Our Bodies, Ourselves: Pregnancy and Birth

Table of Contents

Preface
Introduction

THE JOURNEY TO PARENTHOOD

1: Approaching Birth with Confidence
Climate of Confidence, Climate of Doubt – Questioning High-Tech Birth – Planning a Better Birth

2: Choosing Your Health Care Provider and Birth Setting
Introduction - Models of Maternity Care – Health Care Providers – Midwives – Certified Nurse-Midwives and Certified Midwives – Direct-Entry Midwives – Physicians – Family Physicians – Obstetrician-Gynecologists – Maternal-Fetal Medicine Physicians – Finding a Provider – Birth Settings – Hospital – Birth Center – Free-Standing Birth Centers – Birth Centers in Hospitals – Home – Thoughtful Choices

3: Preparing for Childbirth
Your Birth Team – Why Continuous Support? – Family and Friends – Doulas – Challenges in Finding Support – Childbirth Classes – Hospital-Based Classes – Lamaze
Bradley Method – Birthing from Within – Hypnobirthing – Mindfulness-Based – Birth Works – Certifying Organizations (ICEA, ALACE, CAPPA) – VBAC – Birth Plans – Planning for Pain Management – Strategies for Pain Relief – Physical Preparation – Pelvic Floor Exercises – Perineal Massage – Logistical Preparation – Home Birth – Hospital or Birth Center – Extra Help at Home – Cord-Blood Banking – Elective Cesarean – Valuing Preparation

YOUR PREGNANCY

4: Your Developing Pregnancy and Prenatal Care
Your Due Date – First Trimester – What’s Happening in Your Body – To Tell or Not to Tell – Prenatal Visits – Your First Prenatal Visit – Tests During Pregnancy – Second Trimester – What’s Happening in Your Body – Your Prenatal Visits – Third Trimester – What’s Happening in Your Body – The Last Few Weeks of Pregnancy – Your Prenatal Visits

5: Taking Care of Yourself
Eating Well – Guidelines for Healthy Eating – Special Nutritional Needs During Pregnancy – Folate/Folic Acid – Iron – Calcium and Vitamin D – Protein – Essential Fatty Acids – Prenatal Vitamins – Weight Gain – Foods to Watch Out For – Shark, Swordfish, King Mackerel, and Tilefish – Soft Cheeses and Unpasteurized Milk – Certain Meats – Alcohol – Special Issues in Pregnancy – Coping With Nausea – Coping With Constipation – Cravings – Taking Care of Your Mouth – Staying Active – Benefits of Exercise – Being Active – Squatting – Guidelines for Exercise – Dealing with Discomforts of Pregnancy – Back Pain and Body Aches – Posture and Carpal Tunnel Syndrome – Swollen, Crampy Legs – Fatigue – Protecting Yourself and Your Baby – Violence and Abuse – Alcohol – Tobacco – Caffeine – Illegal Drugs – Legal Drugs Used Inappropriately – Medicines and Herbal Treatments – Medicines – Herbs – Other Toxins Keeping it All in Perspective

6: Relationships, Sex, and Emotional Support
Changing Identity – Changing Relationships – Friends and Family – Your Partner’s Feelings – Sexuality – Changes During Pregnancy – Precautions – Sustaining Your Emotional Well-Being – Getting Support – Problem Solving – Stress Management – Depression During Pregnancy – Sexual Abuse and Domestic Violence – The Effects of Sexual Abuse – How to Respond to these Concerns During Childbearing – Violence – Finding Support

7: Prenatal Testing
Questions to Consider about Testing – Life with Disability – What Tests Can’t Tell You – Discrimination, Advocacy, and Community – Family Life – Types of Tests – Genetic-Carrier Screening – Screening Tests – Diagnostic Tests – Choosing Testing – Counseling – Pre-testing Counseling – Genetic Counselors – Paying for Prenatal Testing – Responding to Test Results – Next Steps – Continuing the Pregnancy – Abortion – The Decision is Yours

8: Special Concerns During Pregnancy
Pregnancy When You Are Younger or Older – Pregnancy in Your Teens – Pregnancy in Your Late Thirties or Early Forties – Twins and Beyond – Reduction of Multiples – Bleeding – Bleeding in the First Trimester – Bleeding in the Second and Third Trimesters – When Labor Comes Too Soon – Preterm Labor – Preterm Premature Rupture of Membranes (PPROM) – “Incompetent Cervix” / “Cervical Insufficiency” - The Rh-Negative Mother – Diabetes in Pregnancy – Managing Gestational Diabetes – The Emotional Impact of Gestational Diabetes – Pre-Existing Diabetes – Pre-Eclampsia/Hypertension – Infections During Pregnancy – HIV/AIDS – Hepatitis – Herpes – Other Infections – Breech Baby – The Long Pregnancy – Induction of Labor – Conclusion

9: Childbearing Loss
Causes of Childbearing Loss – Miscarriage – Ectopic Pregnancy – Molar Pregnancy – Multiple Gestation Pregnancy – Loss After Prenatal Diagnosis – Stillbirth – Infant Death – Coping With Loss – Subsequent Pregnancy

10: Labor and Birth
Signs of Approaching Labor (Pre-Labor) – What Causes Labor and When Labor Begins – Labor Begins (Stage 1, Latent Phase) – Labor Progresses (Stage 1, Active Phase) –Fetal Monitoring – Intermittent Monitoring – Continuous Monitoring – Intermittent Versus Continuous Monitoring – Intravenous Infusion of Saline or Fluids (IV) – Positions for Labor – The Shift to Pushing (Stage 1, Transition Phase) – Pushing (Stage 2) – Episiotomy – Birth Complications – Giving Birth – Your Baby is Born – Cutting the Cord – Delivery of the Placenta (Stage 3) – Meeting Your Baby

