labor

NEW: Upper Valley — Vermont + New Hampshire!

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Tree Life Birth Care in White Riv­er Junc­tion, VT, is our newest loca­tion for Total Preg­nan­cy Fit­ness. The cen­ter is ded­i­cat­ed to pro­vid­ing bal­anced, evi­dence-based sup­port to women and their fam­i­lies dur­ing preg­nan­cy, labor and post­par­tum. They offer doula care, child­birth edu­ca­tion, pre­na­tal dance class­es, and lac­ta­tion con­sult­ing in the Upper Val­ley region of Ver­mont and New Hamp­shire. For more infor­ma­tion, vis­it http://LifeTreeBirth.com or email Mary Etna Haac at DoulaMaryEtna@gmail.com.

Mary Etna R Haac, MPH, PhD, DONA-trained Birth Doula. Bilin­gual: Eng­lish-Span­ish. 703–447-98–94.

Building a Global Team of Teachers for Healthy Pregnancy, Birth & Baby

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Danc­ing Thru Preg­nancy®, Inc.

Women’s Health & Fit­ness Pro­grams
found­ed 1979
MISSION STATEMENT
Many impor­tant health issues for girls and women involve mat­ters of repro­duc­tive
health, child­bear­ing, fer­til­ity and aging. Research informs us that an active, healthy
lifestyle pro­vides a num­ber of ben­e­fits through­out a woman’s life span:

  • reduced dis­com­forts from preg­nancy, labor, birth, recov­ery & menopause
  • reduced risk of hyper­ten­sive dis­or­ders of preg­nancy and pre­ma­ture birth
  • poten­tially short­er active labor and reduced risk of cesare­an deliv­ery
  • more rapid return to joy­ful activ­i­ties, less excess weight fol­low­ing birth
  • moth­er-infant inter­ac­tion, lead­ing to infant psy­chomo­tor enhance­ment
  • reduced rates of obe­sity, car­dio­vas­cu­lar dis­ease, and type 2 dia­betes
  • reduc­tion of some can­cers, osteo­poro­sis, falls and loss of mus­cle mass
  • improved social sup­port, net­work­ing and stress man­age­ment skills
  • greater belief in one’s abil­ity to be strong and capa­ble (self-effi­ca­cy)

Exercise and Body Trust in Birth

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In the gen­er­a­tions since birth moved from the home to the hos­pi­tal set­ting, it has become less and less fre­quent that women in devel­oped nations see birth first hand and accept it as a nat­ur­al part of life pri­or to their own first birth expe­ri­ence. The “epi­dem­ic” of fear sur­round­ing birth may well be part­ly a result of this phe­nom­e­non. In a recent post pub­lished in Mid­wives mag­a­zine, a pub­li­ca­tion of the UK’s Roy­al Col­lege of Mid­wives, DTP direc­tor Ann Cowl­in wrote a blog enti­tled ‘Exer­cise and Body Trust in Birth.’ The post address­es the con­fi­dence in one’s body that accom­pa­nies train­ing spe­cif­ic exer­cise and how this applies to preg­nant women and their prepa­ra­tion for birth. Here is the link to the blog post: http://community.rcm.org.uk/blogs/exercise-and-body-trust-birth

About Pain and Birth

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This is excerpt­ed from our Danc­ing Thru Preg­nan­cy blog.

That Was Then…

As I became involved in the birthing field, one of the nurse-mid­wives with whom I was acquaint­ed intro­duced me to Jung’s quo­ta­tion: “There is no birth of con­scious­ness with­out pain.” (Alter­nate­ly, “There is no com­ing to con­scious­ness with­out pain.”) It struck a deep chord in me.

When I first saw the say­ing, “There is no birth of con­scious­ness with­out pain,” inter­twined with a draw­ing of a woman lit­er­al­ly giv­ing birth, the truth of the image seemed obvi­ous to me. It become hard-wired into my under­ly­ing assump­tions about giv­ing birth. The process itself com­bines intense nox­ious sen­sa­tions with mid brain emo­tion­al input into what neur­al sci­ence calls pain. For years, this real­iza­tion has dri­ven what and how I teach: Being fit and edu­cat­ed in body/mind are the tools of enlight­en­ment and self-empow­er­ment.

