Happy New Year

Just a reminder in the middle of a crazy world, that though home births are reserved for low-risk women, Columbia Midwifery does not discriminate based on religion, nationality, ethnicity, familial or LGBTQ status.  Every mother deserves to be empowered in her birth.


Protecting Your Perineum from the Inside Out


Credit: birthfaith.org

Someone I love gave birth last week for the first time. We talked on the phone about her experience a few days later. While she felt really good about how everything went, she was hurting. An episiotomy+tearing, back pain from her epidural, plus the normal pain associated with initiating breastfeeding were wearing on her. Having experienced some severe tearing with my first birth, I gave her my solidarity. Recovering from perineal trauma was some of the most excruciating physical pain I’ve ever experienced! I’d take labor pains over that any day.

During our phone conversation, she mentioned that one of the nurses at the hospital had asked her if she ate meat (she does eat a little, mostly chicken). Seems like a strange question, but apparently the nurses at that hospital had noticed a trend among the women they attended in labor: in their experience, women who were vegetarians were more likely to tear. A statement like that calls for some follow-up research, no? I jumped on it and starting digging around in the scientific literature to see what dietary substances are associated with increased skin elasticity. I never really found a clear-cut answer to the vegetarian question, but I did find lots of other cool information.

I’ve posted before about how to prevent tears from the outside in, but now I know a whole slew of ways we maybe able to protect our perineums from the inside out. These are some dietary additions you may want to make if you’re hoping to prevent tears (and improve your skin and health in general):

1.  Healthy Fats

Earlier this year, Japanese researchers published their findings: “After controlling for covariates including age, smoking status, BMI and lifetime sun exposure, the results showed that higher intakes of total fat, saturated fat and monounsaturated fat were significantly associated with increased skin elasticity” (Source).  The study also found that adding a high intake of green and yellow vegetables to that fat consumption improved skin health even further.  That’s not to say we should eat just any fats. If you’re going to consume animal fats, your best bets are those coming from organic, grass-fed, free-range, or wild-caught animal sources. Plant sources of healthy fats, include olive oil, coconut oil, avocados, nuts, and seeds. Unfortunately, filler oils such as soybean oil are often added to many of the “olive oil” brands available. Find a reputable brand!

Then there are the fatty big guns: the omega-3s. Research indicates that supplementing with fish oil can significantly improve skin elasticity. Regularly consuming fatty fish like wild-caught salmon will also boost your omega-3 levels. Plant sources of omega-3 fatty acids include flaxseeds, chia seeds, pumpkin seeds, and walnuts. Personally, I try to eat from a wide variety of omega-3 sources to cover all my bases–DHA, EPA, and ALA.

Fats to limit/avoid: processed fats such as hydrogenated oils, trans fats, and any oils that go rancid easily… vegetable oils, corn oil, soybean oil, safflower oil, etc. Hydrogenated and rancid oils can lead to free radical damage which will reduce the health and elasticity of your skin (and contribute to a long list of other health problems).

2. Vitamin C

“(Vitamin) C is for Collagen,” says Allison Tannis in her book Feed Your Skin, Starve Your Wrinkles.  Collagen, she explains, “is a protein with a triple helix structure that provides a strong framework to support cells.  Its tensile strength (the ability to resist force without tearing apart) is greater than that of steel, which explains why your skin is so strong” (p. 20).  Or why your skin should be strong, that is.  Reduced collagen levels lead to unhealthy, weak, aging skin.  Vitamin C has been shown to stimulate collagen production (source).  Logic would suggest, then, that increasing your intake of vitamin C would give your perineal skin added health and strength (a perineum of steel!) to resist trauma.

What are the best dietary sources of vitamin C?  Papaya, red bell peppers, broccoli, brussel sprouts, and strawberries.  Find morehere.  Vitamin C will also boost collagen production (and overall health) when applied topically to the skin (source).

3. Cysteine

Now here’s where the vegetarians and vegans could be low.  Cysteine is an amino acid as well as a powerful antioxidant.  It promotes healthy skin elasticity and is necessary for skin repair.  Most of the potent dietary sources of cysteine are animal products(meats, poultry, eggs, cottage cheese, yogurt, etc), but there are plant sources (red peppers, garlic, onions, broccoli, brussels sprouts, oats, granola, wheat germ) (source). Cysteine deficiencies are rare, but “strict amino acid-imbalanced vegetarian diets may lead to poor sulfur amino acid intake and [cysteine] deficiency signs” (source).  Our bodies will actually produce cysteine on their own as long as enough methionine (another amino acid) is available.  Vegans and vegetarians can pre-empt a cysteine deficiency by supplying their bodies with ample methionine.  Good sources of methionine include eggs, fish, sesame seeds, brazil nuts, soy protein, parmesan cheese, meats, and cereal grains (see more here).


