pregnancy - PowerPoint

Document Sample
pregnancy - PowerPoint Powered By Docstoc
					Holistic Approach to Pregnancy
Shauna Braun Leah Crask

Pregnancy Basics
• • • • • • • • •
Pre-pregnancy health Diagnosing pregnancy Prenatal care Gynecological and general health Milestones Testing and screenings Risk factors Labor and Deliver Post Partum

Pre-pregnancy Health
• Folic Acid • Recent pregnancy • Age • Current medications incompatible with
pregnancy • Social and financial health

• S/S amenorrhea; morning
sickness; frequent urination; tingling, tender, swollen breast; darkening areola; blue or pick lines under skin breast/abdomen; food cravings; darkening line navel to pubis (linea nigra) • Urine test in office or at home (OTC) • Blood test

Prenatal Care
• Call your practitioner as
soon as you suspect your pregnancy • Choosing a practitioner: obstetrician, family practitioner or nurse midwife? • Types of practice solo practice, group, combo, birth centered, independent CNM

Obstetrician (Ob-gyn)
• Trained to handle every conceivable
aspect of pregnancy • Can also take care of all non-pregnancy female health needs (paps, breast exams) • Best for high risk pregnancy, better still an obstetrician who specializes in your type of high risk pregnancy.

The Family Practitioner (FP)
• One stop medical services for the entire
family • Trained in primary care, obstetrics and pediatrics after receiving MD • Ideally familiar with your family dynamics and interested in all aspects of your health • If complications- may send you to OB, but remain involved

Certified nurse-midwife (CNM)
• Emphasis on you as a person, rather than a patient, will take extra
• • •
time to talk about feelings and problems Oriented toward “natural” childbirth More likely to treat pregnancy as a human condition rather than a medical one CNM is a RN who has completed graduate programs in midwifery and is certified by the American College of Nurse-Midwives. Trained to care for women with low-risk pregnancies and attend uncomplicated births Sometimes may provide routine gynecological care May work in a hospital, birthing center or do home births In most states CNMs can prescribe pain medication Less likely to include medication and routine medical interventions Studies show for low-risk pregnancies deliveries are as safe as MDs Select one that is certified and licensed.

• • • • • • •

Direct-entry midwives
• • • •
Trained without first becoming RNs More likely to do at home births Some may also delivery at birthing centers Those evaluated by the North American Registry of midwives (NARM) are called Certified Professional Midwives (CPM) • Other direct entry midwives are not certified • Licensing for direct entry midwives is offered in some states, for more info call Midwives Alliance of North America or check their website

Solo Medical Practice
• MD work alone using another MD to cover
only when unavailable • See same practitioner at every visit • Most likely your MD will deliver your baby, but if unviable than a MD you’ve never met before will deliver

Partnership or Group Practice
• OBs or FPs • Can see a different MD each time to get to
know them all • May not like all equally and will be unable to choose who will attend birth • Hearing different points a view can reassuring or unsettling

Combination Practice
• One or more OBs and one or more CNMs • Same benefits and drawbacks as a group • Some visits extra time and attention a
midwife may offer • Access to CNM and security of MDs extra training and expertise

Birthing Center
• CNMs provide most of
the care MDs on call as needed • Low-risk patients only • May have to change practices if complications arise • May be transferred to hospital for emergency care

Inde CNM
• Maybe deliver at home, • •
hospital or birthing center Personalized pregnancy care Low-tech and natural delivery Covered by most health plans, only some will cover births outside of hospital Should have MD on call for emergencies


Gynecological and General Health
• Practitioner should be informed of all aspects of
gynecological history to provide the best care. • Multiple 2nd term abortions increase risk of premature delivery • Obesity- increased risk of gestational diabetes and high BP, difficulty dating preg. • Age
– Over 35 > risk of Down’s elevated BP, diabetes, cardiovascular strain, miscarriage, preeclampsia, preterm labor, longer labor, interventions needed

Risk Factors
• • • • • • • • • • • • • • •
Maternal Age Pregnancies too close together Previous cesarean (c/s) Obesity Rh negative & incompatibility Fibroids Endometriosis Incompetent cervix Herpes & other STDs Family history of genetic disorders or congenital defects Couples with history of 3 or more consecutive miscarriages Positive screening test Diabetes High blood pressure Diabetes

