Push for Your Baby

Have you ever felt scared or insecure when asking your doctor a question? Personally, there have been times when I felt like, “what if I ask a stupid question,” or “will she think I’m one of those know-it-all internet research junkies,” or “I don’t want to come across as too pushy.” As it turns out, women who feel this way aren’t alone. A recent study in Health Affairs highlights how patients, worried about being labeled “difficult,” can be reluctant to discuss or question a health care provider’s recommendation.[i] For pregnant women, the pressure to agree to certain practices from family and friends, as well as care providers, can be significant. In fact, a Childbirth Connection study showed that many mothers have felt pressured by a health care provider to have an induction (17 percent with induction) and C-section (24 percent with cesarean).[ii]

In recognition of this issue, Lamaze International has initiated the “Push for Your Baby” campaign, which  encourages women to advocate for better care for their babies and themselves. “With the right information and education, women have the opportunity to be active partners in their care during pregnancy and birth, not just recipients of that care,” said Lamaze President-elect Tara Owens Shuler, MEd, CD(DONA), LCCE, FACCE, Director of Continuing Education, Special Projects, and Lamaze Childbirth Educator Program for the Duke AHEC Program. “This campaign is designed to help women be ‘savvy shoppers’ and prepared to seek out the best care for their babies and themselves.”

Through the Push for Your Baby campaign, Lamaze is working to provide expecting parents with the tools and resources they need to partner with their care providers to get that care, including:

    • PushforYourBaby.com – A website dedicated to expecting moms and dads that houses up-to-date information about childbirth challenges, ways to identify the best care, tips for pushing for better care, details about Lamaze education, and questions to ask their care provider.
    • Parents Push – With this shareable video, moms – and dads – share their personal childbirth experience, both the highs and lows, and underscore the importance of childbirth education to having the safest, healthiest birth possible. The video offers those expecting a little one a chance to hear directly from someone who has been in their shoes.
    • Push Story Sharing – Lamaze knows that some of the best learning happens through story telling. The Push for Your Baby campaign gives parents the opportunity to share both written and video birth stories highlighting the things they were glad they knew – or wish they had known – before labor and delivery, as well as the role that childbirth education played in their experience. Submissions will be shared on the campaign website and the top three entries in each category (written and video) will receive prizes from Lamaze, Tomy and GC Brands Childrenswear, and their photos and blogs posted to the home pages of Lamaze.org and PushForYourBaby.com.

“Its all about women getting the care that matches their unique needs, and not just having things happen to them. Sometimes that may mean saying, ‘I’d like to consider another option,’” said Shuler. “Women should know it’s OK to push for better. And knowing how to spot good maternity care is the key to getting it.”

“With clear challenges to getting high-quality maternity care, the value in being prepared and educated is more important than ever,” said Shuler. “Childbirth education may seem like a hassle to busy parents and Google might feel like a decent way to answer questions, but a good childbirth education class can help pregnant women sort through conflicting or inaccurate information, and give them the tools they need to get the care they want. Lamaze certified childbirth educators (LCCE) have a stake in the expecting parents we teach, and it’s our priority to help them achieve the safest, healthiest outcomes.”

In addition to Push for Your Baby, Lamaze recently launched a newly revamped website (www.lamaze.org) with a focus on expecting parents, and a separate site dedicated to supporting Lamaze educators (www.lamazeinternational.org). The new parents’ site features the Push for Your Baby campaign resources, a social media updates, a video library, tips for expecting parents and evidence-backed information about maternity care from pregnancy through birth.

 


[i] Frosch, D., et. al. Authoritarian Physicians And Patients’ Fear Of Being Labeled ‘Difficult’ Among Key Obstacles To Shared Decision Making. Health Affairs. May 2012. Available online: http://content.healthaffairs.org/content/31/5/1030.abstract.

[ii] “Listening to Mothers II Report.” Childbirth Connection. 2006. Available online: http://www.childbirthconnection.org/article.asp?ck=10396. Accessed 4/16/2012.

