|August 13, 2008|
Volume 10, Issue 17
|Midwifery Today E-News|
“Weight Gain in Pregnancy”
|Subscribe • Print Page|
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In This Week’s Issue:
Quote of the Week
"The correlation between poverty and obesity can be traced to agricultural policies and subsidies."
— Michael Pollan
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The Art of Midwifery
We must relearn to trust the feminine, to trust women and their bodies as authoritative regarding the children they carry and the way they must birth them. When women and their families make their own decisions during pregnancy, when they realize their own wisdom regarding birth and its place in their lives, they have a foundation of confidence and sensitivity that will not desert them as parents.
There is an inverse relationship between the amount of technology used in a woman's birth and her subsequent self-esteem: The greater the number of interventions, the less well she regards herself postpartum. On the other hand, women happy with themselves in birth eagerly go on to embrace the responsibilities of mothering. The triumph of birthing on their own terms leads to new depths of self-love and self-respect, emotions readily translated to their babies.
ALL BIRTH PRACTITIONERS: The techniques you've perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to firstname.lastname@example.org.
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Research to Remember
A study of pregnancy in women who were morbidly obese, compared to women of normal weight, showed poor perinatal outcomes. Preeclampsia was determined to occur at a rate of nearly five times as frequently; meconium aspiration, fetal distress and low Apgar scores were also seen more often. In addition, interventions were more frequent, including three times the number of cesareans, a 34% increase in instrumental deliveries, and more inductions. Babies were also more likely to be born preterm.
— Obstetrical & Gynecological Survey 59(7): 489–491, July 2004
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Weight Gain in Pregnancy
Weight gain in pregnancy is a frequent concern among our clients who want to know how much to gain and at what rate. Some want to know why they need to put on what seems to many of them to be an inordinate amount.
Body Mass Index (BMI) is a better indicator of maternal nutritional status than is weight alone. The BMI is readily determined with the use of a pocket calculator by dividing weight in pounds by height in inches, dividing by height in inches again and then multiplying by 705. (Editor's Note: You can find an online BMI calculator at www.cdc.gov/nccdphp/dnpa/healthyweight/assessing/bmi/adult_BMI/english_bmi_calculator/bmi_calculator.htm; or, if you prefer to use metric units, at www.cdc.gov/nccdphp/dnpa/healthyweight/assessing/bmi/adult_BMI/metric_bmi_calculator/bmi_calculator.htm.)
Underweight women should be encouraged to gain weight slightly greater than one pound a week in the second and third trimesters, for a total of 28–40 lb. Overweight women should gain slightly greater than half a pound a week, for a total weight gain range of 15–25 lb. Obese women are counseled to gain at least 15 lb., to optimally support their pregnancy…. (Note: This 15 lb. rule is being re-evaluated, with some advocating weight maintenance and others even weight loss for morbidly obese women; until studies are done, the jury is still out.)
The BMI is a useful tool based on available research and scientific literature giving clients another way of approaching a healthy pregnancy with optimal outcome. The BMI is easily used and can be taught to clients for life-long weight evaluation.
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Products for Birth Professionals
From 1992 to 2006, the rate of pregnant women who were overweight prior to the pregnancy (based on body mass index [BMI]) increased from 32.4% to 43.8%, while the percentage of those who started out underweight decreased from 17.0% to 11.1%. In addition, those who gained more than the ideal weight (determined by starting BMI) increased from 33.2% to 43.2%, while those who gained less than the ideal amount decreased from 35.0% to 24.9%.
— 2006 Pregnancy Nutrition Surveillance, Summary of Trends in Maternal Health Indicators, Centers for Disease Control
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Web Site Update
Read this article excerpt from the most recent issue of Midwifery Today newly posted to our Web site:
"When is a 'choice' truly a choice, and when is it not? Recently, I received an e-mail from a VBAC client. "When I agreed to have a cesarean, was I really making a choice?" she asked. "First of all, I, the chooser, was not truly informed; second, my doctor lied to me. Third, my insurance company limited my choices in many ways. Many of us women are so acculturated as to be unable to think outside the box, so if our insurance doesn't pay for midwives or cover homebirth, we think we can't choose it.'"
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Question of the Week
Q: I am in my third trimester of pregnancy and my husband is complaining that I am snoring—sometimes so loud that he has to sleep in another room. Is this related to the pregnancy? Will it stop once I have the baby? Is there anything I can do in the meantime to minimize or stop it?
— Sue Miller
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Question of the Week Responses
Q: A dear friend of mine was just diagnosed with colon cancer. I'm breastfeeding my 22-month-old and have heard about breast milk helping people with cancer (especially with chemo) but am having a hard time finding info on the subject. I would appreciate any advice or knowledge about cancer patients drinking breast milk. Thanks.
— Eden Robertson
A: I pumped milk for a while for a lady who had cancer. Don't know all the details, but I know she was able to contact a milk bank in California and get a shipment of milk to supplement what I was pumping for her. I know her doctors were impressed with her progress for a while.
A: Hi, I saw your question and thought I would help you along! http://www.wfaa.com/sharedcontent/dws/news/localnews/tv/stories/wfaa080215_lj_breastmilk.c618de8d.html
— Tonya C Buffington
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Think about It
"Until the evidence demonstrates that medically elective cesarean delivery optimizes outcomes for mothers and their infants, perinatal nurses must advocate for vaginal delivery as the optimal mode of birth." That is the conclusion on a recent review of issues related to medically elective cesarean delivery published in the Journal of Obstetric, Gynecologic and Neonatal Nursing (JOGNN 36(6): 605–15). This excellent review is must-reading for nurses and midwives (as well as obstetricians) who work in hospitals with pregnant and laboring women. It provides a comprehensive summation of various studies relating to vaginal versus cesarean delivery—in all its permutations—with substantial references. The authors address medical risks and benefits to mothers and babies, complications, mortality, loss of reproductive capability, psychosocial risks and benefits, professional opinions and economic impact.
While the recommendation that nurses advocate for vaginal delivery may pit them against obstetricians and institutional policies that stand to benefit from cesareans, it really is the only ethical stance they can take. This is in contrast to the American College of Obstetrics and Gynecology's (ACOG) insincere claim that medically elective cesareans should be accepted, based on principles of "patient autonomy" and "informed consent." (We know that if they consistently viewed women's childbirth choices that way, hospital-based breech birth and VBACs would be much more common than they are now.)
I highly recommend that birth care providers and educators obtain a copy of this article, and references as needed, to help the moms they serve understand why vaginal birth is best.
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Hello, I am a nurse and a health writer, and one of my blogs, Womb Within (WW), is dedicated to the subject of pregnancy and health. I have a doula who is writing some fabulous posts for the blog and I was hoping to find a midwife (or a few) who would like to write a piece for the blog every so often. The goal would be to educate the visitors at WW to learn about the role of midwives and perhaps incorporate this into their own experiences.
If you would like to check out the site, it is at www.wombwithin.com. Please feel free to e-mail me with any questions you may have.
— Marijke Vroomen-Durning, RN
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