• 5-8 weeks fetal heart rate (FHR) can be see via • • • • • •
intravaginal ultrasound (U/S) 9-13 weeks external genitalia developed enough to determine sex; FHR heard & seen with Doppler or U/S; U/S for dating 18-22 weeks fetal movement, showing; level 2 U/S 25 viable if delivered 32 + weeks Braxton hicks contractions, colostrum; usually head down; 36 weeks changes in fetal movement 37 weeks term, lightening and engagement,
For more info visit elopment.htm

General Testing & Screening
• Every visit urine test for sugar & protein; fetal heart • • • • • •
beat; fundal height; BP; weight First month 1-4 wks: pregnancy test; blood type & Rh status; urinalysis; antibody for diseases i.e. rubella, STDs; genetics i.e. CF; pap; blood sugar 10-14 wks: 1st trimester screening U/S 15-18 wks: 2nd trimester screening AFP (alpha fetoprotein)- spina bifida, downs, & other chromosomal abnormalities 7 mo 28-31 wks: glucose screening test; Hct & Hgb 8 mo 32-35 wks: GBS > 40 wks: non stress test

Special Testing & Screening
• CVS or chorionic villis sampling- 1st trim. test to detect chromosomal • • • • •
abnormalities ie- downs, tay- sachs, sickle cell, CF. Tube takes piece of chorion/placenta Amniocentesis needle takes amniotic fluid for genetics testing NST/ non stress test indicates if the fetus can remain in the uterus and how it may respond to labor, condition of placenta. CST/ contraction stress test- same as above but with stimulated contractions. Biophysical profile- uses U/S evaluates 4 aspects of life- fetal breathing, fetal movement, fetal tone, amniotic fluid volume Umbilical artery Doppler velocimetry

For more info visit

Birthing Options
• • • •
Family-centered care, not yet offered everywhere, but trending to. LDRP or LDR- labor, delivery, recovery and ideally post partum rooms. Birthing chairs- gravity can speed delivery Lebyer Births- with out violence: soft music, soft lights, and warm bath. No longer routine unending and slapping baby’s bottom, umbilical cord cut delayed, direct to mother’s arms. • Water birth- concept of delivery under water to simulate the uterus environment. Baby is pulled out of the water and placed in the mother’s arms immediately after birth. Breathing doesn’t begin until infant is exposed to air, little risk of drowning. Only for low risk pregnancies. For more info and how to find a water birth • Home birth • Labor room, Delivery room, recovery room and nursery
For more info visit or

Labor and Deliver
• • • • • • • • •
Birthing options Mucous plug, bloody show Rupture of membranes Back Labor IVs Fetal monitoring Labor Positions Pain Management Types of Delivery: vaginal, cesarean, VBAC, forceps, vacuum


Stage 1 Labor
– – – Phase 1 Latent phase: effacement & dilation to 3 Phase 2 Active phase: dilation of cervix to 7 Phase 3: Transition: dilation to 10 INTENSE

– Stage 2 Delivery • Stage 3 Delivery of placenta

For more info visit

Pain Management During Labor
• • • • • • • • • • • • • •
Physical Therapy: massage, heat, pressure, counter-pressure, reflexology Flower Essences Counter Pressure on back Hydrotherapy Biofeedback Acupuncture, Acupressure Hypnosis TENS Transcutaneous Electrical Nerve Stimulation IV & IM Narcotics: Morphine, Fentanyl, Demerol, Tranquilizers: Phenergan, Vistiril Oral Narcotics for early labor Epidural, Spinal and other regional blocks General Anesthesia Distraction: watching TV, music, meditation, breathing exercises, etc… Visit for more information.

Early Labor Positions
• •
STANDING Helps work with gravity; contractions less painful; helps backache; may speed labor; aligns the baby with the pelvic angle; could become tiring, but less tiring if you lean forward supported by partner. WALKING Same advantages as standing, plus may encourage descent of the presenting part SITTING Works with gravity; may be able to rest; sitting cross-legged may open pelvic outlet; fetal monitoring possible; can slow labor after a long period. HANDS AND KNEES Helps relieve back pain; may rotate posterior baby; tiring for long periods KNEES, CHEST SUPPORTED Same as hands and knees, but less strain on arms. SEMI-SITTING Same as sitting; increases back pain. LYING ON SIDE Lowers blood pressure; excellent resting position; contractions may be longer LYING ON BACK Least effective for progress of labor; may become hypotensive and the baby may become distressed; may increase backache; fetal monitoring can be done.


