What is a Midwife?

Midwifery is the term traditionally used to describe the art of assisting a woman through childbirth. In the modern context, this term is used to describe the activities of those health care providers who are experts in women's health care including giving prenatal care to expecting mothers. They attend the birth of the infant and provide postpartum care to the mother and her infant. Practitioners of midwifery are known as midwives, a term used in reference to both women and men (the term means "with woman").


Friday, April 5, 2013

Birthing the Art of Birthing Center



            Art of Nursing Care midwifery is opening a new birth center at the end of April, 2013. It may be a coincidence that the creation of The Art of Birthing Center comes at a time when the world itself is in the process of regeneration—but we really feel like we’re in sync with spring! Tuning into patterns of deep harmony isn’t just part of our belief system, but what we think birth is all about. Our new birth center will give the birthing woman a place where she can center herself and tap into the deepest rhythm of all—the one within her own body.
            Spring is a time of exuberant life, when what before grew unseen flowers into being. It is also a time of renewal and healing. Amy Tinney, who created the Art of Nursing Care in 2006, has been making a full recovery from recent health issues. This transition has allowed her be to fully engaged in the process of opening the new birth center. Amy has also been expanding her knowledge of homeopathy by becoming a licensed practitioner.
            The new center will include some old and new faces. Sarah Shealy will continue to offer care with us. In addition to her substantive work in midwifery, Sarah is a renowned lactation consultant. Her passion for helping birthing women is expressed in her expertise. Sarah brings confidence and compassion to the labor process and postpartum period. She will continue to give mothers the best care possible.
With the help of Marina Alzugary and Krystel Viehmann we’re expanding not only our facilities but our practice as well. It is with great happiness we welcome these two new members to our team. Marina Alzugary brings her passion—and long experience—as a midwife to the Art of Nursing Care team. Her belief in the loving nature of midwifery resonates with our new birthing facility. Giving birth is the ultimate act of love. It makes sense to us that birthing women should feel sustained by lots of affection themselves!
Our other new member, Krystel Viehmann, is coming onboard this summer as a certified professional midwife. Krystel is incredible. Over fifty families have depended on her strength and focus during their delivery. Those new parents attest to her as a bedrock of support and strength. We do too—her last apprenticeship was with us here at Art of Nursing Care. She has a deep reverence for the birthing woman.
Like Krystel, our new birthing center will give mothers and their partners strength. Gentleness. Parents will be sustained by our absolute support as they in turn nurture the precious new life they have created.  
Dr. Hillary Martin is a naturopathic doctor who will be available to see patients at our new Art of Birthing center. She’ll be offering both pediatric and general care. Her training as a credentialed naturopath doctor gave her the tools to be a phenomenal primary care physician. She teaches her patients to create health and well being by enabling them to activate their own bodies’ natural healing mechanisms. Just as the body has everything it needs to go through the birthing process, it has what it needs to heal itself from problems of imbalance. Dr. Martin helps her patients to do that through lifestyle changes and natural therapies. Linking emotional wellness and mental health, her approach is holistic and effective.
            Bringing new life into the world is a natural process. Yet it is also one of the most beautiful. Our new the Art of Birthing Center reflects this in the lovely new birthing suite, complete with two brand-new birthing rooms. Our new facility gives women and their partners a place where the birthing process is natural, peaceful and exactly what their family needs. The Art of Birthing center embraces birthing women within the sacredness of their own birth experience. 
The Art of Nursing Care is excited to continue facilitating the beautiful and transformative process of birth. We’re not pregnant but we can’t help feeling happy and expectant too! Maybe it’s just that spring in the air.


We need your help...
What do we need?


Monetary support to purchase paint and fixtures 
Furniture for the birth suites and Yoga Mats and pillows
Volunteers to help with painting  
Volunteers to help with our grand opening party 


Monday, September 24, 2012

Training your pelvic floor to give birth with no tear..


