Why Breastfeed?

 

ID-100172969

 

 

 

 

 

WHY BREASTFEED?

Cow milk is for calves, human breast milk is for babies. It has the best nutrients for baby. Breastfeeding has benefits for both baby and the mother.

Benefits For Baby

Breast milk is a safeguard against allergies (those babies who get allergies would be worse). Human milk protects against infections, inhibits the growth of virus’ and bacteria in baby.
It is helpful in the development of baby’s jaw and facial structure. It encourages normal weight gain, which assures a less-likelihood of obesity later in life. The developing brain and nervous system of the baby also is benefited.

Benefits For You

Breast feeding without supplementation delays menstruation for six months or more. During this time the chances of getting pregnant is practically nil.

Studies have shown that women who breastfeed their babies, for even a few months, are less likely to develop breast cancer, than if a woman does not breastfeed. It also protects against ovarian cancer, urinary tract infections, and osteoporosis.

The hormones released when you begin to breastfeed assists in the reduction of the size of the uterus after giving birth (Oxytocin) and assists in the bonding process of mother and baby. As does the close contact made between mother and baby.

Oxytocin is also a powerful antidepressant. The act of breastfeeding and its subsequent release of Oxytocin is shown to assist in the reduction of post-partum depression.


FREQUENCY AND DURATION OF FEEDING

Allowing the baby to nurse as often as baby needs to nurse, is the best way. In the beginning this may mean about every two hours, from the beginning of one feeding to the beginning of the next. This assures your supply of milk will come in, and that you meet the baby’s needs.

When a feeding pattern is established, all seems right in the world! But if you suddenly are dealing with a more frequent urgency of the baby to feed, this is not an indication baby is “dissatisfied” or your milk is not sufficient to meet the baby’s needs. It means that baby is working to increase the supply, to meet his/ or her demands. It is normal. You do not need to supplement, nor do you need to begin to feed baby foods.

The length of the feeding depends on the baby’s interest and response. At first baby will seem to be starving and suck eagerly, then after about 10 minutes doze off or lose interest. It is at this point you should burp the baby and change the diaper if necessary. Afterwards, you can switch to the other breast.

WORKING AWAY FROM HOME

To succeed at breastfeeding and working, it’s good to find people will support your goal of breast-feeding when you return to work whose words emphasize being successful at working and breast-feeding, not failing.

A Childbirth Educator can assist you (I personally have experience with working and breastfeeding successfully with two of my babies). You can also call the La Leche League, or visit the online site.

medela manual breast pumpDon’t wait until a week or two before you’re going back to work. Do your information gathering and learn all you can ahead of time.

For success, you will need a good breast pump (The picture above is one of the recommended types and brands). You will need to use your break time and express your milk. If you take with you to work a decent and yet small cooler or even an insulated lunch bag you should be able to keep the milk for later use.

 

SAVING YOUR MILK FOR LATER USE

Breastmilk has the remarkable ability to slow bacterial growth. It will stay fresh safely at room temperature (66 to 72 degrees) for up to ten hours.

It can also be kept in the refrigerator for up to eight days. If you need longer storage, it can be frozen for up to two weeks. Use a separate container (that has been cleaned) for each expression. These can later be combined, once cooled.

Use bottles that are designed for nursing babies. Otherwise the baby may develop what is known as “nipple confusion” and not suck sufficiently at the breast. Brands (all of these simulate the human nipple), such as: Mimijumi Very Hungry (mixed reviews / highest priced), Avent Naturals, Medela Calma (Can be purchased at Amazon / BPA free), and the Playtex Ventaire (some mothers say it leaks), plastic Philips Avent (BPA free that can be purchased at Amazon). All of the aforementioned brands are tooted as having little to no problems with “nipple confusion”.

Remember you are working to simulate the nursing atmosphere. Make sure your babysitter understands the concept of holding the baby as if feeding at the breast and that they should not be propping the bottle for baby.

