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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Orange

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Citris Aurantium: Fresh Fruit

Both the unripe and ripe fruits are used in Chinese Medicine. The unripe bitter fruit is more potent. The unripe bitter fruit (zhi shi) is used for constipation or to move stagnant chi energy. It can be used to make an expectorant for coughs. This bitter fruit is NOT recommended for use in pregnancy.

The ripe fruit has multiple properties for the pregnant woman. It is high in vitamin C and when eaten with the pulp, it contains Rutin.

A Small Orange contains the following nutrients:

Amount Per  1 small (2-3/8″ dia) (96 g) 100 grams 1 fruit (2-5/8″ dia)
Calories 45
% Daily Value*
Total Fat 0.1 g 0%
Saturated fat 0 g 0%
Polyunsaturated fat 0 g
Monounsaturated fat 0 g
Cholesterol 0 mg 0%
Sodium 0 mg 0%
Potassium 174 mg 4%
Total Carbohydrate 11 g 3%
Dietary fiber 2.3 g 9%
Sugar 9 g
Protein 0.9 g 1%

 

Vitamin A 4% Vitamin C 85%
Calcium 3% Iron 0%
Vitamin D 0% Vitamin B-6 5%
Vitamin B-12 0% Magnesium 2%

 

*Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs.

 

Sweet Orange Essence Oil

The essence oil of the sweet orange blossom can be used in a diffuser for lack of energy and / or depression. Sweet Orange is an excellent choice for women who are having difficulty in labor and who are lacking energy. Do not use the essence oil in the bath during pregnancy, and use with extreme caution with infants present. Be sure to dilute with a carrier oil, such as Sunflower or Almond.

Neroli Essence Oil
Citris bigaradia

Neroli is derived from the bitter orange blossom.  It should not be used during pregnancy, but can be used during labor and right after delivery. Neroli helps with stress, fright, exhaustion, and shock. It is also great for anxiety. An excellent choice when there are complications in labor causing the mother to be exhausted, and anxious. If there has been a traumatic birth it will assist with the shock after the birth. Use only with the advice of a trained professional who knows about aromatherapeutic treatments. Do not use in a bath and limit its use around infants.

Miscarriage – Part 1

MISCARRIAGE

A miscarriage is when a pregnancy spontaneously ends. It usually occurs before the 28th week of gestation. Miscarriages occur in approximately 20% of all pregnancies in the United States.

Many women have a miscarriage early in a pregnancy, without even realizing it. The miscarriage just seems to be a “heavy” period. Teenage girls and middle age women are the most common age groups. Miscarriages are more common early on than after the first trimester.

Those women who tend to miscarry repeatedly, or those women who really desire a baby, the loss of a baby can be devastating. Because so many people do not discuss the loss of a baby through miscarriage women do not know what to expect or what to do.

Although painful to think about, and it sounds rather blunt, a miscarriage is nature’s way of preventing an unhealthy baby from being carried to term. It may seem hard to accept, but we should realize that our bodies have a wisdom of their own and prevention of a miscarriage will not be effective with an unhealthy baby.

Other causes for miscarriages include:

• Hormonal imbalances
• Cervical looseness ( called “incompetent cervix”, a medical term)
• Infections
• Nutritional deficiencies
PREVENTING A THREATENED MISCARRIAGE

The signs of a threatened miscarriage include spotting, bleeding, or cramping which may also include a backache. These symptoms may begin suddenly or develop slowly. They can last just a few hours, or may last for days. The spotting or bleeding may be all that occurs. Or the symptoms may be more severe and cause fear that the baby will be lost. A physical exam is not wise at this point as it may stimulate the uterus further. Chances are a woman will still have the symptoms of pregnancy (breast soreness or tenderness and nausea) after spotting or bleeding. Although not always a good idea, the use of the Doppler may help reassure that the pregnancy is still viable.

GENERAL RECOMMENDATIONS

• If You are having contractions or are bleeding / spotting, do get off your feet and rest. Get up only when you need to go to the bathroom.
• Avoid lifting heavy objects and abstain from sexual activity until all signs of a miscarriage have been gone for at least a week
• Warm (not hot) baths will release tension and anxiety, and bring relief to lower back pain.
• Take time, while resting off your feet, to connect with the baby and tell the baby you want him/ or her. Send your baby your love. This may or may not be helpful, but you will feel comforted and assured you are doing all that you can for the pregnancy. Let the baby know you want the baby but also reassure the baby that if he or she must go, you understand and give permission.
• If you are unsure about the pregnancy to begin with, this is a good time to come to terms with having or letting go of the baby.

