American College of Nurse Midwives updates

By dancingthrupregnancy | Published August 12, 2009

Two updates on the ACNM web­site of interest:

• the value of exer­cise in pregnancy

• health care reform

Check out the ACNM site!!

Posted in 1, baby, birth, exercise, health care, pregnancy, worthy global human endeavors | Tagged , , , , , , , , | Leave a comment

Pregnancy Pathway, Pregnancy – Exposure to Toxins and Infection

By dancingthrupregnancy | Published August 10, 2009

Hot topic for today: Tox­ins and infec­tions in pregnancy.

Pregnancy Exposure to Toxins and Infections

Preg­nancy Expo­sure to Tox­ins and Infections

A mother-to-be needs to be aware of items that can have adverse effects on the health and devel­op­ment of her fetus, as well as her own health. Two of these fac­tors are tox­ins and infec­tions.

1. Tox­ins can be food, envi­ron­men­tal fac­tors, and med­ica­tions, alco­hol or drugs. Let’s start with food. Inter­est­ingly, many plants have slight tox­ins in them that can have a small neg­a­tive impact dur­ing early fetal devel­op­ment. One the­ory of nau­sea and vom­it­ing in early preg­nancy is that this helps the mother’s body pre­vent these tox­ins from inter­fer­ing with nor­mal devel­op­ment. Pica — espe­cially eat­ing dirt that is largely clay — may be another man­i­fes­ta­tion of how the body strives to counter plant tox­ins, as clay can coun­ter­act some of the effects of these tox­ins. So, plant tox­ins can be one food source in early pregnancy.

Another source is food addi­tives (things you can­not pro­nounce, so read the ingre­di­ents!). We have no idea how many chem­i­cals and hor­mones added to foods affect fetal development.

NIH illustration of reading food label

NIH illus­tra­tion of read­ing food label

Risk-aversion involves avoid­ing items that are risky. If you are not sure, don’t eat it. For up to date infor­ma­tion, look at the FDA site on food safety or the NIH site on read­ing food labels.

Envi­ron­men­tal fac­tors that may affect fetal devel­op­ment can include air pol­lu­tion, house­hold cleansers, mold and other items encoun­tered any­where one goes. Things we breathe can be par­tic­u­larly dan­ger­ous, so be sure to keep cleanser use to sim­ple items such as vine­gar, ammo­nia or chlo­rine bleach. Wear­ing a mask while clean­ing is also a good idea.

Med­ica­tions, drugs or alco­hol that might nor­mally be con­sid­ered safe for a non-pregnant per­son — some­thing as sim­ple as aspirin — can be dan­ger­ous as they affect blood clot­ting fac­tors and threaten the pla­centa. Or, because they cross the pla­cen­tal bar­rier but can­not be metab­o­lized by the imma­ture fetal liver, they are toxic and induce dam­age to the fetus.

2. Infec­tions are of con­cern, as well. It is pos­si­ble that an active infec­tion at the time of fer­til­iza­tion and implan­ta­tion can con­tribute to dys­func­tion in preg­nancy because it inter­feres with the nor­mal immune responses of early preg­nancy. Hyper­ten­sion in preg­nancy may be related to infec­tion in the early days of preg­nancy. Some infec­tions — par­tic­u­lary sex­u­ally trans­mit­ted infec­tions — are known to have detri­men­tal effects on the baby’s health. Preterm pre­ma­ture rup­ture of mem­branes (P-PROM) almost always reflects active infection.

Tak­ing Pre­cau­tions: First, be sure to let your health care provider know about any ill­ness or infec­tion. Sec­ond, take care of your­self. Fol­low rec­om­men­da­tions for fre­quent hand­wash­ing and carry ster­ile hand gel in your purse or back­pack. Avoid places where hygiene might be com­pro­mised. Prac­tice safe sex.

Posted in baby, fetus, pregnancy, pregnancy, pre-pregnancy, birth, genetics, baby, offspring, fetus, exercise, maternal fitness, placenta, trophoblast, Rh | Tagged , , , , , , , , , , , , , , , | 1 Comment

Worthy Global Human Endeavors

By dancingthrupregnancy | Published July 21, 2009

There are only two truly wor­thy global human endeavors:

1. Humane Birthing. Find out more from the White Rib­bon Alliance for Safe Motherhood.

2. Space Explo­ration. Find out more from the Augus­tine Com­mis­sion.

Pass it on.

