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Rebecca Pugh, Registered Midwife, CPM, Doula
Apr 07, 2011 | 1146 views | 0 0 comments | 5 5 recommendations | email to a friend | print
Rebecca Pugh began her journey into midwifery as a prenatal yoga instructor, when she was asked to attend a birth to help the mother relax. Soon after she became a doula, a non-medical labor support person who accompanies the birthing mother to provide emotional and physical support. Pugh was so inspired by her first experience as a doula attending a home birth that she applied to midwifery school the very next day.

Pugh graduated from the Midwives College of Utah in 2004 and is now a licensed midwife in both Colorado and Utah. She is also a certified Emergency Medical Technician, and is certified in Neonatal Resuscitation, prenatal yoga and childbirth education. In 2007 Pugh volunteered at the Bumi Sehat Maternity Clinic in Ubud, Bali, Indonesia, where she worked alongside local midwives and educated visiting ones.

Since attending her first birth in 2002, Pugh has attended hundreds of births. Her most treasured accomplishment was the home birth of her daughter, Paige this past June. Her business, Mountain Birth, is located in Rico, Colo.

Q: What can a pregnant woman do to promote a low-risk birth?

A: First, let me say that staying low risk allows you to have the labor and delivery that YOU want, not the birth the hospital wants. Despite what many doctors may say, pregnancy and birth are inherently safe and natural processes that happen every day, without complication.

Staying low risk means being an active participant in your care. Bring questions and concerns to your prenatal appointments – writing them down always helps. If you feel you don’t have enough time for your own needs during an appointment then you may be seeing the wrong provider, or you may just need to ask for a longer appointment. Most providers will accommodate you if you ask.

Be aware of your baby’s position. Studies show that women who are aware of their baby’s position have less instances of breech or posterior positioning because they can then be pro-active about changing the position. Breech positioning is now the reason for cesarean section in most hospital-based care, and a posterior position can make for a long and difficult birth. During the third trimester, ask your care provider what they feel and where, practice at home with your partner by trying to guess what parts of the baby you feel and then confirm at your next appointment. Your provider should palpate your belly at EVERY visit during the third trimester.

Avoid the “whites”... white sugar, white flour and white rice. These are empty calories that leave your body needing more. If you crave sugar, your body really needs protein. Try protein first and a small, sweet snack later. Focus on nutrient dense foods like fish, chicken and vegetables and healthy fats like organic dairy, nuts and avocados. Exercise three-to-five times per week and try to get at least three liters of water per day. Pregnancy is NOT the excuse you were looking for to eat whatever junk food you would like; choose whole foods not processed ones. The QUALITY of your weight gain is much more important than the QUANTITY. If you follow these tips you are more likely to avoid problematic diseases of pregnancy such as gestational diabetes and high blood pressure.

Q: Can you address a few common concerns that you hear from women during their pregnancy.

A: Most women are concerned about anything they take into their bodies during pregnancy, from foods, herbs and supplements to medicine and alcohol. A small amount of alcohol is safe in pregnancy, so I believe that it is safe to have a beer or a glass of wine one-to-two times per week – but just one and always with a meal.

I do not think that it is imperative that women eat only organic foods during pregnancy but I ask my clients to prioritize meats and dairy when they buy organic to avoid unnecessarily added hormones and chemicals.

Almost every medication or vitamin and supplement says, “Check with your care provider when pregnant or breast feeding,” despite the fact that many things are safe. But you should always check with your care provider about anything you want to take and bring a list of your medications, vitamins and supplements to your first appointment. Kellymom.com has a very user-friendly list of common prescription and over-the-counter medications and their safety ratings for pregnancy and breast feeding.

Morning Sickness is a common problem. The worst thing you can do is NOT eat. I tell mothers not to be too concerned about the quality of food they eat in the first trimester if they suffer from nausea and food aversions, just as long as they ARE eating. Many women perpetuate the nausea by not eating because they are nauseous and food isn’t appealing, but an empty stomach is a trigger for more nausea. Increasing simple carbohydrates, adding B complex vitamins, especially B6, and eating small, frequent snacks is helpful. Many women have a difficult time digesting proteins and vegetables during the first trimester, so keep it simple – yogurt, bagels, toast, cereal and fruit are good choices. Follow your instincts; most nausea resolves itself spontaneously around week 13, if not, there are options your care provider can suggest.

Anemia, or low iron, occurs due to changes in a pregnant woman’s blood volume. This results in fatigue and in severe cases makes the birthing mother more susceptible to hemorrhage during delivery and post partum. Increasing iron rich foods such as red meat, black strap molasses, dark leafy greens like spinach, dried fruits like prunes, and cooking in an iron skillet are all great ways to combat this problem. If that isn’t enough I recommend a product called Floradix, a food based iron supplement that contains B vitamins and Vitamin C, which helps your body metabolize iron.