DIETARY RECOMMENDATIONS

• To prevent a miscarriage, avoid all cold-natured and cold temperature foods. Cold has a downward moving, heavy force…causing an excess of downward flow in the pelvic area.
• It is better then, to eat warmer foods that are nourishing, such as soups. Also emphasis should be on whole grain stews, hot cereals, root vegetables, and dark greens until all symptoms have been gone at least for a week. For beverages: warm tea (preferably the pregnancy teas) and room temperature water should be consumed.
• Vitamin E is thought to assist placental attachment to the uterus…reducing the likelihood of spotting or a miscarriage. Take up to 800 IU of vitamin E for about three weeks. If you have a heart disease, do not exceed 50 IU per day without discussing the supplementation with your doctor.

Protein Foods

Protein Foods

(with the protein foods containing the most essential amino acids first).

Proteins
Eggs (preferably organic, or at least “free-range”)
Milk
Fish (preferably:
Poultry (preferably: baked, broiled or stewed)
Tofu & other beans
Oats (preferably not quick cooking)
Nuts (especially almonds)
wheat
cornmeal

Protein Food Combinations

(to assure best usage of the most Amino Acids found in the food /Proteins )

Beans + Wheat
Beans + Rice
Corn bread + Beans
Corn tortillas + Beans
Lentil Curry + Rice
Pea Soup + Wheat (bread)
Pasta + milk and/or Cheese
Cheese + Wheat (cheese sandwiches)
Macaroni + Cheese
Garbanzo dip (hummus)
Sunflower seeds, peanuts, roasted soybeans (snack foods)

_______
“Diet for a Small Planet”. Fig.14, page 176
Ibid. page 181 (Chart)

Body Mechanics – 2

BODY MECHANICS

As your pregnancy advances, your body ligaments and joints will naturally loosen to allow for an easier birth, by allowing the pelvis to develop flexibility. The following suggestions will assist you in avoiding strain while doing the normal daily activities.

Stand Smart

To reduce ankle swelling and assist your circulation, avoid standing for long periods of time. In order to avoid circulation issues, periodically flex your calves and /or rotate the foot in circular motions. You should also alternate resting one foot then the other, on a stool.

Lift lightly

stooping lifting carryingYou already are carrying around and lifting more weight. Don’t lift heavy objects. For light lifting, use your arm, leg, and thigh muscles not your back. Don’t bend to get close to an object, squat. Keep that head of yours up and with your back straight. Lift by pushing up with your legs and flexing your arms. Avoid the urge to lift up a toddler, use the squat to get down to the child’s eye-level or sit on the floor to cuddle.

Sit Sensibly

sittingAvoid sitting for more than a half an hour at a time. Use straight-back chairs with a small pillow at the small of the back. Use a footstool, shift positions often, and avoid crossing your legs. Periodically exercise your calf muscles and do foot flexions and / or rotations.

When arising from the chair, avoid lunging forward. Slide your body to the edge of the chair, plant your feet on the floor, and use the leg muscles to lift yourself up. If someone is willingly offering assistance to get up, use it.

Sleep

During the final four to five months, side-lying is the best position. This is the best for baby and the most comfortable for you.

In the last trimester you should have at least four pillows. Two pillows should be under the head and at least one for the top leg to rest upon, and maybe one to support your lower back. Shift slightly forward towards the belly, to get the full weight off the lower leg.

Rise in the Proper Manner

Don’t sit up suddenly when the alarm goes off because it will strain your lower back and abdominal muscles. Don’t immediately swing your legs off the bed, as it would strain your lower back ligaments. Instead, roll onto your side and push yourself up by using your arms, into a sitting position then swing your legs gently over the side.

Body Mechanics- I

START WITH GOOD POSTURE

As the baby grows in the womb, your center of gravity will shift. The additional weight in the front could create a swayback posture, causing discomfort on the lower back. The following suggestions to assess and alter your body mechanics will assist in having less discomfort.