…And This Is Now

A lit­tle while ago I came across a NY Times arti­cle “Prof­it­ing From Pain.” While the arti­cle con­cerns the huge increase in the legit­i­mate opi­oid busi­ness – prod­ucts, sales, hos­pi­tal­iza­tions, legal expens­es and work­place cost – it restart­ed my think­ing about a top­ic fer­ment­ing in my brain between That Was Then And This Is Now: The sense of enti­tle­ment to a pain-free exis­tence. The idea that pain free is bet­ter than painful. And the sell­ing of this idea for prof­it.

Where does this come from? Try­ing to oblit­er­ate pain has led to increased addic­tion, death and oth­er adverse side effects. A new top­ic has shown up in women’s health dis­cus­sions: Increas­ing use and over­dose from pre­scrip­tion pain killers by women, includ­ing dur­ing preg­nan­cy.

Could it be that human fear of pain is being used to gen­er­ate finan­cial prof­it? (the opi­um-is-the-opi­ate-of-the-mass­es mod­el). Per­haps once the notion of pal­lia­tive care reached a cer­tain lev­el of accep­tance for the dying with­in the med­ical com­mu­ni­ty, it began to spill over into oth­er human con­di­tions (the slip­pery-slope mod­el). Or, per­haps we don’t want trans­paren­cy at all (the denial mod­el).

In the last few days, NPR has raised the ques­tion of whether the high cesare­an birth rate is tied to the pay­ment for pro­ce­dure rather than out­come mod­el? The recov­ery from cesare­an is more painful than the recov­ery from vagi­nal birth, has adverse side-effects for moth­er and baby, and was orig­i­nal­ly designed for use only for the 15% +/- of real com­pli­ca­tions that arise in nor­mal birth. So, how is it being sold to 35% of women in the U.S,? At one point, there was a seri­ous dis­cus­sion with­in the med­ical com­mu­ni­ty that if women were afraid of the pain of birth and want­ed a cesare­an, a care provider should do one. No dis­cus­sion of why it seems painful or how to deal with pain.

The Afford­able Care Act aims to improve some of the cost issues in med­ical care by shift­ing the pay­ment incen­tive away from pro­ce­dures and on to out­come assess­ment. As a result, the cesare­an rate and even such seem­ing­ly innocu­ous pro­ce­dures as fetal mon­i­tor­ing are com­ing under scruti­ny. If we tru­ly want to do a ser­vice to the moth­ers-to-be in the ACA tran­si­tion peri­od and beyond, I think we must dis­cuss the ques­tion of birth and pain.

I can think of many ques­tions that fall under this topic…Why do we call the intense phe­nom­e­non of birth “painful”? How do our genet­ics, behav­ior, train­ing and thought-process­es affect our expe­ri­ence of pain? What about the health care cul­ture – has it focused on reliev­ing pain at the expense of what we gain from work­ing with pain short of trau­ma or immi­nent death? How do we pre­pare women for work­ing with sen­sa­tion with­out auto­mat­i­cal­ly label­ing it pain? Is the “empow­er­ment” often attrib­uted to giv­ing birth what is learned by going through the cen­ter of the “there is no birth of con­scious­ness with­out pain” expe­ri­ence? These ques­tions are just a start.

In closing…

Let me address the child­birth edu­ca­tors and preg­nan­cy exer­cise instruc­tors. This is our present chal­lenge. In my work, I feel the neces­si­ty to make all pain man­age­ment strate­gies under­stand­able to my clients. I find that most of the women I see in class­es must deal first with self-dis­cov­ery before they can assess their com­mit­ment to the view of birth they car­ry in their minds. The images of birth we lay out for them to con­sid­er need to include an under­stand­ing that you can­not escape the work of birth. Being present – mind­ful­ness – can be scary and intense but it is the medi­um by which our con­scious­ness expands. Car­dio­vas­cu­lar fit­ness and strength are the source of our endurance and pow­er.

Safe Birth — Who’s in Charge?

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Who Controls Birth? Defining the Argument.

Peri­od­i­cal­ly, argu­ments arise in the birthing field over who con­trols the way we give birth. Often this hap­pens at times when birthing women change their behav­ior trends, putting finan­cial pres­sure on pro­fes­sion­als work­ing in this field. The major play­ers in this argu­ment are med­ical doc­tors (obste­tri­cians), cer­ti­fied nurse mid­wives and pro­fes­sion­al home birth mid­wives.

