Your Labor Room

How To Choose An Obstetrician

2011-12-31T16:39:00.001-06:00

This is a question we get asked from time to time and it really is quite tricky. What one person will love in a health care provider is just the thing another woman will not like. But there are some ways to narrow down your search for an obstetrician to find one who will be a good match for you.

1. INSURANCE

Let's start off with the most practical things first. You will need to make sure that the physician accepts your form of insurance or payment. You can find this out usually with a simle phone call to their office. Next you want to find out if the hospital(s) to which the physician goes also takes your form of insurance or payment. This is important too, because if the hospital doesn't take your insurance, but you still want your physician to deliver you at that institution, you may need to pay your account before the baby is even born. Each institution is a little different in how they like to handle these situations, but it is best to know as much about what to expect from the physician and the hospital before you ever have that first contraction!

2. GENDER

For most women, the gender of their health care provider is strictly a preference. I have spoken with women who have only had men physicians, and in fact describe being cared for by a woman as something they would find very odd or discomforting. I have also spoken with women who would never go to anyone except a woman. Personally, I have had both. I like the fact that for the most part a female care giver can have some firsthand understanding about pregnancy, labor, birth and postpartum. But realistically, it is all very subjective. If her experience was blissful and mine extremely stressful, she still can't really relate to what I am going through. If she had vaginal deliveries and I have C-Sections (or the other way around), she can't fully relate to my experience either.

Some women express anxiety and embarassment at being examined by a male obstetrician and I can tell you that is only enhanced when you have to work side by side with them every day! However, I have had male obstetricians whose bedside manner was so professional and gentlemanly that they immediately put you at ease and made you feel confortable. For me, the bottom line is that I find I can talk to a female about female issues easier than I can talk to a man, I feel less inhibited in the discussion and I feel more likely to bring up issues that need to be dealt with.

3. AGE/EXPERIENCE

Age is probably not the word we are looking for here as much as the word, experience. Would you prefer a physician who has been in practice for a long time, has delivered thousands of babies and knows exactly what he's going to do before he even walks in the room? Or would you prefer a younger physician, someone who has recently finished residency and is fresh with the latest techniques and tips, and may be more open minded about what you may want to do?

While there is great benefit in having learned the latest and best recently, (and many physicians do all they can to keep current with trends, standards and techniques), there is also something to be said for that intuition which comes with having watched hundreds and thousands of babies on fetal monitor tracings, or having seen every emergency situation so many times that you don't have to think about what to do.

One advantage of the younger physician is that often, while starting a practice, they have more time to spend with each patient, so you may feel as if you are getting more individualized care. Older physicians may already have a full practice and schedule of patients to be seen each day and time for each appointment may be more limited.

Another thing to consider is where are you in your child-birthing cycle? Is this your first baby, and do you plan to have a few more? Do you plan to space them out over many years? Are you just about at the end of having babies and you might be finished after this pregnancy?

If you are just beginning to start your family, you may want a physician who will be available for you for all your pregnancies. An older physician who may be planning on retiring in a year or two, may not be the optimal choice for you. If you are finishing your family then the age of your obstetrician may not be so much of an issue.

4. CREDENTIALS

Don't be afraid to ask for your physician's credentials. Of course a physician should have graduated from medical school and completed a residency in obstetrics/gynecology. (In some states a graduate from medical school can actually get a license to practice medicine with only one year of residency.)

It is also advantageous if they areBoard-Certified by the American Board of Obstetrics and Gynecology. This means that they have passed a written test, demonstrating that he or she has obtained the special knowledge and skills required for medical and surgical care of women. They must demonstrate that they have experience in treating women's health care and then they must pass an oral examination. This oral examination is given by a group of well-respected national experts. The exam covers the physician's skills, knowledge and ability to treat different conditions. Physicians must be retested periodically to keep this certification updated.

4. PERSONALITY

This is where no one can tell you what you like or dislike, but you! Do you want a physician who is has more bedside manner, or one who is more "straight from the hip"? Do you want someone who is going to bring topics up gently or do you want your physician to just bring the topic up and discuss it boldly? Do you like a quiet person or a more talkative person? Maybe you don't even know!

Most physicians are willing to schedule a "consultation" appointment with you. This is usually an appointment where you can go and meet the physician and ask questions and get a basic feel for his or her personality. This should tell you alot about whether or not you like this individual. If you don't like them during this visit, or for any reason they make you uncomfortable, then this isn't the obstetrician for you.

5. PERSONAL BELIEFS

During a consultation appointment is a good time to ask your prospective obstetrician some questions about their personal beliefs that may impact your care or your birthing experience. You may want to ask how they feel about unmedicated deliveries and are they generally supportive of that. How do they feel about labor inductions, and what percentage of their OB patients are induced. How do they feel about breastfeeding and are they supportive of that. How do they feel about epidurals and when do they allow them to be given. How do they feel about visitors in during the birth. What is their current C-Section rate? Anything that you can think of that would be important to you for your delivery would be a good thing to ask at this appointment.

You will want to notice the general attitude of the physician as they answer these questions. Are they truly interested in what you are asking and are they respectful in their answers? Then you may find that they are interested in you and about whether the issues are important to you. Are they generally flippant or dismissive about the questions? Are their answers disrespectful or frivolous? Then you might find that they may be dismissive and frivolous about other issues that are important to you as well. If you leave the consultation appointment feeling as if someone really took time with you, cared about what you had to say and made you feel special, you might be on your way to choosing an obstetrician.

6. SOLITARY OR GROUP

Most women don't think about this issue until they begin realizing that delivery is just around the corner and by then it's too late. Is your prospective obstetrician in a solitary practice, meaning that he or she is the only physician in the group, or is he or she in a group with other physicians?

This may not seem to make much difference as you go to visits monthly, or even toward the end of pregnancy when you begin to go weekly. But one visit to Labor & Delivery with a run of false labor can show you the importance of this question.

If your physician is in a solitary group, then chances are pretty good your physician will deliver your baby. Now even in a solitary group, your physician will have a physician from another group (usually another solitary physician) to take call on some weekends, or if he/she has to go out of town, or on (don't say it!) vacation. But still, most of the time they deliver their own babies.

If your physician is in a group with other physicians, they usually rotate the calls, both nights and weekends. The more physicians in the group, the fewer the chances are that your physician will actually be the one to deliver your baby.

7. AFTER THE CHOICE IS MADE

After you have chosen your obstetrician, if you find for some reason it was not the right choice for you, you can change physicians. However, it is recommended you do so very early in the pregnancy as many physicians will not take a new pregnant patient later in pregnancy. You might find your physician's nurse can help you with the issue if you take a few minutes to talk with her, or leave your number with her and have her call you during a slow spot in her day.

If you have gone the whole pregnancy and still are not happy with your choice of obstetrician, there is no reason for you to continue with a physician with whom you do not have a good relationship. Women change physicians all the time. Just make sure you change after your last postpartum checkup and in time for your next scheduled checkup.

If you have found the perfect obstetrician for you then by all means, tell everyone! The greatest compliment you can give your physician is to spread the word to every woman you know of the wonderful job he or she is doing!

Preterm Labor -- Signs

2011-12-28T13:22:00.001-06:00

Yesterday I admitted the sweetest couple who needed to be treated for Preterm Labor. I was very impressed with one of the statements the physician made to the couple regarding preterm contractions. The mother had been relating the fact that she had been feeling tightening for awhile, but having read about Braxton-Hicks contractions, she felt this was normal.

The physician told them that whenever a pregnancy is earlier than 37 weeks (which is considered term), contractions do not have to be considered painful to be effective. She added that by the time these contractions are painful, labor can be too far progressed to stop.

The truth is, there are many signs of preterm labor that may actually be ignored or not even noticed by the mother until preterm labor is much too advanced to be stopped. Some signs of preterm labor are:

Contractions (which may only feel like "tightening" or the "baby knotting up", which occur more than five times in an hour
Change in vaginal discharge, leaking fluid or spotting
A dull, low backache
Cramps that feel like menstrual cramps or gastrointestinal cramps
Pelvic pressure, the feeling that the baby is pushing down

You do not have to experience ALL of these to have preterm labor. If you experience ANY of these symptoms, you need to contact your health care provider. You may worry about making a "false run" to the hospital, but this is one situation where everyone will be pleased if it does turn out to be a "false alarm"!

There are a few things you can do to minimize your chances of preterm labor:

Be aware of the signs and symptoms of preterm contractions
Keep all your scheduled visits with your health care provider
Keep yourself well hydrated
Be aware of the signs and symptoms of urinary tract infections (a major cause of preterm contractions)

- sharp burning and pain when urinating
-the urge to urinate more frequently than usual
-a strong urge to urinate that can't be delayed
-soreness in the back and sides
-small amount of blood when urinating

If you do experience any signs of either preterm contractions, or urinary tract infections, notify your health care provider as soon as possible.

Next we will discuss how preterm contractions are treated.

Dr. Santa and the Reindeer Scrub Nurse

2011-12-24T08:15:00.001-06:00

Throughout my career I have worked many Christmas Eve nights. The first was my first year in Nursing School – with barely enough nursing knowledge to justify receiving a paycheck.

I had volunteered to work 11-7 Christmas Eve. I don’t know to this day what prompted the decision, it just seemed like a good idea at the time, and it was. I had a nice night with nurses who were surprised to have an extra pair of hands to lighten the load and an heart that was willingly working with them. As I took vital signs that night and again early that Christmas morning, I enjoyed being the first one to wish the patients a cheery and heart felt “Merry Christmas”.

