An Empowered Woman’s Guide to a Healthy Pregnancy

By Dr. Nancy Salgueiro

© Nancy Salgueiro, 2011. Except as provided by the Copyright Act of Canada no part of

this publication may be reproduced, stored in a retrieval system or transmitted in any

form or by any means without the prior written permission of the publisher.

Table of Contents

INTRODUCTION FINDING OUT YOU ARE PREGNANT Signs of Pregnancy and Pregnancy Tests How Does Finding Out You Are Pregnant Make You Feel? Telling Others the News

Your Estimated Due Date

CHANGES IN YOUR BODY Menstrual Flow Fatigue Changes in Appetite Nausea or “Morning Sickness” Changes in Your Breasts Increased Need to Pee Relaxin Center of Gravity Skin and Hair

THE 5 PILLARS TO A HEALTHY PREGNANCY Nutrition

Exercise Sleep and Rest Positive attitude

Optimizing Your Brain-Body Connection

CHOOSING A PROVIDER

Midwives Family Physicians Obstetricians

PRENATAL TESTS Urinalysis

Blood Test Glucose Tolerance Testing Ultrasound/Sonogram Doppler Non Stress Test

Prenatal Genetic Screening Chorionic Villus Sampling (CVS) Amniocentesis Fetal Tissue and Blood Sampling

WHAT TO EXPECT IN EACH TRIMESTER First Trimester Second Trimester Third Trimester PLANNING FOR BIRTH AND POST PARTUM Making a Birth Plan

What to plan

EMERGENCY CHILDBIRTH A REFERENCE GUIDE FOR STUDENTS OF THE MEDICAL SELF-HELP TRAINING COURSE

“For me an empowered birth is one where I make the decisions for me and my baby. I

am in an environment of love, support, and respect for the power within my body to

successfully birth my baby. I can be free to express anything I need to express; sound,

movement, fear, love, ecstasy without interference from the outside. I believe women have

the ability to create an empowering birth experience regardless if the birth outcome is

natural, medicated, or surgical. When women are making the decisions for their bodies

and their babies with education, faith, belief and confidence in themselves and not fear or

manipulation they will be empowered. I believe in the human body, in its power, and in

birth’s ability to transform a person, woman, wife, and mother.” Dr. Nancy, Your Birth

Coach

INTRODUCTION

Pregnancy is an exciting time in a woman’s life. You may have been planning this for some time or maybe it has come as a surprise. Either way, pregnancy can be a wonderful and transformative period in any woman’s life. Pregnancy is a time when your health matters more than ever before. Staying in the best health is important to minimize the risks that pregnancy poses, to keep you feeling well and also to help your baby develop to its full potential. We all want the best for our children and that starts by having a healthy pregnancy. This book will help you to achieve optimal health during your pregnancy, naturally. As a parent, you will be making numerous choices for your child, using your own judgement and values to determine what is best for your baby. You may not be aware but your parenting choices have already started. It is best to be making pregnancy and childbirth choices fully informed and educated about the risks, benefits, and consequences of your choices. This guide will help you navigate all the decisions that you will need to make throughout your pregnancy. The outcome of your pregnancy will be the result of the choices you make. You are responsible for what you choose in your pregnancy and what you allow others to choose for you. Being empowered during pregnancy, birth, and the postpartum period means that you are making your own choices and taking responsibility. This book is not designed to be a substitute for proper prenatal care. Every pregnancy is different and every woman’s health needs are different. You may have a perfectly normal pregnancy with no complications or you may need medical care. This book is designed to show you the range of health choices you will be making throughout your pregnancy. Please seek out medical advice when appropriate.

FINDING OUT YOU ARE PREGNANT Signs of Pregnancy and Pregnancy Tests There are a few signs that show that you are pregnant. If you were planning this pregnancy and have been charting or tracking your cycles, you may suspect conception before you even miss a period. Some signs of pregnancy may include sore, tender, or swollen breasts, fatigue, or frequent urination. You may also experience implantation bleeding, headaches, or nausea. Most often women only suspect they are pregnant after they miss or are late for a period. The next step is to confirm your pregnancy. The test to confirm pregnancy is an HCG test. This is a test for the hormone human chorionic gonadotropin (HCG), which starts to be released once you are pregnant. HCG tests are available at drug stores and grocery store pharmacies and are commonly referred to as home pregnancy tests. You may even be able to find inexpensive versions at boutique baby shops and even your local dollar store for a fraction of the price of the drug store brands. Don’t fall for fancy advertising and pretty boxes, these tests all test the exact same way, just in different packaging. Sometimes after taking a home pregnancy test, you will notice a line that confirms your pregnancy. That line may be faint. If a line is present it means you are pregnant no matter how light or dark the line. This has no bearing on the quality of your pregnancy. If you are uncertain, test again the next day or in a couple of days. Your HCG hormone levels will be higher a few days after you miss your period than on the day after you miss it. HCG levels in your urine are also more concentrated in the morning and your first morning pee is the best to test. There is no need to have your physician do a test to confirm your pregnancy; it is just a repeat of the test you already preformed at home. Some physicians will recommend an ultrasound to confirm pregnancy but this is almost always unnecessary and poses some potential risks to your unborn baby. If you have not had a period and have a positive pregnancy test, you are pregnant. How Does Finding Out You Are Pregnant Make You Feel? Finding out you are pregnant can bring, different emotions. Even if you were planning this pregnancy you may find yourself facing some unexpected feelings. You may be so excited that want to shout it from the roof top. You may feel embarrassed or even slightly ashamed when telling your family. Confirming to your parents that you do actually have sex may bring up these emotions even if you have been married and planning pregnancy for a while.

You may be apprehensive about being pregnant, and about how it will impact your finances. You may be nervous about what your partner may say or think about being pregnant. If you got pregnant sooner than expected you may have some challenges accepting the pregnancy. If you have a history of abuse or sexual assault this too may influence your initial feelings. It is normal to experience a variety of emotions upon finding out that you are pregnant. Accept these feelings and make peace with them so you can start loving your baby. Telling Others the News Some people choose to keep their news a secret until they are 12 weeks pregnant; others want to share it immediately. This is completely up to you. You may want to consider how you will tell others about your pregnancy. Some people make sharing the news a momentous event in itself. Others choose to be reserved or even secretive at first. Miscarriage is more likely during the first 12 weeks of pregnancy and some people feel that if they do miscarry, there is no need to deal with others’ reactions to this loss. On the other hand if you do miscarry and no one knows you were pregnant you may feel like you don’t have any support through your loss. You need to decide how you would think and feel and if you had a loss. Would want the support of your family and friends through whatever happens? Don’t wait until 12 weeks to start to enjoy your pregnancy and your baby. Enjoy each day because this time of pregnancy will not last forever. Enjoy all the time you get. The Problem with Due Dates

There are a few things to consider about due dates. First we say that pregnancy lasts 40 weeks. This isn’t actually the case.

The term “due date” is a misconception (no pun intended!). It implies that you are “due” to have your baby by a specific date; in fact, this is not the case.

You are not “due” to have your baby by 40 weeks. You are not “overdue” when you hit that magic date. Every pregnancy will last a different amount of time. Anywhere between 37 and 43 weeks is considered normal. 80% of babies are born within the 2 weeks before or after 40 weeks and only about 5% of babies are born on their “due dates.”

It was noticed that pregnancy lasts approximately 10 moon cycles which would be 40 weeks. This is where this number came from. The average pregnancy is actually 40 weeks + 3 days and the average first time pregnancy is actually 41 weeks +1 day. Therefore, as a first time mom, if you are at 40 weeks + 8 days you haven’t even gone beyond the average.

We use averages as if they mean something expected or ideal. There is nothing ideal about being average.

Average only means the average of when all women give birth. Average could mean for every baby born 14 days before, there is one that is 14 days after. Another way of stating that is 50% of babies will be born before their due date and 50% will be born after. We are not striving to be in the middle, it just gives us a framework to expect for. Anytime within the 3 weeks before or after that date could be when your baby decides to arrive.

Another problem with due dates is how we calculate them.

Most dates are calculated based on the first day of your last menstrual period. We add 40 weeks to that number and that is your due date. This does not factor in ovulation and conception dates. Every woman’s cycle is different; some are 28 days and some are 35 days. We typically ovulate in the middle of our menstrual cycles but this is not necessarily the case for all women. Ovulation could be on day 11 or day 21 or anywhere in between. That means a 10 day discrepancy on the 40 week pregnant mark. Adding 38 weeks to the date of conception, if known, would be more accurate,, but again that date would just give you a better time range for adding 3 weeks before or after.

Ultrasound is yet another confusing factor for calculating a due date.

