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ZIKA VIRUS and PREGNANCY

mosquitoZika Virus: Answers for Pregnant Women

What is Zika virus?

Zika is a virus that’s been around for actually dozens of years; it generally causes a mild viral syndrome and is prevalent in the Tropics—South America, the Caribbean islands, and Pacific islands.

Zika virus is a mosquito-borne illness.  Most people who are infected with Zika virus have no symptoms. If they have symptoms, they are usually very mild such as fever, rash, red eyes, muscle pain or joint pain. People usually do not get sick enough to be hospitalized and they very rarely die.

Is there a link between the Zika virus and birth defects? Infection during pregnancy can be harmful to the fetus or the newborn. Zika virus has been associated with microcephaly, a birth defect in which the size of a baby’s head and brain is smaller than expected. This birth defect is associated with developmental delays including trouble speaking, problems with movement and balance, hearing loss, and vision problems.

How is Zika virus transmitted? Women can be infected with the Zika virus directly by mosquito bite in an area where there is active Zika transmission or by sexual transmission from an infected male partner.

How can I prevent catching the Zika virus? The Centers for Disease Control and Prevention (CDC) has recommended that pregnant women, or women who may potentially become pregnant, avoid travel to countries that have been affected by the virus, including a large number of countries in South America, the Caribbean and the Pacific Islands. Check the CDC website http://www.cdc.gov/travel/page/zika-travel-information for a complete list of affected countries. Both pregnant women and their partners should avoid mosquito bites, particularly if traveling to a country that has been affected by Zika. If your sexual partner has recently visited an area with the Zika virus or is infected with the Zika virus, abstain from sex or use condoms throughout the pregnancy.

 If I am going to travel to an affected area, what should I do to prevent catching the virus? Travel to an affected area is not recommended for pregnant women. If travel is completely unavoidable, talk to your healthcare provider and take precautions to avoid mosquito bites. This should include use of EPA-registered insect repellents, wearing long-sleeved shirts, long pants, and hats to cover exposed skin, and maximizing time spent indoors in air-conditioned or screened rooms.

The recommendations for people contemplating pregnancy are a little bit different. If the woman has been exposed to Zika and gotten sick—meaning she has flu-like symptoms, runny nose, sore throat, low-grade fever, red or itchy eyes—it is possible that it is due to the Zika virus and, currently for people who have symptoms that have been exposed, they can be tested to see if that is true.

For a woman who has been exposed and been sick from Zika, it is recommended  waiting 8 weeks before tyring to conceive. There’s concern for men that the virus can remain in their bodies and be spread through sexual contact. And so for a man who has been sick from Zika, again, been exposed, been in an area and had a viral syndrome, the man can now be tested and, if he’s been sick or tested positive, the current recommendation is that he not have unprotected intercourse with a pregnant woman or try to conceive for 6 months.

If I catch the Zika virus before my pregnancy, is my baby at risk? We do not yet have recommendations about the safe period between infection and conception. However, once the virus is cleared from the blood, prior Zika infection is not thought to affect future pregnancies.

For more information about Zika virus, visit www.ChildrensNational.org/Zika

If you are concerned that you have been exposed to the Zika virus, please talk to your doctor. The Fetal Medicine Institute at Children’s National can work with your doctors directly.

http://childrensnational.org/departments/fetal-medicine-institute

Phone number:  202-476-7409

*SOURCES: Information provided by Children’s National Health System Centers for Disease Control and Prevention

*Excerpts from The Zika Virus and Getting Pregnant, Eric A. Widra, Medical Director,  Shady Grove Fertility

Baby Massage: Bonding Through Touch

Baby Massage has been practiced in many cultures around the world for thousands of years, helping mothers and fathers to better communicate with their children through the power of touch. In today’s busy modern family, working moms and dads can feel guilty for missing out on time with our precious little ones. Infant Massage, or “Baby Massage”, is a great way to bond with your baby and have fun while making a stronger connection.

What is Baby Massage?

This easy-to-learn Massage technique is a gentle-pressure, rhythmic rubbing of your baby’s body and skin with your hands and fingers. You can use a moisturizer or lotion to help your hands glide over their skin and gently wiggle their ankles, elbows, wrists, and fingers. Developing a ritual will help your baby recognize the process. Be sure to make expressive eye contact throughout, engaging the child as much as possible. You can talk softly, hum, or sing a song.

What are the Benefits of Baby Massage?

The soothing rubbing of your hands stimulate the production of the feel-good hormone Oxytocin in the baby. Oxytocin is the hormone that gives you that warm, loving feeling. Mom produces it during breastfeeding, and Dad can produce it simply by holding the baby close. Parents relax, and baby is usually calm and receptive.

