Varicose Veins

WHAT ARE THEY?

Varicose-Vein

Varicose veins occur when the valves (that keep the blood flowing one way through the vessels) have become weak, which allow the blood to pool in the veins. This “pooling” causes the veins to become lax and distended.

CAUSES:

  • May be due to diet
  • Lack of exercise
  • Heredity
  • Hormone changes can cause the laxity of the valves
  • Pregnancy can be a predisposition for some women
    -Because there is a congestion of the blood in the lower extremities due to pressure from the uterus.
    -The return of blood from the legs to the pelvic area is reduced by the heavier uterus.

They are most common in the legs, ankles and feet. They can also show up in vulva (Vulvar variscosities) and anus (as Hemorrhoids). They become more pronounced as the pregnancy advances.

The vulvar variscosities usually are not noticible until birth. Some women notice the large ones during pregnancy. A gentle birth and hot compresses applied to the large distended veins will reduce damage or trauma to the veins. Occasionally bleeding or hematoma (internal pooling of blood) can occur and will require medical care.

Hemorrhoids become evident after birth, normally. So the use of gentle birthing will help with these as well. Constipation will aggravate hemorrhoids, and should be treated (although, following a good diet will reduce constipation due to the additional fiber from foods).

Usually the varicose veins will empty quite quickly after pregnancy. They are quite common during pregnancy, and usually repair is not considered during that time.

RECOMMENDATIONS

• Eat well, and drink lots of water
• Exercise! Exercise improves the circulation, and assists in both the prevention of and treatment for varicosities.
-Brisk walks for 30 minutes each day
-Or ride a stationary bike for the same length of time as walking
-Swim
-Yoga
-Belly dance moves such as pelvic rocks, and rolling/rocking the hips in a figure-eight.
-Dance!
• At least 20 minutes twice a day with feet elevated higher than the heart
• Do NOT sit in one place for too long. This would encourage insufficient pelvic and leg circulation.
• If you have severe varicose veins use support stockings (you can find them at a drug store.
• Use visualization to reduce the size and number of the varicose veins.
• You need to consider who / what is your support. You are not superwoman, and will need support during this very exciting time in your life!

CAUTION: Never massage the varicose veins! Massaging the veins can cause clots to dislodge and lead to an embolism. Embolisms are dangerous! If you see signs of phlebitis (swelling, heat, pain, infections around the veins) you should see the doctor or midwife right away.

DIETARY RECOMMENDATIONS

Follow the “baby wise” diet . Be especially careful to eat whole grains, high quality proteins, fresh vegetable and fruits as often as you can.

• Vitamin C with bioflavonoids is vital for assisting the walls of your veins to be strong.
• Foods with high vitamin C: citrus fruits, rose hips, dark green leafy vegetbles, cherries, alfalfa sprouts, strawberries, cantaloupe, broccoli, tomatioes, and green peppers.
• An additional 2,000 mg. of C with bioflavonoids can also help
• Vitamin E also is good for the vascular system. Take 200 to 600 IU a day. If you have heart or blood pressure problems begin with 50 IU and work up to 400 IU over a three month time-frame.
• B complex vitamins. Whole grains, nutritional yeast (I take mine in orange juice), and yogurt (its helps maintain intestinal integrity ).
• Green Vegetables…romaine (stop eating the low-vitamin Iceburg variety) lettuce, butter lettuce, turnip greens, kale, collards, mustard greens, dandelion greens, and turnip greens. Steam these, do not boil!

HERBALS

• Nettle leaf tea (One herb in the “Pregnancy Tea” blend I use) . Infuse by making 1 ounce of herb to 1 quart of water and allow to steep for 2 hours. Drink a cup to up to a quart a day depending on severity.
• Garlic, onions, oatstraw, calendula, motherwort, can also be consumed. Please consult an herbalist for guidance on their use.
• Kelp. Kelp can be added to soups or taken in a tea form.
• Deficiencies in essential fatty acids may make the varicose veins worse. Take 500 mg. of one of the following oils once each day: evening primrose, flaxseed oil, black currant oil, or borage oil.

REFERENCES:

Romm, Aviva Jill. The Natural Pregnancy Book: herbs, nutrition, and other holistic choices (2003) Celestial Arts

Lowdermilk, Dietra Leonard and Shannon E. Perry. Maternity and Women’s Health Care, 9th ed. (2007) Mosby.

Stress, Part 3

Stress

stress

Stress and Pregnancy

This is a huge transitional period for the family unit, and usually characterized as stressful. Due to new roles to learn, adjustments within the family unit, communication patterns are re-established. These shifts may trigger biologic changes, hormonal function shifts, and immune system vulnerability.

The whole family unit is thrown off it equilibrium due to restructure of family roles, adjustments to family goals, physical and emotional changes that pregnancy may bring. This is the case for the average and normal situation and pregnancy. What about other circumstances or high risk pregnancy?

