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!

Alternative to the Flu Vaccine

It is an annual topic of discussion in my practice, "Do I have to get a flu shot?"  In the workplace, women are pressured and even bullied by their bosses and co-workers to get the shot.  Many companies offer 'free flu shots' to entice employees to get the vaccine, or shame those who refuse the vaccine by making them wear face masks that employees who get the shot do not have to wear.  Pregnant women seem to have a natural suspicion that getting a vaccine during pregnancy could be harmful to their unborn babies, and seek information to support their decision not to get the shot.  These women can rest assured that the evidence is on their side.

Vaccination for the flu during pregnancy has proven to be dangerous and ineffective.  Even the Center for Disease Control reports the flu vaccine is at most 14% effective in preventing the flu. In addition to being ineffective, the flu vaccine contains additives and preservatives that are harmful.  The most dangerous of these include Formaldehyde, a known cancer-causing agent, Aluminum, which is associated with Alzheimer’s disease and seizures, and Thimerosal, a mercury-based preservative that can result in brain injury and autoimmune disease.  In 2009, the flu vaccine caused a 700% increase in miscarriages!  

The flu vaccine actually causes a decrease in the body's natural immune function, making you more likely to get the flu or catch a cold in the days following the vaccine.

Clearly, the flu vaccine is not the best way to avoid the flu.  Achieve immunity by strengthening your body’s own immune system instead.  As an alternative to the flu vaccine, follow this Anti-Flu Protocol:

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Anti-Flu Protocol

Daily supplements:

• RAW Prenatal (or other herbal-based, whole-food prenatal vitamin)

• Vitamin C: 1000 mg

• Vitamin D: 2000 iu

• Chelated Calcium:Chelated Magnesium: 2000mg:1000mg minimum per day

• Garlic: 1-2 capsules or tablets, twice a day

• Water: 3-4 quarts of clear water, may add fresh-squeezed lemon juice or liquid chlorophyll for an extra immune boost

• Avoid junk foods: White flour, white rice, cookies, cakes, pies, pastry, donuts, soda, ice cream and candy all decrease immunity and make you much more susceptible to the flu. 

________________________________________________________________

What if you are exposed or likely to be exposed while traveling?

If you are exposed to someone who is sick or if you are traveling, immediately increase your intake of vitamin C to 2000 or 3000 mg per day, vitamin D to 3000 to 4000 iu per day, and garlic to 3-4 capsules three times per day.  Make you water intake a priority.  Continue this increased protocol for a week after the exposure or a week after you return from your travels.

What if you get the flu?

Even among people following the above protocol, there will be an occasional case of the flu.  Fortunately, during pregnancy the baby is usually protected from the flu because the virus cannot cross the placenta.  Dehydration, lack of nutrition and high fever are the main concerns regarding flu during pregnancy. 

Medical treatment for the flu (Tamiflu) contains harmful chemicals and has side effects that are as bad as the flu itself.  Antibiotics do not work on the flu because it is caused by a virus.  Antibiotics are only effective against bacteria, not the flu.  Taking antibiotics during the flu will only decrease your immune system and cause the flu to last longer.  If you are one of the unfortunate who come down with the flu, the following treatments will help minimize the symptoms you get over the flu more quickly.

• Increase your intake of vitamin C to 3000 mg per day, vitamin D to 4000 iu per day, and garlic to 3-4 capsules three times per day.
• Hydrate: Make sure you keep sipping water, herbal tea and broth throughout the day to avoid dehydration.  Staying hydrated will help the body fight the infection, remove toxins efficiently and decrease fever.
• If you get a fever, check your temperature every hour or two.  If it gets over 103 degrees for more than an hour, take a lukewarm bath and allow your skin to air-dry instead of toweling.  Or use a squirt-bottle to wet your hair and allow it to air-dry.  The cooling effects of evaporation should reduce your fever naturally.  Repeat as needed.  If your fever does not respond to this treatment, consult your healthcare provider.
• If you vomit, you will have approximately 10-15 minutes during which you will not vomit again.  Eat a bite of yogurt or drink some water, tea or broth immediately after vomiting, so your body will have a few minutes to absorb the fluids and nutrients.
• Stay home!
• Rest!
• There are many helpful homeopathic remedies that will help you get over flu and treat the symptoms.  Consult a good homeopathic guide or practitioner for which one(s) fit your symptoms.

Blessings of Wellness!
:) Deborah


Sources:

http://www.ncbi.nlm.nih.gov/pubmed/20614424  http://www.gaia-health.com/ 

http://kellybroganmd.com/article/rejecting-flu-vaccine-in-pregnancy/

http://www.naturalnews.com/030657_vaccines_miscarriages.html

Deborah’s Diary - Muddy Windshield

There is mud on my windshield.  It has been there for days.  I haven’t had time to get my oil changed and my washer fluid refilled, so I dare not use my windshield wipers to remove it...  

