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Could I Be Pregnant?

May 21, 2012 By judith lothian Leave a Comment

By Judith A. Lothian, RN, PhD, LCCE, FACCE, and Charlotte De Vries

Adapted from The Offical Lamaze Guide: Giving Birth with Confidence

Early on in pregnancy, symptoms can be subtle. Is it a missed period? Does your belly just feel sort of “busy?” Or have you been a little more emotional lately? Eventually, you ask yourself, “Could I be pregnant?”

Many women pick up on an early sign of pregnancy before they head to the clinic or the drugstore for a test. They simply know by observing their bodies closely and noticing that something is different. It’s just the first of the many opportunities that pregnancy offers you to be mindful and pay close attention to your body, your environment and your instincts.

During early pregnancy, symptoms you experience are your body’s way of alerting you to the drama that is happening inside. From the very moment of conception (when egg and sperm join), your body undergoes an avalanche of change in a very short time. Even before the embryo (what your baby is called through 8 weeks gestation) implants in your uterus, HCG (human chorionic gonadotropin, the hormone detected by pregnancy tests) levels rise. This is the beginning of hormonal changes that continue through out pregnancy and breastfeeding. These shifts, and your growing baby, change your body in amazing ways.

Take a quiet moment to stand before the mirror after a bath and you might note some changes in your breasts: They might be darker or bigger; your nipples may be bumpier; there could be some blood vessels you don’t remember seeing before; or you may feel a tenderness or heaviness. This early sign of pregnancy is the first of many developments your breasts will make in preparation for milk production.

Of all the pregnancy symptoms, nausea can be the most unpleasant. It varies from woman to woman, and you may be experiencing “morning sickness” when you wake up, at mealtimes or more often throughout the day. Eat and drink whatever you think might help you deal with it. Try small, regular snacks that seem comforting and digestible, and take note of what goes down easily. For many women it’s carbohydrates.

Research shows that about two-thirds of all pregnant women have some nausea, and it may actually serve an important purpose: protecting mother and baby from harmful chemicals and food-borne illness. Certain foods are common triggers for pregnancy nausea. Many expectant mothers feel sick when they consume or smell eggs, poultry, fish, meat, alcohol or caffeinated drinks. Your body might perceive these items as threats to the embryo, which hasn’t finished making a good, strong attachment. In the same way, your body might crave certain foods because it needs those nutrients.

The first weeks of pregnancy are a time of deep tiredness for lots of women. One remembers wanting to crawl under her desk at work for 10 a.m. naps. “Those mornings, I’d long to curl up and sleep – just out of the blue,” she recalls. “It suddenly occurred to me that I’d never needed to sleep like that! That was my first real attention-grabber.” Since her periods had never really been regular, tiredness was the first sign that she should look for changes in her body.

Some women’s emotions send strong signals. You might find yourself snapping back in reply to a casual comment or crying over some small matter. This sensitivity is a message from your baby: “Listen up! We’ve got work to do together, and I need your attention.”

Your body’s signals are valuable as information suppliers and bond builders, whether it is an early sign of pregnancy or at the start of labor. Learning to read those pregnancy symptoms is the first of many intuitive developments you will make throughout your pregnancy and into motherhood. “[It’s] not necessarily an automatic process of nature,” says Pam England, CNM, MA, author of Birthing from Within(Partera Press) “If you want this to happen, you’ll have to play an active part.” So listen and respond to your baby’s message. The bond you will have with your childhas already begun to form. It is only the start of a lifetime of conversation and learning together.

Filed Under Early pregnancy, Featured Story, Pregnancy Tagged With conception

Labor Day: Your Step-by-Step Guide to Birth

August 26, 2011 By judith lothian 4 Comments

Think of this as your “childbirth manual,” a step-by-step guide to prepare you for what lies ahead. We’ve divided the process into stages to describe the typical changes that occur as labor progresses. The first stage encompasses the very beginning of labor, when contractions begin, all the way through active labor, when your cervix is almost fully dilated. The second stage covers transition, when your body shifts from dilating to pushing, and the movement of your baby through the birth canal and into the world. Finally, there’s the third stage, when all of your hard work is done and your body begins to recover. You will most likely move from one stage to another fairly seamlessly. Although every labor and childbirth is unique—yours will unfold in its own way—the process is remarkably constant. Trust that your body will know just what to do.

