Why so much guilt?

Thoughts from: Student midwife, Rhonda Huggins 

During the postpartum period we advise mother to go from couch to bed, bed to couch for the first two weeks.  We advise mother to lift nothing heavier than her baby, have the older children come to her, no lifting them and to allow family and friends to bring her food, run her errands, clean her house, and in short, allow others to take care of her, to serve her.  Why is it that so many women have such a hard time with these orders?  Why do we have such a hard time allowing others to do things for us?  Accepting help from someone does not mean we are incapable or lazy, it means we have people that care about us.  We need to change our perspective. 

Years ago in our couples Sunday school class, we were discussing meeting the needs of others.  Our Sunday school teacher’s wife said, “If someone offers to do something for you and you tell them no, you rob that person of a blessing.”  Wow.  It was very, very impactful to say the least, talk about changing my perspective!  A couple weeks after that, I gave birth to Trinity our youngest daughter.  I received a phone call from guess who?  Of course, my SS teacher’s wife, she offered to bring us dinner.  I humbly accepted.  She came by, dropped off dinner and laundry detergent (just because she knew it was something would need), she sneaked a peak at the baby, gave me a hug and told me to let her know if we needed anything.  She didn’t come by to do those things because she thought I was incapable, lazy or inept.  She came by because she cared, because she was celebrating this special time in our lives and she respected those sacred early bonding moments.  It was a transformative moment, not only had I been blessed, it allowed her the opportunity to be blessed for her generosity AND she helped me to know what being served in that way felt like.  It also created a desire in me to serve others in that same way.  So when you get those instructions from your midwife, follow them.  Allow others to take care of you while you allow yourself time to nurse your baby, rest and recuperate.  

Morning Sickness...more like ALL day sickness

Written By: Audrey Luck, Tree of Life's newest midwife

            Morning sickness is commonly known as nausea and/or vomiting in pregnancy. This is a normal and common occurrence in pregnancy.  It usually starts around 6 weeks of pregnancy, but it can begin as early as 4 weeks. It tends to get worse over the next month or so and disappears around 

12-14 weeks. 

           

            The exact cause of morning sickness is not known for sure. It is believed that rising hormones, Human Chorionic Gonadatropin (HCG), Progesterone, and Estrogen, are the primary suspect. They can increase a woman’s sense of smell and cause sensitive stomachs. For some pregnant women, the symptoms are worse in the morning and ease up over the course of the day, but they can strike at any time and last all day long. Because of this eating can be a challenge.

           

            The initial surge of morning sickness may be hormone induced but the lack of eating because of it perpetuates the condition. Nausea is also a common symptom of low glucose, sugar, in the body. Thus, you have the vicious morning sickness cycle that last ALL day.

           

            Here are some recommendations that you may find to be helpful in reducing your symptoms. First off, do NOT skip meals and snacks. Increasing or spreading out your food intake minimizes the highs and lows of sugar levels in turn minimizing nausea due to low blood sugar. Aim for eating 5-6 small meals/snacks daily (breakfast, snack, lunch, snack, dinner,...snack), but remember the caloric demand in pregnancy is 300 extra calories to you normal non-pregnant caloric demand.

           

            Secondly, make all snacks and meal include protein and complex carbohydrates (ie. whole grains, certain fruits, vegetables, and legumes). When you eat  complex carbohydrates, they get converted to glycogen and are used immediately for energy, providing a steady dose of blood sugar or they are stored in the muscles and liver for energy at a later time. Simple carbs, by contrast, cause a spike in blood sugar that quickly dissipates resulting in nausea. Regarding protein in pregnancy, women should eat 60 – 80 grams of protein. Protein are the building blocks for all muscle cells in the body.

           

            A few other helpful recommendations are: sucking on lemon candies, drinking ginger tea or eating ginger candy, snacking on dry foods like crackers, and trying to reduce stress. Believe it or not, stress has been discovered to play a component in nausea and vomiting in pregnancy.

           

            Morning sickness can be an annoyance at times but it is a reassuring sign of pregnancy. Just remember it does not last for ever. Discuss your morning sickness with your health care provider. If you hold more that 50% of your daily intake you may need medication.

The Truth about Transition

Written by: student midwife, Jaclyn G. Hauge

            Transition is a normal and predictable phase during labor.  It is the shift between the first and second stage of labor and an indication that you will soon be ready to introduce your baby to the world.  It’s during transition that I begin to fill with excitement and anticipation.  I know that birth is imminent and that the waiting, hard work and sensations of labor will soon be over for the woman.  It’s also a point in the birth process where I have to work my hardest.  So, why is this? How can one event illicit such opposing feelings? Frankly, it’s the physiology of birth.

