Mommy Feel Good

May 22, 2010

Prenatal Massage: Massage During Pregnancy

article found at: http://www.americanpregnancy.org/pregnancyhealth/prenatalmassage.html

Therapeutic massage has been used for centuries to improve overall health, reduce stress, and relieve muscle tension. Pregnant women have often received ambivalent responses from the health community regarding the safety and purpose of massage during pregnancy. Modern investigation and research is proving that prenatal massage therapy can be a very instrumental ingredient in women’s prenatal care and should be given careful consideration.

Although most massage training institutions teach massage therapy for women who are pregnant, it is best to find a massage therapist who is

The benefits of prenatal massage or massage during pregnancy:

Studies indicate that massage therapy performed during pregnancy can reduce anxiety, decrease symptoms of depression, relieve muscle aches and joint pains, and improve labor outcomes and newborn health.

Massage therapy addresses different needs through varying techniques, one of which is called Swedish Massage, which aims to relax muscle tension and improve lymphatic and blood circulation through mild pressure applied to the muscle groups of the body. Swedish Massage is the recommended prenatal massage method during pregnancy because it addresses many common discomforts associated with the skeletal and circulatory changes brought on by hormone shifts during pregnancy.

    Hormone regulation

    Studies done in the past 10 years have shown that hormone levels associated with relaxation and stress are significantly altered, leading to mood regulation and improved cardiovascular health, when massage therapy was introduced to women’s prenatal care. Hormones such as norepinephrine and cortisol (“stress hormones”) were reduced and dopamine and serotonin levels (low levels of these hormones are associated with depression) were increased in women who received bi-weekly massages for only five weeks. These changes in hormone levels also led to fewer complications during birth and fewer instances of newborn complications, such as low birth weight. The evidence points strongly to maternal and newborn health benefits when relaxing, therapeutic massage is incorporated into regular prenatal care.

    Reduction of swelling

    Edema, or swelling of the joints during pregnancy, is often caused by reduced circulation and increased pressure on the major blood vessels by the heavy uterus. Massage helps to stimulate soft tissues to reduce collection of fluids in swollen joints, which also improves the removal of tissue waste, carried by the body’s lymph system.

    Improvement of nerve pain

    Sciatic nerve pain is experienced by many women in late pregnancy as the uterus rests on muscles of the pelvic floor and lower back. The pressure of the uterus spreads tension to the muscles of the upper and lower leg, causing them to swell and put pressure on nearby nerves. Massage therapy addresses the inflamed nerves by helping to release the tension on nearby muscles. Many women have experienced significant reduction in sciatic nerve pain during pregnancy through regular massage.

    Other potential benefits of prenatal massage:

  • Reduced back pain
  • Reduced joint pain
  • Improved circulation
  • Reduced edema
  • Reduced muscle tension and headaches
  • Reduced stress and anxiety
  • Improved oxygenation of soft tissues and muscles
  • Better sleep

What precautions should be taken when seeking prenatal massage?

As with any therapeutic approach to pregnancy wellness, women should discuss massage with their prenatal care provider. The best way to address the risks of prenatal massage is to be informed and to work together with knowledgeable professionals.

    Body position during prenatal massage

    Many professionals consider the best position for a pregnant woman during massage is side-lying. Tables that provide a hole in which the uterus can fit may not be reliable and can still apply pressure to the abdomen, or allow the abdomen to dangle, causing uncomfortable stretching of the uterine ligaments. Consult your massage therapist before your first appointment to verify what position they place their clients in during the massage.

    Seek an appropriate massage therapist

    It is important to seek care from a certified prenatal massage therapist. Certified therapists have received training beyond the national standards for massage therapists and know how to address specific pregnancy needs and sensitive areas of the body.

    Be aware of sensitive pressure points

    Trained prenatal or pregnancy massage therapists are aware of pressure points on the ankles and wrists that can gently stimulate pelvic muscles, including the uterus. Certified prenatal massage therapists are trained to avoid very specific and intentional pressure to these areas during pregnancy. Any woman who has experienced pre-term contractions or consistent Braxton-Hicks contractions should alert her therapist to that fact so that pressure points can be avoided completely.

    Women with the following conditions should speak with a health care provider prior to receiving a massage:

  • High risk pregnancy
  • Pregnancy induced hypertension (PIH)
  • Preeclampsia
  • Previous pre-term labor
  • Experiencing severe swelling, high blood pressure, or sudden, severe headaches
  • Recent birth

Is prenatal massage safe throughout the entire pregnancy?

Women can begin massage therapy at any point in their pregnancy – during the first, second, or third trimester. Many facilities will refuse to offer massage to a woman who is still in her first trimester because of the increased statistics for miscarriage associated with the first 12 weeks of pregnancy.