 

STAGE ONE

Prodomal LaborProdomal Labor

What’s Happening

  • The cervix begins to soften, thin and move forward, and it may begin to open. The baby settles into the pelvis.
  • At this point of childbirth, contractions may be noticeable as an achy sensation or as pressure in the lower abdomen or back. Contractions in this phase are usually irregular—starting and stopping; sometimes strong, sometimes mild. This is your body’s natural way of gearing up.
  • This phase can last from a few hours to a few days.

What Helps

  • Don’t worry whether or not this is really labor. For the vast majority, labor eventually makes itself very clear.
  • Try to be patient and have confidence that your body is doing exactly what it needs to do.
  • Take good care of yourself. Eat, drink plenty of fluids, and rest or take a walk.
  • Surround yourself with people that help you feel comfortable and safe. Your support team can keep you company and provide reassurance.

Early Labor (Latent Phase)

What’s Happening

  • The cervix continues to thin out and open, dilating to 3 or 4 centimeters.
  • Labor is meant to be gradual, so this phase may take quite a while—usually about two-thirds of the total labor time. Over a period of several hours, contractions will become longer, stronger and more regular (about 5 minutes apart, each one lasting 25 to 45 seconds).
  • A pinkish vaginal discharge (called “show”) usually increases as labor progresses.

What Helps

  • It can be hard to believe that this is it. Take time to settle down and work with the labor.
  • Once again, the best thing to do is to take care of yourself. Alternate rest and activity (for instance, take a nice walk followed by a relaxing shower), eat easily digested foods and drink plenty of fluids.
  • Many women find that the best place to be during this phase of childbirth is at home, where you can move about and do things for yourself.
  • When contractions become so strong that you can no longer talk yourself through them, try using relaxation and breathing strategies. Your support people should be nearby, helping you to stay calm and confident.
  • Keep the environment pleasant—perhaps listen to music, ask your partner for a shoulder massage or prepare the baby’s room.

Active Labor

What’s Happening

  • Contractions continue to become longer and stronger, until they’re eventually about 3 minutes apart and last for about a minute or more.
  • During this phase, which generally takes from 2 to 6 hours, the cervix effaces and dilates to about 8 centimeters.
  • Women in active labor usually get very focused as the hard work begins.

What Helps

  • Now labor has real momentum. Listen to your body and develop a rhythm with it.
  • Do something active during the contractions, such as breathing in a pattern or moving around, and rest between contractions.
  • As the strength of the contractions increases, so does your need for support. All present should focus their attention on you.
  • Changing positions frequently not only helps you stay more comfortable, but also enhances progress.
  • The environment can influence your labor. Make it peaceful and personalize it
    with music and dim lights.

Transition

Transition

What’s Happening

  • The cervix finishes dilating and effacing.
  • Contractions are now powerful and efficient, so this phase is usually quite short (less than an hour).
  • Some women feel nauseous, shaky, restless or irritable during this phase of childbirth.

What Helps

  • To keep from feeling overwhelmed, focus on one contraction at a time.
  • Continue with breathing, vocalization (if it helps) and rhythmic movement.
  • Even though rest periods are short, they allow you to relax deeply and restore yourself.
  • Those providing labor support should offer close undivided attention, unwavering encouragement and praise. If you’re using a breathing pattern, your team should try “conducting” to help you focus or moving with you in rhythm to your breathing.