The vantage point of the unit on which I worked allowed me to watch the sunrise from a nearby window. While I might have been awake before sunrise on Christmas before, I believe this was the first time I ever watched a Christmas sunrise. It was as if the full meaning of Christmas rose with the sun inside my heart that morning.

At the end of my shift, my mother and I went to my sister’s to watch her children open their presents. Somehow I felt as if I had already been given the greatest present of the day.

For years later I would volunteer to work night shift on Christmas Eve. When our children were young, I would make arrangements with “Santa” about what needed to go where and when I came home, Christmas would begin.

A couple of years ago, I volunteered to work with Tammye and Denise. All of us have children that are either older or grown and we had worked together the previous Christmas Eve. That year we had each brought food for Christmas dinner and because our unit was empty – Santa was bringing no babies that night – we ate our middle of the night Christmas dinner and watched Christmas movies all night. We got paid holiday pay for it, too!

That is exactly what we had planned for this time as well, but Santa had a baby on his delivery list. Denise was the patient’s nurse. I was the scrub nurse for the night and Tammye was the “free” nurse, which means she ran around and did everything else.

It wasn’t a calm night in the manger. The patient was progressing rapidly and it was all we could do to keep up with her. . .get an IV started, get lab work drawn, call anesthesia for an epidural, get her bladder emptied. In the meanwhile, the baby would have times when it concerned us. Not bad enough to do a C-Section. . .just enough to keep Denise on the edge of her chair and us on our toes.

I went to set up a sterile delivery table and remembered I had worn a pair of reindeer antlers to work. Still in the holiday spirit, I didn’t want to take them off, so I made holes in my scrub hat so the antlers could poke through them. On went the hat over the antlers and I finished setting up the table. Just in the nick of time too, the patient was pushing and the table called for.

Image via WikipediaThe baby delivered easily, thanks to Dr. Santa, and as the doctor was trying to sew the episiotomy, with me standing beside her to assist her, we kept noticing shadows that would move along the area. It took awhile for us to realize the bright delivery lights were creating shadows from my reindeer antlers.

Looking back on it, I realize that was my last time to ever work with my dear friend Denise. Fighting cancer these last six years, her body is now too weak to work with us though that is exactly where her heart remains.

Tammye, too, gave us a scare by having a major heart attack and then open heart surgery. She is well now and her bright smile greets me in the morning when I arrive to work.

That night, Santa didn’t just deliver a baby to a mother, he delivered precious memories to three friends who love each other, loved to work together and will cherish the memories of our Christmas Eves together, reindeer antlers and all.

Round Ligament Pain

2011-12-21T17:09:00.001-06:00

I have to confess, for years I was not nearly sympathetic enough with patients who came in complaining of Round Ligament pain. Then, with my third pregnancy, I experienced it for the first time and immediately, I was more sympathetic!

The good news about Round Ligament pain is that it isn't a serious condition as far as your health or the baby's health is concerned. The bad news is that it can be extremely painful. It can be hard to believe that something that painful isn't a sign of something seriously wrong.

The non-pregnant uterus is the size of a pear. It is suspended in place in the lower abdomen with ligaments that begin at the top sides of the uterus and continue all the way down to the labia.

As the uterus begins to grow, in both size and weight, these ligaments begin to be stretched and tensed. This causes resulting pulling on surrounding and attached nerve fibers, causing pain.

The pain from Round Ligament Syndrome can present in any different ways. Most often it is a one-sided, sharp pain frequently noted when changing positions or rising from a seated or lying position. It is more common on the right side that the left because the uterus has a natural shift to the right. Some women can also complain of a sensation of great weight and heaviness in their labia, this is also a result of pulling of the round ligament, which ends in the labia.

There is nothing you can do to make Round Ligament Pain go away, however, there are a few things you can do to be more comfortable:

If you are past the first trimester, a very warm bath or heating pad may give some comfort to the area.

Speak to your health care provider about taking acetaminophen according to package directions, but do not take ibuprofen, it is contraindicated in pregnancy. Do not take any medication without your physician's recommendation.

Change positions slowly, giving the stretched ligaments time to adjust.

You should always report any pain to your health care provider. Also report if you have any fever, pain upon urination, severe nausea and vomiting or bleeding.

One encouraging thing is that Round ligament pain often seems to improve once the uterus is totally out of the pelvis.

How Does it Feel to Get an Epidural?

2011-12-18T11:08:00.001-06:00

I was helping to admit a young woman the other day and she confessed that she was more scared of the needle of the epidural than of delivery. I was able to tell her that most women who receive and epidural, after the procedure is complete, say, "That wasn't as bad as I thought it would be."

Image via Wikipedia

Because each woman is unique and each anesthesiologist is unique, I can't tell you exactly how it will feel for you. I can tell you however how it felt for me, and how many of the women I have cared for say it felt for them.

Some women find having to curl around their baby while having contractions a somewhat uncomfortable. Also, having to remain still while the epidural is being placed frightens many women, but usually there is a nurse right at your side to help you and hold you in your position.

The sterile prep which the anesthesia doctor uses is often cold and is applied with a scratchy feeling sponge. The doctor usually then numbs the skin and deeper tissues with an injection of Lidocaine. This is very similar to the numbing shot one receives at the dentist in that it is a stick and then a burn. It only lasts a few seconds however and within ten to fifteen seconds you should not feel that anymore. At this point, you would only feel pressure as the doctor feels your back for landmarks.

When the catheter is placed into the epidural space, it can brush across a nerve root. This causes a momentary "shock" feeling similar to when you hit your "funny bone", only this shock sensation will occur in your back and run down one leg or the other. It only lasts for two or three seconds.

When the anesthesiologist injects medication into the catheter, there can be a slight cramping feeling in the back and the medication will feel cold. It isn't cold, but the room temperature medication is going into a warm place, making it feel cold by comparison.

As the epidural begins to take effect, your feet and legs will begin to feel warm and tingling, then you will become numb. Some women will still be able to move their legs, some will not. Much depends upon the medication used, the concentration of the medication used and the dose of the medication given.

The majority of women feel quite comfortable throughout their labor, though some may have a "hot spot", an area where the medication did not take effect, or some may need additional injections of medications into the catheter (called a redose) throughout labor.

If the epidural placement is more difficult, the woman may find the procedure more difficult as well, but most of the time the woman feels as if the placement of the epidural was much easier than what she would have imagined it to be.

Infection? What is Group B Strep?

2011-12-14T13:05:00.001-06:00

A friend of mine recently came to me concerned about his daughter. Due to deliver Image via Wikipediawithin a few weeks, she had just told him she was positive for Group B Strep and would need antibiotics during labor. He had never heard of this and wanted my thoughts. He wanted to know if there was any danger for her or for her baby.

Group B Strep is one that frequently puzzles and concerns many people. Group B streptococcus (GBS) is a type of bacteria that is found in 25-30% of pregnant women. Most women do not have symptoms or become sick, but they carry the bacteria in their bodies, hence they are called "carriers". Adults can have GBS in the bowel, vagina, bladder or throat. Most of the time the bacteria poses no threat to the woman at all. However, if her baby comes into contact with the Group B strep bacteria during birth, the baby can become very ill. In fact, according to the CDC, Group B Strep is the most common cause of life-threatening infections in newborns. It is the most common cause of sepsis (blood infection) and meningitis (infection of the fluid surrounding the brain) in newborns.

How Do You Get Group B Strep - Is it a Sexually Transmitted Disease?
The bacteria that causes GBS normally lives in the intestine, rectal areas of men and women, and also lives in the vagina of women. Colonization of the bacteria is not a sexually transmitted disease. GBS may come and go in people's bodies without symptoms throughout their lives.

How Do I Know If I Am Group B Strep +?
Most health-care providers will use a screening test late in pregnancy to determine if you carry Group B strep. Most health-care providers will test between 35-37 weeks of pregnancy.

The test is simple and painless. A sterile swab (Q-tip) is used to collect a sample from the vagina and rectum. It is then sent to a laboratory to be tested for Group B strep.

What if My Test Comes Back Positive?
If your test comes back positive, it will be noted on your prenatal record. You should also be aware of it and inform your care givers as soon as you arrive in labor. You will receive intravenous (IV) antibiotics throughout your labor.

Why Can't I Be Treated As Soon As My Test Comes Back?
Even if treated with antibiotics as soon as your test results were available, it is highly likely the bacteria would return by the time you were in labor. The goal is to keep the baby from coming in contact with the bacteria, so treating the GBS during labor is the best way to accomplish that. In fact, since the early 1990's, the onset of newborn GBS disease has decreased by 80%, due to the treatment of mothers in labor.

Is There Any Risk to Me Being Treated for GBS?
There is a rare chance (about 1 in 10,000) of having a severe allergic reaction to the antibiotic which would require treatment. Penicillin is most often given, but if you are allergic to Penicillin, there are other antibiotics that can be substituted.

By being treated in labor, you reduce the chances of your baby developing newborn GBS disease from 1 in 200 to 1 in 4000!

Is GBS the same as a Yeast Infection? Or the same as Strep Throat?
Yeast infections are caused by yeast and not bacteria. Taking antibiotics can often increase the liklihood of developing a yeast infection because killing the bacteria normally found in the vagina gives yeast more of a chance to grow.

Strep throat, while caused by a streptococcus bacteria, is caused by Group A streptococcus. Group A and Group B streptococcus are two different kinds of bacteria each belonging to the same family, but of different species.

