Our Gynecological Health – Part 1

First of all, we women have left all the charting of our gynecological health in the hands of our doctors. We can keep our own records, at home.

I will be posting a .pdf file of a chart you can use as a “master sheet” of your exams and an example chart to assist you in filling it out. Use it to keep track of your weight, blood pressure, general gynecological health (which would include the breast exam, pap test, vaginal culture, etc.).

Much of what we see in our doctor’s charts, may seem to be a problem, only because we women do not understand or are taught about normal feminine health. We can understand them better when we see what actually are the “true” gynecological conditions.

These “True” Gynecological conditions would be:

• Vaginal infections
• Abnormal bleeding
• Premenstrual syndrome
• Breast lumps
• Endometriosis
• PCOS
• Nabothian (cervical) cysts

“…charting enables a woman to understand her body in a practical way (Wescheler, 230)”. A woman who charts every day is so aware of what is normal for her own body, that she can actually assist her doctor determine what is not normal based upon her symptoms. Keeping the chart of her menstruation cycle assists her In well-being, and working with the doctor.

Normal Healthy Cervical Fluid VS. Real Vaginal Infections

We live in a culture that advertises douche and sprays for vaginal “discharge” giving women the idea that they are “dirty” all the time. Douching and sprays only act to confuse the identity of healthy cervical fluid and what would be a real infection.

Wescheler explains in her book, that doctors say you don’t need either. On a talk show she watched, she says that the doctor stated that the infections from these products were “…enough to send his children to college (Wescheler , 231)”. Then there is also the yeast infection products that women self-diagnose and take every month for a “recurring” problem.

But, using the chart, detection of an actual infection will be easier, and discovered earlier. You can get treatment before discomfort sets in. Secretions mid-month are normal, but late in the month may indicate infection.

Symptoms of Vaginal Infections That Can Be Distinguished from Normal Cervical Fluid
Once you have routinely charted your normal cervical fluid, an infection can be distinguished by the unpleasant symptoms that set them apart from what is normal. Vaginal infections can range from STIs (See: The Effects of Sexually Transmitted Infections on Pregnancy) to a variety of forms of Vaginitis and of course the generic “yeast infection”.

• Abnormal discharge
• Itching, stinging, swelling, and redness
• Unpleasant odor
• Blisters, warts, and chancre sores

Avoiding Infections

Besides the consequences of douching, you should not wear clothing that is damp or too tight, as these create an unhealthy vaginal environment. Also you should wear cotton underwear, or at least cotton crotch underwear as these allow your body to breathe.

For more information see: Part 2

Miscarriage – Part 2

AFTER A MISCARRIAGE

Miscarriage is a loss as much as a full-term pregnancy where the baby is stillborn. Allow yourself to grieve the loss. Those who know ahead of time, when early signs of miscarriage is observed or during premature labor, will begin the process of grieving. This is called “anticipatory grief” and it assists you to prepare for the loss. Don’t feel bad if you have a sense of relief, the uncertainty is now over and you may feel relieved your baby’s ordeal is over.

Other people may not understand your sense of loss, unless they too have had a miscarriage. You may feel alone and isolated. Don’t keep to yourself as this can add to your feeling of doubt, and sense of self-blame.

Many people will expect you to ‘to be back to normal and may say things like ‘aren’t you over this yet?’ or ‘Buck up—no use crying over spilt milk!’ Because you are still grieving so intensely, these remarks can make you wonder if your feelings are silly or unjustified (41)”. Try to surround yourself with people who will listen and care, avoiding those people who are very insensitive.

If the baby miscarried late in the second trimester, you may have memories to grapple with. Such as, when you first heard you were pregnant, the ultrasound that showed you the baby is a boy or girl, and when you first felt the baby move. These types of things are important things to remember in the process of grieving.

You may wonder how long this process will take. It depends upon you and how well you work through the grieving process! Allow yourself the time to work through the shock, anger, denial, your memories, etc.

REFERENCES:

Davis, Deborah L. PhD. Empty Cradle, Broken Heart: surviving the death of your baby. (1994) Fulcrum.

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

Miscarriage – Part 1

MISCARRIAGE

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

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

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

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

Other causes for miscarriages include:

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

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

GENERAL RECOMMENDATIONS

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

DIETARY RECOMMENDATIONS

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

Sphincter Law – Part 2

doula at work

Sphincters May Close Suddenly if the Owner is Frightened

The sudden contraction of the Sphincters is a fear-based reaction, as a part of the fight-or-flight response of adrenals. The Adrenaline/catecholamine level will rise in the bloodstream when frightened or angered.

