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Tanning and Pregnancy: What Is Considered Safe?

May 16, 2012 By Cara Terreri Leave a Comment

By Lori J. Wolfe, MS. CGC, OTIS President

Recently while having lunch at my favorite restaurant, I overheard a conversation at the table behind me. A very pregnant lady was discussing with her friend how she was going to get tan. “Now that it is the month of May, I want to get a head start on my tan,” she was saying. They began discussing her options; tanning booths, professional spray tans, tan at home lotions, tanning pills, or laying out in the sun. What would be best and safe during a pregnancy? Well, usually I don’t jump into other people’s conversations, but I just couldn’t help myself. Being that counseling about exposures and associated risks during pregnancy is my job, I felt I just had to give her a little educated advice!

I turned around, introduced myself, learned that her name was Sally, and began discussing the options. The use of tanning booths during pregnancy can be done, but you need to take a few safety precautions. We are always worried about over-heating during pregnancy. This is called hyperthermia. When you are in a tanning booth, it is easy for your body to become over heated if the booth is not well ventilated and/or you stay in the booth for too long of a time period. The ultraviolet rays that are used in the tanning booths do not get to the baby, so that is not the problem. But if you are in the tanning booth for more than 10 to 15 minutes, your body temperature might get too high. So be sure the booth has good ventilation and limit your tanning session to no more than 15 minutes.  Also when using tanning salons and their tanning beds, please be sure to check and see how clean everything is. We do not want you laying down in dirty beds and perhaps picking up some nasty germs!

At this point Sally asked me about the use of self-tanning products, either done professionally or at home. Self-tanning products come as sprays, lotions or gels, and can be applied at home or in a salon. The main active ingredient in self-tanners is something called DHA or dihydroxyacetone. The amount of DHA can vary from 3 to 5% in products you use at home, or up to 15% in products used by professionals. We do know that only a very small amount of the DHA that is applied to your skin will be absorbed into your bloodstream. Therefore, there would be very little in your system to get to the baby. Since we do not have much information about DHA and pregnancy, we do want you to be careful to not get the self-tanning products into your eyes, nose or mouth.

“Hmm, I have heard about tanning pills,” Sally asked me. “What are those and can I use them while I am pregnant?” Tanning pills can be bought over-the-counter and contain something called canthaxathin as the ingredient that changes the color of your skin. Unfortunately we do not have any studies that have looked at taking large amounts of canthaxathin during pregnancy, and we know that you need to use a lot to change the color of your skin. Therefore, it is best to avoid the use of tanning pills when you are pregnant.

“OK,” Sally said, what if I just want to lay out in the sun and get tan the old fashioned way.” I let her know that our main worry with laying out in the sun would be the same as using tanning booths, hyperthermia or overheating. If you do chose to tan outside, be sure to use a good sunscreen product, drink lots of water, and limit your sessions to 30 minutes or less. Be sure that you are cooling off frequently if you are outside for a long period of time. If you follow these good-sense guidelines, you can gradually build up a nice tan, even when you are pregnant.

At this point, Sally thanked me, paid her bill and left the restaurant. I let her know that if she or her friends had any questions about exposures during pregnancy, they can call OTIS, the Organization of Teratology Information Specialists at 866-626-6847 or visit our website at otispregnancy.org.

**Lori Wolfe, MS, is a board-certified genetic counselor and the president of OTIS. She is also the director of OTIS’ Texas affiliate, the Texas Teratogen Information Service (TTIS), which she founded in 1991. Visit its website at http://www.ttis.unt.edu/. OTIS is a North American non-profit dedicated to providing accurate evidence-based information about exposures during pregnancy and breastfeeding.**

Filed Under Featured Story, Health and well-being, Pregnancy Tagged With tanning during pregnancy

Communicating with Your Care Provider: Are You on the Same Page?

April 25, 2012 By admin Leave a Comment

By Anna Deligio, MSW, Labor Doula, LCCE, Reiki Master

 

First, do no harm.

This instructional value statement is often attributed to different versions of the Hippocratic oath medical doctors take as they embark on their healing careers.  It seems simple enough and certainly it would be easy enough to assume that its interpretation is universal.

We all know what happens to you and me when we assume, though, and to do so within conversations with your medical practitioner can often lead to more than just a need for clarification. Ensuring that a shared understanding exists of the language being used is critical to ensuring that you receive the care that is best for you.

Take the idea of “doing no harm.” Let’s say you’re in active labor and have been going strong for some time without any medicated pain management. You are working through your contractions well but are tired, overwhelmed, and lacking good support. You are starting to feel like you may not be able to continue without medication. The next time your nurse comes in, you say that you’d like to talk about getting an epidural. The nurse alerts anesthesia and soon you are talking with that person about the potential of getting an epidural.

Drawing on what you learned during your pregnancy from your own research and your childbirth preparation class, you know that epidurals can come with increased risks. You ask the anesthesiologist if the epidural will harm your baby. The anesthesiologist gives you a quick and confidant “absolutely not.”

Does that mean that you move forward with the procedure? Not necessarily. First it is important to make sure both of you are operating from the same understanding of “harm.” You might be thinking that “harm” includes the potential for a sleepy baby after the birth and one who may struggle to establish good breast-feeding. The anesthesiologist may be thinking that “harm” means the epidural would kill or permanently damage your baby.  Without clarifying follow-up questions such as “What impact will it have on the baby?” and “How long can I expect that impact to last after the birth?” you are risking approving a procedure that is not in line with your values of birth.

