.

Physiologically, our uterus is preparing for its big day, practicing so to speak. Although not trying to push a baby out just yet, the uterus will move and adjust to move the baby from up in the abdomen to down into the pelvis. Naturally, this puts more pressure on our already sore pelvic bones, and puts the cervix at a funny angle, causing annoying discomfort. I have had some women describe the feeling as “it feels like she is trying to push her hand right through my vagina.” Not entirely likely, but thats a common feeling. If you call your doc or midwife complaining about contractions and discomfort etc., they will probably tell you exactly the same thing mentioned above. Save yourself the worry of overanalyzing, and just take a chill pill. Literally and metaphorically. You are going to need to save your energy and strength for when you do go into labor, so don’t sweat the petty things. If after trying to drink plenty of water, taking some tylenol PM, and resting (or getting up and walking), you are still feeling unusually uncomfortable, again, don’t panic. Pull out your watch and time the contractions (or have someone do it for you that is trustworthy to accurately keep time, i.e. don’t ask baby daddy during March Madness, and your 3 year old toddler will probably be as useful as your dog). What you will want to time is (and it may help to record it as follows), a.) when a contraction starts, b.) when the contraction ends,  and c.) when the next one begins, and so on and so forth, so that when you do call your provider, they can accurately assess your contraction pattern. Making a chart like this may be useful to keep track and stay organized. My preceptor came up with a clever method counting 3-2-1 to know when it time to call. She explains to call if “contractions happen every 3 minutes, for at least 2 hours, lasting at least 1 minute in duration.”

I hate to use the term “false labor” because it still has many of the same bothersome discomforts of “true labor,” but its just too soon to make significant physical changes; I personally think of it as “practice labor,” because in essence, it could go on for days and weeks, and you are still experiencing “labor sensations.”  In true labor, contractions will gradually happen closer together, lasting longer periods of time, and they will gradually become more intense, and rest and home remedies will not give any relief. If you haven’t already, start timing them now, before you call your healthcare provider, so even if it is true labor, we have a baseline to evaluate progression.

Now, as a very important disclaimer to anyone that reads this, recommendations mentioned in this blog are exactly that, JUST RECOMMENDATIONS. They are tips and advise for addressing early labor concerns, and should not be used as primary management. Although probably there is evidence in the literature to support one strategy over the other, this post is strictly an informal recommendation from me to you. ALWAYS talk with your prenatal care provider, and discuss signs of labor, what is “false labor,” and what criteria calls for immediate evaluation. Every provider has their own experiences and opinions on this topic, and different institutions follow different policies, so it is important to know the specific protocols and recommendations of your provider and hospital regarding onset of labor.

Thanks for reading, stick around, I will probably do some research and see if I can get actual real evidence based facts and references, but for now, the recommendations described are only a reflection of supportive strategies and critical thinking in practice. Have a great week!

Breastfeeding is Kosher

In recent decades, there has been a remarkable shift in the way women in modern society are seeking to satisfy the nutritional needs of their newborn. Although nature has provided us with a valuable set of mammary glands, many mothers are abandoning the breast and turning to the bottle. Why is it that a woman would feel the need to nourish their babies with formulas and artificial nutrition?

The answer lies between the fast paced, antifeminist culture and machismo work force, where women are being discouraged from nursing in public, and not given time at work to pump at all, let alone pump enough to keep a steady milk supply for their baby.

This desire to return to a “normal” lifestyle following childbirth serves as the basis for the common complaints of “not making enough milk,” to “the baby wouldn’t latch on” and “being to tired,” that promotes bottle feeding and formula supplementation as a readily convenient alternative.

Sure, there are legit reasons to avoid breastfeeding, such as in the presence of diseases like HIV or hepatitis, maternal drug use, or taking medically necessary medications that could harm the baby. Occasionally, premature or sick newborns are not strong enough to breastfeed, and some endocrine conditions and anatomical defects (extensive breast surgery) can lead to an insufficient milk supply.

More often than not however, women are uninformed about the facts, and influenced by misconceptions and negative pressure from others. So to set the record straight, here are the facts…Breastfeeding is GOOD FOR YOUR BABY!!!

Ok so maybe feeding by the breast is a primitive mammal function. Are human beings that much above the animal kingdom that they cannot rely on natural methods to feed their young? This may come as a surprise to some, but guess what? Mother Nature knew what she was doing; babies were born to breastfeed! Starting with conception and the development of the placenta, the female body was perfectly designed to nourish her offspring, providing a direct lifeline to the fetus, supplying it with just the right amount of nutrients, oxygen, and energy to grow. For the healthy woman, nothing more is needed! Although birth signifies the independence of the baby as its own being, separate from its mother, the need to love and care for the baby doesn’t stop there, and neither does our ability to provide perfect nourishment.

