Holistic Approach to Pregnancy

1. Holistic Approach to Pregnancy Shauna Braun Leah Crask

2. Pregnancy Basics • Pre-pregnancy health • Diagnosing pregnancy • Prenatal care • Gynecological and general health • Milestones • Testing and screenings • Risk factors • Labor and Deliver • Post Partum

3. Pre-pregnancy Health • Folic Acid • Recent pregnancy • Age • Current medications incompatible with pregnancy • Social and financial health

4. S/S amenorrhea; morning sickness; frequent urination; tingling, tender, swollen breast; darkening areola; blue or pick lines under skin breast/abdomen; food cravings; darkening line navel to pubis (linea nigra) Urine test in office or at home (OTC) Blood test Medical exam Call your practitioner as soon as you suspect your pregnancy Choosing a practitioner: obstetrician, family practitioner or nurse midwife? Types of practice solo practice, group, combo, birth centered, independent CNM Diagnosis Prenatal Care

5. Obstetrician (Ob-gyn) • Trained to handle every conceivable aspect of pregnancy • Can also take care of all non-pregnancy female health needs (paps, breast exams) • Best for high risk pregnancy, better still an obstetrician who specializes in your type of high risk pregnancy.

6. The Family Practitioner (FP) • One stop medical services for the entire family • Trained in primary care, obstetrics and pediatrics after receiving MD • Ideally familiar with your family dynamics and interested in all aspects of your health • If complications- may send you to OB, but remain involved

7. Certified nurse-midwife (CNM) • Emphasis on you as a person, rather than a patient, will take extra time to talk about feelings and problems • Oriented toward “natural” childbirth • More likely to treat pregnancy as a human condition rather than a medical one • CNM is a RN who has completed graduate programs in midwifery and is certified by the American College of Nurse-Midwives. • Trained to care for women with low-risk pregnancies and attend uncomplicated births • Sometimes may provide routine gynecological care • May work in a hospital, birthing center or do home births • In most states CNMs can prescribe pain medication • Less likely to include medication and routine medical interventions • Studies show for low-risk pregnancies deliveries are as safe as MDs • Select one that is certified and licensed.

8. Direct-entry midwives • Trained without first becoming RNs • More likely to do at home births • Some may also delivery at birthing centers • Those evaluated by the North American Registry of midwives (NARM) are called Certified Professional Midwives (CPM) • Other direct entry midwives are not certified • Licensing for direct entry midwives is offered in some states, for more info call Midwives Alliance of North America or check their website www.mana.org

9. Solo Medical Practice • MD work alone using another MD to cover only when unavailable • See same practitioner at every visit • Most likely your MD will deliver your baby, but if unviable than a MD you’ve never met before will deliver

10. Partnership or Group Practice • OBs or FPs • Can see a different MD each time to get to know them all • May not like all equally and will be unable to choose who will attend birth • Hearing different points a view can reassuring or unsettling

11. Combination Practice • One or more OBs and one or more CNMs • Same benefits and drawbacks as a group • Some visits extra time and attention a midwife may offer • Access to CNM and security of MDs extra training and expertise

12. CNMs provide most of the care MDs on call as needed Low-risk patients only May have to change practices if complications arise May be transferred to hospital for emergency care Maybe deliver at home, hospital or birthing center Personalized pregnancy care Low-tech and natural delivery Covered by most health plans, only some will cover births outside of hospital Should have MD on call for emergencies Birthing Center Inde CNM

13. Gynecological and General Health • Practitioner should be informed of all aspects of gynecological history to provide the best care. • Multiple 2nd term abortions increase risk of premature delivery • Obesity- increased risk of gestational diabetes and high BP, difficulty dating preg. • Age • Over 35 > risk of Down’s elevated BP, diabetes, cardiovascular strain, miscarriage, preeclampsia, preterm labor, longer labor, interventions needed

14. Risk Factors • Maternal Age • Pregnancies too close together • Previous cesarean (c/s) • Obesity • Rh negative & incompatibility • Fibroids • Endometriosis • Incompetent cervix • Herpes & other STDs • Family history of genetic disorders or congenital defects • Couples with history of 3 or more consecutive miscarriages • Positive screening test • Diabetes • High blood pressure • Diabetes

15. Milestones • 5-8 weeks fetal heart rate (FHR) can be see via intravaginal ultrasound (U/S) • 9-13 weeks external genitalia developed enough to determine sex; FHR heard & seen with Doppler or U/S; U/S for dating • 18-22 weeks fetal movement, showing; level 2 U/S • 25 viable if delivered • 32 + weeks Braxton hicks contractions, colostrum; usually head down; • 36 weeks changes in fetal movement • 37 weeks term, lightening and engagement, For more info visit http://www.smanutrition.co.uk/PlanningPregnancy/Pregnancy/development.htm

