Healthy Mother Presentation

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Healthy Mother Wellness & Care (I) Pvt. LtdHelping mothers rediscover Natural Birth

Pregnancy

&You

Presentation for Infosys, Hyderabad

July 26, 2011


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We dont know if it is normal toWe dont know if it is normal to

expect a normal birth for my baby anyexpect a normal birth for my baby any

moremore

In India, just by walking into aIn India, just by walking into a

hospital, mothers face a 70 to 80hospital, mothers face a 70 to 80

percent certainty of having apercent certainty of having acesarean operationcesarean operation

Think About It


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Birth as a Rite of Passage

We must first believe that pregnancy, labor and birth

are normal, safe, miraculous life events and that women

know how to give birth and babies know how to be born

that has to be our starting place

Giving Birth is Heroic .. Having a Life pass through the

mother is heroic as well.


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The Circle of Birth

What happens to the motherWhat happens to the mother

.. happens to the baby.. happens to the baby


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Hormonal Blueprint of Labor

Oxytocin Hormone of LOVE

Endorphin Hormone for Pain Relief, Pleasure & Causes a high

Catecholamine Hormone that causes excitement, altertness, &awareness (immediately after birth)

Prolactin Hormone needed for breastmilk production

(mothering hormone)

Intervention in the natural process of Labor causesIntervention in the natural process of Labor causes

disruption in production of these hormones, leading todisruption in production of these hormones, leading to

greater chances for the need to have cesareangreater chances for the need to have cesarean

operation.operation.


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Healthy Eating

Keep your plate Colorful

Take 5 3 friuts and 2 veggies OR 3

veggies and 2 fruits daily

Your friends Vitamin C, B6, Calcium & Folic Acid,

Protein and Fiber, Unsaturated Fat

Drink plenty of water 8 glasses every day


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Healthy Eating

Vitamin C Green & Red Pepper, Broccoli, Sprouts, Squash, Sweet

Potatoes, Fruits & Juices

Vitamin B6 Bananas, Fresh Veggies, Chole, Rajma, Nuts & Cereals

Iron Green, Leafy Veggies, Prunes, Dates, Raisins, Nuts

Calcium Diary foods, Milk & Yogurt, Leafy Veggies, Nuts, Cheese

Folic Acid Broccoli & Spinach, Dried Beans, Chole, Oranges & Berries,

Whole Grains

Protein Eggs, Beans, Chicken, Tofu, Sprouts, Paneer

Fats/Fiber/Misc No Transfats or Unsaturated fats, Fruits with skin &Veggies, Whole grain products, Ginger & garlic


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Where does the Weight go?

Baby 3.4 kg

Amniotic Fluid 0.9 kg

Uterus 0.68 kg

Breasts 0.9 kgBody fluids 1.8 kg

Blood 1.8 kg

Maternal stores of fat, protein and

other nutrients

3.2 kg

TOTAL 12.68 kg

American College of Obstetricians & Gynecologists

(ACOG) Recommends Average Weight Gain for Most

Women between 10 and 16 Kg


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Discomforts & Solutions

Nausea Eat 4-5 small meals a day. Chew Imli Goli, drink ginger tea. Well balanced diet, especiallyVitamin B. Eat salty biscuits/Marie biscuits/rusk before getting up in the morning.

Stuffy Nose Warm compress, saline nose drops

Fatigue Take rest and avoid strenuous work if you feel tired listen to your body

Backache Proper posture. Use good body mechanics. Do Pelvic Tilt exercises

Constipation Eat lots of food with grain, bran, raw veggies, fresh and dried fruits. Lost of water / fruit juice.Daily Walking

Leg Cramp Partner places heel of moms foot in his palm and pushes gently. Alternately he pushes atball of great toe and holds for 15 seconds. Do Calf Stretches taught in class. Eat a couple ofMonaco biscuits before going to bed. Take Calcium tablets at night.

Swelling in legs & feet Put feet in bucket of water and do foot twirls. End shower with cool water. Drink more fluids.Elevate feet several times a day. Do foot Twirls, ankle Circle exercises. Fewer carbohydratesduring dinner

Varicose veins Elevate legs at right angle to body 2 to 5 minutes, several times a day. Warm bath to soothelegs. Avoid knees locked or legs crossed positions

Hemorrhoids Avoid constipation, increase fiber and water, Do Kegels exercises for circulation

Shortness of breath Correct posture, sleep with propped up pillows. Slow down the pace of your activities.