Birth

What’s Happening

  • Your body shifts from dilating to pushing.
  • The baby makes his way down through the pelvis and birth canalBirth.
  • This phase can last from 15 minutes to several hours.
  • Although it may take several contractions after full dilation to be noticeable, most women get an urge to bear down. Your body is giving you clear instructions on what to do. The urge to push usually gets stronger as the baby descends.
  • Many women feel more clearheaded and have a renewed sense of optimism when pushing begins.
  • Just before the baby is born, you may feel a burning, stinging, stretching sensation at the vaginal opening: A sure sign that you’re almost there!
  • As the baby’s head emerges, it turns to one side to allow the shoulders to align and then the rest of his body slips outs.

What Helps

  • The urge to push usually feels strongest at the peak of the contractions and then fades toward the end. Just follow along and do what feels right. For most women, this means taking normal breaths as the contractions build and then pushing when it becomes irresistible.
  • It may help to make sounds (much like athletes do) in response to what you’re feeling.
  • Labor supporters should provide quiet, reassuring encouragement. There’s no need for yelling.
  • If progress is slow, change positions. Squatting, all-fours and side-lying are all good options.
  • Let go of any tension in your perineum. Applying warm compresses there may help you push.
  • Rest deeply between contractions.

Recovery
What’s Happening

  • The cord is cut, and your baby is quickly dried and placed on your abdomen.
  • What a mix of feelings—excitement, joy, awe, and relief!
  • The placenta is delivered, usually within the first 10 minutes.
  • Your health-care provider will make sure you are comfortable. Cold compresses are often applied to the perineum to ease discomfort and reduce swelling.
  • Many women get after-pains or “the shakes” after childbirth.

What Helps

  • Touch, caress and cuddle your baby without time constraints. Keep him skin-to-skin with you from the moment of birth.
  • This is a good time for your first breastfeeding, which tightens the uterus and decreases bleeding.
  • All routine infant procedures can be done without removing the baby from your side. Request that measuring, weighing and applying eye medication be delayed for a few hours.
Filed Under All Recent Articles, Birth, Labor Tagged With Birth, early labor, Labor, prodomal labor, stages of labor, transition

Key Tips to Keep Breastfeeding Simple

December 28, 2010 By judith lothian 4 Comments

Nursing is natural, but it helps to learn as much possible before you start.

Nursing is a natural and simple way to provide nutrients to your newborn. Nature intended your baby to drink breast milk, and your body is perfectly designed to produce it. During pregnancy your body has been preparing for breastfeeding, and colostrum (early breast milk) will be ready and waiting. Right from birth your baby is able to let you know when he is hungry, to attach to the breast, and to suck, swallow and digest milk that meets his specific nutritional needs.

So how does it work? Your baby’s sucking at the breast stimulates milk production, so the more he nurses, the more milk will be available to him. Pacifiers and formula supplements will interfere with this process, especially in the early weeks. Your baby should nurse at least eight to 12 times in 24 hours during the first weeks. (The exception to this is the first 24 hours after birth, when many babies sleep more.) He may nurse in clusters, rather than every 2 hours, and he should nurse until he’s satisfied. This ensures that he receives your hind milk, which is rich in fat and calories. Limiting nursing to 5 or 10 minutes on each side deprives your baby of this important and nutritious food. Let baby finish the first breast before offering the second. Watch your baby, not the clock.

Contrary to what you may have heard, you do not need to drink large amounts of fluid or avoid certain foods* when you’re breastfeeding. Eat and drink to satisfy your thirst and your appetite, but aim to take in about 500 additional calories per day, for a total of about 2,700 calories daily (discuss your personal nutritional needs with your doctor). Most women find nursing helps shed some pregnancy pounds since it burns between 600 and 800 calories a day.

Your baby will let you know when he is ready to nurse, lastly by crying but first with a number of early feeding cues: rapid eye movements under the eyelids, an imitation of sucking, hand-to-mouth gestures and small sounds. If you wait until your baby cries, it may be difficult to help him settle down enough to latch on properly. Keep your baby close, and you’ll learn to spot his hunger cues.

