Well Rounded Birth Prep

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Monday, May 20, 2013

Teen Questions About Birth & Our Bodies: Part 2

I had the privilege this week to be a guest speaker in a high school biology class this week, to teach on the topic of birth. I only had 50 minutes, so I really had to condense to the basics. My normal class series for pregnant couples is 12 hours of class time, and I really could use more time than that! So keeping it to "just" 50 minutes was really a challenge!

Since this was the first such class I had taught, I misjudged my timing and ran out of time for questions. I'll try to do better if I have another such opportunity in the future. Fortunately, the teacher had the students write up questions for me before the class, andI brought those home with me to answer here on my blog.

I ask that if you are under the age of 18 and reading this blog, especially if you go to the school where I spoke, ask your parents' permission before proceeding. I am comfortable discussing any of these topics and teaching from an honest, evidence-based, and God-honoring perspective about the incredible design of our bodies, but I do not want any angry parents calling or emailing me or the school.

Here are the teens' questions, continued. Part 2 will be just on cycles and fertility. (Here is the link to Part 1.)
  • "Why is it when you find out you're pregnant, you don't have your period like you normally would?" "Ask about periods (All of the period)." "Can you explain ovarian menstrual cycle?" "Discharge?" "What is estrogen?" "Birth control?"
These are great questions, and I'm glad they were brave enough to ask. Since these questions are all interrelated, I'll try to segue my answers. I'd really love to do a detailed class specifically for teens and young 20's about menstrual cycles, but it would require a permission slip, for certain.

I'm going to have to keep the explanation really basic, because literally, entire books have been written on the topic. In fact, I'll go ahead and recommend a few:

Cycle Savvy: The Smart Teen's Guide to the Mysteries of Her Body for mature pre-teens and teens who are ready to know the details about their body's workings.

The Care & Keeping of You 1: The Body Book for Younger Girls for girls age 8 and up, with very basic explanations of puberty and cycles.

Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Natural Health book and website. For very mature teens and any adult woman who wants to thoroughly understand her reproductive system. I highly recommend that all women read this before they get married and/or plan a pregnancy. 

It calls itself the "Definitive Guide," and that's no exaggeration. Ladies, do you have irregular cycles? Hard cramps? Possible endocrine or hormonal problems or imbalances? Want to know WHAT'S UP DOWN THERE??? Get this book, start charting your cycles as it teaches you (which involves a lot more than just circling days on a calendar!), and take your findings to your midwife, GYN, or OB. Don't have one yet? Most midwives can take care of all your well-woman care, tests, etc. The midwifery model of care for pregnancy and birth is the most evidence-based for the majority of healthy women, so why not get established with a midwife from the start? If you have a rare or high risk situation, they will refer you to a specialist. This collaborative care model is one that we are already familiar with. For instance, most healthy people do not have a cardiologist. They likely see a general/family practice doctor, who will refer them out to a cardiologist if some high risk situation comes up. It's like that with midwifery. 

How to condense this to a very basic overview? This is going to be really long, I can tell. Here's a better explanation from a .gov, trustworthy & not coming from a corporation that's trying to make a buck off you by selling disposable products and making you feel bad about yourself in the process.

From Womenshealth.gov:

What is menstruation?
What is the menstrual cycle?
What happens during the menstrual cycle?
Menstruation (men-STRAY-shuhn) is a woman's monthly bleeding. When you menstruate, your body sheds the lining of the uterus (womb). Menstrual blood flows from the uterus through the small opening in the cervix and passes out of the body through the vagina. Most menstrual periods last from 3 to 5 days.
When periods (menstruations) come regularly, this is called the menstrual cycle. Having regular menstrual cycles is a sign that important parts of your body are working normally. The menstrual cycle provides important body chemicals, called hormones, to keep you healthy. It also prepares your body for pregnancy each month. A cycle is counted from the first day of 1 period to the first day of the next period. The average menstrual cycle is 28 days long. Cycles can range anywhere from 21 to 35 days in adults and from 21 to 45 days in young teens.

The rise and fall of levels of hormones during the month control the menstrual cycle.

In the first half of the cycle, levels of estrogen (the “female hormone”) start to rise. Estrogen plays an important role in keeping you healthy, especially by helping you to build strong bones and to help keep them strong as you get older. Estrogen also makes the lining of the uterus (womb) grow and thicken. This lining of the womb is a place that will nourish the embryo if a pregnancy occurs. At the same time the lining of the womb is growing, an egg, or ovum, in one of the ovaries starts to mature. At about day 14 of an average 28-day cycle, the egg leaves the ovary. This is called ovulation.
After the egg has left the ovary, it travels through the fallopian tube to the uterus. Hormone levels rise and help prepare the uterine lining for pregnancy. A woman is most likely to get pregnant during the 3 days before or on the day of ovulation. Keep in mind, women with cycles that are shorter or longer than average may ovulate before or after day 14.
A woman becomes pregnant if the egg is fertilized by a man’s sperm cell and attaches to the uterine wall. If the egg is not fertilized, it will break apart. Then, hormone levels drop, and the thickened lining of the uterus is shed during the menstrual period.