If you are not yet con­vinced about the global need for humane care for preg­nant and birthing women, google (or bing, or yahoo…) “fis­tula.” If you want more first world infor­ma­tion, com­pare med­ical birth with what’s on YouTube; while these two approaches to birth are at odds in con­tem­po­rary med­i­cine, in a humane set­ting they are both necessary.

As for space, let me para­phrase Craig Nelson’s notion:  In time, the Earth will per­ish. This is noth­ing you need to lose sleep over. It will be a long, long time before this hap­pens. But, we need to start now to pre­pare. In time, the Earth will per­ish, and we will need to be some­where else when that happens.

These two things will reap all the rewards that need be reaped. The enabling of safe moth­er­hood and our move­ment into space are the only things that ensure human survival.

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Back Pain — prevention in pregnancy and postpartum.

By dancingthrupregnancy | Published July 17, 2009

Check out this video, DTP con­tributed con­tent. Back care in preg­nancy and postpartum.

Yale Preg­nancy and Post­par­tum Back Care Video.

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Rant: Health Care Reform/Pregnancy

By dancingthrupregnancy | Published July 13, 2009

Since Health Care Reform is a hot topic, let’s look at it from the per­spec­tive of preg­nancy and birth.

What revi­sions would most ben­e­fit preg­nant women, their off­spring, fam­i­lies and communities?

1. Reward healthy behav­iors. A sys­tem that pro­vides reduced pre­mi­ums for health care for women who exer­cise, eat well, do not smoke and are in a nor­mal weight range is evidence-based.

Yes! We could pro­vide finan­cial incen­tives for being healthy dur­ing preg­nancy. Why? Healthy moms have healthy babies; healthy babies cost the payer less money.

2. Review best prac­tices. Is a 40 or 50% cesarean rate the best prac­tice?  Accom­pa­ny­ing the rise in cesarean births is grow­ing infor­ma­tion that babies born by cesarean are at increased risk for a num­ber of immune dis­or­ders. But the busi­ness model of med­i­cine rewards cesarean because it both pays the provider more and is defen­sive med­ical practice.

Fetal mon­i­tor­ing to deter­mine if a cesarean may be nec­es­sary, is wrong 3/4 of the time. In an effort to change this, guide­lines are chang­ing for the use of mon­i­tors dur­ing labor. What is the evi­dence that this change of prac­tice is ben­e­fi­cial? Will it lead to more or less mon­i­tor­ing, which may itself be an inter­ven­tion that can dis­rupt nor­mal labor?

3. Change the busi­ness model for health care. When we make finan­cial incen­tives for care providers, base them on best prac­tice, not on enrich­ing the mid­dle man. Cur­rently the pay­ers (insur­ance com­pa­nies) are mid­dle men, mak­ing money (i.e., con­duct­ing busi­ness) by charg­ing fees. They ration pay­ments for ser­vices in order to pay their own salaries and over­head. They do not actu­ally do any­thing pro­duc­tive. This is why sin­gle payer, gov­ern­ment, and health care coop options have been pro­posed. They elim­i­nate most of the cum­ber­some mid­dle layer.

Why does insur­ance pay for cesare­ans? Well, they will do it once. After all, the care providers have to prac­tice defen­sive med­i­cine. But, once you have a cesarean, you become a risk for the insur­ance com­pany (they know what the research says about cesare­ans and off­spring health prob­lems) and may be denied insur­ance. They can no longer afford you.

Because care providers are paid fee for ser­vice and must prac­tice defen­sive med­i­cine, preg­nancy and birth have become increas­ingly bur­dened with inter­ven­ing pro­ce­dures that do not nec­es­sar­ily pro­mote a healthy preg­nancy or birth process. How is this play­ing out? Increas­ingly, we see women giv­ing birth in what they per­ceive as a more sup­port­ive and health-inducing set­ting:  their own homes. Think of it this way:  many women now believe that it is safer to stay home than go to a hos­pi­tal to give birth.

Unless health care becomes about best prac­tices and healthy out­comes — not price, size, and get­ting paid for pass­ing money back and forth — the U.S. will con­tinue to have some of the worst maternal/infant out­comes in the devel­oped world.

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Pregnancy Pathway, Pregnancy — Maternal Immunological Response

By dancingthrupregnancy | Published July 6, 2009

Today: Mater­nal Immuno­log­i­cal Response…or…the Mother/Fetus Dance!