Latching On
It’s instinctual for a newborn to attach to the breast. Studies have shown that a baby placed skin-to-skin on his mother’s chest right after birth can crawl to the breast and latch on. If you hold your baby in the traditional cradle position, he’ll be able to latch on properly when his head is level with your breast, aligned with his body, and he is facing you. You should not have to lean toward him, and he should not have to reach toward you to attach. Wait for your baby to open his mouth wide so that he attaches to the areola, not just the nipple.

Another option is the football hold, where your baby is tucked by your side. Hold him on his side, his nose to your nipple. Place your arm along his back, supporting his shoulders and neck with your fingers and thumb behind his ears. Don’t hold the back of his head; he will instinctively throw it back as he latches on. Be patient and let your baby lead you; don’t rush him or pressure yourself. Remember, he knows how to do this.

As he sucks, watch and listen for his swallowing. This is the ultimate assurance that he is getting milk. Your baby will let you know when he is finished by unlatching or falling asleep; he may not want to nurse on the other breast. If he doesn’t, it will feel full when he is ready to nurse again, so start with that side.

If you pay attention to your baby’s feeding cues, nurse him often and allow him to nurse until he is finished, you can be sure he is getting enough milk. Look for these signs:

  • You will notice the change in his sucking: bursts of sucking will be followed by a pause as he swallows. You can also see the neck muscles move as he swallows milk.
  • The color of his stool will change from the dark meconium to mustard yellow by day four if he’s getting enough milk. By day six, your baby should have at least six wet diapers and three or more bowel movements in a 24-hour period.
  • Your baby should be gaining weight, although it may take 2 to 3 weeks for him to regain his birth weight.

Some babies take a few days or even weeks to breastfeed effortlessly. If yours is not nursing frequently, you are unable to identify swallowing or he is not producing enough wet diapers and bowel movements, contact your health care provider or lactation consultant immediately. Also, keep in mind that it’s common to experience some discomfort during the first few minutes of breastfeeding. However, your nipples shouldn’t hurt throughout the entire feeding. If they do, it’s likely that your baby isn’t latching on properly. If your baby is latched correctly and you’re still experiencing pain after a few minutes, you should seek help. Most breastfeeding problems have simple solutions, but it’s important to get help sooner rather than later. Many pediatricians and hospitals have lactation consultants on staff – and may conduct regular breastfeeding classes. Your local department of health may also have a referral service.

You and your baby were made to breastfeed. Have confidence in yourself and your baby’s ability, and treasure this natural bonding time.

*Alcohol and many prescription and non-prescription drugs pass through your breastmilk to your baby. Consult your health care provider or lactation consultant for information on what is safe. Some women have reported that certain foods they consume cause their babies to have increased gas. If you suspect that is the case, discuss it with your pediatrician or a lactation consultant.

Filed Under All Recent Articles, Breastfeeding Tagged With breastfeeding

The Mother Lode of Pain: Getting It All Wrong at the Boston Globe

July 28, 2010 By judith lothian 5 Comments

This post was published in 2006 on the original Giving Birth with Confidence blog. It provides concrete information on the role of pain in labor and shares a beautiful analogy that describes why women would want to experience childbirth fully.

Dr. Darshak Sanghavi author of “The Mother Lode of Pain,” the cover story of the Boston Globe Magazine on July 23, 2006, skims the surface of historical and empirical research and presents us with the most biased and inaccurate story I have read in many years.

At the center of the story is Dr. Sanghvi’s belief that choosing to feel pain in labor is “odd.” “Especially when there is effective, safe, and available pain relief.” He suggests that women who choose to have a normal, natural birth and experience the pain that accompanies labor and birth are “attracting notice”, “setting up an artificial trial that precedes entry into a highly selective sorority”. He goes on to say “It creates drama. It captures attention”.  His most shocking, and utterly ridiculous statement is “…reliance on pain to create meaning during childbirth indicates a constricted imagination.”