4. Evening Primrose Oil

A 2005 study found that adults taking capsules of evening primrose oil for twelve weeks had significantly improved skin elasticity, moisture, firmness, and fatigue resistance compared to adults taking a placebo (source).  Evening primrose oil provides health-promoting forms of omega 6 essential fatty acids—linoleic acid (LA) and gamma-linolenic acid (GLA).  While it has many medicinal uses, midwives have long encouraged evening primrose oil at the end of pregnancy as a means of ripening the cervix (through its prostaglandin content) for childbirth.  Given that traditional usage, it may be wise to delay taking evening primrose oil until the 37th week of pregnancy and only in consultation with your maternity care provider.  I’ve heard mixed reviews about whether it will help put you into labor, but research does indicate that it will improve the elasticity and health of your skin.  I’ve also heard that it can be massaged into the perineum to prime the tissue to stretch well, and it is also supposed to be helpful when applied topically to prior perineal scars to loosen and soften them in preparation for a subsequent birth to prevent re-tearing.

5.  Et Cetera

Other dietary additions that may benefit the strength and elasticity of your perineum…

  • Silica—strengthens the skin and promotes elasticity and wound healing.  Dietary sources: whole grains, dark leafy greens, leeks, green beans, garbanzo beans, strawberries, cucumber, mango, celery, asparagus and rhubarb.
  • Selenium—promotes skin elasticity and prevents free radical cell damage.  Dietary sources: brazil nuts are the most potent source (I hear you can even get too much selenium by eating more than a few per day), wheat germ, fish, garlic, eggs, brown rice, and whole-wheat bread.
  • Vitamin E—promotes overall skin health and promotes wound healing.  Dietary sources:  sunflower seeds, almonds, olives, papaya, and dark leafy greens.

Other external preventative measures to reduce perineal trauma…


Ever Curious What that Whole Dilation Thing is Really About?

This was something I was always curious about as a mother and a new student.  How can providers really tell?  Isn't it very subjective? Is 7 cm dilated for one L & D nurse the same thing as 7 cm for the doctor?  How is it that every woman and every baby just needs to make it to 10 cm?  Won't larger women or women with larger babies have to dilate more?  The fact is that it is very subjective.  And you could be 10 cm (if it were possible to use a measuring tape on your cervix) and still have more to dilate.  That is why the more appropriate term is "complete."  You dilate centimeter by centimeter, cervix softening and opening around baby's head until it is no longer in front and no longer reachable by your provider.  However, keep in mind you can not put numbers on babies in natural birth.  A mother could be zero centimeters and deliver a baby that evening and another woman could walk around town at five centimeters for weeks.  Also note that just because a woman is complete doesn't necessarily mean that it is time for her to push.  Most deliveries go much more smoothly with a less exhausted mother when she is allowed to "labor down" and wait until the urge to push is strong.  That being said, below is a visual representation of what in diameter will be similar to your cervix when you are in labor.

47 Questions You Should Ask Your Midwife [or Doctor] During an Interview

List of 47 Questions to Ask a Midwife During an Interview
by Shannon Brown | Sep 27, 2012 | Best of GrowingSlower, Natural Birth, Pregnancy + Birth | 24 comments

I  will admit, I didn’t ask my midwife too many poignant questions when I was interviewing her.
It was love at first sight, and I was still blissfully unaware of all the unexpected situations that can arise in even a healthy low risk pregnancy.
Luckily, everything turned out beautifully. We couldn’t have been more happy with our decision to have a home birth and with our wonderful midwife as our care provider.
Looking back on my experience and those of many other women who have shared their stories with me, this is the list of questions I should have asked my midwife when I interviewed her.

Some of these questions I did ask during the interview. Some we asked in later prenatal appointments. Some came up when we were trying to explain our home birth decision to family.
All of these questions are important, and the answers can help clue you into whether a particular midwife or obstetrician will be able to support you through a successful natural birth.
Unforeseen circumstances may arise during your pregnancy or birth. It’s great to have the peace of mind that when they do, you know exactly what to expect from your care provider.
47 Questions to Ask Your Midwife
(Download the free printable at the bottom of this post.)
1.   What is your philosophy regarding pregnancy and birth and your role in it?
2.   How many births have you attended?
3.   What percentage of women successfully have a natural birth under your care?
4.   What percentage of women need to transfer to the hospital (if planning a home birth or birth center birth)? What is the typical reason?

