Tuesday, December 31, 2013

Dear Anatomy & Physiology Professor

Yesterday I finished a 12 week anatomy and physiology 2 part course. At the end I posted my professor a note in the discussion area.

I have enjoyed both Anatomy classes and have learned lots of information valuable for the various things I do. I am a birth doula, birth educator, La Leache League Leader, parent educator and more. I do have some ideas about the labor and birth chapter which I meant to contact you about. I'll still try to do that before the discussion areas get closed. 

Thank you,

The professor responded, "I'm glad you enjoyed the course and look forward to your input!"

So I spent a considerable amount of time yesterday going carefully through her lectures and formulating my response. I posted it into the discussion area as I had no other way to connect with her. I found out this morning that she took it down and sent me this reply, 

"To Jennifer,

Thank you for the information.  I am not able to keep that type of post up in the Discussion Area, but I read it carefully and copied and pasted it into a Word document for further review.  I am looking forward to checking out the references you included.  I think the pendulum has swung some on medication during childbirth.  When I was having my children (my oldest is 33 and my youngest is 18), women were encouraged to avoid medication if possible, while women in my mother's generation were significantly medicated.  Now, it seems that epidurals are used almost routinely, rather than reserved for special situations.

I think it's very important for women and their partners to learn as much as they can about pregnancy and childbirth, understand the pros and cons of different types of pain relief, think about their ideal situation for labor and delivery, and then discuss their wishes and concerns with a physician who comes highly recommended and who they trust.  

Thanks again for the info!"

I couldn't agree more. Women should learn all about the pros and cons, safety and risks of ALL medical procedures before they give birth but NOT in an anatomy and physiology class. In an anatomy and physiology class they should learn how a woman's body works without any outside interference. How her musculoskeletal, integumentary, sensory, hormonal, chemical and nervous systems work in concert to bring a baby into this world. 

Here is what I posted on the discussion board:

I have some thoughts about the sections in your lectures which cover normal vaginal birth. Let me explain my background. I have been a doula for over 20 years. In case you aren't familiar with this profession, a doula supports couples during the entire birth process and into the early postpartum period as well. I have been at over 100 births. Some have happened in homes and birth centers, but the majority of my clients have chosen to birth in a hospital setting. I have seen lots of babies come into this world vaginally and some via cesarean section. Along with this I am a birth educator and La Leche League Leader. La Leche League International has been educating and supporting breastfeeding women for over 50 years. They have the most up to date information and studies on lactation, breast milk, and breastfeeding. As a Leader I am trained to support mothers who desire to breastfeed through facilitating meetings and providing one-on-one support.

Throughout your classes I have been impressed with how well you explain the body's systems both anatomically and physiologically. The more I know about the human body the more amazing its abilities seem to me. I am very passionate about women, birth and families. It is very important to me that women are given accurate information about their body's birthing and breastfeeding abilities. Unfortunately in our culture women know very little about birth and what they are told is not at all from an anatomical and physiological stand point. Instead it is heavily mixed with cultural beliefs with no regard for science. Unfortunately I believe your section on birth is skewed in this manner. Women need to know how we were designed to give birth. If they then choose to use medical and pharmacological props or interventions that will be an educated cultural choice. As this is an anatomy and physiology course, I am hoping you will consider taking a more physiologic approach to how you present birth to women. Please understand I am NOT advocating women should birth without skilled help at the ready. How much they use or need that help will depend on their unique situation. I want them to learn what their bodies are capable of doing. 

Here is what I have learned from watching women, keeping up with the latest science, and opening my mind to see past our current birth culture. Women are designed anatomically to labor and birth in upright positions. Left to their own instincts it is very rare indeed for a woman to choose to lie down to birth, especially on her back. Imagine a woman choosing to lie flat on her back to defecate or urinate. Most un-medicated women will choose to stand, semi-squat, full squat or be on their hands and knees. Unfortunately all of your graphics clearly show the supine position. This position is brought about through the use of pain medication and for doctor and hospital convenience. It is considered normal only because of cultural influences on the physiologic birth process. Anatomically it flattens the pelvis and doesn't allow for the sacrum and coccyx to move out of the way of the descending head. It also immobilizes both of the illiac bones making it harder for them to spread laterally giving the additional space needed for the baby. You mention the doctor placing the woman in a semi upright position but as long as her bottom is against the surface of a bed she will be hampered in her abilities to birth unassisted, but unassisted is what we are anatomically and physiologically designed to do.