Once I am GBS +, Will I Always Be?
GBS can come and go in people's bodies without our knowing it. If you have had one pregnancy that was GBS+, your health-care provider may not even test you with Image via Wikipediasubsequent pregnancies, but decide to treat you as positive instead.

The most important thing about GBS to remember is that it is common, it is not a sexually transmitted disease and that it is easily treated to help prevent a dangerous infection in your baby.

Is it a Boy or a Girl?

2011-12-10T14:05:00.001-06:00

Most pregnant women are curious to know the sex of their baby before it is born. Only an amniocentesis can give that information with 100% certainty, although ultrasounds continue to become more and more accurate with each advancement of technology.

Some women want to know, however, how to choose the sex of their baby even before it is conceived. At first this may sound like an impossibility, and there are certainly no guarantees, but it is really a matter of environment, timing, number and temperature.

Let's settle one thing first of all. It is the man who determines the sex of the baby.

Women present XX chromosomes to the party, men can present sperm that are either XY or XX. In the case of humans, a single gene on the Y chromosome acts as a signal to set the developmental pathway towards maleness. So if the XX sperm meets the XX ovum, a girl baby ensues. If the XY sperm meets the XX ovum, you have a bouncing baby boy!

But why do the XY sperm or the XX sperm make it to the ovum? That is a very interesting thing. It is a long journey for the little sperm and the environment plays a big part of the picture.

ENVIRONMENT

Sperm are very sensitive to their environment, from temperature to the pH, or whether their surrounding is acidic or alkaline. In fact, XX sperm prefer an environment that is acidic and XY sperm prefer a more alkaline environment. To further complicate things, women can naturally have a more acidic or more alkaline vaginal mucousa. There are some who recommend a woman douche with water and vinegar immediately before intercourse if she prefers a girl or use water and baking soda if she prefers a boy.

Also, female orgasm is said to increase the alkalinity of the vaginal mucousa, so if a woman wants a boy, she should orgasm prior to the man's ejaculation. If she wants a girl, she should avoid orgasm.

Environment isn't the only factor involved, however. The sperm themselves are different between XX and XY. XY sperm are bigger and faster swimmers, however they have a shorter life span. XX sperm, while slower and smaller, live longer, so timing is an important issue.

TIMING

The mobility and life span of sperm has a big impact upon when intercourse should occur depending upon which sex baby you desire. If your desire is to have a boy, then you should have intercourse as close to ovulation as possible, since the XY sperm are the fastest and strongest swimmers.

If you desire a girl, having intercourse three or more days before ovulation increases the chances to conceive a girl, because the faster sperm with the shorter life spans will have died off, leaving a greater quantity of the XX sperms when the egg is released.

HOW MANY INVITATIONS TO THE PARTY

When it comes to conception, and especially gender selection, sperm count matters. A low sperm count, of course, doesn't favor fertility at all. A high sperm count favors boy babies.

If you are desiring a boy, abstain from intercourse 3-4 days before your ideal date, a day or two before ovulation.

If you are desiring a girl, have intercourse daily from day 1 until 3 days before ovulation.

X MARKS THE SPOT

While trying to maximize the mobility of the sperm, the position of intercourse and depth of penetration during intercourse is important.

The closer the entrance to the vagina, the more acidic the vaginal canal. Avoiding ejaculation close to the entrance would then enhance the likelihood of conceiving a boy. It is recommended that to conceive a girl, the missionary position should be used and to conceive a boy, the rear-entry position.

TEMPERATURE

Sperm are very sensitive to the temperature around them. If you want to conceive a boy, it is recommended that the man wear boxer shorts exclusively. This will reduce the heat that can destroy sperm. The opposite is not recommended for a girl however, as the heat can lower the sperm count. What is recommended if you wish to conceive a girl, is immediately before intercourse the man take a hot bath. This can destroy some of the faster XY sperm, leaving more of the XX sperm to fertilize the egg.

ENHANCEMENT AIDS

Once you have the timing, the position, the temperature and the environment right, another suggestion is for the man to drink a nice cup of caffeinated coffee immediately before intercourse (perhaps while he is sitting in that hot bath) if you desire a boy baby.

CONCLUSION

Hopefully with this information you can begin to skew the statistics a tiny bit in the direction of the gender for which you are hoping.

n all organisms, however, there are those that out-perform and out live their expected parameters. So you may have an XX sperm that is a "Michael Phelps" type swimmer, or an XY sperm that will set the Guinness World Book of Record for sperm longevity. There are no guarantees. Personally, I believe the Lord puts each sperm and egg together to make just the person He wants.

To make all the details a little easier to remember, I've condensed them into this table. I wish you all, Happy Swimming!

Boy Baby	Girl Baby
Alkaline environment	Acid environment
Faster swimmers	Slower swimmers
Short life	Long life
Rear entry position	Missionary position
Less frequent intercourse	More frequent intercourse
Abstinence 3-4 days before	No abstinence before
Female orgasm prior to ejaculation	No female orgasm
Target date 1-2 days before ovulation	Intercourse everyday from day 1, stop 3 days before ovulation
Boxers only	No change
No hot baths	Hot bath for man immediately before intercourse
Caffeinated coffee imediately before intercourse	No caffeine immediately prior to intercourse

Did My Water Break?

2011-12-06T08:59:00.001-06:00

Apart from trying to determine if their contractions are labor, the question of "Did my water break?" is often the most perplexing for many pregnant women.

The amniotic sac surrounding the baby contains approximately a quart of fluid. This fluid is comprised mainly of baby's urine, baby's skin cells and fluid created from the placenta. Since most of baby's waste products are transported through the umbilical cord to the mother's circulation and filtered through her kidneys, baby's urine is not like ours at all. That explains why amniotic fluid is usually clear, or a very pale color.

When a woman's amniotic sac ruptures, or her "water breaks", it usually occurs in one of two ways. It's either a big gush, or a steady trickle.

THE BIG GUSHImage by roychung1993 via Flickr

If your water breaks with a big gush, its going to be pretty easy to tell what happened. Water will be everywhere. It will run down your legs; when you get into the car, it will be in the seat of the car. Everywhere you go, you will leave a trail of water.

Don't try to use a towel to keep up with the flow. Go to your baby's nursery and grab a diaper. They are the perfect hour-glass shape, they are lined with plastic and extremely absorbent. Put one between your legs and you can be on your way!

THE STEADY TRICKLE

If you have a steady wetness, it is much harder to know if it is definitely your amniotic fluid. Many women have a thin, whitish discharge toward the end of pregnancy which is can be normal.

If you are a steady discharge that requires you to wear a pad, you need to notify your health care provider. Don't try to diagnose it yourself at home.

HOW TO KNOW FOR SURE?

If you have a the "big gush" usually it is very obvious and there is nothing else that needs to be done to determine that your water has broken. If however you had small gush and then no more fluid leaked out, or if you are having a continual trickle of discharge, your health care provider will need to determine definitely if it was your amniotic fluid.

The first test performed is often to test the pH of the amniotic fluid. This is a simple litmus test done either with a swab or a strip of paper. A more definitely test involves viewing the amniotic fluid under a microscope.

This is usually done by obtaining a sample of the fluid with a small swab through a speculum. The higher salt content of the amniotic fluid causes it to create a pattern of ferns, like a Boston Fern, on the slide when observed through the microscope.

WHEN WILL MY WATER BREAK?

Many new mothers are concerned about when their water will break, especially the thought of if it should happen in a public place. I usually ask them to think about all the times they have been in the grocery store, out shopping or at the theater. Have they ever been there and seen someone's water break? The answer has always been "No".

Only 10% of women rupture their amniotic sac before labor begins. Of those 10%, rupturing your membranes is usually a private thing, even if you are around many people. It is very rare for it to be something for everyone to see and notice.

WHAT DO I DO WHEN MY WATER BREAKS?

When your water breaks, notify your health care provider immediately. Most will want you to come to the hospital or birth center so they can verify that your water has been broken. Do not put anything into your vagina -- it is now EXIT ONLY! That means no douches, no tampons, no body parts.

The membranes serve as the last guardian against infection for your baby. The normal bacteria that live in your vagina will begin the slow, steady trek upward toward your uterus and your baby. Anything introduced into the vagina will help spread those bacteria along their way.

Take a deep breath and remember that having your water break means that your baby will soon be here. The moment you have been awaiting for so many months is just around the corner. Congratulations!

Is it Baby Blues. . .or More?

2011-12-03T20:23:00.001-06:00

Image by moominmolly via FlickrYour little bundle of joy has arrived and you couldn't be happier! Or at least you thought you would be happy, but you don't feel happy. In fact, you feel sad, very sad.
You may be one of as many as 80% of mothers who experience some type of Postpartum Depression.
Sometimes referred to as "Baby Blues", many women just feel sad, for no specific reason. One woman described it perfectly to me the other day, "I just wasn't me anymore." Some women feel upset, afraid, alone or unloving toward their baby, their partner, or both.

The Baby Blues
The Baby Blues is a period of more sensitive emotions - similar to that experienced in the first trimester of pregnancy - but accentuated with the exhausted and sleep deprivation of caring for a newborn. This occurs in approximately 50% of all postpartum women and may last from a few days to a couple weeks after delivery, peaking within 3-5 days of delivery. Symptoms of Baby Blues may include:

Crying for no apparent reason, or more easily than usual
Difficulty sleeping even when tired
Feeling irritable, or "on edge" emotionally

Baby Blues is a temporary state and is considered a normal part of the postpartum condition. This is not a weakness or a character flaw, it is not a sign of being a "bad mother", it is simply part of giving birth. Baby Blues is not related to stress or more likely to occur because of the mother's previous mental illness.
One of the key factors in determining if what the new mom is experiencing is Baby Blues or something more serious is Baby Blues will not interfere with the mom's ability to care for herself and her baby. Also, for most women the symptoms remain mild and go away on their own.

