Spoke to the Dr at my 32 week appointment this week. Explained the pains I was having. He is sending me in for an ultrasound to make sure the baby is ok, checking the weight and position etc. He is also checking me for kidney stones and a kidney infection. But I was searching the net and came across - Pelvic Pain (Symphysis Pubis Dysfunction) (see blow), this fits sooo much of the pain and discomfort I am having.
Sigh more tests woohoo. I am getting to old for this.
My weigh in this week was 253.50, 1 pound since my last visit which was 3 weeks ago. Other than that the baby's heart beat is nice and strong, so are her darn kicks and punches. lol.
I also had a new thrombosed external hemorrhoid show up a few days ago, and after being out today with my daughter for a Dr.s appointment I come home and go to the ladies room to find myself bleeding. Of course my first reaction was OMG the baby. Turns out I was walking around so much and the baby is giving me sooooooo much pressure down there that it popped. HOLY CRAP talk about hurt.
So I am waiting for a call tomorrow for a date for the ultrasound. If not it will be 10:30am on Wednesday morning. We will get to find out how big the baby is etc. :D
I am getting excited, I just want to hold my baby girl and her big sister wants her to come too. She keeps asking me when we visit the baby Dr if we are bringing home Paige yet. :( I said soon sweetheart soon.
Thursday, February 11, 2010
Pelvic Pain (Symphysis Pubis Dysfunction)
Pelvic Pain (Symphysis Pubis Dysfunction) Please read the whole article it is quite big and so I just posted the Intro, Symptoms and Causes.
Introduction
One problem that many pregnant women complain about is pubic pain. Yet doctors and midwives often dismiss this pain as either 'inconsequential', 'unfixable', or 'just one of those pregnancy discomforts that have to be endured'. Occasionally, some uninformed doctors have even erroneously told women that such pubic pain means that they would need an elective cesarean section in order not to permanently damage that area during birth, or as a result of prior damage to the area.
Yet none of this is true. Pubic pain in pregnancy is certainly not 'inconsequential'; Kmom knows from experience that it can be very difficult to deal with. Although many doctors and midwives do not know what causes it or how to fix it, many women are able to get improvement or relief with chiropractic treatment or osteopathic manipulation. It is not something that you 'just have to live with'. And although extra care should be taken during labor and birth in order to prevent trauma, it absolutely does NOT mean that you 'have' to have a cesarean!
This purpose of this FAQ is to discuss what causes pelvic/pubic pain, what some of the symptoms are, possible causes, hints for coping with pubic pain, how to prevent further trauma during birth, what kinds of treatments are available, and women's experiences with these treatments.
Anatomy and Structure
Your pelvis is a kind of a circular bone that goes all around and almost meets in the middle in front. The two sides do not quite touch; there is a small gap between them connected by fibrocartilaginous tissue reinforced by several ligaments. This area is called the Pubic Symphysis. This is important for helping your pubic bone to move freely, stabilizing the pelvis while allowing a good range of motion. [An illustration of the pelvis can be found at http://omie.med.jhmi.edu/weblec/templatev1/lec11.html.]
The Pubic Symphysis and the Sacro-Iliac joints (in the back of the pelvis) are especially important during pregnancy, as their flexibility allows the bones to move freely and to expand to help a baby fit through more easily during birth. In fact, the pregnancy hormones relaxin and progesterone help the ligaments of your body to loosen and be even MORE flexible than before, so that there is plenty of 'give' and lots of room for the baby to slip right through.
Because of these hormones, it is normal for there to be some extra looseness and pelvic pressure in pregnancy. This is good---it means your body is getting ready for birth! It's loosening up to give you maximum space and flexibility, and to help make things easy for you and your baby.
However, in some women, either because of excessive levels of hormones, extra sensitivity to hormones, or a pelvis that is out of alignment, this area is extra lax or there is extra pressure on the joint. In 1870, Snelling described this condition: "The affection appears to consist of a relaxation of the pelvic articulations, becoming apparent suddenly after parturition, or gradually during pregnancy; and permitting of a degree of mobility of the pelvic bones which effectually hinders locomotion, and gives rise to the most peculiar, distressing and alarming sensations."
Simply put, significant pubic pain is caused by the pelvic girdle area not working they way it should, probably because of hormones, misalignment of the pelvis, or an interaction of the two.
Although not every provider has a name for this condition, it is most commonly called Symphysis Pubis Dysfunction (or SPD), especially in Britain. Other names for it include:
* pubic shear (osteopathic term)
* symphyseal separation
* pubic symphysis separation
* separated symphysis
* pelvic girdle relaxation of pregnancy
* pelvic joint syndrome.
Diastasis Symphysis Pubis (DSP) is the name for the problem in its most severe form (where the pubic symphysis actually separates severely or tears). For ease of use, in this FAQ the 'milder' form will be referred to as SPD.
Symptoms
The symptoms of SPD vary from person to person, but almost all women who have it experience substantial pubic pain. Tenderness and pain down low in the front is common, but often this pain feels as if it's inside. The pubic area is generally very tender to the touch; many moms find it painful when the doctor or midwife pushes down on the pubic bone while measuring the uterus (fundal height).
Any activity that involves lifting one leg at a time or parting the legs tends to be particularly painful. Lifting the leg to put on clothes, getting out of a car, bending over, sitting down or getting up, walking up stairs, standing on one leg, lifting heavy objects, and walking in general tend to be difficult at times. Many women report that moving or turning over in bed is especially excruciating. One woman wrote, "There were days that I didn't think I was going to be able to get out of bed and actually had to roll out of bed and onto the floor to be able to do so!" [See her story below.]
Many movements become difficult when the pubic symphysis area is affected. Although the greatest pain is associated with movements of lifting one leg or parting the legs, some women experience a 'freezing', where they get up out of bed and find it hard to get their bodies moving right away--the hip bone seems stuck in place and won't move at first. Or they describe having to wait for it to 'pop into place' before being able to walk. The range of hip movement is usually affected, and abduction of the hips especially painful.
Many women also report sciatica (pain that shoots down the buttocks and leg) when pubic pain is present. SPD can also also be associated with bladder dysfunction, especially when going from lying down (or squatting) to a standing position. Some women also feel a 'clicking' when they walk or shift just 'so', or lots of pressure down low near the pubic area.
Many women with SPD also report very strong round ligament pain (pulling or tearing feelings in the abdomen when rolling over, moving suddenly, sneezing, coughing, getting up, etc.). Some chiropractors feel that round ligament pain can be an early symptom of SPD problems, and indicate the need for adjustments. Other providers consider round ligament pain normal, part of the body adjusting to the growing uterus. If experienced with pubic and/or low back pain, it probably is associated with the SPD.
Onset of Pain and Duration
Pubic pain often comes on early in pregnancy, even as early as 12 weeks. One mother reports that she had it at 17 weeks. She says:
When I woke up [from my nap] I could hardly move. It took me forever to walk into the next room. Felt like my hips/pelvis were glued together or something. Already this baby feels sooo heavy inside me, like lots of pressure. I've gained 4 lbs. so far, what's the deal? At night when I wake up to go to the bathroom, sometimes I can't move my legs/hips at all, and sometimes things have to 'pop' back into place. I think, what if there is a fire and I died 'cuz I'm too slow!...I thought this problem in my 1st pregnancy was from gaining so much/swelling and it got worse and worse and stayed till over 3 months postpartum."
Indeed, although pubic pain often does go away after pregnancy, many women find that it sticks around afterward, usually diminished but still present. If treatment to resolve any underlying causes is not done, long-term pain usually sticks around. Anecdotally, this often seems to be associated with long-term low back pain or reduced flexibility in the hips. Even worse, if the mother is mishandled during the birth, the pubic symphysis can separate even more or be permanently damaged. This is called Diastasis Symphysis Pubis (diastasis means gap or separation).
Summary
To summarize, SPD is the mild form of this problem. Its symptoms often include one or more of the following:
* pubic pain
* pubic tenderness to the touch; having the fundal height measured may be uncomfortable
* lower back pain, especially in the sacro-iliac area
* difficulty/pain rolling over in bed
* difficulty/pain with stairs, getting in and out of cars, sitting down or getting up, putting on clothes, bending, lifting, standing on one foot, lifting heavy objects, etc.
* sciatica (pain in buttocks and down the leg)
* "clicking" in the pelvis when walking
* waddling gait
* difficulty getting started walking, especially after sleep
* feeling like hip is out of place or has to pop into place before walking
* bladder dysfunction (temporary incontinence at change in position)
* knee pain or pain in other areas can sometimes also be a side-effect of pelvis problems
* some chiropractors feel that round ligament pain (sharp tearing or pulling sensations in the abdomen) can be related to SPD
Cause
No one knows why SPD occurs for sure, or why it happens in some women and not in others. Some ethnic groups report a high incidence, especially Scandinavian women and perhaps Black women. Other risk factors may include having lots of kids, having had large babies, pre-existing problems with this joint, past pelvic or back pain, or past trauma (car accident, obstetric trauma, etc.) that may have damaged the pelvic girdle area. It also seems logical that women who have broken or injured their pelvis in the past would probably be prone to this problem.
Some sources view SPD simply as a result of pregnancy hormones. As noted, the pregnancy hormones relaxin and progesterone tend to loosen the ligaments of the body in preparation for birth. One theory is that some women have high levels of hormones before pregnancy, and then additional pregnancy hormones cause excessive relaxation of ligaments, especially in the pelvis.
Another theory is that some women manufacture excessive levels of relaxin during pregnancy, causing pelvic laxity. However, although still popular, this theory seems to have been disproven by recent research. Another theory is that women whose joints are especially flexible before pregnancy may be more susceptible to the effect of hormones, or that some women's bodies are just more affected by hormones than others. Traditional medical sources tend to view the problem of pelvic/pubic pain (when they acknowledge it at all) as simply a hormone problem.
A different theory holds that the problem is structural instead, and usually results from a misalignment of the pelvis. In this view, if the pelvis gets out of alignment, the bones don't line up correctly in front, and this puts a lot of extra pressure on that pubic symphysis cartilage. If the two sides are not aligned, it restricts full range of motion, pulling on the connecting pubic symphysis, and making it quite painful. The more out of alignment it is, the more painful this area becomes. It also tends to affect the back, especially in the sacroiliac area, since the pelvis and back are interconnected and work as a unit. And since many areas are affected by back problems, pain can also extend to other areas too.
Kmom's personal opinion is that this condition is probably primarily a problem of misalignment, although hormone levels and sensitivity to hormones may also play a role. In her opinion, the first line of SPD treatment should probably address the possibility of misalignment. Others may not agree. But whatever the cause, SPD is certainly annoying and painful to deal with, and Kmom knows this from personal experience!
Introduction
One problem that many pregnant women complain about is pubic pain. Yet doctors and midwives often dismiss this pain as either 'inconsequential', 'unfixable', or 'just one of those pregnancy discomforts that have to be endured'. Occasionally, some uninformed doctors have even erroneously told women that such pubic pain means that they would need an elective cesarean section in order not to permanently damage that area during birth, or as a result of prior damage to the area.
Yet none of this is true. Pubic pain in pregnancy is certainly not 'inconsequential'; Kmom knows from experience that it can be very difficult to deal with. Although many doctors and midwives do not know what causes it or how to fix it, many women are able to get improvement or relief with chiropractic treatment or osteopathic manipulation. It is not something that you 'just have to live with'. And although extra care should be taken during labor and birth in order to prevent trauma, it absolutely does NOT mean that you 'have' to have a cesarean!
This purpose of this FAQ is to discuss what causes pelvic/pubic pain, what some of the symptoms are, possible causes, hints for coping with pubic pain, how to prevent further trauma during birth, what kinds of treatments are available, and women's experiences with these treatments.
Anatomy and Structure
Your pelvis is a kind of a circular bone that goes all around and almost meets in the middle in front. The two sides do not quite touch; there is a small gap between them connected by fibrocartilaginous tissue reinforced by several ligaments. This area is called the Pubic Symphysis. This is important for helping your pubic bone to move freely, stabilizing the pelvis while allowing a good range of motion. [An illustration of the pelvis can be found at http://omie.med.jhmi.edu/weblec/templatev1/lec11.html.]
The Pubic Symphysis and the Sacro-Iliac joints (in the back of the pelvis) are especially important during pregnancy, as their flexibility allows the bones to move freely and to expand to help a baby fit through more easily during birth. In fact, the pregnancy hormones relaxin and progesterone help the ligaments of your body to loosen and be even MORE flexible than before, so that there is plenty of 'give' and lots of room for the baby to slip right through.
Because of these hormones, it is normal for there to be some extra looseness and pelvic pressure in pregnancy. This is good---it means your body is getting ready for birth! It's loosening up to give you maximum space and flexibility, and to help make things easy for you and your baby.
However, in some women, either because of excessive levels of hormones, extra sensitivity to hormones, or a pelvis that is out of alignment, this area is extra lax or there is extra pressure on the joint. In 1870, Snelling described this condition: "The affection appears to consist of a relaxation of the pelvic articulations, becoming apparent suddenly after parturition, or gradually during pregnancy; and permitting of a degree of mobility of the pelvic bones which effectually hinders locomotion, and gives rise to the most peculiar, distressing and alarming sensations."
Simply put, significant pubic pain is caused by the pelvic girdle area not working they way it should, probably because of hormones, misalignment of the pelvis, or an interaction of the two.
Although not every provider has a name for this condition, it is most commonly called Symphysis Pubis Dysfunction (or SPD), especially in Britain. Other names for it include:
* pubic shear (osteopathic term)
* symphyseal separation
* pubic symphysis separation
* separated symphysis
* pelvic girdle relaxation of pregnancy
* pelvic joint syndrome.
Diastasis Symphysis Pubis (DSP) is the name for the problem in its most severe form (where the pubic symphysis actually separates severely or tears). For ease of use, in this FAQ the 'milder' form will be referred to as SPD.
Symptoms
The symptoms of SPD vary from person to person, but almost all women who have it experience substantial pubic pain. Tenderness and pain down low in the front is common, but often this pain feels as if it's inside. The pubic area is generally very tender to the touch; many moms find it painful when the doctor or midwife pushes down on the pubic bone while measuring the uterus (fundal height).
Any activity that involves lifting one leg at a time or parting the legs tends to be particularly painful. Lifting the leg to put on clothes, getting out of a car, bending over, sitting down or getting up, walking up stairs, standing on one leg, lifting heavy objects, and walking in general tend to be difficult at times. Many women report that moving or turning over in bed is especially excruciating. One woman wrote, "There were days that I didn't think I was going to be able to get out of bed and actually had to roll out of bed and onto the floor to be able to do so!" [See her story below.]
Many movements become difficult when the pubic symphysis area is affected. Although the greatest pain is associated with movements of lifting one leg or parting the legs, some women experience a 'freezing', where they get up out of bed and find it hard to get their bodies moving right away--the hip bone seems stuck in place and won't move at first. Or they describe having to wait for it to 'pop into place' before being able to walk. The range of hip movement is usually affected, and abduction of the hips especially painful.
Many women also report sciatica (pain that shoots down the buttocks and leg) when pubic pain is present. SPD can also also be associated with bladder dysfunction, especially when going from lying down (or squatting) to a standing position. Some women also feel a 'clicking' when they walk or shift just 'so', or lots of pressure down low near the pubic area.
Many women with SPD also report very strong round ligament pain (pulling or tearing feelings in the abdomen when rolling over, moving suddenly, sneezing, coughing, getting up, etc.). Some chiropractors feel that round ligament pain can be an early symptom of SPD problems, and indicate the need for adjustments. Other providers consider round ligament pain normal, part of the body adjusting to the growing uterus. If experienced with pubic and/or low back pain, it probably is associated with the SPD.
Onset of Pain and Duration
Pubic pain often comes on early in pregnancy, even as early as 12 weeks. One mother reports that she had it at 17 weeks. She says:
When I woke up [from my nap] I could hardly move. It took me forever to walk into the next room. Felt like my hips/pelvis were glued together or something. Already this baby feels sooo heavy inside me, like lots of pressure. I've gained 4 lbs. so far, what's the deal? At night when I wake up to go to the bathroom, sometimes I can't move my legs/hips at all, and sometimes things have to 'pop' back into place. I think, what if there is a fire and I died 'cuz I'm too slow!...I thought this problem in my 1st pregnancy was from gaining so much/swelling and it got worse and worse and stayed till over 3 months postpartum."
Indeed, although pubic pain often does go away after pregnancy, many women find that it sticks around afterward, usually diminished but still present. If treatment to resolve any underlying causes is not done, long-term pain usually sticks around. Anecdotally, this often seems to be associated with long-term low back pain or reduced flexibility in the hips. Even worse, if the mother is mishandled during the birth, the pubic symphysis can separate even more or be permanently damaged. This is called Diastasis Symphysis Pubis (diastasis means gap or separation).
Summary
To summarize, SPD is the mild form of this problem. Its symptoms often include one or more of the following:
* pubic pain
* pubic tenderness to the touch; having the fundal height measured may be uncomfortable
* lower back pain, especially in the sacro-iliac area
* difficulty/pain rolling over in bed
* difficulty/pain with stairs, getting in and out of cars, sitting down or getting up, putting on clothes, bending, lifting, standing on one foot, lifting heavy objects, etc.