An online search for “tips on communicating with doctors” reveals a theme of writing down questions before the appointment, remembering that you are the consumer, bringing someone with you to appointments, and writing down the answers you get. Added to this needs to be, “ask clarifying questions until you are confident that you and your provider are using the same definitions for words.”

In many childbirth preparation classes, the acronym BRAIN is used to teach participants what questions to ask when faced with a decision. The letters cover the Benefits, Risks, Alternatives, your Intuition, and the potential of doing Nothing and are a way to remember which questions to ask in order to ensure that the procedure undertaken is the one you want.  This model is a wonderful first step, but can still lead to miscommunication if clarification of terms is not established through follow-up questions.

This can be a laborious process and not one you necessarily want to step into during your labor. More the reason to have these conversations during your prenatal visits, write a succinct and clear birth plan, and make sure that you have a support person with you during labor who understands your intent during the birth and can support you in communicating that intent to your medical staff.

Language is wonderful in its ability to convey specific ideas and still leave room for interpretation. While it may be fun to explore the intended meaning behind words when reading a piece of creative writing, it is critical to explore the intended meaning when discussing your care with your medical provider.

Insurance and funding permitting, the ability to pick a provider from the start that shares your values will go a long way in making sure language meaning is shared. That said, you will likely interact with many medical providers during your labor and, like us, each brings his/her own lens, values, histories, and definitions to the conversation.

Practicing asking clarifying questions during your appointments will give you the confidence needed to draw on that tool during your labor with each provider with whom you interact. Each question will get you closer to creating a shared understanding with your providers and build your confidence in your ability to participate actively in the labor you intend to have.

 

Anna Deligio is a Lamaze Certified Childbirth Educator and Labor Doula through her business Nourishing Roots, work that is greatly informed by her previous experiences as an MSW working with families in crisis and babies in foster care, a Special Education teacher of high school students with learning and emotional challenges, a marketing writer, and a waitress at a French restaurant. She loves working with pregnant people and their support people during the transformative time that is pregnancy and birth. When not enjoying the company of pregnant people, she enjoys relaxing with her partner Cathy at their home in Salem, OR.

 

Filed Under Birth, Birth plans, Choosing a care provider, Featured Story, Pregnancy Tagged With birth plan, care provider

Cesarean Awareness Month: Making Your Cesarean Mother-Baby Friendly

April 18, 2012 By admin 3 Comments

April is Cesarean Awareness Month. What should you be aware of? Be aware that a cesarean, while it can be a life-saving procedure for mom and baby, is often prescribed when vaginal birth is a safe and sound option. Be aware that you have options, that you have a right to ask questions, and a right to know your risks. Educating yourself about birth is your best and first defense against an unnecessary cesarean. 

Throughout the month, Giving Birth with Confidence will be posting cesarean resources for moms. We encourage you to add comments with your experience as well as any questions — we will tag cesarean questions and answer them in a subsequent post. For more information and stories this month, check out the International Cesarean Awareness Network Blog.

Making Your Cesarean Mother-Baby Friendly

By Sharon Muza, CD(DONA), BDT(DONA), LCCE, FACCE

You may find yourself headed for a cesarean birth, even when that was not what you planned.  A cesarean might have been in the cards all along for a variety of reasons, or  this change in plans might occur before labor begins, or during labor, when you, your partner and health care providers feel that a cesarean is now the best option.

As a long time birth doula and Lamaze certified CBE, I always encourage my clients and students to plan for a potential cesarean, even though many mothers feel like that outcome is unlikely.  Current cesarean rates in theUnited States tell us that more than 1 in 3 women will give birth by cesarean this year.  Having a simple plan with some wishes that continue to honor the birth of your baby, can go a long way toward making the experience a positive one.

Here are my top tips to make your cesarean birth as mother-baby friendly as possible. Discuss these items in advance with your health care provider to see what is possible in your situation and in your place of birth.

1. If you know you are going to have a cesarean, without an opportunity to labor, discuss with your provider if there is any risk in letting the baby pick his/her birth date and you heading to the hospital when your water breaks or gentle contractions start.  There are many benefits to your body, your baby and future labors if you allow your baby to initiate labor.  There are certain situations that may preclude this from being an option available to you, like placenta previa, where the placenta covers the cervical opening.

2. When the decision is made to have a cesarean, and if time allows, take a moment to talk to your baby.  Let him or her know what will be happening, that you have confidence in your team and your baby and that you will soon be holding him or her in your arms.

3. Walk into the operating room if possible.  It is very empowering to move to the OR under your own steam, if you and the baby are stable.  If you have been laboring without an epidural or the cesarean is planned, anesthesia is usually done in the OR, so you should be able to walk there on your own.

4. Ask for two support people in the operating room with you.  Your partner can be one, of course, and then your doula, family or friend may also be included.  Having two people in the OR means that your partner can go over to greet your baby at the warmer, and you can still have support with you right by your head. If your baby needs immediate transfer to a special care nursery, your partner can go with the baby, without worrying about leaving you alone.

5. Bring in music of your choice that can be played during the birth.  A CD or even an mp3 or smartphone placed on the pillow near your head playing softly can help you remain relaxed and positive.