Tanning and Pregnancy: What Is Considered Safe?

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.**

Skincare Products & Mercury: Understanding Labels to Protect Your Baby

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).

 

 

When Green Is Not Your Color: Coping with Morning Sickness

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?

Choosing a Prenatal Yoga Class

By Deena H. Blumenfeld, RYT, RPYT, LCCE

You’ve heard from your doctor or a friend that it’s a good idea to take a prenatal yoga class when you are pregnant.  There are some things you should know before you sign up for a class.

If I’ve never taken a yoga class before, can I start with prenatal yoga?

Yes! Prenatal yoga classes are structured for women at all levels of physical fitness, and yoga experience.  Let your teacher know that this is your first class and she’ll make sure you are comfortable.

 

I’ve been practicing yoga for a long time.  Do I need a prenatal class or can I stick with my regular yoga class?

You should be able to stay in your regular yoga class for your first trimester.  Somewhere between weeks 15-20, you’ll find your practice needs to change to accommodate your changing shape and needs.  A prenatal yoga class will also introduce you to poses that will be specifically helpful to prepare you for birth and allow you to connect with other pregnant mothers.

 

What if there are no prenatal yoga classes in my area?  Can I take a regular yoga class?

If there are no prenatal yoga classes offered in the area, you should call and talk to those teaching a “regular” class.  Some instructors are not comfortable with a pregnant mother in class because they don’t know how to modify the practice to be safe for her.  Other instructors are comfortable with pregnant women in class.  Do check to see if there is a “gentle” practice available as that might be better suited than a Yoga 1.

 

Are there different styles of yoga?

There’s a wide variety of styles of yoga out there.  Most classes you will find are Hatha classes.  Don’t worry about the terminology so much. If the class description doesn’t give you enough information about the class, please contact the instructor for more information. Remember, there’s no one style fits all yoga class.  If you try it and you don’t like it, don’t give up on yoga, just try another class.

 

What about hot yoga?

Hot yoga is not appropriate when you are pregnant.  Practicing in a heated room for 90 minutes can raise your core body temperature – just like soaking in a hot tub can raise your core body temperature.  This is not healthy for you or baby.  Hot yoga is contraindicated for pregnancy.

 

How is the class offered?

Some classes are session based, so you pay for 6 or 8 weeks of a class.  Other classes are drop-in classes where you pay per class and join the class as fits your schedule.  If you are nearing the end of your pregnancy or you are worried about liking the class, or if your schedule is erratic, a drop-in class might be better suited for you.  Find out if they offer an introductory single class.  That might be a good way to test out a class and see if it’s a good fit for you.

 

Where is the class offered?  Hospital, gym or yoga studio?

Location is important.  How is the parking?  What are the amenities?  One local hospital here in Pittsburgh offers prenatal yoga, however, you are required to buy your own mat and it is hosted in an open lobby area.  A gym may offer a class periodically if there is a need, so things like mats should be provided.  Expect a gym class to have a heavier focus on the physical side of yoga.  At a yoga studio you’ll have mats provided (or be able to rent them), and you will also have a wider array of blocks, bolsters, straps and other props to make your practice more comfortable.

 

What are your instructor’s qualifications?

Not all yoga teachers are created equal.  Ask your instructor where and with whom she did her prenatal yoga teacher training.  Find out if she’s certified by any organization to teach yoga, with an additional prenatal certification.  There are a number of organizations that do certify prenatal yoga instructors.  The requirements differ in not only the number of hours of training, but also the curriculum.  There are also a number of prenatal yoga teachers who teach with out certifications.  Don’t be afraid to ask in-depth questions.  You should feel comfortable with your instructor.

 

Staying within your instructor’s scope of practice

Your Yoga instructor should always work within her scope of practice.  This means, unless she’s a medical professional too, she should not be giving medical advice.  She should refer you back to your care provider for questions that are beyond her level of expertise.