* sciatica (pain in buttocks and down the leg)
* "clicking" in the pelvis when walking
* waddling gait
* difficulty getting started walking, especially after sleep
* feeling like hip is out of place or has to pop into place before walking
* bladder dysfunction (temporary incontinence at change in position)
* knee pain or pain in other areas can sometimes also be a side-effect of pelvis problems
* some chiropractors feel that round ligament pain (sharp tearing or pulling sensations in the abdomen) can be related to SPD
Cause
No one knows why SPD occurs for sure, or why it happens in some women and not in others. Some ethnic groups report a high incidence, especially Scandinavian women and perhaps Black women. Other risk factors may include having lots of kids, having had large babies, pre-existing problems with this joint, past pelvic or back pain, or past trauma (car accident, obstetric trauma, etc.) that may have damaged the pelvic girdle area. It also seems logical that women who have broken or injured their pelvis in the past would probably be prone to this problem.
Some sources view SPD simply as a result of pregnancy hormones. As noted, the pregnancy hormones relaxin and progesterone tend to loosen the ligaments of the body in preparation for birth. One theory is that some women have high levels of hormones before pregnancy, and then additional pregnancy hormones cause excessive relaxation of ligaments, especially in the pelvis.
Another theory is that some women manufacture excessive levels of relaxin during pregnancy, causing pelvic laxity. However, although still popular, this theory seems to have been disproven by recent research. Another theory is that women whose joints are especially flexible before pregnancy may be more susceptible to the effect of hormones, or that some women's bodies are just more affected by hormones than others. Traditional medical sources tend to view the problem of pelvic/pubic pain (when they acknowledge it at all) as simply a hormone problem.
A different theory holds that the problem is structural instead, and usually results from a misalignment of the pelvis. In this view, if the pelvis gets out of alignment, the bones don't line up correctly in front, and this puts a lot of extra pressure on that pubic symphysis cartilage. If the two sides are not aligned, it restricts full range of motion, pulling on the connecting pubic symphysis, and making it quite painful. The more out of alignment it is, the more painful this area becomes. It also tends to affect the back, especially in the sacroiliac area, since the pelvis and back are interconnected and work as a unit. And since many areas are affected by back problems, pain can also extend to other areas too.
Kmom's personal opinion is that this condition is probably primarily a problem of misalignment, although hormone levels and sensitivity to hormones may also play a role. In her opinion, the first line of SPD treatment should probably address the possibility of misalignment. Others may not agree. But whatever the cause, SPD is certainly annoying and painful to deal with, and Kmom knows this from personal experience!
Monday, February 1, 2010
Due Date Rant
So on January 5th, 2o1o we had an Ultrasound to look at the baby and see how she is doing. At that time we were told the baby weighed in at approx. 1903 grams.
For those of you who do not know math you multiply that by 2.2 pounds to get the weight in pounds. So for those who want the quick answer our daughter is weighing in at approx. 4 pounds 2 ounces.
With that being said this I think goes to prove that I am actually 35 weeks not 31 weeks like the first ultrasound had guesstimated.
So hopefully in the next 4 weeks we will have a baby. I am actually thinking on trying Castrol Oil to see if it will help induce the pregnancy. If it does I would be so happy :D At this point in time I believe the baby would be healthy enough to survive.
When we had the first ultrasound done the tech asked me how far along I was I said approx. 12 weeks. After the ultrasound was done she claimed I was 8 weeks not 12 weeks. With the baby weighing in as much as she did on January 5th, I believe my dates were correct which would put me at 35 weeks not 31 weeks like the ultrasound say I am to be.
Sigh so here is hopefully to a speedy February :D so we can get this show on the road. :D
For those of you who do not know math you multiply that by 2.2 pounds to get the weight in pounds. So for those who want the quick answer our daughter is weighing in at approx. 4 pounds 2 ounces.
With that being said this I think goes to prove that I am actually 35 weeks not 31 weeks like the first ultrasound had guesstimated.
So hopefully in the next 4 weeks we will have a baby. I am actually thinking on trying Castrol Oil to see if it will help induce the pregnancy. If it does I would be so happy :D At this point in time I believe the baby would be healthy enough to survive.
When we had the first ultrasound done the tech asked me how far along I was I said approx. 12 weeks. After the ultrasound was done she claimed I was 8 weeks not 12 weeks. With the baby weighing in as much as she did on January 5th, I believe my dates were correct which would put me at 35 weeks not 31 weeks like the ultrasound say I am to be.
Sigh so here is hopefully to a speedy February :D so we can get this show on the road. :D
Thrombosed External Hemorrhoid
These things are extremely painful. OMG. I have read that most women would rather be in labor than to have these. Even the smallest thrombosed hemorrhoid can lead to extreme pain. On Thursday the 28th of January I had a clot removed from one that was the size of a grape. But the nurse practitioner missed the other clot so it is still there just not as painful but still uncomfortable.
On February 1st, I decided to walk back up and see if they could do anything because it has been really awkward and feels like I am walking around with a stool in my pants, when I am not. But I also noticed I have a smaller one, about 2mm that is it and it was more painful than the one that was the size of a grape.
So I had that one removed and was told I am doing the right thing using the Anusol HC Ointment, Sitz Baths, Tucks Pads and Witchhazel, warm baths,laying on my left side to allow the circulation to get better which will decrease the swelling and eventually make it go away. I was also told that because I am pregnant it may not go away until after the baby is born. SIGH.
Anyways that is my rant, below is what Thrombosed External Hemorrhoids are.
What Thrombosed Hemorrhoid Look and Feel Like
Veins in the anus or outside of the rectum can start to swell and become external when they protrude outward from these areas. When blood flow becomes restricted in these veins, the vessels tend to split, causing pools of blood to form and clot under the skin. When this happens, you get a thrombosed hemorrhoid.
Thrombosed hemorrhoids are easy to spot and felt. They can be either hard or soft to the touch. Referred to as a skin tag, these lumps feel like small masses of skin. Thrombosed hemorrhoids also appear to be blue in color. This is because the veins are strangled under the skin and there is no regular blood flow through them. Upon being irritated, they can also turn red.
While they are not considered dangerous, thrombosed hemorrhoids do cause considerable pain and swelling because they affect the nerve endings located in the anal skin. Bleeding is not common but it can occur if the blood clot oozes or receives friction.
Possible Causes
Common causes of thrombosed hemorrhoids include sitting for long periods of time, straining too much during a bowel movement, lifting weights, and giving birth.
Treatment of Thrombosed Hemorrhoids
It is possible for blood clots to break up and be re-absorbed by your body. This can happen over a four to six week period. However, if a thrombosed hemorrhoid grows and creates more pain or there is considerable swelling, it may be necessary to have surgery.
Removing a blood clot can be done at a doctor's office or as an outpatient procedure. Under no circumstances should a blood clot be removed at home as it can lead to severe bleeding and trauma.
The doctor has a number of procedures to choose from when extracting a blood clot. Once quick and easy choice is to make a cut above the clot so it can be squeezed out. However, the probability of blood clots reforming and additional pain remains greater with this procedure. While more intrusive, a full hemorrhoidectomy removes the clot and the blood vessels, leading to better cure results. Both procedures use local anesthesia to numb the area that needs to be cut.
It is recommended that thrombosed hemorrhoids surgery be done within the first three days of symptoms. After that period of time, the level of hemeroids symptom relief may not be as significant and there could be more recovery time required. There is also the possibility that the thrombosed hemorrhoids will go away without treatment.
Alternative Treatments to Consider
Outside of surgery, there are a number of alternative treatments that can bring relief from thrombosed hemorrhoids. These treatments include warm baths and creams to alleviate the inflammation and pain. Dietary changes, including the addition of fiber sources, can solve constipation and soften stools. One of many natural treatments now available, Venapro uses pure botanical and herbal extracts known to soothe and heal. This effective alternative improves venous circulation while calming inflamed areas with absolutely no side effects.
How to Choose a Thrombosed Hemorrhoids Treatment
The level of pain you experience will help you determine the right thrombosed hemorrhoids treatment for you. For example, if the pain prohibits your common daily activities, such as walking, working, sleeping or exercising, surgery is probably the solution. However, minor pain that seems to dissipate might indicate that your thrombosed hemorrhoid is going away on its own and should be left alone or treated with a natural alternative like Venapro.
On February 1st, I decided to walk back up and see if they could do anything because it has been really awkward and feels like I am walking around with a stool in my pants, when I am not. But I also noticed I have a smaller one, about 2mm that is it and it was more painful than the one that was the size of a grape.
So I had that one removed and was told I am doing the right thing using the Anusol HC Ointment, Sitz Baths, Tucks Pads and Witchhazel, warm baths,laying on my left side to allow the circulation to get better which will decrease the swelling and eventually make it go away. I was also told that because I am pregnant it may not go away until after the baby is born. SIGH.
Anyways that is my rant, below is what Thrombosed External Hemorrhoids are.
What Thrombosed Hemorrhoid Look and Feel Like
Veins in the anus or outside of the rectum can start to swell and become external when they protrude outward from these areas. When blood flow becomes restricted in these veins, the vessels tend to split, causing pools of blood to form and clot under the skin. When this happens, you get a thrombosed hemorrhoid.
Thrombosed hemorrhoids are easy to spot and felt. They can be either hard or soft to the touch. Referred to as a skin tag, these lumps feel like small masses of skin. Thrombosed hemorrhoids also appear to be blue in color. This is because the veins are strangled under the skin and there is no regular blood flow through them. Upon being irritated, they can also turn red.
While they are not considered dangerous, thrombosed hemorrhoids do cause considerable pain and swelling because they affect the nerve endings located in the anal skin. Bleeding is not common but it can occur if the blood clot oozes or receives friction.
Possible Causes
Common causes of thrombosed hemorrhoids include sitting for long periods of time, straining too much during a bowel movement, lifting weights, and giving birth.
Treatment of Thrombosed Hemorrhoids
It is possible for blood clots to break up and be re-absorbed by your body. This can happen over a four to six week period. However, if a thrombosed hemorrhoid grows and creates more pain or there is considerable swelling, it may be necessary to have surgery.
Removing a blood clot can be done at a doctor's office or as an outpatient procedure. Under no circumstances should a blood clot be removed at home as it can lead to severe bleeding and trauma.
The doctor has a number of procedures to choose from when extracting a blood clot. Once quick and easy choice is to make a cut above the clot so it can be squeezed out. However, the probability of blood clots reforming and additional pain remains greater with this procedure. While more intrusive, a full hemorrhoidectomy removes the clot and the blood vessels, leading to better cure results. Both procedures use local anesthesia to numb the area that needs to be cut.
It is recommended that thrombosed hemorrhoids surgery be done within the first three days of symptoms. After that period of time, the level of hemeroids symptom relief may not be as significant and there could be more recovery time required. There is also the possibility that the thrombosed hemorrhoids will go away without treatment.
Alternative Treatments to Consider
Outside of surgery, there are a number of alternative treatments that can bring relief from thrombosed hemorrhoids. These treatments include warm baths and creams to alleviate the inflammation and pain. Dietary changes, including the addition of fiber sources, can solve constipation and soften stools. One of many natural treatments now available, Venapro uses pure botanical and herbal extracts known to soothe and heal. This effective alternative improves venous circulation while calming inflamed areas with absolutely no side effects.
How to Choose a Thrombosed Hemorrhoids Treatment
The level of pain you experience will help you determine the right thrombosed hemorrhoids treatment for you. For example, if the pain prohibits your common daily activities, such as walking, working, sleeping or exercising, surgery is probably the solution. However, minor pain that seems to dissipate might indicate that your thrombosed hemorrhoid is going away on its own and should be left alone or treated with a natural alternative like Venapro.
Wednesday, January 27, 2010
Signs of labor
Is there any way to predict when I'm going to go into labor?
Not really. Experts don't fully understand what triggers the onset of labor, and there's no way to predict exactly when it will start.
Your body actually starts preparing for labor up to a month before you give birth. You may be blissfully unaware of what's going on — or you may begin to notice new symptoms as your due date draws near. Here are some things that may happen in the weeks or days before labor starts:
Your baby "drops."
If this is your first pregnancy, you may feel what's known as "lightening" a few weeks before labor starts. You might detect a heaviness in your pelvis as this happens and notice less pressure just below your ribcage, making it easier to catch your breath.
You note more Braxton Hicks contractions.
More frequent and intense Braxton Hicks contractions can signal pre-labor, during which your cervix ripens (see below) and the stage is set for true labor. Some women experience a crampy, menstrual-like feeling during this time.
Sometimes, as true labor draws near, Braxton Hicks contractions become relatively painful and strike as often as every ten to 20 minutes, making you wonder whether true labor has started. But if the contractions don't get longer, stronger, and closer together and cause your cervix to dilate progressively, then what you're feeling is probably so-called false labor.
Your cervix starts to ripen.
In the days and weeks before delivery, Braxton Hicks contractions may do the preliminary work of softening, thinning, and perhaps opening your cervix a bit. (If you've given birth before, your cervix is more likely to dilate a centimeter or two before labor starts, but keep in mind that even being 40 weeks pregnant with your first baby and 1 centimeter dilated is no guarantee that labor is imminent.)
When you're at or near your due date, your practitioner may do a vaginal exam during your prenatal visit to see whether your cervix has started to change.
You pass your mucus plug or notice "bloody show."
You may pass your mucus plug — the small amount of thickened mucus that has sealed your cervical canal during the last nine months — if your cervix begins to dilate as you get close to labor.
The plug may come out in a lump or as increased vaginal discharge over the course of several days. The mucus may be tinged with brown, pink, or red blood, which is why it's referred to as "bloody show." Having sex or a vaginal exam can also disturb your mucus plug and cause you to see some blood-tinged discharge, even when labor isn't going to start in the next few days.
Your water breaks.
When the fluid-filled amniotic sac surrounding your baby ruptures, fluid leaks from your vagina. And whether it comes out in a large gush or a small trickle, you should call your doctor or midwife.
Most women start having regular contractions before their water breaks, but in some cases, the water breaks first. When this happens, labor usually follows soon. If you don't start having contractions on your own within a certain amount of time, you'll need to be induced, since your baby's more likely to get an infection without the amniotic sac's protection against germs.
How can I tell whether my labor has actually started?
It's often not possible to pinpoint exactly when "true" labor begins because early labor contractions might start out feeling like the Braxton Hicks contractions you may have been noticing for weeks.
It's likely that labor is under way, however, when your contractions become increasingly longer, stronger, and closer together. They may be as far apart as every ten minutes or so in the beginning, but they won't stop or ease up no matter what you do. And in time, they'll become more painful and closer together.
In some cases, though, the onset of strong, regular contractions comes with little or no warning. It's different for every woman and with every pregnancy.
When should I call my doctor or midwife?
Toward the end of your pregnancy, your practitioner should give you a clear set of guidelines for when to let her know that you're having contractions and at what point she'll want you to go to the hospital or birth center.
These instructions will depend on your individual situation — whether you have pregnancy complications or are otherwise considered high-risk, whether this is your first baby, and practical matters like how far you live from the hospital or birth center — as well as on your caregiver's personal preference (some prefer an early heads-up).
If your pregnancy is uncomplicated, she'll probably have you wait to come in until you've been having contractions that last for about a minute each, coming every five minutes for about an hour. (You time a contraction from the beginning of one to the beginning of the next one.) As a rule, if you're high-risk, she'll want to hear from you earlier in labor.
Don't be afraid to call if the signs aren't clear but you think the time may have come. Doctors and midwives are used to getting calls from women who aren't sure whether they're in labor and need guidance. It's part of their job.
And the truth is, your caregiver can tell a lot by the sound of your voice, so verbal communication helps. She'll want to know how close together your contractions are, how long each one lasts, how strong they are (she'll note whether you can talk through a contraction), and any other symptoms you may have.
Finally, whether or not your pregnancy has been problem-free up to now, and whether or not you think you might be in labor, be sure to call your caregiver right away (and if you can't reach her, head for the hospital) in the following situations:
• Your water breaks or you suspect that you're leaking amniotic fluid. Tell your practitioner if it's yellow, brown, or greenish, because this signals the presence of meconium, your baby's first stool, which is sometimes a sign of fetal stress. It's also important to let her know if the fluid looks bloody.
• You notice that your baby is less active.
• You have vaginal bleeding (unless it's just bloody show — mucus with a spot or streak of blood), constant severe abdominal pain, or fever.
• You start having contractions before 37 weeks or any other signs of preterm labor.
• You have severe or persistent headaches, vision changes, intense pain or tenderness in your upper abdomen, abnormal swelling, or any other symptoms of preeclampsia.
Some women assume that various symptoms are just part and parcel of being pregnant, while others worry that every new symptom spells trouble. Knowing which pregnancy symptoms you should never ignore can help you decide when to call your caregiver.
That said, every pregnancy is different and no list can cover all situations, so if you're not sure whether a symptom is serious, or if you just don't feel like yourself or are uneasy, trust your instincts and call your healthcare provider. If there's a problem, you'll get help. If nothing's wrong, you'll be reassured.
Not really. Experts don't fully understand what triggers the onset of labor, and there's no way to predict exactly when it will start.
Your body actually starts preparing for labor up to a month before you give birth. You may be blissfully unaware of what's going on — or you may begin to notice new symptoms as your due date draws near. Here are some things that may happen in the weeks or days before labor starts:
Your baby "drops."
If this is your first pregnancy, you may feel what's known as "lightening" a few weeks before labor starts. You might detect a heaviness in your pelvis as this happens and notice less pressure just below your ribcage, making it easier to catch your breath.
You note more Braxton Hicks contractions.
More frequent and intense Braxton Hicks contractions can signal pre-labor, during which your cervix ripens (see below) and the stage is set for true labor. Some women experience a crampy, menstrual-like feeling during this time.