If a female animal in the wild is in process of birth, the birth process will reverse if the animal is startled by a surprise encounter with a predator. Humans can do the same thing.

In her book, Ina May’s Guide to Childbirth, Ina describes a situation where during labor a woman developed a fever; soon it became apparent that there was a bladder infection. She was seven centimeters dilated, but stalled in labor. So Ina chose to transport her to a hospital.

The laboring woman was examined by a doctor that was rough…who stated she was only 4 centimeters. Her dilation retracted from 7 to 4 centimeters as an automatic response to the roughly-handled internal exam…a natural self-protection, evidence of the function of the sphincter function.

What Helps the Sphincters?

• Trust, comfort, familiarity and safety
• Laughter
• Slow and deep [abdominal] breathing
• Immersion in warm water which calms and relaxes
• Relaxation of the mouth and jaw
o Relax the throat and jaw by singing
o Release an audible low moaning sound (similar to the sounds of lovemaking)
o “horse-lips” similar to the tone that horses make when they make that sound with their lips flapping, or “raspberry” sound.
• Relaxed labor supporters

~This information was taken from Ina May’s Guide to Childbirth. Ina May is an internationally known Midwife, who has delivered babies and written books on Midwifery and natural childbirth. She works at THE FARM, in Tennessee.

Sphincter Law- Part 1

doula at work
In birth work, obstetricians use the Law of Three Ps:

• Passenger (baby)
• The Passage (the pelvic structure and vagina)
• And the Powers (strength of uterine contractions)

From these Ina Gaskin believes stems the misunderstood capacity of a woman’s body from both the pregnant woman and the doctors who work with them. From the misunderstood capacities are the causative factors leading to all the interventions and procedures that now create problems in birthing, such as: Cesarean sections, Forceps use, vacuum extractors, etc.

The blame is placed upon women, for what obstetricians see as “dysfunctional birth”. Women have birthed for eons without a hitch; doctors perceive having a baby as “a problem of physics rather than a millions-of-years-old physiological process (168)”.

The Basics of Sphincter Law

• They function best when the atmosphere is private, and familiar.
• They do not open “at will” and do not respond to commands such as “Push!”
• When in the process of opening (relaxing) they will suddenly close down if a person is upset, frightened, humiliated, or self-conscious. This is the reason why in most traditional cultures women assist women in birth.
• If the mouth and jaw are relaxed, there is a direct correlation to the ability of the sphincters opening in the cervical and vaginal area (or the anus, for that matter).

What are the Sphincters?

These are a grouping of muscles that surround the rectum, bladder, the cervix and vagina. Each has a function for the body. These muscles remain contracted to keep the openings of certain organs held shut until something needs to pass through.

How do they work?

They work in conjunction with the brain. The brain has two sections that directly influence the functions of the Sphincters. These sections are the neocortex and the brain stem (or “primal” brain).

The brain stem is the portion that is directly connected to hormonal functions, and more instinctual. The hormones it releases (related to birth) are oxytocin (the main ingredient in the drug Pitocin, used to induce labor), endorphins, and prolactin.

Whereas the neocortex stimulation works to inhibit the brain stem from hormone release. It is “stimulated” during labor by asking too many questions of a woman in labor, bright light, and failure to protect her privacy during birth.

The sphincters work with the brain stem (and its many hormonal excretions) by a relaxation response. They respond to emotions. A good example of this relaxation response is what happens when toilet functions are interrupted. Everything gets held in, and it takes a while to relax again, right?

~more on the “Sphincters” next week!

The Vocabulary of Pain

 

father in delivery room

The following information was written in order to understand pain in childbirth. This is a preliminary to understanding what your body senses when in labor.

Pain Threshold

The definition is “the point in which an individual first perceives the presence of pain”. This could be when ice or heat no longer is affective for blocking and / or reducing pain.
Each person has their own threshold. It is thought that threshold remains the same throughout ones life. But, Childbirth educators have found that the threshold is quite flexible. It is found that when comfort measures are used that effectively reduce pain or make it easier to bear, and the woman is distracted from her comfort measures, then the comfort measures no longer are useful. It will take a stronger stimulus to then break through the pain. Nothing had changed in the strength of the pain itself, “rather, her distraction reduced her pain threshold so that less pain was necessary in order for her to notice it (162)”.