More Serious Than Baby Blues
For another 10-20% of mothers, Postpartum Depression can be more than just "Baby Blues", it can be a more severe form of emotional distress, sometime called Postpartum Non-psychotic Depression. This usually occurs within a few months of delivery. Risk factors include:

Previous major depression
Previous Postpartum depression
Psychosocial stress
Inadequate social support
Previous premenstrual dysphoric disorder

Symptoms of Postpartum Non-psychotic Depression may appear from 24 hours to several months after delivery:

Sad mood, frequenct crying; crying easily
Inability to find pleasure in things that were once pleasurable
Trouble sleeping, even when fatigued
Anxiety, extreme worry over the baby's safety or her own safety
Changes in appetite, either not eating or over-eating
Fatigue
Feelings of inadequacy as a parent
Decreased interest in sex
Inability to concentrate
Feelings of rejection
Suicidal thoughts or expressions
Inability to properly care for the baby

If you have postpartum depression, prompt treatment can help you receive help for your symptoms — and begin enjoy your baby. These symptoms should be taken seriously. If you have these symptoms, or a new mother you know has these symptoms, it is imperative that she see a health care provider for proper treatment.

The Most Extreme Cases
Rarely, an extreme form of postpartum depression known as postpartum psychosis develops after childbirth. This is the most serious of all the Postpartum Depression categories and usually manifests itself within three weeks of giving birth, but can last for much longer. Thankfully, it is rare, but it requires immediate attention. A woman with Postpartum Psychosis may have periods of seeming well, and may even appear to have recovered. Women who have thoughts of hurting their babies are more likely to act upon those thoughts if they are suffering from Postpartum Psychosis. If untreated, postpartum psychotic depression has a likelihood of coming back after the postpartum period and after the birth of other children.

If you have experienced any form of Postpartum Depression you need to know when to seek immediate help:

Inability to sleep more than 2 hours per night
Thoughts of hurting yourself or killing yourself
Thoughts of hurting your baby or other children
Hearing voices or seeing things
Thoughts that your baby is evil

What Will Happen When I Seek Help?
During an evaluation, you can expect your health care provider to ask you about your symptoms, what they are, how long they have lasted and how bad they are. It is important to be as truthful as possible to these questions. You will also be asked about any risk factors you may have for depression, such as a family history of mental illness, drug and alcohol usage, family, marital or financial problems. To help with your diagnosis, your health care provider may use the Edinburgh Postnatal Depression Scale. In this questionnaire, 10 questions help to indicate your probability of having postpartum depression.

How is Postpartum Depression Treated?
The plan of care for Postpartum Depression will depend upon the severity of your depression, based upon the answers you have given your health care provider. There may be several aspects to your care, including referral for psychological help, individual and/or group therapy, medications, marriage counseling, support groups and financial counseling. There are also some things which you can do to aid the therapies suggested by your health care provider.

Don't be afraid to ask for help, especially in caring for the baby
Surround yourself with supportive family members and friends
Take care of yourself.
Get as much rest as you can -- rest when the baby naps.
Try not to spend much time alone.
Spend some time alone with your husband or partner.
Take a shower and get dressed every day.
Get out of the house. Take a walk, see a friend, do something you enjoy. Get someone to take care of the baby if you can; if you can't, take the baby with you.
Don't set unrealistic expectations.
Don't worry too much about the housework. No one is a Super-Mom. Ask friends and family for help.
Talk to other mothers. You can learn from each other, and their experiences can be reassuring.

Untreated, Postpartum depression symptoms can continue for months or years. The illness can cause prolonged misery for the mother and her family, hinder bonding of the mother and baby and even be dangerous if the mother considers hurting her child or herself. Intervention and support are essential.

Other Support References Depression After Delivery

(800) 944-4PPD National Women's Health Information Center -
(800) 994-9662 Postpartum Support International (PSI) -
(805) 967-7636 American College of Obstetricians and Gynecologists Depression
After Delivery Postpartum Depression Postpartum Support International
http://www.mamalove.org
http://postpartumdadsproject.org/
www.postpartum.net

How Long Will it Last?

2011-11-28T23:19:00.001-06:00

I overheard this question being asked between two pregnant employees at work yesterday. They weren't talking about the length of their pregnancies, or even how long labor would last. They were talking about nausea.

NAUSEA AND VOMITING IN PREGNANCY

Nausea, and even vomiting, especially in the first trimester of pregnancy are two of the most common symptoms reported by pregnant women. Up to 85% of pregnant women report some degree of nausea with the first few months of pregnancy.

No one knows for sure what causes this nausea, although it is suspected to be caused by hormonal changes. Human chorionic gonadotropin, a pregnancy hormone, rises during the first trimester, as does the hormone Estrogen.

It is difficult to predict exactly when episodes of nausea will occur as well, although many women report feeling nauseated first thing in the morning. Hence the term, "morning sickness". This has led some to theorize the underlying cause of some nausea to be related to an imbalance in blood sugar.

For most women, the nausea and vomiting will subside after the first three months of pregnancy, however for some unfortunate women, it will continue for four or five months. A very few women will have nausea the entire pregnancy.

HOW TO COPE WITH MORNING SICKNESS

Many experts recommend not allowing your stomach to become empty. This doesn't mean you have to walk around with a full stomach, in fact, just the opposite is more helpful.

Try to eat frequent, very small meals. Carry some saltine crackers in your purse to nibble on. Keep them on your bedside table, too, to snack on during one of those middle-of-the-night trips to the bathroom.   This often helps prevent nausea in the morning. Avoiding heavy and greasy foods can also help to limit nausea and vomiting. Nausea can often be triggered, or made worse, by strong scents and smells, so it may help to avoid those. You may need to ask someone else to do the cooking for you for a few weeks.

Image via WikipediaIf you do become nauseated, you can try to suck on lemon drops, or lemon flavored candy. Some women have had great success with these. Ginger candy is also helpful.   Eating something salty, such as potato chips, may calm your nausea enough to allow you to eat a meal.

Don't forget to drink enough fluid to keep you well-hydrated, but you may want to limit the amount of fluids you actually drink with meals. Drinking before or 15-30 meals after, can help prevent nausea. Also, don't lie down immediately after eating.

If you experience severe nausea, so that you are unable to keep down fluids or any food at all, you need to contact your health care provider. If morning sickness lasts beyond the first thirteen weeks, or into the second trimester, tell your health care provider. There may be medications available which may help you to deal with the nausea and vomiting.

Avoiding Colds and Flu

2011-11-26T17:28:00.001-06:00

Cold and flu season is here. The best way to treat a cold or the flu when you are pregnant is to avoid catching it in the first place. Here are some simple suggestions to minimize your chances of catching a cold or the flu this winter:

Wash your hands -- Wash your hands often and keep your hands away from your face. This is one of the most important things you can do to prevent colds and flu.
Eat well -- eat a balanced diet and take your prenatal vitamins. Keeping your health level at it's highest will help you prevent infection.
Avoid crowded areas -- the more people, the more chance you will encounter someone with the flu or a cold.
Hit the sack -- getting adequate rest helps maintain a healthy immune system.
Quit smoking -- if you smoke, quit. This will boost your immune system and be better for you and your baby.
Work out -- regular exercise not only helps prepare your body for labor, but it will enhances immune function.
Roll up your sleeve -- get your flu shot!

For Your Family

2011-11-21T12:49:00.001-06:00

This post is not for the expectant mother, or even for the expectant father. It is for everyone else who will enter the room before, during or after the baby is born. So if you are the mother, send them this link and tell them I told you to!

Having a baby is an exciting an a stressful time for new parents and even those who have been through it before. Birthing a new baby not only brings a new little one into the world, it often births a new family: a new mother, new father, often new grandparents as well. Everyone is excited and a little nervous. Everyone in some way is concerned about how the day will affect them.

In over three decades I have seen families who deal with this stress and excitement well, and those who don't. I have a few tips for family members to help the day go easier and to help the new parents have an easier adjustment in their very stressful day.

JUST WHO'S THE MOTHER AROUND HERE?

It sounds cruel, but the first thing I have to say to every family member, be it the patient's mother, grandmother, the father of the baby's mother or grandmother (dad's just don't seem to have this problem too much): IT'S NOT ABOUT YOU!

This is her day. She is now the mother. She is the one having the baby. The doctor wants to talk to her. The nurse wants to talk to her. It really isn't necessary for you to be there at all unless she desires you to be there. And sometimes, she won't want you there -- no matter how much you want to be there. You do not have an inherent right to be in her labor room or in her delivery simply because you are "The Grandmother". I was not present in the birth of either of my grandchildren. I knew my son and his wife had a right to their privacy and to go through the delivery of their children without anyone else present if they wanted. The decisions the new parents make are theirs and should be honored with respect. Now, that was hard, but it is true. That being said, there are some things which can make things easier on the new parents, and easier on yourself if you prepare ahead.

