Sexually Transmitted Infections – Part 2

Gonorrhea

Gonorrhea is exclusively transmitted sexually, genital-to-genital contact; but can also be transmitted oral-to-genital or anal-to-genital. In females the disease can spread from the genitals to the rectal area. It can be spread to the newborn in the form of ophthalmia neonatorum through vaginal birth.

AGE is the most important factor. Statistically, sexually active teens, young adults, and African Americans are at the highest risk. The majority of those who have contracted this disease are under the age of 20.

Girls who are prepubescent the two most common symptoms is vaginitis and vulvitis. There may be signs of infection, or vaginal discharge, dysuria and swollen, reddened labia.

The factor of concern, most adolescent females show no signs or symptoms. When they DO have symptoms they are less pronounced than those of men. In women there may be some cervical discharge, but usually it is minimal of lacking altogether. Irregularity of the menses may be the presenting symptom or complaints of pain within the pelvis.

In rectal gonorrhea, the symptoms may not be asymptomatic or the opposite with severe discharge, pain and blood in the stool. There may be rectal itching, fullness, pressure, and pain…as well as diarrhea.

Since Gonorrhea is a highly transmittable disease all recent partners (30-days prior) should be reported, cultured, and examined. Most treatment failures occur due to reinfection.

Screening and Diagnosis

All pregnant women should be screened at the first appointment. Those women with risky behaviors indicated, should be re-screened at 36 weeks. The screening is done through “cultures”.

Management

45% of those women who are found to have Gonorrhea also have Chlamydia. For both pregnant and non-pregnant women, the treatment should be cefixime in a single dose.

All women with co-existing syphilis infections should be treated as for syphilis. Penicillin is the preferred drug for treatment. The alternative (especially for those allergic to penicillin) is Doxycycline, Tetracycline, and erythromycin. Tetracycline and Doxycycline are contraindicated in pregnant.

Sexually Transmitted Infections – Part 1

Chlamydia Trachomatis

This is a highly transmittable disease. It is difficult to diagnose, and the symptoms are nonspecific. It is very expensive to culture.

It is important to identify this disease early. Without doing so and not getting treatment, it can lead to salpingitis or pelvic inflammatory disease.

It increases the risk of ectopic pregnancy and tubal factor infertility. If this disease has infected the cervix, it can cause a cervical inflammation leading to ulcerations…increasing the risk of HIV infection.
Women under the age of 20 are at highest risk for infection. They are 2 to 3 times more likely to have it.

Risk Factors:

Multiple partners
Not using barrier methods of birth control

Cervical cultures should be taken at the first prenatal visit. The use of silver nitrate on the newborn may not be sufficient to prevent the transmission of this disease from mother to infant. Early culture and treatment is a must.

Treatment

For cervical, urethral, and rectal infections: doxycycline or azithromycin.
If the woman is pregnant: erythromycin or amoxicillin.
If she has HIV, treatment would be the same as those without.

Prenatal Vitamins

PRENATAL VITAMINS

2013-03-combo[The image to the left is not an endorsement of the brand, but illustrative of a typical type of package prenatal vitamins may come in]

There is an ongoing argument about the use of vitamin supplementation whether you are pregnant or not. I would say weigh out the pros and cons of the argument.

From my nutrition studies, I learned that even when we eat very well, our bodies will often not absorb all the nutrients within the food. The cause of this can be the natural digestive make-up of the body or a particular health issue we may have. This would hold true, even if we were to eat the best of natural and organic foods.

Unfortunately, most of the American populous chose to eat lousy diets. We also do not exercise properly, nor drink enough plain old water. But, during pregnancy it is important to make sure you eat well, and that your diet is full of pure natural and organic foods.

Even with a great diet, supplementation may be a wise choice. Doctors will recommend a prenatal vitamin supplement, so be sure it contains the nutrients you need.

Look for a prenatal vitamin that includes :

• 400 micrograms (mcg) of folic acid.
• 400 IU of vitamin D.
• 200 to 300 milligrams (mg) of calcium.
• 70 mg of vitamin C.
• 3 mg of thiamine.
• 2 mg of riboflavin.
• 20 mg of niacin.
• 6 mcg of vitamin B12.
• 10 mg of vitamin E.
• 15 mg of zinc.
• 17 mg of iron.

