Teen Questions About Birth & Our Bodies: Part 2

I had the privilege this week to be a guest speaker in a high school biology class this week, to teach on the topic of birth. I only had 50 minutes, so I really had to condense to the basics. My normal class series for pregnant couples is 12 hours of class time, and I really could use more time than that! So keeping it to "just" 50 minutes was really a challenge!

Since this was the first such class I had taught, I misjudged my timing and ran out of time for questions. I'll try to do better if I have another such opportunity in the future. Fortunately, the teacher had the students write up questions for me before the class, andI brought those home with me to answer here on my blog.

I ask that if you are under the age of 18 and reading this blog, especially if you go to the school where I spoke, ask your parents' permission before proceeding. I am comfortable discussing any of these topics and teaching from an honest, evidence-based, and God-honoring perspective about the incredible design of our bodies, but I do not want any angry parents calling or emailing me or the school.


Here are the teens' questions, continued. Part 2 will be just on cycles and fertility. (Here is the link to Part 1.)

• "Why is it when you find out you're pregnant, you don't have your period like you normally would?" "Ask about periods (All of the period)." "Can you explain ovarian menstrual cycle?" "Discharge?" "What is estrogen?" "Birth control?"

These are great questions, and I'm glad they were brave enough to ask. Since these questions are all interrelated, I'll try to segue my answers. I'd really love to do a detailed class specifically for teens and young 20's about menstrual cycles, but it would require a permission slip, for certain.

I'm going to have to keep the explanation really basic, because literally, entire books have been written on the topic. In fact, I'll go ahead and recommend a few:

Cycle Savvy: The Smart Teen's Guide to the Mysteries of Her Body for mature pre-teens and teens who are ready to know the details about their body's workings.

The Care & Keeping of You 1: The Body Book for Younger Girls for girls age 8 and up, with very basic explanations of puberty and cycles.

Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Natural Health book and website. For very mature teens and any adult woman who wants to thoroughly understand her reproductive system. I highly recommend that all women read this before they get married and/or plan a pregnancy. 

It calls itself the "Definitive Guide," and that's no exaggeration. Ladies, do you have irregular cycles? Hard cramps? Possible endocrine or hormonal problems or imbalances? Want to know WHAT'S UP DOWN THERE??? Get this book, start charting your cycles as it teaches you (which involves a lot more than just circling days on a calendar!), and take your findings to your midwife, GYN, or OB. Don't have one yet? Most midwives can take care of all your well-woman care, tests, etc. The midwifery model of care for pregnancy and birth is the most evidence-based for the majority of healthy women, so why not get established with a midwife from the start? If you have a rare or high risk situation, they will refer you to a specialist. This collaborative care model is one that we are already familiar with. For instance, most healthy people do not have a cardiologist. They likely see a general/family practice doctor, who will refer them out to a cardiologist if some high risk situation comes up. It's like that with midwifery. 

How to condense this to a very basic overview? This is going to be really long, I can tell. Here's a better explanation from a .gov, trustworthy & not coming from a corporation that's trying to make a buck off you by selling disposable products and making you feel bad about yourself in the process.

Menstruation and the menstrual cycle fact sheet: Womenshealth.gov

From Womenshealth.gov:

What is menstruation?
What is the menstrual cycle?
What happens during the menstrual cycle?

Menstruation (men-STRAY-shuhn) is a woman's monthly bleeding. When you menstruate, your body sheds the lining of the uterus (womb). Menstrual blood flows from the uterus through the small opening in the cervix and passes out of the body through the vagina. Most menstrual periods last from 3 to 5 days.

When periods (menstruations) come regularly, this is called the menstrual cycle. Having regular menstrual cycles is a sign that important parts of your body are working normally. The menstrual cycle provides important body chemicals, called hormones, to keep you healthy. It also prepares your body for pregnancy each month. A cycle is counted from the first day of 1 period to the first day of the next period. The average menstrual cycle is 28 days long. Cycles can range anywhere from 21 to 35 days in adults and from 21 to 45 days in young teens.

The rise and fall of levels of hormones during the month control the menstrual cycle.

In the first half of the cycle, levels of estrogen (the “female hormone”) start to rise. Estrogen plays an important role in keeping you healthy, especially by helping you to build strong bones and to help keep them strong as you get older. Estrogen also makes the lining of the uterus (womb) grow and thicken. This lining of the womb is a place that will nourish the embryo if a pregnancy occurs. At the same time the lining of the womb is growing, an egg, or ovum, in one of the ovaries starts to mature. At about day 14 of an average 28-day cycle, the egg leaves the ovary. This is called ovulation.

After the egg has left the ovary, it travels through the fallopian tube to the uterus. Hormone levels rise and help prepare the uterine lining for pregnancy. A woman is most likely to get pregnant during the 3 days before or on the day of ovulation. Keep in mind, women with cycles that are shorter or longer than average may ovulate before or after day 14.

A woman becomes pregnant if the egg is fertilized by a man’s sperm cell and attaches to the uterine wall. If the egg is not fertilized, it will break apart. Then, hormone levels drop, and the thickened lining of the uterus is shed during the menstrual period.

OK. So does that answer most of it? For the specifics of the questions asked, the reason a woman her period is that she ovulated approximately 2 weeks before, and the egg was not fertilized. The uterine lining builds up in preparation to make a cozy home for a fertilized egg and sustain it as it grows. If no fertilized egg implants into that rich, nutritious (for a new baby) uterine lining, then the body sheds that lining in preparation to start all over again. So, when a woman misses her period due to pregnancy, there aren't periods during the pregnancy because the fertilized egg implanted, began to grow, and used that lining. Did I explain that well in lay terms?

If a mother exclusively breastfeeds (that means nursing on baby's cue's around the clock, with no bottles or pacifiers and no other foods or supplements), then there is a 98-99% chance that her fertility (periods) will be suppressed for 6 months. This is a great benefit in helping with natural child spacing.

What is discharge?