Sometimes, as true labor draws near, Braxton Hicks contractions become relatively painful and strike as often as every ten to 20 minutes, making you wonder whether true labor has started. But if the contractions don't get longer, stronger, and closer together and cause your cervix to dilate progressively, then what you're feeling is probably so-called false labor.
Your cervix starts to ripen.
In the days and weeks before delivery, Braxton Hicks contractions may do the preliminary work of softening, thinning, and perhaps opening your cervix a bit. (If you've given birth before, your cervix is more likely to dilate a centimeter or two before labor starts, but keep in mind that even being 40 weeks pregnant with your first baby and 1 centimeter dilated is no guarantee that labor is imminent.)
When you're at or near your due date, your practitioner may do a vaginal exam during your prenatal visit to see whether your cervix has started to change.
You pass your mucus plug or notice "bloody show."
You may pass your mucus plug — the small amount of thickened mucus that has sealed your cervical canal during the last nine months — if your cervix begins to dilate as you get close to labor.
The plug may come out in a lump or as increased vaginal discharge over the course of several days. The mucus may be tinged with brown, pink, or red blood, which is why it's referred to as "bloody show." Having sex or a vaginal exam can also disturb your mucus plug and cause you to see some blood-tinged discharge, even when labor isn't going to start in the next few days.
Your water breaks.
When the fluid-filled amniotic sac surrounding your baby ruptures, fluid leaks from your vagina. And whether it comes out in a large gush or a small trickle, you should call your doctor or midwife.
Most women start having regular contractions before their water breaks, but in some cases, the water breaks first. When this happens, labor usually follows soon. If you don't start having contractions on your own within a certain amount of time, you'll need to be induced, since your baby's more likely to get an infection without the amniotic sac's protection against germs.
How can I tell whether my labor has actually started?
It's often not possible to pinpoint exactly when "true" labor begins because early labor contractions might start out feeling like the Braxton Hicks contractions you may have been noticing for weeks.
It's likely that labor is under way, however, when your contractions become increasingly longer, stronger, and closer together. They may be as far apart as every ten minutes or so in the beginning, but they won't stop or ease up no matter what you do. And in time, they'll become more painful and closer together.
In some cases, though, the onset of strong, regular contractions comes with little or no warning. It's different for every woman and with every pregnancy.
When should I call my doctor or midwife?
Toward the end of your pregnancy, your practitioner should give you a clear set of guidelines for when to let her know that you're having contractions and at what point she'll want you to go to the hospital or birth center.
These instructions will depend on your individual situation — whether you have pregnancy complications or are otherwise considered high-risk, whether this is your first baby, and practical matters like how far you live from the hospital or birth center — as well as on your caregiver's personal preference (some prefer an early heads-up).
If your pregnancy is uncomplicated, she'll probably have you wait to come in until you've been having contractions that last for about a minute each, coming every five minutes for about an hour. (You time a contraction from the beginning of one to the beginning of the next one.) As a rule, if you're high-risk, she'll want to hear from you earlier in labor.
Don't be afraid to call if the signs aren't clear but you think the time may have come. Doctors and midwives are used to getting calls from women who aren't sure whether they're in labor and need guidance. It's part of their job.
And the truth is, your caregiver can tell a lot by the sound of your voice, so verbal communication helps. She'll want to know how close together your contractions are, how long each one lasts, how strong they are (she'll note whether you can talk through a contraction), and any other symptoms you may have.
Finally, whether or not your pregnancy has been problem-free up to now, and whether or not you think you might be in labor, be sure to call your caregiver right away (and if you can't reach her, head for the hospital) in the following situations:
• Your water breaks or you suspect that you're leaking amniotic fluid. Tell your practitioner if it's yellow, brown, or greenish, because this signals the presence of meconium, your baby's first stool, which is sometimes a sign of fetal stress. It's also important to let her know if the fluid looks bloody.
• You notice that your baby is less active.
• You have vaginal bleeding (unless it's just bloody show — mucus with a spot or streak of blood), constant severe abdominal pain, or fever.
• You start having contractions before 37 weeks or any other signs of preterm labor.
• You have severe or persistent headaches, vision changes, intense pain or tenderness in your upper abdomen, abnormal swelling, or any other symptoms of preeclampsia.
Some women assume that various symptoms are just part and parcel of being pregnant, while others worry that every new symptom spells trouble. Knowing which pregnancy symptoms you should never ignore can help you decide when to call your caregiver.
That said, every pregnancy is different and no list can cover all situations, so if you're not sure whether a symptom is serious, or if you just don't feel like yourself or are uneasy, trust your instincts and call your healthcare provider. If there's a problem, you'll get help. If nothing's wrong, you'll be reassured.
Braxton Hicks
What are Braxton Hicks contractions?
Braxton Hicks contractions are sporadic uterine contractions that start about 6 weeks into your pregnancy, although you won't be able to feel them that early. You probably won't start to notice them until sometime after mid-pregnancy, if you notice them at all. (Some women don't.) They get their name from John Braxton Hicks, an English doctor who first described them in 1872.
As your pregnancy progresses, Braxton Hicks contractions tend to come somewhat more often, but until you get to your last few weeks, they'll probably remain infrequent, irregular, and essentially painless. Sometimes, though, Braxton Hicks contractions are hard to distinguish from early signs of preterm labor.
Play it safe and don't try to make the diagnosis yourself. If you haven't hit 37 weeks yet and you're having more than four contractions in an hour — or you have any other signs of preterm labor (see below) — call your caregiver immediately.
By the time you're within a couple of weeks of your due date, your contractions may get more intense and more frequent, and they may cause some discomfort. Unlike the earlier painless and sporadic Braxton Hicks contractions, which caused no obvious cervical changes, these contractions may help your cervix "ripen" — gradually soften and thin out (efface) and maybe even dilate a bit. This period is sometimes referred to as pre-labor.
How can I tell the difference between Braxton Hicks and true labor contractions?
In the days or weeks before labor, Braxton Hicks contractions may intermittently become rhythmic, relatively close together, and even painful, possibly fooling you into thinking you're in labor. But unlike true labor, during this so-called false labor the contractions don't grow consistently longer, stronger, and closer together.
What can I do if my Braxton Hicks contractions are making me uncomfortable?
If you're within a few weeks of your due date, try these measures:
• Change your activity or position. Sometimes walking provides relief. At other times, resting eases contractions. (True labor contractions, on the other hand, will persist and progress regardless of what you do.)
• Take a warm bath to help your body relax.
• Try drinking a couple of glasses of water, since these contractions can sometimes be brought on by dehydration.
• Try relaxation exercises or slow, deep breathing. This won't stop the Braxton Hicks contractions, but it may help you cope with the discomfort. (Use this opportunity to practice some of the pain-management strategies you've learned in your childbirth preparation class.)
When should I call my doctor or midwife?
Call your caregiver right away if you haven't reached 37 weeks and your contractions are becoming more frequent, rhythmic, or painful, or if you have any of these possible signs of preterm labor:
• Abdominal pain, menstrual-like cramping, or more than four contractions in an hour (even if they don't hurt)
• Any vaginal bleeding or spotting
• An increase in vaginal discharge or a change in the type of discharge — if it becomes watery, mucusy, or bloody (even if it's only pink or blood-tinged)
• Increased pelvic pressure (a feeling that your baby's pushing down)
• Low back pain, especially if it's a new problem for you
If you're past 37 weeks, there's no need to call your doctor or midwife just for contractions until they last about 60 seconds each and are five minutes apart — unless your caregiver has advised you otherwise.
Braxton Hicks contractions are sporadic uterine contractions that start about 6 weeks into your pregnancy, although you won't be able to feel them that early. You probably won't start to notice them until sometime after mid-pregnancy, if you notice them at all. (Some women don't.) They get their name from John Braxton Hicks, an English doctor who first described them in 1872.
As your pregnancy progresses, Braxton Hicks contractions tend to come somewhat more often, but until you get to your last few weeks, they'll probably remain infrequent, irregular, and essentially painless. Sometimes, though, Braxton Hicks contractions are hard to distinguish from early signs of preterm labor.
Play it safe and don't try to make the diagnosis yourself. If you haven't hit 37 weeks yet and you're having more than four contractions in an hour — or you have any other signs of preterm labor (see below) — call your caregiver immediately.
By the time you're within a couple of weeks of your due date, your contractions may get more intense and more frequent, and they may cause some discomfort. Unlike the earlier painless and sporadic Braxton Hicks contractions, which caused no obvious cervical changes, these contractions may help your cervix "ripen" — gradually soften and thin out (efface) and maybe even dilate a bit. This period is sometimes referred to as pre-labor.
How can I tell the difference between Braxton Hicks and true labor contractions?
In the days or weeks before labor, Braxton Hicks contractions may intermittently become rhythmic, relatively close together, and even painful, possibly fooling you into thinking you're in labor. But unlike true labor, during this so-called false labor the contractions don't grow consistently longer, stronger, and closer together.
What can I do if my Braxton Hicks contractions are making me uncomfortable?
If you're within a few weeks of your due date, try these measures:
• Change your activity or position. Sometimes walking provides relief. At other times, resting eases contractions. (True labor contractions, on the other hand, will persist and progress regardless of what you do.)
• Take a warm bath to help your body relax.
• Try drinking a couple of glasses of water, since these contractions can sometimes be brought on by dehydration.
• Try relaxation exercises or slow, deep breathing. This won't stop the Braxton Hicks contractions, but it may help you cope with the discomfort. (Use this opportunity to practice some of the pain-management strategies you've learned in your childbirth preparation class.)
When should I call my doctor or midwife?
Call your caregiver right away if you haven't reached 37 weeks and your contractions are becoming more frequent, rhythmic, or painful, or if you have any of these possible signs of preterm labor:
• Abdominal pain, menstrual-like cramping, or more than four contractions in an hour (even if they don't hurt)
• Any vaginal bleeding or spotting
• An increase in vaginal discharge or a change in the type of discharge — if it becomes watery, mucusy, or bloody (even if it's only pink or blood-tinged)
• Increased pelvic pressure (a feeling that your baby's pushing down)
• Low back pain, especially if it's a new problem for you
If you're past 37 weeks, there's no need to call your doctor or midwife just for contractions until they last about 60 seconds each and are five minutes apart — unless your caregiver has advised you otherwise.
A childbirth cheat sheet for dads-to-be
One of the best ways to prepare for childbirth — an eye-opening experience for most of us — is to accompany your wife or partner to a childbirth education class. Almost all hospitals and birth centers hold sessions, and parents are usually given the option of attending two or three short evening sessions or one long daytime session. For me, the class was a great introduction to the big event, still several weeks off for us.
We decided to attend a one-day childbirth preparation class at our hospital (Alta Bates in Berkeley, California) rather than attend an offsite class, where the emphasis is more likely to be on natural childbirth. I'll confess up front that I thought 80 percent of the class would be about breathing exercises. Not quite.
We immediately hit it off with our instructor, Janaki Costello, a certified doula, childbirth educator, and board-certified lactation consultant. Here are the ten key lessons she passed along:
1. Recognize the onset of true labor
Late in their pregnancy, most women will experience false labor — Braxton Hicks contractions that may start out strong but taper off and then stop after a while. Look for these signs, among others, that your wife is experiencing the real deal:
• Her water may break, resulting in a trickle or a gush of fluid. When the amniotic sac (also called the bag of waters) breaks, 80 percent of women will spontaneously go into labor within 12 hours. Keep in mind, though, that contractions usually start before her water breaks.
• Persistent lower back pain, especially if your partner also complains about a crampy, premenstrual feeling.
• Contractions that occur at regular and increasingly shorter intervals and become longer and stronger in intensity.
• She passes the mucus plug, which blocks the cervix. This isn't necessarily a sign that labor is imminent — it could still be several days away — but, at the very least, it indicates that things are moving.
2. Know how to time the contractions
Make sure your watch has a readable second hand, and time your wife's contractions from the beginning of one contraction to the beginning of the next. If they're eight to 10 minutes apart and last 30 to 45 seconds each, your partner is likely in early labor. Your doctor or midwife can help you make the decision over the phone about when to come in. As a general rule-of-thumb, if the contractions are less than five minutes apart, last a minute or more, and continue in that pattern for an hour, you should get to the hospital. But some situations call for getting to the hospital sooner, so be sure to talk to your caregiver ahead of time about what's right for you.
3. Don't get to the hospital too early
Costello hit us over the head with this admonition: Don't head to the hospital the minute your partner goes into labor. If she's dilated to only 1 centimeter, chances are they'll send you home because you have a good ways to go. "Take a walk, go to the mall or a museum, hit the beach, catch a movie — anything to help you take your mind off the contractions," Costello said. "Try not to fixate on the clock. If it happens at night, try to get back to sleep for a few hours." Easier said than done, says my wife.
4. Know what to expect during labor
Forget those TV sitcom images where a woman goes into labor and a baby pops out by the second commercial. It sometimes happens that fast, but only rarely. For most, especially first-time mothers, labor is a journey, not an event. Bottom line: Don't expect this will be over in just a few hours. Every woman's experience is different, but it's helpful to understand that there are three distinct stages of labor:
First stage
The first stage really consists of three phases:
• Early phase. This phase typically lasts up to 14 hours or longer, although it's usually considerably shorter for second and subsequent babies. As labor progresses, the contractions get longer and stronger.
• Active phase. Often this phase lasts up to six or more hours, although it can be a lot shorter. You should be in the hospital or birth center by now or en route. Contractions are much more intense, last about 40 to 60 seconds, and are spaced 3 to 5 minutes apart. Breathing exercises, relaxation techniques, and coaching are all important now. If your partner is having trouble coping or she's not interested in a drug-free labor, this is when she might opt for an epidural or other pain relief.
• Transition phase. This phase can last anywhere from a few minutes to a several hours. It's here that your partner is most likely to swear at you like a truck driver. (Don't take it personally; even women who have coped well up to this point often "lose it" during the transition phase.) Contractions last 60 to 90 seconds and come two or three minutes apart.
Second stage
• Pushing and birth. The second stage can last from minutes to hours — the average is about an hour for a first-time pregnancy (longer if she's had an epidural) — and ends with a moment that's made up in equal parts of relief and breathtaking beauty: the birth of your baby. There's a lot to think about during this phase: Do you want to record the birth on video? Will you want to cut the cord? (Be sure to remind your doctor or midwife if you do.) Does your partner want to try to breastfeed immediately after birth? If the doctor or midwife or labor and delivery nurse doesn't make sure that happens, you'll need to be ready to advocate for her.
Third stage
• Delivery of the placenta. It's not over yet! This stage, which begins immediately after the birth of your baby and ends with the delivery of the placenta anywhere from one to 30 minutes later, is usually anticlimactic but necessary. Be aware, too, that your partner may get a case of the chills during this phase or feel very shaky. If that's the case, be ready to offer a warm blanket and to hold your newborn while she's regaining her strength.
5. Be an active participant
Costello looked at the half-dozen expectant fathers around the table. "Remember, dads, it's your baby, too. You're a critical part of the process."
In the days and weeks before your baby's due date, make sure both you and your wife are packed for the hospital, including a possible change of clothes, toiletries, and camera or camcorder, and other essentials. If you have a birth plan, you may need to let the labor and delivery nurses know about it (you should have already discussed it with your doctor or midwife).
During early labor, remind your partner to drink plenty of liquids. Pour her a glass of nonacidic juice such as apple juice or pineapple juice, honey and water, an herbal tea, or just plain water to ward off dehydration. Offer her a bagel, yogurt, or something bland — she might not get anything solid to eat at the hospital for many hours after the baby's birth. Finish packing.
When you head to the hospital, drive carefully. This isn't the time for taking unnecessary chances. When you get to the labor room, stick around to provide comfort and support. "The transition stage is not the time to head out for a long lunch," Costello advised. Feel free to bring fruit or other snacks along if it's in the middle of the night.
6. Be an advocate for your partner
The doctor or midwife and nurses are there to make sure your partner and baby do well during labor and birth. But you have a big role in helping your partner get comfortable and in communicating her wishes. You and she also have a big say in personalizing your room. When it's time to rest, soften the lighting. Freshen the smell by taking along aromatherapy balls, potpourri, or scented oils. Bring pictures and your own music. I found a portable CD player in the garage and packed some of my wife's favorite CDs.
7. Know how to play coach
Take your cues from your partner. Some women love having a massage or having their hair stroked during labor. Others don't. And it may be hard to predict ahead of time what your partner will prefer. In any case, try to reassure her that she's doing fine and be ready to help in any way she asks. See more tips on how to be a great labor coach.
8. Be prepared
We watched two videos of vaginal births and one of a c-section. All showed the messy, unglamorous side of labor. Don't be surprised if your baby's skin looks wrinkled or his head is molded into a cone shape, and, in truth, he doesn't even look like a baby.
9. Cut the cord if you want
Today, most dads choose to cut the baby's umbilical cord in the first minutes after birth. "It's your right, but sometimes they forget," Costello said, "so make sure you remind your doctor or midwife."
We decided to attend a one-day childbirth preparation class at our hospital (Alta Bates in Berkeley, California) rather than attend an offsite class, where the emphasis is more likely to be on natural childbirth. I'll confess up front that I thought 80 percent of the class would be about breathing exercises. Not quite.
We immediately hit it off with our instructor, Janaki Costello, a certified doula, childbirth educator, and board-certified lactation consultant. Here are the ten key lessons she passed along:
1. Recognize the onset of true labor
Late in their pregnancy, most women will experience false labor — Braxton Hicks contractions that may start out strong but taper off and then stop after a while. Look for these signs, among others, that your wife is experiencing the real deal:
• Her water may break, resulting in a trickle or a gush of fluid. When the amniotic sac (also called the bag of waters) breaks, 80 percent of women will spontaneously go into labor within 12 hours. Keep in mind, though, that contractions usually start before her water breaks.