If Dr. Sanghavi had actually done a serious rather than a superficial review of the literature including consulting the Cochrane Library for the most current research and recommendations for maternity care he would have discovered that pain during labor and birth is not “an utterly primitive thing” but plays an incredibly important role.

Pain early in labor lets women know they are in labor. And as oxytocin levels rise, the uterus contracts more effectively to dilate and efface the cervix, and the pain increases. Women respond to the pain they are feeling by trying to find comfort in a wide variety of ways (if allowed any degree of freedom). They moan, change position, walk, sit in a tub of water, are massaged, eat and drink, sing, listen to music. The list is endless. The key is that each woman in labor manages her pain in unique ways that work for her. What she is feeling guides her to finding just the right thing to do. Eventually endorphins kick in and the result is that women go into a dream-like, highly intuitive state and that helps them manage the pain of contractions too. Without pain there is not the same kind of endorphin release. Not surprisingly, if pain is eliminated (with an epidural) naturally occurring oxytocin is not released in increasing amounts. The normal, natural process of birth has been interfered with and there is a need for medical interventions…starting with pitocin. Being able to manage the pain of labor actually helps labor progress by insuring high levels of oxytocin and also by encouraging the mother to move helping baby to settle into and move through the pelvis. Pain is also protective especially during second stage as the baby moves through the pelvis and is born. Women who do not have an epidural respond to what they are feeling at this stage by changing position, and tensing and releasing vaginal and pelvic floor muscles, and in that process protect the birth canal, the perineum and the baby. Pain promotes the progress of labor, protects mother and baby, and helps women find comfort. It is not an unnecessary side effect and eliminating it completely alters the course of labor and sets the stage for interventions and complications.

Women choose to experience (and manage) the pain of labor because it makes birth safer for them and for their babies. At the end of the day the reward for that hard, sacred work are feelings of elation, even ecstasy. And a baby that is alert, competent, and able to nurse easily and well right from the get go. If Dr. Sanghavi had more than a rudimentary knowledge of the process of normal birth and the important role pain plays in that process he might not think the way he does.

As I write this I am looking out the window to the sea in rural Ireland. Later today I will walk down a small lane through farmers’ fields to a little cove to swim. I could get there a lot quicker if I drove it and since the walk back up that lane is very steep in several spots driving would be so much easier. And it takes so much time to walk. The swim would be the same. I would be relaxed and refreshed at the end of my outing. But this is what I would have missed. Feeling the sun and the wind on my face. The sense of well being as I walk, slowly and them more rapidly, getting into a rhythm. Stopping to pick wild flowers (not part of the plan at the start). Picking and eating a few blackberries from the bushes that line the lane. Watching a boat on the sea and wondering what it is doing. Stopping to watch a calf nursing. Smelling the honeysuckle. Chatting with a farmer friend who is moving his cattle from one field to another. And on the way home, up that steep hill, changing the way I walk, slowing up, sweating with the exertion, taking breaks, noticing the blueness of the sky, delighting in how good the wind feels blowing my hair, stopping again to talk, now about how cold the sea was, how fine the day is. Taking gulps of icy water. Eating part of a chocolate bar. Daydreaming. Shaking my legs as they resist the climb. I arrive home refreshed, relaxed and tired. The swim happened. But so much more did too. And therefore the meaning of this lovely afternoon is totally different. I wonder if Dr. Sanghavi thinks that my decision to walk not ride to my little cove is odd and indicates a constricted imagination?

And what if I had not been permitted to eat and drink on my walk, what if I had been tethered to an intravenous and continuous monitoring (just in case I slipped and fell and broke my ankle), what if my pulse was taken every few minutes to make sure I wasn’t too stressed? What if I had to do it all in great haste? That walk would most certainly have lost its allure. In fact instead of a delightful challenge it would become a misery. The ride in the car would seem reasonable!  Like medication in labor — safe, effective and available?