6. Ask that everyone in the room take a moment to introduce themselves before the surgery begins.  There are several more people than you might expect in the OR during a cesarean birth, and everyone may look the same, all gowned and masked.  It can feel a little more personal to hear the staff introduce themselves and state their job…”I am Mary and I am the baby nurse…” can help you to feel like it is not such an impersonal procedure.

7. If you were waiting to discover the sex of the baby at birth, you can still do that.  The staff and surgeons do not need to announce “boy or girl” but leave that to be discovered by you and your partner.

8. Ask if it is possible to delay cord clamping for even a very short amount of time, if baby is stable.  Even 30 seconds of continued pulsing can provide benefit to your baby.

9. Sometimes, women may feel a bit nauseous during the surgery.  It may be a result of the procedure, or nerves, or unfamiliar sights, sounds and smells.  Consider bringing a little cotton ball or gauze pad with some peppermint oil dabbed on it, in a Ziploc bag.  Peppermint oil can reduced the nauseous feeling and help you to not vomit.  There is medication that can be given to you during the operation, but it may also make you sleepy, so if you can avoid it, that is great.

10. Talk to your baby after s/he has been born.  Ask your partner to tell you what is going on, and what your baby looks like; “Oh, honey, he has the same long fingers as you do…” Talk or sing to your baby, so that your little one can hear your voice as it makes the transition to the outside world.  When your baby is brought over to you, you and your partner can sing happy birthday or a special song that you may have been singing to your baby during pregnancy.

11. Ask that all possible newborn procedures be delayed until after you have returned to your room with your baby and had a chance to breastfeed.  Unless it is critical to have the weight of the baby immediately, this measurement and other procedures, (Vitamin K, eye antibiotic medication, dressing, etc.) may be able to wait until you and your baby have had a good snuggle and a breastfeeding session back in your room.

12. Ask if it is possible to get skin to skin with your baby in the OR, while your incision is being closed.  Prepare for this in advance by having removed or unsnapped your gown, and having just a warm blanket on top of you, ready for the baby.  While the baby may not be able to breastfeed in the OR, while you are on the table, you can certainly have the closeness and skin-to-skin snuggles.  You will always need some support during this time, so make sure that partner knows to keep their hands on the baby for safety.  If you are unable or prefer not to have skin-to-skin in the OR, consider letting your partner have some skin-to-skin time with the baby while sitting next to you.  Wearing a shirt that opens in the front, or even a t-shirt that has been cut a little down the neck will make it easier to slip your naked little one inside their OR gown or scrubs.

13. Ask that your uterus not be exteriorized during the procedure.  Exteriorizing your uterus is when the surgeon moves the uterus out of your body and onto the sterile field for examination and repair.  Studies show that postpartum pain after the surgery is greater when this has occurred and offers no benefits over doing the repair “in situ” (in position).

14. Ask that your uterus be double-layer sutured.  While current research is not clear that this provides any advantage over single-layer suturing, should you wish to attempt a vaginal birth after a cesarean with a subsequent pregnancy, some physicians are more comfortable and supportive of this VBAC attempt if there has been double layer suturing during the repair.

15. When you return to your room and get a chance to spend those first minutes really holding your baby and initiating breastfeeding, try and keep visitors and guests away for just a little bit, so you and your baby can get a chance to get acquainted on the outside.  This time is precious and the fewer distractions the better, to help you and your baby connect and bond.

A cesarean birth, whether expected or unplanned, offers unique challenges and circumstances for you and your baby.  It is helpful to recognize that a cesarean birth is still a birth, and you can prepare in advance by including plans for a birth on your terms, even when it occurs in the operating room.

 

Sharon Muza, CD(DONA), BDT(DONA), LCCE, FACCE is a birth doula, doula trainer and Lamaze certified childbirth educator in Seattle, WA.  Sharon is also the co-leader of the Seattle chapter of the International Cesarean Awareness Network, (ICAN.)  Sharon can be reached through her website, www.newmoonbirth.com, if you would like more information or need some support in planning your birth.

Filed Under Birth, Birth plans, Cesarean, Complications and high risk pregnancies, Featured Story, Pregnancy, Preparing for VBAC Tagged With cesarean, Cesarean Awareness Month

Cesarean Awareness Month: A Woman’s Guide to VBAC

April 9, 2012 By Cara Terreri Leave a Comment

April is Cesarean Awareness Month. What should you be aware of? Be aware that a cesarean, while it can be a life-saving procedure for mom and baby, is often prescribed when vaginal birth is a safe and sound option. Be aware that you have options, that you have a right to ask questions, and a right to know your risks. Educating yourself about birth is your best and first defense against an unnecessary cesarean. 

Throughout the month, Giving Birth with Confidence will be posting cesarean resources for moms. We encourage you to add comments with your experience as well as any questions — we will tag cesarean questions and answer them in a subsequent post. For more information and stories this month, check out theInternational Cesarean Awareness Network Blog.

Nearly two years ago, Lamaze published A Woman’s Guide to VBAC: Navigating the NIH Consensus Recommendations, a guide for women seeking to understand the information, risks, and statistics behind vaginal birth after cesarean. The guide has been an invaluable springboard for women to research their decision on VBAC. We invite you to read the following introduction, click through to each section of the guide, and post your own thoughts, comments, and questions on VBAC. 