About EPI-NO

EPI-NO Delphine Plus® 

               Childbirth & Pelvic Floor Trainer

Clinical Studies have shown a link between perineal injuries during childbirth with decreased bladder control, long-term incontinence, and sexual dysfunction. Women delivering over an intact perineum experience a more rapid recovery from childbirth and increased mobility. EPI-NO Delphine Plus was developed in Germany as a dual purpose birth trainer. EPI-NO reduces the risk of tearing and episiotomy (stitches) during childbirth by working with the natural pregnancy hormone Relaxin  to prepare the perineum with gentle stretching exercises after Week 36. EPI-NO also conditions the pelvic floor muscles both before and after delivery.
EPI-NO consists of:
(1) a narrow contoured silicone balloon.
(2) a hand pump,
(3) pressure display,
(4) an air release valve,
(5) connected by a flexible plastic tube.
The EPI-NO balloon is soft, easily inserted, and naturally shaped so that it fits the vagina perfectly. EPI-NO must be used only with a water based lubricant.

Preparation can begin early in Pregnancy

EPI-NO Delphine Plus is a DUAL PURPOSE training device.
1. EPI-NO Pelvic Floor Muscle Exercises can commence early in pregnancy. A strong pelvic floor supports the weight of childbearing, and is more resilient in it's recovery after the birth.  A strong pelvic floor provides more control during delivery. In these exercises the balloon acts as a sensor and is only minimally inflated. Following the birth Pelvic Floor Muscle Exercises recommence after 4-6 weeks and can continue indefinitely.  EPI-NO provides bio-feedback on Pelvic Floor strength.
2. EPI-NO Stretching Exercises commence after Week 36 and continue until the end of the pregnancy term. These exercises gradually stretch the perineum in daily sessions of 20 minutes comprising several cycles of 5 minutes duration. In these exercises the balloon is inserted and inflated at the perineum. Women training with EPI-NO will normally achieve a dilation of between 8.5cm and 10cm over 3-4 weeks. Women achieving 8.5cm will achieve the extra 1.5cm when the head is crowning. Following the stretching exercises the balloon can be glided out, simulating the experience of control during delivery. 

Childbirth Preparation in Stages

Position of EPI-NO when deflated
Childbirth Training (preparing the perineum) commences after Week 36. The balloon is inserted two thirds into the vagina and inflated to the level of personal comfort. The balloon size is gradually increased daily, from one training session to the next, each session lasting about 20 minutes. (usually 4 cycles per session).

Position of EPI-NO when inflated to 10cm after 3+ weeks of training.
Optimum training is achieved when the balloon size has reached a diameter of 8.5 -10 cm (3-4 inches) and can be pushed out while inflated. EPI-NO pelvic floor muscle exercises can be practiced throughout the pregnancy, and recommenced 4-6 weeks following birth after consultation with your doctor.

A German Study indicated a shorter 2nd Stage of Labour and better APGAR Scores forEPI-NO babies.
It is recommended that women consult a health professional before using EPI-NO.

 "The human body performs more efficiently in any physical activity when the body has trained and prepared for it. Childbirth is no Exception"
- Dr Wilhelm Horkel (Inventor of EPI-NO)
Reference: http://www.epi-no.com.au/epi-no/

What you need to know about Group Beta Strep (GBS)



What is Group Beta Strep (GBS) and why do we test for it?
Group Beta Strep (GBS) is a type of bacteria that is found in the lower intestine and/or vagina of 10-35% of all healthy adult women. GBS bacteria are a normal part of the commonly found bacteria of the human body. Ordinarily, the presence of GBS does not cause problems, however, in certain circumstances, GBS bacteria can invade the body and cause serious infection; this is referred to as Group B disease. Group B strep should not be confused with Group A Strep, which causes strep throat. A person whose body carries GBS bacteria but who does not show signs of infection is said to be “colonized”, however, GBS colonization is not contagious. GBS is naturally occurring in the bacteria of both women and men. Since it is commonly found in the vagina of women, however, it is not a sexually transmitted disease. GBS bacteria usually do not usually cause genital symptoms or discomfort and are not linked with increased sexual activity. Women who carry GBS do not need to change their sexual practices.

What is the testing procedure?

The testing recommended: during 35th to 37th week of pregnancy. The test involves collecting mucous with a cotton swab from the lower vagina. It takes a moment. The culture is then sent to a laboratory for evaluation. The test results are usually ready in 3 days.