“Keep in mind that it is possible to jeopardize your baby’s (or your own) health by taking inappropriate amounts of synthetic vitamins, so be sure your health care provider is aware of any supplements you are taking (American Pregnancy. Org).” Notice this quote discusses “synthetic vitamins”? I would recommend prenatal vitamins that are sourced from natural or organic nutrients, not a synthetic vitamin.

As with herbs containing multiple nutrients and constituents within its structure, a range of nutrients comprise the whole of the vitamin you glean from food. The same could be said of a natural or organic nutrient used in the production of a multi-vitamin.

Be sure your diet is balanced and contains the nutrients you need for good health. See my hand-outs on nutrition for the information about a healthy diet during pregnancy. “Getting your nutrients from food is generally the best route. Foods contain other compounds your body needs — such as fiber — that supplements don’t provide.

You shouldn’t use a supplement to correct a poor diet, but rather to supplement a good one (Pari-Keener)” I would liken this concept to building a house. If built on a good foundation (proper whole foods diet) an addition built onto the house, will stand a long time (supplemental vitamins/Prenatal vitamin intake = healthier baby).

Some women may experience nausea, irritated stomachs, and constipation from prenatal vitamin use. If the vitamins are taken properly, and you are eating a good diet, the effects will be greatly reduced.

Prenatal Vitamin Warnings

• Tell your doctor about unusual or allergic reactions you have had to any medications, especially to any vitamin, mineral, or iron products.
• Be sure to tell your doctor if you have ever had bone disease, liver disease, kidney disease, or stomach ulcers.
• Because prenatal vitamins may mask the symptoms of pernicious anemia, they should be used only under a doctor’s supervision.
from How Stuff Works

REFERENCES:

Consumers Guide, Eds. Prenatal Vitamins. How Stuff Works. http://health.howstuffworks.com
/wellness/food-nutrition/vitamin-supplements/define-prenatal-vitamins.htm

Maria Pari-Keener, MS, RD. (n.d.) Prenatal Vitamins Best from Food or Supplements. http://www.parents.com/pregnancy/my-body/prenatal-vitamins/

Pregnancy and Prenatal Vitamins. WebMD. http://www.webmd.com/baby/guide/prenatal-vitamins (2012). Reviewed by Trina Pagano, MD. 5-29-14

Prenatal Vitamins. American Pregnancy Association. http://americanpregnancy.org/pregnancyhealth/prenatalvitamins.html

Water Birth – Part 2

THE USE OF WATER FOR LABOR

Water Birth Tub-from"Birth Pool in a Box"

Water Birth Tub-from”Birth Pool in a Box”

Some suggestions for labor:

• The temperature should be body temperature
or slightly lower.
• Be equipped with an efficient pump, heater, and
a thermostat.
• A thermometer and large plastic strainer to
clear the water.
• At least 2 feet deep, to cover the abdomen when
she is doing squats or is kneeling. In order to
encourage the “freestyle movement” it should
be a pool that is at least 5 ½ feet wide.
• Optimum time: during active labor (5-8
centimeters in dilation).
• When having back labor, get into the water. The water relaxes and acts as a counter-pressure.
• If you have previously had an active labor and then stalls once in the water, get out of the pool
and move: squat, kneel. Walk, sway hips.
• Or if the labor is stalled, get into the pool, sometimes it’s just the relaxation you need to get
things started again.

It is safe to use the pool once your membranes have ruptured. Birthing centers with experience using the pool have not had any increase in infections reported.

Don’t expect all pain sensation to cease. It will decrease the pain, but does not make it completely go away. Often it’s how you move in the water, not just the pool of water.

An advantage of using the water pool for labor in the hospital is that you can really feel a sense of privacy, allowing space to sink into your own intuitive self for labor. Anxiety and blood pressure both are lowered when in the water. The stressors of hospital atmosphere is diminished, lowering the catecholamine (stress hormones) and “the secretion of endorphins” which are the relaxants that you body naturally produces, and the hormones that produce pain relief.

