Friday, January 28, 2011

What you need to know about Premature Labor

If there is one thing I remember about my prenatal visits, it is the little blurb my doctor had memorized verbatim about preterm labor. “Ok remember lots of rest, lots of water, stay off your feet, take a half hour break every day lay on your left side and if you feel cramping, tightening, pressure or have any bleeding or other unusual symptoms give me a call.”
That about sums it up folks…see you next week! 

Seriously though, the question is, how important is each of these things and how do  I implement them into my life? After all, when my left hip gets all knotted up from laying on my left side, all night, am I going to smush my baby by turning onto my right? Or, heaven forbid, my back?

Drinking Enough Water
There is debate whether ample hydration can actually prevent pre-term labor or not. However, I think your body works better when it is well-hydrated, and it also seems (and this just from my personal experience and that of other M.O.M.s) that you are more likely to have contractions in the latter half of pregnancy when you are dehydrated. In fact, the common wisdom to stop recurring contractions is to drink a big cup of water, go pee, and lay down on your left side to relax. I did this only once or twice but it worked!
In general, your body functions optimally when it is well-hydrated, and keeping your body in tip-top shape (operationally) should be your prime directive. Of course, water is the obvious choice for hydration. While low in salt, sugar, fat and just about everything else it does a great job of quenching thirst. For some, the water supply is not palatable. I know from experience that I would fill 2 huge bottles from my home to bring to work because I didn’t like the taste of the water at my work and would not drink as much as I needed, even though I was thirsty. So I started filling up at home. Do what you need to keep yourself drinking enough fluid. If it means finding a bubbly, flavored or otherwise enhanced beverage, go ahead. Just try to stay away from caffeine and artificial sweeteners in large quantities! Translation – 8 glasses of diet Coke a day is not a wise choice for fulfilling your babies’ fluid needs!
Keep a bottle with you at all times so that you don’t have to excuse yourself from any situation to take a swig. Realize the importance of stopping for a moment and listening to your body. If you don’t take a moment here and there to notice if your mouth is a bit dry, you won’t drink enough because you’ll be too busy to realize you are thirsty.
Take note how many times a day you refill your bottle. That should give you a rough estimate. I’m not a proponent of giving you a number of glasses you MUST consume because I think you should follow your thirst as a guide. But, eight 16-ounce glasses a day is probably the minimum amount of fluid you need – and probably more. Be assured that milk and other beverages and even fluid from foods count toward your total too.
I know it is tempting to cut back because of fear of all the bathroom trips, but consider this: Especially early in pregnancy, the trips to the bathroom are more a factor of pregnancy hormones and other adjutants like caffeine. Think of all the water that won’t be coming out…water that is needed to build blood, cells and amniotic fluid for your unborn babies!

Get Off Your Feet
This is a high order for many. So many people have jobs that require standing on your feet for several hours a day. Retail workers, teachers, manual labor jobs and especially you work-at-home mums. Truth is, you need to find a way to at least reduce the number of hours you spend on your feet per day. Why? Because standing puts the most weight and pressure directly on your cervix and because research has shown that those who spend more time on their feet are more likely to go into preterm labor than those who do not.
There is good news. Most ‘standing’ jobs are actually able to be performed sitting down on a high stool. And if you live or work in the good ol’ U.S. of A., your employer is required to accommodate you in a reasonable way under the Americans with Disabilities Act. I know, you are not disabled, but you have special health needs, which counts. A reasonable accommodation would be to allow you to sit on a stool while ringing customers or teaching. If they cannot accommodate that, another option would be to temporarily re-assign you to a sitting task until after the babies arrive. Or even to assign your to a ‘sitting’ task for a few hours each day.
For those who already sit long hours on the job, I recommend getting a nursing stool or other small box you can rest your feet on. This will keep you more comfortable and keep circulation at its prime because it takes the pressure off the blood vessels on the underside of your knees. It will also help prevent those pesky varicose veins that often show up during pregnancy. I’m glad to say I have none even after both my pregnancies! (All of the strain went to creating gray hairs in my case!)
As for resting on your left side, because of the way your arteries lie, it is beneficial to your circulation, but not necessary. Laying on your right side is good too. And though some pregnancy literature warns of laying on your back, I was told at my doctor visits that it is only a problem if you start to have noticeable circulation trouble - dizziness, or light-headedness etc. Still, if I did lie on my back,but I did so slightly inclined on pillows.