Many women have their due dates changed based on ultrasound. Again we are basing this on averages. When measuring a fetus we say, “Based on the size of the fetus, it is X days/weeks old, therefore your due date is…”which assumes that all people grow and develop at the same rate. This would be like saying, “You are 4 foot 10 today so that means you are 12 years and 52 days old. “ or like saying, “OK you have now developed the beginning of breast tissue so you are 12 years and 82 days old.”

Everyone grows and develops within individual time lines. Averages don’t mean anything. An average just means that if you take the entire population and plot it out, we average at certain mean numbers. Most are above or below and a few will actually fall exactly on the average. To say your baby is a certain age because of the average, is not an accurate estimation for a pregnancy.

Can we expect a baby born to two six foot parents to be the same size as a baby born to two 5 foot parents? How can we say they will be the same size on the same date when one may end up being 9 pounds and the other barely 6 pounds by the end of the pregnancy.

Add in human error; when looking at measuring crown to rump length, you may get completely different measurement with different technicians. Ultrasound can be off by as much as 4 weeks when dating a pregnancy. Accuracy with dating is higher early in pregnancy than it is in later pregnancy.

If you truly have no other way of guestimating your due date earlier ultrasounds are more accurate than later ones. This is because fetal development in the very early stages is more consistent from baby to baby than in later weeks.

So where does that leave us?

We need to be a lot more relaxed with our expectations about due dates.

It is advisable that moms be ready by 37 weeks and then add 3 weeks to the 40 week date so that you don’t start to feel like “the baby is going to stay in forever!” When you get into your head that your baby will be born by a certain date, you can start to get frustrated and upset about still being pregnant. When people ask your “due date” give them a month or a range like “anytime from mid September to late October.” This creates less focus on a specific date or time frame.

Many hospitals and care providers have made it a policy to limit the length of a pregnancy, leading to unnecessary inductions. Women are frequently told they “must” be induced because they are 10 days post dates (40 weeks+10 days). When there is no medical reason for this induction, forcing a baby to come before it is ready leads to riskier births with interventions, and it can also cause the baby to be born premature. Many babies taken before labor starts naturally are born with signs of prematurity even when Mom is considered full term.

CHANGES IN YOUR BODY Every woman is different and every pregnancy is different. You may experience some or none of these changes which can last for a short period or for the entire 9 months. Menstrual Flow You may not entirely miss your first period when you get pregnant. You may still have some bleeding around the same time as your period. This is implantation bleeding and is likely a lighter flow than your regular period. Fatigue Your body is working hard to provide everything your baby needs and you may feel the extra strain on your body in the form of fatigue. You are also releasing the hormone progesterone which is a hormone that relaxes you and makes you feel sleepy. It is important to listen to your body and get the extra rest needed. Take naps and go to bed early. Changes in Appetite You may find yourself very hungry or you may have no appetite at all. Some moms feel ravenous early in pregnancy and feel like they could eat all day. You may be hypersensitive to smells and tastes and may be turned off of food you used to like.

Typically you only need an extra 300 calories per day to maintain a healthy pregnancy, don’t start “eating for two”. If you are craving certain foods listen to your body as long as they are healthy whole foods and not processed junk foods. Nausea or “Morning Sickness” Some, not all, women get what is commonly referred to as morning sickness. The nausea or queasiness experienced by some women is more common in the morning or when the stomach is empty. It typically only lasts until the 12-14 week of pregnancy but in some cases can last throughout pregnancy. There are a number of natural ways to deal with nausea in pregnancy.

• Eat small frequent meals including complex carbohydrates throughout the day to maintain blood sugar levels

• Avoid simple sugars that cause large rapid changes in blood sugar levels.

• Eat as soon as you wake up in the morning (have a snack ready by the bed)

• Have a snack if you wake up to pee at night • Only take vitamins and supplements on a full stomach

• Be sure your B vitamin levels are high, especially Vitamin B6 • Eat ginger or steep a teaspoon of freshly grated ginger in hot water to make tea.

• Herbal teas like chamomile, lemon balm, and peppermint can also help

• Rest and reduce stress Changes in Your Breasts Early on your breasts may start to feel sore and sensitive. They may also increase in size and feel heavier and fuller. Your nipples may start to enlarge and the dark areas around your nipples, your areolas, may also enlarge and get darker in color (this is to help to increase the contrast between your skin and nipples so your baby can find the breast easier). Increased Need to Pee You may be surprised at the increased need to urinate early on in pregnancy. This is due to the pressure on your bladder by your enlarging uterus and also because your kidneys are working harder to filter your now larger blood volume. Even though your baby may be the size of a pea, your uterine lining is thickening to be able to nourish the baby. Relaxin The hormone Relaxin is released during pregnancy to relax your pelvic muscles so your pelvis will open for birth (up to 30% as long as you are not lying down or semi seated during delivery). During pregnancy this relaxing of ligaments can increase the likelihood of sprains and sacroiliac joint pain. This is a great time to see your chiropractor; ligaments loosening you a great window of opportunity to correct previous spinal issues. Being under chiropractic care at this time will also help you deal with any symptoms that may arise from pelvic instability.

Center of Gravity As your baby and uterus grow, your center of gravity will change and you may have some loss of normal balance and body awareness. A routine of prenatal yoga and chiropractic care can help you with these changes. Skin and Hair You may have that beautiful pregnancy glow. This is because of the increased blood volume and blood flow to your skin. You may also find yourself with other skin changes like rashes, acne, darkened patches of skin, or a linea nigra (a dark line that appears down the midline of your abdomen). These are normal changes due to the hormones of pregnancy and will go away after you give birth. You may also find your skin itchy and you may develop stretch marks. Stretch marks are often considered unavoidable. They happen when your skin is stretching and can show up literally overnight. To help avoid stretch marks be sure your skin is properly hydrated by drinking 3 litres of water a day. You may find your hair is thicker and more abundant. It is common that your hair does not fall out as much during pregnancy but it will make up for it in the post partum period when you may feel like your hair is continually fully out.

THE 5 PILLARS TO A HEALTHY PREGNANCY These guidelines apply throughout life but are especially critical during pregnancy, nursing, and for developing children.

1. Nutrition

You are what you eat! And so is your baby. Your cells and tissues, and those of your baby, are formed using the building blocks of your diet. If you consume junk food the result will be junk cells and tissues and an unhealthy Mom and baby. However, if you eat good quality food, you will build good quality cells and tissues and will experience good health and quality of life. Your cells also gain energy through your food. Good quality food will give your cells the best form of energy and will allow you to function at your best. Toxins and chemicals added to some food can damage your cells and more critically, your baby’s cells. The following are some things to Do and Don’t Do when it comes to nutrition. If you have specific questions about your pregnancy ask your holistic nutritionist, chiropractor, midwife, naturopath, or other provider trained in natural nutrition.

Do

• Eat 6 small meals daily or 3 regular meals with healthy snacks in between. You should eat something every 3 hours for better digestion (decrease heart burn, etc) and to maintain blood sugar for your energy and your baby’s growth. Avoid missing meals. Add 300 calories in 2nd and 3rd trimester and for nursing.

• Morning sickness has been correlated with low blood sugar. Keep a small snack by

your bed and eat before getting up in the morning. Some prenatal vitamins may also cause morning sickness. Vary the time of day you take your vitamins to see if this is the cause, and consider changing to a better quality supplement. Ginger is also very helpful in treating nausea. Make sure you have adequate B6 levels.

• Get adequate protein. Protein is the major building block of most tissues and

hormones. Eat a large amount of protein each day from sources like beans, lentils, nuts, and eggs. You need 75-100 grams of protein per day but it is the quality not quantity of protein that is important to prevent conditions like toxemia.

• Whole grains provide complex carbohydrates, protein, and fibre in your diet.

Vary the grains you use as many people have unknown sensitivities to wheat. • Essential fatty acids are in fact essential! Our bodies do not have the ability to

produce these fats and must be incorporated in to your diet. Essential fats, omega 3s especially, are critical for proper brain development for baby, better overall health for mom and baby, decrease depression postpartum, and healthy cells. There are many supplements on the market; however, many are not safe, especially during pregnancy, due to heavy metal and pollutants found in fish. There is good quality, filtered, pharmaceutical grade fish oils available from a handful of manufacturers. The average person gets more than enough omega 6 fats in their diet and does not need to supplement with omega 6 fats.

• Prenatal vitamins are important to ensure that you and your baby are getting

sufficient nutrients. Vitamins can help to prevent spina bifida, toxemia, and other conditions. Good quality supplements will help to avoid constipation caused by many poor quality vitamin supplements. Ideally your vitamins will be food based and not synthetic. (Materna made by Centrum, is one of the worst quality supplements on the market.)

• Add high amounts of fibre to improve digestion, to help maintain steady blood

sugar levels, and to prevent constipation. Sources of fibre include fruits, green leafy vegetables, other vegetables, and whole grains.