If the pregnancy is from an already stressful situation such as a rape or domestic violence has occurred, the stressor of pregnancy brings additional problems. Decisions need to be made to assist the mother, if other children are involved, their safety attended to.

In high risk pregnancy situation, stress is further aggravated if hospitalization is required. “High risk” is a label given to those whom the health of the baby or mother to be is threatened.

The pregnant mother’s ability to adjust and or adapt to the situation may be in jeopardy by the excessive level of stress. The mother must understand the causative factors in being labeled high risk and accept the situation in order to have a good outcome. As well as the pregnant mother, all other family members need to assess, accept, and readjust to this prognosis.

Unfortunately, pregnancy on the reservation is almost always considered high risk. This is due to poverty, gang activity, teenage pregnancy, alcohol consumption and drug abuse.

Only YOU can change this! Change the additional stressors in your life, and then you can change the outcome of your pregnancy and delivery!

Stress, Part 2

Stress

stress

Social and Family Stress

Social stress can be an actual threat or that what is perceived as a threat. These are within ones social environment. This could be relationships at work, conflicts at school, or interactions that occur within a person’s society.

Inside the family unit certain life events can affect the family directly or indirectly. Some of the stressors could be things that are deemed “normal” such as a birth in the family.

Stressors could be caused by ambiguous facts, such as an illness of unknown cause in which the doctor states the person will die at some time. Also, there are stressors that are caused by nonambiguous facts such as the onset of a severe storm and its aftermath.

Volitional stressors are things such as divorce, things that members of the family may cause or control the end result. Chronic stressors are events that occur over an extended time, such as a handicapped family member. Acute Stressors are temporary, such the hospitalization of woman giving birth. An isolated stressor is a singular event, such as the arrest of a family member.

Family stressors can proceed a crisis within the family but not all family stress leads to a crisis. Here are four indicators that a family is in a crisis:

• Members within the family are no longer able to function with their family roles
• Family members cannot make decisions and solve problems
• They are unable to give care to each other in a way usually seen
• A shift from family to individual survival

Stress

About Stress

stress

There are two types: the type that is good, making you feel satisfaction and happiness. And there is negative, which leads to fatigue and possibly, illness.

There is no singular thing to point to as a cause of the latter. But, what is known about it is that the body makes biochemical changes when it is present.

GAS or General Adaptation Syndrome, has three stages. These stages are: alarm, resistance, and exhaustion. In the alarm stage the quick initial response is lowered blood pressure and tachycardia. This is in preparation for the fight or flight response to continued stress. The body will continue to increase its production of adrenocortico-tropic hormones. Along with this is increasing heart rate and elevation in blood pressure.

If the condition becomes prolonged, to the point where the adaptation of the body is too great, vulnerability of the body occurs…and exhaustion. The body is not designed to stay in a heightened state of arousal.

If continued, the sympathetic nervous system becomes activated with vasoconstricted blood vessels, increasing blood pressure, increasing heart rate, and the secretion of adrenaline. The immune system will then become suppressed and the increasing cortisol will cause cholesterol and other lipids in the blood to increase at the same time.

Situations or “agents” that cause stress are called STRESSORS. These may include physical things such as heat, exertion, trauma, infection, or cold. Or it may be from psychological reasons such as fear, anxiety, or disappointment. Stress may be caused by external things. Examples may include poverty, inadequate housing, and certain life events.

Factors altering stress responses are called mediators. The MEDIATORS may be genetics, developmental factors, experience, and social context. Some people appear to be more resilient and cope better with stress, while others seem to be more vulnerable.

Women with Disabilities -The Healthcare Team- Part 2

Interviewing the Doctor

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Here are some questions you may wish to ask:

What are the pros and cons of pregnancy for me?

If the doctor is opposed, ask why?

What do you know about my disability, and what access do you have regarding it?

Do you have experience with the pregnancy and delivery of babies with disabled women? How much?

In what way will you be working with my regular doctor?

If there are unusual symptoms that arise, who should I call if I am not sure if those symptoms are pregnancy or disability related?

How will labor and delivery be affected by my disability?

Will there be a need for treatments that differ from the usual types, due to my disability, and how will we get the cooperation of the hospital for those treatments?

Do you think I may need a caesarian section? Why? Would you set a date, or wait for labor to begin spontaneously?

Can I get a referral for genetic counseling?

The physical exam

Besides the questions suggested previously, the examination is also another time to decide on the doctor who will tend to your care. How the doctor behaves during the examination and time taken to let you know what he/she is doing in that exam will assist in your final decision.

Does the doctor ask you questions during the exam? Are you treated with sensitivety and consideration? Are the questions the doctor is asking relative to your level of sensation, mobility, and flexibility? Regarding your comfort?

The doctor’s partners

If the doctor has partners or a physician that they use when they are not available, you will need to schedule an appointment with them on one of your regular visits, as early as possible. See if they also are “on board” and will be responsive to your needs and care.