Some other benefits include:

• A better connection to your child spiritually and intellectually

• Relaxes your baby, putting them in a state of playful curiosity

• Better sleep patterns resulting in better moods

• Helps alleviate gas and stimulate bowel movementsbabymassage.jpg.

• Promotes sensory stimulation

Baby Massage is one of the most natural and pleasant methods of providing early nurturing, helping to strengthen the bond between you and your child. Parents report feeling more comfortable and confident in their ability to care for the baby. They learn to understand and respond to the baby’s cues, and learn techniques to comfort, calm, and soothe their babies. If you are looking for something special to do with your baby, consider adding Infant Massage to your routine.

For more information on infant massage or to host a workshop please visit www.DanaDurand.com

by Dana Durand, NCTMB, Licensed Massage Therapist

What is Thrush?

Thrush/nipple yeast and vaginal yeast are caused by the one-celled organism, Candida albicans. It is a fungus that thrives in moist, dark environments (like the nipples, milk ducts, mother’s vagina, baby’s mouth and/or baby’s diaper area). The use of antibiotics by mom or baby is a contributing factor in the occurrence of yeast. A cracked or sore nipple can also contribute to the occurrence of  yeast.

A consultation with your healthcare provider is  important. Here are a few questions to help you determine if you or your baby has a yeast overgrowth. If you answer yes to one or more of these, you may have thrush.

• Have you noticed white spots/patches in your baby’s mouth?
• Does your baby have a bright red, pimply diaper rash?
• Is your baby gassy, fussy or not nursing well due to oral thrush?
• Is the area around your nipple pink, red, itchy, flaky or shiny?
• Do you feel a burning sensation on your nipples either during or between feedings?
• Do you have a cracked nipple that won’t heal?
• Do you feel shooting pains in your breast (different from the sensation of let-down)? Some women describe the feeling as “a piece of glass” or “stabbing.”
• Have you or your baby completed a recent course of antibiotic treatment?
• Did you have a cesarean birth or were you diagnosed with a vaginal Strep-B infection?

**Note: It is rare for a mom to have a red rash or white spots on her nipples with a nipple yeast infection.**

Here are some common treatments for thrush. It is very important that both mom and baby are treated at the same time, even if only one of them show signs of yeast. Yeast/thrush is highly contagious, and if not treated together, they will keep passing it back and forth to each other. Be sure to continue treatment for at least 2 WEEKS after the signs of Thrush/yeast have gone away.

• Your healthcare provider can prescribe a prescription of Nystatin for you and baby – a cream for mom to use on her nipples and oral liquid for baby. Make a run to the store for yogurt containing live, active cultures (especially acidophilus). The yogurt cultures (acidophilus) will help get rid of the yeast. If your baby is old enough, you can offer him some too.

Acidophilus supplements. This does the same thing as the yogurt. You should be able to find acidophilus in the health food section of your grocery store/pharmacy or at a natural foods store. This can also be crushed (or, if you have the caplets, opened) and sprinkled directly on your nipples. If you wish, you can do this just prior to feeding so your baby gets a dose of acidophilus, too. A daily probiotic, in tablet, capsule or liquid form, is a good way to keep your normal flora from overgrowing. Taken on a daily basis should be a part of your healthy lifestyle behavior.

Gentian Violet. You should be able to find this in your local health food/natural foods store or in the natural food or vitamin section of your store. Using a clean cotton swab, rub some on each nipple. In order to treat baby, also, it works best to put some on your nipple and then latch baby on to nurse. It will coat baby’s mouth while he is nursing. It is a bit messy, so you’ll want to make sure you are wearing clothes you won’t mind getting purple stains on. This should only be used for 3 days.

Grapefruit Seed Extract. (not grape seed extract),  ACTIVE INGREDIENT MUST BE “CITRICIDAL”), 250 mg (usually 2 tablets) three or four times a day orally (taken by the mother), seems to work well in many cases. If preferred, the liquid extract can be taken orally, 5 drops in water three times per day (though this is not as effective). Oral GSE can be used before trying fluconazole, instead of fluconazole or in addition to fluconazole in resistant cases.