            Labor and birth is a positive feedback mechanism initiated by our body.  Our bodies begin the process of labor and then continually intensify it in order to expel the fetus and return to its normal state.  Simply put, the body doesn’t stop working until the job is done.  Transition can be the greatest reminder of this.  Transition exaggerates labor, intensifies sensations, and is the overture to the grand finale of birth. 

            With the onset of early labor moms are excited, coping famously, talking, cleaning, laughing and joking.  They really don’t need a whole lot of focus, they just go on with their day, noticing a surge every 5-7 minutes.  A few hours later once active labor begins, the intensity of surges increases, moms start working a lot harder now.  They may stop during a surge, focus their breathing, and might ask for some help.  Birth partners can be very helpful during this time reminding moms to release tension, focus their breath, and massage their backs, hips or legs.  

            Somewhere around the 7-8 centimeter mark, transition begins.  At this point, the last bit of cervix is beginning to melt away, making room for the passage of the baby. Surges begin to increase in frequency, approximately every 2-3 minutes with 30-60 seconds in between.  Along with the frequency, the intensity also escalates.  Women begin to sound more “primal”, and operate on instinct. Moms move their bodies, they get up, they get down, move to the toilet, then to the bed, then maybe to the tub.  Needless to say women in transition are also very indecisive.  One minute they’re burning up, the next they’re shivering and calling out for a blanket.  Some women experience vomiting, others experience involuntary shaking of the limbs.  They may feel as though nothing helps, and the woman who liked guided meditation during active labor may not want talking at this time. 

            As exciting as this time is for me, women have difficulty seeing the finish line in the distance.  They might feel like they’ve done all the work they can do.  They may begin to doubt themselves.  Usually once a mom says “I can’t do this”, most of the work is done and it’s almost time to push.  It’s hard to convince a woman that what she’s experiencing is all normal.  This may be her first baby, and she’s never felt this way before. It may be her third and she remembers the sensations all too well.  Women may try to back away from transition, they may be scared of what’s to come.

Luckily, transition doesn’t last forever.  On average transition occurs in about 40 minutes.  The most important thing to remember is that the feelings, emotions, and sensations of transition are normal and they are positive. Transition is working with you, it’s helping you to welcome your baby.  So, don’t fear it, embrace it and take solace in your midwives when they say “you’re doing great, this is normal, you’re almost done.”

Breastfeeding Mom and Midwife by Rebecca Luckey

Most of you all know I’m a midwife, well I’m also a nursing mother of a one year old.  Being an on-call practitioner with a nursing infant is not the easiest of things, especially when your kid doesn’t like pacifiers or to self soothe to sleep.  This past year of nursing and pumping while away has been quite an adventure.  Getting a call in the middle of the night or not being home for days is the norm.  I have had to have students make milk runs to daddy for me since we had no other way for him to pick up milk or   to bring baby to me, only having enough “stashed” away for about 24 hours.

As I write this article, I have Nora nursing in my lap, a foot in my chin and little fingers pinching at my arm.  I am a seasoned mother of now four children.  I write this out of a practical need, not a late breaking new article with an English major midwife behind it.  I’m just a working mom with a different schedule than most. 

It takes commitment from not only the mother but daddy too.  My husband would keep track of how much was in the freezer and let me know when I needed to “bump up” my production to ensure the baby will have what she needs.  I will tell you once solids came in to the mix at six months I felt a little reprieve from feeling like a cow, but still without fail I manned the pumps every 3-4 hours.  Finding the right pump makes the difference.  I use a Hygia double pump and it’s so much better than my Medela.  I find I actually can express more per feed with the Hygia and have less clogged ducts when away from my nursling.  You have to find what works for your body.  Not to say Medela is at all a bad pump, it’s very highly recommended across the board, but I found another brand that fit my body and my baby.

Finding the time to pump, that is a dilemma at times.  When in the office I can sneak away for a few minutes and lock myself in a room, but while at a home birth or driving half way across state doing home visits I have to pump and drive.  I single pump with a hands free bra and have cool packs with me to store the milk….sometimes I have to stop in convenient stores for cups of ice along the way.  Oh and believe me you do cry over spilled milk.  Seeing even an ounce of liquid gold go bad or leak out of a bag is so frustrating.  I have had to work hard for every ounce. Even if I go four or five hours and feel engorged I only get 3-4 ounces between the two sides.  But that’s all my daughter needs.  She still only takes 2-3 ounce feeds at one year of age.  For these women that can express eight or more ounces at a time I applaud you.  If you’ve seen my daughter, she is quite the chunk and seems to be doing just fine on my 20-24 ounces per day.