WATER FOR BIRTHING

Water birth is perfectly safe.

Sears & Sears state “The school of water-birthing that practices slow emergence (baby is left under the water, SIC) can be dangerous (156).” They use the example of water mammals that birth in the water, and how these mammals assist the newly born immediately to the surface.

An additional need when doing a water birth, is some salt. Adding salt allows for the pool water to have the same salinity as the amniotic fluid of the womb. The amount necessary is a generous tablespoon of salt. Before filling the pool be sure it is cleaned with mild disinfectant, and rinsed, “unless disposable liners are provided to contain the water (Balaskas, 208)”.

If your membranes break while in the water, there is no need to change the water. The amniotic fluids and “bloody show” are both sterile.

During birth in the water, the relaxation of the sphincter muscles may cause some fecal matter to be excreted. This is when that suggested plastic strainer comes in handy. There is no “evidence to show that it contaminates the water sufficiently to contribute any risk of infection (Balaskas, 212)”
You can kneel on all fours, squat, or be in a semi-sitting position to birth. Your partner can be in the pool with you or sitting just outside the pool.

Once the baby is born, the attendant (doctor or midwife) check to be sure the cord is not around the baby’s neck, and unravel the cord if it is. The baby may float to the surface on its own, or you may gently guide the baby to the surface.

Breathing will not occur until the baby emerges to the air, the coolness of the air causing the reaction to breathe. Occasionally the baby may need suctioning to clear the air passages. The cord has not been cut yet, so there are dual sources of oxygen. “In the rare circumstance that the baby doesn’t breathe, it is wise to take baby gently out of the pool into a cooler atmosphere. This will trigger the breathing reflex (Balaskas, 214)”. If necessary oxygen can be administered.

The baby can be held in the water, at breast level. It is best to sit or kneel in a vertical position. The rooting reflex will be strong, so turn the baby to face you, yours and baby’s bellies facing, to make breastfeeding easier.

You can stay safely in the water until the placenta is expelled, which generally takes place 10 -20 minutes later. Pay attention to the cord, if the pulse decreases it means the placenta is about to be expelled. The baby can be handed to the partner, and you can stand up slowly and leave the pool. If the expulsion occurs sooner and you feel the placenta released from the body, you can still stand up slowly once you have realized it, the cord can be cut before leaving the pool.

The persons you have present to assist the birth can cover you and baby as you leave the pool. It would be important at this time to have the temperature raised in the room. If you had not expelled the placenta before leaving the pool, you can stand or squat at this juncture to deliver the placenta. Then sit upright and enjoy your baby with comfortable warm coverings.

At this point, the midwife or doctor will check both you and the baby. After their examination, you can go to your bed and “…relax with your baby tucked warmly beside you (Balaskas, 215),…”.

 

REFERENCES

Balaskas,Janet. Active Birth: the new approach to giving birth naturally, Rev. (1992) The Harvard Common Press
Sears, William and Martha Sears. The Birth Book: everything you need to know to have a safe and satisfying birth. (1994) Little, Brown and Company.

Your Birth Stories

Share your birth story! I am asking for volunteer submissions of your birth story that you wish to share on my blog.

baby-loading-tshirt

My 3rd Birth:

I was going to county hospital for checkups. I was a week over-due and they put the monitor on me. It was way too tight when I had contractions [Braxton Hicks]…so I pulled it off.

The nurse came to check it and decided there was something wrong with the baby. “The heart beat dropped during contractions”, she said. I explained what had happened, she would not hear me. They began to talk C-Section.

I said “I have my daughter with me, and would need to go home and get her to a sitter. I need arrange for the older two children’s care, and find my husband…” (no cell phone).

I went home and called my mother. I told her I was NOT going back to that hospital. They were C-Section crazy! We discussed that it was too late for a midwife (obviously) and she suggested I go into the emergency room of another hospital.

