Breast Feeding FAQ’s

Breast feeding is always a hot point of discussion for the moms in our Facebook community. Whether it’s your first baby, or your fourth little one, just as the experience of pregnancy is never the same, neither is the experience of breast feeding. While one child may take to it instantly, the next might just not be interested. And while one experience might be smooth sailing, the next might be painful. We’ve talked to some moms over the years about all of these things, including issues with milk coming in, C-sections, and pain.

Why am I Having a Tough Time?

This is one of the most common questions that we get when a mother begins breast feeding for the first time. Everyone experiences breast feeding differently, and while many moms will tell you that it was smooth sailing, there are quite a few who struggle with it during the first week or so. This is completely normal and nothing to worry about.

If you do find that you’re struggling with breast feeding, but you have your mind set on sticking to it, take advantage of the experts around you. The nurses, OBGYN’s, and the lactation consultants are there for you, to answer all of your questions and make sure you have everything that you need before you head home. Our AOA providers will do everything that we can to make sure you are prepared and confident in everything that you do, including breast feeding, before you head home.

Patience, a positive outlook, and a little bit of resilience is sometimes needed to find a comfortable schedule for both you and your new baby and breast feeding. Don’t worry, you two will get it figured out.

When Does the Milk Come In?

In the first few days after your baby is born you will produce colostrum. Colostrum is also called ‘pre-milk’ because it contains essential properties that protect babies from their new world. Colostrum contains antibacterial and immune-system-boosting substances that are important for your new baby. If you have decided not to breast feed, your new baby can be supplemented with many essential nutrients as well through formula.

After a few days of producing colostrums, your amazing body will automatically began to create the milk that your baby will need until they’re done breast feeding. Many moms find the experience of the milk coming in rather uncomfortable, as the transition can last up to 10 days.

Relieving Pain During Breast Feeding

During the transition phase when your milk is coming in, it can help to massage the breast to help release the milk. Many mothers also use cold packs specially created for this area of the body. Simply breast feeding your newborn can be painful on the nipple, so come talk to us about what creams and/or ointments that you can use to ease this pain. If you’re not sure whether or not your little one is latched on correctly, let us know and we’ll discuss proper breast feeding techniques. If your baby is not latched on correctly it can cause some pain.

Breast feeding is a wonderful thing, and though it might not be for everyone, we are here for any question that you might have regarding both breast feeding and formula feeding.

Testing for Birth Defects – Part II

Second Trimester Continued…

This is also the stage of pregnancy at which an amniocentesis may be offered  if necessary. It cannot be performed until a woman is at least 16 weeks along and is only  offered to those that are at high risk for birth defects. The cells collected are analyzed and doctors can provide a diagnosis of possible defects. Women are offered the option of this test depending on their risk of a genetic/chromosomal problem as per the results of the first and second trimester tests.

This is also the time for an ultrasound which can also pick up some defects.   Most women will choose this test as it is a great chance to see their child and assess the sex of the baby if desired!

 Third Trimester

In the third trimester of pregnancy, mothers-to-be may receive a glucose tolerance test, to show if they have gestational diabetes. This test is more for the health of the moms, and can lead your physician to provide many healthy options to maintain a perfectly healthy pregnancy.

Group B Streptococcus is another third trimester test that may be performed. While it does occur in 10 to 30 percent of all pregnant women, it is generally harmless. You physician will only need to give you a few extra pointers when it comes to labor and delivery, but in most cases it is not life threatening for you or the baby.

General

The process of testing for birth defects in moms-to-be can be scary and unnerving, but there is no path to the reassurance the tests provide without some anxiety. It is  useful to know what to prepare for when the time to give birth draws nearer in cases with defects. Conversations with a pediatrician and mental preparation is key to solid medical care decisions that can make a difference in the life of a newborn baby facing uphill medical challenges.

At AOA, we are here with you every step of the way, from the first test to the last, and everything in between. While many of these tests are routine, it can still be a stressful time for moms and dads, so take care in knowing that our highly trained physicians have the experience and compassion to get everyone through it together.

Testing For Birth Defects – Part I

Pregnancy can be quite the scary venture; however the payoff of a beautiful baby at the end is well worth the journey. During pregnancy, there may be times you will be offered  certain tests to check the welfare of your baby. From the outset there are a number of tests that can be run to give you an idea of how the pregnancy is progressing, and of any possible deficiencies your baby might be at risk for.  These tests are performed at various stages in the pregnancy, in most cases are completely normal, and are used to assess the baby’s risk of specific defects.