• Stay hydrated. Dehydration can cause a multitude of problems. Drink plenty of

unchlorinated, unfluoridated water. Coffee, tea, soda, fruit juices, and other beverages and fluids do not contribute to your daily water intake. Many of these

other beverages cause dehydration. General guidelines for water intake are to drink one 8-ounce glass for every 20 pounds of body weight, but drink more during pregnancy and nursing.

Don’ts:

• Preservatives and pesticides. • Genetically modified foods – there has been some question if GMO foods are

causing placenta and cord abnormalities • Artificial flavours and sweeteners

Aspartame – found in all diet soda and sugarless gum – turns into formaldehyde at body temperature and can cause birth defects and kills brain cells. Glutamate – hidden in many foods, usually listed as MSG, monosodium glutamate, hydrolyzed plant or vegetable protein, autolyzed yeast extract – kills brain cells.

• Artificial colours – have been linked with causing cancer and are a factor in

ADD/ADHD (as are artificial flavours). • Caffeine – in coffee, tea, soda, some fitness drinks – can cause miscarriages. • Trans Fat – in most pre-packaged food, usually listed as hydrogenated oil, partially

hydrogenated oil, margarine, lard, or shortening – leads to dysfunctional cell membranes therefore reduced function and reduced health, heart disease, and interferes with brain development.

• Refined and processed foods – high in many of the chemicals above and high in

simple carbohydrates – can lead to gestational diabetes causing a very large baby and high-risk birth.

Other non-food chemicals to avoid:

• Cigarette smoke - 1st or 2nd hand – decreases growth of baby, increases infant death

rates, and can cause miscarriage. Quit smoking as soon as you find out you are pregnant. There are hypnosis programs that may help with the transition.

• Over the counter and prescription medication – According to a study published in

the American Journal of Obstetrics and Gynecology almost 50% of pregnant women are prescribed drugs not known to be safe during pregnancy, known to be a risk to the fetus, or absolutely contraindicated during pregnancy. Do not assume any medication, prescription or over the counter, is safe. Always ask your doctor and read the product inserts.

• Hairsprays and hair dyes – anything you put on your skin gets absorbed into your blood stream. Any chemicals can increase the toxic load in your body and thus the toxins your baby is exposed to. You can try using henna hair dye or other natural dyes or hair dyes that are not applied to the scalp.

• Cleaning products and other chemicals: if you must use cleaning products, use

natural products, and wear gloves and a mask. • Recreational drugs and alcohol – avoid completely • Avoid changing kitty litter or do so only with gloves and a mask.

Exercise

Pregnancy is NOT the time to try to lose weight, however staying fit and active is very important. Maintaining a good level of fitness throughout pregnancy has many advantages including preventing complications during pregnancy, easier birth, easier transition to parenthood, and less effort in getting back your pre-pregnancy body. Think about birth as a marathon of unknown length. It may be a few short hours or if could be an ultra marathon and last a few days. Natural childbirth is more about endurance then strength; you just need to be able to keep going. This is easier if you are more fit. Pregnancy is your time to train for the marathon. How much you should exercise during pregnancy depends on how active you were before you became pregnant. If you were active you can and should maintain the same level of activity. You may need to change the type of activities you are involved with, especially through the last half of your pregnancy. If you were inactive you need to start to increase your level of activity slowly. Do not start a new aggressive exercise program. The best forms of exercise during pregnancy are walking, swimming, stationary bike riding, gentle or prenatal yoga, and Pilates. It is especially important to walk a lot during the last few weeks of pregnancy or if you are past due. Walking helps to stimulate the mechanisms that allow birth to take place. There are specific exercises to strengthen the abdominal and pelvic muscles and recommended during pregnancy, for example Kegal exercises, Pelvic Rock, and abdominal crunches. As squatting is the best position for a safe and easy birth, spend time strengthening your leg muscles by practicing squatting with support. Avoid weight lifting, straight sit-ups, and any other activity that causes increased pressure in your abdomen. Avoid twisting because it can cause torsion and unbalance in the pelvic membranes and interfere with birth (avoid playing golf, baseball, etc).

Avoid lying flat on your back later in pregnancy because it reduces blood flow, oxygen, and nutrients to the uterus and baby. When lying on your back put a pillow under your knees to relieve extra strain on your back. Listen to your body; if you start to feel short of breath, change positions. When standing, be sure to maintain good posture: pelvis tucked, shoulders back, chin slightly up and tucked. Don’t stand for long periods as blood can blood in your legs and cause varicose veins. If you are sedentary for any period of time, e.g. at work, traveling in a car or a plane, get up frequently to move, walk, and stretch. This can help to avoid dangerous blood clots. Always lift from squatting position, even to pick up something light.

Sleep and Rest

It is critical that you get adequate sleep and rest to maintain good health. Keep a regular sleep schedule, avoid fatigue and altered sleep habits. Be sure you have a supportive mattress and pillow and avoid sleeping on your back during the last half of pregnancy. Sleep on your side (most women prefer to sleep on the left) with a pillow between your knees. You may also need a pillow under your tummy to prevent pulling on the other side. Keep a note pad beside your bed to write down thoughts that may keep you awake. Take time to rest during lunch or other breaks at work, after periods of high stress like after the kids are off to school, before dinner and bed. Avoid stress and use relaxation techniques like meditation and visualization. These will also serve useful post pregnancy. Relaxation has many positive effects including decreased fear and anxiety, reduced effect of stress hormones on mom and baby, increased blood flow and nutrients to the uterus and baby. Take a hypnobirthing course.

Positive attitude

This is your birth experience and you should be able to feel good and have what you want for your baby. Remember you are a mom, and Mom knows best. Trust your feelings and instincts. You know what is happening with your body and your baby better than any other person or any machine. Do not hesitate to change providers even if you are late in pregnancy. Your trust in your provider will make all the difference in your birthing outcome. Share your thoughts and feelings with your spouse, partner, family, friends, and/or write them in a journal. Set aside time with your partner to discuss plans for the pregnancy, birth, and baby.

Attend support groups where you can share with other moms. La Leche League is a great way to connect with local moms, share your experience in a supportive environment, and learn about breastfeeding and often infant care all at the same time. Find a birth care provider you are comfortable with. You should always feel at ease sharing your questions and concerns with your midwife, physician, or obstetrician. If not, find a new provider who will listen to and respect your feelings and opinions. Find a Doula or ask a close friend or family member to learn how to be an effective pregnancy support person. A Doula is trained to care for mom and her partner during and/or after birth. The presence of a Doula during birth increases positive feeling about labor, decreases the need for medication, interventions, and caesarean sections, decreases anxiety, and shortens labor. A postpartum Doula can help increase acceptance of the baby, enhance bonding, increases self-esteem and feelings of control, and reduces postpartum depression. Learn as much as you can. The more you know, the better your birth outcome. Optimizing Your Brain-Body Connection Your brain and nervous system control everything that happens in your body. There are trillions of actions being coordinated through your nervous system each moment. Among these actions are the regulation of your blood pressure, the filtering toxins from your blood, and the production of red blood cells. The positive feedback cycle that allows the birthing hormone oxytocin to be released depends on optimal brain-body communication. Subluxations are misalignments in the spinal bones that interfere with proper nerve communication in the body. When subluxated, these bones either irritate or put pressure on the spinal cord and spinal nerves causing malfunction in any part of the body. Doctors of Chiropractic work to correct subluxations of the individual spinal bones. Chiropractic care benefits all aspects of your body’s ability to be healthy. This is accomplished by working with the nervous system. One example of malfunction due to improper brain-body communication can be the tightening of pelvic muscles and ligaments producing uterine constraint. These tight muscles and ligaments and their constraining effect on the uterus can prevent the baby from comfortably assuming the vertex or head down position. The Webster technique is a specific chiropractic analysis and adjustment used to correct subluxations in the pregnant mothers sacrum and pelvis. This correction balances the mother’s pelvic muscles and ligaments, providing the physiologic environment necessary for optimal baby positioning. Dr. Larry Webster, Founder of the International Chiropractic Pediatric Association developed this technique as a safe means to restore proper structure and function for pregnant mothers. In mothers who present breech, this technique has a 75 – 95% success rate of the baby turning to the normal vertex position.