Biologically speaking, during pregnancy, abundant amounts of progesterone are secreted from the placenta (hence why progesterone is called the “hormone of pregnancy”). This inhibits the secretion of prolactin (the milk hormone) from the pituitary gland, and prevents the milk supply from coming in while the placenta is still the primary means of nourishment. After birth, with subsequent delivery of the placenta, progesterone levels drop, and allowing prolactin to dominate and begin milk production. Throughout pregnancy, estrogen and progesterone influences  cause proliferation and maturation of the mammary glands and ducts in preparation for birth. This aids in the development of colostrum, which is the thick, yellowish substance that may be seen prior to delivery and arrival of the milk. Although colostrum is commonly misunderstood to be unsanitary, it is actually superior nutrition, in that it is very rich in calories, protein, and protective antibodies to help establish beneficial intestinal flora to produce vitamin K and protect against harmful extrauterine pathogens. It also creates a mild laxative effect to help pass the first stool and clear the gut of the sticky fetal meconium. Bringing the baby to the breast immediately after birth (or as soon as possible) allows not only for maximum colostrum intake, but it facilitates mother-infant bonding, and nipple stimulation to secrete oxytocin. Oxytocin (synthetically supplied as Pitocin to induce or augment labor) is a natural chemical produced by our body that causes the uterus to contract. Oxytocin serves as a natural protective factor against post partum hemorrhage because it causes the uterus to contract and close off any bleeding uterine arteries. This is often why many women experience abdominal cramping when first starting to breastfeed. Additionally, it produces a positive reflex reaction to promote more milk production. Like most hormones that create physical and emotional effects, release of oxytocin presents a feeling of maternal yearning for her newborn to enhance the bonding period. Unsurprisingly, interference during the postpartum period (such as repairs and recovery after a C section) presents a challenge to initiating these crucial events in the short time just after delivery.

It is commonly believed that the only way to know if the baby is getting any milk is when breasts become engorged and the milk starts leaking out. This leads to many women wanting to use formula and a breast pump to help the milk come in. This is where patient education is crucial. Not only is the baby getting sufficient nutrition from colostrum, but allowing the baby to latch on and suckle provides significantly better nipple stimulation than just the pump alone. Instead of sticking a little rubber pacifier in the baby’s mouth to keep the kid quiet, stick em on the teat! This becomes a big factor later on, when pumping alone often doesn’t produce enough milk. This is due to the mechanism of how milk is expressed. When the baby is properly latched on to the breast, it is able to use the entire mouth and jaw to compress the glands around the nipple to squeeze out more milk than just nipple suction alone (such as with the breast pump, or when a baby is improperly latched on). This method also allows for less trauma to the nipple and helps to reduce nipple soreness.

Now here’s the big kicker….how many formula feeding parents have done their research on the origin of most of the nutritional  ingredients in baby formula? I guess no one ever really thought to ask where many of the enzymes and fatty acids come from…go figure, many formula companies process and use the abdominal fat of swine to supplement their products. Sure, its got plenty of calories, digestive enzymes, vitamins, hell, they even have bacon flavored baby formula!!

So with questionable components of baby formula, why settle for less than what God gave you? Babies are able to get excellent portions of calories, fluids, antibodies, fats, enzymes, and more just from the breast. Most recommendations are supportive of  exclusive use of breast milk to feed during the first 6 to 12 months of life. Not only is it more economic than expensive formulas, but breast milk actually changes its composition to meet the developmental needs and nutrient requirements of the growing newborn. If all else fails in changing perceptions about the benefits of breast feeding, pull the weight loss card….breastfeeding burns about 500 calories a day, or more. A GREAT strategy to lose pregnancy weight! In many cultures, breastfeeding is the primary method of birth control and family planning. In Orthodox Jewish women, prolonged breast-feeding is an unofficial yet effective way to space pregnancies. The consistent secretion of hormones needed for steady milk production introduces one of the most natural and religiously acceptable methods of birth control for any religion.

Unless there are prior contraindications, healthcare providers around the world are in agreement…”breast is best.”

For more information and local support, check out these great websites…

La Leche League:   http://www.llli.org/

http://www.cdc.gov/nccdphp/dnpao/hwi/toolkits/lactation/index.htm

http://www.breastfeeding.com/

http://www.womenshealth.gov/breastfeeding/

http://www.nlm.nih.gov/medlineplus/breastfeeding.html

**Just got off 48 hr shift on L&D, will cite references later…=)