The vagina is self-cleaning. It doesn't need douches, sprays, creams, or lotions. In fact, any of these products can disrupt its healthy, normal pH level and make it have an odor or even cause an infection. Advertisers want to make women feel self-conscious and embarrassed about your lady parts. Well, guess what, ladies? Your parts are awesome! You were fearfully and wonderfully made. Your body is not a lemon, and it deserves some respect! News flash: lady parts were never meant to smell like spring rain. They're supposed to smell like lady parts. In fact, be very cautious what soap you use in that area, because even soaps can throw off the pH of the area or cause a reaction to fragrance, colors, or other ingredients in the soaps. You might be best off just to use fresh, clean water.

So, where am I going with that? What I'm trying to convey is that discharge is not dirty or gross. It's a normal part of our fertility & cycles, part of a healthy body. Part of discharge's function is the body's self-cleaning, but much of its purpose is intricate and amazing: it is cervical fluid produced to help sperm get to the cervix during fertility. Like I said, all the details of it fill a book, but by observing your pattern of normal discharge daily, and getting to know your body, you can know when you are fertile or not fertile. This requires a lot more reading and training than this blog, just as a disclaimer. I'm just introducing the concept to you, perhaps for the first time that you are hearing it, that the texture and consistency of normal vaginal discharge is directly related to fertility and the body gearing up for someday, when you are ready to be pregnant. Pretty impressive, huh?

If you get to know your body's norm, it will be obvious to you if something is *not* your norm. If there is a foul odor to discharge or it's a color you've never seen before, or if there is itching, this could possibly indicate an infection that needs treatment. Please see your midwife or doctor.

On to birth control. There are many options for birth control, both pharmaceutical and non-pharmaceutical. Not many women are advised of the risks of pharmaceutical birth control methods, so if it's something you're considering, I highly recommend you do a lot of reading to make sure the benefits outweigh the risks in your instance. 

Some teens are advised to go on birth control pills because of irregular or very hard and painful periods. This isn't the only option out there. If this is your situation, you might be able to find a midwife or naturopath who can give you options that don't have the short- and long-term risks of pharmaceutical birth control methods. Rather than using a drug to artificially stimulate the body to have periods, it can be beneficial to figure out what the underlying problem is that's causing the symptoms of pain or irregular cycles, and treat THAT instead of treating the symptoms.

Here's one article on the subject. "Natural Alternatives to Hormonal Contraceptives"

It goes through a long list of risks and side effects of chemical/hormonal contraceptives and gives alternative options.

Here's my awesome Pinterest board for Fertility & Cycles. I update it regularly with newly bookmarked articles.

So that's that. Any other questions? I hope I didn't wear you out with too lengthy a response, but I wouldn't know how to answer it with less! 

Here is the link to Part 1 of this series. Part 3 is upcoming!

Teen Questions About Birth & Our Bodies: Part 1

I had the privilege this week to be a guest speaker in a high school biology class this week, to teach on the topic of birth. I only had 50 minutes, so I really had to condense to the basics. My normal class series for pregnant couples is 12 hours of class time, and I really could use more time than that! So keeping it to "just" 50 minutes was really a challenge!

Since this was the first such class I had taught, I misjudged my timing and ran out of time for questions. I'll try to do better if I have another such opportunity in the future. Fortunately, the teacher had the students write up questions for me before the class, and I brought those home with me to answer here on my blog.

I ask that if you are under the age of 18 and reading this blog, especially if you go to the school where I spoke, ask your parents' permission before proceeding. I am comfortable discussing any of these topics and teaching from an honest, evidence-based, and God-honoring perspective about the incredible design of our bodies, but I do not want any angry parents calling or emailing me or the school.

Here are the questions that were submitted.

• "What is the umbilical cord?", "What does the placenta do?", and "What happens to the umbilical cord after you give birth?"

The umbilical cord connects the baby to his placenta. The blood in the placenta and in the cord belong to the baby, not the mother. The mother's blood and baby's blood do not mix. 

The placenta provides all the nutrients, oxygen, etc. to the baby via the cord, and the cord transfers waste materials from the baby back to the placenta to be processed and eliminated.

The placenta is typically the size of a dinner plate and looks a bit like liver or other organ meat. It's not gross, it's pure awesome, once you discover how incredible it is and what it does.

This is the baby's side of the placenta, with the umbilical cord coming from the middle. The baby is attached to the other end of the cord. Source: http://www.pampers.com/common/pdf/pc/hb/CBE_book_for_students.pdf

The cord provides oxygen and other essentials to the baby in the womb and in the first few minutes after the birth, while the baby's lungs are inflating and acclimating to breathing air for the first time. It's essential for baby's oxygenation that the cord remain intact for a *minimum* of 3 minutes after the birth, according to the World Health Organization. Additionally, since the blood in the placenta and cord are part of the baby's total blood volume and designed to be returned to the baby through the cord after the birth, if the cord is clamped and cut prematurely, the baby is deprived of 30-40% of his total blood volume, which means that many babies have low iron levels due to that blood loss. This is a health problem called "anemia," and it's measurable for 6 months or more after the birth in babies whose cords were cut too early.

Here's a video that explains how this transfer of baby's blood occurs after the birth, and why it's important to wait for it. Many hospitals are in the habit of clamping and cutting the cord within 15 seconds after baby's birth, just out of routine.

You can tell the cord is ready to be clamped and cut when it quits pulsating. After the birth, you can put your fingers on the cord and gently squeeze it and and feel a pulse, just like feeling your own pulse. What you are feeling is the baby's pulse. While that pulsing is still going on, baby is still retrieving his blood from the placenta and cord. When it feels and looks empty, then it's ready to clamp and cut.

The OB or midwife will place one sterile, plastic clamp a few inches from where the cord attaches to baby, leave a bit of space, then sometimes place a second clamp. A lot of dads like to be the one who cuts the cord. It's done with surgical scissors, and it's very easy to do. My then-5-year-old son cut his baby brother's cord, in fact. 

That's my 5 y.o. on the left, cutting his baby brother's cord about 20 or 30 minutes after he was born.

It does not hurt the baby at all when the cord is cut.

• "Why are the testicles separated from the rest of the body?"