Cur­rent­ly we are see­ing women leave the tra­di­tion­al hos­pi­tal set­ting for birth in larg­er and larg­er numbers…and tak­ing their dol­lars with them in the process. While the ques­tion of home birth safe­ty aris­es every time this con­trol argu­ment comes around, the ques­tion of whether it is safe to inter­vene in a labor that is pro­gress­ing nor­mal­ly is a new com­po­nent of the dis­cus­sion. This time the argu­ment is: The safe­ty of home birth vs. the safe­ty of using hos­pi­tal tech­nol­o­gy to inter­vene in nor­mal birth.

How Money Affects this Issue

As with all com­mer­cial ven­tures, con­trol­ling access to safe birth requires con­trol­ling the infor­ma­tion in the mar­ket place. This infor­ma­tion needs to address the per­ceived wants of the tar­get audi­ence. For a long time the main mes­sage has been: Safe birth is only avail­able in a hos­pi­tal.

The finan­cial pres­sure of giv­ing women (con­sumers) what they want — a nor­mal expe­ri­ence of birth in a safe set­ting where med­ical help can be quick­ly avail­able — has pow­ered the birth-cen­ter indus­try. Free-stand­ing and in-hos­pi­tal birth cen­ters have grown in num­bers, and are large­ly enabled by cer­ti­fied nurse-mid­wives. Mean­while, pro­fes­sion­al home birth mid­wives have increased both their cre­den­tials and prac­tice stan­dards, as well as their vis­i­bil­i­ty.

Both of these options, birth cen­ters and home birth, threat­en the liveli­hood of tra­di­tion­al obstet­ri­cal prac­tices. Low risk births (about 70% of births) have the poten­tial to be nor­mal births, requir­ing lit­tle or no inter­ven­tion. But, giv­ing birth in the hos­pi­tal means par­tic­i­pat­ing in mea­sure­ment pro­ce­dures that inter­vene in the labor process.

So, to con­vince women they need to be in a hos­pi­tal to be safe, med­i­cine has main­tained the argu­ment that home birth or out of hos­pi­tal birth is not safe. How­ev­er, research does not indi­cate this is true. The nature of this ongo­ing argu­ment is dis­cussed in a 2002 arti­cle from Mid­wifery Today.

What’s New? The Counter Argument.

The phys­i­ol­o­gy of nor­mal labor is dom­i­nat­ed by parasym­pa­thet­ic, med­i­ta­tive, gonadal ener­gy sys­tems. Mea­sure­ment is a sym­pa­thet­ic, ratio­nal, adren­al ener­gy dynam­ic. Only when it is time to expel the baby does the under­ly­ing ener­gy sys­tem make a tran­si­tion (tran­si­tion, get it?) to an adren­al impe­tus for the strength activ­i­ty of push­ing. Imme­di­ate­ly fol­low­ing nor­mal birth, mater­nal phys­i­ol­o­gy is again dom­i­nat­ed by gonad-dri­ven ener­gy along with a rush of endor­phins.

Inter­vene enough and things will go awry. You can eas­i­ly end up being cut and/or sep­a­rat­ed from your baby at birth.” These ideas have gone viral. With the arrival of the inter­net, women have found a very quick way to do what we have always done: Share infor­ma­tion.

Thus, in my exer­cise pro­gram and in my child­birth prepa­ra­tion class­es, I have more and more fre­quent­ly been field­ing the fol­low­ing ques­tion from women who want a nor­mal birth and want to be safe: “How can I avoid inter­ven­tions while I am in the hos­pi­tal?”

So, I ask them what leads them to ask this ques­tion. And, they say: “I read on the inter­net and/or heard from my friends that inter­ven­tions make birth less nor­mal and less safe. I want to pro­tect myself.”

Women them­selves are enter­ing the argu­ment in a much more con­scious way than in the past. Some pro­fes­sion­als would like to keep women out of the argu­ment. But, like with many things in our 21st cen­tu­ry world, we have already past the point of no return. As they say, the horse has already left the barn!

