Preconception Counseling
Following are a few of author/midwife Anne Frye's points
to discuss with a couple who are thinking about getting pregnant:
- Women who are 15% below their ideal weight can be told the benefits of gaining a few pounds before conception. Providing an extra cushion of calories can take them through the early pregnancy discomforts such as bouts of nausea.
- Overweight women should be warned not to go on a crash diet before conceiving. This is likely to deplete their bodies of stored nutrients, which could adversely impact a pregnancy. However, they can begin eliminating junk foods and start a program of moderate exercise.
- Carefully review a woman's diet and lifestyle habits (smoking, drugs, etc.) and support her to curtail harmful habits and make dietary adjustments now.
- A program of vitamin and mineral supplementation and nutritive herbal infusions such as alfalfa, nettles and red clover will maximize her health before conception. Be sure a woman knows to begin taking at least 0.4 mg of folic acid daily to reduce the likelihood of neural tube defects in the baby. This should begin at least one month before trying to conceive.
- Vegetarians who eat no dairy products can be advised to begin taking 3 micrograms of B12 two to three times weekly.
- Ask about the work and environment of both parents and inform them of any associated risks.
- If social services or other community resources are available to a woman, given her income and other factors, make her aware of those now so she can explore when and if she is eligible.
- Discuss how emotional factors are impacted by pregnancy and parenting, and explore options if issues need to be dealt with through therapy.
- Be sure to let women know to avoid taking any over-the-counter or prescription medications; also discuss exposure to environmental hazards which should be avoided before conception.
- Anne Frye, Holistic Midwifery, Vol. 1: Care During Pregnancy, Labrys Press, 1995.
It is not uncommon for potential new parents--even those
who deeply desire and feel they have prepared for their child--to also
feel some ambivalence about conceiving and giving birth to a new life.
Having a baby requires major shifts in your lifestyle and relationships,
as your priorities will be forced to change. Once you become pregnant,
you may experience a wide range of conflicting emotions.
There is a difference between healthy ambivalence and chronic
ambivalence about becoming a mom or dad. Healthy ambivalence includes
the natural tendency to have fleeting fears or doubts about yourself,
your partner, or your future child. Chronic ambivalence is characterized
by a persistent pattern of reluctance to becoming a loving parent. Continual
hesitation about your readiness to handle the challenges of parenthood
can profoundly affect your ability to bond with your future child, thus
leaving yourself and your baby vulnerable to significant emotional pain.
Prospective fathers are also vulnerable to emotional upheavals as they
adjust to their future relationship to the new child, along with profound
changes in their partner.
It is important that you both invest some time clarifying
whether your anxieties about having a child are motivated by a true
unreadiness to bond with your little one. During the earliest stages
of a prenate's life, a profound connection can be instilled between
you and your child. Psychological and biological studies show that a
first-trimester fetus possesses enough self-awareness to sense chronic
rejection from an ambivalent mother. Dr. Thomas Verny states that "a
mother's anxiety-provoking hormones" can flood her baby's system,
"making him worried and fearful." The developmental significance
of emotional dependency between mother and child beginning in utero
suggests that postnatal bonding is a continuum of security that, if
missed, can cause a lifelong primal wound.
- Carista Luminare-Rosen, Ph.D., Parenting Begins Before Conception, Healing Arts Press, 2000
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Midwifery Today's Online Forum
I recently attended a birth as an assistant where there was a moderate
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may be a connection between postpartum hemorrhage and decreased milk supply.
This mom feels that she is not producing enough milk. I have seen this
with another birth about a month ago. Both moms are grand multips in their
early 40s. I wonder if anyone else has heard of this connection??
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Question of the Week
A friend is due on Feb 8 with her first baby. She is 5' 4" roughly,
average weight, and her baby has been in a transverse position for the
last few weeks. As far as I know there are no pelvic problems in her history.
She has been doing the "lying-on-the-ironing-board" trick to
try and turn baby but is looking for other techniques. She asked about
moxa and acupuncture, which I didn't know enough about. She is seeing
an OB who definitely has the conservative, surgical mindset. She has an
appointment in two weeks where a decision will be made about scheduling
a c-section. I know sometimes there are reasons that baby stays in a certain
position and turning may not be the best thing to do for baby; however,
I welcome any thoughts, comments or ideas that might help her have a different
option other than surgical birth. She is open to alternatives, so anything
is welcome.
