Birth Trauma Part 3

According to Cheryl Tatano Beck, traumatic birth is defined as “an event occurring during the labor and delivery process that involves actual or threatened serious injury or death to the mother  or her infant. The birthing woman experiences intense fear, helplessness, loss of control, and horror” she had later revised that statement to include the woman feeling stripped of her dignity.

What is the cause of women perceiving their birth experience as traumatic? It is the systemic elimination of protective care during the birthing process.

In Beck’s study of 40 women she says that there were four themes that emerged. Theme #1 was to care for the women and treating them as human beings. Theme #2: Lack of Communication.  Theme #3 was safety. Theme #4: The ends will justify the means.

With theme One: #1 women feeling they were objectified, and treated arrogantly and with a lack of empathy. The women were #2 left alone, and abandoned. The #3 birthing mother’s needs were not met by the hospital staff. An example given was of a woman from Puerto Rico who was on all fours, when a nurse brought in 20 students to observe…without her consent.

In theme Two: #1 no one communicated with the woman in labor. They were described as having conversations with one another within earshot but not directly talking with or to the laboring mother. As if she were non-existent.

In the third theme:  the #1 laboring mothers felt that the staff (nurses and doctors) did not adequately deliver safe care. #2 The mothers were not being allowed input into the care being given for their own selves and actually fearing for their own and / or the infant’s life!

In theme Four:  entailed #1 the sense that what was endured and experienced by the mothers was the sense of being “pushed to the background” as everyone around them were celebrating the baby’s healthy birth. These women #2 felt invisible, only the infant mattered.

The experiences mothers have had led to severe post-partum trauma and depression.  Beck, Driscoll, and Watson’s book Traumatic Birth goes into detail about feedback loops [pp. 10-12] that describe the interaction of the mother and child after a traumatic birth, with a listing of the causes and consequences of the cause. Sometimes even breastfeeding is difficult, creating “…intruding flashbacks, disturbing detachments with their infants, feeling violated, enduring physical pain, and insufficient milk supply…” Often the anniversary of a traumatic birth amplifies the feedback loop.

 …

My own reaction to the shared experiences the women in this book had illustrated the barbarism of western medical professionals, a barbarism that is completely contrary to those principles I listed from the ACOG website in part #2.

The women who tell their story of childbirth weave an astounding sense of personal alienation.  It is no wonder that there is PTSD, depression, self-destructive behaviors, socially isolationistic behaviors and pelvic floor injuries as a result of the improper calloused form of care received. Many of the women feel as though they were raped, yet most had no “history of physical, emotional, and/or sexual abuse” so birth precipitated  a sense of having “the loss of the soul”.

I only touched on a small portion of the book in these three posts. In the next few blogs, I would like to address how we can alter the outcome for women in these circumstances and possibly change childbirth for women.

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Anovulation and Irregular Cycles

No two females are the same.  Women have cycles that vary.  It is dependent on if she is an adolescent girl, just coming off the pill, breastfeeding, or is approaching menopause.

Women who live in close proximity do tend to cycle together.  You will notice this as you become more aware of your cycle, and your body.


A Typical Cycle

In what is considered a “normal” cycle, the release of the egg occurs in a predictable pattern.  After your menses, “under the influence of rising estrogen, you’ll usually have several days of no cervical fluid, building up to progressively wetter fertile-quality cervical fluid (103)”.  After the egg is released the cervical fluid will dry quickly. Then the pattern starts again.

Different Phases of Anovulation

Adolescence

The average age of American girls to begin menstruation is 12 to 14 years old. At this age, the onset of menses may not be due to the release of an egg.

One of the characteristics of cycles in teenage girls is the fluctuation of the estrogen cycles.  Therefore the cycle of a teenager is not predictable. The distance between menses and duration may vary, with some anovulatory cycles in between.

Breastfeeding

When breastfeeding “on demand” a woman may not have menses for months.  Every time the baby is breastfed the hormones that trigger ovulation are triggered. But, in order for it to work, the baby must feed regularly when baby indicates hunger (no supplementation).