STANDING POSTURE

Head

Keep your head up. Looking down all the time will throw off your balance. Of course, you will want to look at the new bulge as it grows but doing so all the time will make your posture off balance.
Keep your chin level. When your head is held correctly, the shoulders will follow as well as the back.

Drop your Shoulders

Allow the shoulders to rest in a natural position. To do this relax the shoulders. If you tend to wear your shoulders up around your ears or slouched forward, your whole body will be off balance.
Try to avoid “throwing back” your shoulder blades. This will cause back problems. You may need to have someone massage the shoulders to allow them to relax into the correct position.

Avoid Tensing / Swaying the Lower Back

As your baby grows the weight will cause your back muscles to contract as a counter-balance of the shift in weight to the front. The tension of the muscles contracting may cause a backache.
A slight curvature of the back is normal. Avoid an exaggerated curve as it will cause a “swayback”. If there was chronic pain of the back before you were pregnant, it will only get worse from pregnancy. You may need to get Chiropractic attention if you already tended toward a “swayback” before pregnancy or if you had back issues prior.

Tilt your Pelvis Forward

Pull your abdominal muscles in, tuck in your buttock muscles, and tilt the pelvis forward. Doing this will counteract tendency of the lower back to arch abnormally.

Relax the Knees

Bend your knees slightly. Avoid locking them.

Exercise for Pregnancy Health

Throughout the pregnancy year (pre-natal through post-partum) the woman’s body is in physiologic adaptation. Pregnancy is not an excuse to become sedentary, rather a time to “amp up” the exercise program. Exercise increases cardiac output, increases oxygen consumption, and changes the blood-flow distribution.

Doing a good exercise routine will not only assist the body in adapting to pregnancy, but assist in labor preparation. Your body’s muscular / skeletal structure changes in pregnancy. To have the ability, strength, and fortitude for birth a woman should do stretches, walking, squats, and other routines of exercise.

Doing these will also prevent many of the problems of pregnancy. Some of these would include:

• Calf cramping
• Tight back muscles with back fatigue and pain.
• Swelling of the ankles
• Pressure on the bladder
• Finger tingling or numbness
• Discomfort of the upper back due to breast size changes
• Spasms in the groin
• Itching due to stretched skin
• Tightening of the hip flexors (muscle group)
• Pressure and hyper-extended knees
• Sway or hollow back

There are some women who should not be doing exercise, especially rigorous exercise, during pregnancy. Also, each pregnancy should be assessed individually. Consult with your healthcare provider before you start an exercise program. If you had regularly exercised prior to pregnancy it would still be wise to talk to your healthcare provider.

For the childbirth education course, exercises that are included may differ greatly than a full-on prenatal exercise program (unless the instructor is certified in the latter. In a childbirth education coursework, the exercises emphasized are those that would prepare for delivery, reduction of third-quarter pregnancy discomforts, and enhanced post-partum recovery. These are not intended as the sole exercise done by a pregnant woman but as an addition to the physical activity already being done by the pregnant woman.

The first portion would address posture. Good posture is important not only for standing, but also sitting (whether in a car, or at the computer). After posture would be the Pelvic-rock, Squatting, and abdominal Strengthening; along with several stretching exercises for the legs, buttocks and arms.

Recommended recreational exercises would include:

Walking (varying the pace each time), running, cycling, and dancing (especially belly dancing).

Effects of Tetracycline and Aspirin in Pregnancy

Tetracycline

Tetracycline is a wide-spectrum antibiotic. During pregnancy it crosses into the placenta, and goes directly to the unborn child’s teeth. It may continue in affecting the teeth of the fetus causing yellow mottling and staining.

While the mother is taking the antibiotic, it can slow or stop the growth of bone in the unborn fetus. It should not be taken during pregnancy.

aspirin

Aspirin

In general, aspirin or Ibuprofen are not recommended during pregnancy. Aspirin can interfere with the blood’s clotting action. Aspirin can also cause the premature closure of the vessel in the baby’s heart leading to high pressure (pulmonary hypertension).

If you have a headache, a few low-doses will not be detrimental. You should always ask your doctor first. If your headache persists, see your doctor.

If taking Aspirin in the days leading up to birthing Aspirin can cause some problems. It can produce difficulty in blood clotting in both the pregnant woman and the baby. It also can cause neonatal jaundice.