OK. So does that answer most of it? For the specifics of the questions asked, the reason a woman her period is that she ovulated approximately 2 weeks before, and the egg was not fertilized. The uterine lining builds up in preparation to make a cozy home for a fertilized egg and sustain it as it grows. If no fertilized egg implants into that rich, nutritious (for a new baby) uterine lining, then the body sheds that lining in preparation to start all over again. So, when a woman misses her period due to pregnancy, there aren't periods during the pregnancy because the fertilized egg implanted, began to grow, and used that lining. Did I explain that well in lay terms?

If a mother exclusively breastfeeds (that means nursing on baby's cue's around the clock, with no bottles or pacifiers and no other foods or supplements), then there is a 98-99% chance that her fertility (periods) will be suppressed for 6 months. This is a great benefit in helping with natural child spacing.

What is discharge?

The vagina is self-cleaning. It doesn't need douches, sprays, creams, or lotions. In fact, any of these products can disrupt its healthy, normal pH level and make it have an odor or even cause an infection. Advertisers want to make women feel self-conscious and embarrassed about your lady parts. Well, guess what, ladies? Your parts are awesome! You were fearfully and wonderfully made. Your body is not a lemon, and it deserves some respect! News flash: lady parts were never meant to smell like spring rain. They're supposed to smell like lady parts. In fact, be very cautious what soap you use in that area, because even soaps can throw off the pH of the area or cause a reaction to fragrance, colors, or other ingredients in the soaps. You might be best off just to use fresh, clean water.

So, where am I going with that? What I'm trying to convey is that discharge is not dirty or gross. It's a normal part of our fertility & cycles, part of a healthy body. Part of discharge's function is the body's self-cleaning, but much of its purpose is intricate and amazing: it is cervical fluid produced to help sperm get to the cervix during fertility. Like I said, all the details of it fill a book, but by observing your pattern of normal discharge daily, and getting to know your body, you can know when you are fertile or not fertile. This requires a lot more reading and training than this blog, just as a disclaimer. I'm just introducing the concept to you, perhaps for the first time that you are hearing it, that the texture and consistency of normal vaginal discharge is directly related to fertility and the body gearing up for someday, when you are ready to be pregnant. Pretty impressive, huh?

If you get to know your body's norm, it will be obvious to you if something is *not* your norm. If there is a foul odor to discharge or it's a color you've never seen before, or if there is itching, this could possibly indicate an infection that needs treatment. Please see your midwife or doctor.

On to birth control. There are many options for birth control, both pharmaceutical and non-pharmaceutical. Not many women are advised of the risks of pharmaceutical birth control methods, so if it's something you're considering, I highly recommend you do a lot of reading to make sure the benefits outweigh the risks in your instance. 

Some teens are advised to go on birth control pills because of irregular or very hard and painful periods. This isn't the only option out there. If this is your situation, you might be able to find a midwife or naturopath who can give you options that don't have the short- and long-term risks of pharmaceutical birth control methods. Rather than using a drug to artificially stimulate the body to have periods, it can be beneficial to figure out what the underlying problem is that's causing the symptoms of pain or irregular cycles, and treat THAT instead of treating the symptoms.

Here's one article on the subject. "Natural Alternatives to Hormonal Contraceptives"
It goes through a long list of risks and side effects of chemical/hormonal contraceptives and gives alternative options.

Here's my awesome Pinterest board for Fertility & Cycles. I update it regularly with newly bookmarked articles.

So that's that. Any other questions? I hope I didn't wear you out with too lengthy a response, but I wouldn't know how to answer it with less! 

Here is the link to Part 1 of this series. Part 3 is upcoming!

Sunday, May 19, 2013

Teen Questions About Birth & Our Bodies: Part 1

I had the privilege this week to be a guest speaker in a high school biology class this week, to teach on the topic of birth. I only had 50 minutes, so I really had to condense to the basics. My normal class series for pregnant couples is 12 hours of class time, and I really could use more time than that! So keeping it to "just" 50 minutes was really a challenge!

Since this was the first such class I had taught, I misjudged my timing and ran out of time for questions. I'll try to do better if I have another such opportunity in the future. Fortunately, the teacher had the students write up questions for me before the class, and I brought those home with me to answer here on my blog.

I ask that if you are under the age of 18 and reading this blog, especially if you go to the school where I spoke, ask your parents' permission before proceeding. I am comfortable discussing any of these topics and teaching from an honest, evidence-based, and God-honoring perspective about the incredible design of our bodies, but I do not want any angry parents calling or emailing me or the school.