• Persistent lower back pain, especially if your partner also complains about a crampy, premenstrual feeling.
• Contractions that occur at regular and increasingly shorter intervals and become longer and stronger in intensity.
• She passes the mucus plug, which blocks the cervix. This isn't necessarily a sign that labor is imminent — it could still be several days away — but, at the very least, it indicates that things are moving.
2. Know how to time the contractions
Make sure your watch has a readable second hand, and time your wife's contractions from the beginning of one contraction to the beginning of the next. If they're eight to 10 minutes apart and last 30 to 45 seconds each, your partner is likely in early labor. Your doctor or midwife can help you make the decision over the phone about when to come in. As a general rule-of-thumb, if the contractions are less than five minutes apart, last a minute or more, and continue in that pattern for an hour, you should get to the hospital. But some situations call for getting to the hospital sooner, so be sure to talk to your caregiver ahead of time about what's right for you.
3. Don't get to the hospital too early
Costello hit us over the head with this admonition: Don't head to the hospital the minute your partner goes into labor. If she's dilated to only 1 centimeter, chances are they'll send you home because you have a good ways to go. "Take a walk, go to the mall or a museum, hit the beach, catch a movie — anything to help you take your mind off the contractions," Costello said. "Try not to fixate on the clock. If it happens at night, try to get back to sleep for a few hours." Easier said than done, says my wife.
4. Know what to expect during labor
Forget those TV sitcom images where a woman goes into labor and a baby pops out by the second commercial. It sometimes happens that fast, but only rarely. For most, especially first-time mothers, labor is a journey, not an event. Bottom line: Don't expect this will be over in just a few hours. Every woman's experience is different, but it's helpful to understand that there are three distinct stages of labor:
First stage
The first stage really consists of three phases:
• Early phase. This phase typically lasts up to 14 hours or longer, although it's usually considerably shorter for second and subsequent babies. As labor progresses, the contractions get longer and stronger.
• Active phase. Often this phase lasts up to six or more hours, although it can be a lot shorter. You should be in the hospital or birth center by now or en route. Contractions are much more intense, last about 40 to 60 seconds, and are spaced 3 to 5 minutes apart. Breathing exercises, relaxation techniques, and coaching are all important now. If your partner is having trouble coping or she's not interested in a drug-free labor, this is when she might opt for an epidural or other pain relief.
• Transition phase. This phase can last anywhere from a few minutes to a several hours. It's here that your partner is most likely to swear at you like a truck driver. (Don't take it personally; even women who have coped well up to this point often "lose it" during the transition phase.) Contractions last 60 to 90 seconds and come two or three minutes apart.
Second stage
• Pushing and birth. The second stage can last from minutes to hours — the average is about an hour for a first-time pregnancy (longer if she's had an epidural) — and ends with a moment that's made up in equal parts of relief and breathtaking beauty: the birth of your baby. There's a lot to think about during this phase: Do you want to record the birth on video? Will you want to cut the cord? (Be sure to remind your doctor or midwife if you do.) Does your partner want to try to breastfeed immediately after birth? If the doctor or midwife or labor and delivery nurse doesn't make sure that happens, you'll need to be ready to advocate for her.
Third stage
• Delivery of the placenta. It's not over yet! This stage, which begins immediately after the birth of your baby and ends with the delivery of the placenta anywhere from one to 30 minutes later, is usually anticlimactic but necessary. Be aware, too, that your partner may get a case of the chills during this phase or feel very shaky. If that's the case, be ready to offer a warm blanket and to hold your newborn while she's regaining her strength.
5. Be an active participant
Costello looked at the half-dozen expectant fathers around the table. "Remember, dads, it's your baby, too. You're a critical part of the process."
In the days and weeks before your baby's due date, make sure both you and your wife are packed for the hospital, including a possible change of clothes, toiletries, and camera or camcorder, and other essentials. If you have a birth plan, you may need to let the labor and delivery nurses know about it (you should have already discussed it with your doctor or midwife).
During early labor, remind your partner to drink plenty of liquids. Pour her a glass of nonacidic juice such as apple juice or pineapple juice, honey and water, an herbal tea, or just plain water to ward off dehydration. Offer her a bagel, yogurt, or something bland — she might not get anything solid to eat at the hospital for many hours after the baby's birth. Finish packing.
When you head to the hospital, drive carefully. This isn't the time for taking unnecessary chances. When you get to the labor room, stick around to provide comfort and support. "The transition stage is not the time to head out for a long lunch," Costello advised. Feel free to bring fruit or other snacks along if it's in the middle of the night.
6. Be an advocate for your partner
The doctor or midwife and nurses are there to make sure your partner and baby do well during labor and birth. But you have a big role in helping your partner get comfortable and in communicating her wishes. You and she also have a big say in personalizing your room. When it's time to rest, soften the lighting. Freshen the smell by taking along aromatherapy balls, potpourri, or scented oils. Bring pictures and your own music. I found a portable CD player in the garage and packed some of my wife's favorite CDs.
7. Know how to play coach
Take your cues from your partner. Some women love having a massage or having their hair stroked during labor. Others don't. And it may be hard to predict ahead of time what your partner will prefer. In any case, try to reassure her that she's doing fine and be ready to help in any way she asks. See more tips on how to be a great labor coach.
8. Be prepared
We watched two videos of vaginal births and one of a c-section. All showed the messy, unglamorous side of labor. Don't be surprised if your baby's skin looks wrinkled or his head is molded into a cone shape, and, in truth, he doesn't even look like a baby.
9. Cut the cord if you want
Today, most dads choose to cut the baby's umbilical cord in the first minutes after birth. "It's your right, but sometimes they forget," Costello said, "so make sure you remind your doctor or midwife."
Heartburn and indigestion (pregnancy sleep)
Why have I started getting heartburn?
Many women start getting heartburn and indigestion in the second half of their pregnancy. The burning sensation that is associated with heartburn often extends from the lower throat to the bottom of your breastbone. It usually comes and goes until your baby is born.
Heartburn is caused by both hormonal and physical changes to your body. During pregnancy, the placenta produces the hormone progesterone, which relaxes the smooth muscles of the uterus. Progesterone also relaxes the valve that separates the esophagus from the stomach, allowing gastric acids to seep back up the pipe, which causes that uncomfortable sensation of heartburn. The hormone also slows the wavelike contractions of the stomach, making digestion sluggish.
As time goes on in your pregnancy, your growing fetus crowds the abdominal cavity, slowing the elimination of waste from your body and pushing up the stomach acids into your throat. The same process that causes you discomfort actually benefits your baby because nutrients that linger in your bloodstream can be absorbed more fully into your baby's system.
What can I do about it?
There's no sure-fire way to avoid getting heartburn or indigestion, but you can take some steps which might reduce the likelihood of it happening:
• Avoid rich or spicy dishes as well as chocolate, citrus fruit or juices, coffee and alcohol.
• Eat little and often and chew your food slowly and thoroughly. Give yourself two or three hours to digest any meals before going to bed.
• Sleep with two or three extra pillows to keep your head propped up in bed. You can also try sleeping upright in a comfortable chair.
• Wear loose and comfortable clothing, especially around your waist.
• If none of the above help, talk to your doctor about an over-the-counter antacid that is safe to use during pregnancy.
Many women start getting heartburn and indigestion in the second half of their pregnancy. The burning sensation that is associated with heartburn often extends from the lower throat to the bottom of your breastbone. It usually comes and goes until your baby is born.
Heartburn is caused by both hormonal and physical changes to your body. During pregnancy, the placenta produces the hormone progesterone, which relaxes the smooth muscles of the uterus. Progesterone also relaxes the valve that separates the esophagus from the stomach, allowing gastric acids to seep back up the pipe, which causes that uncomfortable sensation of heartburn. The hormone also slows the wavelike contractions of the stomach, making digestion sluggish.
As time goes on in your pregnancy, your growing fetus crowds the abdominal cavity, slowing the elimination of waste from your body and pushing up the stomach acids into your throat. The same process that causes you discomfort actually benefits your baby because nutrients that linger in your bloodstream can be absorbed more fully into your baby's system.
What can I do about it?
There's no sure-fire way to avoid getting heartburn or indigestion, but you can take some steps which might reduce the likelihood of it happening:
• Avoid rich or spicy dishes as well as chocolate, citrus fruit or juices, coffee and alcohol.
• Eat little and often and chew your food slowly and thoroughly. Give yourself two or three hours to digest any meals before going to bed.
• Sleep with two or three extra pillows to keep your head propped up in bed. You can also try sleeping upright in a comfortable chair.
• Wear loose and comfortable clothing, especially around your waist.
• If none of the above help, talk to your doctor about an over-the-counter antacid that is safe to use during pregnancy.
Hemorrhoids
What are hemorrhoids?
Hemorrhoids are varicose veins — blood vessels that have become unusually swollen — that show up in the rectal area. Hemorrhoids typically range from the size of a raisin to the size of a grape. They can be merely itchy or downright painful, and sometimes they can even cause rectal bleeding, especially during a bowel movement.
Sometimes the enlarged veins protrude through the anus. When this happens, you'll feel a soft, swollen mass.
Hemorrhoids are relatively common during pregnancy. Some women get them for the first time while they're pregnant — and if you've had them before pregnancy, you're quite likely to have them again now. They may also develop during the second stage of labor, while you're pushing. Either way, they often go away on their own — or with the help of some simple measures mentioned below — soon after you give birth.
Why are they more common during pregnancy?
Pregnancy makes you more prone to hemorrhoids, as well as to varicose veins in the legs and sometimes even in the vulva, for a variety of reasons. Your growing uterus puts pressure on the pelvic veins and the inferior vena cava, a large vein on the right side of the body that receives blood from the lower limbs. This can slow the return of blood from the lower half of your body, which increases the pressure on the veins below your uterus and causes them to become more dilated or swollen.
Constipation, another common problem during pregnancy, can also cause or aggravate hemorrhoids. That's because straining leads to hemorrhoids, and you tend to strain when having a hard bowel movement.
In addition, an increase in the hormone progesterone during pregnancy causes the walls of your veins to relax, allowing them to swell more easily. Progesterone also contributes to constipation by slowing down your intestinal tract.
What can I do to get relief?
• Apply an ice pack (with a soft covering) to the affected area several times a day. Ice may help decrease swelling and discomfort. Some women find cold compresses saturated with witch hazel to be soothing.
• Soak your bottom in warm water, in a tub or a sitz bath. A sitz bath is small plastic basin that you fill with water and position over your toilet, allowing you to submerge your rectal area simply by sitting down.
• Try alternating cold and warm treatments. Start with an ice pack followed by a warm sitz bath.
• Gently but thoroughly clean the affected area after each bowel movement using soft, unscented, white toilet tissue, which causes less irritation than colored, scented varieties. Moistening the tissue can help, too. Many women find using pre-moistened wipes more comfortable than using toilet tissue. You can buy medicated wipes (such as Tucks) made specifically for people with hemorrhoids.
• Ask your healthcare practitioner to recommend a safe topical anesthetic or medicated suppository. There are many hemorrhoid-relief products on the market, but consult your practitioner before trying one on your own. Most of these products should be used for a short course of treatment only (a week or less). Continued use can cause even more inflammation.
How can I avoid getting hemorrhoids?
Though you're more susceptible to hemorrhoids when pregnant, they're not inevitable! Here are some ways to ward them off — or get rid of them if you do get them:
• Avoid constipation: Eat a high-fiber diet, drink plenty of water (eight to ten glasses a day), and get regular exercise, even if you only have time for a short, brisk walk. If you're constipated, ask your practitioner about using a fiber supplement or stool softener.
• Don't wait when you have the urge to have a bowel movement, try not to strain when you're moving your bowels, and don't linger on the toilet, because it puts pressure on the area.
• Do Kegel exercises daily. Kegels increase circulation in the rectal area and strengthen the muscles around the anus, decreasing the chance of hemorrhoids. They also strengthen and tone the muscles around the vagina and urethra, which can help your body recover after you give birth.
• Avoid sitting or standing for long stretches of time. If your job involves sitting, get up and move around for a few minutes every hour or so. At home, lie on your left side when sleeping, reading, or watching TV to take the pressure off your rectal veins and help increase blood return from the lower half of your body.
When should I call my practitioner?
If your own preventive and relief efforts don't help — or if you notice bleeding — consult your doctor or midwife. (Any rectal bleeding should be checked by your practitioner.)
For most women, hemorrhoids will get better after delivery with the help of the measures discussed above. In some cases, you may need to see a specialist for treatment to help shrink your hemorrhoids. Rarely, minor surgery is required to correct the problem.
Hemorrhoids are varicose veins — blood vessels that have become unusually swollen — that show up in the rectal area. Hemorrhoids typically range from the size of a raisin to the size of a grape. They can be merely itchy or downright painful, and sometimes they can even cause rectal bleeding, especially during a bowel movement.
Sometimes the enlarged veins protrude through the anus. When this happens, you'll feel a soft, swollen mass.
Hemorrhoids are relatively common during pregnancy. Some women get them for the first time while they're pregnant — and if you've had them before pregnancy, you're quite likely to have them again now. They may also develop during the second stage of labor, while you're pushing. Either way, they often go away on their own — or with the help of some simple measures mentioned below — soon after you give birth.
Why are they more common during pregnancy?
Pregnancy makes you more prone to hemorrhoids, as well as to varicose veins in the legs and sometimes even in the vulva, for a variety of reasons. Your growing uterus puts pressure on the pelvic veins and the inferior vena cava, a large vein on the right side of the body that receives blood from the lower limbs. This can slow the return of blood from the lower half of your body, which increases the pressure on the veins below your uterus and causes them to become more dilated or swollen.
Constipation, another common problem during pregnancy, can also cause or aggravate hemorrhoids. That's because straining leads to hemorrhoids, and you tend to strain when having a hard bowel movement.
In addition, an increase in the hormone progesterone during pregnancy causes the walls of your veins to relax, allowing them to swell more easily. Progesterone also contributes to constipation by slowing down your intestinal tract.
What can I do to get relief?
• Apply an ice pack (with a soft covering) to the affected area several times a day. Ice may help decrease swelling and discomfort. Some women find cold compresses saturated with witch hazel to be soothing.
• Soak your bottom in warm water, in a tub or a sitz bath. A sitz bath is small plastic basin that you fill with water and position over your toilet, allowing you to submerge your rectal area simply by sitting down.
• Try alternating cold and warm treatments. Start with an ice pack followed by a warm sitz bath.
• Gently but thoroughly clean the affected area after each bowel movement using soft, unscented, white toilet tissue, which causes less irritation than colored, scented varieties. Moistening the tissue can help, too. Many women find using pre-moistened wipes more comfortable than using toilet tissue. You can buy medicated wipes (such as Tucks) made specifically for people with hemorrhoids.
• Ask your healthcare practitioner to recommend a safe topical anesthetic or medicated suppository. There are many hemorrhoid-relief products on the market, but consult your practitioner before trying one on your own. Most of these products should be used for a short course of treatment only (a week or less). Continued use can cause even more inflammation.
How can I avoid getting hemorrhoids?
Though you're more susceptible to hemorrhoids when pregnant, they're not inevitable! Here are some ways to ward them off — or get rid of them if you do get them:
• Avoid constipation: Eat a high-fiber diet, drink plenty of water (eight to ten glasses a day), and get regular exercise, even if you only have time for a short, brisk walk. If you're constipated, ask your practitioner about using a fiber supplement or stool softener.
• Don't wait when you have the urge to have a bowel movement, try not to strain when you're moving your bowels, and don't linger on the toilet, because it puts pressure on the area.
• Do Kegel exercises daily. Kegels increase circulation in the rectal area and strengthen the muscles around the anus, decreasing the chance of hemorrhoids. They also strengthen and tone the muscles around the vagina and urethra, which can help your body recover after you give birth.
• Avoid sitting or standing for long stretches of time. If your job involves sitting, get up and move around for a few minutes every hour or so. At home, lie on your left side when sleeping, reading, or watching TV to take the pressure off your rectal veins and help increase blood return from the lower half of your body.
When should I call my practitioner?
If your own preventive and relief efforts don't help — or if you notice bleeding — consult your doctor or midwife. (Any rectal bleeding should be checked by your practitioner.)
For most women, hemorrhoids will get better after delivery with the help of the measures discussed above. In some cases, you may need to see a specialist for treatment to help shrink your hemorrhoids. Rarely, minor surgery is required to correct the problem.
What to bring to the hospital?
You may want to pack two small bags for the hospital or birth center: one for the items you'll need during labor, and another for items that you won't need until after you give birth. We recommend packing your bags when you're eight months pregnant, since you could go into labor at any time in the weeks before your due date. Here's a list of things that experienced moms recommend packing:
For labor
* A picture ID (driver's license or other ID), your insurance card, and any hospital paperwork you need
* Your birth plan, if you have one
* Eyeglasses
Even if you usually wear contact lenses, you may not want to deal with them while you're in the hospital.
* Toiletries
Pack a few personal items, such as a toothbrush and toothpaste, lip balm, deodorant, a brush and comb, makeup, and a hair band or barrettes. Hospitals usually provide soap, shampoo, and lotion, but you might prefer your own.