 

Using modifications to poses (postures)

Your instructor should be able to modify the yoga poses for your changing shape.  She should acknowledge your baby and make accommodations for issues that come up, such as carpal tunnel, sciatica, etc.  She should know how and when to use additional props, like blankets or blocks to make your practice more comfortable for you.

 

Meditation and breathing

Meditation and Breathing should be incorporated into any prenatal yoga class.  The extent of the incorporation will vary from class to class.  You can expect your teacher to help you learn relaxation skills as well as how to synch your movements with your breath.  Speak with your individual teacher about how much of the class will cover these aspects.

 

Social Benefits to a Prenatal Yoga Class

In class you’ll be able to connect with other pregnant mothers.  You will have a shared experience, be able to commiserate over pregnancy woes, and celebrate each other’s pregnancy joys.  This community can also help you find a new care provider, decide on which car seat to buy and help you find other local resources for pregnancy, birth and parenting.  Many moms who meet in a prenatal yoga class will also go on to become friends and share baby play dates down the road.

 

Things to note for any prenatal yoga class:

  • Consult your doctor or midwife before beginning a yoga practice.
  • Call and ask questions regarding the specific class.  See if it’s a good fit for you.
  • Eat lightly before class and bring a snack for afterwards.
  • Bring a water bottle with you to class.
  • If you have an injury or a complication with your pregnancy, you must let your yoga teacher know.  She’ll be able to modify your practice to keep you safe.  Always check with your doctor or midwife if a complication arises before continuing your yoga practice.
  • Above all, listen to your body.  Accept your limitations and work within them.  You’ll find that you can have a great class at any level.

 

Namaste!

 

Deena is a Certified Khalsa Way™ Prenatal Yoga Teacher and Lamaze® Certified Childbirth Educator. She has been practicing yoga for more than 15 years. She became a certified Yoga instructor through 3rd Street Yoga in December 2008. She completed her 60 hour Prenatal Yoga training in February 2009 in Los Angeles at Golden Bridge Yoga with Gurmukh.

Her Lamaze certification was completed in October 2010, through Magee Women’s Hospital and Lamaze International. She is an advocate of empowered birth for women. Through the teaching of Prenatal Yoga and Childbirth Education classes, she helps women become more confident in their choices regarding pregnancy, birth and parenthood. Deena has also studied yoga with Doug Keller, Max Strom, KK Ledford and Shakta Kaur Khalsa. Her ongoing professional development as a Childbirth Educator has been with Ina May Gaskin, Penny Simkin, Gail Tully of Spinning Babies and other childbirth professionals.

Deena is also a mom of two – a son, born via c-section in April 2005, and a daughter in March 2009, a VBAC. She is an active member of the local ICAN chapter and a member of the Coalition for Improving Maternity Services.

Yoga and Pregnancy: Relax into the Restorative Pose!

By Debra Flashenberg, CD(DONA), LCCE, E-RYT 500 and Director of the Prenatal Yoga Center

The average pregnant woman is very capable of a doing a challenging asana (yoga) practice that can build confidence and stamina.  However, it is important to strike a balance by also practicing gentler, more restful poses that teach her how to soften and surrender when she needs to relax.  Perhaps one of the greatest benefits of quieter, restorative poses is that they offer the mother time to be with her baby, listen to her baby and to her own body and, if anything, the opportunity to gain a greater understanding of her inner thoughts and feelings.

Some of the other wonderful benefits of restorative poses include:

  • Helps reduce stress
  • Slows the heart rate
  • Lowers blood pressure
  • Slows the breathing rate
  • Increases blood flow to major muscles
  • Reduces muscle tension
  • Reduces hypertension
  • Renews energy
  • Helps concentration
  • Quiet time with baby!

Here are some yummy restorative poses the can be adjusted for all three trimesters.

