Folic Acid/Folate in Pregnancy: New Research on Potential Risks

Folic Acid (otherwise known as Folate, in it's non-synthetic form) : we know it's important for a developing fetus, but should everyone be taking folate?? This article contains groundbreaking information on folic acid and an uncommon, but not rare, genetic condition.

"There’s no solid consensus, but some reports state that anywhere from 10 to 15 percent of Caucasians and more than 25 percent of Hispanics are unable to metabolize folic acid. Called methylenetetrahydrofolate reductase, or MTHFR for short, this defect refers to the MTHFR gene, which produces the enzyme responsible for converting synthetic folic acid (what’s found in prenatal vitamins and fortified grains) to methylated folate (the metabolized nutrient that protects against NTDs)."

Read the full article here.

VBACs are more likely successful if you call the midwife

A new study shows that VBACs (Vaginal Birth After Cesarean) are more likely to be successful if a midwife provides the care instead of an obstetrician. 

You can read a portion of the abstract of the study here, and an excerpt is below:

Background

Research is yet to identify effective and safe interventions to increase the vaginal birth after cesarean (VBAC) rate. This research aimed to compare intended and actual VBAC rates before and after implementation of midwife-led antenatal care for women with one previous cesarean birth and no other risk factors in a large, tertiary maternity hospital in England.

Conclusions

Implementation of midwife-led antenatal care for women with one previous cesarean offers a safe and effective alternative to traditional obstetrician-led antenatal care, and is associated with increased rates of intended and actual VBAC.

From Spinning Babies... The Sacrotuberous Ligament: Key to Unlocking a Long Labor

This article is definitely worth a read if you are pregnant and preparing for labor. And especially if you are interested in anatomy! According to the article, it may be particularly applicable if any of the following are present:

• A long and difficult labor in which normal remedies (Rebozo Sifting, Position Changes, Spinning Babies Maneuvers) are not fully effective

• Persistently malpositioned baby

• Highly athletic mother (especially those who are highly athletic into their pregnancy)

• History of any trauma in which the ligaments of the pelvis could have been affected (accidents, falls, etc.)

• A visible Pelvic Upslip: One (usually left) iliac crest superior to the other, one leg (usually left) functionally shorter than the other.

Tongue Tie and the Newborn Baby

Since I have been training to become a Certified Breastfeeding Counselor, I've been thinking about and learning a great deal about breastfeeding - more than I had ever imagined. Something that comes up quire frequently with many new mothers is the challenge of breastfeeding. At a certain point, once you begin to hear of so many stories of difficulty breastfeeding, and depending on how much detail you hear in these stories - you may start to hear of tongue ties, lip ties, and the procedures done in attempt to remedy these situations. Why, if breastfeeding is supposed to be so natural and necessary for the survival of our species, are so many humans struggling with it? There are MANU reasons. One of the many possible reasons might be folic acid vs. folate. Read on in this article to learn more...

Tongue Tie and Breastfeeding, By Dr. Wilson

Breastfeeding & What to Eat

Spice it up!! I don't think these findings are at all surprising, in fact they seem pretty intuitive. But why not have a little research on it?! It's just one more reason to breastfeed.

Here's an excerpt from the article from the NYT, which you can read in full here:

"The variety of flavors that you eat during pregnancy go into your blood and then into the amniotic fluid, which the baby is constantly drinking, in utero, and the flavors that you eat while nursing cross from the blood vessels that supply the mammary glands into the breast milk. So instead of restricting the maternal diet, there’s now good evidence that by eating a wide variety of healthy and tasty foods during these periods, we are actually doing our babies a major favor.