In your course you say the doctor will tell the mother when second stage has begun. But anatomically when a mother is un-medicated she does not need to be told when to begin pushing. When the baby descends to a certain point in the pelvis he naturally triggers the fetal ejection reflex in mom. Just as when you need to vomit you know you are about to vomit. No one needs to tell you it is time or how to do it. No one needs to say how long each vomiting session should last. This is exactly like the 2nd stage of labor. The mother, even a first time mother, will spontaneously begin to push with her diaphragm and abdominal muscles. She will not be able to help it. She will not be able to stop herself. She will naturally tend to push 3 times during each contraction for approximately 6 seconds. This amount of time works physiologically for the baby. When a mother is pushing she tends to hold her breath to bear down. This breath holding reduces the available oxygen to the baby. Six seconds is an amount of time that babies tolerate well. Longer than that can cause a drop in oxygenated blood with a corresponding rise in fetal heart rate as they physiologically struggle for homeostasis. 

The un-medicated mother will know when she is crowning from the burning sensations she will feel. Most mothers stop pushing and cry out. This releases the vaginal muscles and allows for the last stretching. I agree with you that it can be helpful for a provider to gently put counter pressure on the head to keep it from coming so quickly mom’s vaginal tissues tear but this is not how the system was designed. It was designed for the mother to birth like other mammals, without assistance. Further there have been many studies done that show that an episiotomy does not keep a woman from tearing. As a matter of fact they all agree that a woman is more likely to have a 3rd or 4th degree tear if she has an episiotomy. Currently most doctors only do an episiotomy if the baby's heart rate is dropping into the danger zone. In this situation it can be life-saving.  

When the baby's head appears the supine or semi-reclined position necessitates a care provider to hold the head so the head doesn't flop backward, hyper extending the baby's neck. When a mother births in a squat the head stays perfectly in line with the body as it hangs down. In your lecture you say the doctor will rotate the baby's shoulders but most babies rotate without any assistance. It is part of the anatomical fit between mother and baby that causes them to sort of cork screw out. It is only if their shoulder is stuck under the pubic bone that this doesn't happen. Finally rather than a doctor needing to catch the baby as you suggest, the mother is capable of reaching down and catching the baby as it pops out after the body rotates into position. I have witnessed this. 

As to the physiological process, you mentioned the hormones oxytocin and prostaglandin but equally important in the process are dopamine and endorphins. This combination of dopamine, endorphin and oxytocin is the same combo released during orgasm which causes intense pleasure and a feeling of floating. In labor this powerful chemical combination changes the laboring woman's perception of the pain allowing her to endure much more than she would otherwise. On top of that she is chemically driven to bond with her new baby as soon as he or she emerges. This is a very important feed-back loop which pitocin and an epidural disrupt. It has consequences for the next phase, mothering the baby outside the uterus.

The latest studies all show conclusively that immediate skin-to-skin contact is what we are physiologically designed for rather than taking the baby away even briefly and presenting it back to mother as a wrapped bundle. The mother and baby should continue to be considered one biologic unit. They share bacteria, hormones, body fluids, antibodies, fats and proteins. A neonate has no ability to self-regulate. He does this through his mother. Hearing the mother's heart beat and feeling the rise and fall of her breath regulates his heart rate and respiration. It keeps the levels of adrenalin and cortisol at their appropriate levels; enough to cause the baby to be hyper alert without causing him physical stress. Science has proven babies should not be taken away or wrapped in blankets. This is part of the WHO Baby Friendly Initiative. Their goal is to have all babies go immediately onto their mother’s abdomen or chest unless they need life saving measures. Normal suctioning doesn't count as life-saving. If needed this can be accomplished quite easily on the mother while baby remains skin-to-skin. They are to stay this way undisturbed for the first 2 hours of life so that all of the above sharing and regulation can occur. If you haven't watched a video on delivery self-attachment yet you will be amazed! We are much more like other mammals than we have given our babies credit. When un-medicated, undisturbed, and left skin-to-skin with mom they move themselves into position and find the nipple, latch on, and begin feeding. I just attended a conference where I was blown away by the latest info about epigenetics and breastfeeding. Breastmilk contains, histones, lepten, and microRNA, which all pass to the baby. They attach into their genes and change how the genes are expressed. This is an important further step in passing on genetic information from one generation to the next.  

