Monday, February 1, 2016

Sore Breast and Mastitis Treatment

When you have been away from your baby all day, you thought s/he was not nursing "that" much... but by the time you return home, your breasts are over-full, tight, and sore.

Time to give your breasts some TLC so that sore spot does not turn into mastitis!

A sore breast may have a sensitive, red, hard spot.  If those are the only symptoms, it is probably not yet mastitis.  Don't ignore it!  Treat it right away so it does not get worse or become mastitis!

Treatment for sore breast:

  • increase frequency of feeding with special emphasis on positioning of infant: place baby in several different positions, but most often in a position where his/her chin is over the inflamed area of your breast.  The motion of his/her chin as s/he nurses will work the ducts that drain the affected area, speeding improvement!
  • technique of breaking infant suction: always break the suction before removing your baby from the breast.
  • nipple hygiene: allow your nipples to air-dry after feeding and keep them dry (don't cover them in layers and layers of nursing pads, bras, clothing).  Bra-less with a loose t-shirt or pajama should be fine.
  • prevention of milk stasis: keep the milk flowing!  Nurse baby as often as you can.  Get in a hot shower and let the milk flow out.
  • complete emptying of breasts:  The breast is never truly "empty" but let baby nurse as long as he or she will.
  • massage breast and lymph glands, pressing lumps/hard/red spots towards the nipple, especially while in a hot shower.

Mastitis is more than just a sore breast.  It is an inflammation or infection of the breast, most often caused by stagnant milk remaining in the breast too long, plus a bacteria catalyst (usually staphylococcus) that starts growing in the sweet, warm, wet milk.  It is possible, however, to have mastitis at any stage of life.  Symptoms include: hot, red, inflamed area on one or both breasts, tenderness and pain in the inflamed area, illness, nausea, chills, and fever (over 100.4 degrees F).  With mastitis, you feel like you have the flu plus something wrong with your breast.

If you have recently given birth, you must rule out possible uterine or laceration infection.  Is our lower abdomen sore?  Is there any foul odor to your bleeding?  If so, contact your midwife or doctor right away.

If you are sure it is not an infection of the uterus or tear, you can try these treatment options for 12-18 hours. Extra treatment for mastitis:

  • Follow all recommendations for sore breast above.
  • Rest, except for caring for baby and self, resorting to bedrest if necessary,
  • Supplements, every 4 hours:
    • Vitamin C, 1000mg,
    • Grapefruit Seed Extract, 1 tablet/capsule, taken with food,
    • Garlic or garlic oil, 1-2 capsules,
    • Thyme, 1 capsule, or ½ teaspoon loose herb,
    • Water, 1 quart clear water every 4 waking hours (may add fresh-squeezed lemon juice or liquid chlorophyll). You might not think of water as a supplement, but when we are using it this way, it is a very powerful and effective supplement.
  • Apply hot compresses and use breast pump 1-2x a day after nursing baby until you have extracted all the milk from the breast.  Be sure to boil the flanges to sterilize them before use - you don't want to re-contaminate your breasts with bacteria.
  • Warm wet packs on breast, (a hand-towel is a nice size, but washcloths will work fine)
  • Raw, whole cabbage leaf covering breasts or tucked into bra,
  • Re-evaluate every 12 hours, or more often for worse cases.  If not dramatically improved in 24 hours, confer/consult/transfer care for possible antibiotic treatment.
  • Follow-up: As needed.
  • Referral to lactation counselor if mastitis re-occurs frequently.

If you are not significantly better in 24 hours, call your midwife or doctor or go to urgent care or the emergency room for antibiotics.  You don't want a breast infection to get out-of-control.  I am not a big cheerleader for use of antibiotics, but mastitis that will not dramatically improve in 24 hours with the following treatment is one case where I would recommend them!

Get well!

:) Deborah

Thursday, January 14, 2016

Statistics for my practice 2015

Statistics for my practice for 2015:

Total births: 30
            Homebirths: 26
                        Water birth: 15
                        Land birth: 11
            Hospital transports: 4 
                        Hospital spontaneous vaginal births: 4
                        Hospital forceps or vacuum births: 0
                        Hospital c-section births: 0
                                    Reasons for transport:
1. twin in footling breech presentation
2. high blood pressure
3. premature labor
4. high blood pressure and baby heart rate too low
Intact perineums: 18
First-time mothers: 5
Sets of twins: 1
Planned VBACs: 3
                        Successful VBAC: 3
                        Repeat c-section: 0

I know better than to feel proud about statistics. They can be great one year and bad the next. But 2015 was much better than 2014 for my practice. Praying for healthy mothers and babies again in 2016!

