Gestational Diabetes Screening and Informed Decisions

In honor of a strong first time mama I met this year, who endured a confrontation from her care provider when she dared to decline the routine glucose screening test for gestational diabetes, I wanted to provide some information about the actual risk factors, signs of gestational diabetes, and screening alternatives.

Lamaze International states,
"You have the right to ask about and understand why each test is being recommended, the particulars of how a test will be done, all the risks associated with a test and if there are less risky approaches to diagnosing a problem or concern."

Doctors can easily rattle off a list of common and not so common risks to any procedure. Usually we just smile and nod and accept. But if you have questions about necessity of this, or any test, a key question is, "What other options are available for assessing this potential issue?" Another great question. "What happens if we do nothing?"

Remember your BRAIN

B = benefits

R = risks

A = alternatives

I = intuition

N = do nothing

When deciding if you will accept or decline the gestational diabetes screening, ask yourself these questions:

• Am I overweight?
• Am I related to anyone that has diabetes now, or had it anytime in their lifetime?
• Am I Hispanic/Latina, African American, American Indian, Alaskan Native, Asian American, or Pacific Islander?
• Am I older than 25?
• Have I had gestational diabetes in a previous pregnancy?
• Have I had a stillbirth or miscarriage?
• Have I had a baby greater than 9 pounds?
• Have I had polycystic ovarian syndrome (PCOS) or another health condition linked to problems with insulin?
• Have I every had problems with insulin or blood sugar, such as insulin resistance, glucose intolerance, or "prediabetes" ?
• Do I have high blood pressure, high cholesterol and/or heart disease?

The greater the number of "Yes" answers, the greater your risk for developing gestational diabetes.

Lamaze International continues...

"Your healthcare provider should let you know that you have the right to refuse a test, and he/she should welcome your questions and respect your decisions."

((Sooo...that might mean NOT YELLING at PATIENTS. I would think.))

After her confrontation, the care provider finally conceded that a simple blood test without drinking the sugar mixture would be an acceptable alternative. Sometimes it is not easy to have these discussions with your doctor or midwife, but exploring your options and becoming confident in your pregnancy decisions will go a long way towards increasing your lifelong birth satisfaction.



References
1. Centers for Disease Control and Prevention. (2011). National Diabetes Fact Sheet: 
National estimates and general information on diabetes and prediabetes in the United 
States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for 
Disease Control and Prevention.

2. American College of Obstetricians and Gynecologists Committee on Obstetric Practice. 
(2009). Committee Opinion No. 435: Postpartum screening for abnormal glucose 
tolerance in women who had gestational diabetes mellitus. Obstetrics & Gynecology, 
113, 1419-1421.

Other Sources
American College of Obstetricians and Gynecologists Committee on Obstetric Practice. 
(2011). ACOG Committee Opinion No. 504: Screening and diagnosis of gestational diabetes 
mellitus. Obstetrics & Gynecology, 118, 751-753. 

American Diabetes Association. (2011). Diagnosis and classification of diabetes mellitus. 
Diabetes Care, 34 (Supplement 1), S62-S69.

American Diabetes Association. (2011). Standards of medical care in 
diabetes. Diabetes Care, 34 (Supplement 1), S11-S61.

"It was Truly a Magical Experience"

Really listen to these women. Really see their faces. Birth is important. The birth experience for mother and baby is important. It is not an easy journey. That's why it's called "motherhood".

Postpartum/Breastfeeding Resource for our Area

It was July 2013 when I first posted about meeting the founder of one of the newest (and desperately needed) breastfeeding resources in our community last week.

Ms. Julee Krechel recently held the grand opening of Southeast Maternal Medical Supply in Pawleys Island, South Carolina. Julee together with Ms. Katherine Hunt (who together, have *been there, done that* when it comes to all of the challenges of breastfeeding and pumping) are helping new moms obtain breast pumps and supplies through purchase or rental, in addition to working with insurance providers to comply with the Affordable Care Act (ObamaCare). If you have a breastfeeding question, they have the answer.