 

REFERENCES:

Korte, Diana and Roberta Scaer. A Good Birth, A Safe Birth. (1992) Harvard Common Press.

La Leche League International. The Womanly Art of Breastfeeding, 7th Rev. ed. (2004)

Katelynne Shepard. Breastfeeding Problems.com. http://www.breastfeeding-problems.com/breastfeeding-hormones.html

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”

 

OverduePregnancy

“Overdue” Pregnancy

silhouette of pregnant womanThe word “overdue” is not really a correct term to use. The concept of the length of a pregnancy being a 40-week period of time was just a random time-frame that was chosen.  A German obstetrician in the early 1800s announced strongly that pregnancy should last ten lunar months of four weeks each.

The timing is relative.

The current standard for determining due dates, ultrasonography, does not do so accurately. In the first trimester it can give a time frame of plus or minus 5 days, a ten-day window. Sonograms done later in pregnancy are even less accurate than early-on.

These types of tests have been proven to have “poor predictive outcomes ” or better said, false-positive/non-predictable results. Yet it is exactly what the doctor uses to determine if a woman or/ and her baby are in need of intervention.

The tests are run at the 42-week mark. Usually, these tests are not accurate, but the doctor rushes to “rescue” the baby. Ironically, when the baby turns out to be just fine, then it reinforces the doctor’s belief that the baby needed “saving”.

Babies come when they are supposed to be born.

Just as doctors use the “average” for determining the length of labor, the “average” is what determines whether or not your baby is late, or not. That average does not take into consideration your own cycles (for date determination) or whether you even kept track of your menstruation cycles.

Doctors become concerned about the well-being of your baby if you have hit the 40 week mark and you have not begun labor. Their concern is not always justified. Below you will find some tests used to determine if your baby is well.

TESTS OF FETAL WELL-BEING

The false positives of these tests have begun to shore-up the idea that it would be a dangerous thing to allow a pregnancy to continue. When induction is started, there is an increase of fetal distress and with that, increased cesarean sections.

A test you can do:

Fetal Movement Counts: Beginning a few weeks before the “due-date”, pick a time in the day when baby is awake. Then begin counting 10 movements, doing this several days in a row. If there is marked drop in movement, seeing the caregiver who will follow up with one of the next few tests.

Tests the hospital may do:

Non-stress test: Using an external fetal monitor to track the baby’s heart rate when baby moves or during pre-labor (Braxton-Hicks) contractions. The heart-rate of baby should increase. But, sometimes it will not, because baby is asleep.

Vibroacoustic stimulation: A slightly different method than the previously mention one. Basically, a buzzer is sounded against the belly, which is supposed to startle the baby. There should be a resulting heart-rate increase.

Oxytocin Challenge Test: You get hooked up to the fetal monitor, an IV is started with oxytocin to check the baby’s heart rate when contractions have been stimulated.

Biophysical profile: An ultrasound scan that is for the evaluation of the placenta, the movements of the baby, and how often the baby does a “practice breath”. When a baby is having problems, the baby slows-down his/her movements and will stop the “practice breath”. This test is done on a 0-10 scale (“0” being the worst).

Amniotic Fluid Volume measurement: Ultrasound is used to estimate the amount of amniotic fluid in the uterus. The idea is that too little amniotic fluid creates a probability of stress during labor.

Organizations

ptg02147161Organizations in South Dakota and Nebraska, supporting birth practices outside of hospital settings:

South Dakota Birth Matters

Nebraska Friends of Midwives


Other Organizations to know about:

Citizens for Midwifery

The Midwives Alliance of North America

North American Registry of Midwives

The Farm

Education:

DOULA / POST-PARTUM DOULA EDUCATOR / CHILDBIRTH EDUCATION / LACTATION EDUCATOR / MONITRICE:

Birth Arts International  [where I am taking training]
CAPPA

 

 

My Recommended Reading List:

Active Birth by Janet Balaskas
The Natural Pregnancy Book by Aviva Romm
Ina May’s Guide to Childbirth by Ina May Gaskin

 

 

 

 

 

 

 

 

 

Vices in Pregnancy – Part 1

woman pregnant smoking

Caffeine

Caffeinated beverages do not seem to cause birth defects or preterm labor and delivery in people…but there are other risks. Such as: fetal growth retardation, miscarriage, and low birth weight.