Supta baddhakonasa (Reclined Goddess Pose)

We usually start with this restful pose at the beginning of the class.  Place two blocks on the mat, the first on the medium facet and the second on one the highest.  Place the bolster over the blocks forming a comfortable back rest which should be about a 45 degree angle.  Also, have several blankets available, one or two for knee support and two additional ones for forearm support.  Bring the soles of the feet together and then either place one blanket under each knee, or make a longer roll and wrap it around the ankles and under the shins.  It is also nice to place a trifolded blanket under the forearms to add a little extra support.

Keep in mind with these reclining poses, it is important to have the lower back well supported.  You do not want an excessive lumbar arch when reclining.  So when reclining back, make sure the lower back is snug up against the bolster.

Legs Up the Wall

This pose is particularly good if the mother is experiencing any edema in the legs or feet, suffers from varicose veins or her legs are just feeling tired.

If the mother is still comfortable with legs up the wall, place a bolster under the hips so that she is not lying flat for a prolonged period of time. The bolster should be placed so that the sitting bones are just hanging off the bolster.  This also creates a nice gentle chest opening pose.

Half Legs Up the Wall (Single Leg Drain)

This pose is an option for those that can no longer lay on the back, but still offers the wonderful benefits of having the legs elevated.  It is done with one leg up the wall while in a somewhat side lying pose and the bottom leg gently bent in the torso.

“V” Legs Up the Wall

If neither of the two previous “legs up” options work for the mother, the “V” leg up the wall pose may be a solution.  Take the same bolster/block set up as supta badhakonasana and place the bolster about 1 ½ to 2 feet away from the wall.  The distance will need to be adjusted depending on the height of the woman.  Then in a reclined position, bring the legs up the wall. This forms a “V” like shape in the body offering elevated legs and chest.  (This is a good opti

on if the mother wants to elevate her legs, but she is experiencing acid reflux and can’t have her head below her heart.)

Supported Child’s Pose

Some mothers prefer to rest in a long child’s pose if she feels a lot of pressure or discomfort in her lower back or suspects her baby is in the posterior position.  To do this pose, simply take a wide knee child’s pose and place a bolster under the head or even further down, under the under chest and head.



Tarasana with Block Under HeadIt can be very restful to allow the forehead to rest on something.  This takes pressure and strain off the neck while aiding in quieting the mind.  In this pose, the feet are further away from the groin, decreasing the bend in the knees and one or two blocks are placed in front of the feet.  An individual’s flexibility and the size of the belly will determine how to use and place the blocks.  Most women in their third trimester are not bending forward too easily, so two blocks may be needed.  Or another option is to place a bolster on top of two blocks and create a little “altar” to rest on. *Remember, moms with sacroiliac issues, place a block or rolled blanket under the knees in this pose.Eye Pillow or Head Wrap

Incorporating the use of an eye pillow or a head wrap can help relieve tension and promotes the withdrawal of the outer senses and stillness in the mind.  In yoga we refer to this as pratyahara.  By utilizing an actual object to help withdraw the senses, the eyes, which are often expressive and focused outward, are now encouraged to focus inward.  If you choose to use a headwrap, do not wrap too tightly and draw skin of forehead down, not up.

 

Hopefully, these restorative poses can allow the mother-to-be a little quiet time to rest, renew and restore her energy.

 

Photo © mahamamas.com and Janet MacFarlane, 2012 

Helpful Holiday Tips for Expectant Moms

By Sonia Alvarado, CTIS Pregnancy Health Information Line Counselor

Around the world, December and into January is a time when many people celebrate Christmas, Hanukkah or other holidays that include gift giving, celebrations with food, alcohol, fireworks, and other displays of joy and merriment. If you are pregnant, you may feel the need to exclude yourself from certain activities because of warnings you’ve heard about avoiding certain foods, etc., but there is no need! We’ve prepared a list of ideas to help you create an environment that is stress free, with no post-holiday regret!