I think I get what you're asking. As in, hanging down from, as opposed to as an internal organ? The primary purpose of that is to keep the testes away from the body so that they stay at a lower temperature. Sperm die at high temperatures. This is why men who have low sperm counts are advised to stay away from hot tubs, and to wear boxer shorts as opposed to tighty-whities.

• "Does your stomach go back to normal size after birth?"

For the first few days or weeks after giving birth, many moms still look pregnant. It takes a while for internal organs to go back to where they are supposed to be, and for the uterus to shrink down to its normal non-pregnant size. There is much variation from one mother to the next. Some moms go right back to pretty much the way they looked before pregnancy. Others hold onto pregnancy weight for a variety of reasons; the body needs extra fat reserves to be able to produce milk. That weight is there for a reason (provided it was gained on high quality nutrition)! My midwife always says, "It took 9 months to put that weight on; it should take at least 9 months to take that weight off."

Some moms get stretch marks; others don't. There are many factors to this: genetics, nutrition & hydration, amount of weight gain, speed of weight gain (skin has time to stretch gently if it's gradual as opposed to quick weight gain), and if there are multiples (twins, triplets, etc.). Some moms' skin stays stretched even after the muscles & organs go back, sort of like a balloon that has been filled and then emptied. And some moms look like they never were pregnant, with smooth, taut bellies. 

All of these variations are normal and healthy. In my personal opinion, we need to be focusing on health and wellness more than looks. Many moms feel unnecessary pressure to get back to "pre-pregnancy weight" or "pre-pregnancy shape." Why should we feel outside pressure to conform to societal ideals that moms should look like pre-pubescent or pubescent young women who have never been pregnant? There's no reason to deny our basic biology. Personally, I'm at peace with my stretch marks. God designed our bodies to be capable of incredible miracles in creating, growing, and sustaining human life. My body's marks are proof of that.

A really neat website where you can see the many variations of mothers' bodies after pregnancy is Shape of a Mother, but there is some nudity on that site, for educational purposes of accepting the human form. Please get parental permission before viewing.

• "What is a C-section?"

A C-section, also called cesarean or cesarean section, is major abdominal surgery to deliver a baby. In most cases, a vaginal delivery is safest for mom and for baby, but in some instances, a C-section is helpful or even life-saving for mom or baby or both. Other times, a C-section could have been prevented, and exposes mom and baby to unnecessary risks both short-term and long-term. Since C-sections have become so common (32.8% of all births in the U.S. are surgical births; in WV, the rate is 36.3% of all births, the 5th highest rate in the U.S.), it's important for all pregnant moms to get informed on risk/benefit and factors that contribute to higher cesarean risk.

Free downloadable e-book "What Every Pregnant Woman Needs to Know About Cesarean Section"

Source: http://www.pampers.com/common/pdf/pc/hb/CBE_book_for_students.pdf

From http://www.pampers.com/common/pdf/pc/hb/CBE_book_for_students.pdf

"Most of the time, epidural or spinal anesthesia is used, allowing the mother to be awake during the birth. In almost all cases, a labor partner can also be present... Once the cesarean begins, it only takes a few minutes for the baby to be born through an incision in the mother's lower abdomen. Then it usually takes around 45 minutes to complete the operation."

• "What is the pain level of having a baby?"

That question is tough to answer, because it's so subjective, and varies not just from one mother to the next, but also from one birth experience to the next, even with the same mother.

There are many factors regarding the pain level, but one important one to note is FEAR. The more the mother fears birth, the more painful she will perceive it, the longer her labor is likely to be, the more likely she is to undergo preventable medical interventions, and the more likely she is to end up with a cesarean. Cesarean recovery is a whole different situation, as it is a major abdominal surgery, and if a mother has had more than one cesarean, recovery can be even more difficult.

The antidotes to fearing birth are often education and support. We are in a cultural crisis of fear of birth and negative stories about birth. Many times, the only things a pregnant woman knows about birth prior to giving birth, are what she has seen on reality TV shows about birth. Sadly, instead of giving moms confidence in their bodies' wonderful design and ability to give birth to their babies, these shows terrify viewers with drama and horror stories. (Peaceful, positive births aren't good for ratings or ad revenue.) This is well documented. I highly recommend that expectant moms and their birth partners take a comprehensive childbirth class, fairly early in their pregnancy, to an independent childbirth educator who isn't under a gag order by their employer not to share details beyond their policies and protocols.

There is a difference between pain and suffering in labor. Labor can be intensely painful, but for moms who are confident, well supported, and not fearful, this doesn't mean she will suffer. Moms in labor who are supported emotionally and physically to listen to her body and allow her to move, eat, sleep, and cope as her body tells her to do, are usually able to labor and give birth without pain medications. The positions that feel most comfortable to mom in labor are usually the ones that help the baby move down and through the pelvis, making labor more efficient and safe.

The more intense and painful labor becomes, the more endorphins (morphine-like hormones) the body produces, in an unmedicated birth. The mom actually enters a dreamlike state, a sort of altered state of consciousness, that helps her cope with the increasing pain. So, the more painful it gets, the more capable the body is of handling the pain and reducing the mom's perception of that pain.

Dr. Sarah Buckley has an excellent topic elaborating on this topic.

"Pain in Labour: Your hormones are your helpers"

There are a number of options, both non-pharmaceutical and pharmaceutical, for pain relief in labor. Full explanation would take way too much space here. I encourage all expectant parents to take a class on all their options for coping with labor pain, so they can have the info on risk/benefit well in advance.

Personally, I've had 5 vaginal births with no pain medications whatsoever. Each experience was different; all were painful, but I have no regrets at all. If we were to have another baby, I would make the same birth choices. The benefits of a safe, drug-free birth, not exposing my baby to narcotics unless there were a medical emergency for doing so, getting a good start bonding and breastfeeding, and having that "birth high" from endorphins, far outweigh the hours of pain in the process, for me personally.

On a side note: a very small percent of moms who have unmedicated births will have pain-free or even physically pleasurable labors and/or births, sometimes called ecstatic or orgasmic births. 

• "How far along is it until you can tell the sex of the baby?"

