Pregnancy can be hard on the body.  In order to compensate for the growing baby, a woman’s blood volume increases, her hormones shift and she must compensate for the extra weight she is carrying in her belly.  Our bodies are pretty amazing, and they do a good job of compensating, but sometimes this can cause us to feel more tired, nauseated and sore.  Although we consider these things “normal,” it does not mean that we should accept these things without question.  Below, I’ve listed some tips that could make this time more comfortable and enjoyable.

Body Mechanics
Body mechanics is a term that describes how we use our bodies for daily activities.  We tend to want to move with the least amount of effort whenever possible.  This ability is great most of the time as it helps us to multitask. Without this ability, we would not be able to coordinate breathing, thinking, processing, using muscles, etc.  The problem with this is that we often ignore important muscle groups that need to be used in order to conserve energy.  If we don’t move muscles, they do not get stretched or strengthened.  Over time, the muscles become weak and they are not much good to us.  This can lead to injury too.

My challenge to you is to become aware of your movements. 

During pregnancy, it is especially important to be aware of your movements.  Your growing belly is already prone to putting strain your back and other ligaments that normally you would not be aware of.  Poor body mechanics can lead to muscle strain and while most of the time this is not a harm to the pregnancy, it can make for an uncomfortable mommy.

One of the main complaints I hear from patients is round ligament pain.  The round ligaments hold up the uterus in the front of the body.  As the uterus grows quickly during pregnancy, the round ligaments also stretch quickly.  Preventing injury is key.  Slow position changes and paying attention to your movements can help keep you comfortable.  For example, when you get out of bed in the morning, try rolling to your side, sitting up, putting your feet on the ground and then standing, rather than making this one swift movement.  Good posture will also help by taking some of the weight off of the ligaments and putting it on muscles that are more capable of bearing the weight, if properly strengthened.  This brings me to my next point.

Sit up!
I know I probably sound like your grandmother, but I’m sorry to say, she was right.  For some reason, we like to slouch.  Like I mentioned before, we don’t like to engage a lot of muscle groups so we hold ourselves up with the least amount of effort.  Good posture helps engage the muscle groups throughout your torso.  It might not be comfortable in the beginning but once the core is strengthened, it will help you hold up your growing belly without as much strain.  As the pregnancy goes on, this practice might also help you to breathe with more ease.  Good posture opens up the chest and gives your lungs more room to expand and baby more room to do her thing.  Try sitting on the floor whenever possible or on a chair without a back.  This will encourage you to sit up and use your core muscles as opposed to sitting on a fluffy chair or couch that does all of the work.  You can also try sitting on an exercise/birthing ball.  This will encourage good posture and help you as you train for your labor day!

Try squatting
Have you ever watched little kids that have recently learned to walk?  Their ability to squat is amazing.  Once again, this is an activity that we have replaced with a seemingly easier activity we call bending. Somewhere between 12 months and 12 years old, we seem to lose this important movement.  I’m sure the majority of us have been told to lift with our legs and not with our backs, which of course requires squatting, so we know this is an important movement, but alas, we bend…and strain.

Squatting is especially beneficial in pregnancy as it stretches the muscle groups that facilitate delivery of the baby.  Your pelvic floor muscles are about to be stretched more than they ever have before.  These muscles were made to do this, but healthy muscles stretch easier.  Think about a rubber band. A rubber band with good elasticity is going to go back to its original size and shape much easier than a rubber band that has lost its elasticity.

Join a prenatal yoga class
A yoga class is a great way to stretch and practice moving your body in healthy ways.  These poses can also help to strengthen your muscles.  Yoga is great for super athletes as well as beginners.  Group classes are also good for people who need a little extra motivation and support.   A structured class is also a good place to practice new movements in the correct way to avoid injury.

For more information on HealthNet’s Women’s Services, visit www.indyhealthnet.org.