• •

Second Stage Positions
• • • • •
FORTY-FIVE DEGREE ANGLE. Widens pelvic outlet; uses gravity to some extent; better for backache than lying down; (Legs pulled up may work well with epidural; back and shoulders elevated) LYING ON SIDE Lowers blood pressure; eases backache; easier to relax between pushes. HANDS AND KNEES Excellent for rotating posterior baby; reduces backache. SQUATING Uses gravity to help the baby descend and rotate; partner can support your back and arms; widens pelvic outlet. LITHOTOMY Lying back with legs in stirrups; good for forceps or vacuum, extensive episiotomy, delivery of breech. SEMI-LITHOTOMY Same as lithotomy, with head and shoulders elevated

For more info visit /parented/pain/positions.htm

Alternative Health Care for Pregnancy

Alternative Pregnancy Health Care • Herbs • Acupuncture
• Massage • Reflexology • Aromatherapy • Flower Essences • Chiropractic Care • Yoga • Hydrotherapy
– Moxabustion

Western Herbs and Pregnancy
•There are many herbs known to
be beneficial during pregnancy and post-delivery.

•Herbs are an excellent source of
vitamins and minerals.

•Herbs can be made into teas or
incorporated into foods.

Herbs and Pregnancy
• • • • • • • • • • • • • • • • • • • • • • • •

• There are some herbs which are not safe to use
when pregnant. These herbs can stimulate the uterus.
Aloe Vera Angelica Autumn Crocus Barberry Black Cohosh Celery Seed Cinnamon Devil's Claw Goldseal Hyssop Juniper Male Fern

Mandrake Parsley Seed Pennyroyal Pokeweed Rosemary Rue Sage Southernwood Tansy Thuja Wormwood Yarrow

Herbs and Pregnancy
• There are many herbs which are helpful during
pregnancy and have been used by women for generations.

• Raspberry • Nettle leaves • Oats

• Dandelion root • Alfalfa • Yellow dock

Herbs for Morning Sickness
• Some herbs can work well for morning
– Chamomile – Ginger – Peppermint – Black Horehound

sickness but should be taken under the guidance of an herbalist

Herbs for Labor

Golden Seal
Can be taken during labor to assist the uterus but should never be taken during pregnancy.

Regular treatments throughout pregnancy can:

• Enhance the mother’s health • Prevent complications • Influence the development of the baby • Help relieve morning sickness

Acupuncture for the 1st Trimester
During the 1st trimester acupuncture can help to relieve:

• Fatigue • Migraines and headaches • Bleeding

Acupuncture for the 2nd Trimester
During the 2nd trimester acupuncture can help to relieve:

• • • • • •

Heartburn Hemorrhoids Stress Edema Elevated blood pressure Excessive weight gain

Acupuncture for the 3rd Trimester
During the 3rd trimester acupuncture can help to relieve: • Sciatica • Backaches • Public and joint pain

• By 32-34 weeks acupuncturist will begin to

encourage a head-down position • Last 4-6 weeks treatments will be focused to normalize and optimize labor

If a baby is in the breech position many acupuncturists will use moxabustion to turn the baby. This technique has been used for centuries in China. • Moxabustion is a long stick of moxa or the herb mugwort

• • • •

that is lit and produces a gentle, smoldering heat. Moxa is held by an acupuncture point on the little toe. This is most effective when used at 32-36 weeks of pregnancy Should only be used with healthy pregnancies Can also be used in the treatment of nausea

Prenatal Massage
There are some specific positions for prenatal massage to keep the mother comfortable and to limit pressure. • Lying on side • Lying on stomach with specially designed pillows

cutout at the stomach so the mother can lay flat and be relaxed • Propped up while lying on back- after 22 weeks lying flat on your back can cause pressure on deep blood vessels, reducing circulation to mother and baby.