REFERENCES:

Kitzinger, Sheila. The Complete Book of Pregnancy and Childbirth. (1996) Alfred A. Knopf.

Lowdermilk, Deitra Leonard and Shannon E. Perry. Maternity and Women’s Health Care. 9th Ed. (2007) Mosby/elsevier

Methamphetamine – Use in Pregnancy

Methamphetamine

It is described as the number one drug problem in America. It is relatively cheap, highly addictive, effects the population across the socioeconomic spectrum. It makes its users hypersexual and uninhibited.

When smoked, it produces a potent and very long-lasting high. Those who use the crystalline form, are awake and do not eat for 24 hours then will “crash” for the next 24 hours. Its active ingredient is pseudonephrine. It is easy to make or “cook”.

Clinical Manifestations

It creates an euphoric state, abrupt awakening, increase in energy, the person on Meth is talkative, may be elated, or be agitated. Meth causes irritability, hyperactivity, a sense of grandiosity. The effects also cause weight loss, ectopic heartbeat, urinary retention, constipation, and dry mouth.

Meth can cause paranoid delusions, violent behavior, seizures, cardiac shock, and death from over-dosage. Most of the effects are similar to that of Cocaine.

Neonatal Complications

Complications are less than what is found with cocaine users. But, a meth user may still have preterm birth, intrauterine growth restrictions with smaller head circumference.


REFERENCES:

Kitzinger, Sheila. The Complete Book of Pregnancy and Childbirth. (1996) Alfred A. Knopf.

Lowdermilk, Deitra Leonard and Shannon E. Perry. Maternity and Women’s Health Care. 9th Ed. (2007) Mosby/elsevier

Sexually Transmitted Infections – Part 3

Syphilis

Transmission “is thought to be by entry in the subcutaneous tissue through microscopic abrasions that can occur during sexual intercourse (Lowdermilk & Perry, 182)”. It also can be transmitted through kissing, biting, and oral-genital sex.

The rate of transmission declined from 1995-2004. Syphilis continues to be at a high rate in the southern states.

Primary syphilis appears 5-90 days after as a lesion or chancre, usually painless. Then it erodes into an ulcer appearing sore.

Secondary syphilis occurs 6 weeks to 6 months after transmission. Its appearance is a widespread, symmetric rash on the palms and soles of the feet; with affected lymph nodes. Some individuals also have a fever, headache, and generalized malaise (under-the-weather sensation).

In the vulva, perineum, or anal area Condylomata lata may develop. If left untreated the female may enter a latent phase. If still left untreated, tertiary syphilis will develop, in approximently 1/3 of these women. In this third stage, neurologic, cardiovascular, musculoskeletal, or multi-organ system complications can develop.

Screening and Diagnosis

All women who are diagnosed with another STI or with HIV should have a screen form syphilis. All pregnant women should be screened at the first prenatal visit.

Diagnosis is dependent upon the microscopic exam of primary and/or secondary lesion tissues during the latent or late infection. Serologic tests of antibodies may not be reactive, in early tests.

There may be false-positives with VDRL or RPR screenings. This is not unusual for several reasons, such as: drug addiction or acute infection. To confirm the positive results the use of treponemal tests, fluorescent treponemal antibody absorbed (FTA-ABS) and microheagglutination assays of antibody to T. palidum (MHA-TP) are used to confirm positive results.

Testing should be repeated at 1 to 2 months when genital lesions exist. This is due to early exposure not showing results until 6 to 8 weeks after exposure.

Other STI tests should be done at this juncture, for chlamydia, gonorrhea, et al. HIV should be also offered as a test if indicated.

Management

Penicillin is the preferred drug for treatment. Doxycycline, tetracycline, and erythromycin are alternative treatments. Tetracycline and Doxycycline are contraindicated in pregnancy.

Some pregnant women may get what is known as “Jarisch Herxheimer ” reaction, that may be accompanied with headaches, myalgias, and arthalgias . If the treatment occurs at the second half of pregnancy, it may cause early labor and birth. Their doctor should be contacted if fetal movement stops or if contractions occur.

Women should abstain from sexual activity during treatment and all evidence of primary or secondary syphilis is gone. She should also tell all partners that have been exposed, and that this disease is to be reported.