Woman who drink more than 300mg of caffeine are at the highest risk. That would be about three, five ounce cups. Those that both smoke and drink caffeine are at even a higher risk for babies with stunted growth.

Coffee (5 oz. cup) 60-180 mg
Tea (5 oz. steeped 4 minutes) 38-77 mg.
Cocoa (5 oz. cup) 2-20 mg.
Chocolate milk (8 oz.) 2-7 mg.
Cola drinks (Jolt, Mr. Pibb, Mountain Dew, etc.) 36-72 mg.
Non-prescription drugs (Excedrin, Anacin, etc.) 30-65 mg.


Tobacco

Cigarette smoke is full of chemicals. Many of these migrate to the sperm cells when they fertilize the ovum, and then continue to bombard the fetus when the mother smokes or is exposed to tobacco smoke.

Women who smoke are more likely to experience pre-eclampsia during pregnancy, preterm labor, premature rupture of the membranes, and premature delivery. The baby born to a smoking woman tends to be lower in birth weight, and more likely to die soon after birth than those who do not smoke.

The damage to the baby can persist into later life. They are at more risk for cancer as an adult, susceptible to middle-ear infections, asthma, chronic bronchitis, and wheezing.

If raised in a household where smoking is allowed children are more likely to develop hypertension, as well as neurological and behavioral problems such as attention deficit disorder. They also tend to score lower in intelligence tests later in life.

Men who smoke have a considerable higher risk of having children with birth defects and childhood cancer. This is probably due to the lowering of vitamin C levels in seminal fluids and sperm. Not even the best of nutrition can make up for the damage done by smoking!

Woman smoking and alcohol

Alcohol

Alcohol freely enters the placenta and directly exposes the developing baby to its toxic effects. It travels in the baby’s blood stream at the same concentration as that of the mother. If mother is “buzzed”, so is the baby!

Some babies born develop a condition called “Fetal Alcohol Syndrome” or FAS. They are shorter in length, lighter in weight, than other babies. They do not “catch up” eve with special postnatal care. They also have abnormally small heads, irregularity in their faces, limb abnormalities, heart defects, and poor coordination. Many are mentally retarded and may develop behavioral problems as they grow up (such as hyperactivity). Another condition, which is similar, is called “Fetal Alcohol Effect” or FAE.

No one knows how much alcohol it would take to damage a baby. Since it causes permanent physical and mental birth defects and no “safe” amount is known, the best bet is to abstain from alcohol.

Be aware of the alcohol that may be in certain foods. Such as: Irish Coffee, wine coolers, rum in fruit cakes, liquor-laced desserts, and cough medicines.

 

 

Let Your Monkey Do It

 

 

standing labor

 

Birth: Let Gravity and Movement Work for You

A woman needs to be able to change her position and to move around freely while in labor. The supine position is the antithesis of an easy birthing. “Movement greatly helps cervical dilation during the early part of labor” says Ina Gaskin, and it also assists the baby to be positioned correctly so baby can move into the birth canal.

If there are no hindrances to movement a pregnant mother will have any problems getting into the positions that assist in cervical dilation.

Things such as:

Intravenous lines- when you move the pole and line are awkward, and you really cannot move freely.

Electronic fetal monitoring: the transducer will set off an alarm when you move because it no longer picks up baby’s heartbeat; causing a nurse or midwife to come running.

Epidural anesthesia: would be problems due to the paralysis of the lower limbs.