16. General Testing & Screening • Every visit urine test for sugar & protein; fetal heart beat; fundal height; BP; weight • First month 1-4 wks: pregnancy test; blood type & Rh status; urinalysis; antibody for diseases i.e. rubella, STDs; genetics i.e. CF; pap; blood sugar • 10-14 wks: 1st trimester screening U/S • 15-18 wks: 2nd trimester screening AFP (alpha fetoprotein)- spina bifida, downs, & other chromosomal abnormalities • 7 mo 28-31 wks: glucose screening test; Hct & Hgb • 8 mo 32-35 wks: GBS • > 40 wks: non stress test

17. Special Testing & Screening • CVS or chorionic villis sampling- 1st trim. test to detect chromosomal abnormalities ie- downs, tay- sachs, sickle cell, CF. Tube takes piece of chorion/placenta • Amniocentesis needle takes amniotic fluid for genetics testing • NST/ non stress test indicates if the fetus can remain in the uterus and how it may respond to labor, condition of placenta. • CST/ contraction stress test- same as above but with stimulated contractions. • Biophysical profile- uses U/S evaluates 4 aspects of life- fetal breathing, fetal movement, fetal tone, amniotic fluid volume • Umbilical artery Doppler velocimetry For more info visit http://hcd2.bupa.co.uk/fact_sheets/html/Screening_pregnancy.html

18. Birthing Options • Family-centered care, not yet offered everywhere, but trending to. • LDRP or LDR- labor, delivery, recovery and ideally post partum rooms. • Birthing chairs- gravity can speed delivery • Lebyer Births- with out violence: soft music, soft lights, and warm bath. No longer routine unending and slapping baby’s bottom, umbilical cord cut delayed, direct to mother’s arms. • Water birth- concept of delivery under water to simulate the uterus environment. Baby is pulled out of the water and placed in the mother’s arms immediately after birth. Breathing doesn’t begin until infant is exposed to air, little risk of drowning. Only for low risk pregnancies. For more info and how to find a water birth http://www.waterbirth.org/spa/ • Home birth • Labor room, Delivery room, recovery room and nursery • For more info visit http://www.ahealthyme.com/topic/topic13265 or http://blueprint.bluecrossmn.com/topic/topic13265

19. Birthing options Mucous plug, bloody show Rupture of membranes Back Labor IVs Fetal monitoring Labor Positions Pain Management Types of Delivery: vaginal, cesarean, VBAC, forceps, vacuum Stage 1 Labor Phase 1 Latent phase: effacement & dilation to 3 Phase 2 Active phase: dilation of cervix to 7 Phase 3: Transition: dilation to 10 INTENSE Stage 2 Delivery Stage 3 Delivery of placenta Labor and Deliver For more info visit http://ehc.healthgate.com/GetContent.asp?siteid=1853D48C-AD5D-4ACB-A0C4-9DCEEA0E6A98&docid=/hic/pregnancy/preg/labor

20. Pain Management During Labor • Physical Therapy: massage, heat, pressure, counter-pressure, reflexology • Flower Essences • Counter Pressure on back • Hydrotherapy • Biofeedback • Acupuncture, Acupressure • Hypnosis • TENS Transcutaneous Electrical Nerve Stimulation • IV & IM Narcotics: Morphine, Fentanyl, Demerol, • Tranquilizers: Phenergan, Vistiril • Oral Narcotics for early labor • Epidural, Spinal and other regional blocks • General Anesthesia • Distraction: watching TV, music, meditation, breathing exercises, etc… Visit http://www.reddinganesthesia.com/labor.htm for more information.

21. Early Labor Positions • STANDING Helps work with gravity; contractions less painful; helps backache; may speed labor; aligns the baby with the pelvic angle; could become tiring, but less tiring if you lean forward supported by partner. • WALKING Same advantages as standing, plus may encourage descent of the presenting part • SITTING Works with gravity; may be able to rest; sitting cross-legged may open pelvic outlet; fetal monitoring possible; can slow labor after a long period. • HANDS AND KNEES Helps relieve back pain; may rotate posterior baby; tiring for long periods • KNEES, CHEST SUPPORTED Same as hands and knees, but less strain on arms. • SEMI-SITTING Same as sitting; increases back pain. • LYING ON SIDE Lowers blood pressure; excellent resting position; contractions may be longer • LYING ON BACK Least effective for progress of labor; may become hypotensive and the baby may become distressed; may increase backache; fetal monitoring can be done. www.mjbovo.com