TIPS FOR FAMILY MEMBERS

Don't get there too soon -- believe it or not we have often had family members make it to the hospital before the patient arrives. Labor is often a long process, there is not much need to get there as soon as she does. Often too, the nurses need some time without visitors for the admission process. It can stress the laboring mother to know she has visitors in the waiting room. She feels the responsibility of "hostess" and will try to make everyone as comfortable as possible. That unfair burden needs to be removed from her.
Make your visits short -- even if she seems comfortable, she is still in a stressful time. She needs as much rest as she can get. She will not rest if people are having conversations in her room. She will still be listening and trying to make sure everyone is happy.
Keep your visits quiet -- You will be happy and excited that your new little one is coming, but you never know what the patient in the next room is experiencing. She could even be in very pre-term labor and frightened of what the future holds for her baby! Keeping your voice low will keep your loved-ones room calm and will keep your voices from carrying to other rooms.
Don't eat in her room -- She may tell you it's fine, but if she can't eat, it is just plain cruel to eat in front of her. Not only that, nausea is common in labor and the smell of food may trigger nausea and vomiting for her.
Bring the new father food -- He can eat in the waiting room if he wants, but he shouldn't feel as if he has to leave to find something to eat. Take good care of him throughout the day and you will reduce her stress significantly.
Bring things to keep yourself and little ones occupied in the waiting room -- if there are small children present, bring plenty of things for them to do. Bring things to keep yourself occupied as well. Don't plan to store it all in her room, however, you don't want to be going in and out and in and out to get things. That is not only stressful, it's annoying.
Don't ask "what's taking so long?" -- even if you mean it as a joke, she has no control over the length of her labor and if it has been a while, she is likely to be concerned about that, Your question will only raise more concerns. That fear can actually hinder her body working efficiently and effectively. Be supportive, encouraging and loving.
Don't tell your horror stories -- No one in the room wants to hear how long you were in labor and how much it hurt, and she especially doesn't need to hear it. Don't tell her how badly she is going to hurt, either. The fear you cause in her will increase tension which will stimulate nociceptors to actually increase her pain levels. Follow the "Thumper Rule": if you can't say anything nice, don't say anything at all!
Don't wear perfume or cologne -- laboring women are sensitive to smells and very susceptible to nausea. Strong perfumes and colognes can trigger vomiting.
Don't smoke or eat strongly flavored foods before visiting -- for the same reason. If you must have those onions on that hamburger, use some breath mints before you visit.
Give privacy when privacy is due -- Please leave the room for exams or times when she is exposed. Even if you will be present during delivery, please give her all the privacy you can. If you are her mother, you may remember changing her diapers, but she doesn't. You would want the same privacy if you were disabled and she were caring for you.
Listen to the nurse -- She may look young, but she wouldn't be where is is if she didn't know what she was doing. Things aren't done the same way they used to be done. Listen to her, she can tell you what to expect and why hings are happening the way they are.
When it's time to go, go - After the baby has arrived, keep your stay short. The new parents will need their sleep. They will not sleep as long as they have visitors and in their mind anyone who is not the baby is a visitor.
Ask her permission before you video, take pictures or put posts on facebook --no explanation needed!

These tips come, not from my own observations, but from the hundreds of times I have had a patient turn to me after a family member has walked out and say something like one of the above items. I hope they will help you to reduce some of the stress and anxiety that comes with having a new baby. It is a wonderful time in your life, enjoy every minute!

Induction of Labor

2011-11-18T16:38:00.005-06:00

I can't believe I haven't written on this subject before. The daughter of a friend of was being induced today. I wanted him to read about induction of labor and then realized I had never written about it!

According to ACOG, the American College of Obstetricians and Gynecologists, induction of labor is the use of medications or other methods to bring on (or induce) labor. Labor is induced in about 20% of women in the United States. The American Association of Family Physician sites the rate as between 9.5 and 33.7%, depending upon the area. Obviously, in some areas there are more inductions and in others there are fewer.

The same methods can be used to speed up labor if it is going too slowly, but this is usually referred to as augmentation, instead of induction of labor.

REASONS WHY LABOR MIGHT BE INDUCED

Labor might be induced if conditions exist which put your health or the health of the baby at risk. For the health of some women, having the baby is safer than continuing with the pregnancy. For the health of some babies, the environment outside the uterus may be safer than the environment inside the uterus. Reasons for inducing labor may include one or more of the following conditions:

The pregnancy has lasted more than 42 weeks, or is postterm
The mother has pregnancy-induced hypertension
The mother is a gestational diabetic
There is an infection in the uterus
The mother has premature rupture of membranes (meaning the water has broken several hours before labor has begun)
The baby's growth rate has slowed down considerably and is now considered IUGR
The level of amniotic fluid is significantly decreased, called oligohydramnios

There may be other reasons for inducing labor. For example, occasionally a woman may be induced if she lives a long distance from the hospital or if she has a history of very rapid labors.

HOW DOES MY HEALTH CARE PROVIDER DECIDE I NEED INDUCTION?

The decision for induction is based upon the need for induction, such as the factors listed above, as well as how far along your pregnancy is and the status of your cervix. Unless there is a significant risk factor or problem, labor is not induced before 39 weeks of pregnancy.

WHAT DOES MY CERVIX HAVE TO DO WITH IT?

Labor is the process by which contractions of uterus thin out and open up (or dilate) the cervix so that the baby can pass through. At the end of pregnancy, hormones cause the cervix to become soft and able to thin out during labor. This is called "ripening". A health care provider may often refer to a cervix that is not yet soft as being "green", like a piece of un-ripe fruit. If the cervix has not yet "ripened", it will not be conducive to the induction agents used.

If your cervix is not favorable for induction, your health care provider may decide to use an agent to help ripen your cervix. There are dilators which can be inserted into the cervix which mechanically soften it. There are also certain medications which can be used.

Prostaglandins are drugs that can be used to prepare the cervix for labor. They are synthetic forms of the same chemicals produced naturally by the body. They can be inserted into the vagina or taken by mouth.

A way of causing your body to release prostaglandins is called Stripping the Membranes. During this procedure, your health care provider checks your cervix with a gloved finger. He or she sweeps the finger over the thin membranes that connect the amniotic sac to the wall of the uterus. After this is done you may notice some cramping and may even have some spotting. The release of prostaglandins this causes can result in a softening of the cervix. It can also cause contractions. This is usually done in the doctor's office, or in the hospital.

INDUCING LABOR

Rupturing of the Amniotic sac is a way to attempt to start contractions. Your health care providers can make a small opening in the amniotic sac during a vaginal exam. It is important to stay as relaxed as you can during this exam to minimize any discomfort. This is usually done only after the baby's head has moved down in the pelvis. Most women will begin contractions within a few hours of the rupture of membranes.

OXYTOCIN

Perhaps the most common form of artificially beginning contractions is the use of oxytocin. Oxytocin, or also called Pitocin, is a medication used to induce labor. It is a synthetic form of the same hormone produced by the pituitary gland in laboring women. It can be used to induce contractions, or to increase the strength of contractions.

Oxytocin is administered into your vein through an IV. A pump will control the amount that is given. In most instances, Oxytocin is started off very slowly and increased at regular intervals to mimic natural labor. Your contractions will be monitored carefully to make sure they are not lasting too long or coming too close. If that should occur, the rate of the Oxytocin drip can be adjusted.

WHAT ARE THE RISKS OF INDUCTION OF LABOR?

Image via WikipediaEvery intervention has some risk factors, even those that seem the most benign. Although problems rarely occur with inductions, there can be increased risks. These may include:

Changes in the fetal heart rate
Increased risk of infection (which is true anytime you have an IV)
Overstimulation of the uterus (contractions too close, or lasting too long)
Umbilical cord problems, (Labor induction increases the risk of prolapsed cord - the umbilical cord slipping into the vagina before delivery, which may compress the cord and decrease the baby's oxygen supply)
Uterine rupture - a rare but serious complication in which the uterus tears open along the scar line from a prior C-section. An emergency C-section is needed to prevent life-threatening complications.

To avoid the problems, the fetal heart rate will be monitored continuously. The duration and frequency and force of the contractions will also be monitored.

WILL I BE MORE LIKELY TO HAVE A CESAREAN SECTION?

There are conflicting studies on this question. The answer for this is partially because of the great number of women who are induced also have risk factors which would predispose them to a Cesarean Section. For example, a mother who has oligohydramnios, or a low level of amniotic fluid, may experience more fluctuations of the fetal heart rate during labor due to the compression of the umbilical cord by the contractions.

A study done by Ochsner Clinic of women who had previously given birth, who were being induced for subsequent babies, showed there was little difference in the Cesarean Rate for those who were induced and those in the control group. When women who have never had babies before are added into studies, then the risk of having a C-Section appears to increase. The key factor is the favorability of the cervix prior to the initiation of the induction agent. The more favorable the cervix, the greater the likelihood of a vaginal delivery.

CONCLUSION

The decision of whether or not to induce labor must be made between you and your health care provider. All risk factors of mother and baby, the risks of the procedure as well as the perceived benefits must be discussed.

Be sure that you ask questions, and that you understand the answers fully. Don't be afraid to say you didn't understand. If you feel as if you need time to "think it over", ask if you can take that time.

The majority of inductions occur each day in our country without any problems. If you decided upon an induction, throughout the process you can ask your nurse any questions that might arise. She will be happy to keep you informed of your progress, the process and your baby's status.

Keep in mind the goal of a healthy mother and a healthy baby and look forward to being a mother!

The Physics of Labor

2011-11-14T18:03:00.000-06:00

I had a sweet couple the other night whose labor reminded me of the physics involved in the work of labor.

Although she was only 2 centimeters dilated when she was admitted, her cervix was paper-thin and her contractions in a close, regular pattern. I had a feeling she would go quickly and she did, mainly because of physics.