Ways that I increase my supply: eating steel cut oats, having a dark beer here and there, increasing my water intake and calories as well putting baby to the breast the second I am home.  Even if I just pumped on the way home, I put her on the breast.  I don’t pump when I’m home, only to the breast with baby and I try to take her with me as much as possible. 

I want other moms to know that if I can make it work so can you.  I look back on my other childrens’ nursing experiences and see all of my mistakes…I made a vow not to make them this time.  Breastfeeding is so important that first year...and I finally did it! 

Welcome Abraham James 9lb1oz born at home while siblings patiently waited. Mommy was 42weeks and baby #4 was very different from previous births.....she trusted her body and stayed in the moment and the beautiful baby boy finally entered earthside! Each birth can be so different which is why being out of the hospital allows the space to trust and be present so much easier. The distraction of new faces, hospital equipment, and procedures can really distract and even paralyze the birth process which is why pitocin is so often needed. Remember, we can always transfer into the hospital if we need intervention. We can't leave the hospital and go home once everything is going exactly as it should!

Fatigue.....Not always a bad thing!

Some of you may know that I have gotten back into Bikram Yoga again after an 8 year break. I practiced regularly for about 5 years and then life got busy…..I got married, had two babies, graduated nurse midwifery school, you know…..busy!

Bikram yoga consists of 26 postures that you do in concession the same time every time you practice. It is also done in a room that is approximately 100 degrees so you sweat A LOT. I love it! Since going back I have felt more relaxed, needed caffeine a lot less often (let’s face it I am a midwife), and my back is significantly better after straining it a  birth two years ago. The main reason I go though is for the open eye meditation that is involved when you practice. The quieting of the mind and blurred focus on self which allows the connection to body, mind, and soul, and ultimately a balancing of the three. We are told to turn off our ego and listen to what we are being told, without thinking. I often tell my laboring mommies the same, “turn off your brain and let your body do the work”. 

During many of the classes the instructor mentions fatigue. This class is HARD and some of the best athletes struggle with making it all the way through without needing to take a break. What I found profound was the explanation that it is normal and even good to become fatigued. That it is in the place of muscle fatigue that you can go deeper into the posture and ultimately your awareness of self. When the muscle is tired it stops fighting and the active act of stretching begins. How similar to birth this is. My moms’ often become frightened that they are becoming too tired to birth their baby. Laboring your baby into this work is often the most difficult physical, mental, and spiritual act some women face. The lack of control and the fear of the unknown is most of what makes it so difficult.  We work through that fear by encouraging them to be fatigued. “Stop fighting and trust the body”. It is in our complete exhaustion during labor that we surrender to the process and turn the brain off and “let” our union of body, mind, and soul deliver our babies to us. We prevent the detrimental physical exhaustion by making our laboring moms eat high carbohydrate foods and drink electrolytes to that the muscle has the necessary fuel to keep working for however long it takes. Most first time moms average 12 to 24hours to birth their babies.

I want to encourage every pregnant momma to stretch and exercise during pregnancy to the point of fatigue. This will allow you to practice your breathing and bring you to an open eye meditation where your ego is shut down and the breath brings balance to the mind and soul. Envision your perfect birth in this moment and release any mental fears that may wonder in. Know that your midwife is there during the birth to bring you out of these moments of fear. It is our honor to do so……

Welcome Sweet baby Teo to the World

Teo, 8 lbs 8 oz, was born today at the Tree of Life Birth Center into mommy's arms. Mommy's first words,

 "That was easy," especially since first baby was 26 hours and this one was only 6 hours.

Change of Plans!

Zoe entered this world Sunday August 4th at 1153pm after a long awaited debut! Mommy and daddy had her big brother at home with me 19mo ago. Zoe was somewhat of a drama queen from day one! We weren't even sure mommy was pregnant until second trimester was almost over. Then, at the 20wk sono we found a small normal abnormality that needed follow up. Then, when we followed up there was extra fluid in her pool. So by the end we weren't overly shocked that we were going to need to be in the hospital for her delivery. Parents were very proactive and toured the hospital and meet with my back up MD Dr Besong prior. Wouldn't you know it Mommy developed a serious kidney infection 3 days prior to the scheduled induction and so.....Change of Plans....were having a baby sooner than later. Dr Besong was impressively patient and gave Mommy's body ever chance to do something it wasn't quite ready to do. We had pitocin going....then we stopped to give Miso....change of plans Pitocin again,,,,,,wait change of plans We are giving Miso.....okay nothings really happening maybe you should go home now that the infection is gone......Change of Plans lets break your water....OMG yes I am serious! Mommy and Daddy went with the flow and trusted the MD and me and the doula so beautifully that I believe this is what created this amazing vaginal birth!

Sweet Waterbirth ...

Welcome to the world Caleb Kenneth...9lbs 1oz. Congratulations LaToya, James and big brother Austin. 