First of all, when traveling by car, regardless of how rushed you feel or where you are going, always wear your seat belt and slow down. Every year, there are over 150,000 auto accidents in the United States and pregnant women, in every trimester, are involved in many of them. If you add the fact that many folks are distracted by the holiday, and drinking and driving, it makes it vital that pregnant women drive defensively, be aware of other drivers, and wear their seat belt. According to a 2009 New York Times article, up to 1,000 pregnancies are ended every year due to car accidents. The article also gives great instructions on the appropriate way for pregnant women to wear their seat belts.

Eggnog is the delicious, sweet and rich holiday beverage, also known as ponche roma or rompope in Mexico, Central America, and South America. In Puerto Rico, coconut milk and or coconut cream is substituted for the milk, making it even more decadent! Generally, eggnog is a combination of eggs, milk or crème, sugar and some alcohol, usually brandy, rum, or whiskey. When purchased at the grocery store, eggnog has pasteurized milk and eggs, which remove the risk for bacteria or other pathogens that could ruin your holiday, or worse, affect your pregnancy. It is also alcohol free, making it ideal for pregnant women.

Hanukkah celebration foods are pregnant women friendly because many of the dishes are fried, limiting the potential for any pathogen to harbor on the food and cause infection. Hanukkah foods typically include cheeses, fried potato pancakes, brisket, and chicken. Keep in mind that the cheeses and other dairy products should be pasteurized. As for meats — cook to temperature and enjoy! Here’s a quick go-to guide for the internal cooking temperature of meats:

  • Finfish should be cooked to an internal temperature of 145° F
  • Cook beef, veal, and lamb roasts and steaks to at least 145° F
  • Cook ground beef, veal, lamb, and pork to at least 160° F
  • Cook ground poultry to 165° F
  • Cook pork to an internal temperature of 145° F

Fish is used in many holiday celebrations and pregnant women can certainly enjoy and be included. Typically fish that is cooked for the holidays is not raw or undercooked, as you see in the summer and spring (unless you live in tropical areas). Popular holiday fish include salmon, tuna, and cod, which are healthy choices for pregnant women, when eaten in recommended proportions. Figgy pudding is not a pudding at all — at least not in the American sense. Figgy pudding, a dessert that hails from England, was eaten as far back as the 15th century. It is made with figs or dates and traditional cake mix. Figs are very healthy, containing calcium and potassium and an excellent source of fiber.

Alcohol is part of just about every celebration, particularly at the holidays; however, for the developing embryo and fetus, there is no holiday break, and no time that the brain is immune to the damaging effects of alcohol. Give your unborn baby the best gift of all, and choose the alcohol-free alternatives.

Finally, take time during the holiday season to celebrate your pregnancy and enjoy the quiet moments (and kicks and rolls) with your growing baby!

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).

Preventing Listeria During Pregnancy in Light of Recent Outbreaks

By Sonia Alvarado, CTIS Pregnancy Health Information Line Counselor

Pregnant women who ask their doctor about food recommendations, or who call a pregnancy information service such as ours in California (www.ctispregnancy.org) are typically told to avoid unpasteurized milk products such as raw milk, unpasteurized cheese and deli meats to avoid exposure to listeria monocytogenes, a mycobacteria. Listeria infection in pregnancy can cause neonatal infection, stillbirth, miscarriage or prematurity. While we recommend that everyone wash fruits and vegetables before eating, we had not been specifically concerned about listeria contaminating fruit and possibly infecting pregnant women; until now.

At the time this is being written, there is a large investigation being conducted by the Centers for Disease Control (CDC), other Federal authorities, along with the support and cooperation of local health departments on an extensive listeria outbreak resulting from contaminated cantaloupes. The contaminated cantaloupes originated from aColoradoproducer, Jensen Farms, who distributed to vendors in 25 states, who then trucked the cantaloupes to stores and supermarkets. According to the CDC, at this time there are at least 72 people who have been sickened, including 13 deaths. It is expected that the number of infected people will rise since illness may not occur until 2-3 weeks after infection, and cases would still have to be reported to the appropriate authorities to be counted. The ages of infected individuals so far ranges from 35 to 96 including two pregnant women, according to media reports.