Women will not intuitively lie down to birth. It is the outside forces and/or culture that pressures the women into it. There are some common positions that women worldwide have used, including the Lakota culture. These would be: sitting, kneeling, squatting, and on one’s hands and knees.

Some would require the usage of supports of various types. These supports could include ropes for the mother to pull on, birth chairs, stakes pounded into the ground, or the embracing support of a husband or a female birth attendant.


The benefits of upright positions are:

• Better use of gravity
• Maximum circulation between mother and baby
• Better alignment of the baby to pass through the pelvis
• Stronger rushes
• Increased pelvic diameter … when kneeling or squatting

The classic is: walking. Walking is upright (hence assists with gravity), and assists in the same manner as any of the other positions for birth. It is especially helpful in early labor. Other variations are to stand and gently sway the hips, using the principle of gravity again.

Listen to your intuition. It will tell you what to do…

Or as Ina May Gaskin says:

“Let your Monkey do it”

In other words, don’t let your over busy human mind interfere with the ancient wisdom of your body.

• Monkeys don’t use technology for birth
• They don’t obsess about whether they are inadequate in any way
• They don’t pin blame on anyone else for their condition
• Monkeys do not sit and calculate how long labor will take them, based upon how much dilation takes place.
• Monkeys assume the most comfortable position and not a position they are told to assume
• Monkeys are not self-conscious regarding the noises they make…

How can you “Let your Monkey do it” in a hospital setting?

Ina May Gaskin says:

“I believe it helps to mentally prepare
to be a little wild while you’re there”

It may mean doing something unconventional in order to keep moving through labor. Act as you would if in your own bedroom even though you may be in a hospital setting.

GBS

GROUP B STREPTOCOCCOS

1 out 10 healthy women have GBS living (or colonized) in their vaginas.

Before using antibiotics during labor as a preventative measure about 2.5 out of 100 women with GBS would have a baby that would develop a serious infection.

Out of those babies, 4% would have died.

So statistically: women with “colonized” GBS would have lost a child or 4 to 8 per 10,000.

Those few who survived had neurological damage.
Odds are reduced with full-term pregnancy, most were premature that developed GBS.

The solution would seem to be to test for GBS early in the pregnancy, and take the antibiotics at the time. This often does not work. This is due to the GBS reappearing after the course of antibiotics is done.

The Center for Disease Control Recommends:

• Screening at 35-37 weeks of pregnancy
• Give all women with colonized GBS IV antibiotics while in labor
• Or, if the status of GBS is unknown at birth, and the risk factors are present, give the IV antibiotics.

A baby born to a GBS positive mother does not need antibiotic treatment if the baby shows no signs of infection and is at least 35 week gestational age, and the mother began antibiotics at least four hours prior to birBut the baby should have blood cultures done.

If the mother has received antibiotic treatment due to a suspected uterine infection or baby shows any signs of an infection, the baby should receive a full septic work-up, including a spinal tap and antibiotic therapy.

Cases of newborn infections have declined since the introduction of testing routinely and treatment since the 90s.

The downside is that some cases of severe allergy occurred from the antibiotics. Although GBS strains have not seemed to develop resistance to penicillin, they have to other antibiotics.

 

Symptoms of Marginal Nutritional Deficiencies

wses262116

Symptoms:

• Tiredness or fatigue
• Stressed
• Irritability
• Trouble with concentration or remembering
• Numbness or tingling of extremities
• Low immunity or prone to colds or the flu
• Depression / Anxiety
• Cravings for sweets
• Morning Sickness


DEPRESSION OR ANXIETY:

Deficiencies in vitamin B1.
Whole grains, wheat germ, peanuts, green peas, dark leafy green vegetables, lean pork, cooked dried beans and peas.
CRAVING SWEETS/MORNING SICKNESS:

Deficiency in Vitamin B6
Extra-lean meats, and legumes.


VERY PALE SKIN:

Deficiency in Folic Acid
Dark leafy green vegetables such as Kale, and Spinach.