 

Early indications of certain defects during pregnancy is many times nothing to fret about. Your AOA physician is extremely skilled in reading the results from these tests, and while it might be a scary proposition to run the tests and hear the outcomes, the choice is yours whether you want to conduct the tests to get the reassurance associated with a normal result.

First Trimester

During the first trimester, an ultrasound may be performed to test for fetal nuchal translucency, which tells you if there is fluid around certain areas of the baby. A maternal serum test may also be performed to check for chromosomal abnormalities as well as human chorionic gonadotropin, which is another hormone test that will give the same information in terms of issues with the child’s chromosomes. These first trimester tests are used to look for Down syndrome, and other chromosomal conditions.

Second Trimester

In the second trimester, the alpha-fetoprotein screening is offered. Abnormal levels of the protein may indicate the presence of Down syndrome, spina bifida, the presence of twins, or an inaccurate due date. While these tests might be stress inducing for new moms, they are a great resource to prepare yourself by assessing your risk of some defect.

Jump to Part II

Pregnancy and Emotional Health

Pregnancy brings with it a range of emotions, from elation to apprehension about taking care of a new little life. Your emotional state may also be all over the place because your hormones are almost in a constant state of fluctuation, as your body is taken over by the baby.  Your Arizona OBYN Affiliates provider is available for medical needs but also for emotional support to help you make this a great experience in your life.

 

Yes, it’s a stressful time, but it is the greatest moments of your life, and we are here to guide you through it. Staying positive and removing stress from your life as much as possible is just one aspect of a happy pregnancy. When you come in to meet with your physician, emotional health, your thoughts, fears and questions are always something we openly discuss. In fact, it’s part of the pregnancy process that we encourage; communication on all levels with your physician.

 

Depending on the level of lifestyle changes you are going to be making during your pregnancy, you will find that the more you are able to relax, kick your feet up, and remove stress, the happier your pregnancy will be.  (Yes, feel free to use this reason for not cooking dinner, having your partner do the dishes, and even getting a nice massage every once in a while).

 

Communicate with your family and friends about reducing your stress, spending more time doing fun things. Try to do something every day, at least one thing, to take care of your own emotional health. Whether that is some breathing techniques, yoga, meditation, or simply kicking your feet up, do something for you and let your partner know that it’s your time.

Avoid drama when possible. If your friends are high drama, perhaps consider scaling back the time you spend with them. Talk to your physician about ways to enhance your overall state of emotional health during these next 9 months. If you spend time focusing on ways to make yourself feel more calm and relaxed, you will be a better place mentally to sail through your pregnancy and all its related physical changes and experiences.

 

If you feel down, anxious, scared or have questions about your emotional health, which is completely normal, talk to us. We are here not just for medical purposes, but for the emotional ones that inevitably come along with pregnancy. It’s all normal and quite common, but it can feel overwhelming when pregnant, so talk to us ahead of time so that we can address anything that may sneak up.

Postpartum Depression

Postpartum depression occurs in women that have just had children and can often be debilitating and completely confusing for a new mother to understand. It happens as the body’s hormones adjust back to regular levels and often is characterized by signs and symptoms similar to traditional depression. The mother may lose interest in everything around her, including her new baby. It can be challenging for a women to overcome, however, with help from your Arizona OBGYN Affiliates provider, there are ways to treat this form of depression.

 

Signs of postpartum depression include feelings of sadness or hopelessness that don’t go away after a few days; lack of appetite; an inability to sleep; among other signs. New mothers may feel discontent or resentment towards their new baby and have a lack of understanding for why they feel that way. This is very common for first time mothers, although postpartum depression can affect a woman every time she has a child. In severe cases, women may need to take antidepressants or other medications to stave off the depression, particularly if it gets too bad. An Arizona OBGYN Affiliates provider may prescribe medication to help with the shifts in mood, though if it gets severe he may also prescribe counseling and more extensive treatment since postpartum depression can often manifest into full blown depression that lingers longer after having a baby.

 

The more important component of dealing with this type of depression is to take it seriously. Severe cases can cause mental instability when it is not treated. Talking to an Arizona OBGYN Affiliates provider and recognizing the symptoms as they occur is key to catching postpartum depression before it gets to the point where it is affect your life. There are also support groups available in most areas, which can be a part of an overall treatment plan, where women come together to talk through coping mechanisms for postpartum depression. Sharing tips on how to overcome it can be very helpful since the experience is different for everyone.

 

Postpartum depression can rob you of your experience and time with your new baby, so getting help early keeps it from becoming more severe than necessary. Talk with your Arizona OBGYN Affiliates provider the minute you start to feel down or hopeless and notice that it is not passing. SHe or he may be able to make recommendations that ensure you get your life back and start to feel more balanced so you can enjoy your precious little one.