The cervix, the opening to the uterus, begins thick and closed. The first action it takes, before ever opening up any appreciable amount, is to thin out, or efface. The muscles of the uterus pull upward toward the top and this pulls on and effaces the cervix.

A woman will usually be 90% or more effaced before she begins to dilate any significant amount. With a first baby the cervix will efface as thin as a piece of paper. Never again will the cervix be this thin.

Image via WikipediaThe action of the uterine muscles pulling upward on the cervix is similar to that of putting on a turtle-neck sweater. Most people don't begin by pulling open the turtle-neck as wide as they can and then pulling it over their head. No, they pull the sweater over their head and let the neck portion rest on top of their head, thick and closed.

As they pull the fabric of the sweater from the bottom, the neck portion gradually thins out. Once the neck has thinned out as much as it can, then the opening will begin to open up more and more and begin to slide over the person's head, until finally, their head slides through.

This is the same mechanism for labor. The uterine muscles pull on the cervix, as the baby's head, pressing against it, help it to thin out. Then when the cervix is as thin as it can get, it begins to dilate, or open up, more and more until the baby finally begins to descend through it.

While it is possible for woman who has had several babies to have a cervix that is still thick and dilated at the same time, that is not due to dilation as much to the elasticity of the cervix that multiple labors has caused, much like the stretchiness of a balloon which has been blown up over and over again.

When in labor, it is important to remember that progress in any number -- dilation, effacement or station, is still progress -- especially in early labor. Don't be discouraged if those first early exams only show changes in effacement, those are necessary before the big numbers in dilation can be made possible!

Emma

2011-09-14T09:00:00.000-05:00

From the book, "Memories of Miracles", in honor of our granddaughter's birthday:

Chapter 17
Emma

I had stood at bedsides before and watched preemie babies grunt like this. Many, many times in fact; but this time was so very different.

This was my granddaughter.

I looked at that little face and saw shadows of myself. Each grunt and groan she uttered ripped at my heart. I wanted so much to pick her up, breathe for her, somehow make it all better, and all the while cry my eyes out. But I wasn’t just Grandma, I was also Mom and I was also Nurse. I felt the need to show strength and calm; to show optimism and hope.

I went back to my son and my daughter-in-law and began to explain the problem with Emma’s breathing. Born almost four weeks early, she didn’t have enough of the surfactant in her lungs to make the air sacs slippery so she could close them easily. Along with that, she had a good deal of amniotic fluid in her lungs. She could breathe in well, but she had to use extra muscles to breathe out, which caused the grunting and groaning. As hard as she was working to breathe, she may tire out and then she would need extra oxygen to keep up the oxygen levels in her blood. Their faces were grim as I explained it all and I felt like the wicked witch who had just come in and stolen their precious dreams and hopes. I tried to prepare them for the next step that I knew, by watching Emma, was almost inevitable. I explained the oxyhood, the IV, the antibiotics – everything that I could think of that would be done. Oh, I had given this speech dozens of times to parents, and I don’t think with any less caring or consideration, but with much less wrenching of my heart at their expressions, their tears, their sadness.

I didn’t tell them all I knew.

I knew that if her oxygen was turned up to a certain point, the Neonatologist would be called. I knew that if she had to have high levels of oxygen, she would be entubated and put on a ventilator. I knew that would mean she would be transported across town to the University hospital to a higher level neonatal intensive care unit. I knew there were so many things that could happen. But I wasn’t going to let my mind go down that road. I was going to keep my mind on where Emma was right now and pray, pray, pray. Because I also knew the one Person to whom I was praying cared and could make Emma better.

Emma did go under the oxyhood and stayed there for two days. When Aimee and Noah first went to the nursery to see her, it absolutely broke my heart. I had showed them a picture of her under the oxyhood before we went to the nursery, so they would not be surprised at how she looked, and they cried then. But when they saw her for themselves, Aimee broke down in tears. Noah, too, was wiping his eyes. I stood behind and to the side of them and it was all I could do to not collapse into a heap of tears. One of the nursery nurses came to me and put her arms around my shoulders and hugged me. It was so hard, seeing Emma’s suffering and seeing their suffering, for her. Since then I have often thought how much God the Father must have hurt having to watch the Lord Jesus suffer for our sins. The parent suffers doubly when the child suffers

When Aimee started to leave the nursery, to go to her room, I went to hug her and she started to sob. I could contain my tears no longer and I cried with her. I think every nurse in that nursery had tears in their eyes. The L&D nurse with Aimee told me later, it was all she could do to not start crying herself.

Emma’s progression was short compared to that of many preterm babies. By Sunday night she was off oxygen. She started to eat, and like all Davis’, she did that exceptionally well. By the next Saturday, she spent her first night at home.

As happy as I am that she is home, where she belongs, I am sad too. I have enjoyed stealing away every free minute at work to go to the nursery. The first few days I could only stand there and look at her, or touch her hand and gaze into that perfect, tiny face. And I was perfectly content to do that minute after minute.

Then later, as she got better, I could hold her, or feed her. Sitting there, with her in my arms, held a sweetness that can’t be captured in any other way. I will miss that each day, as if a sweet, little friend has moved away.

"Delight thyself also in the Lord;
and He shall give thee the desires of thine heart."
Psalms 37:4

Remembering September 11th

2011-09-11T06:00:00.000-05:00

From the book, "Memories of Miracles", a story about September 11th:

Chapter 4
Love and Joy from Fear and Terror

The two days could not have been more different, but they are linked in my brain by one simple thing, the date...September 11th.

I would never have imagined the memories of horror and fear of September 11, 2001 could be transformed with those of love and joy a year later, but because of the grace of God and the faith of two young parents, that is exactly what happened.

The morning of September 11, 2001 started much like any other morning. Patty was in labor and even though the baby was five weeks early, things were going well. Patty watched TV as I watched the fetal monitor.

In the quietness of the labor room we listened to the "whoosh, whoosh, whoosh" of Image via Wikipediathe baby's heartbeat and the steady drone of the television program. Suddenly, breaking news reports flashed on the screen. Our eyes were riveted to the screen in horror as planes crashed first into the Twin Towers and then the Pentagon. Later we watched as the Towers collapsed to the ground.

I struggled to keep my thoughts on the fetal tracing in front of me. More than anything I wanted to hear my husband's voice, which never failed to calm and reassure me. Patty was progressing far too rapidly to afford the luxury of a phone call, though

My thoughts flew also to Camp LeJeune, North Carolina. My son was there for the School of Infantry with the USMC. Would they pull them out of training for deployment? Could he already be on a ship to who knows where?

I thought too, of my niece who worked in New York City and of her brother who worked at a law firm near the White House. Were they safe? How would one possibly contact them in all this chaos? I thought of calling my sister, but I knew she would have no information and my concern would only amplify her own.
I didn’t sit idly as these thoughts ran through my mind, but was busy turning on a baby warmer, setting out perineal prep, and preparing warm baby blankets. While my hands and feet moved rapidly to set the final stage for delivery, my mind and heart ached for all those unknown to me whose lives had been shattered by terror.

Then, as if in a daze, we delivered this baby. The joy and happiness, which normally surrounds this event, seemed so inappropriate with the images of horror so fresh in our minds, which were still visible on the television. I found I could not sing "Happy Birthday" to this little one, as I usually did, because I felt anything but happy.

Immediately upon placing the baby on the warm blankets, I realized the mood of the room would not be improving. The baby’s nostrils flared, his chest sunk deeply, the space between his ribs deepened dramatically, and he grunted with each breath.

Preterm babies make a rhythmic, grunting sound when they are struggling to close the tiny air sacs in their lungs. This is because they are using accessory muscles to close those sacs not yet pliable, due to a lack of a substance called surfactant. While parents often think this sound is cute, Labor and Delivery nurses know this grunting is a sign of poor transition of the baby to life outside of the womb. As I listened to this little boy, I watched his retractions continue without improvement. I quickly foot-printed him, applied his identification bracelets and wrapped him up. After a quick kiss from Mom, I took him to the Special Care Nursery, where he stayed for several days.

When I returned to the mother, she said, "I should feel so happy today, but I just feel so sad." She had drawn out the last word until it alone expressed all of our attitudes. I tried to reassure her that her feelings were valid. Not only had she witnessed the brutal murder of thousands of people, but also I had whisked her son out of her presence with hardly a "hello.” Apart from those deliveries where there had been loss of life or severe anomalies, it was the saddest delivery I had ever witnessed. Never will I forget the events of that morning or the cheerless, quiet delivery of the mother with the grief stricken face.

A year later, I was amazed we even had any cases scheduled for 9/11. Who would choose this date for the birth of their baby? What memories would always be associated with this child's birthday? Yet, here they were, pillows and suitcases in hand, ready and anxious to have their baby. They were not strangers to me either; they had been in my six week childbirth classes.

Their class had been my favorite in twenty-one years of childbirth education. It had been a big class and these couples had so bonded with each other and with me, I think if I had let them, they would have continued to meet each Monday night long after the classes had finished. We all laughed together, cried together, and then laughed together again. It was the best teaching I had ever done and the best group of couples I ever had the pleasure to teach.

I was thrilled to be a part of this couple’s special occasion and looking at them; I smiled my first real smile of the day. As I admitted Joan and she settled into bed, she told me many of her family and friends had suggested she change the date of her induction from 9/11. Her response to them changed my outlook for the whole day.
"I thought the best way to thwart the terrorists," she said, "is to bring love and joy and laughter to this date."
What a glorious thought! What a glorious day! This time I sang "Happy Birthday" to their gorgeous little daughter with a heart full of joy.