Dr. Newman’s All Purpose Nipple Ointment (from his Candida protocol handout): Mupirocin 2% ointment (15 grams), Betamethasone 0.1% ointment (15 grams), and micona-zole powder so that the final concentration is 2% miconazole. This combination gives a total volume of just more than 30 grams. This cream requires a prescription sent to your local compounding pharmacy. The combination is applied sparingly after each feeding (except the feeding when the mother uses gentian violet). “Sparingly” means that the nipple and areola will shine but you won’t be able to see the ointment. Do not wash or wipe it off, even if the pharmacist asks you to. I used to use nystatin ointment or miconazole cream (15 grams) as part of the mixture, and these work well enough, but I believe the use of powdered miconazole (or even clotrimazole powder) gives better results. These ointments can be used for any cause of nipple soreness (“all purpose nipple ointments”), not just for Candida (yeast). Use the ointment until you are pain free and then decrease frequency over a week or two until stopped. If you are not having less pain after 3 or 4 days of use, or if you need to be using it for longer than two or three weeks to keep pain free, get help or advice.

Vinegar Wash: 1-cup water and 1 tablespoon of vinegar. Use at least 4 times per day, after nursing. Use a clean cotton ball/swab to apply every time and let air-dry.

Cut back on your sugar intake. Yeast also loves sugar, so the less that is in your body, the less the yeast has to thrive on.

Sterilize anything that goes into your baby’s mouth or has contact with your nipples. This is necessary to kill the yeast that is on those items and prevent it from reinfecting you. This includes any toys, pacifiers, bottle nipples, breast pump parts and your bras.

Wear disposable breast pads. Change them with each nursing and just toss them out. This way, you’re not sterilizing your bra every night.

• Some moms have found swimming in a chlorinated pool to clear up their nipple yeast very quickly.

Diflucan (generic: fluconazole) is a prescription medicine that is commonly used to treat vaginal yeast infections. It has been shown to be effective against nipple yeast/thrush, especially when the yeast has survived all other treatments or it is a ductal yeast infection (meaning it is in your milk ducts, not just in the nipple area). The dosage for proper treatment is: 400mg loading dose on day one, then 200 mg per day for 13-28 days after that. Again, your baby should be treated at the same time you are being treated.

Be sure to keep in contact with your healthcare provider and lactation consultant on your treatment regimen and if the symptoms are improving.

presented by Angel J. Miller, MSN, CNM

http://www.midwiferycareassociates.comCradle_hold_breastfeeding

http://www.metropolitanbreastfeeding.com

http://www.tinyurl.com/yztozrl-Dr. Newman’s candida protocol

 

 

TIME – the Most Precious Commodity of All

breastfeeding momMost mothers are stressed when they have a new baby. I absolutely remember how tiring it is to be a mother – and especially when you’re a breastfeeding mother. Being tired is on my mind right now, because in the midst of working with a new breastfeeding mother of a six-day-old, she flat-out told me that, “this breastfeeding thing is taking way too much of my time.” I was left flabbergasted and flap-jawed. What I wanted to say and what I did say were two very different things. What I wanted to say was “Well, what were you expecting? Did you think you were going to drop the baby in the umbrella stand on the way in and out of your front door?” What I actually said is “Tell me how I can help you.”

The mom went on to explain that nursing every two hours was beginning to grate on her nerves. I went on to explain that babies had tummies the size of golf balls and that breast milk was a “perfect food” that made it digest and move through the stomach very rapidly. I quoted how each DROP of colostrum had 3 million cells (the majority being immune cells). Breastfeeding is as much nurturing as nourishing (hoping the old adage would help). I also described cluster feeding as being analogous to a camel getting ready to cross the desert; feed, feed, feed and then you get the big sleep (maybe 4-5 hours max). In my first book “Start Here; Breastfeeding and Infant Care with Humor and Common Sense” I tried to call the hours between 6-10PM the “arsenic hours,” but the publisher opted for something safer like “the witching hours.” I guess that “every hour on the hour” cluster thing is what put this new mother “over the edge.”

So, here are some suggestions I’ve come up with to help you save time during your busy breastfeeding days.