Labor and Birthing Myths

Oftentimes, what you don’t know is what scares you the most, especially when it comes to pregnancy and labor. You’ve heard all of the horror stories; the labor that lasted three days, the tearing, the recovery. It always seems like when you tell family and friends that you are pregnant, sure they are excited and congratulate you, but then inevitably comes the horror stories. Let’s take a look at those horror stories, those fears of the unknown, and lay it out there. The reality might not be as scary as others make it out to be.

Labor Horror Stories vs Reality

Why is it that whenever you talk about labor, everyone and their mom feels the need to tell you the worst parts about it? And, since you’ve never gone through it before, it’s easy to get sucked into that fear of the unknown.

Myth #1 – Complications that aren’t really complications are always an issue. What I mean by that is often times people will find something wrong with the situation and claim that it will lead to complications. For example, if you’re over 35 and considered AMA (advanced maternal age) there will be complications. This simply isn’t true anymore.  Another quite common one is that if you have a prolonged pregnancy (past 40 weeks) there will be complications. In fact, times have changed greatly and it is still considered ‘normal’ for a pregnancy to last between 37 and 42 weeks from ‘last menstrual period.’

Myth #2 – Moms love to talk about how scary it was when their labor failed to progress, which led to a C-section. While failure to progress is a clinical reason for C-section, only 8 percent of all labor complications are due to failure to progress. If this is something that you’re genuinely concerned about, there are things that you can do to lower your risk, exercise, gaining no more weight than is recommended, and remaining at home in a relaxing environment until your contractions are five minutes apart (with physician approval).

Myth #3 – Moms also love to tell the ‘heroic’ tale of how they fought through the pain to have an ‘all natural childbirth.’ They’ll tell you that it’s the only way to go, no drugs and no risk for having a groggy feeling or putting the baby at risk. Everyone experiences childbirth differently, and each situation is different. Having an epidural or natural birth can be a tough decision for many mommies to be. Speak to your physician to find out the best birthing option for you. Read the studies, do your homework, and make an informed decision for yourself.

Myth #4 – Lacerations and tearing is a topic that really no one wants to hear about, but somehow it makes its way into birthing conversations all of the time. This is one of a new mom’s greatest fears during labor, but we’re here to say that it doesn’t happen as often as you’d think. Even the most minor lacerations only occur in roughly 16 percent of all labors. Second-degree tears, which require stitches, only occur in 17 percent of all labors.

Myth #5 – Everyone has a natural fear of complications such as umbilical cord issues or heart rate issues, so let’s take a look at these. Out of all labors across the U.S, only 23 percent have umbilical cord issues. This can be where the cord is wrapped around the neck or entangled around the baby in some way making labor and birth a bit more complicated. As trained labor and delivery physicians and nurses, this is something that we are well versed at. With simple maneuvering and/or manipulating, most of these situations can be remedied quickly. As for heart rate issues, this only occurs in 15 percent of all labors.

If you have questions or concerns about any of these issues, or need some clarification on other topics, don’t hesitate to contact us immediately or visit our Facebook Page to ask the community of moms.

Tips for Creating Your Birth Plan

Creating your birth plan gives every new mom a sense of control at a time when it seems nothing, not even her own body, is controllable. It often seems like absolutely everything is out of a new mom’s control, and if nothing else creating a birth plan is a necessary step to feeling in control of something. Birth plans are also a wonderful way to really sit down and prioritize what will be important to you on your day of labor, and what thing you could do without.

Creating Your Birth Plan

The very first thing that you need to know about a birth plan is that when the time comes, even if you have expressed a great determination to stick to the birth plan and all of your physicians and nurses know this, there is a strong possibility that birth plan will go right out the window. Every nurse will do their best to stick to that plan and follow every aspect of that birth plan, but when it comes right down to it your ideas of labor might change, your partner’s ideas might change, and the entire birthing and labor circumstances could cause the birth plan to be completely void.

With that said, creating a birth plan is wonderful exercise that includes both you and your partner. It will bring you closer together at a time when intimacy and an emotional connection is extremely important. It will also require you both to express feelings, anxieties, excitements and fears about the upcoming birth of your new baby.