Unfortunately, the test is not perfect and it may miss approximately 5% of women who carry GBS. The bacteria tend be transient (to come and go in cycles) and a woman may test negative at the time of the culture and have colonization at the time of delivery. Fortunately, the test is accurate and will not give a false positive result. A positive culture means that a woman is colonized with GBS. It does not mean that she has GBS disease or that her baby will become ill. Rather, it means that the care provider must plan labor and delivery and newborn care with this in mind.

My Consent form for GBS includes these options:

I choose to screen for GBS between 35-37 weeks.  If I am GBS positive, I will accept intravenous antibiotics in active labor.  I may also use alternative therapies if I desire, but I am fully aware that there is no research to document any efficacy in preventing GBS infection. 

  I choose to screen for GBS between 35-37 weeks.  If I am GBS positive, I decline intravenous antibiotics in active labor.  I may also use alternative therapies if I desire, but I am fully aware that there is no research to document any efficacy in preventing GBS infection. 

I decline to screen for GBS.  Instead I choose the risk-based GBS management strategy.  If I develop any of the risks for increased GBS infection, I will accept intravenous antibiotics.  I may also use alternative therapies if I desire, but I am fully aware that there is no research to document any efficacy in preventing GBS infection. 

I decline to screen for GBS and I decline to accept intravenous antibiotics should I develop any of the risks for increased GBS infection.  I may use alternative therapies if I desire, but I am fully aware that there is no research to document any efficacy in preventing GBS infection.


According to the CDC, if you have tested positive and are not in the high risk category, then your chances of delivering a baby with GBS are (8):
·       1 in 200 if antibiotics are not given
·       1 in 4000 if antibiotics are given

Are certain babies more likely to develop GBS disease?

Premature babies, with their less mature immune systems are more vulnerable than term babies. However, since most babies are born at term, 70% of babies who develop the disease are term.

Risk Based Management

Which women are more likely to develop GBS disease?

·       Women who test positive for GBS colonization at 35-37 weeks
·       Having already given birth to a baby who had GBS infection
·       GBS bacteria in the urine (bacteriuria, either with or without symptoms)
·       Having the water bag break for more than 18 hours prior to delivery
·       Onset of labor or the water bag breaking before 37 weeks
·       Developing a fever higher than 100.4 F

How is the baby tested for GBS disease?

Babies who develop the signs of GBS disease (stiffness, limpness, inconsolable screaming, fever, refusal to feed) must be evaluated immediately by a pediatrician. Blood tests, cultures and x-rays determine whether the baby has GBS disease, and treatment should begin immediately.

How can GBS disease be prevented?

Antibiotics such as penicillin administered through the vein (an IV) 4 to 6 hours prior to delivery to women who have a positive GBS test or who have certain risk factors will effectively prevent most GBS infections in women and their babies.

Antibiotics can cause side effects, which are usually mild, but can be severe; their use should be limited to women who have one or more of the risk factors. Alternatives to penicillin may be used. Risks and benefits of antibiotics should be considered.

Cesarean sections are not likely to prevent GBS disease.

Unfortunately, no plan is 100% effective. Some women with GBS escape detection because they do not have the risk factors. Therefore, medical standard of care dictates that all women be tested with each pregnancy. According to the Centers for Disease Prevention and Control and the American College of Obstetricians and Gynecologists, routine prenatal culture at 35-37 weeks along with IV antibiotics during labor for women who culture positive for GBS offers the very best protection available to the newborn.

Women with GBS colonization may breastfeed their babies.

Garlic protocol for GBS prevention:

Garlic is a natural antibiotic

Garlic has been shown in vitro (in laboratory petri dishes) to kill bacteria and also yeast. In some important research done in China (1), garlic was shown to inhibit the growth of all of the following microorganisms: Escherichia coli, Salmonella typhimurium, Vibrio parahaemolyticus, Pseudomonas aeruginosa, Proteus vulgaris, Staphylococcus aureus, Mycobacterium phlei, Streptococcus faecalis, Bacillus cereus and Micrococcus luteus.