Did you know January is Cervical Cancer Awareness Month? Honor Cervical Cancer Awareness Month by educating yourself on cervical cancer and how you can help protect yourself. HealthNet Certified Nurse Midwife, Carrie Bonsack teaches you everything you need to know about cervical cancer and answers some of the most common questions!

A pap smear is a test used to screen for cervical cancer. Many of you have had a pap smear every year since you were a teenager. Well, those days are over. It’s a new year and time for celebration that we are all done with yearly pap smears!  Some women are worried and feel they need a test every year, but let me reassure you that you do not need a pap smear every year.  Read on to find more about pap smears, HPV, and the importance of an annual “well woman” exam.

Why do I no longer get a Pap smear test every year with my annual exam?

In March of 2012, new pap screening guidelines were developed by the United States Preventive Services Task Force (USPSTF) and the American Cancer Society, American Society for Colposcopy and Cervical Pathology, American Society for Clinical Pathology (ACS/ASCCP/ASCP) based upon the woman’s age.  Basically, all of these organizations looked at research evidence and found that women do not need yearly pap smears and here is why:

• Cervical cancer is rare, especially in young women.
• Precancerous cells are caused by HPV and it will go away in most young healthy women.
• Testing for cervical cancer may lead to more treatment (more tests, more biopsies, and more surgeries) than necessary and may be doing more harm than good.
• Over treatment may lead to unnecessary short-term anxiety or concern.
• Over treatment may lead to pain, bleeding, or vaginal discharge after certain procedures.
• Over treatment may lead to problems with future pregnancies such as preterm birth and low birth weight babies.
  (Moyer, 2012)

When do I start getting screened for cervical cancer?

A woman should begin having a pap smear at the age of 21. Women between the ages of 21-29 should have a pap smear every three years. Women ages 30-65 should have either a pap only every three years or pap with HPV screening every five years. Women under the age of 21 should not have a pap.  (USPSTF/ACS/ASCCP/ASCP, 2012)

When do I stop getting screened for cervical cancer?

If you are age 65 and have had three negative pap smears in a row or two negative pap with HPV tests within ten years, or have no history of CIN 2 within the past twenty years, then you can stop having pap smears. (USPSTF/ACS/ASCCP/ASCP, 2012)

What is Human Papillomavirus (HPV)?

HPV is the most common sexually transmitted infection among both men and women. HPV more commonly infects the genital area, but can also infect the mouth or throat. Nearly everyone who is sexually active will get HPV at some point in his or her lifetime because it is so common. Around 90% of HPV infections can clear on their own within two years.  There are over 100 different types of HPV and some can cause genital warts and certain cancers, such as cervical cancer.  (CDC, 2013)

 Can I prevent HPV?

HPV vaccines can help prevent certain types of HPV, and are available and recommended for 11 and 12 year old boys and girls. Gardasil, an HPV vaccine, is available for males and females. Cervarix is available for females. Women, men, boys and girls between the ages of 13 and 26 can also get these vaccines if they did not get it when they were younger. The HPV vaccines are a series of three shots given over a six-month period.  Condoms can help protect against HPV when used from start to finish of the sex act, however, HPV can infect areas not covered by a condom.  Limiting your number of sex partners can decrease your risk of sexually transmitted infections. (CDC, 2013)

As a certified nurse midwife and a mom of two, I can attest to the misery of morning sickness. I was lucky or shall I say, very unlucky to have it with both of my pregnancies.  I still have a strong sensory aversion to the scent of cucumber melon! I had a car deodorizer in this scent and every time I would drive to work I would throw up. I even had to keep gallon size Ziploc bags in my car for emergencies!

You may be feeling like you are hugging the toilet more than your loved ones, but don’t worry it will eventually go away so that you may experience the joy of pregnancy! Let’s go over a few facts about morning sickness.

What is it?