Newest Bloom...

Welcome baby boy Levi Asher born at home this evening very swiftly, 7lbs 14oz. Congratulations Amy & Scott, big sister Abigail and big brothers Judah and Josiah. 

The Ritual

Written by Midwife Kaleen Richards

At around 36weeks I encourage my pregnant moms to start a nightly ritual to prepare themselves for labor and the birth of their baby. A ritual is defined by Wikipedia as “ a stereotyped sequence of activities, performed in a sequestered place, and designed to influence preternatural entities or forces on behalf of the actors ’goals and interest”.  And so I had to Wikipedia “preternatural” from that point which is defined as “that which appears outside or beside the natural. In contrast to the supernatural, preternatural phenomena are presumed to have rational explanations that are unknown.” Okay so like when I still get blown away at a birth that a little human somehow comes through our bodies and is absolutely perfect……totally preternatural!

To prepare for this event that, in actuality there is no way to prepare for because it requires the complete release of control (am I freaking you out yet lol), we perform a nightly ritual. This mentally gives us or our ego, the security that we have prepared. It physically strengthens our body and encourages good fetal position. It also connects us with our partner and/or our baby and focuses our soul on what our hearts desire.

The ritual generally occurs at night with a hot bath or shower. We encourage practicing with a bath because it is what we use in labor. When you completely relax in the bath now your muscles will remember once in labor and do the same.  Making a playlist of music you enjoy and hope to use for your birth can be listened now to enhance relaxation. Hot baths are fine in pregnancy as long as you get out once cold and don’t keep refilling with hot water. Jacuzzis are not. When you get out of the bath oil up! I like Apricot oil because it is light, odorless, and high in vitamin E but you can use olive oil, coconut oil, or jojoba oil. Get the breasts and appreciate how they have changed and are preparing to grow your baby on the outside. Rub your belly and baby and connect with what position they are in and how much they have grown to prepare for their journey earthside. Spinningbabies.com is a great website for baby mapping and determining how they are lying. Head down most important then back along the front not your back is the second goal. Take your thumb and dip in the oil. Rub it on your perineum to help saturate the area with vitamin E. We don’t need to “stretch” the vagina or perineum for birth, just reinforce it with vitamin E oils for elasticity. Continue down to your legs and now you are truly glowing! Next get into bed and do a few stretches. Cat- Cow, butterfly, inversions, hip flexors, whatever feels good or what we have told you to do for optimal fetal positioning. Lastly, with your partner or by yourself, practice Hypnobirthing.  Even if you fall asleep in the first 5 minutes, subconsciously you are getting the techniques and your muscles are going to remember!

Try to practice your ritual nightly or at least 4 times a week. We all have things we are busy with but this is important…..you are important…..your birth experience will forever change you and this will help you know what you want and prepare  body-mind-and soul for it to happen.

Come out and see us Saturday August 3rd..

We have two awesome events going on this Saturday in Port Orange and Melbourne...come out and see us!

New Arrivals this week...

Welcome baby boy David Vincent...6lbs 6oz. Sweet and calm Waterbirth on a Sunday afternoon 7/28/2013. Congratulations to Diamond and Robert on their third child.

Welcome baby boy Abel Darlington...6lbs 2oz.  Born on 7/30/13 at home...Congratulations on their first child to Monique and Jason.

Kegel Exercises

Thoughts from: Theresa Blahut, Student Midwife MMCI

Kegel exercises were originally developed in 1948 by Dr. Arnold Kegel as a method of teaching how to control or improve urinary incontinence in women following childbirth.  Kegel exercises are also called pelvic floor exercises because they treat and prevent pelfic floor weakness.  In women, (yes, Kegel exercises are for men too!) Kegel exercises are helpful for those who have stress incontinence or uterine prolapse.

During pregnancy and delivery, the pelvic floor can become stretched and weakened, which may cause urine control problems for months to years after childbirth.  A weakened pelvic floor can also allow one or more pelvic organs to sag or prolapse.

The principle behind Kegel exercises is to strengthen the muscles of the pelvic floor, thereby improving the sphincter function.  The success of Kegel exercises depends on the proper technique and adherence to a regular exercise program.

One method to help you identify the muscles is to sit on the toilet and start to urinate, and then try to stop the flow of urine midstream by contracting your pelvic floor muscles, also called pubo-coccygeal muscles.  Repeat this action several times until you become familiar with the feel of contracting the correct group of muscles.  Note that if your stomach or buttocks muscles tighten, you are not exercising the right muscles.

Kegel exercises are easy to do and can be done anywhere.  First, as you are sitting or lying down,  try to contract the muscles you would use to stop urinating. You should feel your pelvic muscles squeezing your urethra and anus.  Then, squeeze for three seconds and then relax for three seconds.  Repeat this exercise ten to fifteen times per session.  Try to do three sessions daily.