Downtown San Jose had a hospital, so I took the bus there. The doctor on call said, after I explained what happened, that he wanted to put a monitor on to be sure. I could understand his reasoning, so the monitor was placed on my abdomen. We had to wait awhile for a contraction and after four hours, he says “Baby looks fine. I will call the other hospital and explain that you will be here”…[taking off the monitor] he says “You can get up an walk around”.

At that point, I had been having regular contractions 20 minutes apart. My mom arrived just before that, so we walked the halls of the hospital.

My water broke, and the monitor was put back on. I was dilated 6 centimeters. Contractions were getting stronger, too. 2 contractions 9 minutes apart…I could feel the baby crowning.

The nurse was called in. I told her the baby was coming NOW.

“Oh no, sweetie, you couldn’t be having the baby now. Your contractions are too far apart!”

“The head is coming OUT!! I know what that feels like, I have had two babies previously…LOOK!!”

She looks under the sheet. Hits the buzzer, slaps the rails up, while saying “Oh shit, the baby IS coming!”

Not longer after, my youngest was born. No stitches, a couple tears, no complications. So much for needing a C-Section.

I am making a page that will feature birth stories. Look for it!

ProfessionalLaborSupport-Pt3

doula at workMONITRICE /MIDWIFE’S ASSISTANT

The Monitrice can assist in providing a continuity of care, from pre-pregnancy through post-partum. They are trained in all the basic skills that a midwife is trained, but without the certifications to actually “catch” the baby.

At the point of a woman going into labor, the Monitrice/Midwife’s Assistant attends the birth in the manner of a Doula. See the blog post: ProfessionalLaborSupport-Pt1 regarding how a Doula assists in childbirth.

A Monitrice/Midwife’s Assistant:

-Assists women with the pre-pregnancy and fertility issues they may have, along with natural birth control methods.

-Has knowledge of local resources

-Monitors the pregnancy with training in taking the blood pressure, FHT, and urine collection
They enter the labor room in a Doula capacity.

-Assist with neonatal care

-Supports breastfeeding of the baby

-May assist in post-partum care

-Knows alternative complimentary methods for pregnancy and childbirth

 

ProfessionalLaborSupport-Part2

mom and babyChildbirth Educator

The childbirth educator teaches and assists women in understanding the nature of childbirth, from pre-conception through the first year of baby’s life.  The information they give assists women in having a better and safer birth experience.

The professional Childbirth Educator trained at Birth Arts International adheres to the “Midwifery Model” of care, as outlined by MANA. This is where I am training (and near completion of).

Here are some things that may be covered:

  • Nutrition – preparation to conceive, during pregnancy, and post-partum
  • Pre-natal tests: What is required and why
  • Exercise: for optimal health, and to tone muscles in preparation for birth, as well as post-partum exercises
  • Stages of labor
  • Interventions
  • C-sections and VBAC
  • Neonatal care (newborn baby care)
  • Breastfeeding

Even second-time mommies can benefit from classes.  It helps you to have a better / safer birth to review information.

Childbirth Educators can assist in labor, in a much similar way that a Doula would.  They can answer your questions and assist after the baby is born.

 Part 3: Midwifery

ProfessionalLaborSupport-Pt 1

PROFESSIONAL LABOR SUPPORT

On the average during an 8 hour shift a nurse will spend about 15 minutes offering physical comfort measures, provide emotional support, or advocate for her patients. Nursing staff are criticized during their reviews for spending too much time with patients if they DO take more time with laboring mothers.

Odds are better with a midwife. But often hospital based midwives have time constraints. You are going to do best with the support of a professional such as a Monitrice or Doula.

doula at work DOULAS

There are two different types of Doulas. A Labor Doula, who will be with you through the pregnancy, meeting with you several times, supporting you while you are in labor (if you so choose), and the first few hours after the baby is born.

There is a Post-Partum Doula, that will work with you and baby for a period of time after the baby is born.

Doulas do not “catch” babies. They will support you in labor and through delivery if you choose to have a Doula.