Incorporating Massage Into Your Prenatal Care

The benefits of massage can improve overall prenatal health for many pregnant women. Along with the guidance and advice of a prenatal care provider, massage therapy can be incorporated into routine prenatal care as an emotional and physical health supplement proven to improve pregnancy outcome, and maternal health. Consult your midwife or obstetrician before beginning any new therapeutic practice.

Compiled using information from the following sources:

Field, T. (1999). Pregnant Women Benefit From Massage Therapy. Journal of Psychosomatic Obstetrics and Gynaecology, Mar;20(1):31-8.

Field, T. (2004). Massage Therapy Effects on Depressed Pregnant Women. Journal of Psychosomatic Obstetrics and Gynaecology, Jun;25(2):115-22.

Heimlich, Patti, RMT, CD, ICCE, The Benefits of Massage During Pregnancy, Labor & Postpartum. http://www.expectantmothersguide.com/library/houston/massage/htm. Article accessed online 10/18/2007.

Howell ,Julie, NMT, PMT, Prenatal Health Through Massage Therapy: For Women and Their Babies. http://www.newlifejournal.com/decjan03/howell/01/03/full.shtml. Article accessed online 10/18/2007.

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May 14, 2010

New York midwives lose right to deliver babies at home

Filed under: News — mommyfeelgood @ 4:02 pm
Tags: , ,

Closure of hospital leaves practitioners without backing or insurance, driving home births underground

Newborn baby after a home birthA midwife tests a newborn baby’s reflexes after a home birth. Photograph: Maartje Blijdenstein/AFP/Getty Images

As residents of the world’s consumer capital, New Yorkers can have anything delivered to their door at any time. They can have their hair cut in the living room, have champagne and caviar rushed to them on a whim, enjoy a shiatsu massage in their own bed or invite a clairvoyant to predict their future from Tarot cards laid out on the kitchen table.

But there is one thing that is currently unavailable for delivery to those who live in this most can-do of metropolises. Women can not legally give birth at home in the presence of a trained and experienced midwife.

This city of more than 8 million people, with its reputation for being at the cutting-edge of modern urban living, now lacks a single midwife legally permitted to help women have a baby in their own homes. “It’s pretty shocking that in a city where you can get anything any hour of the day a person cannot give birth at home with a trained practitioner,” said Elan McAllister, president of the New York-based Choices in Childbirth.

The collapse of New York’s legal home birth midwifery services has come as a result of the closure two weeks ago of one of the most progressive hospitals in the city, St Vincent’s in Manhattan. When the bankrupt hospital shut its doors on 30 April the midwives suddenly found themselves without any backing or support.

There are 13 midwives who practise home births in New York, and under a system introduced in 1992 they are all obliged under state law to be approved by a hospital or obstetrician, on top of their professional training.

St Vincent’s was prepared to underwrite their services, but most other doctors and institutions are not, and they now find themselves without the paperwork they need to work lawfully.

Miriam Schwarzschild, one of the 13, is now in the invidious position of either abandoning her clients or operating illegally. “Apparently by taking a woman’s blood pressure I am committing an illegal act,” she said. She has no doubts about what she will do: she will stand by the six to eight women she helps in labour every month, law be damned. She said she intends to “fly under the radar”, but is anxious about what would happen should she be reported to the state authorities. “At any time a nurse or doctor could report me, and once that happens they could go after my licence and shut me down.”

Jitters are spreading among the tiny community of home birth midwives. The rumour has circulated that one of them has already been shopped to the authorities by an obstetrician at a hospital where she transferred one of her clients in need of medical attention.

The crisis of home birth in New York city is an extreme example of a pattern found across America. Fewer than 1% of babies are born at home in the US, and in New York that figure is as low as 0.48% — about 600 babies every year out of 125,000. That compares with a rate of about 30% in the Netherlands.

In much of Europe, midwives play the lead role in assisting most low-risk and healthy women to give birth, handing over to a specialist doctor or surgeon only when conditions demand. In the US, that relationship is reversed.

Obstetricians, who are trained to focus on interventionist methods and often have never even witnessed a natural birth, are in charge of about 92% of all cases. As a body, they are fiercely resistant both to midwives – who under the private medical system in America are their competitors – and to women choosing to remain at home.

In 2008 the American Congress of Obstetricians and Gynaecologists put out a statement effectively instructing its members to have nothing to do with the “trendy” fashion towards home births. Yet despite Acog’s stance, and despite the fact that the US spends more money on pregnancy and childbirth-related hospital costs than any other type of hospital care ($86bn a year), the country has the unfortunate distinction of having one of the highest rates of maternal mortality in the industrialised world. Its rate stands at 16.7 maternal deaths per 100,000 live births, compared with 7.6% in the Netherlands and 3.9% in Italy. Britain’s rate is 8.2%.

On top of that, about one in three pregnancies in the US end in a caesarean section — a product, critics say, of the highly interventionist approach that includes frequent induced labours and epidurals. Amnesty International recently dubbed the US record on childbirth as a whole a “human rights crisis”.