FATIGUE:

Deficiency in iron

Before becoming fatigued, remember that many foods are packed with iron. So begin eating these foods even before becoming pregnant. These foods are: Black Strap Molasses, Spinach, Kale,
INCREASED COLDS AND SUSCEPTIBILITY TO FLU:

Deficiency in copper, iron, selenium, zinc, Vitamin A & Beta Carotine, Vitamin E, Vitamin C, or any of the B vitamins (especially Folic Acid)


DISORIENTATION/NUMBNESS OR TINGLING OF EXTREMITIES/MOODINESS/IRRITABILITY/DIZZYNESS:

Vitamin B12 deficiency which causes macrocytic anemia, or if the cause is by a lack of digestive factor, pernicious anemia. These two are not the same as an iron deficiency.
Found mostly in food of animal origin, i.e. meats, milk and eggs. If found in plant form it usually is due to fermentation such as Miso.
Note: B12 deficiency may put you at risk for a preterm delivery, or a low-birth-rate baby.

 

Backache

The body undergoes physical changes in pregnancy in your balance, posture, and your mobility. Your center of gravity becomes thrown off due to abdominal protrusion in the front, enlargement of your breasts, and the anterior   (frontwards) rotation of the pelvis. In order to maintain stability, a pregnant woman tends to increase the strain on the back muscles and the vertebral column.

Another cause is the shortening of the hip flexor muscle group caused by the anterior rotation of the pelvis, as well as the increased size of the muscles of the abdomen. This is not helped when a pregnant woman leads a sedentary lifestyle.

Cross-legged Pregnant Woman

REASONS FOR BACKACHES

• Weight of the baby and the contents of the uterus
• Constipation
• Poor posture
• Standing for long lengths of time
• Urinary tract infections
• Over-working
• SCIATICA is a severe form of backache caused by the sciatic nerve being “pinched” or pressure placed on the nerve.
• The pain radiates to the legs
• Occurs due to growing baby and the womb that causes pressure on the nerve.
• The kidneys can also be affected, do the growing uterus causing pressure.

RECOMMENDATIONS

Good posture can assist sciatic nerve issues. When you improve the posture, not only will the backache be relieved but eating and breathing will improve. You find digestion is much easier as well.

Begin by keeping your head up, looking down throws your posture off. Keep your chin level. If you hold your head correctly your shoulders and back will automatically fall into place. Drop your shoulders to a position that is more natural, and avoid allowing the shoulder blades to be thrown back as it will cause a strain on your back.

Tuck your tailbone under to bring it into alignment. Pull inward the abdominal muscles and tucking the buttocks muscles…tilt your pelvis forward. This will act as a counter-balance to the tendency of arching the back.

• Wear flat comfortable shoes. Keep your knees relaxed, not locked
• Sit up straight in chairs and when you drive

Do stretching exercises, and / or exercise by walking briskly for 30 minutes a day, leg lifts and lunges, swimming, or Yoga. Avoid too many weight-bearing exercises . Doing exercise relieves muscle tension. It also Relieves emotional tension. Another thing you can do is to rock your hips, or make love passionately (no joke), the latter relieves pelvic congestion.

Relieve constipation:

• Constipation is directly connected to lower back pain and pelvic discomfort
• To keep from having constipation, drink more water and eat whole grains.
• Increase Calcium and magnesium (see: minerals hand-out).

Elevate your legs, preferably for 20 minutes a day (up on a chair or lying down with two pillows under them)

DIETARY RECOMMENDATIONS

Keep cold or raw foods to a minimum (these increase kidney strain). Eat grapes, pears, and apples as these are the least “watery” of the fruits and are less strain on the kidneys.

Minimalize fruit juices, and caffeine. (coffee, black tea, chocolate, cocoa, and soda). They act like adrenaline in the system due the chemicals they contain. Adrenaline aggravates the kidneys.