Kegel exercises are only effective when done regularly; so it would be helpful to set up a daily routine such as while brushing your teeth, while driving and lying down at bedtime.  After four to six weeks, most people notice some improvement. When done prenatally, increased control is gained over these muscles and this is useful during labor and birth.

Thank you to Tree of Life

Below is a sweet email we received from a client of ours that just delivered her first child with us on February 14 (Valentine's Day Baby) 

Tree of Life Staff, 


I want to thank you so much. I did not know what I was going to do, I felt as if my family would be upset with me if I did not do a hospital birth, but that was the last thing I wanted. after seeing all of my friends children that are so swollen from being forced out of their mommies. But with so much pressure from my family i left my midwife, and went to a ob, as soon as i did i knew this was everything i did not want. And my old midwife would not take me back. I had no where to go and my baby was going to be here any day now. Kaleen you let me join when I was 8 1/2 months pregnant. And fulfilled my prefect dream birth. My little love bug born on valentines day, at home, within 4 hours. With the love of my life holding me in the tub, I grabbed my little girl, and yes I did it alone. I am so proud of myself. I truly could never thank you all enough. <3

Welcome sweet baby girl Leianna Jordan

Welcome Leianna Jordan 6lb 3oz born at home last night 30 minutes after the birth team arrived. This is the 2nd baby mommy has had with Tree of Life. 

Tree of Life's Newest Bloom

Welcome Earthside baby girl Lily Belle.....7lbs 8oz.....daddy is deployed overseas so we skyped him in for the birth. He is on the face time in this photo watching her get her first outfit...tear. Congrats Tabitha and Adam......Tree of Life Birth Center.

Preparing Siblings for the New Baby

Thoughts from student midwife: Theresa Blahut

One of the most difficult tasks for children expecting a new brother or sister is the thought of sharing.  Brothers and sisters may have to share their rooms and toys but also their parents attention.  Mothers may be wondering how they can love and give enough time to the new baby as they did with their first.  Addressing these issues with preparation throughout the pregnancy can lead to less friction once the baby comes.

There are several ways to prepare a child for a younger sibling.  The key is to try to make the child feel important and involved in the preparation.  Here are some suggestions:

• Enrolling him or her in a sibling class which usually includes learning to hold baby; making a gift for the new baby.
• Plan a trip to the library to find books on babies.
• Let him/her pick out items for the baby at the store.
• Have a "special" bag of toys and books for him/her when your attention needs to be on baby such as feeding.
• If the new baby will share him/her room, allow them to help arrange the room.

Once the baby arrives, make sure your older child is made to feel important too.  Perhaps give your older child a gift from the baby saying "I am glad you are my brother/sister".  Let your child know that there will be many visitors to see and spend time with the baby.  It is often helpful to have some quiet time alone with the older child at the end of the day.  Always talk to the older child to learn how best to help her through this time of transition.

Sweet Testimonial that we had to share

Kaleen, Rebecca and staff:
I just wanted to express my heartfelt thanks for Jessi's beautiful birth experience. From the minute Jess knew she was pregnant, she had written her birth plan and you and the student midwives helped her to fulfill all her wishes.

I consider this nothing less than a miracle, because at 37 weeks pregnant, Jess was willing to opt for a hospital birth due to a loss of confidence in her previous care provider. I asked her to reconsider because I was sure she didn't really want to forego her dream birth. (I understand because I was unable to fulfill my dreams of a natural birth-center delivery with Jess almost 19 years ago.)

With Amanda Johnson's encouragement, for which I am extremely grateful, Jessi felt empowered to make her birth plan come true. She e-mailed your office to ask if you would consider taking her as a new patient at an extremely late stage of her pregnancy. I thank you for accepting her!

From the first minute we walked into the birth center, we felt nothing but peace, encouragement, acceptance and love. I know midwifery is how you all make your living, but I also know that you all love what you do … it shows in every action of every person at Tree of Life who touched our lives these past few weeks.

I pray that you all will be blessed abundantly, as you all have blessed the members my family's lives through Jessi's labor and Taiden's delivery.

Thank you again,
Joni Kramer (Jessi's mom and Taiden's grandma)

Tree of Life's Babies of the Week

Tree of Life has had a busy week with new babies

3 home births and 1 birth center birth

David James 8lb5oz was born at home, on Monday Night, after a fast 3hr labor. This mommy laid in bed for 5weeks to let him cook long enough....congrats Camille and Adam! 

Ella Christine 7lb 2oz was born at home, in the water on Tuesday afternoon into the loving arms of her parents Stacie and David. 

