Friday, March 18, 2011

5 Things Every Pregnant Mom Should Know...

I love lists. I've had several "5 Things..." lists in my head.  They are quite random, but hopefully they'll help someone out there!  
1. What you eat matters just as much as how much you eat.   It's easy to think "any calories are good calories," but that's just not true.  I know this goes against what a lot of people say & think, but think about it:  the baby is made of what you eat... or needed nutrients are pulled from your storehouses, including teeth, muscles, organs and bones.  Not a good situation for you there!  Seek to eat nutrient-dense foods in whatever quantities you need to stay full-- for me that was an insane amount (I thought) of meat, eggs, cottage cheese, cheeses, fruits, veggies, nuts/nut butters, and the occasional gluten-free baked good (a treat).  Not to say that you can't enjoy sweets in moderation (especially homemade ice-cream from full-fat milk!), but your baby honestly doesn't need it and neither do you.  (As a comfort for those who think that nothing sounds good at the moment:  at the beginning of my pregnancy- almost the first five full months- I was dependent on real ginger ale (I mean the kind that actually has pieces of ginger root in it) sipped throughout the day, and 4 oz of Coca-Cola (had to be actual coke, not a knock-off) in the morning to keep ANYTHING down at all... )  I've found Nina Planck's book Real Food for Mother & Baby to be the best new-mom-dietary book out there... both readable and nutritionally sound.  It's SO much better than What to Expect, which suggests the low-fat, low-meat approach so prevalent in our unhealthy culture today.  Developing babies NEED fat, and how are they going to get it unless you eat it?

2. If your water breaks before your labor starts, going to the hospital is NOT a good idea.  I wish I could yell this from the tallest roof downtown.  I don't know how many of my personal friends (healthy, not Group-B Strep positive) have been frightened with "you have to have that baby in 24 hours or else we're doing a c-section."  Even more have been told that their labor had to have started in 24 hours or else they'd do an induction (which is usually way more painful than natural labor, technology-ridden- you're strapped to an IV and must be monitored round-the-clock) and prone to complications and further interventions.  Why?  The main concern is that infection is nearly inevitable once the bag of waters ruptures.  My friends, this is simply not true.  Let me make it very clear:  the only way a healthy (non-GBS+) mom could possibly get an internal infection while leaking fluid is if bacteria traveled "upstream" into the uterus. The main way that happens is if it is pushed in via an internal exam. 
Despite a lack of evidence, there is a widespread impression among providers that when duration of rupture of membranes exceeds 24 hours, there is increased danger to mother and baby. Birth within 24 hours is a common management goal when the membranes are ruptured. This may lead to use of oxytocin and associated practices such as internal monitors and more frequent vaginal examinations, which are in themselves independent risk factors for infection.

Factors other than duration of rupture are known to increase risk of infection when membranes are ruptured. One strongly predictive factor is the number of vaginal examinations. The authors of the term PROM study point out that the number of vaginal examinations was more predictive of maternal infection than duration of membrane rupture. (see source here)
The more internal exams you have (the more times someone "checks you to see how far along you are"), the more likely infection becomes.  The first thing they will do at the hospital is to do an exam!! If, however, you stay at home, i.e., you don't have an exam, you probably won't get an infection.   (For those of us with more worry-wart tendencies, I'd suggest taking your temperature every hour or so once your water breaks to keep yourself from wondering.  If you did get an infection you'll get a fever and will then have plenty of time to get antibiotics or anything else needed.  You can also head to the hospital if you feel weird or freak out at any time!) If you stay home until labor starts (in 90% of women this happens within 48 hours) you'll be far more comfortable, less prone to infection (since no one is examining you), and less likely to need any other intervention.  (Even if you have Group-B strep, you have the option of beginning antibiotic treatment along with efforts to naturally start labor, like stair-walking and using a breast pump, instead of immediate induction.)