5.   What percentage of moms end up with a C-section?
6.   What percentage of moms end up with an epidural?
7.   What percentage of babies are transferred to NICU?
8.   What is the mortality rate for moms? For babies?
9.   Do you have hospital privileges? At what hospitals?
10. If you have children, what were your birth experiences like?
11. How many midwives or obstetricians are on the team? Who are your assistants? Will I get to meet all of them? What is their experience? Can I be sure that you will attend my birth?
12. Do you deliver breech babies naturally? VBACs? Twins?
13. How many births do you attend per month?
Download this free list of questions to ask a midwife during an interview printable to take with you to your first appointment.
(Image Credit)
14. What usually happens at prenatal appointments? How many? When? How long are they?
15. Are you available by phone or email for questions?
16. What is your philosophy on weight gain, nutrition, prenatal supplements, and exercise?
17. What factors would risk me out of your practice? How will you help me prevent these?
18. What child birth class do you recommend?
19. What prenatal testing to you encourage?
20. What type of gestational diabetes testing do you typically use?
21. Do you recommend ultrasounds? When? How many?
22. Do you typically do vaginal checks during prenatal appointments? When?
23. What happens if I go past my due date? How late can I be and still birth under your care (if a midwife)?
24. What testing do you do for a late baby? Starting at how many weeks?
25. Do you have any concerns about big babies being birthed naturally?
Download this free list of questions to ask a midwife during an interview printable to take with you to your first appointment.
(Image Credit)
26. When do you do vaginal checks during labor?
27. What type of monitoring do you do during labor? How often? For how long?
28. Do you routinely use an IV or hep-lock?
29. Are there birth tubs in each room in the birth center? What if one is not available when I’m in labor?
30. Is a water birth available? If not, am I able to push in the tub at all?
31. How long do you recommend I stay in the water at one time? Do I need to get out for monitoring?
32. How many women are under the care of one midwife or doctor at a time? How much will you be with me throughout my labor?
33. Are you comfortable working alongside a doula? Do you have particular doulas you recommend?
34. How long can I labor without induction?
35. When would you recommend induction? Do you use natural induction methods first?
36. How long can I labor without intervention after my water breaks?
37. Who attends a birth? (Students, assistants, nurses, etc.)
38. When do you feel amniotomy is indicated?
39. Can I eat and drink during labor?
40. What’s your process for implementing a family’s birth plan?
41. What positions are available during labor? While pushing?
42. What are reasons you would initiate a transfer to a hospital (if a home birth or birth center birth)?
43. How long do you allow for delivery of the placenta? When do you cut the cord?
Download this free list of questions to ask a midwife during an interview printable to take with you to your first appointment.
Postpartum & Newborn Care
44. What post-partum care do you provide? When? How many appointments? Where?
45. What does newborn care consist of? Under what circumstances would my newborn need to be taken away from me for treatment?
46. Are you comfortable with me declining bathing, vitamin K, heel poke, eye ointment, vaccinations?
47. Can you help me initiate breastfeeding?


Originally posted: http://www.growingslower.com/2012/09/47-questions-i-should-have-asked-my.html

11 TED Talks for Pregnancy and birth

Putting Sex Back Into Birth and 10 other great Pregnancy and Birth Ted Talks

Hey, Columbia!  Check out these 11 Ted Talks for Pregnancy and Birth!  Then contact me to find out if home birth in Columbia, SC is right for you!

1. Reducing fear of birth in U.S. culture: Ina May Gaskin

7. Alexander Tsiaras: Conception to Birth Visualized


9.  Jenn Anderson, Breastfeeding is Everyone's Business


10. Tyrone Hayes, The Toxic Baby


11.  Jennifer Senior, For parents, happiness is a very high bar

There's a New Midwife in Town!

After over seven years in the making, Jennifer Lucas O'Briant is now licensed as a midwife in South Carolina!  She worked as a student midwife, doula, and apprentice during that time serving women all over the state and compiling clinical experience under several of South Carolina's great midwives.  She is looking forward to starting her own practice and continuing to provide excellent care to women and families in her community.