Benefits of Prenatal Massage
• • • • • • • • • • • • • • • •
Emotional support and nurturing touch Relaxation and decreased insomnia Stress relief on weight-bearing joints Neck and back pain relief Assistance in maintaining proper posture Preparing muscles used during childbirth Reduced swelling (edema) Lessened sciatic pain Fewer calf cramps Lessened headache and sinus congestion Aiding circulation, keeping blood pressure in check Relieve depression and anxiety Help stabilize hormone levels Increase flexibility (helpful in the last trimester) Help to relieve cramps, constipation, nausea and indigestion Helps to prevent stretch marks

Prenatal Massage Precautions
• Massage is generally not recommended in the first •
trimester Avoid during morning sickness (an increase in circulation can intensify morning sickness) Avoid if the mother has excessive swelling in the arms or legs, fever or vaginal bleeding Avoid deep work on the abdomen Avoid deep pressure applied to the area between the ankle bone and heel and the webbing between the thumb and index finger (these areas are related to the uterus and vagina and pressure can promote/induce labor

• •

Reflexology and Pregnancy
Reflexology is based on the idea that points on the hands and feet correspond with specific organs and systems in the body. Therefore pressure is applied to certain points and the related area of the body is stimulated and cleared of congestion. Reflexology also promotes deep relaxation thereby encouraging the body’s natural healing process.

Benefits of Reflexology during Pregnancy
Reflexology can help to relieve the following complaints during pregnancy:

• • • • • • •

Morning Sickness Nausea and headaches Pain and discomfort Loss of bladder control Backaches Stress and Anxiety Sleeplessness and Fatigue • Digestive Problems

• Constipation and diarrhea • Swollen or puffy ankles and • • • • • •

legs Cramps Gestational Diabetes Heartburn Help to turn posterior babies Help to turn breech babies Induce labor

Reflexology During Pregnancy Precautions

• Go to a Reflexologist who is experienced with

treating pregnancy • Generally recommended that if the mother has not received reflexology treatments before pregnancy she should wait until week 18 to begin treatments • Some medical conditions (such as septicemia) could reduce the effect of treatment • Any unusual results of treatment should be referred to a medical doctor (i.e. vaginal bleeding)

Aromatherapy During Pregnancy
Aromatherapy can help with many emotional discomforts during pregnancy as well as some of the physical discomforts.

Benefits of Aromatherapy
• Aid in relaxation • Assist in dealing with stress • Help ease aches and pains as the pregnancy • •
• • •

progresses Help alleviate tiredness Help reduce stretch marks by keeping the skin well nourished Help the mother feel good about herself Provide some relief from varicose veins Help the mother stay in touch with her body

Aromatherapy During Pregnancy
The way essential oils work is by entering the blood stream through the skin. They are mixed with carrier oils in order to not avoid irritating the skin. When a women is pregnant less essential oils should be used, making the carrier oil less concentrated (advised to use only 5 drops per 1 once of carrier oil).
Essential oils can also be used by inhaling the scent such as through a diffuser or on a tissue.

Tips for Using Aromatherapy During Pregnancy
• Massaging abdomen, breasts and thighs with
essential oils can reduce stretch marks (use a carrier oil such as avocado oil which is very nourishing for the skin) • Add 3-4 drops of an essential oil to a warm bath for relaxation (avoid hot baths during pregnancy) • Put 5 drops of essential oils on a tissue and inhale • Use in a couple drops in a spritzer with water

Aromatherapy Oils for Use During Pregnancy
The following oils are generally considered safe for pregnancy (though there are many conflicting points of view and some say to avoid all essential oils or stimulating essential oils in the 1st trimester): • Orange • Benzoin • Tea Tree • Bergamot • Lavender (avoid in 1st • Lemon trimester or if history of • Neroli miscarriage) • Sandalwood • Patchouli • Spearmint • Vetiver • Grapefruit • Rose • Ylang Ylang • Tangerine • Mandarin • Jasmine

Aromatherapy Precautions During Pregnancy
The following essential oils should be avoided during pregnancy:
• Lavender, rose, chamomile and geranium should be avoided in the
1st trimester or if there is a history of miscarriage otherwise they are generally considered safe to use
Basil Cedarwood Clary Sage Cypress Fennel Jasmine Juniper berry

• • • • • • •

• • • • • • •

Marjoram Myrrh Peppermint Rosemary Thyme Pennyroyal Oregano

Flower Essences and Pregnancy
Flower essences are herbal remedies which contain the energetic healing pattern of flowers infused in water and preserved with alcohol.