When creating your birth plan, follow these simple steps:

  1. Start Early and Add – Creating a birth plan is usually not at the top of your list early on in your pregnancy. You’re too busy thinking about names, cribs, clothes, and decorating the nursery. However, it is helpful to always have the birth plan available and to always have it in the back of your mind should something come up that you’ll want to add and discuss with your partner.
  2. Work Together – This is a joint exercise and it’s crucial that you do it with your partner or individual who will be in the delivery room with you. You’ll need to be on the same page with everything on that list.
  3. Keep It Updated – As the birth date comes closer, review your birth plan making sure that everything on there is up to date. If you’ve discovered that there might be some complications, update your birth plan to reflect that. If you’ve decided on an epidural or not an epidural, update that. If you’ve changed your mind about music, lighting, or who will be allowed in the room, update that as well. This is your chance to have control over something. Take advantage of that fact and keep the birth plan updated to reflect anything and everything you want, right up to the last second as you’re heading to the hospital.
  4. Understand It’s Not Binding – Lastly, when creating your birth plan keep in mind that it’s not a binding contract. While the nurses and physicians will respect your wishes and do their best to stick to the plan, there are circumstances and situations that can greatly alter the plan.

When creating your birth plan, think about these topics:

  1. How will you be handling the pain? Will you want an epidural? Will you want to walk around? How about a birthing ball or light music? Think about how you’ll want to manage the pain.
  2. Who will be in the room and for how long? Do you want family in the room? Do you want them helping with the birth or standing in the distance? At the head of the bed or taking pictures?
  3. How do you want your baby treated after he or she is delivered? Immediate skin-to-skin contact or cleaned up and wrapped up first?
  4. Are you breastfeeding or bottle feeding?
  5. How will you handle unexpected circumstances?

There are many resources available on the internet to assist you with creating your birth plan. See the following for ideas:

http://pregnant.thebump.com/pregnancy/pregnancy-tools/articles/tool-birth-plan.aspx

http://www.babycenter.com/calculators-birthplan

Recovery After Cesarean – Part II

ACOG has not commented on the new guidelines so pap frequency discretion could be different with your AOA provider.

Getting Moving

After surgery, most patients are encouraged to get up and out of bed within six hours. Simply getting out of bed and taking that first step is the toughest part for many new moms, but it’s crucial to a quicker and healthy recovery. You will feel some pain and discomfort, and many C-Section patients feel anxiety about what’s going on inside of them as they begin to move around, but this is a huge milestone in your recovery process.

Typically you won’t be walking laps around the hospital six hours after surgery, but you are encouraged to simply get up and perhaps stand for a few moments. It’s not only scary and uncomfortable, but there are also some rules to remember when getting moving for the first time. Keep your focus, stare straight ahead, and have someone help you.

Coughing, sneezing and even breathing might be uncomfortable during those first few days after surgery. Your nurse will instruct you on how to do these things so as not to increase pain.

Get Walking

By day two, hopefully you are no longer attached to the catheter and are moving around a bit more. You will begin to eat and drink almost like normal again, and, probably with the help of a nurse and/or partner, you will begin to venture out into the halls.

Your nurses will want you to do more than venture into the halls, and soon will be telling you to take a few laps. While it might be the last thing that you’ll want to do, it’s very important that you get moving to help naturally improve circulation, limit your risk for blood clots and Deep Vein Thrombosis (where a blood clot forms deep within the tissues of the body, which can lead to greater complications in the heart, brain or lungs), and get your bowels moving again.

Take A Look

The second day is also a great time as any to take a look at your incision. It’s actually an important part of the recovery process, because you’ll need to keep note of any changes that might indicate an infection in later days. The incision area will probably notice intense itching and numbness, which is normal.

While your physician will monitor your incision site, it’s your responsibility to care for it and notice any changes over the upcoming days.

Home Recovery

Within 2-4 days, depending on your recovery speed and how many laps you’re taking around the hospital floors, you will be heading home. It’s at this point that you’ll feel that overwhelming fear creeping up once again, because not only will you need to take good care of yourself and your incision, you’ll have a new little one to take care of as well.

You’ll need as much help as you can get, so take advantage if anyone asks to lend a hand. You’ll also be given a prescription for any pain or discomfort. A full recovery could take up to eight weeks, so be sure to plan accordingly. You don’t want to rush back into your old routine. Take it easy, spend time with your new baby, and take care of yourself. You will be recovering both emotionally and physically, so be well aware of that fact and make sure that family members know as well.

Should you notice any redness, swelling, or oozing at the incision site call your OBGYN immediately. If you feel sharp pains or worsening pain, call immediately. If you have a fever, feel pain with urinating, or notice blood in your urine, call your OBGYN immediately.

Recovery After Cesarean – Part I

ACOG has not commented on the new guidelines so pap frequency discretion could be different with your AOA provider.