A woman could go a year or more without a change in temperature, experiencing the same cervical fluid.  The reason that she would not see the good kind of cervical fluid, at first, is that prolactin will lower the estrogen levels and keep the fertile quality cervical fluid from being produced. The trick here is, to be able to notice if there is any change in the cervical fluid, which will indicate that ovulation is soon to resume.

Premenopause

Premenopause occurs prior to Menopause, when all ovulation and menses cease. It often will last for years. During this time, her cycles may start to be very different than usual. At first, the cycles may shorten because of more frequent ovulations and shorter luteal phases. As time goes on, the length of the cycles increases as the number of ovulations become more infrequent.  Finally the cycles end altogether.  If the woman is 40 or older and she has had no menses for a year or more, she is said to be in Menopause.

Other Major Causes of Anovulation

Illness

Normally, illnesses do not affect your cycle.  When illness affects your cycle depends upon the phase of your cycle you are in when you become ill, if before ovulation it may delay or cause no ovulation to occur… If after ovulation, it will rarely cause any problems.

A fever will not affect your ability to chart or interpret it.  There are other fertility signs. Not only that, you can still tell whether the temperature affected your cycle in either delaying or preventing the cycle.

Travel 

Travel is notorious for causing an effect on the cycle.  Some women do manage to be regular like clock-work despite traveling.

Your body may interpret traveling as a stressor.  Some women may find that they have an extended cycle while others do not ovulate at all…in fact stop menstruating altogether.  Despite all this, and the fun of travel, you will find charting using all three signs is beneficial to notate the ambiguities.

 Exercise

Heads up!  Strenuous exercise is a well-known cycle buster!  It can delay or stop ovulation.  Exercise mostly affects competitive athletes with low body fat ratios.  For women, it is mostly those who are runners swimmers, gymnasts, and ballet dancers that have issues.  But metabolism, thyroid, and diet must be ruled out first.

Weight Loss or Gain

To maintain normal ovulatory cycles, a woman’s body weight should be a minimum of 20% body fat.  This is in order to have the body store estrogen and to allow for androgen conversion into to the kind of estrogen necessary for ovulation.

Women who are extremely thin, especially those with anorexia, tend to have their menses stop.  This is due to not having enough estrogen to cause ovulation.

Stress

Long cycles are often caused by stress. Stresses can be either psychological or physical. Stress tends to delay ovulation rather than cause an earlier ovulation cycle. Therefore, the later the ovulation occurs the cycle becomes longer. If stress is severe it can cause ovulation to stop altogether.

Medical Conditions

A variety of medical conditions can cause menses to cease.  These are:

  • Elevated prolactin
  • Pituitary gland problems
  • Polycystic ovarian syndrome

A common and useful way to determine the cause of anovulation is with a Progesterone Withdrawal Test.
NOTE:

For both breastfeeding and Premenopause, the use of FAM as your contraception method can be tricky at best.

Natural Contraception – Part 3

chart


The Four Rules

  1.  First Five Days Rule

You are safe during the first five days of the menstrual cycle if you have had an obvious temperature shift about 12 to 16 days prior.

This applies to the first five days of the cycle. Any bleeding after should be considered fertile whether you bleed or not. Bleeding in that 5 day period is true menstruation, not spotting or abnormal bleeding.

This rule can only work if you have been charting your cervical fluid and temperature for awhile. You cannot rely on this rule if you are approaching menopausal age and if any of the signs of menopause are present[i].  This is due to the hormonal fluctuations that occur in Premenopause.

If your last 12 cycles were 25 days or shorter, you should then assume only 3 days are safe.  This precaution is due to the fact that you could ovulate earlier.  You would not be able to detect cervical fluid change due to bleeding.

  1. Dry day Rule

    Before ovulation you are safe any evening of every dry day[ii].

    Dryness[iii] is determined by periodic checks of cervical fluid throughout the day. There should be no wet or any kind of fluid.

It must not be “sticky” either.  Although sticky fluids may not be conducive to fertility, err on the safe side. Many women cannot distinguish between the sticky fluid and the wet fertile cervical fluids.  But if you have a couple “sticky” days and then return to dry, you are then considered safe on the dry days.

on the day after intercourse you chart that day with a question mark if semen or spermicide is present, these tend to mask cervical fluid. Because the fluids are masked that evening is considered fertile, since you cannot determine “wet” or “dry” cervical fluid.  But if by the end of the day after intercourse you are dry and have been all day, you are safe.