Word has got­ten around. More and more, as a pre­na­tal fit­ness expert who strives to lis­ten to my clients, my job has become edu­cat­ing and phys­i­cal­ly train­ing women to cope with a stren­u­ous and prim­i­tive process in a tech­no­log­i­cal world.

Hope­ful­ly, we can all keep our eye on the ball here. Pre­vent­ing trau­ma should be one key goal. Just as we have learned to hold our new­borns skin to skin so they can smell and taste us, lis­ten to our heart beat and voice, and main­tain their core tem­per­a­ture, let us learn to com­fort and nur­ture our new moth­ers, while we steel them for the rig­ors of birth.

Beyond Yoga

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Beyond Yoga

I love Yoga. But…Power Yoga, Hot Yoga, Fast Yoga, Pilates-Yoga, Fresh Yoga, Baby Yoga and even Pre­na­tal Yoga…not so much. I find these phe­nom­e­na strange.

Why? Well, 40 years ago – when I first learned Yoga – it was a priv­i­lege. A per­son came to Yoga in the search for a mean­ing­ful life path. It was a blend of the spir­i­tu­al and the phys­i­cal, and it required a com­mit­ment to what was revealed with­in the prac­tice. Before being allowed to take my first class, I had to demon­strate that I already prac­ticed med­i­ta­tion. It was not exer­cise per se.

It was not adapt­able like it is today. Depend­ing on the teacher, you learned an ancient sys­tem – Hatha, Vinyasa, Ash­tan­ga, Iyen­gar, or Kun­dali­ni. Those were the major meth­ods that have Hin­du roots, and those who prac­ticed these art forms knew what they were doing. The teach­ers them­selves had worked on their craft for decades. Today, I know only a few teach­ers who have a pro­found grasp of each of these meth­ods.

Why is Yoga so popular?

Is there some­thing with­in the work itself – even in the dilut­ed forms, hybrid ver­sions and the celebrity/competitive stu­dios – that allows it to thrive in the self-cen­tered, free-wheel­ing, brand­ing-crazy mar­ket­place of the ear­ly 21st cen­tu­ry devel­oped world?

I find the answer to this in a strange place:  Zen prac­tice, Bhud­dism. One of my favorite notions is from Suzuki’s text Zen Mind, Beginner’s Mind. “When you feel dis­agree­able, it is best to sit.” This is an ele­ment of nin – con­stan­cy – or being present in the moment. Not patience, which requires a rejec­tion of impa­tience and there­fore can­not accept the present as it is. When you sit – just sit peri­od, that’s it – all that is real is the moment. This is at the heart of all spir­i­tu­al expe­ri­ence.

I’m not an expert in Yoga. I don’t teach Yoga, although I have inte­grat­ed Yoga-based skills into my work. I have prac­ticed Hatha and Vinyasa over the years enough to learn how cer­tain skills are treated…belly breath­ing, slow deep breath­ing, main­tain­ing posi­tion and lis­ten­ing to the wis­dom of the body, and iso­met­ric strength­en­ing in prepa­ra­tion for more expan­sive shapes or motions. Long ago, I inte­grat­ed these skills from my Yoga expe­ri­ence into my teach­ing style because these skills are effec­tive for the pop­u­la­tions with which I work. But, I do not teach Yoga.

Can Research Help Us?

Researchers find Yoga a night­mare. There is so much vari­ance now in the prac­tice that find­ings from any one study can­not be trans­ferred to the gen­er­al pop­u­la­tion. One of the most reveal­ing exper­i­men­tal-design stud­ies found that none of the claims of Yoga improv­ing metab­o­lism could be demon­strat­ed. When asked why they thought this out­come had occurred, the teach­ers who were used in the study said they thought the par­tic­i­pants in the study were not fit enough to do Yoga!

One of the most suc­cess­ful Yoga teach­ers in my area, and one of my favorites, has for decades used a bicy­cle for her pri­ma­ry mode of trans­porta­tion. She cred­its her longevi­ty and suc­cess to Yoga. I attribute it to bicy­cling. Dr. Coop­er is right…fitness (which means aer­o­bic fit­ness) is the biggest bang for the buck. Unless you are fit, it is hard to exe­cute some of the more sub­tle demands of many exer­cise reg­i­mens.