After the birth. Seriously. Sort of. Even with all of today's technology, ultrasounds are still not 100% accurate with predicting baby's gender. I've read figures around 85-90% for accuracy of prediction. It depends on the type of ultrasound equipment used, how far along the baby is, baby's position and whether the sonographer can get a clear view of the genitals, skill of the sonographer, and more. Sometimes the baby's genitals are swollen from mom's hormones, which is normal, but can make girl parts look like boy parts, or vice versa. You think that's impossible? Ask the scores of parents who already painted the nursery the wrong color and had all the wrong clothes for the baby.

With that in mind, typically parents can find out (the best guess for) baby's gender at the 20-week ultrasound that is usually performed to help rule out health problems. If an ultrasound is performed earlier for elective or medical reasons, *sometimes* gender can be viewed as early as 13 weeks, but with way less accuracy. (There are risks associated with ultrasounds in pregnancy, so it's not recommended to have them without medical indication for them.)

To be continued in Part 2...

**UPDATE** link to

Part 2 of Teen Questions About Birth & Our Bodies.

What do prenatal checkups look like with homebirth midwives?

I remembered viewing this video some time ago, posted by another momma who had an OB for her previous pregnancy and was seeing a midwife for this pregnancy. (Not sure of her birth location for either.) She put together this funny but 100% true video outlining the actual time spent and how it was spent, at her OB appointments vs. at her midwife appointments. The average amount of time a pregnant momma spends face-to-face with her OB at each appointment is 6 minutes. This momma actually spent 3 minutes face-to-face with her OB. That doesn't leave a lot of time for asking questions, discussing birth plans and preferences, and scoping out OB's birth philosophy and standard routines/practices, let alone relationship-building. My first pregnancy and birth was with an OB group that had 2 midwives in the practice, but the midwives practices were closely in line with the OBs', both with prenatal checkups and at births. The timeline in this video lines up with my experiences at the OB office.

I've had several people ask me what a typical midwife appointment looks like. It will vary from midwife to midwife, and it will also depend on where she practices (hospital, birth center, or homebirth). Her practices may depend on state laws or on the policies of the hospital or birth center where she works, if she's not independent.

Here's a photo essay of a typical prenatal appointment with my primary midwife of the last nearly-8 years, through 3 home waterbirths (thus far), 1 loss, and this upcoming birth. Angy (Angelita) Nixon, CNM has been my primary midwife through it all. Jennifer Stewart, CPM, was my assisting midwife at my other homebirths, and I love her to pieces, but she has a wonderful opportunity to move to California to attend homebirths. She'll be moving before I have my baby, so Dorothy Kaeck, CPM, will be the assisting midwife at my upcoming homebirth. Dorothy is wonderful too, and I'd have been happy to have had her at any of my prior births, but she has only been in WV for 2 years. Here is an overview of the personalized, one-on-one care I receive from my gentle, experienced midwives.

I arrived at my midwife's home/office for my prenatal appointment. What a view.

I got my kids settled in with the toys they brought and the toys that my midwife keeps in her living room for visiting children.

Unlike OB appointments that frequently require moms to wait with a full bladder in a waiting room for up to 30 minutes, I headed directly for the powder room, where I collected the sample, then tested it myself with the test strips my midwife leaves under her bathroom sink.
*Note* the Urine Collection Container in this photo is clean and empty. You're welcome.

This is my midwife's exam room. I didn't need it today.

My primary midwife, Angy, with her cup of coffee, just the way a prenatal should start.

My assisting midwife, Dorothy, making notes in my charts. I told her my weight from this morning when I weighed myself at home, then I told her that my urine sample was negative for both glucose and protein (which is good news on both accounts).  How freeing it is to have that kind of trust with one's care providers.

My kids think that my midwife's spiral staircase is the most fun part of the appointments. That, and smelling her candles to find their favorites.

Dorothy gets ready to prick my finger for the fasting blood sugar test.  She looks way too happy to be inflicting this... Just kidding. It wasn't bad. (At my previous appointment, she drew a vial of blood for the thorough 2 hour blood sugar test plus hemoglobin check and other blood screens. It all came back with healthy results.)

Explaining to my kids what Miss Dorothy is doing and why.

She checks my blood pressure.

My son tries to get her to smell his feet, while stealing her chair. Successfully. He's a charmer.

Having the fasting blood sugar test behind me, now it's time for breakfast. My midwife made me Starbucks coffee and put half & half and sugar in it and brought it to me. I had brought with me 3 pumpkin muffins I made, and I shared the 3rd one with my midwives.

Leopold's Maneuvers, which allow Dorothy to determine baby's position. He is head-down, Right Occiput Anterior.

My son is the blur on the left, always in motion, taking it all in.

Are your prenatals this fun/funny?

Dorothy gave me the option of listening to baby's heartbeat using fetoscope or Doppler. I prefer to use fetoscope when possible to limit unnecessary exposure to ultrasound waves. Dorothy was able to find his healthy heartbeat.

My son is fascinated. I wonder how this will shape his views of healthy and normal pregnancy and birth, for his own future wife and children?

My 5 year old knows more than most adults do about normal pregnancy and birth.

Dorothy let me try to hear baby's heartbeat with the fetoscope, but I couldn't hear it over my children's (quiet-ish) noise. I was content to take her word for it that she heard it and it sounded great. 

Dorothy measures from my pubic bone to my fundus. Baby is measuring 31.5 cm when I'm at 30 weeks, but that's within normal, and could just be a growth spurt or a due to his position.

I arrived at my midwife's home/office right at 9:30 for my checkup (9:30 checkup time). I had 0 waiting time. In between photos, we discussed how I'm feeling, whether I've experienced swelling (some but minimal), how frequently I've been noticing baby's movements and how/when to do kick counts, whether I've had Braxton Hicks contractions, whether I've had any troubling physical symptoms (I haven't), how to recognize symptoms of preterm labor, how and when to get rid of Braxton Hicks contractions, benefits of perineal massage and when to begin, benefits of Evening Primrose Oil and when to begin, what kind of birth control plans we have, what plans I'm making with my doula, scheduled my next appointment for 2 weeks from now, and chatted about what's new in the last 2 weeks since I saw them.