* A bathrobe, a nightgown or two, slippers, and socks
Hospitals provide gowns and socks for you to use during labor and afterward, but most will allow you to wear your own clothes if you prefer.
Choose a loose, comfortable gown that you don't mind getting dirty. It should be either sleeveless or have short, loose sleeves so your blood pressure can be checked easily. Slippers and robe may come in handy when you're walking around during the early stages of labor.
* Whatever will help you relax
Here are some possibilities: your own pillow (use a patterned or colorful pillowcase so it doesn't get mixed up with the hospital's pillows), music and something to play it on, light reading material, a picture of someone or something you love, anything you find reassuring.
For your partner/labor coach
* A camera or video camera with batteries, charger, and memory card (or film or tape)
Someone has to document the big event! (Note: Not all hospitals allow videotaping of the birth itself, but there's usually no rule against taping during labor or after the birth.)
* Toiletries
* Comfortable shoes and a few changes of comfortable clothes
* Snacks and something to read
* Money for parking and change for vending machines
* A bathing suit
If you want to take a bath or shower during labor, you may want your partner to get in with you to support you or rub your back.
Postpartum
* A fresh nightgown, if you prefer to wear your own
* A list of people to call and their phone numbers, your cell phone and charger or, if you'll be using the hospital phone, a prepaid phone card
After your baby's born, you'll want to call family and friends to let them know the good news. Make a list of everyone you'll want to contact ahead of time so you don't forget someone important when you're exhausted after delivery.
* Snacks!
After many hours of labor, you're likely to be pretty hungry, and you won't want to rely solely on hospital food. So bring your own – crackers, fresh or dried fruit, nuts, granola bars, or whatever you think you'll enjoy. A bottle of nonalcoholic champagne might be fun for celebrating, too.
* Comfortable nursing bras or regular bras
Whether or not you choose to breastfeed, your breasts are likely to be tender and swollen when your milk comes in. This can happen anytime during the first several days after delivery. Once it does, breast pads can help absorb leaks.
* Several pairs of maternity underpants
Some women love the mesh underwear usually provided by the hospital; others don't. You can't go wrong with your own roomy cotton underpants. The hospital will provide sanitary pads because you'll bleed after delivery. Make sure you have a supply of heavy-duty pads waiting at home!
* A book on newborn care
The hospital will probably provide you with a book, but you may prefer your own. Of course, the postpartum nurses will be there to answer questions and show you how to change, hold, nurse, and bathe your newborn if you need guidance.
* Photos of your other children
When they come to visit, they'll see that you haven't forgotten them.
* Gifts for older siblings
Some parents bring gifts for the new baby to "give" to big brothers and sisters.
* A notepad or journal and pen or pencil
Track your baby's feeding sessions, write down questions you have for the nurse, note what the pediatrician tells you, jot down memories of your baby's first day, and so on. Some people bring a baby book so they can record the birth details right away.
* A going-home outfit
Bring something roomy and easy to get into (believe it or not, you'll probably still look 5 or 6 months pregnant) and a pair of flat, comfortable shoes.
For your baby
* An installed infant car seat
You can't drive your baby home without one! Have the seat properly installed ahead of time and know how to buckle in your baby correctly.
* A going-home outfit
Your baby will need an outfit to go home in, including socks or booties if the clothing doesn't have feet, and a soft cap if the air is likely to be cool. Make sure the legs on your baby's clothes are separate so the car seat strap can fit between them.
* A receiving blanket
The hospital will provide blankets for swaddling your baby while you're there, but you may want to bring your own to tuck around your baby in the car seat for the ride home. Make it a heavy one if the weather's cold.
What not to bring
* Jewelry
* Lots of cash or other valuables
* Medications, including vitamins
Let your doctor know whether you're on any medications. The hospital will provide them for you if your doctor agrees that you should continue to take them while you're there.
* Diapers
The hospital will provide diapers for your baby while you're there. Leave your supply at home.
* A breast pump
If you end up needing a breast pump for any reason, the hospital can provide one.
For labor
* A picture ID (driver's license or other ID), your insurance card, and any hospital paperwork you need
* Your birth plan, if you have one
* Eyeglasses
Even if you usually wear contact lenses, you may not want to deal with them while you're in the hospital.
* Toiletries
Pack a few personal items, such as a toothbrush and toothpaste, lip balm, deodorant, a brush and comb, makeup, and a hair band or barrettes. Hospitals usually provide soap, shampoo, and lotion, but you might prefer your own.
* A bathrobe, a nightgown or two, slippers, and socks
Hospitals provide gowns and socks for you to use during labor and afterward, but most will allow you to wear your own clothes if you prefer.
Choose a loose, comfortable gown that you don't mind getting dirty. It should be either sleeveless or have short, loose sleeves so your blood pressure can be checked easily. Slippers and robe may come in handy when you're walking around during the early stages of labor.
* Whatever will help you relax
Here are some possibilities: your own pillow (use a patterned or colorful pillowcase so it doesn't get mixed up with the hospital's pillows), music and something to play it on, light reading material, a picture of someone or something you love, anything you find reassuring.
For your partner/labor coach
* A camera or video camera with batteries, charger, and memory card (or film or tape)
Someone has to document the big event! (Note: Not all hospitals allow videotaping of the birth itself, but there's usually no rule against taping during labor or after the birth.)
* Toiletries
* Comfortable shoes and a few changes of comfortable clothes
* Snacks and something to read
* Money for parking and change for vending machines
* A bathing suit
If you want to take a bath or shower during labor, you may want your partner to get in with you to support you or rub your back.
Postpartum
* A fresh nightgown, if you prefer to wear your own
* A list of people to call and their phone numbers, your cell phone and charger or, if you'll be using the hospital phone, a prepaid phone card
After your baby's born, you'll want to call family and friends to let them know the good news. Make a list of everyone you'll want to contact ahead of time so you don't forget someone important when you're exhausted after delivery.
* Snacks!
After many hours of labor, you're likely to be pretty hungry, and you won't want to rely solely on hospital food. So bring your own – crackers, fresh or dried fruit, nuts, granola bars, or whatever you think you'll enjoy. A bottle of nonalcoholic champagne might be fun for celebrating, too.
* Comfortable nursing bras or regular bras
Whether or not you choose to breastfeed, your breasts are likely to be tender and swollen when your milk comes in. This can happen anytime during the first several days after delivery. Once it does, breast pads can help absorb leaks.
* Several pairs of maternity underpants
Some women love the mesh underwear usually provided by the hospital; others don't. You can't go wrong with your own roomy cotton underpants. The hospital will provide sanitary pads because you'll bleed after delivery. Make sure you have a supply of heavy-duty pads waiting at home!
* A book on newborn care
The hospital will probably provide you with a book, but you may prefer your own. Of course, the postpartum nurses will be there to answer questions and show you how to change, hold, nurse, and bathe your newborn if you need guidance.
* Photos of your other children
When they come to visit, they'll see that you haven't forgotten them.
* Gifts for older siblings
Some parents bring gifts for the new baby to "give" to big brothers and sisters.
* A notepad or journal and pen or pencil
Track your baby's feeding sessions, write down questions you have for the nurse, note what the pediatrician tells you, jot down memories of your baby's first day, and so on. Some people bring a baby book so they can record the birth details right away.
* A going-home outfit
Bring something roomy and easy to get into (believe it or not, you'll probably still look 5 or 6 months pregnant) and a pair of flat, comfortable shoes.
For your baby
* An installed infant car seat
You can't drive your baby home without one! Have the seat properly installed ahead of time and know how to buckle in your baby correctly.
* A going-home outfit
Your baby will need an outfit to go home in, including socks or booties if the clothing doesn't have feet, and a soft cap if the air is likely to be cool. Make sure the legs on your baby's clothes are separate so the car seat strap can fit between them.
* A receiving blanket
The hospital will provide blankets for swaddling your baby while you're there, but you may want to bring your own to tuck around your baby in the car seat for the ride home. Make it a heavy one if the weather's cold.
What not to bring
* Jewelry
* Lots of cash or other valuables
* Medications, including vitamins
Let your doctor know whether you're on any medications. The hospital will provide them for you if your doctor agrees that you should continue to take them while you're there.
* Diapers
The hospital will provide diapers for your baby while you're there. Leave your supply at home.
* A breast pump
If you end up needing a breast pump for any reason, the hospital can provide one.
THE COUNTDOWN TO BABY T MINUS 10 WEEKS AND COUNTING
Well today I begin my 30th week. At my last appointment my Doctor said that once I have my 37 week ultrasound that he would be able to determine what date he would induce me on. Here is hoping not too long after. I could use a huge break from all the pain.
So I am hoping at 38 weeks as long as all is well in the ultrasound that I will be induced and shortly there after we will be introduced to our baby girl Paige. My oldest daughter is getting excited she can not wait for her baby sister. Little does she know though how much work is involved both for mommy, daddy and big sister. :D
I had my glucose testing done Monday January, 25th. :( Let me just say OMG. I had the tech from hell who couldn't find my vein in my left arm so she switched to my right. Got it in my right the first time. I then drank the drink (which Paige totally did not agree on, as I am not a sugar person and she protested), and waited my hour. After that I had my blood drawn again or did I. The tech missed my vein AGAIN and then started poking around in my arm and when she thought she had it, it didn't even fill up the tube she got maybe 1/4 blood in the tube.
I get home only to pull off the band aid and wow nice bruise. I had something to eat as the fasting part sucks big time for 8-14 hours before. :( I then laid down. When I woke up an hour and a half later I looked at my arm. WTF a nice 2 inch bruise on my arm. NEVER in my life do people normally have a problem getting blood from me. Well this pregnancy sure has been different from the other 3 so why not be different all together.
Well I will do my best to update everyone at this point every week. :D
Thanks for reading. :D
So I am hoping at 38 weeks as long as all is well in the ultrasound that I will be induced and shortly there after we will be introduced to our baby girl Paige. My oldest daughter is getting excited she can not wait for her baby sister. Little does she know though how much work is involved both for mommy, daddy and big sister. :D
I had my glucose testing done Monday January, 25th. :( Let me just say OMG. I had the tech from hell who couldn't find my vein in my left arm so she switched to my right. Got it in my right the first time. I then drank the drink (which Paige totally did not agree on, as I am not a sugar person and she protested), and waited my hour. After that I had my blood drawn again or did I. The tech missed my vein AGAIN and then started poking around in my arm and when she thought she had it, it didn't even fill up the tube she got maybe 1/4 blood in the tube.
I get home only to pull off the band aid and wow nice bruise. I had something to eat as the fasting part sucks big time for 8-14 hours before. :( I then laid down. When I woke up an hour and a half later I looked at my arm. WTF a nice 2 inch bruise on my arm. NEVER in my life do people normally have a problem getting blood from me. Well this pregnancy sure has been different from the other 3 so why not be different all together.
Well I will do my best to update everyone at this point every week. :D
Thanks for reading. :D
Doula VS Midwife
Some people don't know the difference between the two so I thought I would post what duties are for a doula and midwife.
DOULA
A doula is an assistant who provides various forms of non-medical and non-midwifery support (physical and emotional) in the childbirth process. Based on a particular doula's training and background, the doula may offer support during prenatal care, during childbirth and/or during the postpartum period. A birth doula provides support during labor. Thus a labor doula may attend a home birth or might attend the parturient woman during labor at home and continue while in transport and then complete supporting the birth at a hospital or a birth center. A postpartum doula typically begins providing care in the home after the birth. Such care might include cooking for the mother, breastfeeding support, newborn care assistance, errands, light housekeeping, etc. Such care is provided from the day after the birth, providing services through the first six weeks postpartum. In some cases, doula care can last several months or even to a year postpartum - especially in cases when mothers are suffering from postpartum depression, children with special needs require longer care, or there are multiple infants.
Etymology and history of usage
The word doula comes from Ancient Greek δούλη (doulē), and refers to a woman of service as a slave. In Ancient Greece, the word had negative connotations, denoting "slave." For this reason, Greek women performing professional labor support choose to call themselves labor companions or birthworkers. Anthropologist Dana Raphael first used the term doula to refer to experienced mothers who assisted new mothers in breastfeeding and newborn care in the book Tender Gift: Breastfeeding (1973).[citation needed] Thus the term arose initially with reference to the postpartum context, and is still used in that domain. Medical researchers Marshall Klaus and John Kennell, who conducted the first of several randomized clinical trials on the medical outcomes of doula-attended births, adopted the term to refer to labor support as well as prenatal and postpartum support.[1] Nevertheless, the negative connotation of the word (in ancient as well as in modern Greek) has given rise to doubt as to whether it should be used, or whether it should be replaced by a more appropriate term.
Types of doulas
Labor/birth support doulas are labor support persons who attend to the emotional and physical comfort needs of laboring women to smooth the labor process. They do not perform clinical tasks such as heart rate checks or vaginal exams, nor do they provide advice. Rather, they use massage, positioning suggestions, etc., to help labor to progress as well as possible. A labor/birth support doula joins a laboring woman either at her home, birth center, or hospital and remains with her until a few hours after the birth. Some doulas also offer several prenatal visits, phone support, and one postpartum meeting to ensure the mother is well informed and supported. The terms of a labor/birth doula's responsibilities are decided between the doula and the family. In addition to emotional, physical and informational support, doulas work as advocates of their client’s wishes and may assist in communicating with medical staff to obtain information for the client to make informed decisions regarding medical procedures.
Postpartum doulas are hired to support the woman after birth, usually in the family's home. They are skilled in offering families evidence-based information and support on breastfeeding, emotional and physical recovery from childbirth, infant soothing, mother-baby bonding, and coping skills for new parents. They may also help with light housework, coordinate freshly made nutritious meals for the mother, and help incorporate older children. The terms of a postpartum doula's responsibilities are decided between the doula and the family.
Some hospitals and foundations offer programs for volunteer community doulas.[2] Volunteer doulas play an important role for women at risk for complications and those facing financial barriers to additional labor support. All doulas offer continuous encouragement and reassurance to laboring women. Volunteer doulas can encourage mother-based birth advocacy and motivate a woman to feel in control of her pregnancy.
The doula is an ally and occasional mentor for the father or partner. Their respective roles are similar, but the differences are crucial. The father or partner typically has little actual experience in dealing with the often-subtle forces of the labor process, and may receive enormous benefit from the presence of a doula, who is familiar with the process of birth. Even more important, many fathers experience the birth as an emotional journey of their own and find it hard to be objective in such a situation, and a doula facilitates the family process. Studies have shown that fathers usually participate more actively during labor with the presence of a doula than without one.[citation needed] A responsible doula supports and encourages the father in his support style rather than replaces him.
Labour/Birth doulas in the UK
In the UK doulas are not required to be certified. However, doula preparation courses are available through several different organisations. The main organisation for doulas run by doulas is Doula UK (http://www.doula.org.uk/) They have a recognition process, a Code of Conduct, a philosophy and a complaints procedure. Doula UK also has a hardship fund to ensure that all parents who require the support of a doula have access to one.
Some steps are being made in the UK by governmental bodies to integrate doulas into more mainstream maternity services (see the Goodwin Project (http://goodwindoulas.org/). Many UK working doulas believe that much of the 'doula effect' is due to the doula's independence from Health Services and that the parents choose their own doula.
Doula UK is working to enable local health services to benefit from doulas, while still maintaining the independence of individual doulas.
Labour/Birth doulas in the Switzerland
In Switzerland doulas are not required to be certified. However training programs are available from several organizations. The primary trainer for Switzerland is Birth Arts International (http://birtharts.org), and the primary doula organization is Doula Verbandes CH (http://www.doula.ch/doula/). Many insurance agencies in Switzerland cover doula care. Doula care is not yet as popular as it is in other parts of Europe, but they are expanding coverage areas.
Labor/birth doulas in the US and Canada
In the United States and Canada, labor/birth doulas are not required to be certified. However, certification is available through several different organizations, such as Aviva Institute , CAPPA (Childbirth And Postpartum Professionals Association), A.L.A.C.E. (now called to Labor), Cornerstone Doula Trainings, Birth Wisdom, DONA International, Birth Arts International, International Childbirth Education Association and I.C.T.C. (International Center for Traditional Childbearing), which focuses on increasing the number of Black doulas. Their course, study, and practical requirements vary.
A labor doula provides:
* Continuous physical, emotional, and informational support during pregnancy, labor, and childbirth.
* Support from a person who understands and trusts the process of birth, and who helps facilitate the birth experience for the parents, baby, and primary care providers.
* Emotional support;
* Exercise and physical suggestions to make pregnancy and childbirth more comfortable;
* Help with preparation of a birth plan;
* Facilitation of communication between members of laboring woman's birth team - though most doula certification programs discourage doulas from talking directly with caregivers for the mother/partners;
* Massage and other non-pharmacological pain relief measures;
* Positioning suggestions during labor and birth;
* Support the partner so that s/he can provide support and encouragement to the laboring woman;
* Help to avoid unnecessary interventions;
* Help with breastfeeding preparation and beginning;
* Some doulas offer a written record of the birth (birth story);
* Is present during entire labor and afterwards as long as is needed by parent(s).
Postpartum doulas in the US and Canada
In the United States and Canada, postpartum doulas are not required to be certified, however certification is available through several different organizations. A postpartum doula provides:
* Assistance with breastfeeding education and offers tips and informational support
* In-home support for the mother, baby and family, anywhere from a couple days postpartum to several months.
* Informed and helpful newborn care help and assistance.
* Support for the partner so that s/he can support and nurture the mother, and the newborn baby.
* Evidence-based information.
* May also offer help in the following areas: household care, help with childcare/sibling care, meal preparation, errand running, and other tasks that may be requested.