Some Yoga teach­ers will say that you can make Yoga aer­o­bic or that some forms are aer­o­bic. OK, then it’s aer­o­bics, not Yoga. When­ev­er I see “aer­o­bic Yoga” it reminds me of aer­o­bic danc­ing. It’s help­ful to remem­ber that Yoga devel­oped in a time and place where sur­vival was depen­dent upon fit­ness. Peo­ple didn’t need to do more aer­o­bics to find enlight­en­ment. They need­ed reflec­tion and to be present in the moment.

So, I insist on aer­o­bic fit­ness as the first goal of a fit­ness reg­i­men. In the pre/postnatal field, this is the only con­sis­tent­ly demon­strat­ed fac­tor in improved out­comes. As a birth prepa­ra­tion there are Yoga-based fac­tors that will help in labor and birth IF THE WOMAN IS FIT ENOUGH. It is the fact that some Yoga-based skills help fit peo­ple find nin that is my jus­ti­fi­ca­tion for con­tin­u­ing to use them in con­junc­tion with aer­o­bics and spe­cial pre/postnatal prepa­ra­tion and recov­ery exer­cis­es.

But, there are cau­tions. Not all Yoga assanas (posi­tions) are safe for preg­nan­cy. Down-dog, in par­tic­u­lar, scares me because of inci­dents report­ed in obstet­ri­cal lit­er­a­ture in the 1980s and 1990s that indi­cate such a posi­tion is impli­cat­ed in fatal embolisms. Some shapes are just not doable and oth­ers become less com­fort­able over time. The ones that work have been iden­ti­fied since the 1940s and 1950s and inte­grat­ed into birth prepa­ra­tion cours­es.

What’s Next?

All exer­cise com­po­nents -

  • Mind/Body
  • Strength
  • Flex­i­bil­i­ty
  • Aer­o­bic or Car­dio­vas­cu­lar Fit­ness

- are nec­es­sary for a bal­anced fit­ness rou­tine. Too much empha­sis on any one fac­tor often results in injury. Aer­o­bics is where the great­est health ben­e­fits reside. Recent research has demon­strat­ed that it is phys­i­cal “fit­ness” (which we can mea­sure) as opposed to just spend­ing time in phys­i­cal activ­i­ty (which can be a wide range of inten­si­ties) that is respon­si­ble for improved health out­comes. Strength and flex­i­bil­i­ty train­ing need to be pur­po­sive. There are things we don’t need to do unless we are going to play pro foot­ball or dance Swan Lake! Mind/Body skills help us recov­er and pre­pare.

I for one will be glad when we get beyond yoga and back to cross train­ing!

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Pregnancy Pathway, Birth — Labor

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The First Stage of Child­birth is the long, hard labor. It is the slow process that pro­duces dila­tion, or open­ing, of the cervix — the “neck” or out­let at the bot­tom of the uterus. Once the baby’s head can fit through the open cervix, it is time for the Sec­ond Stage, but that is anoth­er top­ic for anoth­er post.

Labor is generally a long, slow process...there is no "enter" button for dilation!

Labor is gen­er­al­ly a long, slow process…there is no “enter” but­ton for dila­tion!

Before the baby can leave the mother’s body, s/he must leave the uterus. The open­ing of the cervix to let the baby out of the uterus gen­er­al­ly takes up the most time. For a first time mom it can be 10 or 12 hours…or, yes, a cou­ple of days. Of course, for some moms, this time is dif­fi­cult and for oth­ers it only becomes dif­fi­cult in the last few hours.

But, you know all this, right? What you want to know is:  Why do I have to go through this? And, if I must, how can I make it the least painful?

Why labor is impor­tant. Let’s go to anoth­er ques­tion:  How impor­tant would your off­spring be if it was no big deal to drop one out? If you were walk­ing along the side­walk and you could sim­ply drop a new­born on the pave­ment, would you even stop to pick it up if you could do it again in a few days, when, of course, it will be much more con­ve­nient?

Frankly, preg­nan­cy and labor remind us to pay atten­tion. A new­born can­not sur­vive on its own for at least two years. If we don’t pay atten­tion, it will die.