- Marisa White
Send your responses to:
Question of the Week Responses
Q: I recently heard that doing
perineum massage during pregnancy does not change the outcome. Could you
clarify this for me and give more information?
- Kim Johnson, doula aspiring midwife
A: Betty-Anne and Ken of the MANA statistics committee shared
some interesting data in 1996 at the MANA conference. Using the MANA stats,
they determined that doing pregnancy perineal massage increased a woman's
risk for more third and fourth degree tears. However, not doing it meant
more tears overall but they were first and second degree tears. I stopped
encouraging women to do pregnancy perineal massage, and do not do perineal
massage in labor either. I would much rather have more first and second
degree tears that I can suture if needed, than have to transport for third
and fourth. I would say in talking to midwives we all do less hand work
on the perineum--some oil, support and maybe some warm compresses. I think
this approach has contributed to my having to do less suturing since I
heard the news and heeded the advice.
- Kerry Dixon, CPM, LM
Coming E-News Themes
1. INTERNATIONAL MIDWIVES: Tell us about your practice, birth customs
and culture in your country, arts and techniques for the birthing year,
your struggles and triumphs!
2. CHARTING CAN BE AS UNIQUE AS EACH MIDWIFE'S CARE. Do you have charting
methods you would like to share with E-News readers?
3. SECURING AN APPRENTICESHIP: I am a midwife in training with an impressive
record as a childbirth educator, DONA-certified doula, certified infant
massage therapist, and a keen interest in normal birth. Four months ago
I moved to a new area with my family and began the process of trying to
make contacts. I am having a difficult time finding a midwife who is willing
to talk with me about the steps necessary to secure an apprenticeship.
Frankly, I feel a little like I'm crossing into a territory that belongs
to someone else. I have emailed a vita to many well-respected midwives
in my area asking for assistance, that they pass my name along, etc. I haven't had as much as a telephone call from anyone, even to say that
they couldn't help.
Is the society of midwives so closed and myopic that they have lost sight
of the idea behind traditional midwifery, that midwives teach parents
as well as other midwives, that they give the gift and pass along the
art? My grandmother learned from her mother, and she learned from her
aunt, etc. After all, wouldn't we all like to see more homebirths? This
can be accomplished with more midwives who are well trained. It is difficult
not to feel disheartened. What do I do? Do I need to know the secret handshake?
- Jackie McMillan
Send your responses to:
Know a strong woman? Helping empower one? If you haven't already done
so, please forward this issue of Midwifery Today E-News to one or two
of your friends or business associates. Thanks so much!
QUESTION OF THE QUARTER for Midwifery Today magazine
Mamatoto: Motherbaby
How can midwives best facilitate the bonding process of motherbaby in pregnancy, birth and postpartum?
Deadline: March 31, 2001
Send your response to:
Switchboard
I have been incorporating essential oils into my midwifery
practice for over four years. At first I was extremely cautious and skeptical,
but after extensive documented research, I have grown to appreciate their
specific uses. I also have each woman smell the essential oil before I
even think about using it because if an oil doesn't smell "good"
to a person, they shouldn't use it.
I highly recommend the book Aromatherapy
For Health Professionals by Shirley Price and Len Price. The second
edition, 1999, has lots of excellent documented information about many
different essential oils during pregnancy, birth, and postpartum. The
studies have been conducted mostly in England, where they are very experienced
in aromatherapy.
There are many different aromatherapy organizations that may be able
to provide you with information. The National Association for Holistic
Aromatherapy, in Boulder, Colorado, is one such source.
- Alison
====
More on home/hospital birth:
I am an ex-homebirth midwife of 18 years turned CNM (four years) and
am now a midwife in a small rural hospital. While we may be unique in
that we do rare intrathecals and inductions, you have to know the "battle"
is not just with hospitals/providers, but women and our culture! Women
are scared of birth and pain and they HATE being pregnant. I think it
is largely socio-economic and results from lack of love and support in
their lives. Just so you know, there are women out there who beg for inductions,
drugs, ultrasound, etc. My clients are young, poor, single, usually without
a car, job, often being abused, or doing drugs in some fashion (especially
tobacco). So please do not generalize and judge so completely or you will
end up sounding just like those "hospital people" who do it.
- Anon.
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Midwifery Today: Each One Teach One! | 