Welcome Adelyn Iva 8lb even... mama called Kaleen to come in the early hours on Thursday, within 15 minutes baby was out ...... talked Daddy through the delivery and he did great! When Kaleen arrived mommy and baby in bed breastfeeding ......awesome!

Sweet Taiden 6lb 6oz was born this morning at the birth center into the loving arms of new mama Jessica. She did an amazing job and was surrounded by all the loving support of her mother and grandmother. 

Such a beautiful picture of 4 generations. 

Postpartum Bliss

By: Michelle Isla, Student Midwife

The weeks and months following your birth are a powerful time of transition for you and your baby.  It is a magical time I commonly refer to as your babymoon, in which you are falling in love with your baby and forming the deepest of bonds.  You are learning your baby's cues, learning how to nurse, and establishing new rhythms.

Physically and emotionally your body had to do the work of opening to give birth to your baby and it takes time for the body and the emotions to regain a sense of balance.  Tissues need to heal, the body needs to be nourished and allowed to rest so that it may then be able to nourish another life. Taking herbal sitz baths, sleeping when your baby sleeps, eating warm nourishing foods, are just some ways that you can support yourself during your babymoon.

It is important that this time be honored and not rushed.  I cannot stress enough the importance of this period for a mother's short and long-term health.  Rushing out of this phase or experiencing excessive stress during this time depletes a mother's energy and emotional resources and can lead to a weakened physical and emotional state for months and even years to come.

Some keys for postpartum bliss lie in slowing way down and allowing others to support you.  Your partner, family, and close friends can help to take care of YOU so that you can take care of your baby.  Below are some examples of things I strongly recommend you do so that you may have a peaceful and blissful postpartum.

• Ask a friend to set up a meal delivery/chore assistance chain for your family.  This is not the time to entertain visitors but if they are coming to meet the baby they might as well bring fresh food and throw a load of laundry in.

• Limit your guests to certain hours of the day.  This is a great time for your partner to be the guardian of the home and protect you and your baby's sacred space.

• Schedule some postpartum massages, in home if possible, or allow a friend to give you regular warm oil massages that are firm using long stokes. 

• Take at least 2 naps in the daytime for the first 2 weeks after your birth and at least 1 each day in the weeks after.  Sleep when your baby sleeps.  Resist the temptation to "get things done" when your baby is sleeping.

• Co-sleep with your baby.  This can mean bringing your baby into the family bed (please read about how to safely do this) or simply bringing the baby into your room.  You will find that you will nurse more frequently, which establishes a good milk supply, yet you will sleep better because you are not wasting energy on walking to a different room and sitting down to nurse.

• Take an herbal sitz bath twice a day followed by a nice warm shower at least once a day.  Ideally you will have your warm oil massage followed by a warm shower and then tuck yourself in bed with your baby to nurse and sleep.  This can happen at any time in the day or evening.

• Incorporate gentle, restorative yoga poses at home to start regaining your strength and flexibility after the first 2 weeks postpartum.  In the following months, when the time feels right to you, you can venture out to a mama/baby yoga class at a studio.

Each culture has its own postpartum traditions.  Unfortunately here in the U.S we are expected to get "back to normal" as quickly as possible, six weeks being the maximum time allowed for this powerful transition to take place.  It is my hope and intention that every family honor this very special time in ways that support the physical, emotional, and spiritual health of both mother and baby.

Skin Changes in Pregnancy

Thoughts from: 

Theresa Blahut, Student Midwife, MMCI

Along with the physical discomforts of pregnancy, skin changes may become an annoyance for expectant mothers.   Having to deal with increased vascularity, hyperpigmentation and stretch marks can be difficult but rest assured that these conditions are temporary and will subside in time after birth.

Chloasma or melasma gravidarum; commonly known as the "mask of pregnancy", occurs throughout the face in three main patterns.  The first most common  (63%) is in the center of the face involving the forehead, cheeks, nose, lips and chin.  Less commonly, the malar (21%) involves the cheek and nose.  The least common pattern occurs in nine percent along the edge of the jaw.  Little is known about the cause of these pigmentations, however, a melanocyte-stimulating hormone has been found to be elevated during the latter half of the first trimester until birth.

Chadwick's sign is the characteristic violet color of the vagina during pregnancy.  This is thought to be caused by the increase in vascularity. The vagina goes through preparatory changes during pregnancy for maximum stretch during labor and birth.

Striae gravidarum is another term for stretch marks.  Our skin has three layers; the epidermis, the dermis and the subcutaneous layer.  Stretch marks occur in the dermis that is the stretchy middle layer that allows skin to retain its shape.  When the dermis is constantly; stretched as in pregnancy, the stretch marks occur.  Skin becomes less elastic over time and the connective fibers tear leaving marks behind.