For us work-at-home moms, there simply is no ADA law telling your toddler that you will only feed and diaper her on a pre-determined schedule.  But there are plenty of ways you can short cut your load to promote the health and well being of those siblings on the way! The down side, is that you will need to either get other recruits to make up for your well-justified slacker status, or just deal with having a sub-standard cleanliness rating in your home. I recommend wearing slippers because the crumbs at least will not stick to your feet, and the Legos won’t hurt so much. Ten years from now, nobody will remember or care if your windows were washed or if the floor had streaks or if you had an entire basement full of 80’s memorabilia that needed sorting and labeling for your cool bar display or even if your toddler ate crackers off the un-mopped floor.
Instead, lay back on the couch with your kids and read them a story, tell them about the babies growing inside your belly, watch a movie, start telling them about how you will be spending a lot of time with the babies when they come out because they are so little and need so much help. During my second pregnancy, I had a ritual. We would get through lunch time and I was just exhausted, so I would stick a movie in the DVD (yes, usually a full length one!) and just plop on the couch and snooze while my 3-year-olds watched. My doctor gave me full permission. And my children are not dumber for it, nor do they have vision problems or anything else – at least nothing different from before they got to watch a movie every day! Ladies, you need to give yourselves and your unborn children a break for their health. Recruit your husband or neighbors or family or the Jehovah's Witness folks who keep knocking at your door! Just find a way to do it, and don’t feel guilty about it.

Recognizing Labor
My doctor consistently asked if I’d been having any contractions yet. I had no clue what a contraction even was or felt like, I didn’t know what I was looking (or feeling) for, so how would I know? The main point to remember is that contractions can be felt as a variety of sensations from tightening, to menstrual-like cramping, intestinal distress, dull aches, pain, pressure, heaviness, nausea or other unusual sensation. And it is not always felt in the abdomen, but could also be in your lower back, or in your pelvis or vagina. It may be rhythmic or persistent. Some women feel no pain or unusual sensations at all. It may just come to you as a panicky feeling, or a sense of unrest, or a gut feeling that something isn’t the same. Another hint could be a change in discharge, especially what is referred to as ‘bloody show’ (no this isn’t the newest U.K. reality show!) that may appear brown or blood streaked. If you are having unusually heavy watery-discharge, there is a chance that your membranes have ruptured and you are leaking amniotic fluid. In all of these situations, it is necessary to call your physician right away!
Ladies, if you are carrying multiples and you have any of these symptoms – including an inexplicable feeling of unrest or panic, or more than 5-6 contractions in an hour, please don’t worry about whether or not you should call someone. JUST CALL. Call your doctor, call a nurse line, call the labor and delivery ward –whichever you feel the most comfortable with - the chance of premature labor is NOTHING to mess around with. I know you may feel really silly calling the nurse line and saying you are having an inexplicable panicky feeling, but your instinct is usually right. Even if it isn’t, I guarantee the doctor or nurse won’t mind, and will just be relieved that it wasn’t a problem.
The bottom line is that there is no way to ‘undo’ premature labor - defined as the softening, shortening and opening of your cervix in preparation for birth. And the longer you delay making the call, the shorter your cervix may get, the more likely you are to go past the point of no return.
On the other hand it is completely normal to have occasional (read: irregular, not several occurring one after the other) contractions that feel like someone wrapped a wide elastic band around your middle section. They are commonly called 'Braxton Hicks' contractions. Yet, the only other difference between Braxton Hicks contraction and the real thing is that Braxton Hicks do not efface or dilate your cervix...and you wouldn't know that unless you CALL YOUR DOCTOR! (OK, you probably think I'm some sort of 'hyper-spaz' over this, but really, I've just seen too many forum posts from M.O.M.s who are almost in active labor because they totally ignored the contractions they were having for the last 2 days.)
For a really great article on the symptoms of preterm labor, click here.

What Happens Next?
What happens after preterm labor begins depends on a variety of factors. At 37 weeks, twins are considered full term because they actually mature sooner than singletons. (For triplets, 34 weeks is the goal, and about 30 weeks for quads.) If you are between 34 and 36 weeks with twins when labor sets in, an admission to the birthing center and a congratulations are probably in order. Prior to that, you may be admitted for various drug therapies to stop the contractions. If they are successful in stopping the contractions, you may be able to go home and back to business as usual, or you may be asked to remain on bed rest. If you dilated significantly and are early in your pregnancy, you may be asked to remain on bed rest in the hospital. For a thorough article on what course of treatment may be selected for preterm labor, click here.
Whether or not you experience contractions there is a possibility your water could break prematurely (Premature Rupture of the Membranes or PROM). In this case, it is more likely that your babies’ deliveries are imminent, though it is possible to delay labor by days or weeks. At around 34 weeks, the risks of uterine infection outweigh the risks from preterm birth, so beyond this time, it is likely physicians will not try to hinder your labor.
But if you are not yet 34 weeks along, it is possible that your physician will use drug therapies to stop or delay labor and delivery long enough to administer corticosteroid therapy (steroid shots for mom). The steroid shots speed the development of babies’ lungs, greatly reducing breathing problems when they are born (assuming that birth can be delayed for 1-2 days so the steroids can take effect).  
If in fact you succeed in halting labor after your membranes have ruptured, the greatest risk in this scenario (besides pre-term delivery) is the risk of uterine infection. You would probably remain hospitalized under close monitoring during this time and may have antibiotic therapies.