Julee is not ONLY certified as an "Advanced Lactation Consultant" AND a "Certified Lactation Counselor", but has also obtained her credentials as an "International Board Certified Lactation Consultant", which involved a rigorous evaluation by the International Board of Lactation Consultant Examiners. The IBLCE is the only international certifying body, and the gold standard in lactation and breastfeeding professional specialization.

In the Hynes Childbirth Preparation classes, we allow an entire three hour class to discuss the challenges and importance of the postpartum period including newborn care and breastfeeding. Based on my informal research, the postpartum period is one of the most overlooked aspects of childbirth preparation. It is essential to establish your postpartum plan for the first week home, the first month, and the first six months. Breastfeeding is usually a brand new adventure for moms. It can be challenging and it can be exhausting. It is so important to have access to a breastfeeding professional that can help with the latch, reassure you that baby is getting enough, and you are doing well. Feeling isolated in the breastfeeding and postpartum experience is one of the leading causes of postpartum depression. A few positioning tweaks from a professional can do a world of good for a mommy/baby bond and nutrition.

Call Julee  at (843) 235-2305 or visit at 263 Commerce Drive, Unit 101 in Pawleys Island, South Carolina 29585 behind the Sonic and The Fresh Market.

It is OFFICIAL

I am now a certified birth doula!

Amanda Hynes CD(DONA)

www.dona.org

~ * ~ !!!! ~ * ~

I am super over the moon

proud

and 

psyched.

Guess it is time to re-vamp the sidebar of the blog showing my certification status.

:):):)

Delay that Clamp Please

Delayed Cord Clamping.
IMPORTANT!

http://gaia-health.com/gaia-blog/2012-12-01/the-most-harmful-medical-intervention-is-done-to-all-of-us/

Also, a little Penny Simkin for good measure. She shares a dramatic visual of the volume of blood a baby gains by waiting 2 minutes for the cord to stop pulsating.

http://www.youtube.com/watch?v=W3RywNup2CM

NoseFrida (aka booger sucker)

Oooo...so weird. I want to try it.

The website says this:

It's smart.

It's Swedish.

It's maybe a little strange.

But, man, if it works well, I'd love to be able to clear out a child's stuffy nose non-medically.
Check out the video:

http://www.fridababy.com/shop/nosefrida/

Hormones

More inspirational readings from my Lamaze Independent Study...
HORMONES!
Check out these amazing, powerful, interconnected chemicals that we generate naturally to facilitate birth, bonding, and breastfeeding with our babies...and then, the ways that drugs interfere and inhibit them. This is no judgement. These are the facts.

The Pituitary Gland (care of Healthtap.com)

The Adrenal Glands (care of Healthtap.com)

Oxytocin, the *love* hormone

• associated with ejection reflexes (like sperm ejection, fetal ejection, placental ejection)
• released from pituitary gland
• descending baby stimulates the stretch receptors in mom, causing peak levels of oxytocin
• protects against hemorrhage and ensures postpartum contractions
• reduces stress

Endorphins *pleasure/transcendence*

• naturally occuring opiate, similar to morphine and heroine, works same brain receptors
• released from pituitary gland
• creates pleasure, euphoria, mutual dependency
• allows mom to reach an altered consciousness in an undisturbed birth
• in breastmilk, induces pleasure and mutual dependencey for mother and baby

Epinephrine *excitement/adrenoline*

• fight or flight hormones
• released from adrenal glands on kidneys
• released in response to fright, anxiety, hunger, cold, and excitement
• at birth, it activates the fetal ejection reflex
• rush of energy when it is time to push, mom gets upright and alert
• this hormone is implicated in instinctive mothering (who wants to mess with that?!)
• for baby, it protects against hypoxia/acidosis, and ensures baby is wide-eyed and alert at first contact with mom

Prolactin the *mothering* hormone

• major hormone in breastmilk synthesis
• activate mother's vigilence adn help put her baby's needs first 

Synthetic Oxytocin (Syntocinon)

Anyone ever hear of Pitocin? This is synthetic oxytocin.