HERBAL RECOMMENDATIONS

If you are tired, feel overworked, or stressed you may be experiencing adrenal gland deficiency. The best herb to nourish the adrenals is nettle leaf, in a strong infusion (steeping for at least ½ hour). Nettle Leaf is one of the herbs found in your “Pregnancy Tea”.

Take St. John’s Wort and skullcap in a tincture form. About 20 to 30 drops in water or juice a couple of times a day. You can also apply the combination of Arnica and St. John’s Wort oils externally to relieve tension and promote the healing of the muscles of the back. It’s also helpful to use a warm water bottle on the area that has been treated with Arnica and / or St. John’s Wort.

Pre-Natal Tests

What are the Different Prenatal Tests Women are Offered?

The following discussion is about tests conducted,
beyond the usual blood panel and vaginal cultures…

ptg02629155

DOPPLER OR ULTRASOUND

As with EFM, there have been questions raised regarding the use of Ultrasound, as to whether it is actually useful and if it is safe. Just like EFM it was in use before the safety of Ultrasound was confirmed. Now it is commonly used, expected by pregnant mothers.

With its use, are three ways in which women are exposed to ultrasound. First, the Doptone used in listening to the fetal heartbeat. Secondly when doctors order its use during exams, in order to check the fetal position and its growth along with the placenta (and take a picture of the baby within the womb). Third, Electronic Fetal Monitoring uses ultrasound to detect the fetal heartbeat.

So is it SAFE? Well, no one really knows for sure. The “problem lies in what happens when energy-containing sound waves strike growing fetal tissues (Sears & Sears, 82).” It is uncertain if the delicate tissues become damaged on a subtle level.

What happens is the sound-waves bombard the tissues, shaking up molecules causing heat. The heating up of the molecules cause gas bubbles of a microscopic size in the cell which are called cavitation. It is uncertain whether the heat or the bumbles damages the cells.

Not like EFM, Ultrasound has improved the practice of Obstetrics. Since it seems to be safer than X-rays, it can be used to give a more precise dating of gestational age of the fetal in early pregnancy. It also is helpful to determine if the placenta has any abnormalities, whether there is more than one fetus, and if there are abnormalities with the fetus.

Unfortunately, no study has been conducted to confirm whether there is an improvement in the outcome of mothers and their babies. Most likely, there never will be any studies, either.

Maternal Serum Alpha-Fetoprotein (MSAFP) Testing
(also known as: Alpha-Feto Protein (AFP) Screen)

The best time for this test is between 15 to 18 weeks gestation. This time frame seems to be best because the results are the most accurate.
(AFT) Alpha-fetoprotein is a substance that is produced by the liver of a fetus. It enters the bloodstream of the mother by way of amniotic fluid and placenta. It is found in the mother’s bloodstream in minute quantities. In pregnancy the level of AFP raises in progression with the duration of pregnancy. An abnormal low or high level is an indication of fetal anomalies.

MSAFP test does not harm a pregnant woman. It does seem to have an unusually high rate of false positives. If a woman has a very high level she may be referred for amniocentesis. She could be subjected to more tests that have higher risks for both herself and baby.

  • AFP increases as the baby grows.
  • It reads as “elevated” for multiples and for neural tube defects.
  • It reads low when the baby has Down’s Syndrome
  • If baby is found to have anomalies then the choices are: abortion, or keep the baby.


AMNIOCENTESIS

How the test is done:

The doctor inserts a long, sterile needle through the abdominal wall and the uterine wall, into the amniotic fluid. The test is conducted with an ultrasound, so that the fetus and placenta can be viewed.

What does the collected Amniotic fluid tell the Doctor?

The fluid contains cells from the fetus that would indicate certain birth defects. Such as: Down’s syndrome, hemolytic anemia (the destruction of red blood cells due to an Rh disease)metabolism disorders, Cystic Fibrosis, and many other diseases. It can tell the doctor the maturity of the lungs if an early labor or Cesarean is indicated.

What are the risks?

