Wednesday, January 27, 2010

One In 10 Women Expose Their Unborn to Herbs

I get a variety of newsfeeds in my office every day - hundreds of them so I can update our In The News section of The news items are fact based, I try to avoid blogs or opinion pieces - if I do include them, then I note them as such.

I do have to pick on Reuters. They have a way of phraseology that spins a study or report. The spin does not always spin correctly. I guess that is the reason why they call it "spin".

In an article released yesterday by Michelle Rizzo, Herbal Use Common Among Pregnant Women in US, Rizzo opens her article with "This finding is potentially concerning, researchers say, given that data on the safety of herbal use during pregnancy is lacking."

"The products used most often throughout pregnancy were herbal teas and chamomile, which has also been shown to ease morning sickness. The most commonly reported products used early in pregnancy were ginger, which has been shown to help ease morning sickness, without side effects to the unborn child..."

Rizzo goes on to say:

"If we assume that our study sample was representative of the 4.2 million births each year in the United States, our findings project that 9.4 percent, or potentially 395,000 U.S. births annually, will involve exposure to at least one herbal product during pregnancy," lead author Dr. Cheryl S. Broussard, from the Centers for Disease Control and Prevention in Atlanta, told Reuters Health by email.

The findings, reported in the American Journal of Obstetrics and Gynecology, are based on data from 4,239 mothers in the National Birth Defects Prevention Study who delivered liveborn infants with no major birth defects from 1998 to 2004. The 10 study centers were located across the U.S.

Overall, 462 (10.9 percent) of the 4,239 mothers reported using herbal products in the 3 months before or at some point during pregnancy. The prevalence of herbal use anytime during pregnancy was 9.4 percent. The prevalence during pregnancy was highest (6.9 percent) during the first trimester.

We don't have much scientific data on herbs for pregnancy and birth. We do have centuries of anecdotal information.

We do have scientific data that medications giving during pregnancy and birth cause a medley of complications.

We should use caution when entering into unexplored and undocumented areas. We should also use caution when explored and documentation exists about the risks of anything used during critical months of pregnancy.

Educate yourself.

Monday, January 25, 2010

Welcome Our First 2010 Guest Blogger ~ Vonda Gates

During 2010, I will be having guest bloggers sharing their thoughts about pregnancy, childbirth and breastfeeding. These guest bloggers will maternal child health professional, dedicated to the continuum of care we call birth. If you are a birth professional and would like to be a guest blogger, email me at!

The Birth Class Experience and Informed Decision-Making
by Vonda Gates RN ICCE IAT

(Vonda Gates is a chidlbirth educator trainer and doula trainer living in South Dakota.)

My client and her partner were waiting at their car after I finished cleaning up the Thursday night childbirth class. It was the last night of the series they had attended, so they startled me in the dark as I locked up for the evening. I always enjoy talking with clients but was genuinely surprised when they asked if I would attend their upcoming birth as a doula. They had said almost nothing through the entire class series and I had wondered if I was meeting any of their needs, their silence giving me no clues. Now, however, they were talkative and excited about several changes they had initiated related to this birth.

As their story unfolded over the next month, I learned this was a second birth with a second partner. My client had been hospitalized many times in her life for various mental disorders related to sexual and physical abuse of her first partner. The most recent hospital stay was just six months before the class started and she feared this birth would bring about panic attacks as the first birth was a traumatic memory of pain and isolation. Yet, despite her fears, she wondered if things could go differently this time. As she watched other clients in the class discuss options and make choices she wondered if she could dare to make decisions for herself that would leave the outcome more positive.

Penny Simkin, in her book When Survivors Give Birth (2004) points out that every childbirth class most likely includes survivors of abuse, both male and female. Birth educators should realize that one in every three or four clients have survived some sort of abuse trauma. My client fit one of Simkin’s descriptions of an abuse survivor as the reluctant participant. Other signs include clients that appear bored, sleepy, or even hostile.

I wish I could say I was the enlightened childbirth educator Simkin encourages in her text, realizing that clients with abusive backgrounds have special needs in a class setting.
In this case, I don’t think there was much I did that initiated change. Instead, it was the group process in a safe environment and the example of the other clients modeling informed decision-making that triggered the new beginning for this client. In a letter, my client described her new realization that she could make choices also.