Most commonly known for its success in turning breech babies, any position of the baby other than vertex may indicate the presence of subluxation and in-utero constraint. Doctors trained in this technique find that this specific analysis and adjustment of the sacrum used throughout pregnancy can detect subluxations and prevent in utero constraint. Due to the effect chiropractic adjustments have on all body functions, all pregnant mothers should have their spines checked regularly throughout pregnancy, optimizing health for themselves and their developing babies. Chiropractic care starting at conception and continuing after birth, for both mother and child, has given many families the opportunity for greater health. Chiropractic care is safe to both the mother and baby throughout pregnancy. In early pregnancy the baby is protected by the mother’s pelvis, within membranes and ammonic fluid. Later in pregnancy, chiropractors will adjust techniques to accommodate the mother’s changing needs to ensure safety to both the mother and baby. Many of the common complaints in pregnancy - headaches, sciatica, back pain, and sacroiliac joint problems - can be avoided and solved easily with chiropractic care. Studies have shown that chiropractic care significantly reduces average labor time by 24 – 39% and the need for pain medication by 50%.

CHOOSING A PROVIDER

This is your birth, your health, your baby and your family. Your choice of provider will make a difference in the outcome of your birth. The first major decision you make for your child is choosing your birth provider. You essentially have 3 choices; a midwife, a family physician, or an obstetrician. You can also choose to have an alternate health care provider take care of you through your pregnancy as your primary provider, but they will not be allowed to be your primary care giver for birth (with a few exceptions, for example, chiropractors can deal with normal births in Oregon). It is important you find a provider who shares your vision for your birth and is willing to support your desires. If you feel uncomfortable discussing your wishes or do not feel fully supported or listened to, change providers. It is never too late to look for a new provider. Do not feel obligated to stay with a provider you are not comfortable with just to avoid offending or hurting their feelings. Good prenatal care has been consistently shown to improve birth outcomes. Remember: this birth is about your baby, you, and your family; you will remember this birth for the rest of your life. Midwives

Midwifery care is the standard in many countries and continues to be the standard in the countries with the best birth outcomes. International Confederation of Midwives Definition of the Midwife

“The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labor and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.

The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women's health, sexual or reproductive health and child care.

A midwife may practise in any setting including the home, community, hospitals, clinics or health units.”

There are 3 main tenants of midwifery care.

1. Informed Choice With a midwife, you are the one who is making the choices in all areas of your care. Your midwife will give you information and she respects you as the decision maker for your family. She may make recommendations about aspects of your care but she is there to support whatever you choose.

2. Continuity of Care When you have a midwife, you know who will be at your birth. You don’t need to be concerned about who will happen to be “on call.” You will have had the opportunity to develop a relationship with your midwife throughout your pregnancy, allowing you to be sure that she knows and understands your wishes for your birth.

3. Choice of Birthplace Midwifery care allows you a choice of birthplace. With midwives, you can choose home, birth centre, or hospital birth. Some of these options may not be available in your area. Contact a local midwife to find out more.

Midwives can provide all your prenatal, labor and delivery, and postnatal care for you and baby until 6 weeks postpartum. There is no need to also see a physician or obstetrician if you have a midwife. Midwifery care allows you to have the full breadth of choices. You have access to any medical care you may need, and also natural forms of care for pregnancy and birth. You also have access to out-of-hospital birth.

If you choose a hospital birth with a midwife, you can still opt for a medicated birth. If your pregnancy or birth becomes high risk or outside the scope of midwifery care, you will transfer your care to an OB and your midwife will stay with you for continuous support. Midwives are well trained in determining when a pregnancy and birth is no longer “normal” and needs alternate care. Since midwifery care is so personalized, any complications are typically detected quite early. A typical midwifery visit will be 45-60 minutes in length. This gives you time to get to know your midwife, discuss all aspects of your care, and ask any questions you may have. A typical visit with your midwife will include checking your blood pressure, listening for the baby’s heart beat, measuring the fundal height of your uterus, and feeling for the baby’s position. There is no need to disrobe for a prenatal visit. All routine tests can be performed with you fully clothed but you will need to pull up your shirt to access your abdomen. You may also be asked to perform a quick pee test on each visit that tests for glucose and/or proteins in your urine. Some midwives may also check your weight on each visit but this is becoming a less common practice as it is not generally a very important indicator or your prenatal health. There may be other tests or procedures performed if they are deemed necessary. You will also discuss any other testing that may be indicated in your case. In early pregnancy your visits will be once a month. When you reach around 28 weeks your visits will be every 2 weeks, and once a week after 36 weeks of pregnancy. Family Physicians In some cases your family physician may be able to provide all your prenatal care and attend your birth. This may be appealing if you have had a long term and good relationship with your physician. This option is becoming less and less common as malpractice rates for attending births is becoming so high that many physicians have opted out of attending births. They may still be part of your early prenatal care. Obstetricians Obstetricians are medical doctors who have specialized in the conditions and emergencies that can present during a pregnancy and birth. They are trained surgeons who are able to perform Caesarean section surgery. Obstetricians often work in teams. Although you may have one OB attend to your prenatal visits, it is unlikely this will be the doctor who is present at your birth. The OB who attends your birth will depend on who is “on call” when you are delivering. Many hospitals frown upon a doctor coming in “off call,” but you can always ask your OB if s/he would be willing to break protocol for you.

Typical visits with an OB will be similar to a midwifery appointment but will focus on the physical testing and will exclude much of the conversation. You can expect these appointments to be 5-15 minutes. Depending on your OB, s/he may also recommend routine vaginal exams throughout your care. There is no medical reason for these to be done as a routine procedure. You can politely say no thank you and use the extra time to discuss any questions you have, as well as discussing things like the risks and benefits of any recommended further testing. If you feel as though your care provider is trying to control your pregnancy or to limit your choices, change providers. If you feel you are not be listened to, being blown off, being told what you want to hear so you will stop asking questions, change providers. If you are told you are reading too much or just to do as you are told, change providers. If they say “who is the expert,” change providers. (By the way, you are the expert when it comes to your body; trust yourself to know when you need help from the outside).

PRENATAL TESTS

Pregnancy and birth are not medical conditions or problems. This is a normal process and our bodies are perfectly designed for it. There are a small number of women who do have medical problems associated with their pregnancies, but this is not the norm. Medical care is important for those who do develop medical problems. You should not be treated as a medical disaster waiting to happen, but carefully observed to see that everything is progressing as expected. Medical tests and procedures should be reserved for those situations where they are necessary and where the outcome of the test can/will change the outcome of the pregnancy or birth. If there is no valuable information to be gained from the test, think twice before consenting to it. Urinalysis A urinalysis is simply a pee test. It can be used to confirm pregnancy and to test for urinary tract infections (UTIs). UTIs can be asymptomatic during pregnancy and you could have one without knowing it. Having a UTI while pregnant can stimulate you into preterm labor. If it is found that you do have a UTI, the infection can easily be cleared by drinking pure cranberry juice not from concentrate (found in health food stores), taking probiotic supplements, and

drinking copious amounts of water. Once you have done this for a week or so, you should be retested to see that the infection has cleared. Urine tests are also commonly used throughout pregnancy to test for glucose and protein in your urine. Glucose in your urine can be normal or it can be a sign of gestational diabetes. One or two slightly positive glucose tests are not necessarily cause for concern. It may be that you just ate a meal that increased your blood sugar level. If this happens, you can retest with your first morning urine to get a more accurate picture. If you have large amounts of glucose or you are consistently spilling glucose in your urine, you may consider doing a Glucose Tolerance Test (GTT). Protein in the urine can be an indicator of preeclampsia, eclampsia or toxaemia of pregnancy. These conditions can be life threatening to you or your baby and can be prevented by following the 5 Pillars of a Healthy Pregnancy. Trace amounts of protein in the urine are not generally a concern. Blood Test Blood tests can be used to indentify your blood type and your rhesus (Rh) factor. You can also have your haemoglobin levels checked to see if you may be anaemic and if you need to be supplementing with iron. Other information that may be gained from a blood test includes Syphilis exposure, Hepatitis B exposure, HIV infection, immunity to rubella and chicken pox. Glucose Tolerance Testing This test is offered to women between 24 and 28 weeks of pregnancy. It does not need to be done as a routine test if you have no risk factors. If you have a family history of diabetes, have had gestational diabetes in a past pregnancy, are having consistently high levels of glucose in your urine, or are at higher risk for gestational diabetes, this test will be recommended. The test involves drinking a special solution or eating a bar and having a blood test to determine your blood sugar levels. If it is found to be positive, you will be told to modify your diet and exercise. If you follow the 5 Pillars of a Healthy Pregnancy, you can prevent gestational diabetes and the need for this test. Ultrasound/Sonogram An ultrasound is a test that uses sound waves to create an image of the baby on a computer screen. Ultrasound waves are a form of radiation producing both heat and sound but are not ionizing radiation like X-rays. The Society of Obstetricians and Gynaecologists suggests that like all medical tests and procedures, ultrasound should be done only for medical reasons. It is not recommended for entertainment or any other reason. There are a variety of reasons for ultrasounds during pregnancy:

• To determine due dates if you do not know when you had your last period, when you ovulated last, or the date of conception. If you know any one of these dates it is not recommended to be exposed to ultrasound to confirm dates.