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Test & Screens

Nuchal Translucency

Test done using Ultrasound

Accurate between 11 weeks 3 days and 13 weeks 6 days

Not done after 14 weeks because babys lymph nodes develop and

fluid drains away Test measures the depth of the fluid at the back of the babys neck

Normal nuchal fold thickness is 1-5mm; there is increased risk of

Down Syndrome of thickness is greater than 6mm

Test needs specially trained staff if baby arches his neck while

ultra sound is done, it can result in false positive Test done along with Pregnancy Associated Plasma Protein (PAPP

A) test and Free B-Human Chorionic Gonadotrophin tests

increases accuracy to 85%


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Test & Screens

Serum Alpha Protein (AFP)

Done to screen for open neural tube defects (e.g. Spina Bifida) orchromosomal abnormalities such as Downs Syndrome

Alpha Protein (AFT) is produced by yolk sac and fetal liver

It is measured in mg / ml

Its values peak at 12-14 weeks gestation (test should be donebetween 13 16 weeks)

If there are open neural tube defects, Securm AFP levels aregreater than normal

If Chromosomal Abnormalities present, Serum AFP levels less thannormal

Definite association between maternal age and increased risk ofabnormalities (e.g. At 20 yrs, risk is 1:1500; at 30, 1:800; at 35,1270, at 40, 1:100)

However, there are high chances of false positives


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Test & Screens

Triple & Quadruple Screen Triple Screen

Best done between 14-21 weeks

Screens Serum AFP, Serum Chorionic Gonadotrophin andSerum Estriol

Screen useful to detect Dowms Syndrome / Trisomy 21,

Trisomy 18 and Open neural tube defects 70% accurate (30% may be missed)

False positive 5% risk ( 60 babies with high risk results only 1will actually be born Downs; 59 babies will be normal)

Quadruple Screen Combination of Triple Screen markers and Dimeric Inhibin; Alsochecks for levels of alkaline phosphatase

Increases accuracy of the triple test by 80 90%

Women over 35 are recommended to get tested by acombination of this test and Ultrasound


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Test & Screens

Gestational Diabetes 3-15% of pregnant women are diagnosed with Gestational Diabetes (GD)

In pregnancy, mothers insulin is less effective in transporting glucose out of

circulating blood into cells (where it can be used more efficiently)

Therefore, more glucose is in circulation, and so more is available to the developing

baby so chances of large baby are more (this is the premise for testing)

However, there are no randomized tests to date. In 1997, 300 women werestudied and there was no advantage of aggressive management of GD versus

advice to eat right

Informed decision making:

Only 1 in 1000 women really develop GD; Being diagnosed with GD increases

chances of induction and c-section; not really having overly large baby

US becomes less effective in detecting large baby as gestational age advances. Routine induction for large babies has ZERO benefits. 70% of so called large

babies have average weight

Glucose tolerance test (GTT) is really not required unless there is high Fasting

Blood Sugar level


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Stages of Labor

EARLY LABOR EARLY ACTIVE LABOR LATE ACTIVE LABOR TRANSITION

Deep Breathing inwhichever positionyou are comfortable

Light Breathing orDeep Breathing inwhichever positionyou are comfortable

User Modified Paceor Pattern Breathing

Do Deep Breathingif you arecomfortable

Do Pant-Blowbreathing or anyModified breathingof your choice

Do Deep Breathing

DURING CONTRACTIONS

Be Upright and rock back and forth /Lean forward into your contractions

while breathing / Lean forward ontoPartner

Partner can do backmassage or

distractionmassage asneeded

Partner can dodistraction

hand/foot pressurepoint massage


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Healthy Mother Labor Guide

EARLY LABOR EARLY ACTIVE LABOR LATE ACTIVE LABOR TRANSITION

LIGHT EATING &SHOWERING

USE BIRTHING BALL IFDOULA IS AVAILABLE

BETWEEN CONTRACTIONS

Walk

Climb Stairs (if Possible)

Do not get breathless

Use All Upright Positions

- Wall Pelvic Tilt

- Wall Squat

- Sideways Lunge

- Lean Forward Over Bedor Chair and do Pelvic Tilt

- Go on hands & knees (forbackache & turning aposterior baby)