Break a fresh, dry, hard clove from a bulb of garlic and peel off the paper-like cover. Cut in half.  A whole clove will NOT work.  A crushed clove releases more allicin, but is harder to insert.  Tie very tightly (so it cuts a bit into the garlic) a piece of white thread and leave the thread hanging out, as if it was a tampon thread. That way it can easily be removed with very little effort. Putting the clove in gauze will prevent direct contact and decrease effectiveness. Put damaged garlic clove in your vagina in the evening before you go to sleep. Many women taste garlic in their mouths as soon as it is in their vagina- so it is less pleasant to treat while awake.  You can grind up garlic and insert the mush.  This would have the most effectiveness because it increases is the dosage the more surface area of the garlic is exposed. You can put it on the end of a tampon for example. In the morning, the garlic may come out when you poop. If not, many women find it is easiest to take it out on the toilet. Circle the vagina with a finger, till you find it. It cannot enter the uterus through the cervix. It cannot get lost- but it can get pushed into the pocket between the cervix and the vaginal wall. Most people will taste the garlic as long as it is in there. So if you still taste it, it is probably still in there. Most women have trouble getting it out the first time.
For easy retrieval sew a string through the middle of the clove before you put it in- You don’t want to get irritated in the process of getting rid of the GBS. Be gentle. Don’t scratch yourself with long nails.  Repeat this for 8 nights (around week 36). Or for 2 nights on, 1 night off, for 5 times (8 nights in 15 days)

After the eight night of treatment, get cultured at the health care place you go to. Before you go to get the culture, wash perineum and rectal area with soap and put on clean cotton underwear.  GBS usually lives in your large intestine, and from there contaminates the vagina.  A Rectal/Vaginal culture is done with a cotton swab inserted into the vagina and then into the anus.

How often do you find that this remedy is effective? I tell my clients to go ahead and try it if they chose to test at all and really want to be sure that they are negative. Some do and some do not. It is a new option. The more they do the more evidence I will have to give. Currently there is no funding for this natural remedy option so there are very few studies to see. (9)

Does raw garlic tend to cause irritation of the vagina?
Not usually but women say they can taste it while they have it in the vagina. They can also try some oral garlic or other ways to boost immune system. I have all my moms take probiotics to keep healthy flora first off.

Is there a way to prevent this or an alternative treatment? Oh So Many….
Ideally, you will begin treatment at about 32 weeks, on confirmation of the presence of beta-strep in a vaginal culture, a urine sample that showed beta-strep, or a rectal sample. (Some doctors will do both a vaginal and rectal swab.) Treatment will include taking herbs orally that strengthen your immune system and applying herbs vaginally that will restore your healthy vaginal flora, that will enable your body to reduce bacterial overgrowth, and also that will directly fight the bacteria. As you enter the last few weeks of pregnancy, from 37 weeks onward (since your baby is unlikely to be premature), most midwives will be willing to assist you at home if this is your plan. In the hospital, your baby will also be considered close to full term and will not be treated as premature in most circumstances. At 37 weeks, you can therefore begin to use certain herbs both orally and vaginally that are sometimes considered labor stimulants, but are nonetheless effective for reducing bacterial infections.
At 32 weeks, begin to take a supplement of 500 mg of vitamin C, and 1 cup of burdock root and echinacea root infusion. To prepare the infusion, steep 1/2 ounce of each of these herbs in 4 cups of boiling water for 2 hours. Strain and take the above dose, storing the rest in the refrigerator for the next day.
Eat a lot of fresh garlic every day.
Take 1/2 teaspoon each of echinacea and astragalus tinctures twice daily. You can also get dried astragalus in the herb department of your health food store and cook two strips into a pot of rice or soup two to three times per week. Remove the strips when done cooking and eat the rice or soup. Astragalus is an immune system tonic well known in the Chinese pharmacopoeia, but also grows in America.
Garlic Remedies
Chop a clove of fresh garlic and mix with a teaspoon of honey. Swallow this without chewing it. This can be done several times a day, preferably with a meal.
Make a garlic elixir by blending 1/2 cup of honey, 1/4 cup of apple cider vinegar, and half a bulb of fresh garlic in your blender until liquidy. Take 1/2 teaspoon up to twice a day. Adjust the taste as necessary with more or less of the honey or vinegar. Chop fresh garlic onto a salad, or mix with olive oil to use as a dressing or dip French bread into this as a condiment.
Take garlic pearls according to the dosage on the brand you purchase.
If garlic doesn't work, there are other options to consider:

Tea tree oil 2% oil to 98% olive oil soaked tampon. Place tampon in vagina for 4 hours daily times 1 week, then retest for GBS.