Monday, January 4, 2016

Cold Sores and Fever Blisters

Cold sores and fever blisters are much more likely when your immune system is down. :( "Cold sores" and "fever blisters" are caused by the Herpes Simplex Virus type 1. What should you do if you have a "cold sore" or "fever blister" while pregnant (or when your wife is pregnant)?
1.       Avoid spreading the virus
    1. Be sure to avoid any oral-genital sex when you (or your spouse) have any sign of the breakouts,
    2. when your baby is born practice careful handwashing,
    3. avoid kissing the baby if you have any sign of a break out. You don't want it to spread.
  1. Supplements/foods/treatments that help:
    1. L-lysine, start with 500mg per day at the first symptom and increase the amount by doubling the dose until you are taking 5000mg per day.
                                                               i.      Put some L-lysine from the capsule directly on the sores.
                                                             ii.      Foods that contain natural lysine and can help decrease the severity of the outbreak include: eggs, sour cream, yogurt, chicken and fish.
    1. Propolus, 3 capsules/3 times a day
    2. Zinc, 25mg after each meal and gradually increasing. Limit is 5000mg per day. (Increase gradually because it can cause nausea)
    3. Echinacea root and burdock root: place 1 tablespoon of each in a quart jar, fill jar with boiling water, cap, steep 8 hours, strain out herbs, store in fridge. Drink 1/4 cup 3 times a day for 10 days then stop. (Can be repeated 10 days on/10 days off.) There are reports that when repeated every 10 days for 6 months, outbreaks never return!!
    4. Heat lamp for 5 minutes, several times a day can help them go away faster
  1. Things that aggrivate cold sores should be avoided:
    1. Stress!
    2. Nuts, nut butters, seeds, chocolate :( and caffeine.

Monday, December 21, 2015

Monday, December 14, 2015

Holiday Feasting - A Cautionary Tale

During the final few weeks of pregnancy, the baby gains an average of a half pound per week.  When a woman eats a wholesome diet, including plenty of protein, vegetables, fruits and whole-grains, while limiting simple carbohydrates and sugars, her body will NOT grow a baby that is too big to give birth to!  

If the woman over-endulges, however, eating too much/too sweet/too rich/or too junky- foods, baby can (and will) gain much more than a half-pound per week!

This is my sweet, gigantic baby.  Almost 11 lbs!
During my third pregnancy, I ate a very good diet AND lots of dessert.  I felt confident I could push out a 10 pound baby.  I never imagined he would be almost 11 pounds, though!  While pushing, I felt pressure in the front by my bladder and in the back by my rectum - at the same time!  The realization that my baby had a huge head became very clear to me as it scraped down my pelvic outlet!  I finally got his head out and my midwife began dealing with a bad shoulder dystocia.  We got lucky - he began breathing without extensive resuscitative efforts.  After that birth, I was unable to get up from a sitting position without rolling to one side, a sign of a separated symphysis pubis.  It took a lot of binding and lots of time for it to heal.  I vowed to myself that if I ever had another baby I would NOT eat sugar!

Trust me on this one, it is not fun to push put a ginormous baby! Enduring the maneuvers to free a shoulder dystocia and anxiety of waiting while your baby is resuscitated is not fun! The 6-months to a year of sacro-illiac and symphi pain are not what you want. The trauma to your vagina and time healing, with nerve sensitivity, rectocele and/or cystocele are not the lasting reminders you want to remember your birth.  If you end up "needing" a c-section, due to cephalo-pelvic disproportion (CPD) (baby head too big to fit through pelvis) the painful recovery, scarring, adhesions, self-doubt and worry are not worth another helping of dessert!

Please! Save yourself and your baby time, pain and suffering! Do not over-endulge during the holidays, or any other time!  Eat smart!  Eat plenty of protein, vegetables and raw fruits.  Do not eat white flour and simple carbohydrates.  Avoid cookies, cake, pie, pastry, donuts, soda pop, ice cream or candy! 

This does not mean you cannot celebrate!  Please, do enjoy the holidays!  If you are at a holiday party, have an extra helping of turkey, deviled eggs or veggies and dip instead of sweets.

You can thank me later.

:) Deborah

Monday, December 7, 2015

Vitamin & Mineral Supplements

New information comes out about vitamins, minerals and our bodies' processing of those substances all the time. Supplements that used to be recommended as "the best" are put in question and new favorites emerge.  To help make good choices in supplements, I have compiled information for my clients.  I hope this will be useful to many other people as well.