Now, take a moment to step back into reality, take a swig of water and maybe a bite of chocolate, look down at your burgeoning belly and take a big sigh of relief that this is probably not going to happen to you. And even if it does, you now know what to expect and/or request of your medical care team!

Sunday, January 16, 2011

Preparing for Birth: Doulas

28 Weeks Pregnant with Twins
180 Pounds - Measuring 37 1/2 cm
What do doulas do?
I don’t think that most parenting literature and books do justice to describing what a doula does.  And further why do you need a doula when you have 1 or 2, or more labor nurses, midwifes and doctors? I certainly didn’t fully understand until I had one at my side! There are actually two roles doulas fill. Birth doulas attend your birth and support you through it. Post partum doulas help and support you and your baby after birth. In this post, I focus on birth doulas.
A labor nurse has many jobs in managing your labor, measuring your progress, ensuring that there are no complications, monitoring yours and your babies’ vital signs, filling in paperwork and following other hospital protocol, communicating with your doctor and to some extent managing and directing your labor if you are being induced or have pitocin.
A doula is not pre-occupied with those things. She is there to attend to you. To help keep you comfortable, to get you a blanket, to massage your back when it hurts, to help you to the restroom, to give you ideas for positions and techniques  for pain management to keep you company while your hubby runs to grab a snack, to help you progress your labor using every tool available, to encourage you and give you feedback on how you are doing, to give you ideas and options about your labor that may not have known existed (did you know that you CAN get out of bed? Your labor nurse may have forgotten to tell you), and finally to advocate on your behalf, and last, but not least, to catch your husband if he faints.
And doulas are not simply a paid friend for the day. I have plenty of friends who would come to my child’s birth if I asked, but they are not trained in childbirth comfort measures, massage, and lactation assistance or certified by Doulas of North America as so many doulas are. Your best friend may not know to encourage you to try a new position if you’ve been laboring for a few hours without much progress; nor how to help you decide if you are debating between Demerol or an epidural or to trying to stick it out for another centimeter.
I asked Mr. Geek, “As a twin daddy, what do you have to say about doulas?” He responded “Priceless. [Long pause and queue for more info here] They know all the tricks, and it’s nice to have an extra set of hands.”

Doula Resistance
When I asked my hospital birthing instructor if I could have a doula she said absolutely not. I was told only one person may accompany me into the birthing room. Though other ‘normal’ patients could have a doula, since I was having twins, I was to deliver in an operating room instead of a regular birthing room – even if I was having a vaginal birth. Oh the frustrations of having a completely natural and healthy pregnancy, yet being automatically assigned to a statistical category which subjects you to a whole new lineup of protocol that may or may not be justified by actual research. To say the least, I was frustrated.
 Yet, when I talked to a family who had given birth to twins with a doula at this same hospital a few months prior, they let her in. (Mothers of Twins club are a great recourse!)  I don’t see how they couldn’t. We ended up choosing a doula who had formerly been a labor nurse there, and were sure the hospital would agree to allow attend when the time came.
One of the reasons the nurse gave us is that the operating room is small and there are already so many nurses and  personnel that need to be there, physical space is restrictive. But with so many people in there anyway, does one more really change a darned thing? Twelve’s a party but thirteen’s a crowd? I’m sure they don’t want you bringing five of your closest friends if you know what I mean! I eventually found it was all talk and no action, so be persistent in your request and be sure to talk to the charge nurse or other manager of the birth center, and not just someone in a peripheral role (like a birth class instructor!).
Many traditional doctors, providers and nurses seem to be offended by the notion of doulas, as if they aren’t doing their job well enough so we need to get someone else involved. Yet, while some midwives or family doctors will come close to fulfilling the role a doula fills, the vast majority do not.
It is a fact supported by research that births attended by doulas result in fewer C- sections, fewer episiotomies, less anesthesia, shorter labor (9 hours vs. 19!), fewer babies admitted to the ICU and babies more likely to be breastfeeding at 6 weeks, as well as moms who are more satisfied with their birth experience! In fact, after being told years before that I could not have a doula, the perinatologist that handled my second birth highly recommended I have a doula. At the time it looked as though I would be having a vaginal birth without the option for an epidural because of my low platelet count. So hopefully, the medical community is becoming more accepting of doulas as a positive addition to birth support.
I was blessed enough to have two vaginal deliveries of twins, even when both were induced (inductions have a higher chance of Cesarean delivery than spontaneous deliveries). I don’t have reliable statistics, but somewhere between 1/2 and 2/3 of twins are born by Cesarean section. And besides good luck, and physicians experienced in breech presentation, I credit having a doula to help me birth, change positions and aid the natural process. I also waited as long as I could to get an epidural and made sure to move be active and vertical (I was rarely in the hospital bed!) to get those babies moving down and out!