All inclusive, I was there 1 hour 15 minutes, with everything covered at a leisurely and relaxed pace. No wonder I so look forward to prenatals. It's just about the only time I have to devote to real focus on my pregnancy and baby, since life gets so busy with the everyday functions of running a house of 6.

I realize that there are a lot of variations in care among OBs and midwives. This is just *my* experience with *my* midwives. What have been your experiences? Have you changed care providers and experienced different practices?

Cord blood banking vs. delayed cord clamping

A reader wrote in, "Sarah, What can you tell me about cord blood donation, I have heard so many different things on the contribution and I just want correct information to make an informed decision. Thanks for any information you can share."


I'll put together a link roundup so that each family can decide what's best for their situation.


Before we look at cord blood donation or banking as an option, let's first consider the importance for baby to receive his/her own cord blood immediately after the birth. There are options for collecting cord blood for donating or banking that *are* compatible with delayed cord clamping. 


If you haven't yet seen Academic OB/GYN Dr. Fogelson's Grand Rounds on Delayed Cord Clamping, it's well worth the 50 minutes to watch. He touches upon volumes of data supporting the importance of delayed cord clamping, including the effects of premature cord clamping that is common in the US, namely baby losing approximately 40% of his or her blood volume and the oxygenation from that blood. Baby also receives that rich store of his or her own stem cells, which is sometimes called "Nature's first stem cell transplant."  


The World Health Organization supports delayed cord clamping as well. Specifically, WHO states, "The optimal time to clamp the umbilical cord for all infants regardless of gestational age or fetal weight is when the circulation in the cord has ceased, and the cord is flat and pulseless, approximately 3 minutes or more after birth." 


The World Health Organization continues with these reasons for the recommendations:

• "For the first minutes after birth, there is still circulation from the placenta to the infant, the majority of which occurs within 3 minutes, generally coinciding with the end of cord pulsations.
• "Clamping the umbilical cord immediately (within the first 10 to 15 seconds after delivery) prevents the newborn from receiving adequate blood volume and consequently sufficient iron stores. Immediate cord clamping has been shown to increase the incidence of iron deficiency and anemia during the first half of infancy, with lower birth weight infants and infants born to iron deficient mothers being at particular risk. Up to 50% of infants in developing countries become anemic by 1 year of life, a condition which can negatively and perhaps irreversibly affect mental and motor development. According to one longitudinal study, Costa Rican children with chronic iron deficiency in infancy had 10 to 25 point lower cognitive test scores at 19 years of age, when compared to similar children with adequate iron status. Waiting to clamp the umbilical cord allows a physiological transfer of placental blood to the infant which provides sufficient iron reserves for the first 6 to 8 months of life, preventing or delaying the development of iron deficiency until other interventions—such as the use of iron-fortified foods—can be implemented.
• "For premature and low birth weight infants, immediate cord clamping can also increase the risk of intraventricular hemorrhage, and late-onset sepsis. In addition, immediate cord clamping in these infants increases the need for blood transfusions for anemia and low blood pressure."

Australian midwife Rachel Reed's blog "The Placenta: essential resuscitation equipment" is well cited and helpful in understanding the crucial roles the placenta plays immediately after birth. She also explains how delayed cord clamping need not be at odds with neonatal resuscitation, should that become necessary. In many other countries, resuscitation equipment is on wheels and is brought close to the bed so that baby can continue to receive oxygenated blood while medical teams administer oxygen or other helps. 

Here's an article from the UK: "Trolley saves lives of newborn" with a description of a mobile bedside resuscitation unit that is currently used in 3 UK hospitals and may become standard in all UK hospitals. Here's a news clip that shows the Trolley and describes its use.

Here's an FAQ page on cord blood donation at marrow.org. Their page does not appear to address the need of each newborn to receive his or her own cord blood before considering donation for other purposes. It does state "No blood is taken from your baby, only from the cord and placenta after the baby is born," but this is only true if delayed cord clamping is done first. Otherwise, up to 40% of baby's entire blood volume IS taken from baby, only a small amount of which is donated for useful purposes, and the rest of which is disposed of as medical waste.


It's easy to find materials promoting the potential benefits of cord blood banking (many of which are industry advertisements for private banking). I don't currently have any bookmarked links on any solid independent research weighing the pros and cons of private cord blood banking. I do, however, have this article from an Irish newspaper titled "Stem cell storage can put lives 'at risk''. An excerpt: "‘‘In the vast majority of cases, the costs of storage are therefore not justified and the rationale being used by commercial companies recommending storage is misleading," said Sullivan. Sullivan said there was insufficient evidence to recommend its practice in Ireland except for a small number of at-risk families with rare blood diseases, malignancies or bone marrow failure... Collection of cells usually happens within minutes of a baby being delivered, ‘‘where there is a risk of post-partum haemorrhage and when both mother and baby require one to one care’’, Sullivan said.The harvesting of stem cells at this time led to added complications that might actually put the lives of mothers and babies at risk, he added."

For those who feel that cord blood banking or donation is right for them, Science and Sensibility posted an excellent article on the skill of some care providers to accommodate both delayed cord clamping AND cord blood collection after the birth of the placenta. This would mean that baby receives all of the blood that he or she needs, and that cord blood would be collected from the "excess" after the cord quits pulsating. It's not always possible as sometimes the cord blood has begun to coagulate by that time, but it's worth a try, if you would like to have the best of both worlds. Here it is for more info: "Journal of Perinatal Education 20.1 Feature Article: Umbilical Cord Blood: Information for Childbirth Educators."

See also my previous blog "Photo illustration: delayed cord clamping vs. immediate cord clamping"


As I collect more research on the subject, I'll add more links. I hope this helps as a springboard for more info.