Nausea and vomiting is a common condition in pregnancy also known as “morning sickness”.   This condition is so common that is has been shown to affect 70-85% of pregnant women[1].  Morning sickness can occur at any time during the day. Some women may have nausea only, while others have both nausea and vomiting.

In most cases, morning sickness will not harm you or your baby.  A severe form of morning sickness, Hyperemesis, is where the woman can’t stop vomiting, lose at least 5% of pre-pregnancy weight, and presence of ketones in the urine. Women with hyperemesis need medical attention.

Why am I sick and how long will this last?

Hormones are thought to be a cause of morning sickness, although the true reason is unknown. Women, who are pregnant with twins, have had it with a previous pregnancy, or who have a history of migraines or motion sickness are more likely to have nausea and vomiting.

Symptoms usually start between the 4^th and 9^th week of pregnancy, and typically last until between the 12^th and 16^th week of pregnancy[2] .  There is no magic cure, but here are some helpful hints.

What can I do that helps me feel better?

Taking a multivitamin before getting pregnant can reduce the severity of morning sickness symptoms.

• Rest as much as possible
• Powdered Ginger capsules (250mg) one capsule during the day and one at bedtime may help[3].
• Eat small, frequent meals (5-6 times/day rather than 3 big meals)
• Eat high protein snacks (milk, yogurt, peanut butter)
• Eating crackers or dry cereal before getting out of bed in the morning may help
• Taking folic acid and a multivitamin vitamin or chewable/gummy children’s vitamin without iron for the first trimester may help.
•  Acupressure wrist bands (Sea Bands) may help[4]
•   “Preggy Pops” are lolly pops made of brown rice syrup, sugar and essential oils, that come in several different flavors created to help relieve morning sickness.
• Slices of lemon with salt are used by some women
• Your medical provider may decide to place you on a medication such as Vitamin B6 (Pyridoxine) and/or Doxylamine (an antihistamine), or other antiemetics such as Phenergan or Zofran if these measures don’t help.

What should I avoid doing?

• Certain smells can trigger nausea or vomiting, so try avoid bad smells.
• Avoiding fatty and spicy foods may help

When should I seek help from a medical provider?

If you have tried the above recommendations for nausea and vomiting and are still feeling sick you may need to seek medical treatment from your HealthNet midwife, nurse-practitioner, or physician. At the health center, your provider will find out if you are having morning sickness or if something else is causing your nausea and vomiting.  Your provider will work with you to determine if you need medications to help relieve the sickness. If you are dehydrated, you may need to have fluids placed in your body through an intravenous line (IV).

Call for these symptoms of dehydration (not enough fluids in your body):

• You cannot keep down food or fluids for 24 hours
• Your urine is dark and you are not urinating very much
• You are dizzy or feel like you might faint
• You are vomiting blood

Christina Graham, Certified Nurse Midwife

If you had told me when I was growing up that I would be a Nurse-Midwife, I wouldn’t have believed you.  But now, after practicing midwifery for 6 years, I can’t imagine doing anything else.  When people find out you are a midwife there is a certain look that you get.  And then you inevitably get a plethora of similar questions.  Even amongst those in the medical community there isn’t a good knowledge of what a nurse midwife is or what exactly we do.  So here’s a rundown of the most common things I get asked about when people learn what I do for a living.

1.) Why are there so many kinds of midwives? 

The entry into the field of midwifery can vary. A Certified Nurse Midwife (CNM) (like the ones that practice at Methodist Hospital with HealthNet) all have nursing degrees and then continue their education by getting a masters degree specializing in nurse-midwifery.  They are licensed by the State of Indiana and can write prescriptions.  They are regulated by the American College of Nurse Midwives.  For more information about CNMs click here.

A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwives Model of Care. The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings.  If you’d like to read more about CPMs visit http://narm.org.

A lay midwife may not have any formal education.  Instead they are educated through an apprenticeship model of learning.

2.) What? You have a male midwife in your practice? 

