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Section 1 - Why Prenatal Care Is Important
1. First of all, what is prenatal care?
Prenatal
care is caring for the mother & baby from conception to birth, which last
till around 38 or 40 weeks gestation. Prenatal care is necessary to help
promote good physical and mental health, and to also educate the parents
for labor, delivery and breastfeeding. Knowledge is often a means of eliminating
unnecessary problems.
2. Why is early prenatal care so important?
Early care can
help detect problems that could possibly be turned around, and may also
aid in ruling out high risk conditions that could endanger the mother
and the baby. Oftentimes, a mother doesn't even realize she is pregnant
until 8 weeks-the most critical time.,
3. What types of things do you check for during the prenatal period?
First of all, we
check the mother's medical and O.B. history. We want to know how many
pregnancies she has had, any miscarriages, C-sections, problems, etc.
We like to do some blood work to make sure that the mother's hemoglobin
(hgb) isn't too low. We need to know the blood type. A prenatal panel
is recommended (especially for first time moms). Then at every visit
we check weight, B.P., pulse, edema, urinalysis, fetal movement, uterus
size or fundal height, palpation and fetal heart tones. (See
my book for more info.)
4. Is it important for a mother to watch her weight during pregnancy and how
much weight should she gain?
Well, if she is on
a healthy diet she would not have to worry much, but a normal weight gain
is 20-25 lbs.
5. What is edema and what should be done if edema is a problem?
Edema simply means
swelling brought on by an accumulation of fluid in the intercellular spaces
of tissues. This puffiness will be seen usually on ankles, feet, hands
and sometimes the face. (See
my book for more info.)
6. What is meant by palpating, and what is the purpose for that?
This is a very important
tool that we use. Palpating is done with our hands to feel the baby in
the uterus to determine the position and the size. We also listen for
fetal heart tones (FHT) while palpating.
7. Aside from the physical needs of the mother, what other needs or concerns
might you address during the prenatal period?
Emotional support
also plays a role. She may have fears that she needs to express or share.
I find a lot of fear arises simply from not being informed.
1. Can you give us an overview of the things that a pregnant woman
can do to promote good health for her and the developing baby?
I put
together a "Birthing 8 Laws of Health" tract for pregnant moms to go by.
Let's look at the acronym, 'BIRTHING'. Bodily exercise, Inhale pure air,
Rest, Temperance, Hydrotherapy, In the sunshine, Nutrition, and God's Word.
BIRTHING: EIGHT LAWS Of HEALTH:
Bodily exercise: Gardening, walking. - Genesis 2:15,
Proverbs 3 1:16,17.
Inhale pure air: Breathe deep. - Genesis 2:7, Job 27:3.
Rest: Go to bed early. - Exodus 23:12, Psalm 127:2,
Proverbs 3:24.
Temperance: Self discipline. - 2 Peter 1:6; Proverbs
23:1,2.
Hydrotherapy: Drink plenty and bathe often. - Proverbs
25:21, Isaiah 1:16.
In the sunshine: Bask in the sun. - Ecciesiastes 11:7,
Psalm 74:16.
Nutrition: Eat for strength. - Genesis 1:29, Ecciesiastes
10:17, 1 Corinthians 10:3 1.
God's Word: Trust Him! - Proverbs 4:22, 31:30; Psalm
119:105.
"Perceive the evidences of God's love... Instead of looking upon an
observance of the laws of health as a matter of sacrifice or self-denial...
regard it as it really is. as an inestimable blessing."-MINISTRY
OF HEALING, pg. 147.
2. Bodily exercise. What are the benefits of exercise and what types of exercise
would you recommend?
Of course exercise
will help tone up muscles to get prepared for birth. It helps blood circulation,
which is good for mother and baby. Exercise is needed for proper elimination.
It helps reduce stress and reduces indigestion. A pregnant mother needs
to be in good physical condition in order to have the stamina she needs
to give birth. The more exercise she gets the better she will stimulate
the production of endorphins, which is a hormone that acts as a natural
pain killer. Exercise may increase endorphin level in the blood by 60%.
It is also interesting that prolactin, which stimulates the breast to
make milk, may be increased by 40%. There are many types of exercises
you can do, but the best is walking and/or gardening. Outdoor exercise
in fresh air is healthiest.
3. Inhale pure air. Why should that be emphasized?
Inhaling pure air
increases oxygen supply to mother and baby. It purifies the blood and
improves sleep. We encourage our mothers to get fresh air in their houses
and bedrooms. As for labor, I recommend the slow relaxed breathing from
the diaphragm instead of breathing fast, to avoid hyperventilation. Slow
relaxed breathing will expend less energy so the mother won't be so tired.
This also helps ease the pain that comes with contractions.
4. Rest. Are there some benefits that perhaps we don't realize from proper
rest?
Of course! We tell
our mothers that every hour before midnight is worth two hours after.
If they maintain regular hours and establish a schedule now, it will help
establish regular sleeping patterns for their newborn. If you stay up
almost all night, your baby probably will as well.
5. Temperance. There is more to that word than most people think, isn't there?
Temperance in all
things is essential. Don't over exert, don't sleep too much, don't over-eat.
