FYI for native women

Just an FYI for all of you…

 

Midwives Resistance: How Native Women are Reclaiming Birth on Their Terms

Mana Preconference/for native midwives

2 FULL DAYS:

Indigenous Midwifery: Ancestral Knowledge Keepers – $150. (Proceeds go to Native American Midwives Alliance)

When: October 14-15, 8:00-5:00PM

Indigenous Birthworkers Network Birthworkers who are Midwives, Doulas, mothers…

Midwifery is On the Rise In Native Communities

Nicolle Gonzales CNM ~ Blessingway of a Native American Midwife  Video

Midwives of Color

2018 American Indian and Alaska Native National Behavioral Health Conference

View original post

Advertisements

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 2

The Fertility Awareness Method [FAM] works as a contraceptive only if you choose to either postpone intercourse or use a barrier method when you are fertile. You should be aware the method is most effective when you abstain.

chart

Here are the reasons why:

  1. If the barrier method is going to fail, it will fail when you are in the fertile phase. ALL contraceptives have a failure rate.
  2. Using barriers with spermicides during the fertile phase can mask your cervical fluid.


Drawing the “Cover Line” For Charting

The purpose for charting your temperature is determine when ovulation occurs.  Your temperature rises on the days after.  But to accurately do this, you need to draw a cover line.

The instructions are as follows:

  • After your menstruation ends and when charting your temperatures, always notice the highest temperature of the previous 6 days.
  • Identify the first day your temperature rises at least 2/10ths of a degree above the highest temperature
  • Now, go back and highlight the last 6 temperatures before the rise
  • Draw the coverline 1/10th of a degree above the highest of that cluster of 6 highlighted days


Charting Cervical Fluids

 Day 1 of the cycle is the first day menstrual bleeding. Brown or light spotting prior is considered a part of the last cycle.

  • The graph below shows how the various types of cervical fluids are recorded in your chart.
    Note: Menses are marked with
    * while spotting is marked (*)


Menses:  Red Blood Flow

Eggwhite          
Creamy          
Sticky          
Dry, Spotting or Menses *        


Spotting: Brown, pink, discolored

Eggwhite          
Creamy          
Sticky          
Dry, Spotting or Menses *  (*)      

Nothing:

Eggwhite          
Creamy          
Sticky          
Dry, Spotting or Menses *  (*)  —    

Sticky:

It is opaque, white, or yellow, and occasionally clear.  Can be thick.  The main quality is stickiness or lacking true moisture.  It can be crumbly or flaky like a paste, of gummy and rubbery (similar to rubber cement). When separating fingers it forms peaks.

Eggwhite          
Creamy          
Sticky        fill in box
 
Dry, Spotting or Menses  *  (*)  —    


Creamy:

Milky, cloudy, white or yellow in color.  Is “creamy” like lotion.  Can be wet, watery or thin in nature.  Does not form peaks when separating fingers.

Eggwhite          
Creamy      
 fill in
Sticky        fill in
 fill in
Dry, Spotting or Menses *  (*)  —    

Eggwhite:

Usually it is clear, but can have opaque streaks in it.  Very slippery and wet like an eggwhite. Feels like extreme lubrication in the vaginal opening.

Eggwhite        
Creamy      
 fill in
Sticky        fill in
 fill in
Dry, Spotting or Menses *  (*)  —    

NOTE: There would be an additional column on the right side, but due to constraints in page size, is omitted. The last column not shown has “eggwhite, “creamy”, and “sticky” boxes filled in.

 

Pain in Childbirth – Part 2

father in delivery room

What contributes to PAIN in labor?

Fatigue

Muscles that are stretched, hurt. The muscles of the uterus work faster, the blood and oxygen flow is lessened. When there is tension, the uterus works even harder and fatigue sets in. The tension of the surrounding muscles has created a “brick wall”. So, relax.

Tension

The stretching of the lower uterine portion and the intense contractions of the upper uterine muscle are what is thought to be the source of the pain felt. But these muscles actually have very few pain receptors. You would not feel the pain unless the muscles were forced to work in an unnatural manner. If tense and fearful the nerve endings of the muscles and tissues around the uterus send messages to the pain receptors. There is a direct correlation of tension to pain.

Tired muscles

The biochemistry of the muscle is imbalance when tired. It creates tension that sends out more electrical activity. The physiological changes will lower the point at which the muscle will hurt.

