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Why I Ask Clients to See Their Regular Doctor

8/1/2023

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Can we talk? I think there's a myth that anything that comes up during pregnancy is because of being pregnant or should be handled by your maternity care provider. Pregnancy can bring some typical complaints and discomfort, but not everything that happens during pregnancy is because of being pregnant. Sometimes pregnant women can get sick and it has nothing to do with being pregnant.

My focus and expertise is on pregnancy, labor, birth and postpartum, so everything pregnancy and birth related. As a CPM in Kansas, I have to rely on holistic remedies to bring relief or resolve something. I cannot prescribe medications even if they are necessary to treat an illness that pops up during pregnancy.

If I have a client who has a urinary tract infection that is not resolving with herbal remedies, I will ask them to see their regular doctor. If a am working with a client who has extreme morning sickness that natural treatments aren't able to make manageable, I will encourage her to see a doctor. I have asked a client with heat exhaustion to see the doctor.  She needed IV fluids right away. I have had a client seek care with medical professionals who learned her symptoms were caused by food poisoning. Both these clients needed more help than I could provide. I do not take it lightly that I am asking someone to see a doctor.  If I am asking it is because I'm concerned that something is going on that needs more help than I can offer.

I am thankful that we have doctors, and can avail ourselves of their expertise when needed. I also appreciate when clients understand that we need more help and are willing to see their doctor. Not everything that happens during pregnancy is related to the pregnancy, and sometimes medical help is necessary.
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Baby's Movements

7/15/2023

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The wonder, and joy of feeling the first little flutters that you are sure is baby moving around is incomparable. It is amazing to have that intimate connection to your baby!

Just as we are all different, when baby movements can be felt will be different for each mother, and for each pregnancy.  Some Moms are so in tune with their body that they can feel the flutters around 14 weeks, and rarely, even earlier.  Other Moms may not notice the movements until 20 weeks or a little later, especially if the placenta is implanted on the front of the uterus. At first they feel like little flutters but as baby grows and gets stronger the flutters are replaced by kicks and punches. Once baby gets even bigger, those movements change to more rolling, nudging movements because there isn't room for baby to punch or kick as much.

Early in pregnancy, there may be days when you may not feel much movement from baby. This is normal.  As pregnancy progresses, baby's movements become more noticeable. Around 28 weeks gestation, babies have settled into a predictable movement pattern. I encourage clients to become familiar with this pattern.  

It is pretty common for baby to move more at night when you are laying down. As pregnancy progresses, it is my opinion that baby has more room when you are laying down compared to when you are standing or sitting so that is why they tend to be more active.  

Baby can be affected by how Mom is feeling. If Mom is dehydrated, or has a cold or other illness, baby's movements may be a little less or subdued. I have worked with mothers who just needed to eat, and then baby was ready to dance a jig. Sometimes Mom is up and busy and doesn't notice movements but when she slows down and focuses on baby, the movements are noticeable.
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Baby's movements can give insight into how baby is doing in utero, so it is important to pay attention to them. Changes in baby's movement pattern might mean something is happening that we need to check on, usually with an ultrasound. Significant changes in baby's movement pattern can indicate baby may need help to prevent a stillbirth, so get to know baby's movement pattern well. 
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Sleeping While Pregnant

1/15/2023

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Sleep. We all need it and most of us would benefit from better sleep or more sleep. During pregnancy, getting good sleep or enough sleep can be challenging.  

Pregnancy can create new issues with sleeping. Trying to get comfortable, having to get up to go to the bathroom, having vivid dreams, and not being able to fall asleep again if waking up are common issues that can interfere with sleep during pregnancy.

Getting comfortable can be a challenge, especially if you are used to sleeping on your back. Pillows can be your best friend in this situation. Putting a pillow under a hip just enough to tilt you off your back can help in early pregnancy.  As your baby grows, having a pillow tucked behind your back, one between your knees, and one to support your belly may help you with being comfortable. I am a huge fan of the pregnancy pillows that surround you, almost like a nest. As pregnancy progresses, you might need more pillows for more support, or you might want your partner to tuck you into bed, helping get the pillows just right to let you sleep in comfort and bliss.