Maternal Immune Response During Pregnancy

Mater­nal Immune Response Dur­ing Pregnancy

Back to work! Thank you for your fore­bear­ance while we wrote a chap­ter for a nurs­ing textbook!

Dur­ing the course of preg­nancy, the mother/fetus dance is ongo­ing. The mater­nal immune sys­tem and the tro­phoblast cells con­tinue to influ­ence each other even beyond the implantation.

Because the mother’s immune response mod­u­lates near the start of each trimester, the fetus is affected to some degree and mounts a response, as well. For a long time it was thought that mater­nal and fetal DNA mate­r­ial was not exchanged across the pla­cen­tal mem­brane, how­ever recent find­ings indi­cate that there is some exchange of mate­r­ial. Thus, we all carry some por­tion of our mother’s DNA and our mother car­ries some of ours.

What is the impact of this chimeric effect? It depends on how well our DNA gets along!

How does this affect the fetus in utero? The fetus may be affected by clot­ting issues. Depend­ing on mater­nal health sta­tus s/he may be sub­ject to a stronger or weaker immune system.

How does this affect the mother? Women are more likely than men to develop autoim­mune dis­or­ders (preg­nancy play­ing a role here), and those who bear male off­spring are more likely than those who only have girls to have these disorders.

The maternal/fetal dance goes on.…

Be Prepared for Birth!

Be Pre­pared for Birth!

Posted in 1, Genetics, Pregnancy Pathway, fetus, placenta, pregnancy, trophoblast | Tagged , , , , , , , , , , , | Leave a comment

Pregnancy Pathway, Pregnancy

By dancingthrupregnancy | Published May 11, 2009

Time for an entre: Preg­nancy!!

Up for discussion…

Health Influences in Pregnancy

Health Influ­ences in Pregnancy

Let’s start at the begin­ning…in the first trimester you feel sick and tired, right? Three things:

1) your immune sys­tem is pro-inflammatory (caus­ing nau­sea and fatigue), 2) your body is pro­tect­ing your fetus from some tox­ins (if you eat some­thing not so great for the fetus, you throw up), and 3) you have extreme swings in blood sugar lev­els so that after you eat, the level soars and you feel sick.

Num­ber 3 can be fixed with behav­ior, but you may have to wait out 1 & 2. To fix num­ber 3 eat very small meals fre­quently (6 or 8 times a day) and be sure to eat pro­tein, that is, eggs, meat, fish, fowl, cheese, nuts, rice & beans, soy, etc. with each small meal. This sta­bi­lizes blood sugar and pre­vents dra­matic ele­va­tions that can cause nausea.

In most healthy preg­nan­cies, the immune sys­tem will rebound in the sec­ond trimester so that you feel good; it is pro­tect­ing you again!  But, those wicked tox­ins and infec­tions are still out there in the envi­ron­ment, so the mes­sage is beware bad air (smog, smok­ing, indus­trial air pol­lu­tion), highly processed foods (lunch­meats, things with names you can’t pro­nounce), any drugs or meds not pre­scribed or okayed by your ob or mid­wife, alco­hol, and dan­ger­ous bac­te­ria, viruses and other microbes!

Exer­cise wisely…no sky-diving or scuba div­ing! Eat healthy food and get enough sleep. De-stress through relax­ation and med­i­ta­tive tech­niques. Don’t take risks with your health, but do stay active and start to pre­pare for birth and bring­ing home a baby (or two?).

Third trimester & the immune sys­tem goes on the fritz again — can’t keep this baby in here for­ever; must expel! You may feel sick and tired again. BUT, keep your pre­na­tal care appoint­ments, keep mov­ing, get good nutri­tion, rest and stay focused. Before you know it the real work begins, not to men­tion the 18 years of sleep deprivation.

Get­ting from here…

Being Fully Present in Your Pregnancy...

Being Fully Present in Your Pregnancy…

…to here..

Being Fully Present as Mom

Being Fully Present as Mom.

…is a jour­ney like no other. The adap­ta­tions of your body to the demands of preg­nancy are amaz­ing. If you pay atten­tion, you will learn more about the mean­ing of exis­tence from this than from any­thing else.

BE HERE NOW!!

Sign up for this Blog (top tool­bar, click blog info and sub­scribe)!! Learn from our more than 30 years of help­ing make healthy moms & healthy babies.