Here are the questions that were submitted.

  • "What is the umbilical cord?", "What does the placenta do?", and "What happens to the umbilical cord after you give birth?"
The umbilical cord connects the baby to his placenta. The blood in the placenta and in the cord belong to the baby, not the mother. The mother's blood and baby's blood do not mix. 

The placenta provides all the nutrients, oxygen, etc. to the baby via the cord, and the cord transfers waste materials from the baby back to the placenta to be processed and eliminated.

The placenta is typically the size of a dinner plate and looks a bit like liver or other organ meat. It's not gross, it's pure awesome, once you discover how incredible it is and what it does.

This is the baby's side of the placenta, with the umbilical cord coming from the middle. The baby is attached to the other end of the cord. Source: http://www.pampers.com/common/pdf/pc/hb/CBE_book_for_students.pdf

The cord provides oxygen and other essentials to the baby in the womb and in the first few minutes after the birth, while the baby's lungs are inflating and acclimating to breathing air for the first time. It's essential for baby's oxygenation that the cord remain intact for a *minimum* of 3 minutes after the birth, according to the World Health Organization. Additionally, since the blood in the placenta and cord are part of the baby's total blood volume and designed to be returned to the baby through the cord after the birth, if the cord is clamped and cut prematurely, the baby is deprived of 30-40% of his total blood volume, which means that many babies have low iron levels due to that blood loss. This is a health problem called "anemia," and it's measurable for 6 months or more after the birth in babies whose cords were cut too early.

Here's a video that explains how this transfer of baby's blood occurs after the birth, and why it's important to wait for it. Many hospitals are in the habit of clamping and cutting the cord within 15 seconds after baby's birth, just out of routine.

You can tell the cord is ready to be clamped and cut when it quits pulsating. After the birth, you can put your fingers on the cord and gently squeeze it and and feel a pulse, just like feeling your own pulse. What you are feeling is the baby's pulse. While that pulsing is still going on, baby is still retrieving his blood from the placenta and cord. When it feels and looks empty, then it's ready to clamp and cut.

The OB or midwife will place one sterile, plastic clamp a few inches from where the cord attaches to baby, leave a bit of space, then sometimes place a second clamp. A lot of dads like to be the one who cuts the cord. It's done with surgical scissors, and it's very easy to do. My then-5-year-old son cut his baby brother's cord, in fact. 

That's my 5 y.o. on the left, cutting his baby brother's cord about 20 or 30 minutes after he was born.

It does not hurt the baby at all when the cord is cut.

  • "Why are the testicles separated from the rest of the body?"
I think I get what you're asking. As in, hanging down from, as opposed to as an internal organ? The primary purpose of that is to keep the testes away from the body so that they stay at a lower temperature. Sperm die at high temperatures. This is why men who have low sperm counts are advised to stay away from hot tubs, and to wear boxer shorts as opposed to tighty-whities.

  • "Does your stomach go back to normal size after birth?"
For the first few days or weeks after giving birth, many moms still look pregnant. It takes a while for internal organs to go back to where they are supposed to be, and for the uterus to shrink down to its normal non-pregnant size. There is much variation from one mother to the next. Some moms go right back to pretty much the way they looked before pregnancy. Others hold onto pregnancy weight for a variety of reasons; the body needs extra fat reserves to be able to produce milk. That weight is there for a reason (provided it was gained on high quality nutrition)! My midwife always says, "It took 9 months to put that weight on; it should take at least 9 months to take that weight off."

Some moms get stretch marks; others don't. There are many factors to this: genetics, nutrition & hydration, amount of weight gain, speed of weight gain (skin has time to stretch gently if it's gradual as opposed to quick weight gain), and if there are multiples (twins, triplets, etc.). Some moms' skin stays stretched even after the muscles & organs go back, sort of like a balloon that has been filled and then emptied. And some moms look like they never were pregnant, with smooth, taut bellies. 

All of these variations are normal and healthy. In my personal opinion, we need to be focusing on health and wellness more than looks. Many moms feel unnecessary pressure to get back to "pre-pregnancy weight" or "pre-pregnancy shape." Why should we feel outside pressure to conform to societal ideals that moms should look like pre-pubescent or pubescent young women who have never been pregnant? There's no reason to deny our basic biology. Personally, I'm at peace with my stretch marks. God designed our bodies to be capable of incredible miracles in creating, growing, and sustaining human life. My body's marks are proof of that.

A really neat website where you can see the many variations of mothers' bodies after pregnancy is Shape of a Mother, but there is some nudity on that site, for educational purposes of accepting the human form. Please get parental permission before viewing.