The naturally occurring sources of iron in Floradix do not have a constipating effect, unlike the ferrous sulfate in prescription prenatal vitamins. Unfortunately, the vitamins that most hospital-based practices prescribe have ferrous sulfate in them. Many doctors even prescribe a stool softener when they give you the vitamins. This is crazy to me when there are excellent prenatal vitamins,with more easily metabolized forms of iron available over the counter.

Q: The fear of pain during delivery is significant concern for many women. What are your suggestions for pain management, whether or not natural childbirth is planned?

A: In the hospital there are two main forms of chemical pain relief: the epidural and IV pain medications. Both administer similar drugs, however the route differs. The epidural sends a combination of an anesthetic agent and a narcotic, such as Lidocaine and Fentanyl respectively, into the dural space surrounding the spinal cord, lessening the transfer of the medicine into the blood stream. This in turn reduces the amount of medicine the baby receives. The epidural provides long-term pain relief by numbing the woman from about waist level down to her toes. The laboring woman is unable to leave bed, requires continuous fetal monitoring, a urinary catheter and IV fluids. Sometimes other medications are necessary to counteract some of the negative side effects of the epidural, including fetal distress, maternal hypotension, allergic reactions and cessation of labor. Most women receiving an epidural also receive Pitocin, which is used to accelerate and intensify labor contractions.

IV medications are narcotics, often Fentanyl, administered directly into the mother’s blood stream through a catheter in a vein. IV medications tend to be short acting and don’t provide the long-term pain relief most first-time mothers need. Because they are administered directly into the bloodstream the baby does receive some of the effects of the medicine and may experience respiratory distress at birth. The mother often feels drowsy and sluggish, but receives a short-lived amount of pain relief that gets her “over a hump,” allowing her to persevere.

Natural pain relief comes in the form of tender loving support from a partner, doula or the hospital staff. A doula is a non-medical labor support person who works for the couple, not the hospital. Her role is to provide unwavering support, both physical and emotional, for you, your partner and your birth preferences. Anyone can act as your doula.

My advice for a mother planning an unmedicated birth in the hospital is to not rely on the hospital staff for support, but come with the support you need. Honestly, you should stay out of the hospital for as long as possible if you want to avoid pain medication and you are a first time mom.

Massage, counter pressure, positioning, visualization, hypnosis and physical support are all valuable tools that will relive pain. Soaking in a hot tub is one of the best forms of pain relief available. There are no negative side effects and it is available in most hospital settings. The warm water increases blood flow, relaxes sore muscles and provides relief from the pressure of contractions.

Q: How can parents promote the bond with their newborn immediately following delivery?

A: Having the baby put on the mother’s chest skin-to-skin immediately after delivery is very important. If that is not possible because of a cesarean delivery or a complication, the father can go with the baby and provide a loving touch, or at the very least the sound of his voice to soothe the baby. Most women have uncomplicated, vaginal deliveries; in this case there is no reason why the baby can’t be with the mother skin-to-skin. Dim lighting is preferable because this encourages the newborn to open her eyes and make eye contact with the parents. Breast feeding within the first hour of life is preferable and studies show those that latch on in that first golden hour are more successful nursers. Newborns are typically awake for the first 1-3 hours following delivery; after that they tend to sleep for several hours. I believe these first few hours are very important to the bonding process. The room should be quiet and the parents should be allowed the space to touch, explore and nurture their new baby. All vital signs can be easily collected while the baby is in the mother’s arms and most newborn procedures can be delayed for at least the first hour, if not more.

Q: What can parents expect from their newborn in the first week?

A: There is no schedule in the first weeks of life, so take the pressure off of yourself by sleeping when the baby sleeps and allowing others to help you. Your baby’s poop will become the center of your universe because the state of his digestive system usually dictates his mood. His poops will transition from dark black meconium to brown and then to bright yellow when your milk comes in. Newborns take their time adjusting to the world outside; they may take some time to “pink up” and sometimes have blue hands and feet, so just keep them bundled.

The stomach of a newborn is very small so they only need to take in the colostrum from your breasts until your milk comes in. This is the “liquid gold” that is produced in very small quantities and is loaded with antibodies and protein. It is a highly concentrated “super food” that helps prevent jaundice by clearing meconium from his bowels and provides growth factors that safeguard the gut from disease. Nurse on demand until your milk supply becomes regulated, and try conforming to your baby’s needs, rather than vice versa. It is impossible to spoil a baby; they want to be held ALL the time.