Remember: sperm cannot survive with a dry cervix.  The longest that the sperm stays alive is just a few hours. The sticky fluid of the cervix is just about as inhospitable as a dry cervix, so the risk is low.

  1. Temperature Shift Rule

    You are safe the evening of the 3rd consecutive day your temperature is above the cover-line.

You are infertile starting at 6 p.m. the third consecutive night that your temperature is above the cover-line.   If the temperature falls on or below the cover-line during that three day time frame, you must start your counting over until  it is above the line again.

If you develop a fever due to illness, you cannot consider yourself safe until you have had and recorded three days consecutively of normal temperatures above the cover-line.  If you have had no obvious thermal shift use a more conservative rule.  This would mean you would consider yourself safe only until the evening of the third day you are above the line.

  1. Peak Day Rule
    You are safe the evening of the 4th consecutive day after your peak day

Your peak day is the last day of “wetness”.  On the chart mark “PK” in the peak day column.  Subsequent days should be marked as “1”, “2”, “3”, etc., in that same row.  You should record them only in the evening after having observed your cervical fluid.

You are considered safe on the 4th consecutive day following a “peak day”after 6 p.m. Draw a vertical line on the 3rd and 4th day to indicate your being safe from day four.


Putting it all together

  • The peak day of cervical fluids typically occurs a couple of days before the temperature rises.
  • Before ovulation, the cervical fluid is the critical fertility sign to observe
  • But after ovulation , it is the temperature that is a critical sign.
  • The rules that apply to ovulation will often work in harmony with each other, so the the 3rd evening of high temperatures will coincide with the 4th evening after the peak day.
  • However:
    • If there is a discrepancy between the two post-ovulatory rules, always wait until both signs indicate infertility.
    • If it is critical that you avoid pregnancy, do not take the chance of unprotected sex!

 

[i] Hot flashes, vaginal dryness, etc.

[ii] After 6 p.m.

[iii] No fluids present, the slight moisture at the vaginal opening is not “wet” per se.

Natural Contraception – Part 1

chart

Many women have said to me “Oh, charting is just too much bother”.  Well, is it too much bother to pencil in your eyebrows and put on lipstick before you leave the front door? This is YOUR body, it is your health we are talking about.  Once you get the blank charts, it probably will take you five minutes. Easy peezy… like tying your shoe laces!

Waking Temperature

Why do it?

  • you can see when you are ovulating
  • tell when you can have safe sex without unwanted pregnancy
  • see when you are no longer fertile (Great for when you want a “green light” for safe sex” or when you are trying to get pregnant, it is not gonna happen…
  • indicates when you will get your menses
  • potential issues with period

How to do it
glass thermometer
When you first wake up, before you drink water or anything else.  Everyday, including during your menses. If possible, take your temperature at the same time each day. Note the time on your chart. The later in the day, the higher the temperature…so if you forget to do the temperature upon waking, you need to note the time.

If your thermometer is digital, make sure to wait until it beeps.  The reading would then be more accurate. A glass thermometer, should be left in the mouth a full five minutes.  Shake it down the night before or at least remember to do so before you take the temperature for that day.

Take your temperature ORALLY.

Also note on your chart if you have had unusual events in your life, such as: stress, illness, are traveling, or you are moving. These events can affect your temperature.

 

Our Gynecological Health – Part 2

Normal VS Abnormal Bleeding

Normal menstruation lasts about five days and usually will follow a pattern, here are two variations:

Light –> heavy –> medium –> light –> very light
Heavy –> heavy –> medium –> medium –> light

Also, some women may spot (ordinarily brownish) or bleed at other times in their cycle besides actual menstruation. Spotting is one of the most misunderstood aspects of a woman’s cycle. A common mistake is to assume any type of bleeding episode is menstruation. True menstruation occurs after ovulation, about 12 to 16 days after. Any other type of bleeding is either anovulatory bleeding, what is considered normal spotting, or is symptomatic of a problem.
Ovulatory Spotting

Light bleeding may occur right around ovulation in some women. It is not only normal, but an indicator for fertility, a sign that tells where the woman is in her cycle. It results from a sudden drop in estrogen, just before ovulation. It occurs more in long-cycles.