  • If you have an exceptionally sleepy baby (or just have to get the show on the road once in a while), I find that you can feed on one side while you simultaneously pump on the other: Tarzan Pumping (at least that’s what I call it). That trick alone can save you up to a half hour per feeding and maximize your milk supply. Your body will react as it you’re feeding twins (because both sides are going at the same time) and perhaps even increase supply a bit. It will also expedite your feeding and have your baby feel as though a bigger, stronger twin was on the other breast helping him or her out. Now you’ll want to feed that milk to your baby at some point (perhaps during cluster feeding time), as when I previously instructed another mom to do this, she was giddy with her new frozen stash; problem was the baby hadn’t gained any weight in a week…whoops; I should have been more clear with my instructions.
  • Anyone who tells you to sleep when the baby sleeps probably doesn’t shower, do laundry, use the bathroom, open the mail or eat; I never understood that suggestion. I mean, that’s the only time you have to do ANYTHING, isn’t it? So, ALLOWING others to do things for you will help put time back in your day. You shouldn’t feel as though you’re not a good mother if you don’t do everything and do it well (do as I say, not as I do/did). I remember 28 years ago how I came creeping out of my house to get the mail and was spotted by my neighbor. She promptly sent her “nanny” over to my house with instructions to “help that poor woman out.” Problem is that I wouldn’t let the well-meaning nanny in! As I look back on it, I was afraid that I’d be found out; that I’d be “exposed” and my neighbor would know how I wasn’t really holding things together as a mother “should.” In my experience, many mothers feel that same way. They’re overwhelmed but think that they’re the only mother experiencing that. I’m here to tell you that MOST mothers feel overwhelmed in the beginning and if they tell you otherwise, I’d be wary.
  • Remember the saying “time is fleeting,” so are these stages!  Many times these cluster feeds will pass quickly and after a couple days you’ll have an entirely new baby.  It’s important to keep in mind that babies patterns change quickly and you won’t always be feeding around the clock. 

When I heard this mother complaining about time, as I think more about it, I’m suspicious there might be something else going on. Is she depressed? Is she lonely and needs to get out of the house for companionship, does she simply have cabin-fever, or are her expectations unrealistic as to how much time infants take out of a mothers day? What do you think?

Blog written by  Kathleen F. McCue, DNP, FNP-BC, IBCLC-RLC, 

Owner of Metropolitan Breastfeeding

Building a Strong Foundation for Your Pregnancy

Contemplating pregnancy?  Nutritional and optimal health should be priority number one!  Women contemplating pregnancy must keep in mind that healthy eating habits and healthy lifestyle behaviors should be established before pregnancy to make sure proper nutrient levels for early embryo development and growth.

Eating a balanced diet that includes the proper amount servings of protein, grains, fruit, and vegetables is key. Protein is essential to the very foundation of your baby’s growth. Eating enough protein ensures that your little one, from the very beginning, is getting adequate food stores to support cell growth and blood production.  Regular exercise should also be incorporated in your daily routine to prepare your body for the demands of pregnancy. Habits such as drinking or smoking must be avoided to allow for optimal health and development of the child during pregnancy and after birth.  Good habits should  include taking a daily multivitamin or a daily prenatal vitamin.  Even if you are consuming healthy foods daily, you can miss out on key nutrients.  A daily prenatal vitamin — ideally starting three months before conception — can help fill any gaps.  A quality, fast absorbing prenatal vitamin is necessary for all the basic micronutrients needed during pregnancy.eat-well-teaser

Through the course of pregnancy there is an increased need for nutrients and calories to make sure proper fetal growth. The increased need for vitamins and minerals such as folate, calcium and iron is necessary to prevent birth defects, ensure proper bone formation/retention, and to reduce the risks of preeclampsia or anemia. Folic acid intake increases to a daily amount of 800 mcg, calcium to 1200 mg, and iron to 30 mg. Your Vitamin D levels should be checked with your initial prenatal labs to be sure you levels are not insufficient or deficient.  Fetal needs for vitamin D increase during the latter half of pregnancy, when bone growth and ossification are most prominent. Vitamin D travels to the fetus by passive transfer, and the fetus is entirely dependent on maternal stores. Your body needs vitamin D to maintain proper levels of calcium and phosphorus, which help build your baby’s bones and teeth. A vitamin D deficiency during pregnancy can cause growth retardation and skeletal deformities. It may also have an impact on birth weight.  Therefore, maternal status is a direct reflection of fetal nutritional status.

Researchers believe that a vitamin D deficiency during pregnancy can affect bone development and immune function from birth through adulthood.

Blog by Shelia Kirkbride

Grief and Self-Care

This blog was originally published (by the author) on Reconceiving Loss in July 2015.

It’s the time in your life when the hardest thing to do is to be selfish. Yet, that is how you might feel in terms of your emotions. The sadness, tears, heaving sobs that are unrelenting threaten to unhinge you. You yearn to stop, but you can’t. Those around you try to offer you comforting words or platitudes. Sometimes they help, but often they don’t. This is what grief can look like, particularly the soul-crushing grief of losing a pregnancy or baby.

Through this grief, you often feel alone. Friends and family don’t seem to understand that one month later, you haven’t “snapped out of it” and “moved on.” Your partner is also at a loss for words or actions that might be comforting as he embraces you for the hundredth time. Perhaps he sees the loss differently. Or maybe more time has passed and you even have another baby, yet you still feel some numbness that this new baby hasn’t been able to fully eclipse.