Everyone’s experience with labor is different, as is everyone’s experiences with a Cesarean. Whether it’s an emergency C-section with high stress, or a planned C-section with low anxiety, recovery is a whole different story. Some women can recover from a Cesarean within a matter of weeks, some a matter of months. And while everyone’s experience with C-section recovery is unique, there are a few things that you’ll need to be aware of when returning home with your new addition to the family.

Cesarean Recovery

You will have a million questions both before and after surgery; how is the post-partum pain, what will I be able to do, what are my restrictions, when can I hold my baby, how long with it take to recover?

Cesarean recovery involves a variety of steps; all monitored closely by your OBGYN and the hospital staff.

Initial Moments after C-Section

 In the initial moments after your Cesarean, you will be closely monitored in a post-op recovery room. Your OBGYN and the hospital staff will closely watch all of your vital signs for the next one to three hours depending on how much anesthesia you were given. The staff will keep an eye on your level of nausea, which could be a result of the anesthesia, your blood flow, any pains you might be feeling in your abdomen, and the firmness of your uterus.

As with a vaginal birth, you could still go through ‘the shakes,’ as they are called, feel extremely fatigued, groggy and nauseous. Much of the way that you will feel immediately after the surgery has to do with the anesthesia that was given.

If you were given morphine through your epidural, an itchy sensation is quite common and can be counter-treated with medicine.

Recovery Room

When you’re OBGYN feels you’ve recovered well, they will move you into the recovery room. You’ll probably notice that this room is a bit more ‘roomy’ and allows for more visitors. You will also notice that things are beginning to hit you first the first time. With C-Sections, once the affects of anesthesia wear off and you’re moved into the recovery room, it is quite common to feel a bit overwhelmed with everything that has just happened. Whether you were completely prepared and it was a planned Cesarean, or it was an emergency situation, when you move into the recovery room is usually when the gravity of the entire situation sets in.

This is the time when family and friends, and the sight of your newborn baby, are extremely important. It is also a very important time for your partner to step up and be by your side, reassuring you that all is well.

You will continue to be closely monitored by the nurses, and will most likely have your catheter, blood pressure monitors, and IVs with you in the recovery room for another day or two. You can expect to feel some pain and discomfort. It is important that you remain honest in discussing the amount of pain you’re in with your nurses so that they can prescribe the proper pain medication.

Jump to Part II

Emotional Stress, Physical Stress, and Pregnancy Risks

Stress is a part of life. Whether it’s work related, family related, or financially related; we all live with stress in our lives. As physicians, we all know how detrimental extreme stress and chronic stress can be on heart health. From increasing your risk for heart disease, studies have shown that chronic stress can also limit your life expectancy. But when it comes to pregnancy, how much ‘normal’ stress is too much? What constitutes extreme, chronic stress?

Physical Stress and Pregnancy

Your body goes through an entire array of stressful conditions while pregnant, from morning sickness to lower back pain, vomiting and nausea, constipation and headaches, and much more. The natural stress and is associated with pregnancy can sometimes be far worse than any physical or emotional stress that comes from outside sources. So, it’s important to keep in mind how stressed your body already is, how taxing pregnancy can be on your body, and how your stress threshold is a bit lower now that you’re dealing with these additional physical stresses.stress and pregnancy

Physical stresses on the body include lifting, bicycling, amusement park rides, snowboarding and surfing and waterskiing, and tennis or contact sports. Most of these items seem pretty self-explanatory. The main idea is that you do not want to stress the abdomen. Trauma to your abdomen, according to the MayoClinic, is the leading cause of ‘pregnancy-associated maternal deaths in the United States.’ So, when considering physical activity and actions that might affect your abdomen, consider not only your baby’s health but your own as well.

Emotional Stress and Pregnancy

According to the March of Dimes, women who experience high levels of stress also may be at increased risk of premature delivery.

 

Babies born before 37 completed weeks of pregnancy are considered premature. Babies born too small and too soon are at increased risk for health problems during the newborn period, lasting disabilities (such as mental retardation and cerebral palsy), and even death.

 

Don’t fret if you’re facing everyday stresses such as being late for work, getting the kids off to school, making dinner, etc. However, those stresses that involve a death in the family, divorce, loss of a job, or any other catastrophic life event, can constitute an extreme stress and one in which you’ll want to consult your physician.

Extreme stress causes a hormonal reaction within the body, and a hormone called corticotrophin-releasing hormone, or CRH, which is produced by the placenta, can trigger the release of prostaglandins and uterine contractions.

Stress is a factor of our lives, yet if that stress becomes chronic; where it lasts for many weeks, if it is physical such as a car accident, or emotional such as a death in the family, speak to your physician immediately.