Natural vs. Synthetic Supplements

Natural vitamins, minerals and enzymes occur mixed with other nutrients that work together for our health and well-being.  If one part is missing, or is fractionated, or is in the incorrect form or the incorrect amount, entire chains of metabolic processes cannot and will not proceed normally. Only nature can provide us with naturally-occurring vitamins as found in real, wholesome organic foods.  

Mainstream marketing has created the myth that synthetic vitamins and inorganic minerals may be isolated individually, and that we can derive total natural benefit from taking these fractionated chemical creations.  Many of these synthetic ingredients are derived from coal tar, a known carcinogen.  Almost all commercial supplements contain synthetic ingredients, which can cause un-intended side effects, blockage of uptake of natural nutrients and deficiency diseases.  

(may be 10% natural and 90% synthetic and still allowed to use “natural” on the label.
“100 percent natural”
“100 percent plant-based”
“100 percent animal-based”
Individual vitamins/minerals listed as ingredients
Example “Vitamin C”
Foods listed as ingredients
Example “acerola cherry powder”
Ingredients include: acetate, acid, bitartrate, chloride, gluconate, hydrochloride, “hcl”, nitrate, palmitate, succinate

Words ending in “-ide”, “-ate” or

One exception to the “-ate” rule is Folate (natural Vitamin B9) vs. Folic Acid (synthetic B9)
Words beginning with “dl-”

Common Synthetic Vitamins to Avoid

  • Vitamin A: Acetate and Palmitate
  • Vitamin B1 (Thiamine): Thiamine Mononitrate, Thiamine Hydrochloride
  • Vitamin B2 (Riboflavin): Riboflavin
  • Pantothenic Acid: Calcium D-Pantothenate
  • Vitamin B6 (Pyridoxine): Pyridoxine Hydrochloride
  • Vitamin B12: Cobalamin
  • PABA (Para-aminobenzoic Acid): Aminobenzoic Acid
  • Folic Acid: Pteroylglutamic Acid
  • Choline: Choline Chloride, Choline Bitartrate
  • Biotin: d-Biotin
  • Vitamin C (Ascorbic Acid): Ascorbic Acid
  • Vitamin D: Irradiated Ergosteral, Calciferol
  • Vitamin E: dl-alpha tocopherol, dl-alpha tocopherol acetate or succinate

Prenatal Vitamins

Your goal should be to obtain all the nutrients you need from your food.  Improvements in food choices should be made when you decide to conceive or as soon as you know you are pregnant.  Supplements should be thought of as extra assurance that you are getting all you need and never used instead of good foods.  Avoiding the artificial ingredients listed above, I can no longer recommend many of the vitamin supplements I used to suggest!  The only prenatal multivitamins I can recommend include: RAW Prenatal, MyKind Organics Prenatal Multi, and MyKind Organics Once Daily Prenatal Multi, all from Garden of Life; and Prenatal Gummy from Natures Dynamics.

Folate vs. Folic Acid

Since the 1950’s and 60’s, the role of Vitamin B9 in preventing birth defects like spina bifida and other neural-tube and midline defects has been known.  The US government has attempted to reduce the number of babies born with these defects by requiring the “fortification” of processed foods with Vitamin B9 and other nutrients.  Foods like white bread, cereals, crackers and almost all other grain products have added Folic Acid, the synthetic form of Vitamin B9, to comply with the government requirements.  This was a well-meaning step in the right direction.  However, 50 years of Folic Acid exposure has revealed problems with the synthetic vitamin.

Folic Acid (synthetic Vitamin B9) is added to “fortified” foods and cheap vitamin supplements.  Folic Acid is absorbed by the body and broken down in the liver for use.  This time- and energy-consuming process uses up other nutrients in the process, and can lead to other vitamin deficiencies and liver-related problems.  Folic Acid also “clogs up” the folate receptors on our cells, so natural Folate cannot be absorbed.

Folate (naturally occurring Vitamin B9) comes from foods like dark green vegetables, leafy greens, fruits and vegetables.  Folate is assimilated by the body in the bowel and made available for use immediately.  This process does not deplete the body of other nutrients and does not burden the liver.

What to do?

  • Increase Folate intake by eating plenty of fresh fruits and vegetables. 
  • Avoid processed foods and vitamins listing “Folic Acid” in the ingredients. 
  • Switch to a supplement with Folate instead of Folic Acid.
  • Avoid hormonal birth control, Methotrexate, drugs which increase homocysteine such as Nitrous Oxide (mostly used in dentistry), and antacids.
  • Reduce or eliminate dietary intake of gluten, wheat and dairy.
  •  Avoid cooking, drinking, storing and heating in any type of plastic container.