A Woman’s Guide to VBAC: Navigating the NIH Consensus Recommendations

In June 2010, a National Institutes of Health (NIH) panel published a Consensus Development Conference Statement on vaginal birth after cesarean (VBAC).

In addition to examining the current evidence related to VBAC and offering recommendations for future research on this topic, the NIH panel concluded that VBAC was a “reasonable option” for most women with a previous cesarean section.

In the context of a current birth climate that can be somewhat hostile toward VBAC, this was an exciting moment for many birth advocates, maternity care providers, and mothers!

But even with all that is included in the NIH Statement on VBAC, it might be difficult for many of us to wade through the information in it and figure out what it means for us and our particular birth options and unique circumstances.

This is where A Woman’s Guide to VBAC comes into play.

A group of maternity care experts and VBAC advocates came together to create A Woman’s Guide to VBAC: Navigating the NIH Consensus Recommendations, a free online resource guide that addresses the most common and pressing questions women may have about their birth choices in what could be called the “post-NIH-Consensus-Recommendations Era.” We hope the guide gives you the tools you need to empower yourself to advocate for you, your baby, and your birth choices!

Sections in A Woman’s Guide to VBAC:

 

The Inspiration for this Project

The concept for this guide was borne out of many things: the timeliness of the NIH panel’s statement on VBAC, the importance of the statement itself, and our personal interest in advocating for women seeking vaginal birth after cesarean.

But we would be remiss if we didn’t acknowledge another source of inspiration for this project: namely, the heartfelt and heartening consumer participation in the NIH Consensus Development Conference on Vaginal Birth After Cesarean.

As women who were lucky enough to attend the NIH Consensus Conference on VBAC in person (Kristen) or view the entire proceedings in real time by webcast (Amy), we can say with some certainty that consumers — that is, the mothers, doulas, midwives, nurses, doctors, and other birth advocates who traveled from near and far and volunteered their time to attend — played a big role in this conference!

We listened, we read, we talked with one another, we got the word out to women who couldn’t participate in the meeting, and we asked some of the most incisive questions of the entire conference proceedings.

Quite simply, we made a difference.

This guide is dedicated to those consumers—and to all of us who are maternity care consumers, whether we are currently pregnant, have been pregnant, or simply work and advocate on behalf of pregnant women.

What exactly is a National Institutes of Health Consensus Development Statement?

This statement is the product of an NIH Consensus Development Conference. These two-and-a-half day conferences—which are free and open to the public—are organized by the NIH to address issues in medicine that are both controversial and pertinent to health care providers and the general public.

During the NIH Consensus Development Conference on VBAC, an independent panel listened to presentations given by invited expert speakers.  The panel also heard input from members of the general public during Q&A sessions. Finally, drawing upon the conference proceedings and upon a systematic review of the evidence on VBAC, the panel drafted their statement on VBAC.

Like all Consensus Development Statements, the statement on VBAC is not legally binding. It does not create practice guidelines, nor does it establish any health policies. Nonetheless, it is still an exceedingly important document. In fact, because of the high-quality evidence that the NIH panel uses to create consensus development statements, the NIH claims that it is “reasonable to expect that the panel will be able to give clinical guidance” to care providers.


Filed Under A Woman's Guide to VBAC, Birth, Complications and high risk pregnancies, Featured Story, Pregnancy, Preparing for VBAC Tagged With VBAC

Skincare Products & Mercury: Understanding Labels to Protect Your Baby

April 6, 2012 By Cara Terreri 1 Comment

By Sonia Alvarado, CTIS Pregnancy Health Information Line Counselor

What do you know about the safety of the cosmetics you use on your face and body every day? I’m not talking just about foundation and lipstick, but face cream, body lotion, stretch mark cream, skin lighteners, shampoo, and conditioner? Do you read — or understand – the labels on all of the products that you buy? What about the skincare products that you get as gifts?

 

On March 6, the FDA issued a press release alerting consumers and retailers about mercury poisoning/toxicity in women and in some cases, the entire family, as a result of exposure through skin lightening creams that were sold in the U.S. but manufactured outside of the country. A search of the medical literature found reports of mercury toxicity related to creams/lotions manufactured in Mexico and China, although the FDA site reports that these products have also been sold illegally in the United States in shops found in Latino, Asian, African or Middle Eastern neighborhoods. Online shops have no borders, so the possibility of purchasing a tainted product may be higher.

 

Mercury is divided into three types – elemental, inorganic, and organic. Organic is the kind that you find polluting streams and fish (methyl mercury).

 

Inorganic mercury is the type found primarily in batteries. It’s also been reported in some disinfectants, health/homeopathic remedies, and skin and acne creams and lighteners (illegally). Inorganic mercury can be labeled as mercuric chloride, mercuric acetate, and mercuric sulfide. In the case of lotions containing inorganic mercury, not only is the user exposed, but the entire household may be at risk as the lotion is exposed to air, becomes a vapor, and members inhale or ingest it.

 

Exposure to inorganic and organic mercury is a concern for the entire family, including pregnant women. It’s important to understand, however, that each type of mercury has potential risks depending on the route of exposure and the dose. Some forms are more readily available (absorbed into the body) if inhaled and some more available in the body if ingested.