Flower essences interact with the human energy field to harmonize the emotions, clear and calm the mind and bring about a sense of peace and well-being.
(Flower Essences for Pregnancy and Childbirth by Peggy Rada, September 1999)

Usage of Flower Essences During Pregnancy
Flower Essences:

• Can be used throughout pregnancy and

labor • Have no side effects • Can be used by everyone • Can be used alongside other treatments or therapies

Taking Flower Essences During Pregnancy
There are several ways to take flower essences:
• Place several drops on the tongue, two or more times a day (most common) • Place on the insides of wrists • Place a drop on the forehead (most common with babies and children) • Added to bath water

Benefits of Flower Essences
• • • • • • • •
Help gain and keep inner balance Support decision making Restore peace of mind Help both parents face changes Encourage bonding between mother and child Soothe emotional oversensitivity Help relieve backaches and sleeping problems Keep the parents calm and collected before and during the birth

Flower Essences for Pregnancy
There are many flower essences which can be beneficial during pregnancy. A few are listed below:
• Alpine Lily- especially beneficial the physical experience of
pregnancy and weight gain Borage- uplifts spirits during pregnancy California Wild Rose- for difficult pregnancies or births Centaury- overwork or exhaustion Chamomile- to balance emotions Cherry Plum- for extremely stressful pregnancy Fairy Lantern- for young mother challenges Shooting Star- to prevent miscarriages Pear- inner peace

• • • • • • • •

Chiropractic Care and Pregnancy
Chiropractic care involves adjusting misaligned joints of the body, especially the spine, to promote overall health.

Use of Chiropractic Care During Pregnancy
• Chiropractic care is safe during pregnancy when
provided by a chiropractor trained to work with pregnant women. • Chiropractors should use tables that will adjust to pregnant women’s bodies. • Chiropractors should avoid unneeded pressure on the abdomen. • Many trained chiropractors will provide exercise and stretches that are safe to use during the pregnancy.

Reasons for Chiropractic Care During Pregnancy
• Changes in the body can result in
misalignment of the spine or joints • To help establish balance and alignment with the pelvis • Increase the amount of room in the pelvic cavity for the developing baby • Position the baby for delivery

Chiropractic Technique for Pregnancy
The Webster Breech Technique Developed by Larry Webster of the International Chiropractic Pediatric Association
• Used to release stress on the pregnant woman’s pelvis and
cause relaxation of the uterus and surrounding ligaments. • Making it easier for a breech baby to turn in the womb naturally. • Facilitates safer deliveries for mother and baby • There has been a high success rate reported

Potential Benefits of Chiropractic Care During Pregnancy
• Reduce chance of miscarriage • Controlling vomiting and morning sickness • Increased rate of full-term delivery • Reduce labor and delivery time • Relieve back, neck or joint pain • Prevent cesarean section or vaginal
breech delivery • Can be used to induce labor

Yoga and Pregnancy
Many women find that yoga helps to relieve pregnancy discomfort and teaches healthy relaxation skills in order to better prepare mentally and physically for the coming birth.

Yoga Tools and Benefits for Pregnancy
• Yoga exercises- ensure a smooth pregnancy and

• • • •

relatively easy childbirth Breathing or Pranayama- help ensure abundant supply of oxygen Mudras or Bandhas- stimulation of these gestures have effects on the reproductive organs Meditation- helps resolve neuroses, fears and conlfcits, as well as create a deep awareness which help the mother connect to the child Deep relaxation- Yogic sleep (Yoga nidra) effective for physical and mental relaxation and childbirth preparation


Yoga Positions for Pregnancy
• The Swan
– Good release posture – Takes the weight off the back – Stretches hip joints and opens pelvic area – Opens chest area , encouraging deeper breathing

• Tadasana (Mountain
– Helps relieve pregnancy related back ache – Helps with tiredness by encouraging deep breathing

Yoga Positions for Pregnancy Continued
• Trikonasana (Triangle
– Helps with fluid retention in feet and ankles – Be careful not to over stretch muscles especially near the end of pregnancy (muscles and
joints are more stretchy during pregnancy because of the release of relaxin in preparation of birth)

• Recovery Position

– Relaxation postures such as the recovery position oppose the effects of stress – Use any number of blocks or cushions for comfort


Precautions for Yoga During Pregnancy
• After the 1st Trimester women should not perform and poses on
their back because these can cut blood flow to the uterus (some women are comfortable with these poses and should take care to listen to their bodies). Avoid poses that stretch the muscles too much, especially the abdominal muscles, since because of the pregnancy hormone relaxin. Take care when performing standing poses, use a chair or the wall for extra support. Bend forward from the hips and allow as much distance as needed to make breathing easier. Twist more from the shoulders and back to avoid putting pressure on the abdomen. Listen to the body carefully and adapt poses to the body’s physical changes. If there is discomfort stop the exercise.