As September 11 rolls around each year, I remember those lost in the horrible tragedy and those brave fire fighters and police officers who died trying to save them, but I also remember something else. I remember two smiling joyous faces and the daughter they love, destined to bring love and joy out of terror and fear.

"Weeping may endure for a night, but joy cometh in the morning."
Psalm 30:5

Much Ado About. . .Mucous

2011-06-14T12:33:00.002-05:00

I have often found it interesting how often questions arise regarding the "mucous plug." For something to have so little actual obstetrical consequence, it generates incredible maternal attention.

JUST WHAT IS THE MUCOUS PLUG, ANYWAY?

The mucous plug is exactly what it sounds like. Formed by secretions of the mucous glands of the cervix, it is a plug of mucous which seals the cervix. This prevents bacteria from entering the uterus during pregnancy.

WHEN DOES THE MUCOUS PLUG COME OUT?

Although pregnant women often focus a great deal of attention on the possibility of "losing their mucous plug," rarely does the plug come out in one large lump of mucous, although that can occur. It is much more common for the mucous to be expelled gradually and slowly over time. It may happen so slowly, in fact, that the pregnant woman never even notices it.

WHAT DOES THE MUCOUS PLUG LOOK LIKE?

Well, to be honest, it looks like. . .mucous. The texture and color may be very similar to what would come out of your nose if you had a cold. The mucous may be clear, white or yellowish; it may even be pinkish or lightly tinged with blood, due to the changes in the cervix late in pregnancy. The mucous may be thick or thin, it may even be watery.

WHAT DOES IT MEAN WHEN IT COMES OUT?

In general, nothing. It might mean -- depending upon the softness and thinness of your cervix -- that you might go into labor within the next two to four weeks. But a vaginal examination or even intercourse can also disturb the mucous plug.

Loss of the mucous plug is NOT a sign of labor, even though you might read that in some places. It does not mean that the onset of labor is imminent, even though you might read that as well. It simply means that the mucous had released from the cervix and is a normal occurrence late in pregnancy.

WHAT SHOULD I DO ABOUT IT?

Basically, nothing. Unless you have signs of labor -- progressive contractions, or your membranes have ruptured; or you are having heavy bleeding for which you need to call your health care provider, you can just relax. Losing your mucous plug is a sign your body is working as designed. There is nothing you need to do -- or NOT do. Go about life as normal, as your health care provider has instructed you and look forward to the arrival of your new little one. Image via Wikipedia

CONCLUSION

I once heard a seasoned nurse tell an anxious patient in false labor "Labor has a way of declaring itself." This is such a true statement. But when pregnant, we all sit on pins and needles waiting for that first sign that labor is starting. Instead, take a deep breath and relax. Labor usually begins when you least expect, or sometimes at the most inconvenient moment. Let nature take it's course and don't pay any more attention to your mucous plug than you would the mucous when you blow your nose.

Natural Childbirth

2011-04-27T08:15:00.000-05:00

I have never run a marathon. Actually, I have never run much at all. I have done a few very slow jogging miles which would better be termed slogs considering the pace at which I was traveling.

If I were to run a marathon, though, I think I would at least purchase some running shoes. Perhaps I would also invest in some proper attire for the expected weather conditions. I would most likely read some about marathon running. Oh, and I might run a few miles first.

I say this because I am always surprised when patients come to the hospital in labor, planning on "natural childbirth", or planning on using no medication or anesthesia whatsoever, and yet have not prepared for this momentous event in any fashion.

I admitted one such couple this past week. The mother was in active labor, already 4 centimeters dilated when admitted, and was in obvious pain. Her husband's powerlessness to help her was as obvious as her pain. I asked if they had gone to childbirth classes.

"No, we didn't have the time," was the response.

I asked if they had read any on childbirth breathing techniques or ways to help deal with labor. Again, the answer was "No".

Choosing to face labor without medication or anesthesia, especially a first labor, without preparing in any way to deal with the pain of the contractions, would be like choosing to run a marathon without ever taking the first step of running beforehand.

If you are contemplating, or choosing to, approach your labor without medication or anesthesia, there are some ways to prepare yourself:

Attend childbirth classes. Most hospitals and birthing centers offer childbirth classes for free or for a minimal fee. If you don't find one associated with the hospital of birthing center where you plan to deliver, attend one from another site in town. Even if all the information isn't as accurate, the basic information on childbirth, breathing techniques and relaxation will be helpful.

If you have attended a childbirth series and felt the information did not help prepare you for your labor experience, search for independent childbirth instructors in your area. Often these might have the name "Lamaze" or "Bradley" in the title.

Read all you can on natural childbirth techniques. The hallmark techniques of natural childbirth are breathing techniques, relaxation and partner participation -- often in the form of massage.

Practice the techniques you learn daily. Labor is no time to be deciding which techniques work best, or which the mother prefers. Practice until you know them by heart. Practice until you feel very comfortable with them and feel very relaxed doing them. It will be more stressful with the pain of contractions.

Discuss together what you perceive as your roles throughout childbirth. Be open and honest about what you would like and wouldn't like, what you would feel comfortable with and wouldn't feel comfortable with. Labor is not a time to be having a heart-to-heart discussion about what to do.

You may also want to prepare a bag of tools to help you along the way. Things that can often help during labor include:

Music -- whatever makes you relax and feel good. The more soothing the music, usually the better.

Scents -- in the form of scented lotions, sprays, candles (if allowed). Scents can add a peaceful feeling to the room and aid relaxation.

Massage tools --tennis balls, lotions, any number of items available at your local massage or lotion shop, can help make massage easier to give and more enjoyable to receive.

Temperature --ice packs and hot packs can be used in various places to help encourage relaxation and to reduce soreness in muscles.

General comfort --simple things such as lip balm, a hairbrush and contact solution and container can be big tools in labor. Remember to toss in a pair of socks, pony-tail holders and any other thing you think might help to make the mother (and father, too) more comfortable along the way.

Natural childbirth can be a rewarding experience, but more so for the couple who has prepared in advance and is ready to face the experience. Don't be caught off guard, don't wait until the last minute to prepare. Have everything ready well before you think you will need it, and practice more than you think you should.

With proper preparation, you can increases the chances of having your labor experience be all you have dreamed it would be.

A Tribute to a Wonderful Obstetrican

2011-04-26T11:15:00.002-05:00

We could always tell he coming down the hall as the whistling of some Jimmy Buffet tune would precede him by several seconds. Whistling was such a hallmark of his, and such a habit of mine, that often I would turn a corner and find the nurses had been expecting to see him instead of me.

He was of the "old school." He believed in assessing the patient with your hands, your eyes, your ears. . .not with machines. More than once he would ask a new nurse how strong the patient's contractions were and when she pointed to the fetal monitor, he would shake his head, take her hand and place in on the uterine fundus. "Here is how you tell how strong the contractions are!"

The machine he disliked the most was the computer. He felt it had no place in the labor room, in the operating room, well, let's face it, I don't think he thought it belonged in the hospital at all! While he eventually acquiesced to using them, he always maintained computers didn't make everything quicker and easier for everyone, some people just seemed to be faster with pen and paper. He was one of them.

His patients, without fail, loved him. He had a way of caring for them that like a kindly uncle or a substitute father. He cared about the patients and their families. He wanted to know who everyone was in the room.

That isn't to say he didn't "tell it like it was." He did. to everyone: patients, family members, nurses, administrators, anyone within earshot. You never knew what story, what description, what exclamation was going to come out of his mouth. But somehow you knew, even if he was passionately complaining about something, that the source of it underneath was a genuine caring.

I saw that caring time and time again, not just to patients, but to our nurses. He would put a fatherly hand on the shoulder of a nurse on orientation and ask her how she was doing, and it was obvious he was truly concerned. Nurses who might be out sick for a while would find him asking if they were "doing ok now?" when they returned. He cared for us when we were sick and he cared for us when we were sad, when others might have just walked on by.

He was the very best, the very best, at watching a questionable fetal heart rate tracing. He was never quick to jump in to operate. He would sit at the patient's beside (which was reassuring to both the patient and the nurse) and watch that heart rate. He would sit and watch and wait and watch and wait. He would explain to everyone in the room how the baby's heart rate resolve if we would give it some time. Never, never did I see him be wrong.

He was a unique physician, a unique man, and it will be so difficult to be at work and not hear that whistling down the halls. We will miss that heart of song and smile of joy. . .

Benjamin Robert Busbee, MD

IUGR -What Is It and What Does It Mean To My Baby?

2011-03-29T13:03:00.005-05:00

IUGR, or Intra-Uterine Growth Restriction is a condition in which the fetal weight (as determined by ultrasound) is below the 10th percentile for gestational age. Some may also call this fetal growth restriction.

HOW IS IUGR DIAGNOSED?

One of the most important things when attempting to diagnose IUGR is to ensure accurate dating of the pregnancy. Because the appropriate fetal weight is based on the length of the pregnancy, the duration of the pregnancy in question must be known. Once the estimated gestational age (or EGA) of the pregnancy has been established, the current fetal weight can be estimated by ultrasound.

Perhaps the first indication of possible IUGR would be a fundal height that does not correlate with gestational age. At each prenatal visit, your health care provider measures from the pubic bone to the top of your uterus (called the fundus). If this measurement measures substantially lower than expected, (a lag in fundal height of 4 cm or more is suggestive of IUGR), your health care provider may decide further testing is in order.