Okay, now that labor has your atten­tion, what else does it do that is ben­e­fi­cial? It stim­u­lates the baby’s stress response and teach­es the new­born to be alert dur­ing sit­u­a­tions of duress. Each con­trac­tion is pulling the cervix, help­ing it slow­ly open. If you are upright, each con­trac­tion is also alert­ing the baby to the influ­ence of grav­i­ty.

Why is labor painful? So, you need to go through this because it is the bridge from preg­nan­cy to par­ent­hood. Why does it have to be painful?

The first thing to keep in mind about pain is that pain is a com­bi­na­tion of sen­sa­tions and emo­tion, main­ly fear. Fear makes you tense; ten­sion reduces blood flow. Reduced blood flow to the uterus makes the con­trac­tions less effec­tive. In addi­tion, cor­ti­sol is released, mak­ing sen­sa­tions stronger and evok­ing greater fear.

Fear is the emo­tion of fight or flight. Inter­est­ing­ly, the oppo­site response, the relax­ation response, is very effec­tive in pro­mot­ing labor. So, relax. Breathe deeply and slow­ly, focus, move through the cen­ter of your expe­ri­ence. You don’t have to be in fear if you know what is hap­pen­ing and if you are phys­i­cal­ly fit and pre­pared. Both child­birth edu­ca­tion and phys­i­cal fit­ness teach your body to work with dis­com­fort. By includ­ing them in your prepa­ra­tion, you give your­self a tremen­dous advan­tage.

Does this mean you will nev­er feel like you want to stop in the mid­dle of labor? No, but it does mean you can do it. It is finite. The notion that the baby will not do well is also tied to your phys­i­cal fit­ness…babies of fit moth­ers less often expe­ri­ence fetal dis­tress. Your care providers will let you know if there is some fac­tor beyond your con­trol that requires med­ical inter­ven­tion.

Birth is an empow­er­ing event. But, before the baby can be born, it must escape the uterus. It is a clas­sic con­flict and the mother’s body is the venue. Give your­self over; go with it. Only women can do this.

Pregnancy Pathway, Birth

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There is no birth of con­scious­ness with­out pain.

Birth is a process with two major components

Birth is a life process with two major com­po­nents

Okay, be here now:  This is about a real­ly major experience…bringing human con­scious­ness into the world…opening a door to a room of love in your heart that you can only know by giv­ing birth to this person…changing your iden­ti­ty for­ev­er.

Get­ting your mind around the image: If you have not tak­en the time yet to get your mind around this, take a moment. Breathe in deeply. Gen­tly blow the air out. Repeat. Repeat. Let go of any resis­tance. Slow your heart. Slow your mind. Con­sid­er:  Your body has the pow­er to cre­ate a per­son. Your body has the pow­er to expel this per­son when the rent is up.

Your brain, glands and organs are hav­ing a con­ver­sa­tion with the baby’s brains, glands and organs. At some point, this dis­cus­sion reach­es a place where it is time to end this arrange­ment of two peo­ple shar­ing one body. It is true that occa­sion­al­ly the pas­sen­ger doesn’t want to leave, but that is rare. And, we have a rem­e­dy for that. Let’s just focus now on the what hap­pens when it’s time to go.

Labor starts how? Well, it depends. Some­times con­trac­tions start in fits and spurts and take a while to get orga­nized. Some­times they start strong­ly from the get go, and for oth­ers the process of get­ting rolling can take a few days. Some­times it starts ear­ly, and some­times has to be helped to start. Once in a while, the water breaks and labor starts…or not. So, the first les­son of hav­ing a child come to live with you is that you need to be flex­i­ble in your expec­ta­tions.

In the next two posts, we’ll cov­er Labor and then the Birth Mode. Each of these process­es is unique. They involve dif­fer­ent ener­gy sys­tems. They require dif­fer­ent mind-sets from the moth­er and her sup­port team. The out­comes are dif­fer­ent. Going through the cen­ter of these process­es helps you deal with them, helps you recov­er from their stren­u­ous nature and helps you move on to being a par­ent.

Remem­ber: Breathe in deeply. Gen­tly blow the air out. Repeat. Repeat. Let go of any resis­tance. Slow your heart. Slow your mind. Con­sid­er:  Your body has the pow­er to cre­ate a per­son. Your body has the pow­er to expel this per­son when the rent is up.