  • "What is a C-section?"
A C-section, also called cesarean or cesarean section, is major abdominal surgery to deliver a baby. In most cases, a vaginal delivery is safest for mom and for baby, but in some instances, a C-section is helpful or even life-saving for mom or baby or both. Other times, a C-section could have been prevented, and exposes mom and baby to unnecessary risks both short-term and long-term. Since C-sections have become so common (32.8% of all births in the U.S. are surgical births; in WV, the rate is 36.3% of all births, the 5th highest rate in the U.S.), it's important for all pregnant moms to get informed on risk/benefit and factors that contribute to higher cesarean risk.

Source: http://www.pampers.com/common/pdf/pc/hb/CBE_book_for_students.pdf

"Most of the time, epidural or spinal anesthesia is used, allowing the mother to be awake during the birth. In almost all cases, a labor partner can also be present... Once the cesarean begins, it only takes a few minutes for the baby to be born through an incision in the mother's lower abdomen. Then it usually takes around 45 minutes to complete the operation."
  • "What is the pain level of having a baby?"
That question is tough to answer, because it's so subjective, and varies not just from one mother to the next, but also from one birth experience to the next, even with the same mother.

There are many factors regarding the pain level, but one important one to note is FEAR. The more the mother fears birth, the more painful she will perceive it, the longer her labor is likely to be, the more likely she is to undergo preventable medical interventions, and the more likely she is to end up with a cesarean. Cesarean recovery is a whole different situation, as it is a major abdominal surgery, and if a mother has had more than one cesarean, recovery can be even more difficult.

The antidotes to fearing birth are often education and support. We are in a cultural crisis of fear of birth and negative stories about birth. Many times, the only things a pregnant woman knows about birth prior to giving birth, are what she has seen on reality TV shows about birth. Sadly, instead of giving moms confidence in their bodies' wonderful design and ability to give birth to their babies, these shows terrify viewers with drama and horror stories. (Peaceful, positive births aren't good for ratings or ad revenue.) This is well documented. I highly recommend that expectant moms and their birth partners take a comprehensive childbirth class, fairly early in their pregnancy, to an independent childbirth educator who isn't under a gag order by their employer not to share details beyond their policies and protocols.

There is a difference between pain and suffering in labor. Labor can be intensely painful, but for moms who are confident, well supported, and not fearful, this doesn't mean she will suffer. Moms in labor who are supported emotionally and physically to listen to her body and allow her to move, eat, sleep, and cope as her body tells her to do, are usually able to labor and give birth without pain medications. The positions that feel most comfortable to mom in labor are usually the ones that help the baby move down and through the pelvis, making labor more efficient and safe.

The more intense and painful labor becomes, the more endorphins (morphine-like hormones) the body produces, in an unmedicated birth. The mom actually enters a dreamlike state, a sort of altered state of consciousness, that helps her cope with the increasing pain. So, the more painful it gets, the more capable the body is of handling the pain and reducing the mom's perception of that pain.

Dr. Sarah Buckley has an excellent topic elaborating on this topic.

There are a number of options, both non-pharmaceutical and pharmaceutical, for pain relief in labor. Full explanation would take way too much space here. I encourage all expectant parents to take a class on all their options for coping with labor pain, so they can have the info on risk/benefit well in advance.

Personally, I've had 5 vaginal births with no pain medications whatsoever. Each experience was different; all were painful, but I have no regrets at all. If we were to have another baby, I would make the same birth choices. The benefits of a safe, drug-free birth, not exposing my baby to narcotics unless there were a medical emergency for doing so, getting a good start bonding and breastfeeding, and having that "birth high" from endorphins, far outweigh the hours of pain in the process, for me personally.

On a side note: a very small percent of moms who have unmedicated births will have pain-free or even physically pleasurable labors and/or births, sometimes called ecstatic or orgasmic births

  • "How far along is it until you can tell the sex of the baby?"
After the birth. Seriously. Sort of. Even with all of today's technology, ultrasounds are still not 100% accurate with predicting baby's gender. I've read figures around 85-90% for accuracy of prediction. It depends on the type of ultrasound equipment used, how far along the baby is, baby's position and whether the sonographer can get a clear view of the genitals, skill of the sonographer, and more. Sometimes the baby's genitals are swollen from mom's hormones, which is normal, but can make girl parts look like boy parts, or vice versa. You think that's impossible? Ask the scores of parents who already painted the nursery the wrong color and had all the wrong clothes for the baby.

With that in mind, typically parents can find out (the best guess for) baby's gender at the 20-week ultrasound that is usually performed to help rule out health problems. If an ultrasound is performed earlier for elective or medical reasons, *sometimes* gender can be viewed as early as 13 weeks, but with way less accuracy. (There are risks associated with ultrasounds in pregnancy, so it's not recommended to have them without medical indication for them.)

To be continued in Part 2...

**UPDATE** link to

Part 2 of Teen Questions About Birth & Our Bodies.