11: Coping with Pain
Planning Ahead – Thinking about Pain – Pain Versus Suffering – Preparing to Meet the Challenges of Labor and Birth – Nondrug Strategies to Ease Labor – Movements, Positions, and Rhythms – Movement – Positions – Rhythms – Techniques of Breath and Focus – Breathing – Hypnosis – Visualization – Stillness – Techniques that Use the Senses – Touch – Counterpressure – Heat and Cold – The Comfort of Water – Focal Points – Music – Using Your Voice – Aromatherapy – Techniques that Require Special Skills – Acupuncture and Acupressure – Sterile Water Injections – TENS Units – Medications for Pain Relief – Systemic Medicine – Advantages and Disadvantages of Systemic Medicines – Regional Medicine – Epidurals and Spinals – Advantages and Disadvantages of Regional Medicines – Paracervical Block – Pudendal Block – Conclusion

12: Special Concerns During Labor and Birth
Prolonged or Stalled Labor – “Back Labor” / “Posterior” Baby – Variations in Fetal Heartbeat – Hemorrhage – Retained Placenta – Postpartum Hemorrhage – Infection – Lacerations (Tearing) – Meconium-Stained Amniotic Fluid – Premature Birth – Preterm Labor in the Second Trimester – Previously Unrecognized Pre-eclampsia – Uncommon Problems During Labor and Birth – Shoulder Dystocia – Breech Presentation – Placental Abruption – Problems with Implantation of the Placenta – Conclusion

13: Cesarean Births
Reasons for Recommending a Cesarean – Before Labor Begins – Prior Cesarean Section or Other Uterine Surgery – Abnormal Location of the Placenta – Early Separation of the Placenta – Multiple Babies – Breech Position of Baby – Pre-eclampsia –Maternal Infection – Large Baby – Other Reasons to Plan a Cesarean – During Labor – Lack of Progress in Labor – Changes in Fetal Heart Rate – Prolapsed Umbilical Cord – How Cesarean Birth Works –Recovery – VBAC or Repeat Cesarean Section? – After a Cesarean Section

BECOMING A MOTHER

14: Your Physical Recovery and Your Newborn
Your Physical Recovery – Soreness – Lochia – Cramping – Perineal Pain – Spinal Headache – Pain After Cesarean Section – Constipation – Abdominal and Pelvic Floor Weakness – Fatigue – Temperature Instability – Mood Changes – Sore Breasts – Your New Baby – Early Signs of Health – The Initial Alert Period – Dressing – Sleeping – Tests and Treatments for Your Newborn – Eye Antibiotics – Vitamin K – Newborn Screen – Hepatitis B Vaccine – Hearing Test – Jaundice – Cord Care – Circumcision – Are You Ready to Go Home?

15: Feeding Your Baby
Deciding to Breast-Feed – How Birth Practices Affect Breast-Feeding – Planning Ahead – Establishing Breast-Feeding – Latching On – Problems with Latching – Feeding Twins – Early Breast-Feeding Patterns – Uterine Cramps and Oxytocin – Feeding Yourself While Feeding Your Baby – Challenges to Breast-Feeding – Sore Nipples – Engorgement – Mastitis (Breast Inflammation) – Low Milk Supply – Breast Surgery – Breast-Feeding as Birth Control – Breast-Feeding in Public – Expressing and Storing Milk – Breast-Feeding and Work – Formula Feeding – Choosing a Formula – Powder, Concentrate, or Ready-to-Feed? – Avoiding Excess Fluoride – How Much and How Often? – Formula Marketing – Bottle-Feeding Breast Milk or Formula – Choosing the Right Bottle – How to Bottle-Feed – Conclusion

16: Life as a New Mother
Early Adjustment – Getting Support – Ways to Get Support – Family and Friends – Parenting Support Groups – Social Service Organizations – Paid Caregivers – Postpartum Mood Disorders – Baby Blues or Postpartum Depression? – Other Postpartum Mood Disorders – Who is at Risk? – Getting Help – Treatment – Therapy –Medications –Sexuality – Relationship Issues – Physical Considerations – Vaginal Discomfort – Abdominal Pain – Changes in Our Breasts – Birth Control – Barrier Methods – Condoms – Diaphragms – Cervical Shields and Vaginal Sponge – Intrauterine Device (IUD) – Combined Estrogen + Progestin (The Pill, Patch, and Ring) – Progestin-Only Methods (Mini-Pills, Injectables, Implant) – Emergency Contraception (EC) – Fertility Awareness Method (FAM) – Sterilization – Being a Mother Today – “Mommy Wars” and “Opting Out”

KNOWLEDGE IS POWER

17: Advocating for Better Maternity Care
Maternity Care Today – Why is Maternity Care Like This? – Obstetrical Training and the Medical System – Economic Incentives – Fear of Lawsuits – A Rushed, Risk-Averse Society – The Language of “Choice” – Assisted Reproductive Technologies and Older Mothers – Advocating for Change – Racial and Economic Disparities – Better Health Care for Mothers and Babies

18: Advocating for Mothers and Families
Putting Mothers and Children Last – Mothers in the Workplace – We Can Do Better! – What You Can Do

Resources
Authorship and Acknowledgments
About the Contributors
Disclosures
Index