Linea negra is a skin pigment condition where the midline of the abdominal skin becomes darker, usually a brownish color.  The linear streak runs vertically along the midline of the abdomen from the symphysis pubis to the xyphoid process.  An old wives tale states that if the line runs to the naval, it is a girl and if the line extends all the way to the xyphoid process, it is a boy. 

Cesarean Awareness Month

Tiffany here--

I know I am so very late on this but the month of April is Cesarean Awareness Month! For the rest of the month of April I will be posting articles and blogs on this topic. Please feel free to share anything that Tree of Life post to your friends and family. We at Tree of Life feel that it is very important that women educate themselves about their health and their rights as a pregnant women.

I am very saddened when I read or hear a women's past birth story that involves a unnecessary c-section. 

Below is the link to improvingbirth.org Facebook page, their page has been great at the amount of articles and discussion post that they have had this month all centered around c-section. If you have time to please like their Facebook page and read some of the statistics on the c-section rate in the USA, I have a feeling you will be surprised and alarmed at the number.  

https://www.facebook.com/ImprovingBirth 

Thoughts from a Student Midwife

Preeclampsia and HELLP Syndrome

By: Theresa Blahut, Student Midwife, MMCI

The most serious complication of pregnancy-induced hypertension is eclampsia, which is servere preeclampsia complicated by seizures or coma.  Eclampsia occurs in approximately .2% of pregnancies and terminates one in 1,000 pregnancies.  Preeclampsia occurs in approximately five to eight percent of all pregnancies in the United States and is one of the most common causes of perinatal morbidity and mortality resulting in an estimated 35-300 deaths per 1,000 births.

Signs and symptoms of  preeclampsia include:  hypertension (high blood pressure) defined as a diastolic blood pressure of at least 90mm Hg or a systolic blood pressure of at least 140 mm Hg; ( these blood pressures must be manifested on at least two occasions six hours or more apart), water retention leading to puffiness of the feet, ankles, hands and face, and protein in the urine.  Preeclampsia is the development of hypertension with proteinuria (presence of 300 mg or more per liter).  This level of proteinuria should produce a 2+ reaction on a standard urine dip stick in at least two random urine  specimens collected six hours or more apart.   Water retention or edema is a generalized accumulation of fluid of greater that 1+ pitting which can result in a weight gain of five pounds or more in one week.

Additional signs and symptoms of severe preeclampsia include; headaches, visual disturbances (blurring or inability to tolerate bright light), lethargy, nausea and vomiting, pain in the right upper abdomen and shortness of breath.  If undiagnosed, preeclampsia can progress to HELLP syndrome and eclampsia.

The HELLP syndrome is seen in up to twelve percent of mothers with preeclamptic symptoms.  HELLP syndrome consists of hemolytic anemia (the H is hemolysis), elevated liver enzymes, and low platelets (HELLP). Hemolysis refers to those broken cells that were damaged when they traveled through the narrow, clogged vessels.

The exact causes of preeclampsia are not known, although some researchers suspect poor nutrition, high body fat, or insufficient blood flow to the uterus as possible causes.  The only cure for preeclampsia and eclampsia is to deliver the baby.  If the baby is not close to term, bed rest and careful observation with a fetal heart rate monitor and frequent ultrasounds may be ordered as well as medicines to lower the blood pressure.  

Thoughts on breastfeeding

Thoughts on Breastfeeding 

By Michelle Isla, SM

We all remember the famous TIME magazine front cover image of a mom breastfeeding her 4 year old son with the words “Are You Mom Enough?” next to it.  Here’s an interesting article (http://blogs.babycenter.com/mom_stories/02172013if-all-moms-breastfed-their-babies-right-after-birth/) about breastfeeding citing a recent press release by the Save the Children organization identifying barriers to breastfeeding.  In this article the authors parody that famous front cover image with a similar one stating “Are We Supporting Moms Enough?”  The organization’s recent breastfeeding report identified the following four barriers to breastfeeding success:

1. cultural and community pressures
2. the health worker shortage
3. lack of maternity legislation
4. aggressive marketing of breast-milk substitutes – or formula.

As a former lactation counselor for the Seminole County Health Dept., having discussed these kinds of topics ad nauseam,  I can’t help but feel this isn’t really new information.  The question is, what is being done about it in this country?  There are certainly initiatives I’ve read about and political discussion about maternal rights in the workplace, government incentives for corporations, etc.  Sometimes it feels like progress is too slow!  In the meantime the formula companies continue their unethical propaganda undermining breastfeeding and contributing to the health epidemic in this country.