Anovulary Bleeding and Spotting

Once in a while an egg is not released. It could be due to the estrogen not reaching the level for the egg to release. When this happens the drop in estrogen will cause light bleeding.

For women over 40, the cause is a decreased sensitivity to FSH and LH hormones. This would result in these women not ovulating. The progesterone level is not able to sustain the lining and some spotting or bleeding may occur.

The way to know if actual ovulation did occur, is to chart the temperature. As a reminder: the temperature pattern is: low before ovulation, followed by the high temperature after.

Implantation Spotting

So when a woman notices spotting rather than bleeding a week after her temperature shifts she might want to consider a pregnancy test. This may be an indication of “implantation spotting”, because as the egg burrows into the lining of the uterus, a bit of spotting may occur. If temperatures remain high for another 18 days or more, this is an indication that the corpus luteum is viable.

Breastfeeding Spotting

After the initial flow of birth has stopped, some women may have some bleeding about six weeks postpartum. This is due to the withdrawal of hormones that were high during pregnancy.

Also there may be a fluctuation of hormones while breastfeeding because of the needs of the baby. The temporary imbalance of hormones may cause women who breastfeed a few anovulatory spotting.

Other times

• After office procedures
• While on the pill
• Or during postmenopausal hormone replacement therapy

Our Gynecological Health – Part 1

First of all, we women have left all the charting of our gynecological health in the hands of our doctors. We can keep our own records, at home.

I will be posting a .pdf file of a chart you can use as a “master sheet” of your exams and an example chart to assist you in filling it out. Use it to keep track of your weight, blood pressure, general gynecological health (which would include the breast exam, pap test, vaginal culture, etc.).

Much of what we see in our doctor’s charts, may seem to be a problem, only because we women do not understand or are taught about normal feminine health. We can understand them better when we see what actually are the “true” gynecological conditions.

These “True” Gynecological conditions would be:

• Vaginal infections
• Abnormal bleeding
• Premenstrual syndrome
• Breast lumps
• Endometriosis
• PCOS
• Nabothian (cervical) cysts

“…charting enables a woman to understand her body in a practical way (Wescheler, 230)”. A woman who charts every day is so aware of what is normal for her own body, that she can actually assist her doctor determine what is not normal based upon her symptoms. Keeping the chart of her menstruation cycle assists her In well-being, and working with the doctor.

Normal Healthy Cervical Fluid VS. Real Vaginal Infections

We live in a culture that advertises douche and sprays for vaginal “discharge” giving women the idea that they are “dirty” all the time. Douching and sprays only act to confuse the identity of healthy cervical fluid and what would be a real infection.

Wescheler explains in her book, that doctors say you don’t need either. On a talk show she watched, she says that the doctor stated that the infections from these products were “…enough to send his children to college (Wescheler , 231)”. Then there is also the yeast infection products that women self-diagnose and take every month for a “recurring” problem.

But, using the chart, detection of an actual infection will be easier, and discovered earlier. You can get treatment before discomfort sets in. Secretions mid-month are normal, but late in the month may indicate infection.

Symptoms of Vaginal Infections That Can Be Distinguished from Normal Cervical Fluid
Once you have routinely charted your normal cervical fluid, an infection can be distinguished by the unpleasant symptoms that set them apart from what is normal. Vaginal infections can range from STIs (See: The Effects of Sexually Transmitted Infections on Pregnancy) to a variety of forms of Vaginitis and of course the generic “yeast infection”.

• Abnormal discharge
• Itching, stinging, swelling, and redness
• Unpleasant odor
• Blisters, warts, and chancre sores

Avoiding Infections

Besides the consequences of douching, you should not wear clothing that is damp or too tight, as these create an unhealthy vaginal environment. Also you should wear cotton underwear, or at least cotton crotch underwear as these allow your body to breathe.

For more information see: Part 2