Stress The Modern Day Predator

Holly A. Lammer, RNC-OB C-EFM

“The history of man for the nine months preceding his birth would probably be far more interesting and contain events of greater moment than for all the three score and ten years that follow it.”

~Samuel Taylor Coleridge

Decreasing the amount of stress that we encounter daily is beneficial to our health.   Stress initiates the body’s ‘emergency response system’ which activates the adrenal glands to secrete cortisol and adrenaline.  Cortisol is important for energy (glucose metabolism), blood pressure regulation, immune function and inflammatory response, but is secreted in higher levels during increased stress.  Heart disease, diabetes, autoimmune disorders, chronic inflammatory disorders, mental health issues, obesity can all in some way be linked to how the chemicals of stress wreak havoc on our bodies.   Statistics paint a grim picture:

• Preterm birth in the U.S. is higher than in other developed countries (Kaiser Family Foundation, 2015).
• Stress is associated with an increased chance of preterm birth (PLos One, 2012)
• High rates of anxiety and depression, according to WHO, the U.S. has one of the highest rate of mental disorders of any other developed country. (U.S. News, 2016)
• High rates of obesity – females affected more than males (World Obesity, 2017)
• Immune and allergy disorders, chronic diseases have increased drastically in the last few decades (overwhelming majority affecting women)(Molecular Metabolism, 2016)

One concern is how these chemicals affect a woman and her growing fetus during pregnancy.  Many pregnant women  are exposed to chronic stress;  examples are the stress of jobs, finances, family responsibilities, the expectation and drive for success, high fat and low nutrient diets, lack of time for physical activity,  lack  of community and family support, intimate partner violence, effects of racism and social marginalization.  Stress chemicals can pass to the developing baby through the placenta.

Watering the Seeds of Peace:

But pregnant women can seek to balance and reduce their stress in order to pass on positive neurological chemicals to their babies.  In particular, mindfulness practices such as yoga and meditation have profound impacts on the human brain and, when practiced in the prenatal period, can also influence the growing brain of the fetus. (PLos One, 2012)These types of practices produce changes in the neural pathways and hormonal centers that support parasympathetic response and as these neural connections are strengthened, sympathetic hypersensitivity is decreased. Mindfulness has the potential to reduce the effect of stress chemicals in the body (Journal of Obstetric, Gynecologic and Neonatal Nursing, 2009) since these chemicals are being sent directly to the fetus, through the placenta.

Mindfulness may also reduce the effects of stress chemicals in the baby.  Research shows increases in gray matter concentration in the left hippocampus, which affects learning, memory, and emotional control.  Infants  born of mothers who practice meditation have been shown to have better self-regulation and more emotional control. (Infant Behavior and Development, 2014)

Practicing mindfulness on a regular basis can also “create change in the brain that support feelings of peace, contentment, self-confidence and joy.  As these connections in the brain are strengthened, states of anxiety, worry and anger are decreased. Consequently, incidence and severity of stress related conditions are decreased and may, at the very least, become easier to manage.  Mindfulness practice has been shown to decrease anxiety, depression, insomnia, hyperactivity, substance abuse and chemical dependency.  It can also increase bonding and connection to others.

Preparation for Birth

In addition to all the above mentioned benefits, mindfulness has the added benefit of decreasing sensation of chronic and acute pain and possible subsequent psychological distress caused by pain.  This effect has been correlated to altered function and structure in somatosensory areas and an increased ability to disengage regions in the brain associated with the cognitive appraisal of pain, basically ‘reframing’ the sensation.  Most childbirth methods are based on meditative techniques (Lamaze and Bradley breathing, Hypnobirthing, etc.)  Mindfulness practices also enhance immune function – extremely important in pregnancy where it is already suppressed.  If there is a complication that is present (obesity, immune disorder, mental illness) or one that is diagnosed during the pregnancy (gestational diabetes, hypertension, multiples) or that happens during birth (prolonged labor, surgical intervention), regular meditative practices can help prime the immune system so that the effects of these events may be milder.

It’s as simple as ‘ABC’

One of the great things about mindfulness is that it can be practiced literally anytime, anywhere.

A is for Awareness:  Simply pause or stop and become AWARE of the present moment. An easy way to do this is just notice the body in space… the arrangement of the legs or arms, the overall tone in the body… the sensations in the body. Use the senses to drive your awareness:  the feel of the coffee cup in your hand, the sound of a bird chirping or the rain on the roof, the warmth of the sun on your skin.