Labour/Birth doulas in Australia
In Australia, the doula industry is not regulated and certification is not compulsory. Thus, anyone can be a doula. The course requirements are not regulated, so courses range from weekend courses to online courses, to year-long courses. Registration is not available. It is illegal for doulas to practice elements of midwifery as this is seen to be practicing midwifery without a license. Hence, doulas may not provide clinical care such as listening to the baby's heart rate, checking the blood pressure and so on. They also may not give clinical advice or provide opinion on the advice of professional care providers.
Benefits
Studies have found that birth companions, of which doulas are one type, offer numerous benefits both to the mother and child. Women with support have a reduction in the duration of labor, less use of pain relief medications, lower rates of operative vaginal delivery, and, in many studies, a reduction in caesarian deliveries. Newborns in supported births have lower rates of fetal distress and fewer are admitted to neonatal intensive care units. In addition, one study found that 6 weeks after delivery, a greater proportion of doula-supported women, compared to a control group, were breastfeeding, and these women reported greater self-esteem, less depression, and a higher regard for their babies and their ability to care for them. These results are similar to findings that support from a female relative during childbirth has similar effects.
One study found doula support without childbirth classes to be more helpful than childbirth classes alone, as measured by levels of emotional distress and self-esteem evaluated at an interview four months after birth. In particular, it was noted that women in the doula-supported group reported their infants as less fussy than the group attending childbirth class without any doula support.
MIDWIFE
Midwifery is a health care profession in which providers give prenatal care to expecting mothers, attend the birth of the infant, and provide postpartum care to the mother and her infant including breastfeeding.
A practitioner of midwifery is known as a midwife, a term used in reference to both women and men. (The etymology of midwife is Middle English mid = with and Old English wif = woman). In the United States, nurse-midwives (see below) are advance practice nurses (nurse practitioners]). In addition to giving care to women in connection with pregnancy and birth, they also provide primary care to women, well-woman care (gynecological annual exams), family planning, and menopause care.
Midwives are autonomous practitioners who are specialists in a low-risk pregnancy, childbirth, and the postpartum stage. They generally strive to help women have a healthy pregnancy and natural birth experience. Midwives are trained to recognize and deal with deviations from the norm. Obstetricians, in contrast, are specialists in illness related to childbearing and in surgery. The two professions can be complementary, but often are at odds because obstetricians are taught to "actively manage" labor, while midwives are taught not to intervene unless necessary.
Midwives refer women to obstetricians when a pregnant woman requires care beyond the midwives' area of expertise. In many jurisdictions, these professions work together to provide care to childbearing women. In others, only the midwife is available to provide care. Midwives are trained to handle certain situations that are considered abnormal, including breech births and posterior position, using non-invasive techniques.
Defining midwifery
A woman giving birth on a birth chair, from a work by Eucharius Rößlin.
According to the International Confederation of Midwives (a definition that has also been adopted by the World Health Organization and the International Federation of Gynecology and Obstetrics):
“ A midwife is a person who, having been regularly admitted to a midwifery educational program that is duly recognized in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery. The educational program may be an apprenticeship, a formal university program, or a combination".
The midwife is recognized as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the infant. This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, accessing of medical or other appropriate assistance and the carrying out of emergency measures.
The midwife has an important task in health counseling and education, not only for the woman, but also within the family and community. This work should involve antenatal education and preparation for parenthood and may extend to womens health, sexual or reproductive health and childcare.
”
A midwife may practice in any setting including in the home, the community, hospitals, clinics or health units.
Early historical perspective
Due to its importance it is assumed that midwifery has existed as long as human civilization.
In ancient Egypt, midwifery was a recognized female occupation, as attested by the Ebers papyrus which dates from 1900 to 1550 BCE. Five columns of this papyrus deal with obstetrics and gynecology, especially concerning the acceleration of parturition and the birth prognosis of the newborn. The Westcar papyrus, dated to 1700 BCE, includes instructions for calculating the expected date of confinement and describes different styles of birth chairs. Bas reliefs in the royal birth rooms at Luxor and other temples also attest to the heavy presence of midwifery in this culture.
Midwifery in Greco-Roman antiquity covered a wide range of women, including old women who continued folk medical traditions in the villages of the Roman Empire, trained midwives who garnered their knowledge from a variety of sources, and highly trained women who were considered female physicians.[4] However, there were certain characteristics desired in a “good” midwife, as described by the physician Soranus of Ephesus in the second century. He states in his work, Gynecology, that “a suitable person will be literate, with her wits about her, possessed of a good memory, loving work, respectable and generally not unduly handicapped as regards her senses [i.e., sight, smell, hearing], sound of limb, robust, and, according to some people, endowed with long slim fingers and short nails at her fingertips.” Soranus also recommends that the midwife be of sympathetic disposition (although she need not have borne a child herself) and that she keep her hands soft for the comfort of both mother and child. Pliny, another physician from this time, valued nobility and a quiet and inconspicuous disposition in a midwife. A woman who possessed this combination of physique, virtue, skill, and education must have been difficult to find in antiquity. Consequently, there appears to have been three “grades” of midwives present in ancient times. The first was technically proficient; the second may have read some of the texts on obstetrics and gynecology; but the third was highly trained and reasonably considered a medical specialist with a concentration in midwifery.
Midwives were known by many different titles in antiquity, ranging from iatrinē, maia, obstetrix, and medica. It appears as though midwifery was treated different in the Eastern end of the Mediterranean basin as opposed to the West. In the East, some women advanced beyond the profession of midwife (maia) to that of obstetrician (iatros gynaikeios), for which formal training was required. Also, there were some gynecological tracts circulating in the medical and educated circles of the East that were written by women with Greek names, although these women were few in number. Based on these facts, it would appear that midwifery in the East was a respectable profession in which respectable women could earn their livelihoods and enough esteem to publish works read and cited by male physicians. In fact, a number of Roman legal provisions strongly suggest that midwives enjoyed status and remuneration comparable to that of male doctors.[5] One example of such a cited midwife is Salpe of Lemnos, who wrote on women’s diseases and was mentioned several times in the works of Pliny.
However, in the Roman West, our knowledge of practicing midwives comes mainly from funerary epitaphs. Two hypotheses are suggested by looking at a small sample of these epitaphs. The first is the midwifery was not a profession to which freeborn women of families that had enjoyed free status of several generations were attracted; therefore it seems that most midwives were of servile origin. Second, since most of these funeral epitaphs describe the women as freed, it can be proposed that midwives were generally valued enough, and earned enough income, to be able to gain their freedom. It is not known from these epitaphs how certain slave women were selected for training as midwives. Slave girls may have been apprenticed, and it is most likely that mothers taught their daughters.
The actual duties of the midwife in antiquity consisted mainly of assisting in the birthing process, although they could also help in other medical problems relating to women if needed. Often, the midwife would also call in a physician to be on-call with her in case a more difficult procedure was needed during an abnormal delivery; and in most cases she brought along two or three assistants. In antiquity, it was believed by both midwives and physicians that a normal delivery was made easier when a woman sat upright. Therefore, during parturition, midwives brought a stool to the home where the delivery was to take place. In the seat of the chair was a crescent-shaped hole through which the baby would be delivered. The chair also had armrests for the mother to grasp during the delivery. Most chairs had backs which the patient could press against, but Soranus suggests that in some cases the chairs were backless and an assistant had to stand behind the patient and support her.[5] The midwife then faced the patient, gently dilating and pulling the fetus forward, all the while instructing the mother on proper breathing and how to push downwards during a contraction. The assistants helped by pushing downwards on the patient’s abdomen. Finally, the midwife received the infant, placed it in pieces of cloth, cut the umbilical cord, and cleansed the baby. The child was sprinkled with “fine and powdery salt, or natron or aphronitre” to soak up the birth residue, rinsed, and then powdered and rinsed again. Next, the midwives cleared away any and all mucus present from the nose, mouth, ears, or anus. Midwives were encouraged by Soranus to put olive oil in the baby’s eyes to cleanse away any birth residue, and to place a piece of wool soaked in olive oil over the umbilical cord. After the delivery, the midwife made the initial call on whether or not an infant was healthy and fit to rear. She inspected the newborn for congenital deformities and testing its cry to hear whether or not it was robust and hearty. Ultimately, midwives made a determination about the chances for an infant’s survival and likely recommended that a newborn with any severe deformities be exposed.
A second-century terracotta relief from the Ostian tomb of Scribonia Attice, wife of physician-surgeon M. Ulpius Amerimnus, details a childbirth scene. Scribonia was a midwife and the relief shows her in the midst of a delivery. A patient sits in the birthing chair, gripping the handles and the midwife’s assistant stands behind her providing support. Scribonia sits on a low stool in front of the woman, modestly looking away while also assisting the delivery by dilating and massaging the cervix, as encouraged by Soranus.
The services of a midwife were not inexpensive; this fact that suggests poorer women who could not afford the services of a professional midwife often had to make do with female relatives. Many wealthier families had their own midwives. However, the vast majority of women in the Greco-Roman world very likely received their maternity care from hired midwives, either highly trained or possessing a rudimentary knowledge of obstetrics. Also, many families had a choice of whether or not they wanted to employ a midwife who practiced the traditional folk medicine or the newer methods of professional parturition. Like a lot of other factors in antiquity, quality gynecological care often depended heavily on the socioeconomic status of the patient.
During the Christian era in Europe Midwives became important to the church due to their role in emergency baptisms, and found themselves regulated by Roman Catholic canon law. In Medieval times, childbirth was considered so deadly that the Christian Church told pregnant women to prepare their shrouds and confess their sins in case of death. The Church pointed to Genesis 3:16 as the basis for pain in childbirth, where Eve's punishment for her role in disobeying God was that he would "multiply thy sorrows, and thy conceptions: in sorrow shalt thou bring forth children." A popular medieval saying was, "The better the witch; the better the midwife"; to guard against witchcraft, the Church required midwives to be licensed by a bishop and swear an oath not to use magic when assisting women through labour.
Later historical perspective
In the 18th century, a division between surgeons and midwives arose, as medical men began to assert that their modern scientific processes were better for mothers and infants than the folk-medical midwives.
At the outset of the 18th century in England, most babies were caught by a midwife, but by the onset of the 19th century, the majority of those babies born to persons of means had a surgeon involved. A number of excellent full length studies of this historical shift have been written.
German social scientists Gunnar Heinsohn and Otto Steiger have put forward the theory that midwifery became a target of persecution and repression by public authorities because midwives not only possessed highly specialized knowledge and skills regarding assisting birth, but also regarding contraception and abortion.[11] According to Heinsohn and Steiger's theory, the modern state persecuted the midwives as witches in an effort to repopulate the European continent which had suffered severe loss of manpower as a result of the bubonic plague (also known as the black death) which had swept over the continent in waves, starting in 1348.
They thus interpret the witch hunts as attacking midwifery and knowledge about birth control with a demographic goal in mind. Indeed, after the witch hunts, the number of children per mother rose sharply, giving rise to what has been called the "European population explosion" of modern times, producing an enormous youth bulge that enabled Europe to colonize large parts of the rest of the world.
While historians specializing in the history of the witch hunts have generally remained critical of this macroeconomic approach and continue to favor micro level perspectives and explanations, prominent historian of birth control John M. Riddle has expressed agreement.
Midwifery in the United States
There are two main divisions of modern midwifery in the US: nurse-midwives and direct-entry midwives.
Nurse-midwives
Nurse-midwives were introduced in the United States in 1925 by Mary Breckinridge for use in the Frontier Nursing Service (FNS). Mrs. Breckinridge chose the nurse-midwifery model used in England and Scotland because she expected these nurse-midwives on horseback to serve the health care needs of the families living in the remote hills of eastern Kentucky. This combination of nurse and midwife was very successful. The Metropolitan Life Insurance Company studied the first seven years of the FNS, and reported a substantially lower maternal and infant mortality rate than for the rest of the country. The report concluded that if this type of care was available to other women in the USA thousands of lives would be saved, and suggested nurse-midwife training should be done in the USA. Mrs. Breckinridge opened the Frontier Graduate School of Midwifery in 1939 the first nurse-midwifery education program in the USA. The Frontier School is still educating nurse-midwives today but in a new way. In 1989 the program became the first distance option for nurses to become nurse-midwives without leaving their home communities. The students do their academic work on-line with the Frontier School of Midwifery and Family Nursing faculty members and they do their clinical practice with a nurse-midwife in their community who is credentialed by Frontier as a clinical faculty member. This community based model has graduated over 1200 nurse-midwives. http://www.frontierschool.edu/.
In the United States, nurse-midwives are variably licenced depending on the state as advanced practice nurses, midwives or nurse-midwives. Certified Nurse-Midwives are educated in both nursing and midwifery and provide gynecological and midwifery care of relatively healthy women. In addition to licensure, many nurse-midwives have a master's degree in nursing, public health, or midwifery. Nurse-midwives practice in hospitals, medical clinics and private offices and may deliver babies in hospitals, birth centers and at home. They are able to prescribe medications in all 50 states. Nurse-midwives provide care to women from puberty through menopause. Nurse-midwives may work closely with obstetricians, who provide consultation and assistance to patients who develop complications. Often, women with high risk pregnancies can receive the benefits of midwifery care from a nurse-midwife in collaboration with a physician. Currently, 2% of nurse-midwives are men. The American College of Nurse-Midwives accredits nurse-midwifery/midwifery education programs and serves as the national professional society for the nation's certified nurse-midwives and certified midwives. Upon graduation from these programs, graduates sit for a certification exam administered by the American Midwifery Certification Board.
Direct-entry midwives
A direct-entry midwife is educated in the discipline of midwifery in a program or path that does not also require her/him to become educated as a nurse. Direct-entry midwives learn midwifery through self-study, apprenticeship, a midwifery school, or a college- or university-based program distinct from the discipline of nursing. A direct-entry midwife is trained to provide the Midwives Model of Care to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings.
Under the umbrella of "direct-entry midwife" are several types of midwives:
A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwives model of care. The CPM is the only US credential that requires knowledge about and experience in out-of-hospital settings. At present, there are approximately 900 CPMs practicing in the US.
A Licensed Midwife is a midwife who is licensed to practice in a particular state. Currently, licensure for direct-entry midwives is available in 24 states.
The term "Lay Midwife" has been used to designate an uncertified or unlicensed midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, just that the midwife either chose not to become certified or licensed, or there was no certification available for her type of education (as was the fact before the Certified Professional Midwife credential was available).
The American College of Nurse-Midwives (ACNM) also provides accreditation to non-nurse midwife programs, as well as colleges that graduate nurse-midwives. This credential, called the Certified Midwife, is currently recognized in only three states (New York, New Jersey, and Rhode Island). All CMs must pass the same certifying exam administered by the American Midwifery Certification Board for CNMs. The North American Registry of Midwives (NARM) is a certification agency whose mission is to establish and administer certification for the credential "Certified Professional Midwife" (CPM). CPM certification validates entry-level knowledge, skills, and experience vital to responsible midwifery practice. This certification process encompasses multiple educational routes of entry including apprenticeship, self-study, private midwifery schools, college- and university-based midwifery programs, and nurse-midwifery. Created in 1987 by the Midwives' Alliance of North America (MANA), NARM is committed to identifying standards and practices that reflect the excellence and diversity of the independent midwifery community in order to set the standard for North American midwifery.
Practice in the United States
Midwives work with women and their families in any number of settings. While the majority of nurse-midwives work in hospitals[who?], some nurse-midwives and many non-nurse-midwives[who?] work within the community or home. In many states[which?], midwives form birthing centers where a group of midwives work together. Midwives generally support and encourage natural childbirth in all practice settings. Laws regarding who can practice midwifery and in what circumstances vary from state to state.
Midwifery in the United Kingdom
Midwives are practitioners in their own right in the United Kingdom, and take responsibility for the antenatal, intrapartum and postnatal care of women, up until 28 days after the birth, or as required thereafter. Midwives are the lead health care professional attending the majority of births, mostly in a hospital setting, although home birth is a perfectly safe option for many births. There are a variety of routes to qualifying as a midwife. Most midwives now qualify via a direct entry course, which refers to a three- or four-year course undertaken at university that leads to either a degree or a diploma of higher education in midwifery and entitles them to apply for admission to the register. Following completion of nurse training, a nurse may become a registered midwife by completing an eighteen-month post-registration course (leading to a degree qualification), however this route is only available to adult branch nurses, and any child, mental health, or learning disability branch nurse must complete the full three-year course to qualify as a midwife. Midwifery students do not pay tuition fees and are eligible for financial support for living costs while training. Funding varies slightly depending on which country within the UK the student is in and whether the course they are on is a degree or diploma course. Midwifery degrees are paid for by the NHS and some students may also be eligible for NHS bursaries.
All practising midwives must be registered with the Nursing and Midwifery Council and also must have a Supervisor of Midwives through their local supervising authority. Most midwives work within the National Health Service, providing both hospital and community care, but a significant proportion work independently, providing total care for their clients within a community setting. However, recent government proposals to require insurance for all health professionals is threatening independent midwifery in England.
Midwives are at all times responsible for the woman for whom they are caring, to know when to refer complications to medical staff, to act as the woman's advocate, and to ensure the mother retains choice and control over her childbirth experience. Many midwives are opposed to the so-called "medicalisation" of childbirth, preferring a more normal and natural option, to ensure a more satisfactory outcome for mother and baby.