Walk, Walk, Walk

Use all Upright Positions

Continue on Hands-and-knees if possible

Use Kneeling Position

Use Chair Straddling position

Partner can help with focusedrelaxation

Use Butterfly position

Rest when you can

Use R E L A X

Partner can help with verbalrelaxation

Use pillows for Chair-to-bedand bed-to-chair lean

forward position

Use reclining bed to relax ifyou need to

User Butterfly position withpillows

Labor in reclining position onbed

Can labor on toilet seat ifcomfortable

Lie on your side; changesides often

Do pelvic tilts if possible

Partner can do rub-down-relaxation

Keep yourself well hydrated

Drink lots of clear fluids and water

Ice Chips help to keep mouth moist

User the rest room at least once every hourChange positions frequently


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Cascade of Interventions

When Labor is induced, Pitocin (unlike naturally occurring Oxytocin),does NOT cross Brain-Blood-Barrier, so brain cannot respond to painand stimulate Pituitary gland to release Endorphins

Lack of right levels of Endorphins causes lesser relief from pain

Mother is more likely to receive Epidural / pain relief medication instead

Epidural causes ALL pain sensation to be removed

Naturally occurring Oxytocin levels drop

Therefore, increased levels of synthetic Pitocin are required

Low levels of Oxytocin, Endorphins and Catacholamines at birth

LESS RESPONSIVE MOTHER AND BABY


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C-Section

Major abdominal surgery!

Most common surgery that is beingperformed today!

Risks to mother Immediate & Long Term

Risks to baby

WHO recommendation Risk of not doing a C-

section, should outweigh the risk of doing it.At > 15% - risks of surgery, outweigh itsbenefits.


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Lamaze Philosophy Of

Natural Birth

Birth is normal, natural and healthy

The experience of birth profoundly affects women and their families

Womens inner wisdom guides them through birth

Womens confidence and ability to give birth is either enhanced or

diminished by the care provider and place of birth

Women have a right to give birth free from routine and unnecessary

medical interventions

Birth can safely take place in hospitals, birth centers, and homes

Childbirth education empowers women to make informed choices

in health care, to assume responsibility for their health and to trust

their inner wisdom.


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Healthy Mother Philosophy

1. Labor begins on its own

2. Freedom of movement throughout labor

3. Continuous labor support

4. No routine interventions

5. Non-supine (e.g. Upright or side-lying) positionsfor birth

6. No separation of mother and baby after birth


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Breastfeeding

Benefits of breastfeeding To Mom & To Baby

WHO recommendation Exclusive

breastfeeding for 6 months, and continue up to 2

years

Ease of breastfeeding starts with good practicessurrounding birth

Awake, aware Mother = Awake, aware Baby!

Immediate skin-to-skin contact Breastfeeding is not just about nourishment to

the baby It is equally about bonding with your

baby!


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Breastfeeding - 2

Breast Crawl

Challenges What have you all heard?

How much milk does the baby need??? Demand=Supply! You will always have

enough, as long as you are demand feeding

your baby Good lactation support is priceless .

Healthy Mother Breastfeeding Support

Group


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Dads role in

Pregnancy & Labor

Dad is the most important source of strength

for the laboring mother

During labor, when mother is drawn inwards

within herself she looks to her husband as her

and her babys sole guardian

Dads role is to offer encouragement to her

during labor, act as a gatekeeper and screen

any interventions hospital may employ

Back rubs, massage, offer water as needed


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Dads role - 2

Infant massage, soothing the baby, playing,

changing diapers

More time spent with your baby = More

bonding with your baby


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Family Planning

Family planning Individual needs different

Contraceptive Options: Condoms; Intrauterine

device (Copper T, Marina); Pills; Mini Pills

More permanent options Vasectomy; Tubal

ligation; Tubectomy

Safe abortion I Pill; Medical Termination ofPregnancy


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Troublesome Discharge

Normal Vaginal Discharge

Yeast Infection

Bacterial vaginosis Urinary tract infection

Vaginal discharge during pregnancy


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Cancer Prevention

Pap Smear what is it? Who should get it done? Prevention is the best form of cure!

Decrease of cancer rates in women has been found

by: Being active/exercising regularly Eat 5 Fruits/veggies

Colorful plate! Add dark greens/orange

Limiting alcohol and caffeine, stopping smoking

Using soy, lentils, and whole grains

Decreased breast , ovarian, and uterine cancer rates inwomen who have breastfed their babies!!


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Healthy Mother Wellness & Care (I) Pvt. LtdHelping mothers rediscover Natural Birth

Regd. Office: R-39, Srila Park PrideHydernagar, Hyderabad 500 049

+91 78930 68666; +91 40 2304 1482

[email protected] http://healthy-mother.com

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Healthy Mother Presentation