Rinse your vaginal area every six hours for one week before your GBS test with a chlorhexidine wash (which can be purchased from your local drug store under the brand name Hibiclens), diluted as four tablespoons Hibiclens to 2 ¼ cups water. I put a bottle in each birth kit and rarely need it.

“Other practitioners of herbal remedies and supplements have found GREAT success rates of the following strict regime to eradicate GBS from their bodies all together: a daily regiment of douches and oral remedies. Oral acidophilus and a grapefruit seed extract douche in the morning. Garlic capsules inserted vaginally in the afternoon. And an oral once a day garlic capsule in the afternoon. Finally a goldenseal root powder douche at night along with another oral acidophilus.” (7)

Constance Rock LM Protocol:

The following treatment plan is designed to boost your immune system. For most women, this helps reduce or even eliminate the growth of Group Beta Strep.  We’ve had excellent results with this protocol. Nearly all of our clients who have cultured positive at 36 weeks have been able to completely eliminate the GBS by the time they delivered. Some clients have only been able to minimize the growth, but the large dose of vitamin C causes their amniotic sack to thicken, thus preventing the bag from rupturing until they’re pushing which significantly reduces the baby’s time of exposure and the likelihood of infection. For those women who test positive, we recommend culturing once a week until delivery so we can see the positive effect the protocol is having.

Twice a day, with breakfast and dinner:

    • Acidophilus – 4 billion cells per dose
    • Echinacea – 350 mg capsules – 2 capsules
    • Garlic – 580 mg capsules – 2 capsules (you may also
    • Vitamin C – 1000 mg with 200 mg bioflavonoids
    • Grapefruit Seed Extract – 15 drops
    •  Zinc 50mg a day
    •  Also douche with wheatgrass 2x per week
    •  Insert plain yogurt vaginally 2x week
    •  Colloidal Silver, 1 dropper a day, low dose

If you are successful at eliminating the Group Beta Strep, we suggest continuing the treatment until your baby is born to give yourself the best possible chance that the bacteria will not be present at the time of birth.
References:
  1. Chen, H.C., Chang, M.D., Chang, T.J. (1985) Antibacterial Properties of Some Spice Plants Before and After Heat Treatment. [English translation of Chinese article]. Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi 18: 190–5.
  2. Klein, J.O. (1999) Management of Acute Otitis Media in an Era of Increasing Antibiotic Resistance. Int J Pediatr Otorhinolaryngol 49: S15–17.
  3. Honig, E., Mouton J.W., van der Meijden, W.I. (1999) Can Group B Streptococci Cause Symptomatic Vaginitis? Infect Dis Obstet Gynecol 7: 206–09.
  4. Christensen, K.K, Dykes, A.K., Christensen, P. (1985) Reduced Colonization of Newborns with Group B Streptococci Following Washing of the Birth Canal with Chlorhexidine. J Perinat Med 13: 239–43.
  5. Irving, W.L. Best Practice in Labour Ward Management. Edited by L.H. Kean, P.N. Baker and D. Edelstone. London: WB Saunders, 2000.
  6. Albandar, J.M., Gjermo, P., Preus, H.R. (1994) Chlorhexidine Use after Two Decades of Over-the-counter Availability. J Periodontol 65: 109–12.
  7.  http://wonderfullymadebelliesandbabies.blogspot.com/2007/08/gbs-giant-bothersome-stumblingblock.html
  8. http://www.americanpregnancy.org/pregnancycomplications/groupbstrepinfection.html
  9. http://www.ncbi.nlm.nih.gov/pubmed/15651446