Listeria infection causes listeriosis and this disease is most dangerous to pregnant women, immunocompromised individuals, children and senior citizens. Pregnant women are reported to be 20 times more likely to get listeriosis. The symptoms of listeriosis are different in the various sensitive groups; pregnant women may experience a mild, flu-like illness, seniors may suffer septicemia: infection throughout the body, and meningitis. Pregnant women may not realize what’s happened until after they’ve suffered a pregnancy loss, one of the risks associated with listeria infection in pregnancy.

Most worrisome at this time is that we do not know how the cantaloupes were infected. Was the listeria in the soil or in the water that irrigated the cantaloupes? This critical piece of information is necessary to prevent this outbreak from occurring again.

This outbreak is yet another warning about the importance of having evidence-based and enforced regulations on food handling, production and inspection. However, since no system is perfect, we all need to take steps to reduce the chance that we’ll be infected from listeria or other bacteria and parasites.

The following are recommendations from the CDC in combination with other sources, to reduce your chance of exposure; recognizing that no recommendations are going to be 100% effective.

1. Wash your hands before handling any food (meat, fruits, vegetables, canned, prepared, not prepared, etc). Wash hands for 20 seconds with soapy, warm water.

2. Wash all homegrown produce and store-bought before eating it. You can use water, a 1% vinegar solution, soapy water or a commercial vegetable-cleaning product. Use a vegetable brush if possible.

3. Wash knives, countertops, and cutting boards after handling and preparing uncooked foods.

4. Thoroughly cook raw food from animal sources, such as beef, pork, or poultry to a safe internal temperature. What’s the appropriate temperature? From the USDA (using a food thermometer):

  • All whole cuts of meat (ground beef, veal, lamb, and pork) to 145 °F as measured with a food thermometer placed in the thickest part of the meat (rest time of 3 minutes before eating)
  • Ground meats, (ground beef, veal, lamb, and pork): 160 °F no rest time recommended
  • All poultry products (ground beef, veal, lamb, and pork); 160 °F no rest time recommended

5. Separate uncooked meats and poultry from vegetables

6. Separate uncooked meats from cooked foods and ready-to-eat foods.

7. Do not drink raw (unpasteurized) milk, and do not eat foods that have unpasteurized milk in them.

8. Consume perishable and ready-to-eat foods as soon as possible.

9. Clean dishes with soap water in the hottest temperature that is safe and comfortable for you. The FDA requires restaurants clean dishes with a minimum temperature of 110 degrees F, so if you have a dishwasher, you may be able to get the water to this recommended temperature.

10. When possible, choose irradiated foods. Cleaning foods on the surface may not get to all of the bacteria. For example, cleaning lettuce with water may not get to bugs that get between nooks in the leaves. Irradiation exposes food to a source of electron beams, and destroys bacteria and parasites. Get informed about irradiated foods from the experts! http://hps.org/searchresult.cfm

11. Clean your refrigerator! You won’t get all the listeria out, but most of it and slow its growth.

12. Keep your refrigerator at 40 degrees or below. This temperature slows the growth of listeria in refrigerators.

 

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).

 

References:

http://www.thepacker.com/fruit-vegetable-enewsletter/packer-daily/130708503.html

http://www.cdc.gov/listeria/index.html

http://www.denverpost.com/news/ci_18966612

http://www.ext.colostate.edu/pubs/foodnut/09369.html

http://www.sciencedaily.com/videos/2007/0810-are_your_dishes_clean.htm

http://www.sciencedaily.com/releases/2008/04/080410153655.htm

http://www.fsis.usda.gov/News_&_Events/NR_052411_01/index.asp

The Mind-Body Connection: A Powerful Force

The mind-body connection — it’s something we hear a lot, but what exactly does it mean?  In short, the thoughts and emotions in one’s mind have the capability and potential to affect the physical body and its reactions, as a result of a complex system of hormones coursing throughout the body. This mind-body connection is evident throughout all aspects of life, but is especially notable as far as pregnancy, birth, breastfeeding, and parenting is concerned.