 This information is vital for people with a genetic mutation called “MTHFR.”  People with MTHFR are at a higher risk of developing heart disease, stroke, diabetes, cancer and many other diseases, as well as being more likely to have a baby with a midline defect like spina bifida, cleft palate, tongue-tie, etc.

Iron Supplements

Most prescription or over-the-counter “iron pills” and cheap prenatal vitamins contain ferrous sources of iron.  Just look at the label and you will find ferrous sulfate, ferrous gluconate or other ferrous form of iron.  Taking these pills is like swallowing rust.  They slow the bowel transit time and cause constipation.  They are hard for the liver to process, creating a back-log of work for the liver.  The liver has a lot of work to do during pregnancy and it doesn’t need to be bogged down with ferrous iron processing!  Also, the liver dumps waste into to bowel for removal.  But the constipation caused by the ferrous iron slows the bowel so much that the waste is re-absorbed into the bloodstream where it ends up back in the liver.  The poor liver is already taxed by the extra work due to pregnancy, ferrous iron, and now it has to re-process the same waste over and over.  The result can be liver problems like cholestasis of pregnancy, jaundice or persistent or slow-to-resolve anemia!  Please don’t tax your liver by ingesting ferrous iron.  Check the label of your prenatal vitamins.  If you see the word ferrous on the label throw them away and get something better!

If you need to increase iron intake to correct anemia, do it with food first, supplements second.  Foods that raise the hemoglobin include:

  • All the dark green vegetables like broccoli, green peppers and asparagus
  • Leafy salad greens like romaine lettuce, spinach and kale
  • Dried apricots (containing the most easily assimilated form of dietary iron!),
  • Raisins, prunes, dried black cherries
  • Sea vegetables,
  • Molasses, especially black-strap molasses (careful, it is sweet!),
  • Nutritional yeast - sprinkle on food (delicious on popcorn!)
  • Egg yolks, and
  • Organ meats like organic liver.

If you are already consuming these foods and are still anemic, or need to get your hemoglobin numbers up quickly, you can supplement with concentrated herbal iron sources:

  • Alfalfa tablets or capsules - up to 2 or 3 with each meal.  I think of these as a compressed salad!
  • Liquid chlorophyll - Liquid chlorophyll comes in plain and spearmint flavored.  I think the plain tastes like grass clippings pulled them fresh off the lawn mower blade!  But some people prefer the plain to the spearmint.  They both work great.  Put a tablespoon in a glass of water once or twice a day.
  • Chlor-Oxygen drops, follow the label for dosage, it is much more concentrated than regular liquid chlorophyll
  • Nettles tea - high in iron and many other minerals, drink at least a cup a day
  • Red Raspberry leaf tea - also high in minerals, good for pregnancy and all times of life
  • Vitamin C - 500 mg per day, helps with iron assimilation
  • Hemaplex capsules, 1 per day
  • Floradix liquid iron, up to 2 teaspoons, twice a day
  • Ferrofood from Standard Process, follow label instructions
  • Homeopathic ferrum phos - a homeopathic cell salt that enhances iron absorption, once or twice a day
  • Spirulina
  • Chlorella
  • Dandelion leaf (good for the liver, too), up to 3 capsules per day
  • Yellow doc tincture - up to 3 dropperful three times per day (high in iron and supports the liver)

Calcium & Magnesium
“Chelated” minerals have been combined with amino acids to form mineral complexes.  Chelated minerals are more absorbable and useable by the body.  Look for a chelated calcium/magnesium supplement in a 2:1 ratio.  That means there are 2 milligrams of calcium for every 1 milligram of magnesium.

I hope this information is useful to you!

:) Deborah

Monday, November 30, 2015

Deborah’s Diary - Postpartum Housecalls and a Boy for Evelyn

Monday I drove 1.5 hours each way to check on the new baby and her mama.  They were both doing well, baby nursing great and mama amazed how different home birth was. She commented how much she liked being able to move around and get into any position she wanted.  It was a lovely visit.  My 16 year old son drove me there and back so he could get more supervised driving time to count toward his driver license.  We had a nice time chatting during the trip.

Tuesday I had to hustle to get my home-office paperwork done and drive to my Springfield office by 10 o'clock am for my first scheduled checkup.  I was pleased to see progress on the office remodeling, and the construction workers had been considerate enough to cover my furniture with plastic to keep the dust off. At 11 am I drove to the north side of Springfield for a home visit, followed by another home visit down on the south side at noon. I grabbed a quick lunch and went back to the office for more checkups, finishing at 6:00pm.  