B is for Breathing:  Bring your awareness to your breath.  The breath is always present.  Notice the inhalation and the exhalation.  Just by noticing the breath without changing it in any way, nervous system shifts to parasympathetic activity. You can enhance this shift by guiding the breath to be longer and deeper. Regulating the breath in this way also decreases blood pressure and heart rate.  Imagine your breath bringing oxygen to your growing baby. Imagine your baby listening to your deep rhythmic breaths and the slowing of your heart beat.  Calm, serene.

C is for Consciousness:   Or ‘thinking’. Now you have the space in the nervous system to examine your thoughts. Notice that they come and go like clouds on a windy day.  If there is a particular thought or sensation that is troubling you or seems uncomfortable, you have the ability to CHOOSE your reaction instead of unconsciously reacting with habitual patterns of response.

When we practice in this way, even for a few minutes a day, our nervous system slowly begins to rewire and connections of peace and joy are strengthened.  In the pregnant mom, this benefit is wiring the baby’s brain from the very beginning of development.

Helpful Resources and Links

• Antenatal mindfulness intervention to reduce depression, anxiety and stress
• Fit Pregnancy: 5 Prenatal Meditation Techniques
• Impact of stress and stress physiology during pregnancy on child metabolic function and obesity risk
• Incidence and prevalence of chronic disease
• Mindful Birthing
• Prenatal meditation influences infant behaviors
• Relaxation Response and Resiliency Training and Its Effect on Healthcare Resource Utilization
• The Association for Prenatal and Perinatal Psychology and Health
• The effects of mindfulness-based yoga during pregnancy on maternal psychological and physical distress.
  

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  Holly Lammer is an Obstetric Nurse, Clinical Educator and Childbirth Instructor for St. Luke’s Health System based in Boise, ID.  In addition to teaching credentialed courses through AWHONN and AHA,  she develops and teaches curriculum for prenatal and perinatal specialty courses offered in the St. Luke’s system.  Holly is also registered with the Yoga Alliance as a 500-hr Yoga Instructor and on faculty as a Prenatal Yoga Teacher Training Instructor. She is certified in Inpatient Obstetrics and Electronic Fetal Monitoring through NCC and is in process of obtaining her Pre and Perinatal Psychology Educator through the Association for Pre and Perinatal Psychology and Health.

  Holly has blended her experience in high volume high risk inpatient setting with her training and research in mind-body therapies to form unique educational programs for pregnant women and the providers that care for them, including Intuitive Birth – the area’s only Mindfulness-Based Childbirth Education series. A driving force for patient centered, evidence-based practice, her passion is apparent in her program content and her ability to drive changes at the policy level to improve outcomes for women and babies.

  Holly has spoken regularly at multidisciplinary local and regional conferences on the subjects of physiologic birth, prenatal psychology and health, and mindfulness-based strategies to improve health.  In addition, she provides regular educational opportunities for the public and for inpatients and care providers in her community.

What I Wish I’d Known About Alcohol & Pregnancy

by, Kathleen Tavenner Mitchell, MHS, LCADC

“Your daughter has full-blown fetal alcohol syndrome.”

Those words hit me like a tsunami. I was drowning in waves of grief, disbelief, horror and remorse. For 15 years, I searched to understand why Karli wasn’t learning and growing stronger, like my other two children. Doctors told me ear infections had caused her minor delays, but she would “grow out of it.” Today, Karli is 42 years old; developmentally, she is about 6 years old.

I grew up in the 1960s in an upper middle-class suburban neighborhood. My charismatic father suffered with alcoholism, and my co-dependent mom worked hard to cover his tracks. At 16, I was already experimenting with alcohol and other drugs when I got pregnant, married and dropped out of school. I wanted to have a healthy baby so I gave up all of the drugs and drank apple wine on the weekends.

Effects of Alcohol in Pregnancy
My first child, a boy, was born with a clubbed foot, which the doctor told me was a genetic disorder. I had Karli a year later, when the research describing fetal alcohol syndrome (FAS) was published. A few years later, I gave birth to another daughter and still had never been told not to drink during pregnancy.

I divorced my high school sweetheart and remarried another man who liked to drink. My own issues with alcoholism and addiction spiraled out of control. I had two unplanned pregnancies while on methadone to treat my heroin addiction. No one at the clinic ever mentioned that it wasn’t OK to drink. My second son came prematurely and died the day he was born. After a full-term pregnancy with my third baby girl, I found her breathless in her crib at 10 weeks old: Sudden Infant Death Syndrome (SIDS). I didn’t realize how those years of addiction affected each of my children.