This is the time when you just want everything to disappear. Or you throw yourself back into your life, willing the everyday motions to undo the feelings. You want to be cared for, but all of the attempts of asking aren’t helpful. Perhaps there are a few people that get it, but you don’t want to burden them. The temporary salve they provided in just talking and listening has worn off, and reaching out seems too hard.

A compounded loss in grief is the temporary loss of your sense of self and the idea that you have a semblance of control in your life. Taking this back and reclaiming you can be important and healing through your grief journey. But how? Taking tiny steps to care for yourself. Yes, take care of yourself.

In the throes of grief, it can be difficult to even get out of bed in the morning and go through your hygiene routine. Even past this phase, doing anything pleasurable can seem like plodding through molasses. Often, grieving mothers fear that if they start to engage in life again, that somehow this means that they are forgetting the baby that died. There might be continued focus on trying to achieve a new pregnancy (from yourself or from those around you) as if this is the answer to healing. Ultimately, at the end of the day, you are your own best resource. You are your own best advocate. To do either, you need strength and perhaps the permission that it is OK to matter. It is OK to indulge. It’s OK to ask for a break and to take charge of your needs.

What might self-care look like? It can be as minimal as taking time to journal, take a bath, go on a walk, or sing. Self-care doesn’t have to cost money (as the previous examples suggest) but it’s also fine if it does. Examples might be: a manicure, massage, a weekend retreat, signing up for a class or learning a new skill.) The only limit is you. And you are the only one who is fully able to care for yourself in the way that feels best.

by  Julie Bindeman, Psy-D, Co-Director of Integrative Therapy of Greater Washington

http://www.greaterwashingtontherapy.com/

Is it safe to continue breastfeeding if I’m pregnant with another child?

Many mothers choose to continue breastfeeding throughout pregnancy, while others decide to wean. The following ipregnantwithsonkissinnformation may help you decide what is best for you and your family.

Generally, it’s possible to safely continue breast-feeding while pregnant — as long as you’re careful about eating a healthy diet and diligently drinking plenty of fluids. There’s an important caveat, however. Breast-feeding can trigger mild uterine contractions. Although these contractions aren’t a concern during an uncomplicated pregnancy, your health care provider may discourage breastfeeding while pregnant if you have a history of preterm labor. In an uncomplicated pregnancy there is no evidence that continuing to breastfeed will deprive your unborn child of necessary nutrients. In addition, according to the LeLeche League International Breastfeeding Answer Book, 3rd Edition 2003, page 407. “Although uterine contractions are experienced during breastfeeding, they are a normal part of pregnancy. Uterine contractions also occur during sexual activity, which most couples continue during pregnancy.” if you are having a difficult pregnancy and are at risk for preterm labor and birth, and in particular, have been advised to avoid intercourse during pregnancy, then weaning would probably be advisable.

It is important to have a healthy diet if you plan to breastfeed during pregnancy. Depending on how old your nursing child is, you may need an additional 650 calories a day if your breastfeeding child is under the age of six months, or about 500 if your child is now eating other foods. This is in addition to the 350 (second trimester) and 450 (third trimester) calories you need during your pregnancy. (No additional calories are needed during the first trimester as you work your way through morning sickness and some healthy foods are just not palatable. In malnourished populations, pregnant, nursing mothers do have lower weight gain and lower weight babies, as well as lower weight nursing siblings, than those who wean.

If you’re considering breastfeeding while pregnant, be prepared for changes your nursing child might notice. Although breast milk continues to be nutritionally sound throughout pregnancy, the content of your breast milk will change — which may affect the way your milk tastes. In addition, your milk production is likely to decrease as your pregnancy progresses. These factors could lead your nursing child to wean on his or her own before the baby is born.

Your comfort may also be a concern. During pregnancy, nipple tenderness and breast soreness are common. The discomfort may intensify while breast-feeding. Pregnancy-related fatigue may pose challenges as well. If you want to continue breast-feeding while pregnant — or breast-feed both the baby and the older child after delivery — you may need additional support from loved ones or other close contacts. Also check with your health care provider about taking supplemental prenatal vitamins.

Info provided from Midwifery Care Associates and LeLeche League International, Breastfeeding Answer Book, 3rd Edition, 2003.

Sara Walters, B, Breastfeeding During Pregnancy, Carmathen Wales UK; from New Beginnings, Vol. 25, No. 1, January-February 2008, pp. 32-33