It rained mud down on my car the other night when I was called to repair a torn perineum for a mother who had an unassisted homebirth.  I didn’t get home until 1:30am and went straight to bed.  

The next day I woke early and made my rounds, doing house calls for postpartum mothers and newborns and working my way to my office in town for prenatal checkups.  I got home after midnight again and still hadn’t had time to go through a carwash or refill the washer fluid, so the mud remained.

The next morning I left home at 7:00am and drove an hour to do a home visit for a postpartum mother.  As I was leaving to go to a second home visit, I got a call from a client who was about a week before her due date.  I had helped her with her two previous births and have never witnessed two births more alike than those.  So when she said she was at work but having regular contractions that were hard to talk through I asked her to go home and prepare for the birth.  I would send my apprentice to be with her.  I planned to head to her house after I finished the second home visit.  Half way through the visit, the mother texted me a list of contraction times about five minutes apart.  I quickly left and drove quickly to her house, about 40 minutes away.

This birth, the third for this mama, took a little longer than her first two.  She soaked in the birth tub while we quietly chatted about work, family, and relatives.  Because she had torn with each of the first two births, I encouraged her to push in a different position this time.  That plan to ease baby out slowly went out the window when the urge to push came!  She pushed the baby out very quickly and suffered another perineal tear.  Her baby was a gorgeous 7 lb 0 oz girl.  

After an hour or so of skin-to-skin nursing in the birth pool, daddy took baby while we helped mama out of the tub and my apprentice guided her to the bathroom.  My apprentice alerted me that there was a trickle bleed that wasn’t stopping.  I got my flashlight and took a look as she sat on the toilet.  Blood was trickling, but not from the tear.  I guarded her uterus as I attempted to express any clots.  There were none.  Strange, I thought.  I got my flashlight to look at the blood again and saw something large, smooth and pink protruding from her vagina.  Her cerivx.  A prolapse!  

I quickly called my apprentice to bring the sleeping bag to the bathroom and make a pallet for mama to lay on.  “I can see your cervix sticking out and I am going to put it back where it belongs,” I told the mama.  She looked scared.  “It will go right back where it should be and the bleeding will stop,” I confidently predicted while praying it would be true.  I guided the mother onto the fluffy mat my apprentice had prepared and asked my apprentice to get me a sterile glove.  Mama was now laying on the mat on the floor, cervix visible at the introitus.  I didn’t feel like waiting for the sterile glove, so I felt, externally, through her abdomen for the firm mass of her uterus and found it easily.  I held it firmly and pulled/pressed it up toward her ribcage, pulling the cervix along with it, up inside her vagina and back where it should be.  Just then, my apprentice returned with the gloves.  I quickly traded my soiled gloves for sterile and did a quick internal exam to confirm that the cervix was indeed in the proper position.  Then I checked and re-checked her uterus for firmness and position.  It stayed normal.  Bleeding normal.  I assured the mother that everything I was seeing was normal and all good signs.  

After many minutes had passed and all signs were good, we had her slowly and gently sit up, then kneel, then climb onto a waiting office chair with wheels.  We wheeled her to her bed and put her in it, with hips propped a couple inches so gravity would help keep her uterus where it should be, and reunited her with baby for more nursing.  

Hours later, with everyone fed and watered, mother assessed and re-assessed, newborn exam complete, repair of second degree laceration complete, mom and baby tucked safely into bed, I got back into my car and drove home, peeking between the blobs of mud on the windshield.

Another busy day, another successful homebirth.  I arrived home after midnight again, sterilized instruments, started a load of laundry, showered and fell into bed.  

...This work can be messy, but it is what I am called to do.  Someday I'll have time to get my car washed, but for now it remains muddy.

Anemia of Pregnancy and Ferrous Iron Supplements (part 3 of 3)

Welcome back for the final episode in this three part series on Anemia of Pregnancy.  We began by talking about how our bodies make an extra three to four quarts of blood during the first 30 weeks of pregnancy, and how that naturally results in mid-pregnancy anemia for many women.  We talked about boosting iron levels using food and herbal iron supplements.  Last week we talked about using exercise to stimulate hemoglobin production.  This week we will discuss some supplements to avoid and why they are not helpful.

Sometimes women transfer to my care after several visits with a physician.  Inevitably, they have been prescribed iron pills to cure their Anemia of Pregnancy.  These prescription or over-the-counter pills contain ferrous sources of iron.  Just look at the label.  You will find ferrous sulfate or ferrous gluconate or many 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 have already been taking ferrous iron and you are constipated, follow these steps to get your bowel moving!  You don’t want those toxins to be re-absorbed into your bloodstream, you want to move them OUT!