Q: What can a mother expect of her own body in the first week after delivery?

A: I encourage my clients not to leave their bed for the first 24 hours and not to go any farther than the living room in the first week – rest is so important. Your bleeding will pick up if you are active, so use that as a guide; if your bleeding is heavy you are doing too much. The mama should be the queen who is waited on hand and foot in the first weeks. If you think you don’t need help, you are wrong. There are fabulous online services like mealtrain.com that help your friends and extended family organize meals for your family. And visitors should be limited to close friends and family, those who are truly helpful and those dropping off a meal without fuss.

Your milk will come in around day three or four; your breasts will become large, engorged, hard and uncomfortable. The only cure is nursing your baby. Be careful not to start pumping, or you will fool your body into thinking that you have two babies and you will produce more milk. Just nurse and your supply will regulate within a week or two.

After birth, many women are very sore, even if they don’t have a perineal tear. Your body has worked incredibly hard so expect to be sore from head-to-toe. Just rest and be thankful. A cesarean birth requires more time for healing. Make sure you ask your care providers about special considerations for cesarean birth healing.

Many women sweat profusely the first night or two after birth as your body sheds retained fluid, so don’t be surprised if you soak the sheets. This should resolve within 48 hours.

In the months following birth, many women experience extreme hair loss as a shift in hormones can result in hair falling out in clumps. This can be the perfect time for a short do that makes you feel beautiful again.

Around 70 percent of women report some sort of “baby blues” after birth. Even if you had exactly the birth experience you were hoping for and you and your baby are perfectly happy and healthy, it is normal and common to feel slightly depressed. This feeling often comes in waves and is accompanied by moodiness, heightened emotions and a sense of being overwhelmed. This is in large part due to hormonal changes but is exacerbated by sleep deprivation. Don’t be afraid to ask for help if this happens to you. Ask a loved one to hold the baby while you shower, eat and take a nap. Sleep when the baby sleeps and talk to other mothers who understand what you are going through.

If you feel as though you cannot make it through the day without crying, if you wish harm to yourself or your baby, or if you have no desire to care for yourself or your baby and basic duties are being ignored, you may have post partum depression. Family members often notice a problem before the mother does. Talk to your care provider about post partum mood disorders during a prenatal visit, especially if you have a history of depression.

Q: What advice do you have for a new mom who is desperate to get back in to her pre-pregnancy weight?



A: Breast feed! When you are producing milk you are burning calories – making milk requires a lot of energy and helps many women lose weight. But there has to be a balance; over exercising results in dehydration in the form of sweating, which depletes the milk supply. Also, good nutrition and hydration are important to keep up the milk supply up. Remember that it takes 10 months to grow a baby, so it will probably take 10 months to shrink the mama! Don’t be in a hurry; your body will be forever changed by birth. I hear many women say that they may return to their pre-pregnant weight before the first year is over but they lack the tone they had before. Your hips will be wider for a long time, so you may NEVER return to the same size jeans you wore before. Or you may be lighter on the scales but your shirt is tighter because your breasts have grown. Exercise is so important, so pack up your baby and get out! But my best advice is patience and acceptance. You may never fit into those jeans again, but your baby doesn’t care what size you are.

Q: So coming full circle…when will her libido return?

A: Unfortunately, breast feeding has the hormonal side effect for many women of reducing their sex drive. When your baby suckles you produce oxytocin, this is the “love hormone” that makes you feel unconditional love for your baby and deepens the bond between you and your baby. For many, the hormone receptors become saturated, leaving you without a desire for any other types of “love.” Combine this with healing from birth, sleep deprivation and a general sense of being overwhelmed, and you have a recipe for celibacy! If you are co-sleeping with your baby the problem is even worse – your privacy has been dashed.

Many couples take their sex life out of the bedroom at this point and get creative. Also, making love during the day is a better option for an over-tired mom who doesn’t want to be bothered at night when sleep is at a premium. Some parents hire a babysitter who can take the baby on a walk while the parents “play.”

Couples need to be patient with one another and understand that this is only a phase. A baby is demanding of a mother’s time, attention and love, and a partner who wants sex is often seen as another demand. Expressing your love is so important and you may need to find new ways to do so. A tired mother may find more value in having dinner made for her or having her partner hold the baby while she goes for a walk, giving her time to herself. Every woman is different – I can’t say when the libido will return, but it will.

Rebecca Pugh may be reached by calling 970/708-1298. Her website is www.mountainbirth.com.

– Cynthia Sommers


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