It doesn't crosses the blood/brain barrier, so when injected with Pitocin, the mom does not experience above-mentioned benefits of the *love hormone*. However, the body does believe the hormone is present, and thus ceases to the natural production of oxytocin, thereby increasing the chance of hemorrhage (that natural oxytocin prevents).

Epidurals

Epidurals have major effects on all of the above-mentioned hormones.

• INHIBITS endorphine production, thus restricting the natural shift in consciousness
• INHIBITS oxytocin production since mom's stretch receptors are numb and cannot trigger natural oxytocin
• No natural oxytocin, no natural ejection reflex, leading to increased second stage of labor.
• INHIBITS Prostagladnin F2 alpha (which makes uterus contractible). 

One study showed women with epidurals and decreased PGF2 alpha had average labors increased from 4.7 hours to 7.8 hours.

One study showed mothers given epidurals spent less time with their babies in the hospital in inverse proportion to the dose of drugs they received during the second stage of labor. (lack of *love hormone* maybe?)

One study showed mothers with epidurals describe their babies as "more difficult to care for" one month after birth. (lacking that *mothering hormone* maybe?)

This hormone system is common to all mammals. For birth to proceed optimally, the mother must shift from her neocortex (rational) brain to her mammillian, or middle brain, also known as the limbic system. We as a society need to place some importance on this shift in consciousness and facilitate it.

I love this quote from a Dutch professor, G. Kloosterman, 

"Spontaneous labour in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other than any interference will only detract from the optimal character."

These innate chemical reactions are so powerful when allowed to proceed on their own.

Let's trust in ourselves, and our natural, untapped potential.

Information from:

Ecstatic Birth, The Hormonal Blueprint of Labor by Sarah J. Buckley

First printed in Mothering Magazine, March-April 2002.

H.3731

I am very late to the party on this one, but I'm going to share the information and post the petition because it is sooooo important that the *powers that be* see that birthing women, husbands, families, and their children DEMAND that educated, experienced and TREASURED midwives be available for homebirths in our state. Midwives shouldn't be suffocated out by new restrictions and made underlings to the obstetricians who (although necessary in certain situations) represent a complete opposite approach when it comes to pregnancy and birth.

Handing over birth to the medical and managed model of care is not good for our women and babies and families, or future. It is unnecessary and it is not an approach that is supported by:

documented

repeated

scientific evidence

If I have learned anything from this amazing Lamaze training, it is that the information is out there, and it supports a simple, normalized birthing method. Flat out, the more interventions, the greater the complications, the lower the resulting birth satisfaction.

Midwives are the protectors of normal birth. The women of South Carolina deserve access to licensed midwives. But our representatives are currently reviewing a bill that (I'm told by those much more knowledgeable than I) would essentially kill homebirth midwifery in our state. 

Bill 3731, the South Carolina Lay Midwife Act

It is insane to characterize licensed midwives as "lay" i.e. "not of a particular profession. lacking extensive knowledge on a particular subject."  

Don't let this happen. As of today, over 5,000 people have signed the petition against this bill.

Petition Against Bill 3731

This blog explains it beautifully. 

"Calling Licensed Midwives "lay" would be the equivalent of suddenly calling all Licensed Builders in the state "lay" and requiring citizens to hire structural engineers to build their deck."

She also details the current licensing requirements for midwives under SCDHEC. With all required of them, I cannot believe someone can call these professionals "lay" with a straight face.

This site has the most current information on what is happening with the bill.

www.supportscmidwives.com

Just Because it Burns...

"Where there is desire, there is gonna be a flame.

Where there is a flame, someone's bound to get burned.

Just because it burns, doesn't mean you're donna die.

You gotta get up and try."

Pink, "Try"

Those lyrics always make me think of birth.