Paying for it
One thing you will notice if you are searching for a doula is that they are not usually covered by insurance. Insurance companies should want to minimize surgery, expensive interventions and NICU stays as well as maternal bleeding complications (which are more common with Cesarean section). So I urge you to call or write your insurance company and urge them to cover doula services. Cite the research that supports the positive implications of doula-attended births.

When you consider if you can come up with the cash to pay for one yourself, think about how much it would cost in hospital co-insurance for a Cesarean birth versus a Vaginal delivery, or a NICU stay or even just an epidural. Also, many doulas are willing to work with you on their fees and newer doulas who have less experience are more willing to be flexible. Less experienced doulas often want to gain experience with twins, so twin mamas in a tight financial situation can take advantage of that and ask if they would be willing to work for a reduced fee or even for free.
The other thing to note is that most birth doulas not only attend your birth, but also visit with you before hand to help create a birth plan and get an idea of what your preferences are before labor begins. They also will meet with you after birth to check on you and baby and offer lactation advice. DONA certified doulas all have some training in lactation.
Finally, some hospitals will provide doulas as part of their birthing package, and some hospitals have an organization of volunteer doulas on call, so be sure to ask about that at any hospitals you are considering. Meanwhile, I say, ‘Just doula it!’. [Insert rolling eye smiley here!]

Tuesday, January 4, 2011

A Few Recipes for Eating Well

 Here are a few recipes that I used and enjoyed while I was pregnant. The flaxseed meal can be sprinkled into almost any casserole, soup, on sandwiches, or anything, to add some Omega 3.

Chicken salad sandwiches
1-    13oz Can Chunk chicken
½ Cup Kraft Parmesan Romano Salad Dressing (or your favorite dressing)
½ Cup frozen peas
¼ cup Flaxseed meal
Mix together serve as a sandwich on buttered bread with fixings as desired.
Broccoli Salad
2 heads broccoli, cleaned and cut
1 lb Fried crispy Bacon (I used the Hormel uncured with no Nitrates)
½ cup Sunflower seeds
½ cup Raisins
½ Cup Red onion, chopped
2 Cups Mayo or Miracle Whip
¼ - ½ Cup Rice Wine Vinegar
¼ - ½ Cup Sugar
¼ cup ground flaxseed meal
Mix Broccoli, Sunflower seeds, onion and raisins. Add the dressing. Mix to coat and add bacon before serving.

Super Duper homemade Power Bars
3 ½ cups oats
¾ cups raisins
2/3 cups sunflower seeds
½ Cups toasted sesame seeds
½ cups wheat germ
½ cup oat bran
3 tablespoons flax seeds
1 Tablespoon cinnamon
1 Teaspoon salt
1 cup coconut (organic, unsweetened if you desire)
1 + cups honey
5 cups butter (again, organic if desired) – melted
In a large bowl, combine first 11 ingredients. Stir in peanut butter, honey and butter. Press mixture into foil-lined 9x13 inch pan. Bake in oven preheated to 350 F for 15 minutes. Remove from oven, sprinkle chocolate chips over bars. Return to oven until its softened (about 2 minutes). Cool and keep refrigerated.

Hard Boiled Eggs
A great breakfast or snack on the go.
Place eggs in a saucepan covered by at least an inch of water. Heat to boiling. Remove from heat. Some recipes call to remove the saucepan from the heat and let sit in the heated water for 18 minutes, but I find that this consistently results in undercooked eggs (especially if you have jumbo size eggs!). I like to boil mine for several minutes, perhaps 5-10 and then remove from heat and let sit for another 10 minutes. I then strain the hot water from the saucepan and fill it with cool water and ice. This not only stops the cooking, but it also makes them easier to peel. Leave shell intact until ready to eat for better freshness.

Deviled Eggs
6 Hard boiled eggs
3 Tablespoons Mayonnaise, Salad dressing or half and half
½ teaspoon ground mustard (prepared mustard works in a pinch!)
Salt and pepper to taste
Paprika, olives or other garnish if desired
Peel eggs and cut in half lengthwise. Slip out yolks and mash them with a fork. Stir together remaining ingredients with yolks. Heap whites full with yolk mixture and garnish. Refrigerate in an airtight container.