Ultrasound biometry is the standard for assessing fetal growth. The diameter of the baby's head, the circumference of the head, the baby's abdominal circumference and the length of the baby's femur (the large bone in the upper leg) will all be measured. Percentiles have been established for each of these parameters and an approximate fetal weight can be calculated from these measurements.

Another important measurement taken during the ultrasound will be estimating the amount of amniotic fluid present. Decreased amniotic fluid volume can be associated with IUGR. Health care providers prefer to see an amniotic fluid index of greater than 5 centimeters.

WHAT IS THE TREATMENT?

If the baby is considered to have IUGR, serial ultrasounds are important in monitoring the growth restriction. Each case must be individualized according to the degree of growth restriction, any complicating or underlying maternal factors and the fetal gestational age.

If the baby is 35 weeks or greater, many health care providers may recommend induction for an early delivery, although some may prefer to wait as long as 36 weeks if there are no other precipitating factors.

If the baby is less than 35 weeks, many health care providers will continue monitoring unless other precipitating factors present themselves. Monitoring during this time might include serial ultrasounds, level of amniotic fluid and external fetal monitoring of the fetal heart rate. If at any time any of these parameters becomes a concern, immediate delivery may be indicated.

You will likely be seeing your health care provider at least every 2-3 weeks until you deliver. If it is suggested to deliver prior to 34 weeks, your health care provider may request to perform an amniocentesis to remove a small amount of amniotic fluid to evaluate fetal lung maturity.

WHY DOES IUGR HAPPEN?

In some cases, no underlying reason is ever found. Pregnancies with any of the following conditions, however, may be at a greater risk for developing IUGR:

Maternal weight of less than 100 pounds
Poor nutrition during pregnancy
Chromosomal abnormalities
Alcohol, tobacco and drug use
Pregnancy-induced hypertension
Placental abnormalities
Multiple pregnancies
Gestational diabetes
Oligohydramnios, or low levels of amniotic fluid

WHY IS IT IMPORTANT TO DIAGNOSE IUGR?

Identification of IUGR is crucial, because for those babies, proper evaluation and management can result in a favorable outcome. Fetal growth restriction is the second leading cause of perinatal morbidity and mortality, followed only by prematurity. Occuring in about 5% of the general population, the risks to a baby born with IUGR can include:

Increased risk of Cesarean delivery
Increased risk of hypoxia (lack of oxygen)
Increased risk of hypoglycemia (low blood sugar)
Increased risk for motor and neurological disabilities possibly related to the increased risk of preterm delivery

CONCLUSION

During pregnancy, try to provide your baby with the best environment in which to grow.

Provide the best nutrition for you and your baby that you possibly can. Avoid any harmful substances, such as alcohol, tobacco and drugs. Make sure to keep all your visits with your health care provider so that those important measurements can be taken at each visit.

Keeping yourself healthy during pregnancy can go a long way toward helping your baby have a healthy start as well.

Unexpected Outcomes

2011-03-14T20:02:00.004-05:00

We all approach Labor & Delivery with expectations of a happy and healthy delivery and the eventual outcome of a beautiful baby and thriving new family. This is true not only for the new parents, but for those who care for them as well.

Unfortunately, sometimes things don't go according "to plans". Sometimes complications arise which could not have been anticipated, or prevented, which preclude that "happy" or sometimes even, "healthy", outcome.

Sometimes the things that don't go according to plans may be simple and small, like the new father who forgets to bring the camera to the hospital. While this may seem small, but for the new father who envisioned his primary role in labor as the photographer, or videographer, not having that piece of equipment can bring a great sense of disappointment and let-down to his experience. I actually had a delivery where this occurred and the laboring mother scolded the dad for being disappointed. I could see however, that for months this man had looked forward to this very thing and in their haste to make it to the hospital, the video camera had been forgotten.

Sometimes the things are not quite as simple as that. Perhaps an epidural that never quite seems to make the mother completely comfortable. For the couple who had been promised a labor of relative ease, this can significant change their attitude and perception of the day and the events. Telling them to think about their baby won't help erase the disappointment they are experiencing.

For the patient who desires to go totally without interventions or medications and then finds it necessary, in spite of their plans, to have a Cesarean Section, the disappointment and grief afterward can be quite severe. Some patients have even been diagnosed with Post Traumatic Stress Disorder afterward.

Then there are those cases where the unexpected outcomes are very big. Perhaps the baby is very ill, is born with unexpected anomalies, or perhaps there is even the loss of the baby. Although "fetal demise" as health care providers term it (perhaps to help them stave off grief until a later time) doesn't happen often, it does still happen.

It is important when handling disappointment and grief related to labor to approach it the same way you approached the expectations of delivery, together. Each partner needs to allow the other to express their emotions in the manner which is most consistent with their character. Some people are very vocal and open with their emotions. They cry easily, perhaps even loudly. Others are very quiet and stoic. It does not mean that the person who is more vocal feels more strongly than the person who is more quiet. These are just personality difference.

Most people at some point of grieving will experience times of anger. The anger may not be directly related to the event or those around the event. It may be directed to their partner or other family members. Anger is a normal part of the grieving process and must be dealt with for closure to occur.

Some people will begin to question themselves regarding the situation. "If I had only done this", or "If I hadn't done that", are normal thoughts and expressions of the grief process. These too must come and go for the person to find healing of their grief.

If you have experienced perinatal loss, which includes the loss of a pregnancy or a newborn, please seek a perinatal support group in your area. You and your spouse will find the help, comfort and encouragement of those who have walked the path before you invaluable. If you don't have a support group in your area, here is a website that is a great place to start: http://www.griefwatch.com/.

Remember, you do not need to go through this alone. There is help available for you. Speak to your health care provider, call your local Labor & Delivery unit or contact your clergy, but talk to someone. Grief should never be shouldered alone.

The Labor Bag

2010-11-12T04:56:00.050-06:00

Getting a good night’s sleep in pregnancy.

How to know when you are ovulating.

Exposure to viral infections during pregnancy.

Great stretches for pregnancy.

What to expect from doctor’s visits.

Spotting during pregnancy.

A cute video of real men changing diapers
(you want to see this!):

The Unexpected Delivery. . .

2010-11-10T07:56:00.001-06:00

From chapter 12 of the book, Memories of Miracles:

Sometimes the unexpected part of the delivery is something that would normally be routine. That was the case when Leteisha came in to deliver.

Image via WikipediaShe had a C-Section with her first baby and had been told she would need one again with this pregnancy. She came into the unit late one night in early labor. After notifying her physician, we did everything to prepare for her repeat C-Section, but while we were prepping her, another woman came in for her physician. This woman was pregnant with her fifth baby and her labor was progressing rapidly, so the physician decided to do Leteisha's C-Section after this woman delivered.

It was during this delay we heard the blood curdling scream. Each nurse ran in a different direction trying to find the woman who had produced that terrible sound. It didn't take long for me to discover what had happened.

I ran into the Labor Room closest to me and through the open door I could see the woman from the adjoining room sitting on the toilet, rocking and moaning. On the floor was her foley catheter, the tube placed in the bladder used to keep the bladder empty and out of the way during surgery. It was on the floor with blood splattered all around and the golf-ball sized balloon filled with sterile water (used to hold the catheter in place) still intact.

Obviously Leteisha had forcibly yanked out this catheter, thinking it was the source of her pain, causing the scream we had heard. It only took one glance for me to know that the catheter wasn't the only source of her pain. As the next contraction started, I could just barely see the top of the baby's head poised over the toilet. I knew I only had two minutes or less before the next contraction came, and the baby with it.

I tried asking Leteisha to walk back to her bed, but she was so frightened and in so much pain, she wasn't listening to anything I said, so I had to lift her off the toilet.
Now that I had her off the toilet I had to somehow convince her to walk, and all the while the seconds were ticking away. Any moment the next contraction would start, and no matter what her position, I would be delivering this baby.

I half carried, half dragged her into her labor room and toward the bed. but when we got there, both side rails were up! She had climbed over the side rails, in active labor, with a catheter and an IV to get to the bathroom!

How was I going to get her back in bed? If I let go of her, she would collapse on the floor, and most surely deliver there. I couldn't let the rail down with one hand, I needed one hand to release the latch and one to push the rail down. The seconds were still ticking by -- the next contraction could be starting even now. So I did what any nurse would do...I screamed, "I NEED SOME HELP,NOW!"

The anesthesia resident, who had been sitting just outside the door, waiting for the C-Section, rushed in. He put the side rail down, helped me pick up Leteisha and put her in the bed. Then the next contraction started. As the head began to crown, he grabbed a pair of gloves to deliver the baby. In a matter of seconds Leteisha was holding a squirming, crying little boy.

I had to laugh as the anesthesia resident came to me with his anesthesia papers in hand and asked, "How do I write that I went from doing a C-Section pre-op, to delivering the baby?" Obviously, this vaginal delivery was something none of us had expected.

2010-10-30T23:39:00.000-05:00

What you need to know about Cord Blood Banking.

Choosing the best diapers for your baby.

Get the scoop on baby-poop.

Pacifier do’s and don’ts.

Info about home pregnancy tests.

Relaxation for childbirth.

Helping a dog prepare for the arrival of your new baby:

2010-10-23T23:44:00.000-05:00


Tips on picking out a stroller.	Baby books, memory keepsakes and sibling gifts.


Weight gain during pregnancy.	Traveling during pregnancy.


Create a personalized photo album of your baby’s special day.	Is intercourse okay during pregnancy?


How much protein do I need when pregnant?	How to store and freeze breastmilk.

Medela Freestyle Breast Pump: