Tip Tuesday: Learning How to Relax

Relaxation is actually something that many people must learn. There are several ways to learn how to relax: meditation, guided imagery, even dance and moment classes can all teach relaxation. Relaxation is about learning how to control your mind and body. Some relaxations exercises involve tensing and relaxing of each muscle group in a coordinated series. Some ways to relax include breathing or rhythmic movements. Others can even involve hypnosis.  Practice relaxing so that you are very comfortable with your ability to relax yourself.  If you find it difficult, consider taking a yoga class, talking to a health care providers, or reading material on relaxation to get some technique tips.

Which IUD should I choose?

I receive many questions about IUDs (intrauterine devices) and because of older versions of these devices were harmful, their current offsprings have gotten a bad rap. In fact, IUDs are
extremely effecitve and patients who use them are very satisfied.  We only have about 6% of women in the United States who use birth control using IUDs. Part of this is becasue are mothers are remembering IUDs from the 60's and how they decreased fertility and increase the risk of uterine infection. We also still think that they are not for women who have never been pregnant, when in fact, they are a great idea for these women.  Currently, there are three types of IUDs on the market: Click on each for a link to their site.

• Skyla
• Mirena
• Paragard

Hormonal
Skyla are Mirena are progesterone containing IUDs and are made of plastic. The Paragard is a non-hormonal containing IUD made of copper. The Skyla and Mirena work by thickening the cervical mucus and blocking sperm from entering the uterus. They also work to inhibit ovulation and implanation.  

Non-Hormonal
The Paragard IUD works by preventing fertilization.  When there is a foreign body in the uterus, it causes an inflammatory reaction which disruptions fertilization, implanation and is hostle to sperm.

For more information, click of each link to see the prescribers information and talk to your healthcare provider.

10 Childbirth Facts - From Babble

I love this:
What women should know about giving birth

Click Here to see Babble's 10 Childbirth Facts 

1) It's not like how it is in the movies

2) Labor goes through very distinct phases with different challenges

3) It's not a due date, it's a due month.

4) An epidural is just one of many ways to cope with labor

5) The philosophy of your care-provider matters. A lot.

6) Your doctor will not be with you for most of your labor. You midwife, may.

7) Induced labors are twice as likely to end in C-Section

8) Staying Home in Early Labor Can Reduce the Chances of a C-section

9) Birth is a normal physiological event.

10) A good birth experience is not about how you do it       

Internet Information Overload

Nowadays, we are on internet information overload. For almost anything and everything we think up, we can find some internet article, website, group or post to back our claim.  We then discuss, distribute, and disseminate.  This can sometimes lead to having medical information backed by views or popularity as opposed to clinical evidence.  It can lead to a bit of confusion.  Is Sushi bad? What about induction if I've had a VBAC?  Should I take progesterone? and on an on.  This is why I strongly advocate women talking with a provider they trust about their questions or concerns.  As a provider myself, I strive to be an expert provider that has a moderation between experience combined with evidence-based practice and offer this continually to my patients.  The benefit of an provider who is experienced but also up-to-date on the latest research is invaluable.

The field of Obstetrics changes every month as new research is tested and trialed. There are new treatments, new recommendations, and new safe practices.  Because a lot in the field of obstetrics stays the same over time (giving birth has been around for a while!), even some providers can get complacent when it comes to reading research and changing their practices and conceptions.  It's common for even some long practicing providers to practice out-of-date care, so its not surprising that internet information can also be a bit behind the times. 

While the internet can be a great source of information, it can also be a scary and frightening place for an already vulnerable pregnant couple. I strongly advocate talking with your provider about the latest research regarding a question or concern that you have.  Most providers who read research regularly are happy to "get geeky" and talk shop for a while in terms that are easily understandable, even if they are in a rush.  So go for it and don't be afraid to ask about what the research says.

Obama Care

The Affordable Healthcare Act
It's hard to completely understand how this change will impact us each specifically. The Obama campagin has a tool on their website where you can put in specific factors about the health care you have now and it will generate a read out of how your care will change.  Linked here

The Pros include: (taken from Slate, the Wall Street Journal and Barack Obama and Mitt Romney's campaign websites)

• An increase in benefits for the uninsured
• Senior citizes will gain acess to billions of dollars in prescription benefits
• Everyone withinsurance will get free preventive serices
• It will increase coverage for those with a pre-existing condition
• Working families are protected from losing their health care or being forced into bankruptcy when a family member gets sick or is in an accident
• adult children can stay on their parent's health plan until the age of 26
• Mammograms, pap smears and immunixations will be covered without a co-pay including breastfeeding support, contraception, HPV testing, and domestic volence screenings
• Insurance companies are now required to justify rate hikes, and consumers have the ability to appeal to an independent third party when insurance companies refuse to cover services or care
• Starting in 2014, all Americans will have access to affordable health insurance no matter their circumstances—whether they change jobs, lose their job, decide to start a business, or retire early
• For patients, there will be fewer cash payments and lower fees.
• States can opt out of the act
• The law is expected to reduce the deficit by $127 billion from 2012 to 2021.

The Cons

• The act forces an insurer to sell a policy to someone who is already sick, which severely limits the insurer's right to charge that person a higher premium
• The bill, itself more than 2,400 pages long, relies on a dense web of regulations, fees, subsidies, excise taxes, exchanges, and rule-setting boards to give the federal government extraordinary control over every corner of the health care system
• States can opt out of certain sections of the act
• It you don't purchase health insurance you are responsible for a tax
• Flexible Spending Accounts will shrink to a maximum of $2,500
• You will only be able to deduct a medical expense from your taxes if it exceeds 10% of your gross income
• The costs are unknown

The unknowns:

• It is not known exactly how much this act will cost.  Speculation on both sides report a drastic increase in governement spending while democrats boast a reduction in spending and the overal deficit.  It remains unknown.
• The effect of “comparative effectiveness” practice guidelines on individual practioners. This is a part of the act that is aimed at improving quality while reducing costs. Republicans argue that it will be a way to manipulate provider freedom. This is explained in more detail in this NYT article. Click here

The Birth Plan

It's true, there is a common belief among labor & delivery nurses and obstetricians that birth plans lead to the BIG ROOM, aka the operating room. While this stereotype is entirely unfair (as many stereotypes are), in their defense, I think it may be that a few women who "birth plan" sort of ruined it for the rest, by zealously typing up binders full of planning and structuring for their exact, idyllic birth.

The birth plan, theoretically makes sense. Planning in any situation usually makes that situation less stressful and more enjoyable. That's the funny thing about the birth plan - you can't! And birth often is more than idyllic without adhering to a plan.

The best way to "birth plan."

1) Prepare. Prepare for the unexpected. Labor will most likely begin at an unexpected moment. Pack ahead of time and have plans for different scenarios with work, transportation, and childcare (if needed). Tour the facility where you plan to give birth.
2) Communicate. Talk to your partner and your provider about what your preferences are for the birth. Ask your provider about what you expect and any protocols at the facility where you will give birth. A lot of your preferences may be what your provider already practices like skin to skin and not performing episotomies.
3) Trust. Trust your body and your ability to birth. Trust your provider to have your interests at heart. Trust your provider to take your preferences and make them happen whenever possible.
4) Be flexible. Plan to go with the flow
5) Relax and enjoy. As much as possible, try to relax and enjoy the birthing process.

Filling out a birth plan or a list of preferences can be a good way to go over your preferences with your provider.  In the birth setting, it can prevent you from having to constantly repeat yourself.   Keep it brief and relevant.

Midwives as a Status Symbol

New York Times Article Click Here

Midwives as a Status Symbol

Are we really the next pooch in a prada or a Buggaboo stroller?

The NewYork consumer has changed, but so have we; and, so has New York herself.  Nowadays, most of us have higher education degrees and are delivering in the hospital as well as the home. It wasn't until 1992 that we were legally prescribing medication in New York and 2010 that we were able to legally practice independently.  New York trusts us, while we have the outcomes and education to support why she should.  In addition, we happily provide care for the "hippy-dippy spiritual birth," but we also provide what many women want: simple and supported, natural hospital birth.

New York Times Magazine: Ina May Gaskin

Thank you Ina May!

Mommy Wars: The Prequel
Ina May Gaskin and the Battle for at-Home Births

New York Times Article. Click here