 

Mercury crosses the placenta. High levels in the mom would be expected to produce high levels in the developing embryo or fetus. High levels of exposure in pregnancy have been associated with miscarriage. Studies of high levels of methyl mercury exposure (the kind typically found in fish) have been associated with neurologic disorders in the exposed infants/children (see http://www.otispregnancy.org/files/methylmercury.pdf). Studies of methyl mercury in pregnancy or children are more common than studies of inorganic mercury related to exposure from cosmetics or imported homeopathic remedies, which leaves a gap in our awareness and ability to treat individuals who have been exposed. This also means that it is difficult to know the levels that may be more or less harmful to the developing pregnancy.

 

Symptoms of mercury toxicity in the early stages include nausea, vomiting, and diarrhea. Symptoms of high acute exposure or chronic long-term exposure include kidney problems, gastroenteritis, metallic taste in the mouth, hypotension and shock, rashes, and excessive sweating, as well as others.

 

The FDA advisory reminds us of the importance of reading labels and understanding the potential risks with using hygiene products or cosmetics products (or supplements, herbal remedies, etc.) that are foreign-made. Per the FDA:

  • Check the label of any skin lightening, anti-aging or other skin product you use. If you see the words “mercurous chloride,” “calomel,” “mercuric,” “mercurio,” or “mercury,” stop using the product immediately.
  • If there is no label or no ingredients are listed, do not use the product. Federal law requires that ingredients be listed on the label of any cosmetic or drug.
  • Don’t use products labeled in languages other than English unless English labeling is also provided.
  • If you suspect you have been using a product with mercury, stop using it immediately. Thoroughly wash your hands and any other parts of your body that have come in contact with the product. Contact your health care professional or a medical care clinic for advice.
  • If you have questions, call your health care professional or the Poison Center at 1-800-222-1222; it is open 24 hours a day.
  • Before throwing out a product that may contain mercury, seal it in a plastic bag or leak-proof container. Check with your local environmental, health or solid waste agency for disposal instructions. Some communities have special collections or other options for disposing of household hazardous waste.

Cosmetic products in the U.S.are, unfortunately, not regulated by the FDA. Furthermore, while companies are required to properly label products, the FDA does not pre-approve cosmetic product labeling either. It is illegal to sell misbranded cosmetics in the U.S., but, again, the FDA does not regulate or approve “cosmetic” products.

 

Cosmetics are commonly used during pregnancy and typically a low concern to the pregnancy due to expected low absorption into the bloodstream and therefore low exposure to the pregnancy but it can’t hurt to be cautious and take a second look at the products we are using especially in light of this recent FDA warning.

For more detailed information on cosmetics, please visit the FDA website: http://www.fda.gov/Cosmetics/default.htm

References:

http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm294849.htm

http://www.epa.gov/teach/chem_summ/mercury_inorg_summary.pdf

Mercury exposure among household users and nonusers of skin-lightening creams produced in Mexico – California and Virginia, 2010.

Centers for Disease Control and Prevention (CDC).

MMWR Morb Mortal Wkly Rep. 2012 Jan 20;61(2):33-6.

Sonia Alvarado is a bilingual (Spanish/English) Teratogen Information Specialist with the California Teratogen Information Service (CTIS) Pregnancy Health Information Line, a statewide service that aims to educate women about exposures during pregnancy and breastfeeding. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/lactation via CTIS’ toll-free hotline and email service, she’s provided educational talks regarding pregnancy health in community clinics and high schools over the past decade. In addition, Sonia contributes to the service’s website, develops training materials for new CTIS staff, and is the supervising Teratogen Information Specialist trainer. Sonia attended San Diego State University and has worked in Tuberculosis Control for San Diego County’s Public Health Department. Sonia’s work has also been published through several tuberculosis studies. In her spare time, she loves to volunteer with the March of Dimes as an expert speaker on themes related to pregnancy.

 

CTIS Pregnancy Health Information Line is part of the Organization of Teratology Information Specialists (OTIS), a non-profit with affiliates across North America. California women with questions or concerns about pregnancy exposures can be directed to (800) 532-3749 or by visiting CTISPregnancy.org. Outside of California, please call OTIS counselors at (866) 626-OTIS (6847).

 

 

Filed Under Featured Story, Health and well-being, Medications During Pregnancy, Pregnancy Tagged With mercury, skincare products

When Green Is Not Your Color: Coping with Morning Sickness

March 17, 2012 By Cara Terreri 1 Comment

Happy St. Patrick’s day! Today is the day when people across the globe wear green and make merry. But if you’re one of the many women who experience morning sickness (about half of all do), you likely won’t feel too merry. Morning sickness varies in intensity and length. Some women will experience mild symptoms, like nausea and food aversions, for about 12 weeks, while others may endure more intense symptoms, like vomiting, sometimes lasting throughout pregnancy. While there isn’t anything you can do to cure morning sickness, there are many things you can do to help ease your discomfort and lessen the intensity of nausea.

 

Give in to cravings. Morning sickness often comes with intense cravings to eat “bad” foods, like carbohydrate rich and high fat snacks. If that’s what you crave — give in. Sometimes, those foods do help your stomach feel better temporarily. And some relief is better than none, right?