The Springfield chapter of the International Cesarean Awareness Network (ICAN) met at my office at 7pm, construction mess and all!  If anyone has had a c-section or other traumatic birth experience, I hope you will find a support group as great as this one! The discussion tonight was informative and reassuring.  I wish more people could have been there!

I was home and in bed by midnight.  Around 1:00am I awoke to the windchime sound of my text alert.  Evelyn, my second-time client, was texting to say she had one contraction.  If a first-time mother told me she had one contraction I wouldn't think much of it, but this five-time homebirther knew her body.  And at 40 weeks, 6 days, she was *ready* to have this baby!  I replied that I was ready when she needed me and tried to get back to sleep.  At 3:00am she texted again that she was too uncomfortable to sleep.  I wanted more sleep so I alerted my apprentices and rolled back over.  I slept only lightly, though, so when her husband texted me at 6:37am that the contractions were stronger and he wanted me to come, I leaped out of bed, dressed and was on the road only ten minutes later.

My apprentice who would be acting in the role of Primary Midwife Under Supervision was herself almost 36 weeks pregnant, and has a history of having her babies early.  To take some of the physical workload off of her (and me, I'm getting old!) another apprentice was also coming to lift, carry, clean and do the charting for us.

I arrived at the house after a short drive (short for me, anyway) and found Evelyn squatting in the driveway, supported by her husband.  I waved and drove past them to the house.  Inside was all excitement.  Grandma was helping one child finish her breakfast.  Grandpa was looking for someone's lost shoe.  Two kids were zipping around trying to find beach towels and swimming suits.  The floor was strewn with oats and the sink full of dishes.  It was a mild form of chaos!  No wonder Evelyn had escaped outside to labor.

I carried my supplies into the master bedroom and started setting up, glancing out the window every couple minutes to keep an eye on the laboring couple.  They were walking up and down the drive, stopping to squat through a contraction every 3 or 4 minutes.  My apprentice, Jess', car came down and soon she was helping me with setup.  "Let's put some supplies in our pockets and receiving blankets under our shirts just in case she starts pushing out there and can't get to the house in time," I advised.  "And be ready when the kids leave.  I predict she will come inside and have a baby as soon as they are gone!"  I sent Jess out with my doppler to get hearttones.  She returned with Crystal, my Primary apprentice for this birth, who arrived as the grandparents were loading the kids into their car.  The birth team was in place!

As predicted, Evelyn came into the house as soon as her parents' car left the driveway.  She went straight into the master bath.  We placed chux underpads on her bed, as she planned to give birth side-lying in bed.  From the bathroom, we heard her working through transition and groaning that she lost the mucus plug.  After the next contraction she got on the bed in a semi-reclining position.  My apprentice's pregnant belly hung over the bed as she stretched the doppler to Evelyn's belly.  Everything was going smoothly except Crystal was working extra hard!  Baby's hearttones were great and Evelyn was completely focused on her labor.  

After only a couple minutes, Evelyn whispered that she was already feeling some pressure.  She was too uncomfortable to stay in bed, though that was where she planned to give birth.  She crawled out and knelt on the floor, leaning forward on the side of the bed and gave her first push.  Crystal and I half-knelt and bent to get a good view of her perineum.  Lucky for Crystal, we were not stooped over very long.  The baby's head crowned after only two or three pushes and was born.  The whole baby emerged easily and we pushed it forward for Evelyn to reach down and pull him up.  "I can't believe it!  I had the baby already?!" Evelyn whispered breathlessly, astonished how much faster this birth had gone compared to her last birth.  We helped her into bed and her husband climbed in with her.  Baby boy, 8 lbs 3 oz, perineum intact, everything perfect.  As we left the family bonding in bed, we overheard Evelyn announcing to her husband, "Never again!"  LOL!  It may look easy, but it sure doesn't feel easy!

I stopped and got some breakfast and started another long drive to check on Sunday's mama and baby again. I do a lot of follow-up visits, standard care for my practice.  I usually do a postpartum housecall on day 1, day 3, day 7, and 3 weeks after the birth, but more often if needed.  The 6-week postpartum checkup is back at my office.  I don't mind all of these visits. It's just part of my work. 

This was a busy week, but I feel so blessed to be able to do this work.  It is my honor and privilege to serve these women in birth.  I hope I am able to do it for many years to come.  

Me with 'Evelyn' and her sweet baby!