I am irate that thousands of women will read an article that perpetuates the myths that pain in labor serves no purpose and that working hard in labor is “odd.”

Filed Under All Recent Articles, Birth, Coping with pain, Healthy Birth Practice, Labor

Birth: A Family Celebration

May 3, 2010 By judith lothian 1 Comment

This post was originally published on March 24, 2007.

My daughter Mary gave birth last week to her fifth daughter and our eighth grandchild. Baby Claire was born at home on Sunday morning, the day after St. Patrick’s Day, and 36 hours after an unexpected ice and snow storm in New York City.

Mary started having strong but irregular contractions early Sunday morning. Her midwife and I arrived around 4 am. Mary paced the floors for several hours with no change in the contractions. At 8:30 she got into bed and slept for an hour. The life of Mary’s little family went on. I made hot chocolate, we ate breakfast, the little girls (all four of them) were terribly excited. There was endless chatter about the soon to be born baby. Cate, who is 2, insisted on wearing a “party dress” and “party shoes”. It was peaceful and beautiful: sun shining, drifts of snow in the garden, returning birds clamoring to be first in line at the bird feeder. The champagne was waiting. The refrigerator was overflowing. The laundry done. Everyone knew this was a special day.

Mary woke after an hour with super strong contractions and worked hard for 30 minutes, then she vomited twice, the second time simultaneously pushing her baby into the world. Eight year old Nora noticed as the baby’s head emerged that “her little hand was next to her face”. It all happened so fast!

The little girls surrounded their mother and the new baby delighting in every detail– the little ears, the eyes, her hair, her tiny toes, long fingers and big feet, her sweet mouth. Claire was vigorously nursing 3 minutes after the birth and the big sisters moved in close to watch her. They felt the still pulsing cord and noted rather indifferently the placenta when it emerged 30 minutes later. Shortly after the birth Cate asked “Party bags, Nanie??” Of course party bags…today is most definitely a birthday party. Nora noticed how dirty her mother’s feet were (all that pacing) and quietly set about washing them, and then massaging them with lotion. Each of the little girls attended their mother and their new sister in ways that were special and spontaneous. I helped them dress Claire…Nora diapered, Cate put the little hat on, Molly put the tiny undershirt on, and Maggie was in charge of the sweet pink outfit. Life moved effortlessly on: a trip to the store to buy candy and treats for those “party bags”, making lunch, champagne, helping Mary into the shower and changing the sheets. The difference between even the most family centered hospital birth and this birth was monumental.

My nursing students had a hard time with the idea of children at birth. If all I knew was medical birth in a typical American hospital I might feel the same way. Hospital birth is scary. But normal birth is not medical birth, and birth at home is not scary. Normal birth is a family celebration.

Photo by Spigoo.

Filed Under All Recent Articles, Birth

Breastfeed: Be a Star!

April 22, 2010 By judith lothian 3 Comments

This post was originally published on April 20, 2008.

You must visit the U.K. Breastfeed: Be a Star website. On the home page a beautiful, glamorous woman is nursing her baby. On one side of them, the words “She’s Not a Pop Idol, She’s a Star” and on the other side, “Breastfeed: Be a Star.”

The Be a Star campaign is dedicated to increasing the number of young mothers in Lancashire, England who choose to breastfeed. “We hope to do this by showcasing the beauty, confidence and pride that comes with breastfeeding, as well as providing breastfeeding information and support and highlighting the unique health benefits that it brings to both baby and mum”.

I love this campaign. The message? Breastfeeding is not drudgery. Breastfeeding mothers are special, attractive, even glamorous. This is marketing breastfeeding in a powerful, hard to resist way. Campaigns to increase breastfeeding rates that focus on the benefits of breastfeeding for mother and baby, or the risks of not breastfeeding have been only marginally effective. This creative, fun campaign gets across all the same information but let’s women know that choosing to breastfeed lifts them to a whole new place: stardom. Truth in advertising at its best!

Filed Under All Recent Articles, Breastfeeding