22. FORTY-FIVE DEGREE ANGLE. Widens pelvic outlet; uses gravity to some extent; better for backache than lying down; (Legs pulled up may work well with epidural; back and shoulders elevated) LYING ON SIDE Lowers blood pressure; eases backache; easier to relax between pushes. HANDS AND KNEES Excellent for rotating posterior baby; reduces backache. SQUATING Uses gravity to help the baby descend and rotate; partner can support your back and arms; widens pelvic outlet. LITHOTOMY Lying back with legs in stirrups; good for forceps or vacuum, extensive episiotomy, delivery of breech. SEMI-LITHOTOMY Same as lithotomy, with head and shoulders elevated For more info visit http://www.transitiontoparenthood.com/ttp/parented/pain/positions.htm Second Stage Positions

23. http://www.amazingpregnancy.com/weekbyweek/laborandbirth/jeannie/11.htmlhttp://www.amazingpregnancy.com/weekbyweek/laborandbirth/jeannie/11.html

24. http://www.amazingpregnancy.com/weekbyweek/laborandbirth/jeannie/15.htmlhttp://www.amazingpregnancy.com/weekbyweek/laborandbirth/jeannie/15.html

25. Alternative Health Care for Pregnancy

26. Alternative Pregnancy Health Care • Herbs • Acupuncture • Moxabustion • Massage • Reflexology • Aromatherapy • Flower Essences • Chiropractic Care • Yoga • Hydrotherapy

27. Western Herbs and Pregnancy There are many herbs known to be beneficial during pregnancy and post-delivery. Herbs are an excellent source of vitamins and minerals. Herbs can be made into teas or incorporated into foods.

28. Herbs and Pregnancy • Aloe Vera • Angelica • Autumn Crocus • Barberry • Black Cohosh • Celery Seed • Cinnamon • Devil's Claw • Goldseal • Hyssop • Juniper • Male Fern • Mandrake • Parsley Seed • Pennyroyal • Pokeweed • Rosemary • Rue • Sage • Southernwood • Tansy • Thuja • Wormwood • Yarrow • There are some herbs which are not safe to use when pregnant. These herbs can stimulate the uterus.

29. Herbs and Pregnancy • Raspberry • Nettle leaves • Oats • Dandelion root • Alfalfa • Yellow dock • There are many herbs which are helpful during pregnancy and have been used by women for generations.

30. Herbs for Morning Sickness • Some herbs can work well for morning sickness but should be taken under the guidance of an herbalist • Chamomile • Ginger • Peppermint • Black Horehound

31. Herbs for Labor Golden Seal Can be taken during labor to assist the uterus but should never be taken during pregnancy.

32. Acupuncture Regular treatments throughout pregnancy can: • Enhance the mother’s health • Prevent complications • Influence the development of the baby • Help relieve morning sickness

33. Acupuncture for the 1st Trimester During the 1st trimester acupuncture can help to relieve: • Fatigue • Migraines and headaches • Bleeding

34. Acupuncture for the 2nd Trimester During the 2nd trimester acupuncture can help to relieve: • Heartburn • Hemorrhoids • Stress • Edema • Elevated blood pressure • Excessive weight gain

35. Acupuncture for the 3rd Trimester During the 3rd trimester acupuncture can help to relieve: • Sciatica • Backaches • Public and joint pain • By 32-34 weeks acupuncturist will begin to encourage a head-down position • Last 4-6 weeks treatments will be focused to normalize and optimize labor

36. Moxabustion If a baby is in the breech position many acupuncturists will use moxabustion to turn the baby. This technique has been used for centuries in China. • Moxabustion is a long stick of moxa or the herb mugwort that is lit and produces a gentle, smoldering heat. • Moxa is held by an acupuncture point on the little toe. • This is most effective when used at 32-36 weeks of pregnancy • Should only be used with healthy pregnancies • Can also be used in the treatment of nausea

37. Prenatal Massage There are some specific positions for prenatal massage to keep the mother comfortable and to limit pressure. • Lying on side • Lying on stomach with specially designed pillows cutout at the stomach so the mother can lay flat and be relaxed • Propped up while lying on back- after 22 weeks lying flat on your back can cause pressure on deep blood vessels, reducing circulation to mother and baby.