UPDATE:

Nurturing Hearts Birth Services posted this fantastic series of time lapsed photos of an umbilical cord transitioning from full of blood immediately after birth, to thin, limp, and empty in fifteen minutes, after which time the cord was clamped and cut. If you are wondering how you will know whether the cord is ready to be cut, this is a great resource. Magic Umbilical Cords

Coping tips for "morning sickness"

My personal stash of nausea remedies. Top row, l-r: Old Ballycastle Ginger cocktail mixer; The Ginger People Ginger Beer; Vita Coco coconut water; lemon juice; Gatorade; Barritts Bermuda Stone Ginger Beer; Middle row, l-r: ginger Altoids; Reed's Ginger Candy Chews; The Ginger People Gin-Gins hard candy; Buderim Ginger Bears; The Ginger People Crystallized Ginger; Bottom row, l-r: Crystal Light Pure Fitness; True Lemon, True Orange, True Lime; Earth Mama Angel Baby Organic Morning Wellness Tea.

It's funny. I posted this link by the InfantRisk center on safe remedies for Nausea and Vomiting in Pregnancy (including safe OTC medicines) the day BEFORE I got my positive pregnancy test in April. Then it became relevant.

I really feel badly for mommas who have severe nausea and vomiting in pregnancy, which is the official term for "morning sickness," since the symptoms can occur any time of night or day (or even non-stop). For many moms, symptoms will ease up on their own by around the 14th week of pregnancy, but a few have various degrees of nausea and vomiting until delivery.

Unfortunately, not much research has been done on the causes of nausea and vomiting in pregnancy (beyond knowing that it's a side effect of hCG and other pregnancy hormones), nor in available treatments. It may be a matter of trial-and-error to find something that will help you cope, because what works for one momma has no effect for another. What worked with the last pregnancy might not bring relief with the next pregnancy for the same woman. Whatever gets you through is the "right answer."

Here's a list of options that have worked for some moms (some of whom contributed on my Well Rounded Birth Prep Facebook page). I hope you find something that works for you.

General diet:

• Healthy, well-balanced meals in general. 
• Avoiding consuming liquids and solids at the same time.
• Eating small meals more often (5 or more times per day) as opposed to larger meals 3 times per day. Some moms find relief eating small amounts almost hourly. Some issues with "morning sickness" are related to low blood sugar, and frequent small meals can help prevent this. A midnight snack can help if this is the case.
• Avoiding greasy or fatty foods.
• Reducing or eliminating refined sugar. Reducing dairy.
• B complex vitamin supplement.
• Keeping food by the bedside to nibble on before arising in the morning. Some moms swear that eating a cracker or half a cracker before arising was their salvation. Others find it doesn't make much difference.
• Eating a low-fat or fat-free protein with a complex carb at each snack and meal when possible, such as string cheese with whole wheat crackers, or peanut butter with apple slices.

Foods and drinks:

• Ginger in a variety of forms can alleviate morning sickness, heartburn, or reflux. Some options: Candied ginger, ginger gummy bears, ginger caplets or tablets for those who don't like the strong flavor, ginger Altoids, ginger hard candy, ginger chews.
• REAL ginger ale or ginger beer (non-alcoholic) (most ginger ale is artificially flavored). 
• Ginger tea, which you can purchase or make by steeping a slice of ginger root in hot water. One great brand of ginger tea is Earth Mama Angel Baby Organic Morning Wellness Tea with ginger root, spearmint leaf, chamomile, orange peel, lemon balm leaf, and peppermint leaf. 
• Ginger syrup non-alcoholic cocktail mixer with real ginger. Can be mixed with seltzer water, Sprite, tea, or drink of your choice.
• Crackers in many forms. Saltines, Wheat Thins, whatever works.
• Gentle foods that you would eat when recovering from a stomach bug. Dry toast. Unsweetened applesauce. Bananas. Rice or plain noodles. Plain yogurt (lightly sweetened with honey, jam, or berries). Toasted whole wheat bagels. Chicken noodle soup. Broth. The same things that make good labor snacks.
• Peppermints. Altoids. Mint hard candies or Tic Tacs. Mint gum.
• Hard candies such as Lemonheads or cinnamons. Suckers. Preggie Pops.
• Sour candies and foods. Sucking on a lemon. SweetTarts. Dill pickles and pickle juice. No joke. I've heard a few moms say they drank it straight up and it was the only thing that helped their morning sickness.
• Decaf tea, hot or cold, unsweetened or lightly sweetened with honey. With or without a squeeze of lemon.
• Lemon water (squeeze lemon wedge in water or use squirt of bottled lemon juice). True Lemon crystallized fruit wedge, also True Lime and True Orange. Eating powdered True Lemon straight out of the package may appeal to you if you find sour lemon soothing.
• Beans. There's no research to back this, but some nutritionists say that legumes are the answer to helping the body absorb and eliminate the excess bile caused by hCG, which will alleviate or completely eliminate morning sickness. If you think about it, pharmaceutical companies are unlikely to fund or promote any research that could show that simple nutrition could help with morning sickness. There's no risk to trying to eat more beans to see if that helps; they're inexpensive, nutritious, and loaded with fiber and protein, which will help you meet the 80-100 g of protein expectant moms need daily.
• Popsicles. You can make your own from juice, herbal tea, or fruit smoothies. Electrolyte drinks don't freeze well due to the salt content. Some moms find that popsicles, ice chips, or blended frozen drinks stay down more easily.
• Electrolyte drinks, especially if you are becoming dehydrated from vomiting or from avoiding drinking due to nausea. Some options: coconut water (*not* coconut milk), Ultima Replenisher, Vitalyte, Crystal Light Pure Fitness, Gatorade, or make your own. 