Visit our web­site:  www.dancingthrupregnancy.com

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Pregnancy Pathway…Important Notes from Wonderrobyn

By dancingthrupregnancy | Published May 2, 2009

The fol­low­ing are notes from co-author Robyn Bran­cato, CNM (cer­ti­fied nurse mid­wife) who prac­tices in New York City, or, as she is know here: Won­der­robyn! You can read about both authors in the About tab above. Here they are on the beach in San Diego, when they gave a talk at con­fer­ence there a cou­ple years ago. Robyn on the left, Ann on the right.

Robyn and Ann, Pathway authors

Robyn and Ann, Path­way authors

1. Addi­tion to Small Rant: “Resist the temp­ta­tion to watch A Baby Story on TLC! It does not por­tray birth accu­rately, as they con­dense 15 hours of labor into 30 min­utes and play up the drama so that you will be on the edge of your seat! In the major­ity of women, birth is not that dangerous.”

2. Regard­ing: When does con­cep­tion occur? “This is a really inter­est­ing post… I love the dis­cus­sion about at what point con­cep­tion occurs! Per­son­ally, I like the Bib­li­cal notion of quick­en­ing. Even though this varies from woman to woman and can range any­where from 16 to 22 weeks ges­ta­tion, it seems like the most nat­ural theory.”

Dear Reader:  What do YOU think? Did you read the con­cep­tion post on March 23, ’09?

3. About sperm & preeclamp­sia. “Is the con­nec­tion between bar­rier meth­ods and preeclamp­sia actu­ally estab­lished? I have read stud­ies stat­ing the con­trary — that bar­rier meth­ods have no effect on preeclamp­sia rates.”

HURRAY! THIS REQUIRES FURTHER CONSIDERATION.

More infor­ma­tion: The immune mal­adap­ta­tion the­ory sug­gests that tol­er­ance to pater­nal anti­gens, result­ing from pro­longed expo­sure to sperm, pro­tects against the devel­op­ment of preeclamp­sia. Thus, bar­rier meth­ods and being young may pre­dis­pose women to this major dis­or­der of pregnancy.

Evi­dence exists on both sides of this the­ory. Here are two recent stud­ies (one of each) that read­ers may find help­ful in under­stand­ing this idea. Keep in mind that other fac­tors than just sperm expo­sure may be affect­ing research find­ings. But, it does seem that under some con­di­tions, bar­rier meth­ods and amount of expo­sure to sperm can affect the preg­nancy itself.

Ness RB,  Markovic N, Harger G, Day R. Bar­rier meth­ods, length of pre­con­cep­tion inter­course and preeclamp­sia, Jour­nal: Hyper­ten­sion in Preg­nancy 23(3):227–235. 2005.  Results did not sup­port the immune mal­adap­tion theory.

Yousefi Z, Jafarnezhad F, Nas­rol­lai S, Esmaeeli H. Assess­ment of cor­re­la­tion between unpro­tected coitus and preeclamp­sia, Jour­nal of Research in Med­ical Sci­ences 11(6):370–374. 2006. In a matched con­trols study, women with <4 months cohab­i­ta­tion or who used bar­rier meth­ods had higher risks of devel­op­ing preeclamp­sia than those with >4 months cohab­i­ta­tion. Oral con­tra­cep­tion users had a lower preeclamp­sia rate than those who used no oral contraception.

In a com­men­tary arti­cle in OB/GYN News ‚  July 1, 2002, the fol­low­ing note was made by Dr. Jon Einars­son: With insuf­fi­cient expo­sure, preg­nancy may induce an immune response and preeclamp­sia in some women with pre­dis­pos­ing fac­tors such as an endothe­lium that already is sen­si­tive to injury due to age, insulin resis­tance, or pre­ex­ist­ing hypertension.

Is there a plain and sim­ple truth about sperm expo­sure and preg­nancy risks? Alas, no. But, know your cir­cum­stances. If you are young, pro­tect your­self. Wear a con­dom. When you are ready to be a mom, you will be ready to fig­ure out your risks. So, this, too fol­lows the axiom:

Events in life are rarely plain and never simple.

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Pregnancy Pathway, Conception — Review & Small Rant!

By dancingthrupregnancy | Published May 1, 2009

REVIEW: Evi­dence is clear - pre-pregnancy mater­nal health sta­tus, includ­ing phys­i­cal fit­ness, healthy nutri­tion and an uncom­pro­mised immune sys­tem affect the health and well-being of both mother and off­spring, in both short and long term.