Right from the beginning of pregnancy, a woman’s thoughts and emotions can affect her growing baby.  When a woman is fearful, upset, or anxious, her body releases stress hormones. These hormones enter the bloodstream, traveling through the placenta, and then on to her baby. Some studies suggest that this early exposure to these stress hormones can cause a baby to be more fussy and irritable once he or she arrives.  On the contrary, mamas who spend time relaxing every day doing such activities as meditation or yoga, pass that same sense of calm and well-being to their little ones.

During labor and birth, the mind-body connection is amazingly powerful.  In order for a woman to progress in her labor, she needs to really let go, trust the process of birth, and dig deep within herself.  The logical, thinking part of her brain is pushed aside, as her primitive, instinctual part of the brain comes forward.  When she is able to do this, her body responds, and labor is often shorter and easier, requiring little to no outside intervention. If she is stressed, anxious, afraid, nervous, hungry, thirsty, scared, uncomfortable in her surroundings, or concerned with the well-being of those around her, her body will release stress hormones. These hormones impede the production of oxytocin, the hormone that causes contractions of the uterus. When the oxytocin isn’t flowing, labor will often slow or stop until she feels safe and secure in her environment. Think of a wildebeest laboring in the wild.  If a lion attacks, will she continue to labor and birth her calf? Certainly not.  She will get to safety first before bringing her little one into the world. In the birthing world of humans, we often forget our animal roots. Much of the time, this slowing of labor leads to interventions that are designed to speed up labor artificially, when what a woman really needs is to talk about her fears, eat something, or be reassured that what she is experiencing is normal.

After birth, the mind-body connection continues. When breastfeeding, a woman needs to be very relaxed. Oxytocin plays a crucial role in breastfeeding, causing the milk ejection or “let-down” reflex. Just like in birth, if a woman is stressed, her oxytocin production is diminished and she’ll have difficulty getting her milk to flow. If she is uncomfortable or anxious, not only will feeding be more difficult, but also parenting in general.  Babies pick up on positive and negative energy of their caregivers, so a calm parent will make for a calm baby, while an anxious parent will make an anxious baby.

Throughout pregnancy and beyond, take time every day to improve your mind-body connection. Relax in a warm bath, talk about your fears, meditate, practice yoga, do some deep breathing, and connect with your baby–your mind, your body, and your baby will feel the positive effects!

 

What do you do to make sure you find time to relax in your daily schedule? 

Healthy Pregnancy Tips for Vegetarians and Vegans

 

Rest easy, all you pregnant vegans and vegetarians out there: Medical experts, including the American College of Obstetricians and Gynecologists and the American Dietetic Association (ADA), have given you the green light to continue your current way of eating— as long as it’s well-planned. “You can have a healthy pregnancy on such a diet,” says Dawn Jackson Blatner, R.D., an ADA spokeswoman who sees pregnant vegetarians in her private practice. “You just have to do it right.”

A vegetarian (meat-free) or vegan (no animal products, not even milk or eggs) diet can help prevent obesity and chronic illnesses, including heart disease, cancer and diabetes. It’s also more Earth-friendly than the typical American carnivore’s diet. That said, “Pregnancy is not the right time to become a vegetarian if you aren’t one already,” says Lara Field, M.S., R.D., a dietitian at the University of Chicago Medical Center who counsels pregnant women.

Here’s the reason: The risks of nutritional deficiencies are more pronounced with a vegetarian diet, and pregnancy is a time when you need more of certain vitamins and minerals. If you’ve been eating animal products, quitting now would just limit your options, Field says.

In addition to taking a high-quality prenatal vitamin, here’s how you can make up for any nutritional weak links if you do decide to stay meat-free during your pregnancy.