No Safe Amount of Alcohol
Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. Most people with FASD don’t have intellectual disabilities, but do have attention deficits, behavioral issues, learning disabilities, mental health issues, and problems with memory, judgment and reason. Each person can be affected in different ways and, often, a person with an FASD has a mix of these problems. FAS is the most severe form of FASD.

Alcohol is a leading cause of fetal brain damage, birth defects and both fetal and infant death, including SIDS. While pregnant, there is no safe amount of alcohol, no safe time to drink alcohol, and no safe type of alcohol.

Clean and sober for the last 31 years, I have dedicated my life’s work to increasing awareness and improving services for individuals with FASD and for women dealing with addiction issues. I have a beautiful marriage and 5 wonderful grandchildren. I went on to receive my Master of Human Services (MHS) degree and became a licensed clinical alcohol and drug counselor (LCADC). I know that treatment works, and by encouraging women to get help, we save their children too. Now I am that good mother I always wanted to be.

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If you’re struggling or think your child may be affected by FASD, don’t hesitate to reach out to your nurse, midwife or other healthcare provider. There is no shame in asking for help—your child’s life depends on it.

Fetal Alcohol Syndrome Disorder (FASD)

• FASD’s effects are lifelong—but they’re also preventable
• Alcohol in pregnancy is more harmful than any other recreational drug, including cocaine, heroin and marijuana
• Alcohol can damage a developing baby before you even know you’re pregnant
• FASD is rarely diagnosed, making it an invisible disorder

Source: NOFAS.org

Kathleen is vice president of the National Organization on Fetal Alcohol Syndrome (NOFAS).

 

 

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Resources

• Get Help: Circle of Hope
• Learn More: http://www.health4mom.org/alcohol_in_pregnancy_how_much_is_safe

FASD PREVENTION PROJECT

AWHONN is a national partner on the Fetal Alcohol Spectrum Disorders Prevention Project of the Arc, a non-profit advocacy organization serving people with intellectual and developmental disabilities. The goal of the FASD Prevention Project is to increase health care professional knowledge of the risks alcohol can pose to a fetus, encourage the use of FASD prevention strategies and provide educational opportunities to health care professionals, including nurses, midwives, and nurse practitioners. Learn more about this project and resources you can use. 

Trying to Conceive After Miscarriage

by Aimee Poe

My husband and I always wanted a family. The summer before I turned 29, we decided to start trying. Little did we know there would be a roller coaster of a journey ahead.

I got my first positive pregnancy test in September. I knew my life was about to change. I quit smoking, which was a huge deal for me. My husband and I were thrilled. At my first ultrasound, there was silence. The verdict was devastating: I was miscarrying due to a blighted ovum.

My doctor advised me to wait two full cycles before trying to conceive again. I didn’t track anything; I just guessed at when I was going to be ovulating. In February, I got my second positive test. Though nervous, I had a better feeling, thinking the odds were low I would have a second miscarriage.

We picked out names, I looked at birth plans, and at 8 weeks I started building a baby registry. We were cautious to share the news, waiting to tell even our parents. On March 20, one week after announcing our new addition, I went to the restroom and noticed blood. I immediately fell on the floor crying. In that split second, my dreams of our family were crushed.

When they did the ultrasound in the emergency room, they wouldn’t let me see the screen, saying only that they couldn’t detect a heartbeat. I felt like I died inside. My doctor ordered a D&C (dilation and curettage) and told us to wait two cycles.

This time, I took ovulation and trying to conceive (TTC) seriously. I continued taking prenatal vitamins, educated myself, and tracked my ovulation with digital ovulation predictor. The moment I saw the little smiley face letting me know I was ovulating, I told my husband it was go-time! The two-week waiting period after that felt even longer than the two cycles we had to wait to start trying again.

On July 11, I got my big fat positive! I called my husband, and then I called my mom, who was so supportive. I had a form of PTSD after dealing with two miscarriages, and I didn’t want to tell anyone I was pregnant, so as to avoid the embarrassment.

At 6 weeks, I had my first ultrasound. When we saw that tiny little heartbeat, I cried. My doctor put me on progesterone. We had our next ultrasound at 11 weeks, and there was our baby, active and wiggling around. It was amazing! I wasn’t used to seeing my ultrasounds. Every time I saw my baby felt like a miracle. We learned my due date was March 20—the date of my second miscarriage. Everything was coming full circle. Even more exciting, it was a boy!

As badly as I wanted to meet my son, he was even more anxious: At 34 weeks and 4 days, Charles David Poe made his appearance. His birthday is February 9, the same date I had my second positive pregnancy test the year before. Tiny but strong, Charlie came into our lives so fast and has made it indescribably beautiful. It was beyond worth it to have gone through all the turmoil of TTC to get to this amazing part of my life.