Pink had planned to have a natural birth with the midwives of The Sanctuary in LA, 

but her baby girl was a frank breech and no amount of convincing could get her to flip.

Willow Sage was born on June 2, 2011.

Science Behind Doulas

I fell in love with this book the moment I picked it up back in 2006. Henci Goer's "The Thinking Woman's Guide to a Better Birth." I'm reviewing it again as reference for the upcoming Hynes Childbirth Education Series. It is full of invaluable information.

“Randomized controlled trials produce the strongest kind of research evidence because researchers randomly assign participants to have the treatment or not, which eliminates all kinds of biases. We now have more than a dozen randomized controlled trials.

Various trials have shown that the continuous presence of a caring, experienced woman can reduce:

• the length of labor

• the use of pain medication
• the need for IV oxytocin (Pitocin)
• the likelihood of having an episiotomy
• the percentage of instrumental vaginal deliveries (forceps/vacuum)
• and the Cesarean Section rate

Doulas can reduce the number of babies:

• born in poor condition
• admitted to special-care nurseries
• have prolonged hospital stays
• who have evaluations for infection

These studies also show that women who have a doula

• experience less pain and anxiety in labor
• express greater satisfaction with the labor
• feel that they coped better
• have a heightened appreciation of their bodies’ strength and performance and themselves as women
• breastfeed longer
• experience less difficulty in mothering

They have:

• have more positive feelings toward the baby
• better self esteem
• a better relationship with the father
• and less postpartum depression

The fact that these studies took place in different countries with different populations of women under different circumstances and consistently found benefits further strengthens confidence in the validity of their results.”

This book should be issued with every uterus. :)

"It's All Happening..."

That keeps running through my head, because, IT IS.
I am bubbling over with excitement about childbirth again.
I want to learn.
I want to contribute.
I want to help.
I want to be fearless.
It is ~all happening~.

I'm all about throwing away stuff I don't need.

Stuff that doesn't serve me, or fuel life any more.

Usually it's a quick and easy assessment.

This blog has stuck around, for years now.

I haven't deleted it yet. I haven't pulled the trigger on that simple key stroke that would erase so many of these aggressive, maybe slightly biased and maybe embarrassing posts. I've tried to tone them down a bit. I've added a keyword search for important posts. I've deleted the random snippets, in order to focus in on education of the birth and pregnancy process.

My goal is to provide honest, "evidenced-based" information to families facing this adventure. This blog might also include some *birthie* current events, rumors, ideas, and inspiration. 

It is such an emotional time of life. I want to be a reassuring, constant presence, and sounding-board to help ensure confidence in their decisions. I want all mothers to look back on their birth experience and be fueled by their own fire, no matter what the path ends up looking like.

I want women to be confident in their bodies, and confident in their choice of a birthing team, and above-all to go into birth feeling...

~SAFE~

~RESPECTED~

~HONORED~

The tools seem to have fallen in to my hands. The inspiration has cracked me over the head like a hammer.

People have wandered into my path that seem so much like angelic guides, I cannot ignore the message anymore. I am taking action and jumping in with both feet. 

Here is my own birth of sorts....

www.HynesChildbirthServices.com

I am a pretty proud mama.

We shall see where it all leads. 

Studies Enforce Doula Benefits...AGAIN

"She was the blessing of my life."

A Unversity of Minnesota study, which looked at births among low-income families, found the odds of needing a cesarean were 40 percent lower when women had support from a doula.



Led by Katy Backes Kozhimannil, Ph.D., an assistant professor at the School of Public Health's Division of Health Policy and Management, the study shows:

• Doula support may improve birth outcomes for diverse, low-income women
• State Medicaid programs offering coverage for birth doulas could potentially save taxpayer dollars

http://www.health.umn.edu/healthtalk/2013/02/14/doula-care-for-low-income-women-could-save-taxpayers-money/

Birth Can Be Amazing

Get your childbirth education.

EARLY.