Midwife training
Midwifery training is considered one of the most challenging and competitive courses amongst other healthcare subjects. Most midwives undergo a 32 month vocational training program, or an 18 month nurse conversion course (on top of the 32 month nurse training course). Thus midwives potentially could have had up to 5 years of total training. Midwifery training consists of classroom based learning provided by select Universities[15] in conjunction with hospital and community based training placements at NHS Trusts.
Midwives may train to be community Health Visitors (as may Nurses).
Community midwives
Many midwives also work in the community. The roles of community midwives include the initial appointments of pregnant women, running clinics, postnatal checks in the home, and attending home births.
Midwifery in Canada
Midwifery was reintroduced as a regulated profession in Canada in the 1990s.[16] After several decades of intensive political lobbying by midwives and consumers, fully integrated, regulated and publicly funded midwifery is now part of the health system in the provinces of British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, and Nova Scotia, and in the Northwest Territories and Nunavut. Midwifery legislation has recently been proclaimed in New Brunswick where the government is in the process of integrating midwifery services there. Only Prince Edward Island and Newfoundland and Labrador do not have legislation in place for the practice of midwifery.
Midwives in Canada come from a variety of backgrounds including: aboriginal, post nursing certification, direct-entry and "lay" or traditional midwifery. However, after a process of assessment by the provincial regulatory bodies, registrants are all simply known as 'midwives', 'registered midwives' or 'sage femme' regardless of their route of training. From the original 'alternative' style of midwifery in the 1960s and 1970s, midwifery practice has become somewhat standardized in all of the regulated provinces: midwives offer continuity of care within small group practices, choice of birthplace, and a focus on the woman as the primary decision-maker in her maternity care. When women experience deviations from normal in their pregnancies, midwives consult with other health care professionals. The women's care may continue with the midwife, in collaboration with an obstetrician or other health care specialist; her care may be transferred to an obstetrician or other health care specialist, temporarily or for the remainder of her pregnancy and birth. Founding principles of the Canadian model of midwifery include informed choice, choice of birth setting, continuity of care from a small group of midwives and respect for the woman as the primary decision maker.
Four provinces offer a four year university baccalaureate degree in midwifery. In British Columbia, the program is offered at the University of British Columbia.[17] In Ontario, the Midwifery Education Program is offered by a consortium of McMaster University, Ryerson University and Laurentian University. In Manitoba the program is offered by University College of the North, which offers the only degree program exclusively for aboriginal students; combining education in western and traditional aboriginal midwifery. In Quebec, the programme is offered at the Université du Québec à Trois-Rivières. In northern Quebec and Nunavut, Inuit women are being educated to be midwives in their own communities. A Bridging program for internationally educated midwives is in place in Ontario at Ryerson University. A federally funded ["Multi-jurisdictional Midwifery Bridging Program"] is offered in Western Canada. Regulated provinces and territories admit internationally educated midwives to their regulatory body if they can demonstrate compentency through a Prior Learning and Experience Assessment (PLEA) process.
The legislation of midwifery has brought midwives into the mainstream of health care with universal funding for services , hospital privileges, rights to prescribe medications commonly needed during pregnancy, birth and postpartum, and rights to order blood work and ultrasounds for their own clients and full consultation access to physicians. To protect the tenets of midwifery and support midwives to provide woman-centered care, the regulatory bodies and professional associations have legislation and standards in place to provide protection, particularly for choice of birth place (see home birth), informed choice and continuity of care. All regulated midwives have malpractice insurance. Any unregulated person who provides care with 'restricted acts' in regulated provinces or territories is practicing midwifery without a license and is subject to investigation and prosecution.
Prior to legislative changes, very few Canadian women had access to midwifery care (in part because it was not funded by the health care system). Legislating midwifery has made midwifery services available to a wide and diverse population of women and in many communities midwives cannot meet the growing demand. Midwifery services are free to women living in midwifery regulated provinces.
Midwifery in New Zealand
Midwifery regained its status as an autonomous profession in New Zealand in 1990. The Nurses Amendment Act restored the professional and legal separation of midwifery from nursing, and established midwifery and nursing as separate and distinct professions. Nearly all midwives gaining registration now are direct entry midwives who have not undertaken any nursing training. Registration requires a Bachelor of Midwifery degree. this is currently a three year full time programme but is in the process of being reviewed by the New Zealand midwifery regulatory authority.
Women must choose one of a midwife, a General Practitioner or an Obstetrician to provide their maternity care. About 78 percent choose a midwife (8 percent GP, 8 percent Obstetrician, 6 percent unknown). Midwives provide maternity care from early pregnancy to 6 weeks postpartum. The midwifery scope of practise covers normal pregnancy and birth. The midwife will either consult or transfer care where there is a departure from normal. Antenatal and postnatal care is normally provided in the woman’s home. Birth can be in the home, a primary birthing unit, or a hospital. Midwifery care is fully funded by the Government. (GP care may be fully funded. Obstetric care will incur a fee in addition to the government funding.)
Midwifery in Japan
In Japan, midwives are licensed and regulated by the government, and only women are allowed to take the examination to become a midwife.
Midwifery in Mozambique
When a 16-year-long civil war ended in 1992, Mozambique's health care system was devastated and one in ten women were dying in childbirth. There were only 18 obstetricians for a population of 19 million. In 2004, Mozambique introduced a new health care initiative to train midwives in emergency obstetric care in an attempt to guarantee access to quality medical care during pregnancy and childbirth. These midwives now perform major surgeries including Cesareans and hysterectomies. As the figures now stand, Mozambique is one of the few countries on track to achieve the United Nations Millennium Development Goal (MDG) of reducing the maternal death rate by 75 percent by 2015.
DOULA
A doula is an assistant who provides various forms of non-medical and non-midwifery support (physical and emotional) in the childbirth process. Based on a particular doula's training and background, the doula may offer support during prenatal care, during childbirth and/or during the postpartum period. A birth doula provides support during labor. Thus a labor doula may attend a home birth or might attend the parturient woman during labor at home and continue while in transport and then complete supporting the birth at a hospital or a birth center. A postpartum doula typically begins providing care in the home after the birth. Such care might include cooking for the mother, breastfeeding support, newborn care assistance, errands, light housekeeping, etc. Such care is provided from the day after the birth, providing services through the first six weeks postpartum. In some cases, doula care can last several months or even to a year postpartum - especially in cases when mothers are suffering from postpartum depression, children with special needs require longer care, or there are multiple infants.
Etymology and history of usage
The word doula comes from Ancient Greek δούλη (doulē), and refers to a woman of service as a slave. In Ancient Greece, the word had negative connotations, denoting "slave." For this reason, Greek women performing professional labor support choose to call themselves labor companions or birthworkers. Anthropologist Dana Raphael first used the term doula to refer to experienced mothers who assisted new mothers in breastfeeding and newborn care in the book Tender Gift: Breastfeeding (1973).[citation needed] Thus the term arose initially with reference to the postpartum context, and is still used in that domain. Medical researchers Marshall Klaus and John Kennell, who conducted the first of several randomized clinical trials on the medical outcomes of doula-attended births, adopted the term to refer to labor support as well as prenatal and postpartum support.[1] Nevertheless, the negative connotation of the word (in ancient as well as in modern Greek) has given rise to doubt as to whether it should be used, or whether it should be replaced by a more appropriate term.
Types of doulas
Labor/birth support doulas are labor support persons who attend to the emotional and physical comfort needs of laboring women to smooth the labor process. They do not perform clinical tasks such as heart rate checks or vaginal exams, nor do they provide advice. Rather, they use massage, positioning suggestions, etc., to help labor to progress as well as possible. A labor/birth support doula joins a laboring woman either at her home, birth center, or hospital and remains with her until a few hours after the birth. Some doulas also offer several prenatal visits, phone support, and one postpartum meeting to ensure the mother is well informed and supported. The terms of a labor/birth doula's responsibilities are decided between the doula and the family. In addition to emotional, physical and informational support, doulas work as advocates of their client’s wishes and may assist in communicating with medical staff to obtain information for the client to make informed decisions regarding medical procedures.
Postpartum doulas are hired to support the woman after birth, usually in the family's home. They are skilled in offering families evidence-based information and support on breastfeeding, emotional and physical recovery from childbirth, infant soothing, mother-baby bonding, and coping skills for new parents. They may also help with light housework, coordinate freshly made nutritious meals for the mother, and help incorporate older children. The terms of a postpartum doula's responsibilities are decided between the doula and the family.
Some hospitals and foundations offer programs for volunteer community doulas.[2] Volunteer doulas play an important role for women at risk for complications and those facing financial barriers to additional labor support. All doulas offer continuous encouragement and reassurance to laboring women. Volunteer doulas can encourage mother-based birth advocacy and motivate a woman to feel in control of her pregnancy.
The doula is an ally and occasional mentor for the father or partner. Their respective roles are similar, but the differences are crucial. The father or partner typically has little actual experience in dealing with the often-subtle forces of the labor process, and may receive enormous benefit from the presence of a doula, who is familiar with the process of birth. Even more important, many fathers experience the birth as an emotional journey of their own and find it hard to be objective in such a situation, and a doula facilitates the family process. Studies have shown that fathers usually participate more actively during labor with the presence of a doula than without one.[citation needed] A responsible doula supports and encourages the father in his support style rather than replaces him.
Labour/Birth doulas in the UK
In the UK doulas are not required to be certified. However, doula preparation courses are available through several different organisations. The main organisation for doulas run by doulas is Doula UK (http://www.doula.org.uk/) They have a recognition process, a Code of Conduct, a philosophy and a complaints procedure. Doula UK also has a hardship fund to ensure that all parents who require the support of a doula have access to one.
Some steps are being made in the UK by governmental bodies to integrate doulas into more mainstream maternity services (see the Goodwin Project (http://goodwindoulas.org/). Many UK working doulas believe that much of the 'doula effect' is due to the doula's independence from Health Services and that the parents choose their own doula.
Doula UK is working to enable local health services to benefit from doulas, while still maintaining the independence of individual doulas.
Labour/Birth doulas in the Switzerland
In Switzerland doulas are not required to be certified. However training programs are available from several organizations. The primary trainer for Switzerland is Birth Arts International (http://birtharts.org), and the primary doula organization is Doula Verbandes CH (http://www.doula.ch/doula/). Many insurance agencies in Switzerland cover doula care. Doula care is not yet as popular as it is in other parts of Europe, but they are expanding coverage areas.
Labor/birth doulas in the US and Canada
In the United States and Canada, labor/birth doulas are not required to be certified. However, certification is available through several different organizations, such as Aviva Institute , CAPPA (Childbirth And Postpartum Professionals Association), A.L.A.C.E. (now called to Labor), Cornerstone Doula Trainings, Birth Wisdom, DONA International, Birth Arts International, International Childbirth Education Association and I.C.T.C. (International Center for Traditional Childbearing), which focuses on increasing the number of Black doulas. Their course, study, and practical requirements vary.
A labor doula provides:
* Continuous physical, emotional, and informational support during pregnancy, labor, and childbirth.
* Support from a person who understands and trusts the process of birth, and who helps facilitate the birth experience for the parents, baby, and primary care providers.
* Emotional support;
* Exercise and physical suggestions to make pregnancy and childbirth more comfortable;
* Help with preparation of a birth plan;
* Facilitation of communication between members of laboring woman's birth team - though most doula certification programs discourage doulas from talking directly with caregivers for the mother/partners;
* Massage and other non-pharmacological pain relief measures;
* Positioning suggestions during labor and birth;
* Support the partner so that s/he can provide support and encouragement to the laboring woman;
* Help to avoid unnecessary interventions;
* Help with breastfeeding preparation and beginning;
* Some doulas offer a written record of the birth (birth story);
* Is present during entire labor and afterwards as long as is needed by parent(s).
Postpartum doulas in the US and Canada
In the United States and Canada, postpartum doulas are not required to be certified, however certification is available through several different organizations. A postpartum doula provides:
* Assistance with breastfeeding education and offers tips and informational support
* In-home support for the mother, baby and family, anywhere from a couple days postpartum to several months.
* Informed and helpful newborn care help and assistance.
* Support for the partner so that s/he can support and nurture the mother, and the newborn baby.
* Evidence-based information.
* May also offer help in the following areas: household care, help with childcare/sibling care, meal preparation, errand running, and other tasks that may be requested.
Labour/Birth doulas in Australia
In Australia, the doula industry is not regulated and certification is not compulsory. Thus, anyone can be a doula. The course requirements are not regulated, so courses range from weekend courses to online courses, to year-long courses. Registration is not available. It is illegal for doulas to practice elements of midwifery as this is seen to be practicing midwifery without a license. Hence, doulas may not provide clinical care such as listening to the baby's heart rate, checking the blood pressure and so on. They also may not give clinical advice or provide opinion on the advice of professional care providers.
Benefits
Studies have found that birth companions, of which doulas are one type, offer numerous benefits both to the mother and child. Women with support have a reduction in the duration of labor, less use of pain relief medications, lower rates of operative vaginal delivery, and, in many studies, a reduction in caesarian deliveries. Newborns in supported births have lower rates of fetal distress and fewer are admitted to neonatal intensive care units. In addition, one study found that 6 weeks after delivery, a greater proportion of doula-supported women, compared to a control group, were breastfeeding, and these women reported greater self-esteem, less depression, and a higher regard for their babies and their ability to care for them. These results are similar to findings that support from a female relative during childbirth has similar effects.
One study found doula support without childbirth classes to be more helpful than childbirth classes alone, as measured by levels of emotional distress and self-esteem evaluated at an interview four months after birth. In particular, it was noted that women in the doula-supported group reported their infants as less fussy than the group attending childbirth class without any doula support.
MIDWIFE
Midwifery is a health care profession in which providers give prenatal care to expecting mothers, attend the birth of the infant, and provide postpartum care to the mother and her infant including breastfeeding.
A practitioner of midwifery is known as a midwife, a term used in reference to both women and men. (The etymology of midwife is Middle English mid = with and Old English wif = woman). In the United States, nurse-midwives (see below) are advance practice nurses (nurse practitioners]). In addition to giving care to women in connection with pregnancy and birth, they also provide primary care to women, well-woman care (gynecological annual exams), family planning, and menopause care.
Midwives are autonomous practitioners who are specialists in a low-risk pregnancy, childbirth, and the postpartum stage. They generally strive to help women have a healthy pregnancy and natural birth experience. Midwives are trained to recognize and deal with deviations from the norm. Obstetricians, in contrast, are specialists in illness related to childbearing and in surgery. The two professions can be complementary, but often are at odds because obstetricians are taught to "actively manage" labor, while midwives are taught not to intervene unless necessary.
Midwives refer women to obstetricians when a pregnant woman requires care beyond the midwives' area of expertise. In many jurisdictions, these professions work together to provide care to childbearing women. In others, only the midwife is available to provide care. Midwives are trained to handle certain situations that are considered abnormal, including breech births and posterior position, using non-invasive techniques.
Defining midwifery
A woman giving birth on a birth chair, from a work by Eucharius Rößlin.
According to the International Confederation of Midwives (a definition that has also been adopted by the World Health Organization and the International Federation of Gynecology and Obstetrics):
“ A midwife is a person who, having been regularly admitted to a midwifery educational program that is duly recognized in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery. The educational program may be an apprenticeship, a formal university program, or a combination".
The midwife is recognized as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the infant. This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, accessing of medical or other appropriate assistance and the carrying out of emergency measures.
The midwife has an important task in health counseling and education, not only for the woman, but also within the family and community. This work should involve antenatal education and preparation for parenthood and may extend to womens health, sexual or reproductive health and childcare.
”
A midwife may practice in any setting including in the home, the community, hospitals, clinics or health units.
Early historical perspective
Due to its importance it is assumed that midwifery has existed as long as human civilization.
In ancient Egypt, midwifery was a recognized female occupation, as attested by the Ebers papyrus which dates from 1900 to 1550 BCE. Five columns of this papyrus deal with obstetrics and gynecology, especially concerning the acceleration of parturition and the birth prognosis of the newborn. The Westcar papyrus, dated to 1700 BCE, includes instructions for calculating the expected date of confinement and describes different styles of birth chairs. Bas reliefs in the royal birth rooms at Luxor and other temples also attest to the heavy presence of midwifery in this culture.
Midwifery in Greco-Roman antiquity covered a wide range of women, including old women who continued folk medical traditions in the villages of the Roman Empire, trained midwives who garnered their knowledge from a variety of sources, and highly trained women who were considered female physicians.[4] However, there were certain characteristics desired in a “good” midwife, as described by the physician Soranus of Ephesus in the second century. He states in his work, Gynecology, that “a suitable person will be literate, with her wits about her, possessed of a good memory, loving work, respectable and generally not unduly handicapped as regards her senses [i.e., sight, smell, hearing], sound of limb, robust, and, according to some people, endowed with long slim fingers and short nails at her fingertips.” Soranus also recommends that the midwife be of sympathetic disposition (although she need not have borne a child herself) and that she keep her hands soft for the comfort of both mother and child. Pliny, another physician from this time, valued nobility and a quiet and inconspicuous disposition in a midwife. A woman who possessed this combination of physique, virtue, skill, and education must have been difficult to find in antiquity. Consequently, there appears to have been three “grades” of midwives present in ancient times. The first was technically proficient; the second may have read some of the texts on obstetrics and gynecology; but the third was highly trained and reasonably considered a medical specialist with a concentration in midwifery.