“Breast-fed babies are generally easier to feed later because they’ve had this kind of variety experience of different flavors from their very first stages of life, whereas a formula-fed baby has a uniform experience,” said Lucy Cooke, a psychologist specializing in children’s nutrition, who is a senior research associate at University College London. “The absolute key thing is repeated exposure to a variety of different flavors as soon as you can possibly manage; that is a great thing for food acceptance.” "

Premature Birth & Air Quality: New Findings

This is heartbreaking. As if there are enough terrible effects on our environment and our health... now we are (not surprisingly) learning about the consequences of air pollution on newborn infants and what it costs our economy. It's obviously not just a financial issue. This affects all of us and our futures.

Read the full article here:

http://www.techtimes.com/articles/145548/20160331/premature-birth-linked-to-air-pollution-costs-us-4-3-billion-per-year.htm

Zika! Being pregnant in NYC/Brooklyn this summer.

Ah, Zika and NYC and Brooklyn and being pregnant this summer. Or maybe you've traveled recently to somewhere where it's prevelant. Regardless, ah, it's a bit of a stress. Here's an article with some practical info:

http://www.democratandchronicle.com/story/news/2016/04/12/zika-virus-an-unlikely-threat-in-upstate/82926754/

Natural Hospital Birth

As a birth doula serving clients who live primarily in Brooklyn and Manhattan, I work with many women who see both OBs (often low intervention practices) and midwives in the hospital setting. However, many of my clients are looking for a holistic birth experience, or a natural birth experience, within a setting that typically is not set up to accommodate un-medicated births. The odds are generally stacked against women hoping to have intervention-free births in a hospital. BUT, as a doula, I have witnessed many women successfully do this! Here are a few resources on how to work towards, or achieve some version of, a natural hospital birth:

Video

Book

Flipping A Breech Baby

It happens! Babies are breeched and babies flip to the head down position. Occasionally they stay in the breech position. Ideally, baby flips! If your baby is in the breech position and you need to get them to flip, these are my recommended resources:

Spinning Babies: Breech Babies - very informational and detailed - recommend reading it all the way through

Prenatal Chiropractic Visits - ask me for a recommendation, based on where you are

Acupuncture - ask me for a recommendation, based on where you are

Good luck!!
 

Advanced Maternal Age

What does this mean? In the U.S., women who are 35 years and over who are giving birth are considered "Advanced Maternal Age" (AMA). According to the research, only about 15% of women who are giving birth are 35 years are older, however it's hard not to believe that rings true in NYC. I would estimate that about 1/3 of my clients could be categorized as AMA. The important thing to know about this, if you are 35 or over, is that your care provider may apply different policies to you than if you were under 35. Please read this very important article from Evidence Based Birth by Rebekkah Dekker, Mimi Niles, and Alicia Breaky for some well-rearched info on what AMA means in pregnancy:

The Evidence on Advanced Maternal Age

How to Avoid an Episiotomy in Birth

I have not yet met a woman who does not want to avoid an episiotomy in birth!! Read on below to get some tips on how to avoid this unwanted procedure, published by Choices in Childbirth.

ASK THE MIDWIFE: HOW CAN I AVOID AN EPISIOTOMY DURING BIRTH?
FEBRUARY 16, 2016

Childbirth, Midwifery, Nutrition, Pregnancy, Sexuality

“How can I avoid an episiotomy during birth?”

Today an episiotomy is no longer a routine procedure – thank goodness – but is performed for cause. Some reasons include a tight perineum which prevents the baby’s head from distending the perineum, prior scarring of the perineum, female circumcision, and/or the baby’s heart beat is low and delivery needs to be expedited. We can decrease the problems with the perineum but not some of the other causes.

The other question is how to prevent natural tears of the vagina and the perineum. It is important for women to know that there is a group of muscles in the vagina that support the vagina, bladder and rectum. These muscles need to be strengthened and toned prenatally to increase their elasticity to allow for relaxation of the vagina and perineum during birth. These same muscles need continued exercise for the remainder of our lives. Thank Dr. Kegel for giving us the Kegel exercise!!

Proper overall fitness is important so consider walking and squats for toning. Proper nutrition is also key. Make sure that you get adequate protein and other nutrients for your tissues to respond well to the stretching of birth.