• To confirm a suspected ectopic pregnancy.

• To determine baby’s position at the end of pregnancy if a breech or other malposition is suspected and cannot be confirmed with palpation (feeling the baby).

• To see the placenta if there is bleeding in pregnancy and a possibility of a placental abruption or placenta previa (The position of the placenta early in pregnancy is not diagnostic as the placenta migrates as the uterus expands).

• To confirm multiples (twins, triples, etc).

• To check for structural abnormalities and signs of genetic diseases.

• To check on growth and development if a problem is suspected.

• To guide the technician when performing invasive tests like amniocentesis and chronic villus sampling. Ultrasound may be used during an external cephalic version.

It is not recommended to use ultrasound to confirm the pregnancy, the HCG test is sufficient.

There is no evidence to suggest that repeated ultrasounds are valuable to treating the threat of miscarriage. There is nothing that can be done to stop a miscarriage if it is going to happen. If the outcome of the test does not affect the treatment, there is no real value to the test. The Alberta Clinical Practice Guideline states: “Ultrasound as a routine examination in the first trimester is NOT recommended” (emphasis theirs).

Heath Canada States:

“Diagnostic fetal ultrasound is done only on referral from a licensed health care provider. It is performed in a clinical setting by highly qualified professionals. Health Canada recommends that diagnostic fetal ultrasound should be done only when the expected medical benefits outweigh any foreseeable risk.”

“There is also suggestive evidence that there may be a biological effect on the fetus even during diagnostic use.”

“The persons responsible for the ultrasonic exposure must ensure that the exposure is justified, i.e., that reliable diagnostic information can be achieved and that the benefits outweigh the risk.”

“In all instances, the risks of fetal ultrasound will depend on the ultrasound levels and duration of exposure. The ultrasound level is now displayed on the monitor, and this lets qualified operators assess the potential for damaging the fetus. Risks can be minimized by keeping the ultrasound level and exposure time as low as possible without losing the information needed for diagnosis.”

Health Canada and The Society of Obstetricians and Gynaecologists of Canada have produced guidelines on diagnostic ultrasound. They state that “ultrasound should not be used for any of these reasons:

• to have a picture of the baby, solely for non-medical reasons • to learn the sex of the baby, solely for non-medical reasons • for commercial use, such as trade shows or making videos of a baby”

Ultrasound has been accepted as safe even though studies to determine long term effects have not been done. There are potentially unknown risks to the baby. Ultrasound has been shown to change the movement and growth of cells. Increased use of ultrasounds has been suspected to play a role in autism, epilepsy, ear infections, birth defects, and central nervous system damage. What is known is that ultrasound does raise the baby’s temperature and has been recorded to be as loud as a “subway train pulling into the station.” To minimize your baby’s exposure to ultrasound, only do tests for medical reasons; ask the technician to turn down the intensity of the machine; and ask that the test last only the length of time needed to get the pertinent information. Often when ultrasounds are performed, the technician will also measure the baby and do a comprehensive exam, even if it is only to determine the position of the baby. Again if there is no benefit to the information gained from a medical test, it is best to choose to avoid the potential increased risk from the test. Doppler Doppler uses higher frequency ultrasound waves than a sonogram and may pose a greater risk. As with ultrasound, the benefits of this medical procedure should outweigh the risks before deciding to go ahead. Doppler is used to listen to the baby’s heart beat sooner than can be heard through a fetoscope. It is not necessary to listen to the heart beat to confirm pregnancy. If you have missed your period and have a positive pregnancy test, there is no need to confirm with Doppler or an Ultrasound. If there are no medical reasons, it is fine to wait to hear the heart beat with the fetoscope at around 20 weeks. Some practitioners do not have much experience with the fetoscope as it requires more skill. Nowadays many practitioners have defaulted to the easier way of using a Doppler and have not developed the skill of using a fetoscope. Regardless of your practitioner’s comfort level, it is still your choice to expose your child to Doppler or not. Some practitioners are more comfortable using Doppler during labor but again, this is your choice. You can choose to only allow the fetoscope unless medical need arises. Non Stress Test A non stress test will be recommended if you are beyond 41 weeks pregnant, if there are any suspected problems with the function of the placenta, if you find the baby has not moved for a long period of time, or you are high risk for some other reason like gestational diabetes, high blood pressure, or intrauterine growth restriction. This test lasts anywhere from 20-60 minutes. It involves using a continuous fetal monitor (continuous Doppler) that measures the baby’s heart rate and a monitor to measure the contractions of the uterus. (This is similar to the continuous fetal monitoring you may have seen done in birth videos of births that are being medically managed).

The test is designed to determine if the baby is getting sufficient blood flow and oxygen. The baby’s heart rate is measured during movement and rest to see if the normal increase in heart rate during activity and decrease during rest is observed. If the baby is sleeping at the time of the test, you may have a false positive result.

Prenatal Genetic Screening

Early on in your pregnancy, you can decide whether or not you would like to have prenatal genetic screening.

These tests are optional – they are your choice. The question to ask yourself is, what will you do with the information? Will you abort a pregnancy if there is a chance of a defect, understanding that there are false positives with these tests? Would you keep the baby regardless of a genetic defect? If so, do you need to know the information ahead of time? Will it be useful for planning or will it be a source of extra stress during your pregnancy? Knowing that stress hormones interfere with optimal brain development, it is worth creating a stressful situation during your pregnancy? Are you willing to do more invasive testing that is needed to confirm a positive finding?

• These are blood tests, sometimes with an ultrasound, which are done starting at 11 weeks of pregnancy.

• They are SCREENING tests, which mean they tell your chances of having a baby with Down syndrome, Trisomy 18 or an open neural tube defect.

• Screening tests cannot confirm whether or not your baby has one of these three conditions, only indicate a chance of this.

• To find out for sure, you would have to decide whether to have a DIAGNOSTIC test. • Prenatal screening cannot find every birth defect.

Prenatal Screening is Available for:

• Down Syndrome • Trisomy 18 • Open Neural Tube Defects

Down syndrome

People with Down syndrome usually have mild to moderate intellectual delay. Individuals with Down syndrome may have a greater incidence of health conditions than the average person such as heart, stomach, bowel, thyroid, vision and hearing problems. Treatment is available for many of these conditions. Each person with Down syndrome is different. There is no way to test how serious the disabilities will be. People with Down syndrome generally live into their fifties. In general, about one in 1000 births has Down syndrome. The chance of having a child with Down syndrome increases with the mother’s age.

Trisomy 18

Babies with Trisomy 18 have both mental and physical disabilities. Many pregnancies with Trisomy 18 will miscarry. Most babies born with Trisomy 18 do not survive past the first few months of life. In general about one in 6,000 births have Trisomy 18. The chance of having a child with Trisomy 18 increases with the mother’s age

Open Neural Tube Defects

These conditions occur when the brain or spinal cord does not form properly.

An open neural tube defect involving the spinal cord is called ‘Spina Bifida which causes physical disabilities such as difficulty walking, and difficulty controlling the bladder and/or bowel. People with Spina Bifida may also have mental disabilities. Treatment can help with many of the physical disabilities.

An open neural tube defect involving the brain is called ‘anencephaly’ and it will cause the baby to be stillborn or die shortly after birth. In Canada, the chance of having a baby with an open neural tube defect is about 1 out of every 2000 births. The chance of a child being born with this condition does not increase with the mother’s age.

Chorionic Villus Sampling (CVS) Chorionic Villus Sampling (CVS) is a test for genetic disorders. This test can be performed between 11 and 12 weeks of pregnancy and is performed by inserting a needle through the cervix into the placenta to take a sample of cells. This test cannot be used to detect neural tube defects. The risks of CVS are miscarriage, infection, and leaking of amniotic fluid. If the amniotic fluid continues to leak, the baby’s lungs can become underdeveloped. There is also a risk that part of the baby will be extracted during the process, leading to missing fingers or limbs. The risks increase the earlier the test is performed. This test should not be done as routine. If should be used only when medically necessary. Amniocentesis If you have a positive prenatal screening test and you want confirmation of a possible abnormality, an amniocentesis is indicated. When Amniocentesis is performed, it is done between 15 and 20 weeks by inserting a needle into the uterus through the abdominal wall and extracting a small amount of amniotic fluid. Ultrasound is used to help guide the path of the needle. This test is used to identify a number of genetic or inherited disorders and neural tube defects. There is an increased chance of miscarriage, preterm labor, respiratory distress, postural deformities, fetal trauma, and rhesus disease when amniocentesis is performed. The risks are higher if the test is performed earlier in pregnancy. Like all medical tests, amniocentesis should be performed when there is medical reason not as a routine part of all pregnancies. Fetal Tissue and Blood Sampling

This test is similar to amniocentesis except that the sample is of the fetal tissue instead of the amniotic fluid. The tissue extracted may be from the baby’s skin, liver, abdomen, or other orgasm or from the umbilical cord. This test would carry the similar risks as amniocentesis and chorionic villus sampling. Always discuss the medical necessity of any test that is recommended to you with your provider. Determine if the information you will gain is worth any increased risks of the test itself. It is always your choice what tests you consent to.

