Newborn Hearing Testing Available

I have just spoken with Brooks Hearing Clinic and they have informed me that they have the ability to perform newborn hearing testing at their office.  The charge for testing is a very reasonable $45.   

I encourage all of my clients to have their babies’ hearing tested in the first month of life to detect any problems and develop a plan for care.  This is a very simple and non-invasive test for detecting hearing problems before they cause developmental delays.  I have known mothers whose babies had hearing problems, but they weren’t diagnosed until the child was older.  The delay in treatment can compromise language development and reduce communication and school performance.

Their office is located at 301 W. 19th St. in Mt. Pleasant, near the hospital, and their phone number is 903-717-3597 in Mt. Pleasant or 903-737-8800 at their main office.

Every mother wants a healthy baby…every mother deserves one!

Gestational Diabetes

Gestational diabetes mellitus (GDM) is defined as a carbohydrate intolerance of varying severity that occurs in about 6% of pregnancies in the U.S.  

When women develop GDM, they are at higher risk for adverse pregnancy outcomes and long-term negative outcomes for mom and baby. Potential complications  of GDM include preeclampsia, polyhydramnios (excess amniotic fluid), higher weight gain in the fetus (possibly leading to C-section or shoulder dystocia), newborn complications (jaundice, nerve damage, low blood sugar), and of the mother developing Type II diabetes after pregnancy.

When we take in nourishment, we convert it into glucose, a fuel immediately usable by our bodies. Insulin metabolizes and regulates glucose levels. Diabetes can be simply defined as the result of a weakened pancreas producing too little insulin. This causes an abnormally high amount of glucose in the blood.

There are several factors that may contribute to an abnormally functioning pancreas, the primary ones being family history and obesity. Genetic weakness can be aggravated by a diet high in sugars, processed foods, and alcohol along with smoking, emotional stress, and lack of exercise.

Insulin is the key that tells our body to either store extra glucose in the liver as glycogen, use it immediately, or release glycogen for energy in the absence of enough glucose in the bloodstream. During pregnancy, placental hormones that peak around 28 weeks suppress insulin levels raising the mother!s blood glucose level. This occurs because the baby will be gaining the most weight and needs the most fuel to grow during the last 12 weeks of pregnancy.

I have spent the last couple of weeks researching information and guidelines on gestational diabetes, in an effort to create a guideline to use in my practice.  There is much new information and research available and this has led me to a change in thinking and new recommendations for my clients.  My plan is to use a simple screening algorithm to allow low-risk clients to avoid testing, while moderate and high risk clients are screened a second time and finally tested if necessary.

While gestational diabetes can have serious consequences, it is usually very easily controlled by diet and exercise.  The risk of complications decreases dramatically when GDM is controlled.   And the lifestyle changes that are required to control GDM are positive ones that many of us would do well to follow  (yours truly included!) and to continue even after the birth to help reduce the risk of Type II diabetes later.

I still recommend that my clients eat 70+ grams of protein in their diet each day and to avoid refined flours, starches and sugar.   Your focus should be on protein, fruits and vegetables for optimal health!

Evidence Based Birth  – notes on the NIH Consensus Conference, Day 1

U.S. Preventive Services Task Force recommendation (2014)

 

What Area Do I Work In?

For the most part, my clients live in an area within 50 miles of my home.  Anyone who lives within this range is within an hour’s drive from me.  If you live further than 50 miles from my home, I charge a “distance fee” of $200 in addition to my regular fee, and if you live beyond the 75 mile range the fee will be calculated on an individual basis and will include a per diem fee to cover lodging and meals for myself and an assistant.  Please note that even though the map shows parts of Arkansas and Louisiana within range, I do not attend home births in these states due to licensing laws.

How do I help my diastasis recti heal?

First time moms usually have pretty nice abs.

They are strong and firm and help hold the baby in a nice, head-down position provided the baby doesn’t choose to present breech.  But that growing baby and the fluid around him puts a lot of pressure on those abdominal muscles from the inside.  And then, if you aren’t careful to use proper body mechanics when moving you can actually add even more strain to them.

Diastasis recti is when the abdominal muscles separate along a line between the rectus abdominus muscles right down the middle of your belly.  The severity of the separation is judged by how many fingertips you can fit in the gap.  Two or more fingertips in the gap and you have a diastasis.

This separation is likely to get worse with each pregnancy unless something is done to heal the separation and strengthen the core muscles.  The weakening of the abdominal muscles may make it difficult to lift objects, and cause lower back pain. It can also result in weakened pelvic alignment and altered posture.

The good news is, there is something you can do to help your diastasis heal!