Puncture of other areas of the uterine area, such as the umbilical cord, placenta, or another area of the uterus. It can cause infection or miscarriages.

Not only that, but if an inadequate amount of fluid is collected, or the cells of the fetus do not grow in the culture, another test will be necessary.

What Happens then?

  • If the baby is found to have a disorder, then the mother needs to choose what to do next. Does she keep or abort the baby?
  • Is the test able to screen for all disorders of the fetus?No it does not. In fact it can damage the fetus.


CHORIONIC VILLI SAMPLING (CVS)

How is it done?

Tissues are removed from what will develop into the placenta. These tissues are gathered by one of two ways: either through the abdomen or the cervix, using an instrument to collect tissue while looking at the area.

At what point in the pregnancy is the test conducted?

The test is done at the nine to eleven weeks’ gestational point.

What would it indicate?

It would indicate whether there are any chromosomal abnormalities in the fetus. It is not able to detect all the abnormalities that can be seen in an Amniocentesis.

What are the risks of taking this test?

The risks include possible damage to the embryo, damage to the uterus, infection, hemorrhage, and miscarriage. It should not be conducted when an infection is already present, if there is a known Rh factor, or multiple gestations. It has a high false positive rate.


GLUCOSE TOLERANCE TEST (GTT)

This test is conducted around 24-28 weeks of pregnancy, and then repeated again at around 32-34 weeks for high risk mothers.

How is the test done?
A sweet liquid called glucola is given to her and then the blood sugar is checked an hour later. If positive, the doctor may then order the 3 hour test, which is more accurate. Only 15% of the women with abnormal results from the 1 hour test will have the same results in the 3 hour test.

Why would the test be important?

The hormones of pregnancy normally suppress insulin release, allowing more glucose to be released for the developing baby. Occasionally the blood sugar is too high (2-10% of pregnant women) causing blood sugar levels to be raised. This is condition called gestational glucose intolerance or gestational diabetes.

  • A lengthy exposure to the high blood sugar in pregnancy causes the infant to grow exceptionally large.
  • Babies of women with blood sugar issues also tend to be born prematurely and have respiratory problems.
  • The baby may manufacture too much of his / her own insulin instead. The manufacture of too much insulin would cause the baby’s blood sugar to drop quickly and dangerously once born.

Who would be at risk?

High blood sugar during pregnancy is more common in obese women, older women, and those who have a family history of diabetes, or in women who have delivered a baby weighing more than 9 pounds previously. If discovered early in pregnancy, by being tested, the pregnant woman can alter her diet to alleviate the issue of high blood glucose.


X-RAY PELVIMETRY AND / OR FETAL INDEX X-RAY (prelabor or labor)

How is it Done and why?

A series of x-rays are done in which the radiologist measures various dimensions of the pelvic passage in order to determine if it large enough for the baby to pass through safely. These measurements are compared to tables of “normals”.

  • The test is done on a mother whose baby is failing to descend during labor.
  • If delivery is contemplated for a breech birth
  • Or if there is a previous history of a difficult birth because of a presumed cephalopelvic disproportion (CPD)*

What Problems Can it Potentially Create?

The X Ray Pelvimetry is being used less often because of concerns over safety and accuracy. Studies have linked X Ray exposure of the fetus to higher odds of childhood cancers. This correlation is not determined accurate because of conflicting study results.

Considerations Regarding the Pelvic Opening:

What is not considered is that the process of labor is an amazing one, that changes of position such as using squatting, can increase the pelvic outlet by as much as 20%. This test also only considers the outlet, not the size of the baby itself.

A newer technique using measurements of the pelvis by X ray and the size of the baby by ultrasound, called the Fetal Pelvic Index (FPI). It considers the size of the whole baby, not just the head. It is useful for those mothers considering VBAC who have had a previous diagnosis of CPD based upon X rays.

 

* To be discussed in a future blog.  Next topic coming up: Teen Pregnancy and Nutrition