Contrary to popular belief, a male midwife is NOT called a ‘midhusband.’  While the presence of men in obstetrics and gynecology has traditionally been accepted in the role of physician, midwifery does still remain female dominated.   In the United States approximately 0.6% of midwives are men.  Additionally, 90% of midwives are white females.  We are fortunate in our practice here at HealthNet to have a wonderful male midwife!  He brings a much-needed balance to our female dominated practice.  If you’d like to read more about the evolution of males in midwifery a very interesting article can be found here.

3.)  You do more than deliver babies? 

Certified Nurse Midwives are considered experts on normal, well woman care from the time that women start menstruating through menopause.  We perform annual well woman exams, pap smears, and birth control consults, and address common gynecological issues.  This is all in addition to being able to take care of pregnant women from the time of conception through delivery!  At Methodist Hospital we are fortunate to collaborate with physicians who love working with CNMs and are available to us whenever a problem or need may arise.   For more about what CNMs can do click here.

All deliveries by a HealthNet midwife take place at Methodist Hospital’s Maternity Center. We do not offer home births. All HealthNet midwives are registered nurses with additional education in midwifery and national certification by the American Midwifery Certification Board. For more information about our midwifery program, click here or call us at (317) 957-2000. 

This month, HealthNet Certified Nurse Midwife Blythe Kinsey joins a team of nurses on an amazing adventure to Tanzania, East Africa. Here’s an excerpt from the team’s blog: 

Jambo!

I just thought I would send a note from Tanzania! For those who don’t know I am working as part of a Vocational Training Team through a Rotary International grant at Aga Khan University in Tanzania. We are working with the University to review their assessment and evaluation standards for their nursing and midwifery students.

I woke this morning sleepy but excited….We have been preparing for months to help the professors of Aga Khan University look at assessment tools for students, to help evaluate the students practice. We will be offering our assessment tools to help guide their evaluation process.

It has allowed for a deepening of the ideals that I think about when I think of a good student, who turns into a good nurse, who then can turn into a good nurse-midwife. How as preceptors, professors and instructors do we foster those skills that are imperative as well as the attitude behind them that allows for success? We are excited to facilitate this discussion!

We will all deepen our knowledge and understanding of this through this process. We will share our ideas and will learn from the ideas of Aga Khan…and I know will all be the wiser for the process.

Blythe

Click here to follow the team’s blog!

Kay: Jill, what made you decide to become a nurse midwife?

Jill:   It was truly a God-directed thing for me. I’ve always enjoyed caring for people. After high school, several things fell into place for me to go nursing school. During my last year, I had the chance to shadow a midwife for a week. It was really awesome to see the relationship she had built with those women. That experience stuck with me.

After I graduated, I worked as a medical/surgical nurse at a hospital for a short time before transferring to maternity services. I really enjoyed it, but I knew I wanted to help women not just when they’re in the hospital. I wanted to see them day in and day out — to build relationships and help guide them in making good decisions, while caring for themselves and their families. That’s why I went back to nursing school to become a certified nurse midwife. I wanted to be in a position to empower women.

Kay:  Is midwifery care becoming more popular these days?

Jill:  I think women are learning that pregnancy and childbirth are normal, healthy processes for which a woman’s body is well-designed. Yet each woman’s experience is unique. Some women are interested in water birth. Others prefer having a birth ball, shower, or rocking chair close by. And many simply want all of their relatives by their bedside. More and more mothers-to-be are having babies their way, with the help of a midwife who is there to do as much or as little as the woman wants.

Kay: Midwifery has been around for centuries, yet there are misperceptions about it. What ones do you encounter most often?

Jill:   I wish the general public knew that nurse midwives do not only deliver babies at home. They also deliver babies at the hospital and in birth centers. Most people are surprised to find out I work at a health center and deliver babies at a hospital.

Kay: What other misperceptions come to mind?