WHAT TO EXPECT IN EACH TRIMESTER First Trimester Your Baby Your pregnancy is typically dated from the first day of your last period. This is usually about 2 weeks before you actually ovulated and conceived. Again if you know when you conceived, count that date as 2 weeks pregnant. Conception must take place within24 hours after ovulation. Sperm are viable for 72 hours so sperm that were released up to 3 days before or up to 24 hours after ovulation could be responsible for fertilizing the egg. This fertilized egg or zygote now needs to travel down the fallopian tubes to the uterus. At day 7-9 after fertilization, it will implant into the wall of the uterus and start forming a placenta. By 2 weeks after fertilization - 4 weeks pregnant - the embryo has started to develop its brain and spine. The nervous system now coordinates the development of all the other organs and systems, with the heart and circulatory system forming next. Although you may not be able to detect the heart beat, it may be visible on sonogram. Week 6 marks the time when the neural tube is almost closed. This process depends on the vitamin folic acid. Since this occurs so early in pregnancy, it is important for you to be well nourished even before you know you are pregnant. Basic facial features are forming along with arm and leg buds. By the 9th week of pregnancy your baby’s reproductive organs have started to develop. Towards the last part of the first trimester, your baby will have its vital organs, eyelids, outer ears, arms, leg, fingers, and toes. Your baby may be about 3 inches long and weigh only an ounce. Your Body During this first trimester, many of the changes discussed above have taken place. You may have experienced nausea and/or vomiting, changes in appetite, weight gain, fatigue or exhaustion,

swollen and tender breasts. Typically morning sickness peaks at 8 weeks and subsides around the end of the first trimester. For some, it continues further into pregnancy and for others its lasts the whole 9 months. You may also note having headaches due to hormonal fluctuations.. These headaches typically subside as you get further in your pregnancy. Consult your family chiropractor for help with your headaches. Avoiding pain relieving medication is important during pregnancy. You may also find yourself emotional; you are on a hormonal roller coaster as your body adjusts to pregnancy. Some women already need to make the move to maternity pants and larger bras. To avoid purchasing multiple sets of bras you could purchase a nursing bra to wear through your pregnancy. You can still do almost all of your usual the activities, as long as you are not exposing yourself to toxic chemicals. Listen to your body and take the extra rest that you need. Your body is working overtime and you do need time to recoup. Second Trimester Your Baby Your baby’s prostate gland or ovaries are forming early in the second trimester. If you are having a girl, her ovaries along with all the eggs she will have in her life will now be forming. This means that you have a direct impact on the health and well-being of your grandchildren. It is critical that you pay close attention to the 5 Pillars to a Healthy Pregnancy. You are nourishing your child and seeds of your future grandchildren. Be sure to provide the best building blocks and an environment free of avoidable toxins. Your baby is starting to develop more detail like skin, hair, and eyebrows. There is more definition in the eyes and ears and your baby starts to become sensitive to light and the sound of your heart beating. Your baby is active and may even react to loud noises. You may start to feel the sensations of your baby’s movement by about the 18th week. Your baby is breathing amniotic fluid in and out of its lungs and is developing more fat. Fingerprints develop in this trimester along with more critical brain development. Sleep and wake cycles are in place mimicking yours, as your baby responds to maternal levels of melatonin.

By the end of the second trimester, your baby may be 2 pounds and has tripled or quadrupled in length.. Your Body Many women report feeling better than ever. Continue to get plenty of rest, but do not use pregnancy as an excuse to be inactive. Consider that you are training for a marathon and need to maintain your best physical fitness.. Create healthy support networks around you so you can express your feelings about the baby, the changes in your body, and the upcoming birth. If you find you are not getting the support you need from family and friends you can look for online communities like http://naturalbirthbabyandbeyond.com, where you can express your feeling about your pregnancy and upcoming birth in a safe and supportive environment. Start your prenatal education. Planning well in advance will help you be prepared for birth and the post partum. You will be able to find a complete online childbirth education course at http://naturalbirthbabyandbeyond.com and additional information at http://yourbirthcoach.com. You may notice the areola (darker area around your nipples) darkens and starts to form bumps that produce oils to lubricate and clean the nipples. The nipples are self cleaning and do not require soap. You can wash your nipples with just water. Sonograms are typically recommended in the second trimester. It is your choice if you want to go ahead with it or not. Consider if the information gained will be worth any potential risks of doing the test. Be sure to be doing Kegal exercises regularly to strengthen your pelvic floor muscles. Your feet may now be are larger due to the relaxation of ligaments and a change in the structure of the many bones in your feet. This is an exciting time for many women as they begin to notice their baby moving inside. Third Trimester Your Baby Now is the period of rapid growth for your baby, growing from 2-3 pounds to triple that by the end of your pregnancy. Your baby’s lungs are not yet fully developed but with care, 90% of babies can survive if born prematurely; as early as 28 weeks. Baby’s bones are fully formed by 29 weeks. By 30 weeks your baby’s eyes are often open.

As your baby’s head continues to grow, it eventually pulls the baby into a head-down or vertex position that is optimal for giving birth. Ideally the baby will be sitting with its back on your right side or in line with your abdomen. Your baby will typically find this position by 36 weeks. Any other position of the baby can make birth more complicated and warrants a visit to your chiropractor for Webster’s In Utero Constraint Technique. Thirty seven weeks is considered full term. The chance of survival is greater, as all organ systems have now formed. You are clear to go ahead with a planned home birth if you go into labor after the 37 week mark. This does not mean that your baby is done “cooking,” and it is not acceptable to force the baby out. Your baby should remain inside until labor is stimulated naturally. These lasts week allow for additional growth. Your placenta continues to provide immune cells to protect the baby in the outside world. There is no rush to get this baby out; it is normal for babies to be born up to 3 weeks before or after their due dates. All babies develop at their own rate and some may not be ready to be born sooner than 42 weeks. Your Body You will likely experience the most growth of your belly in the third trimester. Stretch marks may result when there is such rapid growth. You may feel shortness of breath or acid reflux as the baby starts to restrict space for your organs. This may subside as the baby drops into your pelvis at the end of this trimester. You may find yourself tired again this trimester, as your sleep may be disturbed and you are carrying around quite a bit of extra weight. Some women get tired of being pregnant and are anxious to get birth started. Do your best to be patient and enjoy these extra days to yourself. It is best for your baby to come in its own time. Plan some special date nights with your partner. Take care of projects you wanted to complete. If you expect birth to come at 43 weeks, you won’t be tempted to rush it too early. If you do pass your due date, you may feel the pressure to go into labor from many sources. Well meaning friends and family may start to call and check up on you, and your care provider may start talking to you about being “post dates.” Remember that your baby will come when it is ready and you do not need to induce it to come unless there is a clear medical risk.. You may be asked to go for stress tests but you can decline if you choose. Avoiding induction is a very important step in having a birth free of unnecessary interventions. Some providers use language that make it seem like induction is mandatory. You are in control of this pregnancy and birth; do not feel pressured into forcing your baby out early.

PLANNING FOR BIRTH AND POSTPARTUM

Making a Birth Plan

What is a birth plan?

A birth plan is simply a written description of what you want for your birth experience, it is not a

contract or a script.. Birth can be unpredictable and you need to be willing and ready to surrender

to that unpredictability.

If birth is unpredictable, why make a birth plan?

Just like any other situation, you must know what you want in order to get it. Making a birth

plan is really the practice of learning about all the different choices that may be presented to you in

labor and delivery, and evaluating which ones you want, which you would like to avoid, and under

what circumstances you would consent to something that is not in line with your ideal goal.

It is critical that you go through this process so you are ready to make informed decisions when you

are in labor.

Being in the midst of birthing a baby is not the best place to be learning your birth options and

evaluating the pros and cons. Being prepared means that this is your birth experience, not that of

hospital staff who may have different reasons for choosing birth options for you.

What to plan

Many people spend months to years planning for their wedding day. I suggest a similar amount

planning for the birth of your child. Here are some things to consider in your Birth Plan Where you

will birth and who will be with you?

What role do you want each person to play?

Have you discussed that role with each of your support people?

What environment do you want to create in your surroundings?

Are you willing to have other people come in when you are birthing- for example medical students?

What comfort measures are you prepared to use?

In what situations are you willing to change the plan?

Where will the baby go once it is born, in mom’s arms or to be examined?

What newborn procedures do you want done and which do you want to avoid or postpone?