We also encourage our mothers to abstain from tobacco and alcohol. And
what many people do not realize is that caffeine can be damaging. (see
Chart 1 - Effects of Caffeine)
6. Hydrotherapy. What does this involve?
We encourage our
ladies to drink at least 8 glasses of water a day. This will promote good
circulation, elimination, blood building, and supplies water for the amniotic
fluid, which provides protection for the baby. Much of the fluid is being
replaced every 3 hours.
7. In the sunshine. What types of benefits do we find in that for the mother-to-be?
Sunshine increases
white blood cells, which strengthen the immune system. It destroys bacteria
and helps lower high blood pressure as it brightens the disposition and
soothes nerves. We also use it for treatment of jaundice in newborns.
8. Nutrition. Are there nutritional needs that are perhaps unique to pregnancy?
The pregnant mother
does need to be concerned that she gets enough vitamins and minerals and
protein for herself and her baby. The best source is what God has provided
in good natural food. Mothers should choose their foods from principle
rather than cravings. We encourage lots of fresh fruits and vegetables.
(See my book for more info
9. God's Word. What role does the Bible play in pregnancy?
We encourage our
mothers to read God's word and meditate on His promises. This provides
spiritual strength for the day and keeps the mind clearer. It also helps
eliminate stress, worry and fear. I find that Christians have the most
peaceable births.
Section 3 - Are Homebirths a Good Idea?
1. Having babies at home is certainly nothing new, but most births
are done in a hospital setting today. Why is that?
Because
hospitals can handle emergencies when a problem arises. They have medical
equipment, they can perform surgery, and they have medications for pain
relief, like epidurals. Also, hospital staff are available to wait on you,
a luxury not always available at home.
2. I understand that homebirths are making a comeback, so to speak. Why is
that?
Some couples want
to have a natural birth without interventions in their home setting, with
just the privacy of the family. The husbands can get more involved this
way. There is less risk of infections for mom and baby, and the cost is
much less.
3. Have there been any studies to verify the safety of homebirths?
Yes, the Mehl Study
and the JAMA Study are perhaps the best known. Both basically concluded
that low-risk home births are as safe or safer than hospital births.
4. What are some of the interventions that might routinely be performed in
a hospital that would not be done in a homebirth?
In the hospital they
have what they call Standard Operating Procedures (S.O.P.), which they
must go by. As soon as the patient has been registered, the staff will
obtain her OB history and do some additional blood work. Most women get
IV's unless they refuse. Enemas are generally routine, although some doctors
aren't doing that . They get hooked up to fetal monitors for monitoring
contractions and FHT's. Labor is augmented by the use of Pitocin. Epidurals
are freely given for pain, although the patient may choose to request
a natural birth. Depending on the doctor, forcep deliveries or vacuum
extractors may be used. Most doctors routinely give episiotomies (to create
a bigger opening for delivery), and c-sections are becoming more common-place.
5. What should a couple look for in a midwife, and how can they know that the
person is competent?
You should probably
ask how many years of experience she has. Does she carry emergency and
medical equipment (diagnostic instruments) like B.P. cuffs, stethoscopes,
and chemstrips to the birth? Does she carry oxygen, an Ambu bag to administer
a certain amount of oxygen by positive pressure to a severely depressed
baby (this is very rarely needed at home)? Does she carry devices to listen
to FHT's? How does she handle hemorrhages? Does she work with an assistant
and is she trained as well in neonatal emergencies? Has she ever lost
a baby or mother? Is she accessable (on call) all the time? Does she have
a Doctor back-up that works with her? Does she do prenatals, labor and
delivery, postpartum care?
6. Can you summarize the steps for a safe homebirth?
Section 4 - What Are Considered High Risk Situations?
1. Are there times when you would not encourage a homebirth?
Yes,
certainly you should rule out complications and high risk situations during
the prenatal period. Unless it is something that can be turned around, refer
to OB care.
2. What are some examples of what you would consider "high risk"?
Here are a few:
- Smokers
- Diabetics
- Placenta previa
- Multiple pregnancies
- Breech presentations
- Venereal disease
- Heart disease
- Hypertension
- Etc.
3. Is it possible to have a normal delivery after a Cesarean section?
Yes, most of the
uterine incisions are low and horizontal, making the risk of uterine rupture
less than 1%. The Flamm Study (1994) documented 75% of women with previous
C-sections were able to have successful vaginal births. Also, the American
College of Obstetricians and Gynecologists (ACOG, 1994) recommended that
the practice of routine repeat cesareans be abandoned.
4. What if the mother has had several babies - do you run into any particular
risk there?
Yes grand multips
(a woman who has had 5 or more babies) will have a greater risk of uterine
inertia or boggy uterus than one whose had less babies. When the uterus
does not contract well, a major hemorrhage is possible. But it also depends
on what kind of shape she is in. If she is in good health and follows
a good diet and lifestyle, she may have no trouble. Also, there is greater
risk if she is having one baby on top of another without sufficient time
in between to give the uterus a break.