Jill:   Midwifery care is a safe option for women, especially for those who want to be cared for by someone who views birth as a natural process.

CNMs are nurses first. I went through four years of training to become a nurse, then went back to school for extra training focused specifically on labor and delivery, before and after childbirth care and OB/GYN. We are certified by the American Midwifery Certification Board. At HealthNet, we are credentialed by the hospital and work side-by-side with OB/GYNs. We view things more naturally, but when we need to intervene for the health of the mom or baby, we will.

Kay: There’s been a lot of talk in the news about the national Caesarean section rate being on the uptick, and how that may not be the best thing. What are your thoughts about it?

Jill:   In the 1960s, the national c-section rate was approximately 5%. These days, it hovers around 30%. I feel like we as midwives are helping to reverse that trend.

A woman’s due date is really just an estimation. In general, we wait until 10 days past the due date to induce labor. In most cases there needs to be a medical reason to induce sooner. When a woman goes into labor on her own, the labor usually goes more quickly and smoothly. Often times when you introduce medicines to speed up the process the woman’s body isn’t ready yet or the baby is not able to tolerate it well. Anytime you give the body the chance to do it on its own, it will go a lot better than trying to force it.

Kay:  You are expecting your second baby soon. Did being a nurse midwife change your outlook on your own birth experience?

Jill:   Absolutely! It really made me look at my own pregnancy and labor very differently. I had my first child naturally. He was a big baby too — 9 lbs. 3 oz.! I like being able to share appropriately from my personal experience to encourage moms who are considering natural childbirth.

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HealthNet Midwifery Services is the largest midwifery practice in the state, assisting in the birth of more than 2,400 babies each year at IU Health Methodist. The program’s 24 nurse midwives work with the OB/GYN physicians on staff to provide prenatal care, postpartum care, well-woman care, family planning and more for women at HealthNet’s six community health centers and one OB/GYN care center. The program celebrates its 20^th year this year.

Lisa Glazik has been working for HealthNet for over 6 years.  She started out working in different centers during the week but now she is stationed at the hospital downton.  And, from one quick phone call she made me happy to boast about HealthNet’s Midwives!

Willie: Lisa, why did you become a Nurse Midwife?

Lisa: I was always interested in women’s health.  When I had the chance to start shadowing other nurses in OB programs while at Illinois, I noticed that they were missing out on a BIG piece of a woman’s pregnancy, THE BIRTH! To spend almost an entire pregnancy with a patient and to not be in the room for that special moment made me feel as if I’d be missing on some closure in the process.

Willie: What is the most satisfying part of your job?

Lisa: Being a part of that special moment.  Seeing the culmination of teaching a mother about pregnancy, what to expect and healthy lifestyle choices is very rewarding.

Willie: What is the biggest challenge you face when dealing with a patient?

Lisa: When someone comes to us uneducated about healthy lifestyle choices, it makes it really hard to get them to make new ones.  Change is hard for EVERYONE, but learning about the changes that need to be made can be even harder.  It is a challenge to get the new information to sink in when a patient already has set habits.  But it is awesome to see them succeed!

Willie: What do you all do to celebrate National Midwifery Week?

Lisa: The fall brings a slower period, so we usually plan a retreat day for ALL of us to get together, relax, but also learn from what has been happening all year.  This year, however, we couldn’t plan it until November. 

I like Midwifery Week, though, because I get a lot of questions directed my way about what exactly a midwife does.  I enjoy educating others, even some IN health care, and dispelling some of the old stereotypes that some may have about midwives.

Willie: If you could sum up your goal, in one sentence, to make sure a pregnancy is a success, what would it be?

Lisa: I would tell the mother-to-be, “Your birth experience is YOURS, I am here to give you THAT experience in the best way possible with a healthy mom and a healthy child as an end result.”

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To learn more about Nurse Midwives at HealthNet, stay tuned to our Twitter feed and Facebook page to get statistics and tidbits all week!