Intensity
Intensity is defined as “the quantitative measure of how strong or severe the pain is (Ibid.)”. The usual measurement is a scale of 0 to 10. O being no pain, and 10 meaning that the pain is out of control.

Character
Character is a qualitative measure, using verbal or pictorial descriptors and analogies. Pain character may be described as burning, aching, tearing, or sharp like a knife. Character is the most important aspect to consider when managing pain.

Duration
Concerning when pain is first noted, and how long it lasts, and whether it is a steady pain or sporatic. It is particularly significant in that smaller diameter nerve fibers may, after repetitive signals become more responsive to pain signals. Many management strategies that are not pharmaceutical focus on the larger nerve fibers, which respond well.

Location
It is where the pain is perceived in the body. Depending on the location, the distress level may rise and start to interfere with eating, breathing, sleep, concentration, or the ability to otherwise function normally. If she is unable to concentrate due to location or any other aspect of the pain, she will be less able to use the pain management strategies she has learned.

Sensation Threshold
It is the point where the stimulus was first perceived. When reached, it is when the client first is aware of itching, cold, pressure, pain, or any other sensation. Of these, pain is the most important in that it could signify potential or actual tearing. Other sensations that may later become concerning may eventually grow strong enough to be perceived as pain.

Pain Tolerance
Defined as the greatest severity of painful stimulation an individual is able or is willing to tolerate. “Encouraged Tolerance” is the highest level of pain a person will tolerate when encouraged to try to tolerate more”. It serves a purpose, but not for women in labor as it may lower the tolerance to pain. It actually would translate to suffering rather than just pain.

Categories of Pain

Cutaneous
Occurs at the dermal level, and is sharp, localized, and generally tonic. An example would be the prick of the needle when given an injection.

Visceral
Occurring at the organ level, could be sharp or dull. There is less localization and could either be tonic or episodic. Examples: uterine contractions, severe constipation, and intestinal gas.

Somatic
It occurs at the soft tissue level. It is dull, aching, not localized and usually tonic.

Nerve Compression
The pain results from pressure on one or more nerves. It may be localized, or be referred pain to one or more regions of the body.

Women with Disabilities -The Healthcare Team- Part 1

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When do you start your Search?

The search should begin as early in the pregnancy as possible. When you do a gynecological examination is the opportune time to decide if you are able to become pregnant. Hopefully, that will occur with a doctor with whom you feel comfortable.

But if the pregnancy was unexpected, or you have not found that great doctor with whom you feel comfortable, the earliest point of time is best. It is important for the baby’s sake. It has been discovered that women who receive care late in the pregnancy or have had no prenatal care at all tend to run a higher risk of infant mortality.

Finding a doctor may be a challenge. Some will immediately advise an abortion. Other doctors will become enthused by the challenges.

You need that doctor to know you well enough to understand the way the changes of pregnancy will affect you. Health issues unrelated to the disability you have will most likely need to be addressed early.

How to Find a Doctor

You could find the doctor via those with whom you trust. You may also get recommendations from the doctor who has been working with your disability.

Evaluating the Doctor’s Practice

The recommendations of friends with whom you trust can assist you in assessing the skills of the doctor. Or listening to the impressions of the patients the doctor has had in the past.

Sometimes there may be differing experiences; it’s in this instance that the opinion of an older and well-trusted doctor in the community may come in handy. There is no singular way to assess what doctor may work for you, other than knowing what you are looking for in the care administered by a doctor.

Check the office policies, by checking with the receptionist. You can ask about fees, for normal birth and caesarian section. Ask about payment and billing, insurance the doctor will accept. You will need to know what hospital the doctor is affiliated. Also check the doctor’s flexibility with requests, such as persons allowed to attend the birth, and whether the doctor will work with you on having a natural birth. Most importantly, check accessibility, if you are using a wheelchair…are the rooms and bathrooms set-up for your ease of use. The answers to these questions may narrow the choices of whom to visit.

You could ask for only a consult, rather than a visit with a full physical examination until you have decided upon which doctor you will use. Bring with you the father-to-be or an advocate. You then will have someone to share impressions and ideas with, or who would think of questions you may have not been able to think about in your nervousness.

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

Sexually Transmitted Infections – Part 3

Syphilis

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

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

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

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

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

Screening and Diagnosis

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

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

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

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

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

Management

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

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

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

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.