5. What are the dangers of smoking in pregnancy?
The effects of smoking
are tremendous, but let us look at just a few. 5% of still births and
neonatal deaths are attributed to smoking (British Medical Journal). 70%
greater risk of miscarriage (Ibid.). Babies are stunted in growth (Ibid.).
Section 5 - When to Call for Help! - Labor & Delivery
1. Are there some early signs that a woman is about to go into labor?
Yes,
let's look at some. Braxton Hicks contractions increase and become more
regular. Mucus discharge will increase. The "bloody show" or pinkish glob
of mucus may appear. Bowel movements (soft) will increase.
2. How can a couple tell when it is time to call their midwife?
This can be confusing
sometimes, even if they have had children before. Here are some typical
signs, but remember, not every one is always the same.
3. Are there ever occasions where there are no signs and suddenly the mother
is in hard labor?
Yes, sometimes, but
this is rare.
4. In the hospital, mothers generally are kept on their backs during labor.
Is this the preferred position?
In the hospital it
may be preferred due to the monitors that are hooked up to the patient.
However, you will find in Exodus 1:15-18 that the Hebrew women delivered
quicker and easier. They were using birthing stools. This is like squatting
with support. It is less painful because of the upright position, and
gravity is in the patient's favor. The cervix dilates quicker, and helps
the pelvis open up wider.
5. Are episiotomies necessary?
No. Very rarely,
if ever, are they necessary in a homebirth. By using (olive) oil massage
on the perineum, combined with hydrotherapy and controlled pushing, tears
can be generally avoided.
6. In the hospital, a woman in labor has recourse to anesthesia. What about
at home?
No anesthesia is
generally available, but wonderful comfort measures may be employed, such
as warm baths, hydrotherapy (the use of warm moist towels), massage, and
walking. In addition, the patient may stay well hydrated and rest when
she wants. That will help keep her energy level and pain tolerance up.
7. What takes place in order for an eight pound or so baby to pass through
the birth canal?
The pelvic joints
are greatly influenced during pregnancy due to the hormones progesterone
and relaxin which increase flexibility of the sacroiliac joints and the
symphysis pubis to open greatly during labor. This allows the baby to
pass through the birth canal.
8. After the delivery of the baby, what happens next?
There is the 3rd
stage of labor, the expulsion of the placenta. By nursing her baby, a
natural oxytocin is released which will cause the uterus to contract,
which releases the placenta. The uterus will begin to go back to its normal
size, a process called uterine involution.
Section 6 - Postpartum Care for Mother & Newborn
1. What is meant by the term postpartum care?
Caring
for the mother and the baby from birth and through the next 6 weeks.
2. How important is postpartum care?
After delivery, it
is important to make sure the fundus is firm. This may be accomplished
by massage. Bleeding needs to be under control. She should be able to
void. She needs to be fed and well hydrated, and generally cared for.
The baby needs to be examined and nursing well. She should have a two
week and six week visit also. At 6 weeks the placental site should finally
be healed.
3. What type of things should the mother watch for in the newborn?
4. In the hospital the mother has attendants waiting on her. What about at
home?
We encourage them
to have help at home, either the husband taking off work for a while to
help or her mother. Often, church members will bring meals in for at least
2 weeks.
5. When can she return to her normal lifestyle?
After 6 weeks the placental
site is healed.
Section 7 - Charts
Chart 1
Effects of Caffeine
- Damage to chromosomes (Thrash, M.D., Poison With a Capital C)
- Lessens muscle tone in baby (Ibid)
- Higher incidence of breech birth (Medical World News)
- Higher incidence of miscarriage (American Journal of Obstetrics
& Gynecology)
- Heart palpitations in mother and baby
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Chart 2
For a Safe Homebirth
- A well trained attendant is used
- High risk cases are screened
- Good prenatal care is practiced
- The diet and lifestyle are appropriate
- Labor is allowed to take its natural course
- There is trust in Divine power
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Chart 3
Signs of Labor
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False Labor
- Irregular contractions
- Contractions do not intensify
- Contractions rarely exceed 60 seconds
- Do not get closer together
- Mostly felt in front and high
- May cease with position change or activity
- Hot baths or sleep usually stop contractions
- Usually do not lose mucus plug
- Minimal cervical change
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True Labor
- Regular contractions
- Contractions intensify
- Exceed 30-60 seconds
- Grow closer together
- Felt in back & lower front
- Do not cease with position change or activity
- Hot baths or sleep will not stop contractions
- Lose mucus plug (pink show)
- Effacement & dilation
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Chart 4
When to Call Your Pediatrician
- No stools or urination in 24-48 hours
- Difficulty breathing
- Baby's color is blue
- Jaundice (yellow) with lethargy and failure to nurse
- Vomiting
- Fever (over 99.6 under arm)
- Umbilical cord red or swollen with odor
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Chart 5
Breastfeeding Advantages
- Bonds mother and baby
- Breast milk contains essential nutrients
- Breast milk is easier to digest
- Strengthens baby's immune system
- Colostrom contains antibodies
- More convenient than bottles
- Helps protect against allergies
- Helps uterine involution
- Messy diapers are not as unpleasant
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