TheBirthDoula

It has been documented that with the support of a BIRTH (Labor) Doula:

• Lessens problems with babies born in poor condition, babies are less often admitted into special-care nurseries, the hospital stay is shorter in duration, nor are they likely to have infections.
• Women are shown to have less pain and anxiety during labor, cope better with labor, less likely to have lowered numbers of episiotomies, the use of IV Pitocin is lowered, the use of instruments during delivery is lowered and best of all: C-section rates are lower. The length of the labor is shorter.
• Breastfeeding past the 6 week mark is higher when a Doula is utilized for support.
• Also women who have had Doula support have more positive feelings towards the new baby, a better relationship with the father, and lowered postpartum depression.

A BIRTH DOULA:

• Can accompany you when you go to the doctor the first time.
• Visit with you a few times during pregnancy to:
o Assess your nutritional needs and help you stay healthy through your pregnancy.
o Assist you with good posture and exercises that will keep you strong and help in having an easier delivery.
o Before the time of labor and delivery, discuss your options and help you write up a Birth Plan.
• During labor: assist with pain measures, advocate in your behalf with hospital staff (when necessary), help coach your labor partner during labor, etc.
• Afterwards, will assist you in breastfeeding and baby care (first couple hours after delivery).
• Make a visit Post-Partum to see how you are doing, and assist where necessary.
• Do not “catch” the baby.


POST PARTUM DOULA
:

Generally, they offer some or all of the following:

• Breastfeeding Support
• Mother Care Support
• Cooking meals
• Shopping
• Cleaning
• Caring for infant while mother bathes, eats, etc..
Some also offer:
• Other childcare (not directly caring for newborn)
• Laundry

NEXT WEEK: The Childbirth Educator

Issues Part 3

What are the issues that affect Lakota Native women during pregnancy and childbirth in regards to: Racism, Sexism, and Oppression – Part 3

After years of encroachment upon traditional healing practices, the stage was set for an Eugenics movement. This movement “… in the 20th century began as a means of controlling the perceived increase in ‘degenerate’ population and maintaining or protecting hereditarily ‘fit’ members in society from being overrun by the genetically ‘unfit.’ (Forbes, 2)” or groups that were marginalized, such as Native Americans.

Initially, the population targeted was those with low intelligence and those with physical disabilities. But, soon it expanded to “ a program to implement ‘racial hygiene’ in the United States, eugenics essentially entailed taking the principle of natural selection and enforcing it by employing allegedly ‘scientific’ means (Forbes, 2)” The concern was that the white populace were being degraded by the influx of people with racial differences. The classifications included socio-economic, class, status and race.

…policies founded on eugenic theories (sic) started to emerge, forcing procedural sterilizations and other means of population control upon people believed to be unfit (Forbes, 2-3)”. In the late 60s and through the 70s the target was Native American people. Indian Health Services began a systematic sterilization policy.

Women would go to the I.H.S. hospital, told they needed a cesarean section (for a variety of reasons), anesthetized; and when they awoke, these women found they had been given a hysterectomy, which is what happened to my friend. She stated that she was not informed of the need for a hysterectomy. She had gone to deliver her baby, the doctors examined her and stated that she needed an emergency cesarean section. She awoke, finding that she had her uterus removed. My friend’s experience was not uncommon, “…in 1975 alone, some 25,000 Native American women were permanently sterilized – many after being coerced, misinformed, or threatened .

In 1990, a former nurse at I.H.S. reported that tubal ligations were used on women who did not want the surgical procedure. Birth control also was forced upon unsuspecting females such as Depo-Provera, without informed consent, and prior to the FDA having given its approval (this would include the mentally retarded ).

Health risks of the drug Depo-Provera are high in native populations due to Diabetes, obesity, and cigarette smoking. Many who were forced to have it or Norplant administered were not informed of the risk. A secondary aspect is the cultural issues. Irregular bleeding that is caused by these drugs can prevented participation in traditional spiritual practices.

In my own research of the issues of native women in the child-bearing years I was shocked by the high numbers of cesarean sections done on this sector of women. The rate of C-Sections nation-wide is 32.8%; whereas South Dakota is around 25.3%. But, I.H.S. rates are higher than the state average, last internet search showed it at 34%.