Aimee Poe is an experience specialist at Verizon. She loves playing video games, watching movies, hanging out with her family, and flexing her creative muscle with various projects.

 

 

Nurse expert and Healthy Mom&Baby Editorial Advisory Board member Susan Peck, MSN, APN shares her best tips for those trying to conceive.

1. Timing is key. “Many women don’t know there is a small window of opportunity each month for conception to occur. Talk to your health care provider about how to predict ovulation based on the length of your menstrual cycle—there’s an app for that!”
2. Quality, not quantity. “Couples may not realize that having sex multiple times a day can actually lower sperm counts. I usually recommend daily or even every other day during the few days before during and after ovulation.”
3. Patience is a virtue. “If you don’t get pregnant right away after going off birth control, that doesn’t always mean something is wrong. Most couples will take 4-ish months or so before conception occurs.”
4. Plan ahead. “Preconception care is so important. Talk with your health care provider about any health problems you have that could affect pregnancy as well as the safety of any medications you take.  You may need to switch medications while trying to get pregnant. You can reduce your risk of neural tube defects by beginning a prenatal vitamin which includes 0.4 mg of folic acid before getting pregnant. Now is also the time to quit smoking.”
5. Leave the lube. “Using a lubricant during sex can make it harder for the sperm to swim the long distance to the fallopian tube. If you must, try using a sperm-friendly lubricant like Pre-Seed instead.”

5 things that nurses wish all parents knew about newborn screening

by Emily Drake, PhD, RN, FAAN

1. Newborn screening saves lives.  In the first few days after birth, clinicians screen newborns for over 30 rare but serious diseases, most of which are easy to treat with diet changes or other treatment.  This screening, along with early intervention, can save babies from death or disability. Your baby’s pediatrician works with the state health department to ensure that this screening is done.  Many professional organizations including the Association of Women’s Health, Obstetric and Neonatal Nurses support newborn screening.

Postpartum Recovery Tips for Moms from Our Nurses & Midwives

In preparation for your new arrival it is likely you will take classes, read books and get advice from friends and family on how to take care of your new baby.

What you can easily forget in all the excitement is that you take care of yourself too!

To help you focus on YOU, we recently asked our nurses and midwives what postpartum recovery advice they give their patients.

We received advice for you from over 100 nurses!

Take note of the clear themes – limit visitors to take that time to bond with your new baby, accept help from others, do skin-to-skin and sleep when the baby sleeps!

Good luck in all your new parenting adventures!

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Top 20 tips from our nurses and midwives:

1. Absolutely choose a hospital for the care you will receive and not the new beautiful building. You’re much more likely to receive a positive birth experience and the education you receive from your postpartum nurses will make all the difference in the world.
2. As a former postpartum nurse, I noticed how often new mothers put their needs last. It seems often families look at postpartum time as party time. I have seen c-section moms sleeping in the same room as 15-20 family members talking loudly and passing baby around for hours. My best advice is for new mothers to have 1-2 designated family helpers to be there to help care for baby while she gets much needed naps throughout those exhausting first days. Baby’s hunger cues are often missed when there are too many visitors for long stretches of time. It is difficult for new mothers to set limits.
3. Don’t be afraid to ask people to leave. I have seen so many new mothers that are worn out from feeling like they cannot turn people away. Turn off your phone too. I wish I did for the first couple of days.
4. Breastfeeding is an acquired skill for you and baby, be prepared to be patient and try, try again. It is a wonderful thing for you both, but needs to be learned. Do not suffer in silence, please contact your OB/midwife for lactation nurse help/referral if you are having difficulty with latching and/or very sore nipples.
5. Sleep when baby sleeps.