The outlet is too small, or baby too big

These actually do not need to be an issue. Usually the position of the baby or laboring mother, are the causative factor of pain. The pain messages are signaling that something isn’t right. What will help is a change of position of the mother.

Get out of the horizontal position, to a vertical one, and things will change. The baby is assisted (most of the time) to re-position him/or herself in the womb to facilitate birth without as much pain. As stated in a different hand-out, just doing this type of change in position opens the outlet by 20%.

Fear

Information is out there on all the things that “can go wrong”. We are not taught that birthing is a natural process; we women are pummeled with media and other females telling horror stories about birth.

There is a shroud over the whole process of birth, making it seem to be a great mystery. What is needed is correct information.

Your uterus is a magnificent muscle which is affected by the neuro-hormonal pathway that connects the brain, the circulatory system and the uterus. Fear causes an alteration of the pathway creating a reduction of blood and oxygen to the brain. This results in the tightening of the cervical opening of the womb.

Fear unbalances the hormones of the body. Being fearful causes the release of labor inhibiting hormones. These are the stress hormones of the adrenal glands that when in stress, we release hormones that are the fight-or-flight mechanisms. Animals also have them, and the hormones are released to stop labor allowing them to find a safe place for birthing. These then block the labor enhancing hormones . This lengthens the labor and increases the pain felt.

A well-informed, correct education about birthing will assist you. Make sure your labor supporters also have been educated so that their fear is not surrounding you when you are in labor.

Occasionally, the sensation of pain will continue, even after all the relaxation techniques are implemented. This may be due to a tightened psoas muscle or mal-aligned hip. Both can cause tension in the body, and / or problems with the baby being delivered easily. These two issues can be checked, and remedied.

The Natural Pain relieving Narcotic: Endorphins

“Circulating throughout the body are natural hormones that relax you when stressed and relieve pain when you hurt (138)”

What is sad is that most women do not know about these hormones, or that they can activate them when needed. In the 1970s studies were being done for drug addiction and the presence of these hormones in the receptor sites of the brain (for morphine-like substances). What was found was that the nerve cells that are attached to receptor sites, had chemical pain relievers that acted to dull the sensation of pain in the cells. Here is how they can work for you:

As you probably know, Endorphins are raised during exercise and well, labor is strenuous exercise!

  • When the abdomen contracts in labor, the Endorphin level is raised.
    o This is especially true in the second stage of labor.
    o They are the highest after labor, and two weeks beyond.
    Endorphins are highest during vaginal birth, not so much when labor was started but delivery was cesarean.
  • Endorphins are higher in newborns that had signs of fetal distress during their delivery.
    o Baby also receives Endorphins during birth.
  • The release of Endorphins also will stimulate the production of prolactin, the hormone that relaxes and creates the “mothering” sensation.
    o Prolactin regulates milk production, which boosts the interaction with baby and mother.
    o These hormones are what researchers think are the cause of the “birth high”.
  • Mothers who had surgical birth have lowered hormone levels, which would account for the delay in milk supply after cesarean birth.
  • Endorphin production is directly tied to a person’s emotional state.
    o So if stress and anxiety are not resolved the body increases the stress hormones, Catecholamines, which counteract the relaxation produced by Endorphins.
    o Like commercial narcotics, Endorphins may behave differently woman to woman, which is why some women may feel more pain than others.
  • Injectable narcotics give you a bit of blast of pain relief, whereas Endorphins give you a steady dose throughout labor.

Women in labor are very aware of the natural hormone effects and describe the experience as a “natural high”.

The Vision

CHAIR STRADDLE

It has been my long-term goal, to start the work of Childbirth Education on the Rosebud Reservation, then expand the birthwork to local native women assisting families and extended family in childbirth.  This vision includes a mobile bus that would be able to reach even the most rural of communities to assist in health care for pregnant and post-partum women, and a free-standing childbirth center.  BIG dreams!

Today, I was thinking “What are the obstacles for young women who may be interested in becoming a Doula?” Well, first it would be the funding necessary to have the training as a Doula. So I set-up a scholarship funding campaign on Go Fund Me.

The campaign is designed to raise money for a minimum of 10 women. I believe that is a good start!  If you are interested in supporting my vision, here is my campaign: https://www.gofundme.com/rstdoulas

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.

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