This is the mes­sage sum­mary from our first two areas of dis­cus­sion:  Pre­con­di­tions and Con­cep­tion — the green and sand col­ored sec­tions on the chart below.

pregnancy_pathway

COMING ATTRACTIONS: We are about to move on to the blue sec­tion — Preg­nancy!!  So, book­mark this Blog for future reference!

Also, you can sub­scribe to this Blog by click­ing on Blog Info in the upper right cor­ner and then click­ing on Sub­scribe in the drop down menu.

But, yes, you guessed it, first we have a small rant!

SMALL RANT: When we note that fit­ness, nutri­tion and a healthy immune sys­tem play sig­nif­i­cant roles in the out­come of preg­nancy and the future health of mother and child, we are appeal­ing to young peo­ple of child­bear­ing age to be care­ful about your bod­ies. The alliance of egg and sperm shapes the world. With 6.5 Bil­lion egg/sperm com­bi­na­tions (yes, peo­ple) presently liv­ing on earth, our resources are stretched. With time, either we get more picky about doing this, or the 3rd rock from the sun (remem­ber that show?) is cooked.

Humor­ous incur­sion: In case you need fur­ther enlight­en­ment on this whole area, there is a great web­site that will help you out. Be pre­pared to be amused and amazed!

The Truth about Eggs and Sperm

Hope­fully, this gets you in the right mood and keeps you smil­ing. After all, once you actu­ally are preg­nant, we have more seri­ous mat­ters to discuss.

Posted in 1, Pregnancy Pathway, birth, conception, exercise, pre-pregnacy, pregnancy, trophoblast | Tagged , , , , , , , , , | 2 Comments

Pregnancy Pathway, Conception — Prior Sperm Exposure

By dancingthrupregnancy | Published April 27, 2009

Today:  Sperm!!!

For com­plete graphic, see Feb. 5 or 23 post.

The mother's prior sperm exposure can affect her pregnancy.

The mother’s prior sperm expo­sure can affect her pregnancy.

Not every sperm is your friend! Sperm expo­sure — like so many expo­sures — affects our immune sys­tem. Women who have babies with more than one father may be at risk for dis­or­ders of preg­nancy because the chal­lenges to their immune sys­tem have been exten­sive. And, very young women who become preg­nant are at increased risk of some dis­or­ders because they have had very lit­tle expo­sure to sperm.

In addi­tion, women who have pri­mar­ily and exten­sively used bar­rier meth­ods of con­tra­cep­tion may be at risk for dis­or­ders for rea­sons sim­i­lar to young women with lit­tle expo­sure. Unlike women whose immune sys­tem has had too much chal­lenge due to preg­nan­cies by sev­eral men, women with lit­tle expo­sure may not have a strong defense against for­eign DNA. Please do not take this as a rea­son to not use a con­dom — one of the bar­rier meth­ods along with a diaphragm and cer­vi­cal cap. Rather, if you use a bar­rier method of con­tra­cep­tion, keep in mind that your body’s adjust­ment to preg­nancy may take time.

For more infor­ma­tion on bar­rier meth­ods, to go the Amer­i­can Col­lege of Obste­tri­cians and Gyne­col­o­gists’ online pam­phlet: ACOG Pam­phlet on Bar­rier Con­tracetp­tion.

Another way sperm can affect the preg­nancy is that the com­bi­na­tion of the mother’s and father’s nat­ural immune responses may be strong against the tro­phoblast implan­ta­tion. This is not some­thing  you can know ahead of time. Also, women are eight times more likely than men to develop autoim­mune dis­or­ders. One rea­son may be the pre­na­tal expo­sure to for­eign DNA encoun­tered in pregnancy.

Keep in mind that by get­ting good pre­na­tal care, exer­cise, suf­fi­cient rest, stress man­ag­ment and healthy nutri­tion, you do all within your power to have a healthy preg­nancy. Your health care provider will deter­mine your risk fac­tors that may affect preg­nancy out­come and treat you in an appro­pri­ate manner.

Moms and babies enjoy exercise together!

Moms and babies enjoy exer­cise together!

Once your baby comes, there will be time to max­i­mize health for both of you. Exer­cis­ing together is great fun!

Get­ting there may require some patience, but the reward is well worth it.

When you are look­ing around for sperm, use your head. The same behav­ior that pro­tects you from infec­tions you never want to get, pro­tects you from sperm you don’t really want to meet. When the time comes to adopt some sperm, find out about it’s credentials!

Posted in Genetics, baby, conception, exercise, trophoblast | Tagged , , , , , , , | 1 Comment