Keeping the vagina healthy and reporting any signs of an infection to your provider promptly to maintain good vaginal tissue integrity is hugely important. Perineal massage is advocated by many to be helpful in preparing the vagina and the vaginal muscles for birth. This needs to be initiated at 34 weeks and done for approximately 5 minutes 3-4 times per week.

When it comes time to push, your position is important, as is the use of warm compresses on the perineum. The lateral position or squatting for birth is protective of the perineum.

Finally, a slow, controlled delivery of your baby’s head will definitely help to decrease tears. This is difficult when you have a very strong urge to push. I recommend practicing techniques learned in childbirth classes such as focused relaxation.

Susan Papera, CNM,MSN received her undergraduate degree from Cornell University and her Master’s degree and Midwifery from Columbia University. She joined the staff at NYC Health + Hospitals/North Central Bronx as a staff midwife shortly after the Obstetrical services were open in 1978 and she has been helping to care for the women and families in the Norwood section of the Bronx ever since. Presently, she is Director of Midwifery Services. Working with such a richly diverse group of women is extremely rewarding and also an on going learning process as she says. Ms Papera is particularly proud of the fact that she is an NCB “Grandmother”- babies she has helped into the world are returning and she has had the privilege of helping their babies into the world.

Spinning Babies!

Ever since I became a doula, I've been fascinated with the concept of fetal positioning. With my background in dance and yoga, and my interest in alignment, optimal fetal positioning is right up my alley when it comes to birth! A baby that is positioned well can make for a smoother birth. How does a baby get positioned well? Some of it relates to the mother's physical structure, and some of it is related to lifestyle. The good news is that during pregnancy, there are daily and weekly exercises that women can practice to encourage balance. What if you are about to give birth and haven't practiced any of these exercises? You can rest assured that most babies do turn in labor, if they haven't rotated into the optimum position already. And some babies just make their entrance in whatever position they want to be in, regardless of how "optimal" it may be. 

Interested in learning more about Spinning Babies? This is something I cover with my clients during their prenatal sessions. In addition, you can also watch the parent class, available on DVD or as a download. Visit the site here to purchase: http://spinningbabies.com/shop/

The Truth About Your Due Date

Get some perspectives on your due date, or "EDD" (estimated due date), as well like to call it. Read what a midwife, a doula, an OB, a labor nurse, an acupuncturist, and a pediatrician have to say about. it And in case you didn't know already, only about 5% of women give birth on their due date. The rest of us tend to naturally go somewhere from week 37 (full term) to week 42. There are exceptions to this, of course - as always, with birth. My best advice on the "due date" situation is to consider it your due month, and when people ask you when you are due, you give them the month, not the date :)

Read the article on due dates from Well Rounded NY here.

Home Birth in the News

Fox News covering home birth!

Watch the video here.

Doula Support Could Improve Health Care & Reduce Costs

Well, this one kind of seems like a no-brainer and no big surprise, but read the story on NPR if you need more of a reason to get a doula! An excerpt is below:

" Previous research has shown lower rates of cesarean births, more satisfaction from mothers and better newborn Apgar scores — a measure of a baby's condition at birth — among mothers who use doula care. In fact, the American Congress of Obstetricians and Gynecologists says in guidelines for safe prevention of cesarean births that doula care is "probably underutilized."

This is the first study, however, to show a reduction in preterm births and a net savings for public insurance. Cesarean births — about a third of all U.S. births — cost about twice as much as vaginal births, and the 1 in 10 U.S. infants born preterm (before 37 weeks) incur medical costs 10 times greater than those of full-term infants."

The Rise of Ultrasounds: Be Informed

Ultrasounds are on the rise. It's fun to get cute pics of your babe in utero, but how necessary are these scans? Are they helping healthy birth outcomes or posing a risk? Check out these articles.

Wall Street Journal

US Food and Drug Administration

Midwifery Today

PubMed Study