When it comes to postpartum, who will be making food and doing laundry for the next few weeks?

LEARN MORE

You can learn more by visiting http://yourbirthcoach.com and by joining the community at

http://NaturalBirthBabyandBeyond.com.

NaturalBirthBabyandBeyond.com is designed to be a complete comprehensive childbirth

empowerment program. It includes everything you need to know to create the most empowered

birth and mothering experience. You will have access to more books by Dr. Nancy Salgueiro, Your

Birth Coach, videos, articles, and audio recordings. Most importantly you will receive ongoing

support from Dr. Nancy herself and a community of like minded parents and parents to be on the

interactive member’s only forum. Learn more about our community here and take advantage of

our special trial offer.

EMERGENCY CHILDBIRTH

I have included the U.S. Department of Defense and U. S. Department of Health, Education, and

Welfare’s Reference Guide to Emergency Childbirth to give you and idea of what childbirth is all

about. This is a very simple guide to dealing with childbirth when you do not have medical

professionals with you. Emergency in this context really means a birth happening right here, right

now, not that anything life threatening is happening to mother or baby. For more information

about natural childbirth visit: http://yourbirthcoach.com.

EMERGENCY CHILDBIRTH

A REFERENCE GUIDE FOR STUDENTS OF THE MEDICAL SELF-HELP TRAINING COURSE

LESSON NO. 11

ACKNOWLEDGMENT

We wish to acknowledge with grateful appreciation the many services provided by the American Medical Association, through the Committee on Disaster Medical Care, Council on National Security, Board of Trustees and staff, in the preparation of this handbook.

From the inception of studies to determine emergency health techniques and procedures, the Association gave valuable assistance and support. The Committee on Disaster Medical Care of the Council on National Security, AMA, reviewed the material in its various stages of production, and made significant contributions to the content of the handbook.

A joint publication of the U.S. DEPARTMENT OF DEFENSE

Office of Civil Defense

and the

U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service

Health Services and Mental Health Administration Division of Emergency Health Services

5600 Fishers Lane, Rockville, Maryland 20852

Reprinted December 1970

EMERGENCY CHILDBIRTH

What To Do

1. Let nature be your best helper. Childbirth is a very natural act. 2. At first signs of assign the best qualified person to remain with mother. 3. Be calm; reassure mother. 4. Place mother and attendant in the most protected place in the shelter. 5. Keep children and others away. 6. Have hands as clean as possible. 7. Keep hands away from birth canal. 8. See that baby breathes well. 9. Place baby face down across mother's abdomen. 10. Keep baby warm. 11. Wrap afterbirth with baby. 12. Keep baby with mother constantly. 13. Make mother as comfortable as possible. 14. Identify baby.

What Not To Do

1. DO NOT hurry. 2. DO NOT pull on baby, let baby be born naturally. 3. DO NOT pull on cord, let the placenta (afterbirth) come naturally. 4. DO NOT cut and tie the cord until baby AND afterbirth have been delivered. 5. DO NOT give medication.

DO NOT HURRY—LET NATURE TAKE HER COURSE.

If it becomes necessary for families to take refuge in fallout shelters there will undoubtedly be a number of babies born under difficult conditions and without medical assistance.

Every expectant mother and the members of her family should do all they can to prepare for emergency births. They will need to know what to do and what to have ready. (See "Expectant Mother's Emergency Kit.")

SPECIAL SAFEGUARDS

A pregnant woman should be especially careful to protect herself from radiation exposure. She should have the most protected corner of the shelter and not be allowed to risk outside exposure. She should not lift heavy objects or push heavy furniture. If food shortages exist, she should be given some preference.

Fear and possible exertion involved during an atomic attack will probably increase the number of premature births and of miscarriages.

PREPARATIONS

Usually there is plenty of time after the beginning of first pains to get ready for the delivery. Signs of are low backache, bloody-tinged mucous strings passing from the birth canal, or a gush of water from the birth canal.

The mother will need a clean surface to lie on. Her bed should be so arranged that the mattress is well protected by waterproof sheeting or pads made from several thicknesses of paper covered with cloth. Cover these protective materials with a regular bedsheet.

A warm bed should be made ready in advance for the baby. It may be a clothes basket, a box lined with a blanket, or a bureau drawer placed on firm chairs or on a table. If possible, warm the baby's blanket, shirt, and diapers with a hot water bottle. Warm bricks or a bag of table salt that has been heated can be used if a hot water bottle is not available.

A knife, a pair of scissors, or a razor should be thoroughly cleansed and sterilized in preparation for cutting the umbilical cord. If there is no way to boil water to sterilize them (the preferred method of sterilization), sterilize them by submersion in 70 percent isopropyl alcohol solution for at least 20 minutes or up to 3 hours, if possible. Sterile tapes for tying the umbilical cord will be needed. (Do not remove them from their sterile wrappings until you are ready to use them.) If no tapes are available, a clean shoestring or a strip of sheeting (folded into a narrow tie) can be boiled and used wet as a cord tie substitute.

STAGES OF LABOR

Labor is the term used to describe the process of childbirth. It consists of the contractions of the wall of the womb (uterus) which force the baby and, later, the afterbirth (placenta) into the outside world. Labor is divided into three stages. Its duration varies greatly in different persons and under different circumstances.

During the first and longest stage, the small opening at the lower end of the womb gradually stretches until it is large enough to let the baby pass through. The contractions (tightening) of the uterus, which bring about this stretching and move the baby along into the birth canal, cause pains known as labor pains.

These pains, usually beginning as an aching sensation in the small of the back, turn in a short time into regularly recurring cramplike pains in the lower abdomen. By placing your hand on the

mother's abdomen just above the navel, you can feel each tightening of the uterus as an increasing firmness or hardness. It lasts for 30 to 60 seconds. The pains disappear each time the uterus relaxes.

At first these pains occur from 10 to 20 minutes apart and are not very severe. They may even stop completely for a while and then start up again. The mother should rest when she is tired but need not be lying down continuously. She may sleep between tightenings if she can. She can take a little water or perhaps tea during the entire labor process. She should urinate frequently during labor so the bladder will be as empty as possible at the time of birth.

The skin in the vaginal area of the mother should be sponged occasionally with soapy water. Special attention should be given to cleaning the inner sides of the thighs and the rectal area with heavy lather. Soap or water should not be allowed to enter the vagina.

A slight, watery, bloodstained discharge from the vagina normally accompanies labor pains or occurs before the pains begin.

For first babies, this stage of labor may continue for as long as 18 hours or more. For women who have had a previous baby, it may last only 2 or 3 hours.

The end of this first stage is usually signaled by the sudden pressing of a large gush of water (a pint or so), caused by the normal breaking of the bag of waters which surrounds the baby in the mother's womb. For some women, the bag of waters breaks before labor begins or perhaps as the first sign of its beginning. This should not cause the mother or those helping her any concerns. It usually does not seriously affect the birth.

Through this first stage of labor, the mother does not have to work to help the baby be born. She should not try to push the baby down, but should try to relax her muscles. She can help do this by taking deep breaths with her mouth open during each tightening.

[Illustration: A. At full term, or after 40 weeks of pregnancy, the baby is ready to be born. The cervix through which baby must leave the uterus is shown clearly here, still closed. The contractions of the muscles of the uterus will open the cervix, and force the baby down through the vagina, or birth canal, to the outside.]

[Illustration: B. At the end of the first stage of labor the cervix is completely open and the baby's head is beginning to come down through the vagina. Contractions begin in the lower back and later are felt in the lower abdomen. At the time shown here contractions are probably coming every 2 minutes, lasting 40-60 seconds and very strong.]

[Illustration: C. The first stage of labor usually lasts several hours and is hard work. The mother needs to relax, rest, and be reassured. Give her water and fruit juices. In this picture the second stage of labor is well along. It is shorter than the first stage and the mother will now be pushing down with each contraction, helping to force the baby into the world. ]

[Illustration: D. The head of the baby has been partially born. This shows the usual position with the face down and the back of the head up. The bag of waters in which the baby is enclosed throughout the pregnancy may have broken at the beginning of labor, before or during the first stage. It may break now, or have to be torn with the fingers.]

[Illustration: E. Here you see the baby's head turned to the right as is usual. The shoulders are about to be born. The head must turn so that the baby's body can fit into the birth canal and come through

more easily. After the birth of the baby there will be further uterine contractions and the placenta will be separated from the uterine wall and expelled.]

CHANGE OF FEELING

Gradually the time between the labor pains grows shorter and the pains increase in severity until they are coming every 2 to 3 minutes. It will not be long now before the baby is born.

At this stage the mother will notice a change. Instead of the tightness in the lower abdomen and pain across the back, she will feel a bearing down sensation almost as if she were having a bowel movement. This means the baby is moving down.