3. The average length of a first pregnancy is 41 weeks and a day.  That's over week past your "due date" (which is a ball-park estimate anyway) and that's an average, meaning as many women go longer as go shorter!  I've often scratched my head at women who say in one breath "God is in control and I'm trusting Him" and in the next "I'm getting induced on my due date because I'm so tired of being pregnant!"  If He's in control, can't you hang on until your labor starts in His timing?  There's rarely cause to induce a "post-due-date" baby, though it's recommended to keep a close eye on mom & baby as the due date comes & goes.  Getting induced because pregnancy is uncomfortable isn't a good idea (I don't mean when pregnancy is life-threatening, as in preeclampsia or toxemia, etc.)-- labor is uncomfortable, parenting a newborn is uncomfortable, and healing from a labor is uncomfortable!!  All of the above are often made more difficult by an induction.  Some women "bake" their babies longer-- seems to be genetic.  Other times, the due date or date of conception has been miscalculated.  Here's a good antidote to the idea that babies start to lose weight and be sickly if they "stay in" for too long.
A major conceptual problem with routine induction at 41 weeks is that the median length of pregnancy in healthy first-time mothers is 41 weeks 1 day. The conventional 40 weeks is just that: a convention. It is based on nothing more than a German obstetrician's fiat two centuries ago that since women cycle according to the moon, pregnancy lasts 10 moon months, that is, 10 months of 4 weeks each. Practitioners may argue over how great a deviation from normal warrants intervention, but in the case of routine induction at 41 weeks, they are arguing for intervening when there is no deviation from normal.  (Henci Goer, author of The Thinking Woman's Guide to Better Birth)
4. When you're in labor, laying on your back is usually the most painful position.  Wow, I speak from personal experience on this one.  When I had to lay down to be "checked" in labor, if a contraction happened before I could get back up it was agony (well, lying on my side was even worse, due to Eowyn's position). Walking around, squatting, leaning on Ryan, swaying, even just sitting up made the pain far more manageable.  Nothing was exactly comfortable, but it was doable!  This is a really good reason to avoid induction (as long as you have Pitocin dripping into you, you need to be monitored constantly, and few hospitals have wireless monitoring systems), as well as to opt for intermittent external fetal monitoring instead of continuous or internal.  Even in bed, though, you can move a bit.
How do you picture yourself during labor? Perhaps you've imagined yourself getting into bed, pulling up the covers, and simply lying there awaiting your baby's birth. Your husband mops your face with a wet washcloth while doctors and nurses flutter around your bedside. This image bears little resemblance to reality. If you really want to have your baby more quickly and with less pain, plan to get up and keep moving around as long as you can through labor.  [...]
But lying down has no medical benefits for most mothers. In fact, it carries several proven risks. When you lie on your back for long periods of time, the weight of the uterus compresses the descending aorta and inferior vena cava, blood vessels that supply or drain the lower part of your body. This interference with your circulation reduces your blood pressure, compromising blood flow to your baby and causing his heart rate to drop. When you stay upright (or at least off your back), placental circulation improves and fetal heart rate abnormalities may be alleviated. [...] A British study comparing mothers who walked during labor to mothers who stayed in bed demonstrated that walking not only shortened labor but also reduced pain and the need for medication.

How does walking help your labor along? For one thing, your contractions become stronger, more regular, and more frequent when you stand up. Gravity helps your baby make his way through your pelvis. Furthermore, the upright position improves both the angle of your baby's body to your spine and the application of his head to your cervix. Because your uterus naturally tilts forward in your abdomen during contractions, it meets the least resistance when you are standing, leaning slightly forward.  (The source article is a good one to read!)

5. It's standard procedure to inject all newborn babies against Hepatitis B, but this is completely optional. Hep B is an STD, and if you don't have it, your baby isn't at risk... AT ALL.  Even if you choose to vaccinate for everything else, injecting an immune-stimulating drug immediately following the trauma of birth into a tiny person for a disease they aren't even able to contract is pretty pointless.  At the very least, hold off for a while! (You can read the risk factors for the disease here.)  Get your pediatrician & doctor (or midwife) to sign your birthplan for extra back-up.  Most practices test for Hep B during the 2nd trimester of pregnancy, and if you test negative and are in a monogamous relationship with another Hep-B-free person, most doctors will back you up no prob.

And a bonus...
6. Your milk usually doesn't come in until 3 days after your baby is born (sometimes it's delayed even more if you have a C-section).  A newborn's stomach is as big as an adult pinky (or picture a marble or thimble), which is why colostrum (first "milk") is super-dense and comes in very tiny quantities.  The newborn's stomach grows quickly, and as the baby nurses it tells the body to produce mature milk.  Most newborns also have quite a reserve of fat to get them through the first few days of learning how to nurse, etc.  I've had friends whose babies were given bottles in the hospital within hours of birth because "their milk hadn't come in."  The answer (unless the baby is tiny, malnourished and dehydrated) isn't a bottle in that situation; it's being put to the mother's breast as often as possible, and kept near her as often as possible!  Here's a good little article by a Lactation Consultant on the topic.  (Note:  this doesn't mean you will have to nurse on-demand for the baby's whole life; the first few days, even weeks, are pretty unique.)  (image credit)

So, what do you wish you could know or had known as an expectant parent? Any ideas for a "5 Things" list I could do?  Comment away!


Luke and Patty said...

Hey Christina! Thanks so much for your comment on my blog! I had actually already read your post on things that pregnant women need to know, and I would give a hearty AMEN! I was so blessed with my first though, in that I went into labor naturally (my water broke and contractions started) at 39 weeks. As far as diet while pregnant, it sounds like we do a lot of the same things as far as whole foods, unprocessed, natural, etc. (although, I have to admit the first trimester is rough...whatever I can keep down...lately that's been gatorade and least it's real popcorn with real butter and we pop it ourselves!). I totally agree with you on #4. I did give birth in a hospital, but I told them I did not want to be hooked up to anything (no IV, just intermittent monitoring, etc.). I spent most of my labor walking around the L&D ward, sitting on the birthing ball, taking a shower, etc. I don't think I could have birthed a 10lb 1oz. baby without an epidural if I'd been on my back the whole time! And as far as the Hepatitis vaccine, that is a very interesting argument that you make and one that I had never considered, so thank you for that! Ok, that comment was longer than I had planned...sorry...and I would LOVE for Eowyn and AK to meet one day!

Eowyn's Heir said...

Can't wait to hear how your next one goes, Patty! So excited for you (and Luke & AK)!! :)

Ceska said...

I probably bought 15 pregnancy books while pregnant with my first baby last year and this was by far the best one. Concise (even though long), organized, well indexed and all around well rounded. I recommend the mother of all baby books as well and will be buying the mother of all toddler books when the time comes.