38. Benefits of Prenatal Massage • Emotional support and nurturing touch • Relaxation and decreased insomnia • Stress relief on weight-bearing joints • Neck and back pain relief • Assistance in maintaining proper posture • Preparing muscles used during childbirth • Reduced swelling (edema) • Lessened sciatic pain • Fewer calf cramps • Lessened headache and sinus congestion • Aiding circulation, keeping blood pressure in check • Relieve depression and anxiety • Help stabilize hormone levels • Increase flexibility (helpful in the last trimester) • Help to relieve cramps, constipation, nausea and indigestion • Helps to prevent stretch marks

39. Prenatal Massage Precautions • Massage is generally not recommended in the first trimester • Avoid during morning sickness (an increase in circulation can intensify morning sickness) • Avoid if the mother has excessive swelling in the arms or legs, fever or vaginal bleeding • Avoid deep work on the abdomen • Avoid deep pressure applied to the area between the ankle bone and heel and the webbing between the thumb and index finger (these areas are related to the uterus and vagina and pressure can promote/induce labor

40. Reflexology and Pregnancy Reflexology is based on the idea that points on the hands and feet correspond with specific organs and systems in the body. Therefore pressure is applied to certain points and the related area of the body is stimulated and cleared of congestion. Reflexology also promotes deep relaxation thereby encouraging the body’s natural healing process.

41. Benefits of Reflexology during Pregnancy • Morning Sickness • Nausea and headaches • Pain and discomfort • Loss of bladder control • Backaches • Stress and Anxiety • Sleeplessness and Fatigue • Digestive Problems • Constipation and diarrhea • Swollen or puffy ankles and legs • Cramps • Gestational Diabetes • Heartburn • Help to turn posterior babies • Help to turn breech babies • Induce labor Reflexology can help to relieve the following complaints during pregnancy:

42. Reflexology During Pregnancy Precautions • Go to a Reflexologist who is experienced with treating pregnancy • Generally recommended that if the mother has not received reflexology treatments before pregnancy she should wait until week 18 to begin treatments • Some medical conditions (such as septicemia) could reduce the effect of treatment • Any unusual results of treatment should be referred to a medical doctor (i.e. vaginal bleeding)

43. Aromatherapy During Pregnancy Aromatherapy can help with many emotional discomforts during pregnancy as well as some of the physical discomforts.

44. Benefits of Aromatherapy • Aid in relaxation • Assist in dealing with stress • Help ease aches and pains as the pregnancy progresses • Help alleviate tiredness • Help reduce stretch marks by keeping the skin well nourished • Help the mother feel good about herself • Provide some relief from varicose veins • Help the mother stay in touch with her body

45. Aromatherapy During Pregnancy The way essential oils work is by entering the blood stream through the skin. They are mixed with carrier oils in order to not avoid irritating the skin. When a women is pregnant less essential oils should be used, making the carrier oil less concentrated (advised to use only 5 drops per 1 once of carrier oil). Essential oils can also be used by inhaling the scent such as through a diffuser or on a tissue.

46. Tips for Using Aromatherapy During Pregnancy • Massaging abdomen, breasts and thighs with essential oils can reduce stretch marks (use a carrier oil such as avocado oil which is very nourishing for the skin) • Add 3-4 drops of an essential oil to a warm bath for relaxation (avoid hot baths during pregnancy) • Put 5 drops of essential oils on a tissue and inhale • Use in a couple drops in a spritzer with water

47. Aromatherapy Oils for Use During Pregnancy • Benzoin • Bergamot • Lemon • Neroli • Sandalwood • Spearmint • Grapefruit • Ylang Ylang • Mandarin • Orange • Tea Tree • Lavender (avoid in 1st trimester or if history of miscarriage) • Patchouli • Vetiver • Rose • Tangerine • Jasmine • Chamomile The following oils are generally considered safe for pregnancy (though there are many conflicting points of view and some say to avoid all essential oils or stimulating essential oils in the 1st trimester):

48. Aromatherapy Precautions During Pregnancy • Basil • Cedarwood • Clary Sage • Cypress • Fennel • Jasmine • Juniper berry • Marjoram • Myrrh • Peppermint • Rosemary • Thyme • Pennyroyal • Oregano The following essential oils should be avoided during pregnancy: • Lavender, rose, chamomile and geranium should be avoided in the 1st trimester or if there is a history of miscarriage otherwise they are generally considered safe to use

49. Flower Essences and Pregnancy Flower essences are herbal remedies which contain the energetic healing pattern of flowers infused in water and preserved with alcohol. Flower essences interact with the human energy field to harmonize the emotions, clear and calm the mind and bring about a sense of peace and well-being. (Flower Essences for Pregnancy and Childbirth by Peggy Rada, September 1999)

50. Usage of Flower Essences During Pregnancy Flower Essences: • Can be used throughout pregnancy and labor • Have no side effects • Can be used by everyone • Can be used alongside other treatments or therapies