Aromatherapy:

• Identify and avoid smells that nauseate you.
• Avoid perfume, scented lotions, or fragranced soaps and shampoos if they bother you. Switch out your partner's and/or childrens' soaps or shampoos if they're bothering you. You can always switch them back after your nausea subsides.
• Keep fragrances around that are pleasant to you. Some moms find mint, ginger, citrus (lemon, orange, or grapefruit), or chamomile to be soothing fragrances during morning sickness. Options: scented candles, sprays (body spray, linen sprays, room sprays), or essential oils applied to a cotton ball then double bagged in zip-top bags so you don't have to smell them unless you want to. Earth Mama Angel Baby sells a wonderful multipurpose Happy Mama aromatherapy Spray that may help.
• If you have a toddler in diapers and it nauseates you to change poopy diapers, and if you can't find someone else to change him or her for you, it's OK to take them outside to change them so long as it's not subarctic temperatures out there. I've changed my poopy toddlers outside on a covered porch in too-hot or too-cold temps since I had everything ready and did it as quickly as possible. If I have to choose between that or smelling the aftereffects in my living room, I'm choosing the outside diaper changes.
• If you can't stand the smell of food cooking, using the crockpot and plugging it in in the garage or basement is an option. Excellent for when you don't feel like eating but have to prepare something for everyone else, for when you're too tired in the evenings, or when the smell of cooking bothers you. Also good for those who are queasy earlier in the day but feel like eating by dinnertime. Your partner might be able to help you prepare the crock pot the night before and load it, ready to go, in the fridge, so that all you have to do is plug it in in the morning.

Other options:

• Moderate exercise. Taking a walk. Getting fresh air.
• Air circulation. A fan with a breeze pointing on mom's face.
• A cool, damp washcloth applied to the face and/or neck.
• Chiropractic can help alleviate morning sickness, and is extremely beneficial throughout pregnancy for many reasons.
• Acupressure has been used for centuries to combat morning sickness. One simple way to try this is Sea-Bands which are sold in any pharmacy and are designed to prevent and treat motion sickness.
• Acupuncture by a licensed practitioner can sometimes help.
• Hazelwood necklaces. From Inspired by Finn: "Wood from the beaked hazel tree has the medicinal property of neutralizing the body's acidity, and helps the body create and maintain an alkaline balance. It is an ancient remedy first used by aboriginal people, and is effective for people of all ages... Beaked hazel wood can relieve acid-related ailments such as acid reflux, ulcers, heartburn, and other acid-related ailments. Our necklaces are a great remedy to take the edge off of heartburn and morning sickness during pregnancy."
• If excessive salivation is an issue, it's better to spit it out than to swallow it, as swallowing it can exacerbate nausea.
• Some moms find that homeopathics can help. Ask your care provider whether this is an appropriate option for you.
• Some moms find that Vitamin B12 injections can help alleviate their symptoms for up to a week, for severe cases of nausea and vomiting. Ask your care provider whether this is appropriate for you.
• Anecdotally, I hear moms say that when they are highly stressed and/or have a heavy schedule at work, their morning sickness is worse. Saying "reduce stress and work less" is easier said than done, but something to consider when looking at the big picture and possible options if morning sickness is severe.
• Some moms report that when they have to get out of bed quickly in the morning, it makes them feel worse. For some, setting the alarm clock a bit earlier and hitting the snooze while snacking on crackers helps them acclimate. For others, letting natural sunlight in the windows helps awaken them gradually and gently. In any case, slowly rolling over, then slowly lowering legs to the floor, then slowly sitting up, slowly getting up and slowly walking to the bathroom may be less jarring to the body than hopping up suddenly when the alarm goes off.

Coping in the meanwhile:

• Keep a few plastic bags tucked in your purse and in your car in case you can't get to a bathroom in time (or even pull over in time when driving).
• Scout out where the nearest bathroom is wherever you go. This will come in handy when you have to pee on the hour anyway, even if you don't throw up.
• Dehydration can lead to contractions and potentially preterm labor, so finding some way to keep some fluids down is crucial. Dehydration can also cause a urinary tract infection (which also causes contractions) and/or bladder infection which needs to be treated with antibiotics, which can lead to a yeast infection and gut flora imbalance. If dehydration is severe, your doctor or midwife may recommend an enema to help you absorb some fluids, or you may need to be rehydrated by IV. 
• Prescription medications are available for moms with hyperemesis gravidarum (severe nausea and vomiting in pregnancy). Ask your doctor what meds are available, what the risks are vs. the benefits, and whether this is could be a viable option for your situation. In some cases, prescription meds are the only way moms with hyperemesis gravidarum can manage to keep any amount of sustenance down.

More links:

Nausea and vomiting in pregnancy-- (safe non-medicinal tips as well as safe OTC and prescription meds)-- InfantRisk Center

Help HER - Hyperemesis Education & Research Why HG is more than just morning sickness

The importance of staying hydrated while pregnant--Associated Content from Yahoo!

Morning Sickness: Tips on how to combat it naturally & drug-free--Earth Mama Angel Baby 

Common treatments for Hyperemesis Gravidarum-- Mothering Magazine



What remedy or combination of treatments worked for you? Or did nothing seem to help? Was it different with different pregnancies?

Good labor snacks--and why moms need them

There's an old wives' tale that you shouldn't have anything to eat other than ice chips during labor (with the possible exception of clear liquids such as popsicles). The good news: research has shown for years that there are clear risks to withholding food and drink from laboring moms, and that they need calories and hydration to complete the hard work of labor and birth, with literally no benefits at all to withholding food or drink. This means you should be able to eat and drink anything you want! The bad news: most OBs believe the old wives' tale and aren't even aware of research contradicting it.

Chapter 4 of The Thinking Woman's Guide to a Better Birth, by Henci Goer, is called "IVs: 'Water, Water,  Everywhere, Nor Any Drop to Drink." She details the history behind current obstetrical traditions and superstitions regarding eating and drinking during labor, as well as the risks of withholding food and drink from a laboring woman, and risk/benefit comparisons. There are several pages of explanation of why routine IVs have serious risks of their own with no potential benefits; routine IVs do not replace eating and drinking in labor.

Synopsis of Ms. Goer's Bottom Line on Forbidding Food and Drink in Labor:

Pros: None

Cons: Hunger, thirst, discomfort, dehydration sometimes resulting in fever, exhaustion leading to fewer or less effective contractions (which is viewed "Failure to Progress" and is seen as a necessity to augment labor by means of Pitocin or other drugs and interventions), imbalance of electrolytes, drop-off in blood sugar levels producing ketones which can cross into fetal circulation causing fetal blood to become more acidic (acidosis) which is a symptom of fetal distress. Increased perception of pain when hungry and/or thirsty. Seizures can result if mom's electrolytes are out of whack and blood sugar is bottomed out.