Eat bland, eat small, and eat often. If you’re not craving anything, but need to eat, try eating very bland, small meals or snacks frequently. Eating often and in small doses helps aid in better digestion and keeps from overloading your stomach, which can lead to more intense nausea.

Electrolytes. If you’re vomiting, you need to counterbalance your loss of fluids. Try small doses of electrolyte enhances fluids. Be aware, however, to check the added sugar content of some electrolyte drinks. High sugar isn’t necessary and may only add to your nausea. (Vitamin Water is sweetened naturally through fruit juice as opposed to Gatorade, which is sweetened with high fructose corn syrup.)

Consider your environment. Food isn’t the only nausea trigger. Warm, stuffy rooms, heavy perfume, and even loud noise can all add to morning sickness.

Have a night cap. If you’re taking prenatal vitamins, they could be adding to your nausea. Consider taking your vitamins before bed and never take them on an empty stomach.

Ginger aid. Ginger has long been known to help ease nausea. It can be taken in many forms — in ginger ale drinks, in pill form, in hard candies, in tea, or by eating the root directly.

Slow to rise. When you wake up in the morning, get out of bed slowly. Getting out of bed too quickly, especially when you’re pregnant can make you feel faint, dizzy, or nauseous. Also, keep some water and a few crackers on your bedside table. Putting food in your stomach before getting out of bed can help quell the nausea.

Alternative therapy. Some women swear by alternative treatment to ease morning sickness, including accupressure, accupuncture, and chiropractic care.

Medication. For women with severe and debilitating nausea, which includes frequent or constant vomiting, prescribed medication may be the answer. Talk with your care provider about your options and any risks that may be involved. If  left untreated, severe vomiting can lead to dehydration, which can cause preterm labor.

 

What did you do to deal with morning sickness?

Filed Under Featured Story, Health and well-being, Medications During Pregnancy, Morning sickness, Pregnancy Tagged With morning sickness

Jessica Simpson Is Right About Birth but Wrong About Lamaze

March 14, 2012 By Cara Terreri Leave a Comment

A very pregnant Jessica Simpson appeared on Monday night’s The Tonight Show with Jay Leno. During her interview, Jessica covered the basic details of her pregnancy, including the surprise of Braxton Hicks contractions, and her relationship with dad-to-be. She also answered questions on her preparation for birth. When asked whether she would be attending a Lamaze class, Simpson replied no — that women in Lamaze classes “get so out of breath.”

While Simpson was likely playing up her signature ditsy humor, she touched on a commonly misunderstood element of Lamaze: breathing. Simpson remarked that women need energy to push and that being “breathless” or “seeing stars” would not be helpful. She’s right — hyperventilating and breathing without focus can be counterproductive to labor and pushing. It depletes a woman’s energy and can raise her adrenaline level, causing exhaustion and anxiety.

Today’s Lamaze classes focus on all elements that make up a healthy, safe birth. Breathing is just one the many suggestions offered to provide focus and increase comfort during labor and birth. The following, excerpted from The Official Lamaze Guide: Giving Birth with Confidence by Judith A. Lothian and Charlotte DeVries, provides an overview of breathing during labor and birth:

Conscious Breathing
Conscious breathing (especially slow breathing) reduces heart rate, anxiety, and pain perception. It works in part because when breathing becomes a focus, other sensations (such as labor pain) move to the edge of your awareness.

Conscious breathing is an especially useful labor tool because it not only keeps you and your baby well oxygenated, it’s also easy to learn and use. It’s naturally rhythmic and easy to incorporate into a ritual. And best of all, breathing is the one coping strategy that can’t be taken away from you—even if you’re stuck in bed attached to an electronic fetal monitor and intravenous fluids.

Conscious (or patterned) breathing used to be the hallmark of Lamaze childbirth education. For many women, it’s still an important way to stay relaxed and stay on top of their contractions. It’s true that conscious breathing can help you relax and feel less pain during contractions.  There’s no “right” way to breathe in labor, despite what others may tell you. Slow, deep breathing helps most women manage the pain of contractions. But the right way for you to breathe is whatever feels right to you. Issues like your number of breaths per minute, breathing through your nose or your mouth, or making sounds (like hee-hee) with your breaths are only important if they make a difference for you.

That last part — “….are only important if they make a difference for you” — is so key. Quality birth preparation, like Lamaze classes, should provide you with several tools in your tool box to be able to choose the best one for the job when the time comes. Labor and birth is such an “in the moment” experience  – you simply cannot predict exactly how you will react until you’re there.

It may help you to have a visual focus to accompany your conscious breathing. You can recall an image with your eyes closed, focus on a picture or special object from home, keep your eyes on your partner, or simply stare at a spot on the wall. You may also find that as labor progresses, faster, shallower breathing—like a dog gently panting—feels better. You’ll figure out what works best for you. And what works best will probably change as you move through labor.

Many women “practice” breathing during pregnancy by using conscious breathing when everyday life presents stressful situations, like being caught in traffic, running late for an important meeting, or worrying about any number of things.

Find Your Rhythm
At some point in labor, you’ll “find your rhythm” or “get in a groove,” much like a marathon runner does. You’ll be living in the moment, doing without thinking.  To others you’ll appear to be in another world. Your movements will be rhythmic; you’ll relax between contractions; you’ll respond to contractions in the same way over and over again, perhaps shaking your arms, rolling your head, breathing slowly, chanting, or praying.