When this happens, she should lie down and get ready for the birth of the child. The tightening and bearing down feelings will come more frequently and be harder.

She will have an uncontrollable urge to push down, which she may do. But she should not work too hard at it because the baby will be brought down without her straining too hard. There will probably be more blood showing at this point.

The person attending the delivery should thoroughly scrub hands with soap and water. Never touch the vagina or put fingers inside for any reason. The mother also should keep her hands away from the vagina.

As soon as a bulge begins to appear in the vaginal area and part of the baby is visible, the mother should stop pushing down. She should try to breathe like a panting dog with her mouth open in order not to push the baby out too rapidly with consequent tearing of her tissue.

She should keep her knees up and legs separated so that the person helping her can get at the baby more easily.

MOMENT OF BIRTH

The person helping the mother should always let the baby be born by itself. No attempt should be made to pull the baby out in any way.

Usually the baby's head appears first, the top of the head presenting and the face downward. Infrequently the baby will be born in a different position, sometimes buttocks first, occasionally foot or arm first. In these infrequent situations, patience without interference in the birth process is most important. The natural process of delivery, although sometimes slower, will give the child and the mother the best chance of a safe and successful birth.

The baby does not need to be born in a hurry, but usually about a minute after the head appears the mother will have another bearing down feeling and push the shoulders and the rest of the baby out.

As the baby is being expelled, the person helping the mother should support the baby on her hands and arms so that the baby will avoid contact with any blood or waste material on the bed.

If there is still a membrane from the water sac over the baby's head and face at delivery, it should immediately be taken between the fingers and torn so that the water inside will run out and the baby can breathe.

If, as sometimes happens, the cord, which attaches the child from its navel to the placenta in the mother's womb, should be wrapped around the baby's neck when his head and neck appear, try to slip it quickly over his head so that he will not strangle.

After the baby is born, wrap a fold of towel around his ankles to prevent slipping and hold him up by the heels with one hand, taking care that the cord is slack. To get a good safe grip, insert one finger between the baby's ankles. Do not swing or spank the baby. Hold him over the bed so that he cannot fall far if he should slip from your grasp. The baby's body will be very slippery. Place your other hand under the baby's forehead and bend its head back slightly so that the fluid and mucus can run out of its mouth. When the baby begins to cry, lay him on his side on the bed close enough to the mother to keep the cord slack.

The baby will usually cry within the first minute. If he does not cry or breathe within 2 or 3 minutes, use mouth-to-mouth artificial respiration.

Very little force should be used in blowing air into the baby's mouth. A short puff of breath about every 5 seconds is enough. As soon as the baby starts to breathe or cry, mouth-to-mouth breathing should be stopped.

CUTTING THE CORD

There should be no hurry to cut the cord. Take as much time as necessary to prepare the ties and sharp instruments.

You will need two pieces of sterile white cotton tape or two pieces of 1-inch-wide sterile gauze bandage about 9 inches long to use to tie the cord. (If you do not have sterile material for tying the cord but do have facilities for boiling water, strips of sheeting—boiled for 15 to 20 minutes to make them sterile—can be used.) Tie the umbilical cord with the sterile tape in two places, one about 4 inches from the baby and the other 2 inches farther along the cord toward the mother, making two or more simple knots at each place. Cut the cord between these two ties with a clean sharp instrument such as a knife, razor blade, or scissors.

A sterile dressing about 4 inches square should be placed over the cut end of the cord at the baby's navel and should be held in place by wrapping a "bellyband" or folded diaper around the baby. If a sterile dressing is not available, no dressing or bellyband should be used. Regardless of whether a dressing is applied or not, no powder, solution, or disinfectant of any kind should be put on the cord or navel.

If the afterbirth has not yet been expelled, cover the end of the umbilical cord attached to it (and now protruding from the vagina) with a sterile dressing and tie it in place.

[Illustration: Cut between the square knot by bringing the left tape over right tape for first loop and right tape over left for second loop. Tighten each loop firmly as tied. Use scissors or a razor blade to cut cord.]

THIRD STAGE OF LABOR

Usually a few minutes after the baby is born (although sometimes an hour or more will elapse) the mother will feel a brief return of the labor pains which had ceased with the birth. These are due to contractions of the uterus as it seeks to expel the afterbirth. Do not pull on the cord to hurry this process.

Some bleeding is to be expected at this stage. If there is a lot of bleeding before the afterbirth is expelled, the attendant should gently massage the mother's abdomen, just above the navel. This will help the uterus to tighten, help the afterbirth come out, and reduce bleeding.

It may be desirable to put the baby almost immediately to the mother's breast for a minute or two on each side even though the mother will have no milk as yet. This helps the uterus contract, and reduces the bleeding.

Someone should stand by the mother and occasionally massage her abdomen gently for about an hour after the afterbirth is expelled. After that the mother should feel the rounded surface of the uterus through the abdomen and squeeze firmly but gently with her fingers. The bedding should be cleansed and the mother sponged. Washing and wiping of the vaginal area should always be done from the front to the back in order to avoid contamination. A sanitary napkin should be applied.

Keep the mother warm with blankets. She may have a slight chill. Give her a warm (not hot) drink of sweetened tea, milk, or boullion. Wipe her hands and face with a damp towel. She may drop off to sleep.

The mother's diet after delivery may include any available foods she wishes. She may eat or drink as soon as she wants to, and she should be encouraged to drink plenty of fluids, especially milk. Canned milk can be used and made more palatable by diluting with equal parts of water and adding sugar, eggs, chocolate, or other flavoring.

For the first 24 or 48 hours after delivery, the mother will continue to have some cramping pains in the lower abdomen which may cause a great deal of discomfort. Aspirin may help relieve these afterpains. She should empty her bladder every few hours for 2 days following the birth. If her bowels do not move within 3 days after delivery she should be given an enema.

MISCARRIAGE

If a pregnant woman shows evidence of bleeding, she should restrict her activities and rest in bed in an effort to prevent possible loss of the baby. If a miscarriage does occur, keep the patient flat with the foot of the bed elevated from 12 to 18 inches to retard vaginal bleeding. Keep her warm and quiet, and give her fluids.

EXPECTANT MOTHER'S EMERGENCY CHILDBIRTH KIT

The public health and civil defense agencies of one State have planned a 1 1/2-pound emergency childbirth kit made up of basic supplies that can be carried in a 1-yard-square receiving blanket.

The kit consists of the following:

One-yard square of outing flannel, hemmed (receiving blanket). Plastic (polyethylene flexible film) for outer wrapping of the kit if desired. (Do not wrap the baby in this plastic film.) One or two diapers. Four sanitary napkins (wrapped). Adhesive tape identification strips for mother and baby. Short pencil. Soap. Sterile package containing: Small pair of blunt-end scissors (cheapest scissors will do), or a safety razor blade with a guard on one side. Four pieces of white cotton tape, 1/2 inch wide and 9 inches long.[1] Four cotton balls. Roll of 3-inch gauze bandage. Six 4-inch squares of gauze.[1] Two or more safety pins.

[1] You will actually use only two tapes for tying the umbilical cord. The two extras are included as a safeguard in case one or two should be dropped or soiled. Extra 4-inch squares of gauze also are included.

Emergency childbirth kit

Instructions such as those contained in this chapter also should be considered a part of the emergency childbirth kit.

To make the kit ready to carry, lay the plastic (if used) out flat, and lay receiving blanket out flat on top of the plastic. Place the diapers, sterile package, soap, sanitary napkins, identification tapes, pencil and instructions in the center. Pull two opposite corners of the receiving blanket and plastic together and tie. Do the same with the other opposite corners, pulling each side together well so that nothing will fall out. Then tightly knot the loose ends together in the same way, leaving an opening so that the kit can be slipped over the arm for carrying the kit while leaving the hands free.

Such an emergency delivery kit will weigh about 1 1/2 pounds. The contents suggested are basic essentials only, for extreme emergency. Much more could be added, but the extra weight might mean leaving behind some other items needed for survival. Additional supplies could be stored in your home shelter to be ready in the event the birth takes place there. In the case there is no need for an emergency delivery, either in the home, shelter or in some evacuation situation, the supplies in the kit can be used in home care of the baby.

IDENTIFICATION TAPES

In emergency situations, identification will be particularly important, especially if the birth should take place in a group shelter rather than a family shelter, or in an evacuation situation.

Two wide strips of adhesive tape will be needed—one long enough to go around the mother's wrist, and the other long enough to go around the baby's ankle. Information should be written on these strips as shown below.

Identification tape—for mother

[Illustration: For mother—Write parents' names, blood types, and mother's Rh factor, street address, and whether it is a first or later child.]

Identification tape—for baby

[Illustration: For baby—Write date and hour of birth and parents' names and address.]

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