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

Effects of Marijuana on Pregnancy – Newborns

marijuana

Marijuana: Effects on the Mother

Prolonged use may lead to apathy, lack of energy, lack of desire to work or be productive, diminished concentration, poor personal hygiene, preoccupation with marijuana – the amotivational syndrome

Effects on the fetus

Marijuana can easily cross into the placenta, and causes increased levels of carbon monoxide in the mother’s blood, reducing the level of oxygen to the fetus.

With more states legalizing the sale of Marijuana, there are more users. Those that smoke or exposure to the smoke from their significant others who smoke, Need to be aware of the effect on the unborn fetus.

Issues

One issue with Marijuana use, is that often it has other street drugs combined with the plant itself. Or additional THC is added to compound the effects. These two, and other contaminants can create the issues that will be discussed regarding the development of the fetus, and the later development of the fetus through early childhood.

There have been few definitive studies conducted on humans as to the effects of Marijuana on the fetus. “A new study in animals suggests that children who are exposed to marijuana in the womb may suffer from a variety of long-term problems even if they aren’t born with obvious birth defects.”

One of the components of Marijuana, that the researchers call WIN, has shown an effect in studies conducted on lab rats. Although, not causing birth defects, Marijuana does cause memory loss and inability to learn. “Researchers say they also found that WIN interfered with the release of a brain transmitter called glutamate, a key chemical associated with learning and memory processing.”

An Italian research team found that marijuana caused a disruption from “chemical and electrical processes in the brain during gestation (Bhattacharya)” in lab rats. The effects the study indicates, can be confounded by smoking, wealth, and urban living.

Even second-hand Marijuana smoke can affect the unborn fetus. It can cause your baby to be born premature, and have a lower birth weight, both are risks for the baby. Studies are few and far between, due to the risks involved on the fetus. “In the very few studies available, there appears to be an increase in the incidence of premature labor and low birthweight. In cases in which pot had been tainted with a stimulant (cocaine, for example), there was an increased risk for dangerously fast labors (less than three hours) and for placental abruption (separation of the placenta from the uterine wall)” states Dr. David Barrera.

Observation has shown that “…babies born to women who abused marijuana during their pregnancies display altered responses to visual stimuli, increased tremulousness (trembling or shaking), and a high-pitched cry — any of which may indicate neurological problems in development”. Later in the child’s development these children have a lack of problem-solving skills, and poor memory.

Based on a study conducted by University of Utah School of Medicine, Salt Lake City, and colleagues in the Eunice K. Shriver National Institute of Child Health and Human Development, babies born to smokers of Marijuana are two times more likely to have stillborn babies.

REFERENCES:

Bhattacharya, Shaoni. Marijuana use in pregnancy damages kids’ learning. 25 March 2003 http://www.newscientist.com/article/dn3543-marijuana-use-in-pregnancy-damages-kids-learning.html#.VQWPAeGgZ-8

Hackethal, Veronica MD. Smoking Pot May Double Risk for Stillbirth. http://www.medscape.com/viewarticle/817503 Medscape Medical News. December 9, 2013

Herbert, Clare. I’m pregnant and my partner smokes weed. Will it affect our baby? http://www.babycentre.co.uk/x1043727/im-pregnant-and-my-partner-smokes-weed-will-it-affect-our-baby#ixzz3USuXGKAG November 2014

How could marijuana use affect your unborn baby? http://www.pregnancyandbaby.com/pregnancy/articles/937071/secondhand-toke-marijuana-pregnancy

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.

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

Issues Part 3

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

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

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

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

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

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

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

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

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

Other Factors Regarding Childbirth in Indian Country

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

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

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