Pregnancy Pathway…Important Notes from Wonderrobyn

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The fol­low­ing are notes from co-author Robyn Bran­ca­to, CNM (cer­ti­fied nurse mid­wife) who prac­tices in New York City, or, as she is know here: Won­der­robyn! You can read about both authors in the About tab above. Here they are on the beach in San Diego, when they gave a talk at con­fer­ence there a cou­ple years ago. Robyn on the left, Ann on the right.

Robyn and Ann, Pathway authors

Robyn and Ann, Path­way authors

1. Addi­tion to Small Rant: “Resist the temp­ta­tion to watch A Baby Sto­ry on TLC! It does not por­tray birth accu­rate­ly, as they con­dense 15 hours of labor into 30 min­utes and play up the dra­ma so that you will be on the edge of your seat! In the major­i­ty of women, birth is not that dan­ger­ous.”

2. Regard­ing: When does con­cep­tion occur? “This is a real­ly inter­est­ing post… I love the dis­cus­sion about at what point con­cep­tion occurs! Per­son­al­ly, I like the Bib­li­cal notion of quick­en­ing. Even though this varies from woman to woman and can range any­where from 16 to 22 weeks ges­ta­tion, it seems like the most nat­ur­al the­o­ry.”

Dear Read­er:  What do YOU think? Did you read the con­cep­tion post on March 23, ’09?

3. About sperm & preeclamp­sia. “Is the con­nec­tion between bar­ri­er meth­ods and preeclamp­sia actu­al­ly estab­lished? I have read stud­ies stat­ing the con­trary — that bar­ri­er meth­ods have no effect on preeclamp­sia rates.”

HURRAY! THIS REQUIRES FURTHER CONSIDERATION.

More infor­ma­tion: The immune mal­adap­ta­tion the­o­ry sug­gests that tol­er­ance to pater­nal anti­gens, result­ing from pro­longed expo­sure to sperm, pro­tects against the devel­op­ment of preeclamp­sia. Thus, bar­ri­er meth­ods and being young may pre­dis­pose women to this major dis­or­der of preg­nan­cy.

Evi­dence exists on both sides of this the­o­ry. Here are two recent stud­ies (one of each) that read­ers may find help­ful in under­stand­ing this idea. Keep in mind that oth­er fac­tors than just sperm expo­sure may be affect­ing research find­ings. But, it does seem that under some con­di­tions, bar­ri­er meth­ods and amount of expo­sure to sperm can affect the preg­nan­cy itself.

Ness RB,  Markovic N, Harg­er G, Day R. Bar­ri­er meth­ods, length of pre­con­cep­tion inter­course and preeclamp­sia, Jour­nal: Hyper­ten­sion in Preg­nan­cy 23(3):227–235. 2005.  Results did not sup­port the immune mal­adap­tion the­o­ry.

Youse­fi Z, Jafarnezhad F, Nas­rol­lai S, Esmaeeli H. Assess­ment of cor­re­la­tion between unpro­tect­ed coitus and preeclamp­sia, Jour­nal of Research in Med­ical Sci­ences 11(6):370–374. 2006. In a matched con­trols study, women with <4 months cohab­i­ta­tion or who used bar­ri­er meth­ods had high­er risks of devel­op­ing preeclamp­sia than those with >4 months cohab­i­ta­tion. Oral con­tra­cep­tion users had a low­er preeclamp­sia rate than those who used no oral con­tra­cep­tion.

In a com­men­tary arti­cle in OB/GYN News ‚  July 1, 2002, the fol­low­ing note was made by Dr. Jon Einars­son: With insuf­fi­cient expo­sure, preg­nan­cy may induce an immune response and preeclamp­sia in some women with pre­dis­pos­ing fac­tors such as an endothe­li­um that already is sen­si­tive to injury due to age, insulin resis­tance, or pre­ex­ist­ing hyper­ten­sion.

Is there a plain and sim­ple truth about sperm expo­sure and preg­nan­cy risks? Alas, no. But, know your cir­cum­stances. If you are young, pro­tect your­self. Wear a con­dom. When you are ready to be a mom, you will be ready to fig­ure out your risks. So, this, too fol­lows the axiom:

Events in life are rarely plain and nev­er sim­ple.