Protein This nutrient is vital for cell growth and development—yours as well as your developing baby’s—and you need about 70 grams every day right now. Beans can provide much of what you need. “Beans are the magic bullet for vegetarians and vegans,” says Blatner, who is also the author of The Flexitarian Diet (McGraw Hill). “Along with lots of protein, beans provide iron and zinc.” Zinc is also necessary for cell growth and normal fetal development.

To get the protein you need, simply replace animal products with any type of beans, including soybean products like tempeh and tofu; just keep in mind that experts advise limiting your soy intake to one or two servings daily during pregnancy. In recipes, substitute one-half cup of beans for every 3 ounces of meat.

And here’s a bonus if you’re concerned about putting on too much weight during your pregnancy: Beans are a low-calorie protein source: 1 cup of soybeans has 298 calories and 29 grams of protein; 1 cup of lentils has 226 calories and 18 grams of protein; 1 cup of pintos has 245 calories and 15 grams of protein; and 1 cup of firm tofu has 176 calories and 20 grams of protein.

Don’t forget about nuts, too: These are also rich sources of protein (and healthy fats), as are low-fat dairy foods—milk, yogurt and cheese.

A word of advice: Don’t rely too heavily on cheese or faux burgers to replace meat in your diet. Why? Veggie “meats” are usually laden with sodium, and cheese is very high in saturated fat. “Vegetarian and vegan diets are perceived to have a ‘health halo’ around them,” says Blatner. “But if you’re not eating the right foods, these diets can be unhealthy, too.”

Iron This mineral, which helps red blood cells deliver oxygen to the fetus, also protects you from anemia, a common problem during pregnancy even among meat eaters. According to Blatner, pregnant vegetarians and vegans need as much as 50 milligrams of iron daily. Besides beans, other vegetarian iron sources include iron-fortified cereals, prune juice, black-strap molasses, spinach and raisins.

To help your body absorb the iron contained in foods, eat vitamin-C- rich foods (such as red peppers, citrus fruits and strawberries) and sprouted grains along with them. “Sprouting decreases the compounds that make it more difficult for your body to absorb iron,” Blatner explains.

Vitamin B12 This vitamin, which is required for proper red blood cell formation and neurological function, is most abundant in animal products, which makes getting enough of it a little tricky for vegetarians. Though there are a few nonmeat sources of B 12 (fortified breakfast cereals, for example), the ADA recommends that both vegans and lacto-ovo vegetarians (those who eat eggs and dairy products) take B 12 supplements to help them get the 2.6 micrograms daily needed during pregnancy.

Calcium & vitamin D Dairy products are chock-full of these baby bone-building nutrients, but vegans will have to turn elsewhere to get the 1,000 milligrams of calcium and 400 IU of vitamin D they need daily. “Vegans can eat dairy alternatives—like milk and yogurt made with soy and hemp—as well as orange juice,” Field suggests, “but read labels to make sure they’re fortified with calcium and vitamin D.” Fortified tofu, seaweed, figs, collard greens and mustard greens are good vegan sources of calcium.

Omega-3 fatty acids Cold-water oily fish, such as salmon, are the main sources of these healthy fats, which enhance fetal brain and nervous system development. Good plant sources include algae, canola and flaxseed oils, walnuts and leafy green vegetables. Supplements are also safe during pregnancy. The recommended dietary allowance (RDA) for pregnant women is 1.4 grams daily, but up to 3 grams of fish oil daily is probably safe. Vegan omega-3 sup- plements are also available.

3 SMART VEGETARIAN SNACKS

■ VANILLA HEMP MILK 1 cup contains at least 25 percent of your daily requirements for calcium and vitamins D and B 12.

■ PLAIN YOGURT 8 ounces of low-fat unsweetened yogurt contain 12 grams of protein and 45 percent of your calcium needs.

■ LENTIL SOUP 1 cup contains 9 grams of protein and 4 milligrams of iron.

>> By: Nancy Gottesman is a health and nutrition writer in Santa Monica, Calif.