While I feel it’s important to stay on top of what’s happening politically on a national level I also feel it’s equally important to focus on what WE can do in our day to day to effect change.  Although it may not feel like it sometimes we actually have tremendous power to create change in our communities and that’s where we can start.  One individual CAN change the world!  Does that sound too idealistic?  Well look at it this way, every single action we make that affects someone’s life contributes to change in that person’s life.  We do this enough times and inspire others to do the same and we inevitably create a domino effect.  Now, I realize that this bottom up approach has to also be coupled with top down initiatives.  This is why I mentioned earlier that it’s important to stay on top of what is happening politically and get involved with organizations that push for legislative change.  As a side note, Moms Rising is an incredible organization that does just that!  Check them out, www.momsrising.org.

Bringing it back to breastfeeding now, how can we as individuals help increase breastfeeding initiation and duration rates?  I say “duration” because the science shows that the most significant health contributions of breastfeeding occur the longer we provide our children breast milk.  At Tree of Life we are certainly committed to supporting mothers in achieving this.  We are one of the only midwifery practices that offers our new mamas a breastfeeding consultation with an International Board Certified Lactation Consultant within the first week after giving birth at NO COST to the mother.  We also offer an ongoing breastfeeding support group that meets each week as this model is statistically proven to increase breastfeeding duration rates.  I’d say we’re off to a good start at Tree of Life.  What can YOU do to support breastfeeding?  Here are some suggestions:

1. refer your new mama friend/neighbor to a lactation consultant if she is having trouble nursing, make the call for her if she’s willing!
2. Talk to your girlfriends pregnant or not about attending a breastfeeding class with a lactation consultant prior to giving birth
3. Show a new mama how easy it can be to nurse in public
4. Smile at the next mama you see nursing in public and tell her you’re so happy to see her doing it
5. “Share” posts on Facebook that have to do with breastfeeding awareness, there are some cute ones out there
6. Tell your care providers (midwife, OB, pediatrician) that you would really like to see them have onsite breastfeeding support
7. Tell your care provider that having that formula propaganda up on display has been proven to undermine breastfeeding and affect breastfeeding rates in this country
8. Tell the Motherhood Maternity store that you don’t wish to receive their free formula sample in the mail after you shop there, maybe you’ll still get it but at least they’ll have heard your piece
9. Nurse your baby in public, cover or no cover.  I wasn’t much of a coverer myself!
10. Share your breastfeeding success stories with other new and pregnant mamas, offer them emotional support when the going gets rough for them

Tree of Life's 200th Baby

Tree of Life's 200th baby!!!! 

Welcome Lexi Leigh 8lb 2oz born at the birth center.

This was mommies 3rd baby but first without pitocin or epidural and she did GREAT! Blessings to Cynthia and Mark!

Gestational Hypothyroidism & Postpartum Thyroiditis

Thoughts and research from one of Tree of Life's wonderful students:

Theresa Blahut, Student Midwife MMCI

Gestational hypothyroidism and postpartum thyroiditis occurs at a much higher rate than one may expect.  Gestational hypothyroidism is a term used to describe women who are hypothyroid while pregnant but did not have a thyroid imbalance prior to pregnancy.  A recent publication in the Journal of Clinical Endocrinology & Metabolism documented that 15.5% of the pregnant women tested had gestational hypothyroidism.  It was also found that women ages 35 to 40 years are nearly twice as likely to suffer from gestational hyperthyroidism as women who are ages 18 to 24 years.  Also, women who weigh more than 275 pounds are 25 times more likely to develop gestational hypothyroidism.

Thyroid disease is common in women of child-bearing age and may affect both mother and baby.  Potentially, gestational hypothyroidism may cause premature delivery or miscarriage and effect the baby's neurological development.  Hypothyroidism symptoms in the mother include; fatigue, lethargy, constipation and feeling cold.

Women should have their thyroid tested before pregnancy and ideally, thyroid testing will become routine in pregnancy.  Pregnant women who are on thyroid hormone should have their blood tested frequently during pregnancy as dosage requirements may change.

Postpartum thyroiditis is a condition with similar pathogenic features as Hashimotos disease were in the immune system attacks the thyroid gland. This disease affects between 5 to 9 percent of postpartum women.  Typically, there is a transient hyperthyroid phase that is followed by a phase of hypothyroidism.  The hyperthyroid phase will not usually require treatment.  The hypothyroid phase should be treated with hormone replacement.

Long term follow up is necessary to access thyroid function and adjust the medication dosage. Nearly all the women with postpartum thyroiditis have positive TPO antibodies.  This marker can be a useful screening test early in pregnancy as 50% of women with these antibodies will develop thyroid dysfunction postpartum.  In addition, some studies have shown an association between postpartum thyroid disorder and depression so that thyroid function should be checked postpartum in women who have significant mood changes.