Why is this of concern? The health risks of women in the child-bearing years due to unnecessary surgery being conducted. Childbirth is treated by the modern medical doctors as though the baby a ‘disease’ that needs to be cut-out, rather than a natural biological reproductive process. Had the traditional practices of midwifery had been continued within the native culture, allowed to flourish, there would have been very few cesarean sections necessary in our modern times.

Other Factors Regarding Childbirth in Indian Country

Next below the black woman, the native woman is recorded as 2nd to the highest in infant mortality rates . This is due to living in rural areas with poor access to proper care during pregnancy. “Poverty is an important risk factor for poor health outcomes ”.

Compounding the issues mentioned above are those of teen and pre-teen births. A female who is younger than 18 or 19 years of age are not fully developed, in other words are still growing themselves. Teenagers tend to eat poorly, are more prone to drink alcohol, smoke, and take drugs during pregnancy.

Next: What are the issues that affect Lakota Native women during pregnancy and childbirth in regards to: Racism, Sexism, and Oppression – Part 4

Culture Part II

Cultural Perspectives on Childbirth

Achomawi mother and childMulti-cultural Beliefs (Continued)

Last week I ended with discussion about the Lakota belief in a spiritual being who assists the souls of the unborn in their journey to human existence. It is thought she “marks” them before entry into this world.  This “mark” is what the medical field calls a “Mongolian” mark.

Because of the spiritual forces in play, many indigenous cultures had and still practice rituals at the birth of a child. This is due to the understanding that childbearing and childbirth are a sacred act.

This may not necessarily be understood by present-day women within the culture, but in their soul and spirit the women do recognize that modern medicine’s “managed care” works against the traditions and ageless wisdom of their tribe. This is true whether they have a traditional spiritually based upbringing in their lives or they have adopted non-traditional religious practice. Their sense of “knowing” from their soul, speaks out against what is not natural and spiritual in the birthing process.

Western culture encourages reading and the attendance of Childbirth Education classes, along with other strategies for birthing. In traditional cultures women “…prepare more symbolically. They avoid all actions and thoughts that have anything to do with ‘getting stuck’ or ‘closing up’ and ‘letting go’…  In traditional societies, women often go to midwives to confirm the pregnancy and then again only if there are special problems… (145)” prior to childbirth.

Another aspect is that most women within many traditional cultures would have been directly involved in the childbearing and child birthing aspects from a young age. Her mother or aunts and grandmother would have taught her about the processes of childbearing and childbirth during childhood and/or adolescent years. The concepts would have “…been integrated into her maturity into adulthood (Ibid.)”. It would have come from her experiential life and stories told to her instead of a class or books.

Unfortunately, much of this kind of experiential life and tradition has been lost or no longer practiced today by local tribal women. Some of the other women will talk about this or that grandma who was a midwife, and who may have been allowed at IHS for a birth. When I have asked women, they mostly talk about a more negative experience for their childbirth if they speak up at all.

Traditionally, the birth of a baby was in the home, not a hospital. Some cultures used “a special hut [that] is constructed for that purpose ;…(Ibid)”. But today in the local area, birthing mostly takes place in a hospital setting, here on the reservation. Locally, there is the IHS. There also is Winner Regional, in Winner South Dakota (45 minutes from Mission, SD) or Cherry County Hospital in Valentine, NE.

Due to past experiences with IHS (the “Eugenics Project” of the 60s and 70s, for one), many women may opt to not have their babies unless there is an emergency. Both Winner and Valentine have doctors that have demonstrated certain biases against native women. Without midwives to deliver locally, this is what women on the Rosebud (Sicangu Oyate) Reservation face today (with the exception of one community).

Each of these three hospitals has their own regulations as to who may attend the birth. They also decide on whether a woman can have assisted births (Nurse-midwives/doulas/etc.).  My attempts to discover these policies, and the reasons for them, have been futile.

– Next week will be “Part 1 – The issues that affect Lakota Native women during pregnancy and childbirth in regards to: Racism, Sexism, and Oppression”