And choices she made. She changed care-providers to one that would allow a doula present at a surgical birth. This required a change to another hospital an hour away. She decided to breastfeed and made arrangements for immediate support in recovery. Her partner’s caring support and their shared commitment to the new plans brought them closer together.

Her desire to not panic at the surgical birth of her second son came to be and it was a happy welcoming with many endearing memories. An unexpected surprise for this doula and educator was when she called the next day to share details of her first night mothering this new child. I did not recognize her voice on the phone. What was so different: a new lilt, a contented tone?

The first sign of many positive changes that followed this birth and of the new beginning she so craved.

Simkin, P. & Klaus, P. (2004). When survivors give birth. Seattle, WA: Classic Day Publishing.

Wednesday, January 20, 2010

"How To" ~ Belly Casting

Ever wonder how to do a belly casting?

Here is a great step-by-step video! And if you want to take some of the guess work out, look at the Belly Casting Kits from!

Monday, January 18, 2010

Just the Facts...Ma'am

The Childbirth Connection (formerly Maternity Center Association) released the Maternity Quality Matters: Latest US Maternity Care Statistics in December. This fact sheet updates statistics in the Evidence-Based Maternity Care: What It Is and What It Can Achieve. Both the fact sheet and the Evidence-Based Maternity Care report are available online in PDF format.

Some highlights from the fact sheet are that there were more than 4.3 million births in the US during 2007. Six of the 10 most common hospital procedures in 2007 were maternity-related including cesarean section (ranked #3, an 85% increase), circumcision (ranked #7), fetal heart monitoring (#8) and artificial rupture of membranes to assist delivery (#10).

2007 marked the 11th straight year of increase for cesarean sections to an amazing 31.8%. Utah had the lowest cesarean rate of 22% and New Jersey the highest with 38.3% ~ although Puerto Rico had a cesarean rate of 49.2%.

Preterm births generally rose to 12.8% in 2006, but dropped to 12.7% in 2007 with Vermont having the lowest rate of 9.2% and Mississippi a rate of 18.3% (Puerto Rico = 19.4%).

What is the take-away from these statistics? Before we can ever make a statement that our technology is improving and should be used, we must also look at our maternal child/health outcomes. In November 2009, the March of Dimes noted that the US received a “D” for the Preterm Birth Rate .

The US has ranked as low as 41st in the world for maternal mortality with 1 in 4,800 women dying from pregnancy complications (October 2007).

The U.S. infant mortality rate of 6.78 infant deaths per 1,000 live births in 2004, compared unfavorably with the lowest rates of 3.5 per 1,000 reported in Scandinavian and East Asian countries. Overall, 22 countries had infant mortality rates below 5.0 in 2004.

Education should be the take-away. Education of parents ~ an increase in prenatal education as stated in the Healthy People 2010/2020 initiative. Education of care providers about evidence-based care.

Education will change our statistics…or as Nelson Mandela once said, “Education is the most powerful weapon which you can use to change the world.”

Thursday, January 14, 2010

Preventing Late Preterm Births ~ Since Every Week Counts

I recently attended a webinar in the comforts of my office, complete with Power Point presentation and bibliography downloadable.

Presented by NPIC/QAS Educational Services, this webinar (complete with CEUs) was titled: Preventing Late Preterm Birth: Since Every Week Counts. The presenter was Karla Damus PhD, MSPH, RN, FAAN Dr. Damus is an Associate Clinical Professor and Dir. of the Div. of Public Health and Community Programs in the Dept. of Ob/Gyn and Women's Health at the Albert Einstein College of Medicine. She is a consultant to the Office of the Medical Director at the National Office of the March of Dimes where she designed and is Program Director of the national model initiative to reduce preterm births in Kentucky - Healthy Babies are Worth the Wait. Dr. Damus is a Fellow of the American Academy of Nursing, a Fellow of the NY Academy of Medicine, and a member of: the Select Expert Panel on Preconception Health, and the Nurse Advisory Council for the National March of Dimes. She is also a consultant to the Ob/Gyn Devices Panel of the Medical Devices Advisory Committee Food and Drug Administration. Dr. Damus is a perinatal epidemiologist and nurse, having received her PhD in epidemiology from the University of California and two masters degrees from UCLA in Nursing and Public Health.