The MuTu program was recommended to me by a client who used it with great success to heal her own diastasis recti.  It is a 12 week exercise program that is suitable for women who have diastasis and are at least 6 weeks postpartum.  If you have more serious problems, like an abdominal hernia or pelvic organ prolapse, there is a program called MuTu Focus that you can use.  In addition to healing diastasis, this program will also help you loose that tummy bulge and strengthen your pelvic floor muscles.   In fact, it doesn’t matter if your last child was born umpteen years ago, MuTu can help!

If you don’t know where to start on getting back to exercise after having a baby, or if you have a diastasis recti, take a look at the MuTu program.

Update on International Midwifery

Well, my trip was a success! The birth went well, and I had a wonderful stay with my client and her family, as well as having a little time to do some sightseeing.

This is something I can definitely see myself doing more of in the future, but I need to hash out some of the details. I need to proceed a little differently for traveling births than I do for my local business, however. I need to have a different fee structure and will provide a different type of care for distant clients. I also have to consider my local business and clients and how to make sure they continue to get good care while I am away from home.

It is always exciting to travel to new places, at home and abroad!  If you are living in another country and don’t have access to local midwifery care, feel free to contact me.  I also have connections with other midwives who work internationally, so if I can’t come to you, perhaps one of them can.

A New Tool in My Birth Bag…

I recently made an important purchase that I hope will help me give the best care possible to my client’s babies. This piece of equipment was expensive, but it is something that I know can be a useful tool in helping to screen for problems before they become life threatening. It will also help guide my care if a baby has problems transitioning to life outside the womb.

I bought a pulse-oximeter that is specifically meant for monitoring newborns and infants, though it can also be used on adults. My pulse-oximeter tells me the baby’s pulse and oxygen levels. This type of pulse-oximeter can be used during resuscitation to help guide efforts to get the baby breathing on its own. It can also help to detect serious heart defects that may not show symptoms in the first week or two of life. The sooner a heart defect is detected, the sooner the baby can get help.

A pulse-oximeter takes the pulse and oxygen measurements by the means of two sensors that are placed on the baby’s skin on the hand, wrist, or foot. It is simple and non-invasive, but very effective.

I would like to begin screening all newborns for critical congenital heart defects at the 2 day home visit. The test usually takes about 5 minutes and is done when the baby is awake and calm.  This testing is currently required by law to be offered for infants born in birth centers and hospitals in Texas.  You can read more information about this testing and critical congenital heart defects at the CDC website.

My pulse-ox will have a place in my resuscitation bag as well, so that I can monitor a newborn’s oxygen levels during resuscitation or whenever it becomes necessary in the hours immediately after the birth.

Openings available

In looking at my calendar for the coming year, I have some months that are not filled…yet! If you are thinking about having a home birth, it is better to contact me earlier than later.

I currently have a few openings in April, May, June, and July. I am happy to set a time for a free consultation for you and your partner to meet me and ask any questions you may have about my services.

Call today!

Twins and Breeches?

I am occasionally asked if I would attend twin or breech births.  Let me begin by saying that I have attended such births, but never as the primary midwife.  Out of six births, the outcome in each was fine, but at one, the mother had problems with bleeding afterward.

That said, I do not feel that I currently have the experience or skill level needed to attend breeches or twins at home.  Could I, in the event of an emergency or a surprise?  Yes, and I think I have enough knowledge that I could do it without causing harm.  But I would not intentionally plan to midwife a woman having twins or a breech baby.  Twins and breeches carry a somewhat higher level of risk than your average head-down delivery.  The provider MUST have knowledge of what can go wrong and know exactly how to assist in each situation to provide the safest birth possible.

I would like to go in search of training and experience with breech deliveries.  This will likely require travel and expense, but I believe that it would be a valuable skill to have in my practice.  I do not agree that cesarean birth is the best and safest option for all breech babies.  For some breeches, yes, but not all.  I would have a selective policy for breech birth in my practice, and I would still do everything possible to encourage babies into a head-down position before labor.  The parents must also be fully informed of the risk and complications that could occur.  It is not something to be treated lightly or glossed over.

While I completely disagree with the current obstetrical policy of planned cesarean at term for all twins, I am not sure that home birth is a wiser or safer option.  Even when the babies are full-term and in an optimal position, there is plenty that can go wrong for both babies and mother in a twin birth.  Problems can require quick and sometimes invasive action to correct, which may carry further risk of harm.  Better to find a doctor who supports natural twin birth in the hospital, even if it means traveling to find one.   At this time, I do not plan to attend twin births at home.

Here is a brief list of some of the risks and complications of twins and breeches:

Twins:  placental abruption before the second baby is born, turning of the second baby to an unfavorable position for vaginal birth, hemorrhage, obstructed birth due to position of babies

Breeches:  cord entanglement, cord prolapse leading to asphyxia, cord compression leading to asphyxia, arms stuck over or behind the head, entrapment of the head in a partially dilated cervix, extension of the head