• Stop taking the ferrous iron!  If you are anemic, see part 1 for the list of iron-rich foods that you should be eating every day.  If you must have an iron supplement, choose from the natural supplements listed in part 1.
• Increase clear water intake to three quarts per day (not counting teas, soups or other liquids).
• Make sure you are eating a minimum of a large salad with dark leafy greens every day, plus three raw fruits or vegetables.  
• Do a minimum of 20 minutes of brisk walking per day.  This is to get your bowel moving, not just for raising the hemoglobin (see part 2).
• If you are still constipated, you can use magnesium to temporarily get things moving - but you MUST continue to do the steps above or you will return to constipation in the end.  Get some magnesium tablets or powder (like Natural Calm).  Take one tablet (or ½ t powder) at bedtime the first night.  You should have a bowel movement the next morning.  If not, increase the magnesium by one tablet (or ½ t powder) per night until you have a bowel movement first thing in the morning.  Use that dosage for a week, then slowly decrease the magnesium over the next week or two until you are not taking any.  If you ever have a random day of constipation in the future, you can quickly remedy it with magnesium.  WARNING: Magnesium works by slightly irritating the lining of the bowel, causing the body to flood water backwards through the system (from bloodstream to bowel, the reverse of the way it is supposed to flow).  This robs your body of water and can cause dehydration.  Do not take magnesium unless you are drinking at least  three quarts of water each day.

I hope you have enjoyed learning about Anemia of Pregnancy over these past three weeks!  In summary, a drop in hemoglobin in early to mid-pregnancy is a good sign the blood volume is expanding as it should.  It is not an illness or disease.  You can support your body as it builds the extra three to four quarts of blood by eating a diet high in organic iron-rich foods.  If you need an iron supplement, choose one containing organic plant-based natural iron sources instead of the rust found in ferrous sources of iron.  Go for a brisk walk at least twice a week.  By the third trimester, your blood volume will be expanded  to just the right amount and your hemoglobin reading will show that you are not anemic.  This will lead to a healthier baby and an easier labor, birth and postpartum.

Blessings!

:) Deborah

Anemia of Pregnancy and Exercise (part 2 of 3)

Welcome back to our three-part discussion about anemia of pregnancy.  Last week we talked about the natural expansion of blood volume, anemia, hemoglobin, iron-rich foods and supplements.

In addition to increasing iron-rich foods in your diet and taking herbal iron supplements, you can also boost your hemoglobin with exercise.

Now, I am NOT the exercise police!  I am a couch potato.  I don’t enjoy exercising.  I don’t even like thinking about exercising.  

Studies show that only 20 minutes of exercise twice a week results in an increase in hemoglobin!  This information that gets me off the couch and moving!  The exercise must be enough to get you breathing heavy.  When your muscles need more oxygen to work, the body responds by increasing the heart rate and breathing to supply more oxygen more quickly.  But the body doesn’t want to work that hard, so it also builds more hemoglobin so the next time you exercise it doesn’t have to raise the heart rate and respiration rate as much.  Amazing!  This is why when you first begin to exercise you are exhausted very quickly, but after a couple weeks of regular exercise you can do so much more with ease.  Your body has increased the hemoglobin to carry oxygen to the body more quickly and efficiently.

Swimming is also a fantastic exercise to raise your hemoglobin! It is easy on your body and fun to do.  When swimming make sure to only do the freestyle or breaststroke, if you’re feeling adventurous you can do the butterfly, but that stroke is hard enough when you’re not pregnant! Avoid scuba-diving because the pressure changes can be too much for the bag of water to withstand.  Doing any inverted underwater moves, like handstands or somersaults, has been shown to cause baby to flip to breech, so I would avoid that as well (unless your baby is breech already and you want to turn him back to head-down!)  Also, make sure to drink plenty of water after any sort of exercise to keep you and baby hydrated!

Another great effect of exercise and the resulting hemoglobin increase is that labor will be easier.  Oxygen will be more abundantly supplied to your uterus (a large muscle doing a lot of work) and your baby!  This means the baby will fare better during labor, your contractions will hurt less and your birth will be easier.

Hopefully this information will inspire you to get out a walk today.  At a minimum, walk briskly away from home for 10 minutes, then turn around and walk briskly back.  That’s all it takes to signal your body to build more hemoglobin.

I’ll meet you back here next week when we will discuss iron supplements to avoid during pregnancy and why.

I’m going for a walk now!

Blessings!

:) Deborah