Vivid dreams can be something else that interferes with sleep. These dreams can be weird, intense or scary.  It seems like the mind goes into overdrive as you sleep, and you just don't feel as rested as you would with more normal dreams. Catnip tea, or Valerian tea are options to help you quiet your mind and let you have more restful dreams. Have a cup shortly before you go to bed.

If you are waking up often, or having a hard time getting to sleep in the first place, it might be time to add a snack to your bedtime routine. Sometimes your blood sugar can drop low enough that your body just isn't happy and it will wake you up or keep you awake. I recommend a protein rich snack such as nuts, cheese, or jerky before bed. If you fall asleep easily enough but can't get to sleep after waking up to go to the bathroom in the middle of the night, try adding in a small protein rich snack while you are up.

In the last trimester, many mothers can sleep but it is often interrupted by having to go to the bathroom multiple times in the night. Baby might be low enough to use your bladder as a pillow which means there's just less capacity in there. My suggestion for this situation is to set a cut off time for hydrating and focus on getting all your hydration in before that cut off time. Usually 2 hours before bed is plenty of time. Just make sure to start hydrating again as soon as you wake up for the day.

Hopefully, these ideas will having you sleeping through your pregnancy like a baby!  

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What's the Deal With Gestational Diabetes?

10/15/2022

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What is it?
Gestational diabetes is the label given to diabetes that is diagnosed during pregnancy. For some mothers, gestational diabetes may be diabetes or prediabetes that was undiagnosed before pregnancy. Sometimes, diabetes may resolve after pregnancy only to appear in subsequent pregnancies. A diagnosis of diabetes during pregnancy increases the risk of having diabetes after pregnancy. ACOG recommends every woman get tested for diabetes at around 24- 28 weeks gestation.

How is it diagnosed?
Symptoms of gestational diabetes may be increased thirst, increased urinary output, fatigue, or recurring yeast infections (most women have no symptoms). Also, if there are any predisposing factors such as PCOS, multiple unexplained miscarriages, or a family history of diabetes, we might want to consider testing.  I like to check HbA1c which measures average blood sugar for the past 90 days during the first trimester (after the first trimester, the results aren’t as reliable). If the HbAic results are elevated, or in the high end of the normal range, we may discuss testing for diabetes. Typically gestational diabetes is diagnosed by having the mother drink a hyper-sweetened beverage and then have a blood sugar check in one hour to see how well your body processed the sugar. If sugar levels are too high with that test, then a second test using an even sweeter beverage and checking blood sugar over 2-3 hours is done. There are other testing options I prefer to use if we decide there is a reason or if a client wants to check for gestational diabetes. I like to start with checking fasting blood sugar, so you would stop eating at least 8 hours before your test. If your blood sugar is outside of normal range, we may want to run a two-hour postprandial blood test. For this test, you would fast for eight hours or overnight, have your fasting blood sugar checked and then go eat a high carbohydrate meal and have your blood drawn two hours after you started eating your meal. These two blood glucose numbers will tell us if your body is handling sugar in an appropriate manner.

What are the risks of gestational diabetes?
Your baby will have an elevated blood sugar, so baby’s pancreas reacts by overproducing insulin, leading to an increase in growth so you may birth a very large baby. Baby’s increased insulin production can interrupt production of surfactant in the lungs which can lead to respiratory distress. The newborn may have severe problems with hypoglycemia (low blood sugar) or hypocalcemia (low calcium levels) after birth. The risks to the mother includeincreased risk of high blood pressure, higher risk of developing preeclampsia, higher risk of polyhydramnios, and a high risk of postpartum hemorrhage.

What is the treatment if I have it?
Treatment for diabetes in pregnancy depends on how severe it is. A diet that is high in protein and complex carbohydrates and low in simple sugars is the first thing to adopt to manage blood sugar. Regular exercise is also key to managing blood sugar levels. The goal of all treatments is to hold blood sugar steady at a safe level. For some women, insulin therapy may be needed to manage blood sugar in addition to diet and exercise.

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    Author

    Gail Webster, CPM

    Gail is a Certified Professional Midwife serving Manhattan, Junction City, Fort Riley and other areas in Kansas.  


    When Gail is not occupied with birth work, she enjoys reading, quilting, baking, riding her motorcycle and spending time with family.
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