You’ll be totally focused, but you won’t necessarily look comfortable. You’ll look like you’re working very, very hard—which you are. When this happens, you’ll know endorphins are working their magic—dulling your pain and helping you ride your contractions intuitively. You’ll be doing exactly what you need to do. You won’t need to be rescued; in fact, the worst thing that could happen to you at this point is to be disturbed or interrupted. A healthy dose of encouragement, support, and respect are all you’ll need from your support team.

Simpson commented to Leno, “it’s all about being calm [in labor]” — and in a sense, she’s right. Being “calm,” in the way that one feels confident in her ability to birth and in the support from those around her, is key to a positive birth experience. Whether a woman finds her calm through breathing, labor support, meditation techniques, back massage, or laboring in water is inconsequential; that she has access to such tools when she needs them is indispensable.

 

Filed Under Birth, Childbirth education, Featured Story, Pregnancy, Support Tagged With comfort measures, Lamaze breathing

Why Bed Rest May Not Be the Best Prescription

March 13, 2012 By admin Leave a Comment

This article is reposted with permission from our sister blog, Science & Sensibility. 

By Darlene Turner-Lee

Bed Rest, When Used for Anything Other Than Sleep Has no Proven Benefit and May, In Fact, Be Harmful

“Bed rest is ineffective in treating anything”

So reads the title of the clinical POEM presented in Essential Evidence (www.essentialevidence.com) in January 2000. The poem is a summary of a study published in the Lancet by Allen et al entitled, “Bed rest: a potentially harmful treatment needing more careful evaluation”. In this study, Allen and associates perform a meta-analysis of bed rest studies up to that time and found that bed rest was ineffective in improving outcomes for a variety of medical conditions, including pregnancy complications, and in many instances caused patients to have worse outcomes.

Judith Maloni, PhD, RN, FAAN, nursing professor at the Frances Payne Bolton School of Nursing at Case Western Reserve University has studied high risk pregnancy and ante partum bed rest since 1989 and has found that despite its prevalence, there is no scientific basis for the bed rest prescription. In “Antepartum Bed Rest for Pregnancy
Complications: Efficacy and Safety for Preventing Preterm Birth” (2010) Maloni also shows that in addition to being ineffective at preventing preterm birth, bed rest actually has many negative health effects on both mother and baby. In mothers prescribed bed rest, many experience muscle atrophy, cardiovascular problems, bone loss, insufficient weight gain and depressive symptoms. For babies born to mothers on bed rest, many are born at low birth weight and many end up in the NICU with complications. Maloni also shows that hospital bed rest is no better than bed rest at home and that bed rest at home often has better outcomes as mothers feel more secure and comfortable in familiar surroundings.

Where did the “bed rest” prescription come from?

Bed rest has been described in medical literature since the beginning of time. However, in the 19th century, Silas Weir Mitchell, a prominent neurologist at the time, introduced “the bed rest cure” which consisted of isolation, confinement to bed, a high fat diet and massage. The bed rest cure was initially indicated for those suffering “nervous injuries and maladies” as a result of fighting in the Civil War. Later, the bed rest cure was specifically prescribed to people (primarily women) with mental disorders, particularly hysteria. Most physicians abandoned the bed rest cure when it became apparent that it did not help their patients and in many cases made them more mentally unstable.

Charlotte Perkins Gillman, a 19th century feminist, sociologist and writer was treated by Mitchell with the bed rest cure. Best known for her semi-autobiographical short story The Yellow Wallpaper, Gillman wrote the story after her own ordeal with post partum psychosis. Interestingly, the narrator in the story is driven insane by her rest cure.

So why is bed rest prescribed and given the lack of evidence, why does it persist as a treatment for preterm labor? Most other medical disciplines have abandoned bed rest as a treatment. Most heart patients are sat up and ambulated almost as soon as they are extubated, because it has become common knowledge that prolonged bed rest can lead to complication, notably pneumonia.

In orthopedics, post operative back and joint patients are quickly started on physical therapy so that they can achieve the optimum function and range of motion in the area treated. Yet, we persist in putting pregnant women on prescribed bed rest. Why?

Bedrest persists as a “treatment” for high risk pregnancy primarily because of litigation and lack of research (or more aptly, lack of implementation of current research). The potential for litigation in the United States makes it almost impossible for obstetricians not to utilize bed rest. Who wants to be responsible for the death of a baby or mother? If a pregnant woman has a complication and an obstetrician doesn’t put her on bed rest and she has an adverse outcome (or worse yet, she, her baby or both die), it can be career ending. Yet, our statistics show that bed rest is not improving outcomes nor making any dent whatsoever in maternal or infant mortality. Everyday I read articles and studies showing “promising” new treatments and yet these potentially lifesaving treatments and procedures are years away because of the need to provide evidence of efficacy and then for them to go through the approval process of the US FDA and then final adoption by ACOG. Yes we want safety and efficacy of treatments, but with all this bureaucracy, are we providing protection for mothers and babies or for those who treat them? It’s heartening to see so many new treatments available such as Fetal Fibronectin tests and the broadening use of Progesterone therapies. But we still need more.