• • •

Hydrotherapy and Pregnancy
Hydrotherapy is the use of water for therapeutic purposes. Hydrotherapy is self-applicable, reliable, safe and pleasant to experience.

Hydrotherapy for Pregnancy
• Paddling- run 6 inches of cold tap water in a bath.
Walk up and down the bath raising feet out of the water with each step. Start with 30 second and build up each day until reaching 2 minutes. • Pelvic Splashing- splash lukewarm water around legs, squat and splash around hips, between legs and on the abdomen. Reduce the water temperature over 3 days until the water is cold. Step out of bath into warm towels and dress quickly.

• Benefits- assist with increased pressures of pregnancy,

stimulate circulation in the venous system and improve muscle tone. Influences the internal muscles better than stretching and conditions softer tissues, making them less likely to tear or need surgical intervention.
( )

Hydrotherapy During Labor
• Splashing or Spraying the Face- use an atomizer or dip
hands into cold water and direct to forehead and eyes
– Benefits- stimulates the cranial nerves, helping concentration and reducing anxiety

• Cold Compress of the Neck- place a towel wrung out in cold
water around the neck lower back and pelvis

• Hot Compress on Lower Back- place a hot towel against the • The Birth Pool- float in water, briefly at the beginning of labor
and then increase the length of time as the labor progresses (Giving birth in water is an option)
– Benefits- eases pressure on the spine, body is decompressedinterrupting the intensity of labor pains, giving birth in water is less stressful on the perineum
( )

– Benefits- Steadies and deepens breathing, relieves tiredness

– Benefits- encourages relaxation of the pelvis between contractions

Common Hydrotherapy for Pregnancy
• A warm bath (thought not a hot bath) • Prenatal water exercise classes
– These exercises help maintain muscle function and improve circulation and the water helps bare some of the weight of the pregnancy.

Doula or Labor Support Person
• Trained and experienced in childbirth • Provides physical, emotional and informational support • • • • • •
to woman and their partners during labor and birth Provides help and advice on breathing, relaxation, movement, and positioning Assists in gathering information about labor options May attend prenatal appointment with the mother and assist the mother in developing questions to ask the provider Provides continual emotional reassurance and comfort Do not diagnose medical conditions, perform clinical tests or give medical advice. Goal is to help women have a safe and satisfying childbirth experience

Possible Benefits of a Doula
• Decrease the chance of a cesarean • Decrease the length of labor • Reduce the need for pain medications • Facilitate a normal, natural, nonintervening birth experience

References and Resources
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Eisenberb, H. & Hathaway, S. What To Expect When Your Expecting 3rd Ed.. Workman Publishing Copyright 2002. NY, NY

References and Resources
1. 2. 3. 4.
5. 6. 7. cture___pregnancy.html West, Z. (2002). Acupuncture in Pregnancy and Childbirth. New York, New York: Churchill Livingston.

1. 2. 3. 4. Fawcett, M. (1993). Aromatherapy for Pregnancy and Childbirth. United Kingdom: Element Books.

Chiropractic Care
1. 2. 3.

References and Resources
1. 2. 3.

Flower Essences
1. 2. 3. 4.

1. 2. 3. 4. 5. 6. 7. Gardner Goodson, J. (2000). Healing Yourself During Pregnancy Freedom, California: Crossing Press. Weed, S. (1986). Wise Woman Herbal for the Childbearing Years. Woodstock, New York: Ash Tree Publishing. Weschler, T. (2002). Taking Chare of Your Fertility. New York, New York: Quill.

References and Resources
1. 2.

1. 2. 3. 4.

1. 2. 3.,,1-9-10-30_3849,00.html

1. 2. 3.