What kinds of foods make good snacks during labor? Here's Ms. Goer's suggestion: "Fat delays digestion. Solids must be broken down into tiny bits to pass into the intestines. High concentrations of sugar and acid and either low or high concentrations of salt also slow digestion. Heavily sweetened drinks can also cause nausea and acid in the stomach, which, as we have seen, should be avoided. Icy liquids empty more slowly as well. Given these criteria, choose food and drink that you know you tolerate well, the kind you would consume if you were recovering from the stomach flu."

Eating and drinking small quantities more often is easier on the digestion than larger quantities less frequently.

That being said, it's your labor, and if you're craving something that's on the forbidden list (for example, greasy or rich foods) and don't care if it comes back up, have at it. While not all moms vomit during labor, vomiting can help with dilation.

Many mommas can manage to eat lightly in early labor but don't want to eat as labor progresses. Some moms aren't hungry in labor or are nauseated and food doesn't appeal to them. For a short labor, that's fine; listen to your body. For a long labor, momma will need sustenance from somewhere (if not from food and drink, then from IVs. See chapter 4 of The Thinking Woman's Guide to a Better Birth for full list of pros and cons to that option). Sometimes it's easier to drink little sips in between contractions even in active labor, transition, and pushing, than it is to eat.

I've compiled a list of popular labor snacks and drinks. Feel free to take what works for you and leave the rest behind, keeping in mind your particular dietary needs and preferences.

Labor drinks:

water (will meet your hydration needs but not needs for calories, blood sugar, electrolytes, and more). Bring plenty of bottled water for your birth partner and doula, as well as for yourself for dumping in electrolyte powdered drink mixes.

100% fruit juice (non-acidic). If packing for hospital or birth center, 100% fruit juice boxes are convenient.

electrolyte drinks. You can make your own safe electrolyte drinks if you don't want to ingest the artificial ingredients in Gatorade. Some moms have enjoyed Emergen-C powdered instant drinks for a labor pick-me-up, but as the previous linked article explains, there's a question whether Vitamin C overload (or possibly the imbalance of calcium and other minerals/vitamins in the presence of large volumes of Vit C) can contribute to hemorrhage. A sort-of-natural alternative to Gatorade is Crystal Lite's Pure Fitness powdered electrolyte drink, which contains no artificial colors, flavors, or preservatives, and is sweetened by Stevia.   While traditional artificial sweeteners such as aspartame, saccharin, acesulfame K, etc., are clearly not safe for pregnancy, Stevia may be a safe alternative. I'm not turning this blog into a discussion about Stevia; you can Google it if you're concerned. I've also heard good reviews about Vitalyte electrolyte drink, but I do not have personal experience with it.

coconut water, which contains many nutrients and also contains electrolytes and outperforms electrolyte sports drinks and plain water in research on rehydration.

decaffeinated tea, unsweetened or sweetened with honey

Red Raspberry Leaf tea, which also confers labor benefits (as well as 3rd trimester benefits). You can also blend RRL tea into Pregnancy Punch with apple juice, honey, and frozen red raspberries for a delicious and nutritious labor snack, or freeze it as popsicles.

skim milk

fruit smoothies made with non-acidic fruits (and any other ingredients from this list that sound good, such as honey, yogurt, skim milk, etc.) Here's Birth Faith's Birthing Brew for labor nutrition and possible prevention of hemorrhage (this statement has not been tested by the FDA for effectiveness of use, etc.).

protein shakes/drinks

Light carbs:

honey. Honey sticks, honey packets, honey bears, whatever is most convenient. Honey sticks are easiest for mom to suck on without changing her position.

soft, non-acidic fruits

100% applesauce. If packing for hospital or birth center, individual packs are handy. Here's an innovative form of applesauce packaging: you slurp it through a built-in straw. Handy so that mom doesn't have to change positions.

rice cakes (with jam, honey, applesauce, etc.)

plain bagels (with jam, honey, applesauce, etc.)

toast (with jam, honey, applesauce, etc.)

oatmeal

Cream of Wheat

graham crackers. saltine crackers, any other crackers

cooked pasta, plain or with a bit of salt or cheese

cooked rice. If packing for hospital or birth center, the ready-packs of rice that only need microwaved 90 seconds are a convenient option.

granola bars or trail mix

cereal with skim milk

pancakes or waffles. You can make your own healthy ones ahead of time and freeze them to reheat, or buy pre-made ones. They have healthy alternative ones in the organic frozen section now.

puddings, custards (nonfat or low fat)

Jell-o. Make your own or buy pre-made packs.

sorbet. Individual cups are always a good idea. Do you really want to be looking for an ice cream scoop during labor?

popsicles

lollipops, especially sour ones. They tend to be less nauseating than sweet ones.

Light proteins:

fat-free yogurt or Go-gurt (These taste great frozen, and they have new natural Go-gurts with no HFCS and no artificial colors, flavors or preservatives.)

cheese cubes or string cheese

peanut butter crackers

eggs

chicken noodle soup or broth

protein bars

Don't forget to have more substantial food to sustain your birth partner (husband or significant other), doula, and possibly your midwives (if homebirth). Crackers likely won't tide them over. Also, Mom will likely be ravenous after delivering and will want a hearty meal to reward her for her hard work.

If your hospital has a policy of "nothing but ice chips or clear liquids," it's best to discuss this well in advance with your care provider to see whether this is strictly enforced or whether most moms do in fact eat and drink freely while in labor at that facility. Find out early enough so that if this is going to be a problem, you have time to shop for another care provider or another birth location.  If you cannot or choose not to change birth location, you can pack a small lunchbox/cooler of foods and drinks for your birth partner who will certainly be very hungry and thirsty. If any staff asks about the food stash, you can truthfully tell them that your birth partner gets hungry and needs to eat to maintain blood sugar and supportive mood. Do you catch my drift? Good, because I would never tell you to lie to staff or care provider.

Now, go eat, drink, and be merry!

What did you eat and drink during labor? What did you wish you could have but didn't/couldn't? What was satisfying?