Should bed rest be completely eliminated as a treatment for high risk pregnancy? It can’t be because when a pregnant woman presents with acute vaginal bleeding or with uncontrolled hypertension, or preterm labor, she needs to be stabilized and immediate bed rest needs to be part of that stabilization.  But once she is stabilized, it becomes unclear whether further confinement is necessary or beneficial. This is where more research, new treatments and new information are essential.

Bed rest has been around for a long time. Organizations like Sidelines and Better Bedrest have been in operation supporting high risk pregnant women since 1991 and 1995 respectively. I first came to know bed rest when it was suggested for me in 2002 when I was pregnant with my daughter. It is amazing to me that here we are in 2012 and we are still prescribing bed rest for high risk pregnancy. Bypasses have been changed and are more streamlined and less invasive. Prostate surgeries and hysterectomies are facilitated by robotics. Most disciplines have moved away from bed rest, but in obstetrics, still the same old prescription. Why am I so “anti” bed rest? I have a daughter who is 9. I imagine that in roughly 20 years, she’ll be considering starting a family of her own. I don’t know if my reproductive problems will be passed on to her or not, but it is my sincerest hope that if my daughter becomes pregnant with a high risk pregnancy (circa 2032), we’ll have something more effective and beneficial to offer her than the same bed rest prescription offered to her mother almost 30 years prior.

References
Allen C, Glasziou P, Del Mar C. “Bed rest: a potentially harmful treatment needing more careful evaluation”. Lancet 1999: 354:1229-33.
Judith Maloni, PhD, RN, FAAN. “Antepartum Bed Rest for Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth”. Biological Research for Nursing: 12(2) 106-124
ª The Author(s) 2010
Reprints and permission:
DOI: 10.1177/1099800410375978

Wikipedia Encyclopedia
http://en.wikipedia.org/wiki/Bed_rest

http://en.wikipedia.org/wiki/Silas_Weir_Mitchell

http://en.wikipedia.org/wiki/Charlotte_Perkins_Gilman

 

 

Filed Under Complications and high risk pregnancies, Featured Story, Pregnancy Tagged With bed rest

Find Expert Answers to Your Pregnancy and Birth Questions

March 7, 2012 By Cara Terreri Leave a Comment

Pregnant women have questions — lots of  ’em. And the internet has answers — lots of ‘em. Often, the answers, advice and anecdotes on pregnancy and birth found on the internet are varying, contradictory and leave women feeling confused and frustrated. Women need trustworthy resources, outside of their care provider, that they can rely on.

The Lamaze “Ask an Expert” forum is hosted by obstetrical research expert Henci Goer and answers women’s questions carefully, timely and with accurate, research-supported information. Here are some of the recent topics covered by Henci at Ask an Expert:

  • How long can early or false labor last?
  • Breathing techniques during actual labor
  •  How do I interpret my OB’s responses to these questions?
  • Gestational diabetes and homebirth
  • The safety of using vacuum extraction during delivery
  • VBAC beyond 40 weeks

If you’re looking for solid answers to your most pressing questions, visit the Lamaze Ask an Expert forum and post your concerns. One mom had this to say about her recent experience on the forum:

“Knowing that people care and want to help other people is a really great thing. I really think its awesome that you take time out of your schedule just to try to make someone elses life a little easier. Your forum really helped me when I was pregnant and during early labor. Thanks for all you do.”

Filed Under Featured Story, Pregnancy

How to Buy Maternity Clothes on the Cheap

February 27, 2012 By Cara Terreri 2 Comments

After finding out you are pregnant, you may be among the many women who wait with eager anticipation to the time when you can fit into maternity clothes. Some women dread wearing maternity clothes, but for first-time moms especially, the milestone of no longer fitting into your regular clothes is an exciting one. You can finally announce to the world — without saying a word — that you are pregnant.

Buying maternity clothes, however can be a hefty expense. Think about it — you’re essentially replacing your entire wardrobe for about a year (don’t forget the postpartum period!).  Here are a few tips and tricks to cut corners when buying maternity clothes.

 

1. Borrow! Do you have friends or family members who are either done with or in between pregnancies? If their pre-pregnancy size is close to yours, chances are that their maternity clothes size will fit you. Ask if they would let you borrow a few key pieces of their maternity wardrobe. Be sure to take good care of borrowed clothes and be prepared to return in good condition, or replace if necessary.

 

2. Buy second hand. Because pregnancy is short-term, there is a slew of gently used maternity wear floating around the planet. Often, women will sell large portions of their wardrobe in lots. You can find second-hand maternity clothes in a variety of places, including:

3. Buy on sale. This includes both maternity clothing and non-maternity clothes. Often, you can find regular tops that are longer in length, stretchy or have an empire waistline that work well to wear during pregnancy. So, check the sales racks in the regular clothing section — you might be surprised! The bonus about these items is that they can often be worn during postpartum and beyond.

4. Rubber bands, belly bands, safety pins. There are lots of tricks out there to extend the life of your own clothes throughout pregnancy. A hair band will give you about 3-5 more inches of waistline when looped around the button hole in a pair of jeans. A belly band will lengthen just about any shirt so that your tummy doesn’t show, and allow you to walk around with pants unzipped/unbuttoned without showing. The longer you can wear your own clothing, the longer you can put off having to purchase maternity clothes.

 

What are your tips for buying maternity clothes on the cheap?

Filed Under Featured Story, Pregnancy Tagged With maternity clothes
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