You will need to feel comfortable with any one of these doctors, in case they are the one in delivery with you. It would be much more comfortable to have a familiar face, and know if they also will support your needs.

How to “Trust the Process” in Childbirth

Trust the Process

Trusting is a big word. We oftentimes say we trust others, but do not even trust our own selves. The nurturance of our babies and bonding that would be necessary in utero, assists in developing a trust between baby and mother. But before working on the baby-mother bond learn to trust your own instincts.

Science has determined that the mother-baby bond is essential after a child is born. But what about the significance of bonding while the baby is growing inside the uterus? This is the essential missing information not communicated to women in our modern times.

Due to the obsession of the over-technological world we live in, we forget to listen within. We tend to not realize important knowledge lies inside our psyches. We avoid listening to our bodies. The cues are there, we just do not stop to listen.

The pregnant body is communicating what it needs all the time, and, believe it or not, the unborn baby is, too. All we have to do as mothers is learn to listen, give ourselves permission to trust the connection, and take the time to respond (Peters & Wilson, 22).

For survival, the baby must begin to adapt to its environment while in the womb in order to survive. There are special molecules that act as messengers, to allow the mother to communicate to her baby in utero. Components such as hormones and neuro-peptides cross the placental wall, sending information to the fetus.

Emotional intelligence is taught to the fetus via this mechanism. So he or she learns the whole range of emotions via the mother. Her responses teach the fetus. She sets the tone, so-to-speak for coping within the world.

Creating the bond with the fetus is a spiritual act that transcends the normal functions of mothering. How one adjusts to life, begins during the prenatal period.

Researchers and clinicians have found that prenatal and birth experiences of the mother, effect the birthing patterns she has with her own babies. These would include cultural patterns imbedded in the lives of the family. We can prevent “life-constricting patterns (McCarty, 9)” that are developed while in utero by addressing these issues and healing our own birth traumas.

This scientific approach closely parallels the work of John Upledger in his ground-breaking work with Cranio-Sacral and Somato-Emotional Release therapies. His theory is that the body stores memories at the cellular level.

Have you ever massaged someone, or been massaged, and a small soft-tissue lump is discovered that almost feels like it “crackles”? That is a “energy cyst”. When released it creates an emotional response, and the muscular tension abates. It is thought this “cyst” holds the memory of the injury. In Unpledger’s book, he states that traumatic injury can be fully healed by the release of these “cysts”.

I have come to look upon this phenomenon as ‘tissue memory’. By this I mean that the cells and tissues of the body may actually possess their own memory capabilities. These tissue memories are not necessarily reliant upon the brain for their existence [[Upledger, 64].

I would consider this muscular and tissue intelligence. If Upledger’s theory is true [and is likely, due to hundreds of patients having experienced his work] then it is an important aspect to consider for the mother and the mother-baby bond.

There are four essential KEYS to developing the mother-baby bond, and learning to be aware of and trust your own instincts.

Being: an awareness of thoughts and feelings
Observing: a state of mindfulness
Nourishing: involves all the things women do to tend to their emotional and physical needs.
Deciding: to make an active participation in creating your own reality. A conscious agreement
to make decisions based on deep inner-listening.

Steps to making the conscious agreement are:

1. Separating ourselves from all external influences (even for a few moments in the day)

2. Get quiet and pause. A few deep breaths in order to connect to your “source”

3. Listen. What is your gut saying to you? How does your body feel? How is your body reacting? How does your baby react to what you are feeling, physically or emotionally?

4. Then decide and commit. This is when you honor your feeling and that of your baby. Make a decision that will be in harmony with the messages your intuition says.

Through this practice, then you will develop a trusting respect for your own intuitive thought process, allowing it to guide you. You have several months of your pregnancy to find your awareness of self and of your baby.

When the day comes for labor to begin you take this newly-developed self-awareness, the bond you created between you and baby, and the education you have gained about safe birthing practices to trust fully the process of labor! “Listen” to your own self, and what your baby is telling you.

Relax into labor, BE with it. OBSERVE what is transpiring within your own body, and NOURISHING your emotional / physical needs while you are in labor. Then DECIDE. Decide to trust your instincts, trust your body (which is wonderfully made!), and to trust your bond you’ve made with your baby…

COMMIT to Trusting the Process.

REFERENCES:

McCarty, Wendy Anne. Ph.D. , R.N. The Call to Reawaken and Deepen Our Communication with Babies: What Babies Are Teaching Us. International Doula. Summer 2004, Vol 12.

Tracey Wilson Peters, CCCE, C.L.D., and Laurel Wilson, IBCLC, CCCE. The Mission Piece: Consciousness and the MotherBaby Bond. Pathways to Family Wellness. Issue 31, Fall 2011

Upledger, John E., D.O., O.M.M. Your Inner Physician and You. 2nd Ed. North Atlantic Books. 1997

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.

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