Knowledge of these statistics, and of what is now happening to New York midwives, makes Julie Jacobowitz-Kelly see red. She is one of Schwarzschild’s clients and is preparing to give birth to her first child, a boy she and her partner have already named Benjamin, whose due date fell today.

She said the current illegal status of the home birth midwives was “a travesty, it’s absolutely ridiculous. It angers me that experienced midwives like Miriam are in jeopardy.”

That is a view shared by some senior New York politicians, including Scott Stringer, Manhattan borough president. “There are 600 women who are going to give birth in the next year who want midwives with them at home, and to take away their rights and choices is so backwards it’s embarrassing,” he said.

Midwifery organisations are scrambling to persuade other hospitals to take over St Vincent’s role by signing the so-called “written practice agreements” the midwives need to be legal. So far 75 hospitals have been approached; not one has replied.

Meanwhile, a bill is sitting before the New York state assembly that would scrap the system of practice agreements and allow the midwives to offer their services free of the control of obstetricians. But the bill may not be put to a vote at all this year.

“At the end of the day, hospitals are for sick people, and I’m not sick,” said Jacobowitz-Kelly. “I’m going through one of the most natural processes women can go through, so why do it anywhere other than the most natural setting — my home.”

May 5, 2010

The Lie of the EDD: Why Your Due Date Isn’t When You Think

Filed under: Uncategorized — mommyfeelgood @ 5:43 pm

Written by Misha Safranski

We have it ingrained in our heads throughout our entire adult lives-pregnancy is 40 weeks. The “due date” we are given at that first prenatal visit is based upon that 40 weeks, and we look forward to it with great anticipation. When we are still pregnant after that magical date, we call ourselves “overdue” and the days seem to drag on like years. The problem with this belief about the 40 week EDD is that it is not based in fact. It is one of many pregnancy and childbirth myths which has wormed its way into the standard of practice over the years-something that is still believed because “that’s the way it’s always been done”.

The folly of Naegele’s Rule

The 40 week due date is based upon Naegele’s Rule. This theory was originated by Harmanni Boerhaave, a botanist who in 1744 came up with a method of calculating the EDD based upon evidence in the Bible that human gestation lasts approximately 10 lunar months. The formula was publicized around 1812 by German obstetrician Franz Naegele and since has become the accepted norm for calculating the due date. There is one glaring flaw in Naegele’s rule. Strictly speaking, a lunar (or synodic – from new moon to new moon) month is actually 29.53 days, which makes 10 lunar months roughly 295 days, a full 15 days longer than the 280 days gestation we’ve been lead to believe is average. In fact, if left alone, 50-80% of mothers will gestate beyond 40 weeks.

Variants in cycle length

Aside from the gross miscalculation of the lunar due date, there is another common problem associated with formulating a woman’s EDD: most methods of calculating gestational length are based upon a 28 day cycle. Not all women have a 28 day cycle; some are longer, some are shorter, and even those with a 28 day cycle do not always ovulate right on day 14. If a woman has a cycle which is significantly longer than 28 days and the baby is forced out too soon because her due date is calculated according to her LMP (last menstrual period), this can result in a premature baby with potential health problems at birth.

The inaccuracy of ultrasound

First trimester: 7 days

14 – 20 weeks: 10 days

21 – 30 weeks: 14 days

31 – 42 weeks: 21 days

Calculating an accurate EDD

Recent research offers a more accurate method of approximating gestational length. In 1990 Mittendorf et Al. undertook a study to calculate the average length of uncomplicated human pregnancy. They found that for first time mothers (nulliparas) pregnancy lasted an average of 288 days (41 weeks 1 day). For multiparas, mothers who had previously given birth, the average gestational length was 283 days or 40 weeks 3 days. To easily calculate this EDD formula, a nullipara would take the LMP, subtract 3 months, then add 15 days. Multiparas start with LMP, subtract 3 months and add 10 days. The best way to determine an accurate due date, no matter which method you use, is to chart your cycles so that you know what day you ovulate. There are online programs available for this purpose (refer to links in resources section). Complete classes on tracking your cycle are also available through the Couple to Couple League.

ACOG and postdates

One of the most vital pieces of information to know when you are expecting is that ACOG itself (American College of Obstetricians and Gynecologists) does not recommend interfering with a normal pregnancy before 42 completed weeks. This is why knowing your true conception date and EDD is very important; if you come under pressure from a care provider to deliver at a certain point, you can be armed with ACOG’s official recommendations as well as your own exact due date. This can help you and your baby avoid much unnecessary trauma throughout the labor and delivery. Remember, babies can’t read calendars; they come on their own time and almost always without complication when left alone to be born when they are truly ready.

Sources:

Mittendorf, R. et al., “The length of uncomplicated human gestation,” OB/GYN, Vol. 75, No., 6 June, 1990, pp. 907-932.

ACOG Practice Bulletin #55: Clinical Management of Post-term Pregnancy

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