Preterm birth is currently the #1 obstetric challenge in the US and is the major cause of all infant mortality in the US. Preterm birth is a leading problem in pediatrics, responsible for nearly all neonatal morbidity, half of all neurodevelopmental conditions, 20% of mental retardation, 33% of vision impairments and 50% of cerebral palsy. Preterm birth has also been associated with higher rates of chronic illness, such as heart disease and diabetes, in adults.

Over the last 20 years, there has been a 30% increase in preterm births in the US, with 37% of all preterm births being late preterm births or those babies born between 34 and 36 weeks. Dr. Damus defined preterm as being between 20 weeks and before 37 completed weeks; late preterm as 34 weeks 0/7 days to 36 weeks 6/7 days (239-259 days); term as live birth between 37 weeks 0/7days to 41 weeks 6/7 days (260-294 days); and postterm as live birth from 42 weeks 0/7 days (295+ days). Non-Hispanic Black women tend to have significantly more late preterm births than Hispanic or Non-Hispanic White women. Similarly, women 24 years old and younger plus women 35 and older had more late preterm births than women 24 – 35. Geographic difference were significant was well and you can check your states report card at

Dr. Damus cited the changing culture of childbearing as contributing to the rising late preterm rates including more high risk pregnancies, public preferences for elective induction and CDMR, clinical management with more interventions and defensive medicine due to today’s litigious society.

She also discussed the progression of fetal brain development, noting that the lower functions of the brain mature first, the cortex is the last to develop and the brain at 35 weeks gestation weighs only 2/3 what it will weigh at term. The volume of white matter increases 5 fold from 35 -41 weeks and the brain basically organizes during this time period – developing synapse, neurotransmitters and more.

This great webinar is available on the NPIC/QAS Educational Services website for $25. Other webinars are also available in their archive section. Truly a great opportunity!

Monday, January 11, 2010

Great Nutritional Advice ~ Print them now!

Whether you are expecting a baby OR are a maternal child health specialist (such as childbirth educator or doula) who educates about nutrition, I have found some valuable tools for you to add to your nutritional information arsenal! All are in a convenient PDF format, which means they will look great every time you print them!

The Pregnancy Food Guide was developed by a panel of experts (including former ICEA president Jane Hanrahan) organized by the Brigham and Women's Hospital (a Harvard teaching affiliate). The free PDF download is a colorful and informational guide to staying energized, eating small meals, and emphasizes the role of water in life. With sample meal and snack guides, plus estimated portion sizes, this Guide also includes logical and easy-to-follow tips for dining out and incorporating salt in a pregnant woman's diet. Salt had long been a controversial food additive. While not intended to be the sole source of nutritional information for expectant parents, this seven page Guide can become a great resource for any childbirth education class handout grouping or doula client folder!

The Mayo Clinic has a informational webpage that is titled "Pregnancy Nutrition: Foods to Avoid During Pregnancy". Included in the discussion are precautions for seafood that may contain mercury, raw and undercooked foods, unpasteurized foods, proper washing of fruits and vegetables, caffeine and alcohol.

From the Tennessee Department of Health is a one page PDF handout, Relief For Common Discomforts of Pregnancy, about the three common discomforts of pregnancy: morning sickness, heartburn and constipation. From the EPA, What You Need To Know About Mercury in Fish and Shellfish. And finally, from the Department of Health & Human Services (Office on Women's Health) is the Frequently Asked Questions about Folate (Folic Acid).

The Healing Foods Pyramid is a unique version, from the University of Michigan, of the FDA Food Guide Pyramid, although there is one now for moms-to-be! According to the creators of the Healing Foods Pyramid, the categories and their placement on the pyramid generally support their intent: to emphasize the foundational role of water in everyone's diet - whether pregnant or not. Following water is a rainbow of fruits and vegetables. Grains for fiber, then legumes are excellent sources nutrition in this plant-based pyramid. Eggs and dairy includes foods low in fat yet rich in calcium and offer high quality protein . Lean meats are viewed as complements rather than have a major role with fish & seafood, fish high in omega-3 fatty acids encouraged often. Seasonings include herbs, onions, garlic, pepper, salt and others that add flavor while contributing healing benefits. Dark chocolate is a source of antioxidants. Tea is recommended as a healthful beverage choice. Tea is, however, also a natural diuretic which means it will cause a depletion of water stores. Use tea beverages in moderation.

If you know of other great pregnancy nutrition resources, email me at And don't forget the pregnancy nutrition articles available at!