6. If you had a cesarean, take a pillow for the car ride home to support your incision for the bumps in the road.
7. Use the Dermoplast (benzocaine topical) spray before having a bowel movement…it’ll make the process a whole lot more comfortable and a lot less scary.
8. If someone offers to come over so you can shower, take them up on it.  For c-section moms remember not only did you have a baby, but you had major surgery.
9. Trust yourself and your instincts. Pick and choose the advice, tips, expert advice etc. that works for you. And know that if you’re worried about being a good mom, you already are.
10. Padsicle! Pad, ice pack, tucks, then a spray of Dermoplast.
11. Know your body. When you get home, use a hand held mirror to look at your perineum or you cesarean section incision. This way, if you experience problems, you will have a baseline to know if something is different, for example: increased swelling, redness, tenderness, or drainage from incision. It is helpful in knowing when to contact your physician with these issues.
12. Limit your visitors. You will not get this time back. Use it to bond as a family, seek help with breastfeeding. Skin to skin is the best bonding tool! We want to help you succeed with breastfeeding. You can press your call light for every feeding if you need to. Your baby needs your love and protection. You are your baby’s primary advocate. Not all mothers’ choose to or are able to breastfeed. How you feed your baby is your decision and your nurse will support you. Ask visitors to wait until you’ve been home for at least a couple weeks. Settle in, recover. Don’t be afraid to ask for help. If someone wants to visit, ask them to leave their little ones at home.
13. Sleep when the baby sleeps. Keep drinking water to flush out the excess fluids and keep hydrated. Accept help from anyone willing to cook a meal, run errands or do housework so you can rest and spend more time enjoying your new baby. Get outside for a walk. Fresh air and activity help to restore and rejuvenate sleep deprived minds and bodies as well as improve the blues!
14. While planning your new routine, ask someone to watch the baby for an hour of each day for you to spend as you please.
15. Good nutrition is key. Have a healthy snack each time you feed baby if you don’t have an appetite. Try to get a good four hour blocks of sleep several times a week. Ask support people to change, burp, comfort baby and only bring baby to you for breast feeding to extend your sleep when tired. Have a good support system and don’t be afraid to ask them for help. Soak up the sun when you can. Have an enjoyable activity to look forward to each week. Try to get out of the house, but if you can’t do something you enjoy at home or pamper yourself. Relax and enjoy your baby. Use what works for you and don’t try to follow everyone else’s advice.
16. Accept offers of help and assistance with meals, cleaning etc. I tell father’s to give moms one uninterrupted hour to herself each day. She can bathe, sleep, read, or anything that she wants for that hour. Daddy needs time to get to know baby too!
17. When you get home, set visiting hours and have each visitor bring groceries or food (they’ll be thrilled to get what you need). And stay in your pajamas. Most people will be less likely to overstay their welcome.
18. Once “settled” in with the baby reach out to a Mother’s group ( stroller club, baby sitting co-op, Mommy and me Gym or Yoga class), to get out of the house and receive and provide support to other new Mom’s.
19. Give yourself a break. Sit at the bottom of the shower and cry if you need to every now and then, parenting is hard work. Learning to breastfeed is hard work and so is incorporating another member into your family. Sleep deprivation and shifting hormones will, in fact, make you feel crazy at times but it will get better. You will find your new norm. It’s not all cute onesies and hair bows, it’s more like poopy onesies and newborn rashes, and that’s ok.
20. You’re stronger than you think! Don’t worry about what others might think. Enjoy every moment.  Parenthood is a beautiful experience. Allow yourself grace & room to grow.

Do you have advice for new moms as well? If so let us know. We’ll keep rolling out the advice.

For additional resources for mom visit our Healthy Mom&Baby website!

5 Q&A about Inducing Labor from our CEO

We asked moms what questions they had about inducing labor and Lynn Erdman our CEO answered back.

1. My girlfriends told me that having labor induced is the safest, and certainly most convenient, way to have my baby, but my nurse is saying that waiting for labor to start on its own is the safest. Which is true?

Many people don’t realize that undergoing labor induction for any reason is associated with immediate and long-term health risks. Induced labor can lead to excessive postpartum bleeding (or hemorrhage), which in turn, can increase the risk for blood transfusion, longer hospital stays, hysterectomy, more hospital re-admissions and, in the worst cases, death. Induction is also associated with an increased risk for cesarean birth. Cesareans increase a woman’s  risk for infection, problems with how the placenta implants in future pregnancies, and life-long pain from abdominal adhesions.

AWHONN recommends against inducing labor at any time during pregnancy unless it is medically necessary, because a woman or her baby have problems. The medication used to induce labor is a manufactured hormone and a type of drug that bears an increased risk for causing serious patient harm when used in error. With the increasing use of labor induction and its resulting complications, it’s more apparent than ever that we must improve our understanding of the health consequences of administering artificial hormones, especially to vulnerable populations like pregnant women and infants. The short- and long-term health risks are just too serious to undergo labor induction when there is not  a medical need.

10 Things Your Labor Nurse Wishes You Knew

by, Shelly Lopez Gray, MSN, RNC, IBCLC

1. No one wants you to have the birth you want more than we do. Except maybe you, of course… We want to support you to stay healthy and have a healthy baby. If you end up with an unexpected birth experience, we mourn the loss of the idealized birth with you, and are here to help the experience you have be the best possible.