Midwives were known by many different titles in antiquity, ranging from iatrinē, maia, obstetrix, and medica. It appears as though midwifery was treated different in the Eastern end of the Mediterranean basin as opposed to the West. In the East, some women advanced beyond the profession of midwife (maia) to that of obstetrician (iatros gynaikeios), for which formal training was required. Also, there were some gynecological tracts circulating in the medical and educated circles of the East that were written by women with Greek names, although these women were few in number. Based on these facts, it would appear that midwifery in the East was a respectable profession in which respectable women could earn their livelihoods and enough esteem to publish works read and cited by male physicians. In fact, a number of Roman legal provisions strongly suggest that midwives enjoyed status and remuneration comparable to that of male doctors.[5] One example of such a cited midwife is Salpe of Lemnos, who wrote on women’s diseases and was mentioned several times in the works of Pliny.
However, in the Roman West, our knowledge of practicing midwives comes mainly from funerary epitaphs. Two hypotheses are suggested by looking at a small sample of these epitaphs. The first is the midwifery was not a profession to which freeborn women of families that had enjoyed free status of several generations were attracted; therefore it seems that most midwives were of servile origin. Second, since most of these funeral epitaphs describe the women as freed, it can be proposed that midwives were generally valued enough, and earned enough income, to be able to gain their freedom. It is not known from these epitaphs how certain slave women were selected for training as midwives. Slave girls may have been apprenticed, and it is most likely that mothers taught their daughters.
The actual duties of the midwife in antiquity consisted mainly of assisting in the birthing process, although they could also help in other medical problems relating to women if needed. Often, the midwife would also call in a physician to be on-call with her in case a more difficult procedure was needed during an abnormal delivery; and in most cases she brought along two or three assistants. In antiquity, it was believed by both midwives and physicians that a normal delivery was made easier when a woman sat upright. Therefore, during parturition, midwives brought a stool to the home where the delivery was to take place. In the seat of the chair was a crescent-shaped hole through which the baby would be delivered. The chair also had armrests for the mother to grasp during the delivery. Most chairs had backs which the patient could press against, but Soranus suggests that in some cases the chairs were backless and an assistant had to stand behind the patient and support her.[5] The midwife then faced the patient, gently dilating and pulling the fetus forward, all the while instructing the mother on proper breathing and how to push downwards during a contraction. The assistants helped by pushing downwards on the patient’s abdomen. Finally, the midwife received the infant, placed it in pieces of cloth, cut the umbilical cord, and cleansed the baby. The child was sprinkled with “fine and powdery salt, or natron or aphronitre” to soak up the birth residue, rinsed, and then powdered and rinsed again. Next, the midwives cleared away any and all mucus present from the nose, mouth, ears, or anus. Midwives were encouraged by Soranus to put olive oil in the baby’s eyes to cleanse away any birth residue, and to place a piece of wool soaked in olive oil over the umbilical cord. After the delivery, the midwife made the initial call on whether or not an infant was healthy and fit to rear. She inspected the newborn for congenital deformities and testing its cry to hear whether or not it was robust and hearty. Ultimately, midwives made a determination about the chances for an infant’s survival and likely recommended that a newborn with any severe deformities be exposed.
A second-century terracotta relief from the Ostian tomb of Scribonia Attice, wife of physician-surgeon M. Ulpius Amerimnus, details a childbirth scene. Scribonia was a midwife and the relief shows her in the midst of a delivery. A patient sits in the birthing chair, gripping the handles and the midwife’s assistant stands behind her providing support. Scribonia sits on a low stool in front of the woman, modestly looking away while also assisting the delivery by dilating and massaging the cervix, as encouraged by Soranus.
The services of a midwife were not inexpensive; this fact that suggests poorer women who could not afford the services of a professional midwife often had to make do with female relatives. Many wealthier families had their own midwives. However, the vast majority of women in the Greco-Roman world very likely received their maternity care from hired midwives, either highly trained or possessing a rudimentary knowledge of obstetrics. Also, many families had a choice of whether or not they wanted to employ a midwife who practiced the traditional folk medicine or the newer methods of professional parturition. Like a lot of other factors in antiquity, quality gynecological care often depended heavily on the socioeconomic status of the patient.
During the Christian era in Europe Midwives became important to the church due to their role in emergency baptisms, and found themselves regulated by Roman Catholic canon law. In Medieval times, childbirth was considered so deadly that the Christian Church told pregnant women to prepare their shrouds and confess their sins in case of death. The Church pointed to Genesis 3:16 as the basis for pain in childbirth, where Eve's punishment for her role in disobeying God was that he would "multiply thy sorrows, and thy conceptions: in sorrow shalt thou bring forth children." A popular medieval saying was, "The better the witch; the better the midwife"; to guard against witchcraft, the Church required midwives to be licensed by a bishop and swear an oath not to use magic when assisting women through labour.
Later historical perspective
In the 18th century, a division between surgeons and midwives arose, as medical men began to assert that their modern scientific processes were better for mothers and infants than the folk-medical midwives.
At the outset of the 18th century in England, most babies were caught by a midwife, but by the onset of the 19th century, the majority of those babies born to persons of means had a surgeon involved. A number of excellent full length studies of this historical shift have been written.
German social scientists Gunnar Heinsohn and Otto Steiger have put forward the theory that midwifery became a target of persecution and repression by public authorities because midwives not only possessed highly specialized knowledge and skills regarding assisting birth, but also regarding contraception and abortion.[11] According to Heinsohn and Steiger's theory, the modern state persecuted the midwives as witches in an effort to repopulate the European continent which had suffered severe loss of manpower as a result of the bubonic plague (also known as the black death) which had swept over the continent in waves, starting in 1348.
They thus interpret the witch hunts as attacking midwifery and knowledge about birth control with a demographic goal in mind. Indeed, after the witch hunts, the number of children per mother rose sharply, giving rise to what has been called the "European population explosion" of modern times, producing an enormous youth bulge that enabled Europe to colonize large parts of the rest of the world.
While historians specializing in the history of the witch hunts have generally remained critical of this macroeconomic approach and continue to favor micro level perspectives and explanations, prominent historian of birth control John M. Riddle has expressed agreement.
Midwifery in the United States
There are two main divisions of modern midwifery in the US: nurse-midwives and direct-entry midwives.
Nurse-midwives
Nurse-midwives were introduced in the United States in 1925 by Mary Breckinridge for use in the Frontier Nursing Service (FNS). Mrs. Breckinridge chose the nurse-midwifery model used in England and Scotland because she expected these nurse-midwives on horseback to serve the health care needs of the families living in the remote hills of eastern Kentucky. This combination of nurse and midwife was very successful. The Metropolitan Life Insurance Company studied the first seven years of the FNS, and reported a substantially lower maternal and infant mortality rate than for the rest of the country. The report concluded that if this type of care was available to other women in the USA thousands of lives would be saved, and suggested nurse-midwife training should be done in the USA. Mrs. Breckinridge opened the Frontier Graduate School of Midwifery in 1939 the first nurse-midwifery education program in the USA. The Frontier School is still educating nurse-midwives today but in a new way. In 1989 the program became the first distance option for nurses to become nurse-midwives without leaving their home communities. The students do their academic work on-line with the Frontier School of Midwifery and Family Nursing faculty members and they do their clinical practice with a nurse-midwife in their community who is credentialed by Frontier as a clinical faculty member. This community based model has graduated over 1200 nurse-midwives. http://www.frontierschool.edu/.
In the United States, nurse-midwives are variably licenced depending on the state as advanced practice nurses, midwives or nurse-midwives. Certified Nurse-Midwives are educated in both nursing and midwifery and provide gynecological and midwifery care of relatively healthy women. In addition to licensure, many nurse-midwives have a master's degree in nursing, public health, or midwifery. Nurse-midwives practice in hospitals, medical clinics and private offices and may deliver babies in hospitals, birth centers and at home. They are able to prescribe medications in all 50 states. Nurse-midwives provide care to women from puberty through menopause. Nurse-midwives may work closely with obstetricians, who provide consultation and assistance to patients who develop complications. Often, women with high risk pregnancies can receive the benefits of midwifery care from a nurse-midwife in collaboration with a physician. Currently, 2% of nurse-midwives are men. The American College of Nurse-Midwives accredits nurse-midwifery/midwifery education programs and serves as the national professional society for the nation's certified nurse-midwives and certified midwives. Upon graduation from these programs, graduates sit for a certification exam administered by the American Midwifery Certification Board.
Direct-entry midwives
A direct-entry midwife is educated in the discipline of midwifery in a program or path that does not also require her/him to become educated as a nurse. Direct-entry midwives learn midwifery through self-study, apprenticeship, a midwifery school, or a college- or university-based program distinct from the discipline of nursing. A direct-entry midwife is trained to provide the Midwives Model of Care to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings.
Under the umbrella of "direct-entry midwife" are several types of midwives:
A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwives model of care. The CPM is the only US credential that requires knowledge about and experience in out-of-hospital settings. At present, there are approximately 900 CPMs practicing in the US.
A Licensed Midwife is a midwife who is licensed to practice in a particular state. Currently, licensure for direct-entry midwives is available in 24 states.
The term "Lay Midwife" has been used to designate an uncertified or unlicensed midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, just that the midwife either chose not to become certified or licensed, or there was no certification available for her type of education (as was the fact before the Certified Professional Midwife credential was available).
The American College of Nurse-Midwives (ACNM) also provides accreditation to non-nurse midwife programs, as well as colleges that graduate nurse-midwives. This credential, called the Certified Midwife, is currently recognized in only three states (New York, New Jersey, and Rhode Island). All CMs must pass the same certifying exam administered by the American Midwifery Certification Board for CNMs. The North American Registry of Midwives (NARM) is a certification agency whose mission is to establish and administer certification for the credential "Certified Professional Midwife" (CPM). CPM certification validates entry-level knowledge, skills, and experience vital to responsible midwifery practice. This certification process encompasses multiple educational routes of entry including apprenticeship, self-study, private midwifery schools, college- and university-based midwifery programs, and nurse-midwifery. Created in 1987 by the Midwives' Alliance of North America (MANA), NARM is committed to identifying standards and practices that reflect the excellence and diversity of the independent midwifery community in order to set the standard for North American midwifery.
Practice in the United States
Midwives work with women and their families in any number of settings. While the majority of nurse-midwives work in hospitals[who?], some nurse-midwives and many non-nurse-midwives[who?] work within the community or home. In many states[which?], midwives form birthing centers where a group of midwives work together. Midwives generally support and encourage natural childbirth in all practice settings. Laws regarding who can practice midwifery and in what circumstances vary from state to state.
Midwifery in the United Kingdom
Midwives are practitioners in their own right in the United Kingdom, and take responsibility for the antenatal, intrapartum and postnatal care of women, up until 28 days after the birth, or as required thereafter. Midwives are the lead health care professional attending the majority of births, mostly in a hospital setting, although home birth is a perfectly safe option for many births. There are a variety of routes to qualifying as a midwife. Most midwives now qualify via a direct entry course, which refers to a three- or four-year course undertaken at university that leads to either a degree or a diploma of higher education in midwifery and entitles them to apply for admission to the register. Following completion of nurse training, a nurse may become a registered midwife by completing an eighteen-month post-registration course (leading to a degree qualification), however this route is only available to adult branch nurses, and any child, mental health, or learning disability branch nurse must complete the full three-year course to qualify as a midwife. Midwifery students do not pay tuition fees and are eligible for financial support for living costs while training. Funding varies slightly depending on which country within the UK the student is in and whether the course they are on is a degree or diploma course. Midwifery degrees are paid for by the NHS and some students may also be eligible for NHS bursaries.
All practising midwives must be registered with the Nursing and Midwifery Council and also must have a Supervisor of Midwives through their local supervising authority. Most midwives work within the National Health Service, providing both hospital and community care, but a significant proportion work independently, providing total care for their clients within a community setting. However, recent government proposals to require insurance for all health professionals is threatening independent midwifery in England.
Midwives are at all times responsible for the woman for whom they are caring, to know when to refer complications to medical staff, to act as the woman's advocate, and to ensure the mother retains choice and control over her childbirth experience. Many midwives are opposed to the so-called "medicalisation" of childbirth, preferring a more normal and natural option, to ensure a more satisfactory outcome for mother and baby.
Midwife training
Midwifery training is considered one of the most challenging and competitive courses amongst other healthcare subjects. Most midwives undergo a 32 month vocational training program, or an 18 month nurse conversion course (on top of the 32 month nurse training course). Thus midwives potentially could have had up to 5 years of total training. Midwifery training consists of classroom based learning provided by select Universities[15] in conjunction with hospital and community based training placements at NHS Trusts.
Midwives may train to be community Health Visitors (as may Nurses).
Community midwives
Many midwives also work in the community. The roles of community midwives include the initial appointments of pregnant women, running clinics, postnatal checks in the home, and attending home births.
Midwifery in Canada
Midwifery was reintroduced as a regulated profession in Canada in the 1990s.[16] After several decades of intensive political lobbying by midwives and consumers, fully integrated, regulated and publicly funded midwifery is now part of the health system in the provinces of British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, and Nova Scotia, and in the Northwest Territories and Nunavut. Midwifery legislation has recently been proclaimed in New Brunswick where the government is in the process of integrating midwifery services there. Only Prince Edward Island and Newfoundland and Labrador do not have legislation in place for the practice of midwifery.
Midwives in Canada come from a variety of backgrounds including: aboriginal, post nursing certification, direct-entry and "lay" or traditional midwifery. However, after a process of assessment by the provincial regulatory bodies, registrants are all simply known as 'midwives', 'registered midwives' or 'sage femme' regardless of their route of training. From the original 'alternative' style of midwifery in the 1960s and 1970s, midwifery practice has become somewhat standardized in all of the regulated provinces: midwives offer continuity of care within small group practices, choice of birthplace, and a focus on the woman as the primary decision-maker in her maternity care. When women experience deviations from normal in their pregnancies, midwives consult with other health care professionals. The women's care may continue with the midwife, in collaboration with an obstetrician or other health care specialist; her care may be transferred to an obstetrician or other health care specialist, temporarily or for the remainder of her pregnancy and birth. Founding principles of the Canadian model of midwifery include informed choice, choice of birth setting, continuity of care from a small group of midwives and respect for the woman as the primary decision maker.
Four provinces offer a four year university baccalaureate degree in midwifery. In British Columbia, the program is offered at the University of British Columbia.[17] In Ontario, the Midwifery Education Program is offered by a consortium of McMaster University, Ryerson University and Laurentian University. In Manitoba the program is offered by University College of the North, which offers the only degree program exclusively for aboriginal students; combining education in western and traditional aboriginal midwifery. In Quebec, the programme is offered at the Université du Québec à Trois-Rivières. In northern Quebec and Nunavut, Inuit women are being educated to be midwives in their own communities. A Bridging program for internationally educated midwives is in place in Ontario at Ryerson University. A federally funded ["Multi-jurisdictional Midwifery Bridging Program"] is offered in Western Canada. Regulated provinces and territories admit internationally educated midwives to their regulatory body if they can demonstrate compentency through a Prior Learning and Experience Assessment (PLEA) process.
The legislation of midwifery has brought midwives into the mainstream of health care with universal funding for services , hospital privileges, rights to prescribe medications commonly needed during pregnancy, birth and postpartum, and rights to order blood work and ultrasounds for their own clients and full consultation access to physicians. To protect the tenets of midwifery and support midwives to provide woman-centered care, the regulatory bodies and professional associations have legislation and standards in place to provide protection, particularly for choice of birth place (see home birth), informed choice and continuity of care. All regulated midwives have malpractice insurance. Any unregulated person who provides care with 'restricted acts' in regulated provinces or territories is practicing midwifery without a license and is subject to investigation and prosecution.
Prior to legislative changes, very few Canadian women had access to midwifery care (in part because it was not funded by the health care system). Legislating midwifery has made midwifery services available to a wide and diverse population of women and in many communities midwives cannot meet the growing demand. Midwifery services are free to women living in midwifery regulated provinces.
Midwifery in New Zealand
Midwifery regained its status as an autonomous profession in New Zealand in 1990. The Nurses Amendment Act restored the professional and legal separation of midwifery from nursing, and established midwifery and nursing as separate and distinct professions. Nearly all midwives gaining registration now are direct entry midwives who have not undertaken any nursing training. Registration requires a Bachelor of Midwifery degree. this is currently a three year full time programme but is in the process of being reviewed by the New Zealand midwifery regulatory authority.
Women must choose one of a midwife, a General Practitioner or an Obstetrician to provide their maternity care. About 78 percent choose a midwife (8 percent GP, 8 percent Obstetrician, 6 percent unknown). Midwives provide maternity care from early pregnancy to 6 weeks postpartum. The midwifery scope of practise covers normal pregnancy and birth. The midwife will either consult or transfer care where there is a departure from normal. Antenatal and postnatal care is normally provided in the woman’s home. Birth can be in the home, a primary birthing unit, or a hospital. Midwifery care is fully funded by the Government. (GP care may be fully funded. Obstetric care will incur a fee in addition to the government funding.)
Midwifery in Japan
In Japan, midwives are licensed and regulated by the government, and only women are allowed to take the examination to become a midwife.
Midwifery in Mozambique
When a 16-year-long civil war ended in 1992, Mozambique's health care system was devastated and one in ten women were dying in childbirth. There were only 18 obstetricians for a population of 19 million. In 2004, Mozambique introduced a new health care initiative to train midwives in emergency obstetric care in an attempt to guarantee access to quality medical care during pregnancy and childbirth. These midwives now perform major surgeries including Cesareans and hysterectomies. As the figures now stand, Mozambique is one of the few countries on track to achieve the United Nations Millennium Development Goal (MDG) of reducing the maternal death rate by 75 percent by 2015.
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