The third stage is more easily accomplished if baby stays with mom. This triggers further oxytocin release, especially if the baby latches and begins to nurse, which stimulates the placenta to fully separate and then keeps blood flow to the amount which brings mom back to homeostasis. She loses the extra blood she created to maintain the pregnancy which she no longer needs. There is no need for "a little bit of pitocin" as you have taught unless the mom actually IS bleeding too much. Again our physiology is miraculously designed to take care of most contingencies. Only when it is not able to do its job successfully should we vary from this amazing design which you clearly have so much respect for.

Finally I want you to imagine what would physiologically occur if the mother and neonate were all alone immediately after birth. What would the mother do? Would she immediately clamp and cut the umbilical cord as you have stated the is done in our hospitals? Highly unlikely. Therefore what is supposed to occur? As you detailed so well, the baby's circulation and respiration have major changes that need to happen. These will generally take place quite peacefully without any gasping or stress to the baby. There is significant pressure around the baby's chest when it is squeezing through the vagina. When the baby is born there is therefore a significant drop in pressure which causes air to try to rush into the lungs. Also there are nerves in the skin of the neonates face which, when exposed to air for the first time, trigger him to breath in. This is why babies can be born under water and not drown. They do not attempt to breathe until their face is lifted out of the water. Further as long as the cord and placenta are intact and still pulsing the neonate continues to receive oxygenated blood from the mother through the placenta. The cord is covered with a substance called Warton's Jelly. When the air hits the cord it dries this out and triggers the cord to slowly stop pulsing. Meanwhile inside the baby his body is working to close the foramen ovale and reroute the blood. Most cords will pulse for 5 to 10 minutes after birth and placentas stay adhered to the wall for anywhere from 15 to 30 minutes. This gives the baby buffer time. I don't believe in this scenario there is a fall in blood PH, but I could be wrong. This also gives the mother/baby system time to bring their blood exchange into homeostasis with the neonate receiving exactly the right amount of blood. If you clamp the cord too soon you will leave 1/3 of the fetal blood in the placenta. This blood is needed by the neonate for many reasons. They are discussed in one of the links below. 

Thank you for listening and thank you for expanding and deepening my knowledge of the human body. I'm very glad I took this class. If you wish to ask me further questions about labor, birth or breastfeeding please email me at jenniferstoverdoula@gmail.com.

A standing unassisted birth video: https://www.youtube.com/watch?v=zFMHB4RqpjI  

An MRI study of Pelvimetry in 3 positions:

Further explanation about up right positions: http://www.givingbirthnaturally.com/birth-positions.html

Discussion of labor hormones and how catecholamines disrupt the natural hormonal cascade:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595201/  

Delayed cord clamping: http://www.scienceandsensibility.org/?p=5730

The requirements for a hospital to become Baby Friendly certified:http://www.babyfriendlyusa.org/about-us/baby-friendly-hospital-initiative/the-ten-steps

Importance of skin-to-skin contact: http://www.medscape.com/viewarticle/806325

Breast Crawl video: https://www.youtube.com/watch?v=zrwfIcPB1u4   

I hope dear reader you found this information helpful to you. Please feel free to share it with others. You can link to this blog or share it via Facebook. Even copy and paste it into an email or on your own web site. Please remember to attribute it to me.

Monday, December 30, 2013

California Measles Outbreak; What's a Parent to Do?

Yesterday I caught the tail end of Dave Congalton on the radio talking with a local pediatrician who has written a new e-book about baby's first year. She was adamant about vaccinations and was sure that if parents were simply told the facts by their doctor they would automatically want to vaccinate. During the short time I was listening, 2 other docs called in to FULLY support vaccinations.                                 
She also said we were having a measles epidemic in California. At that point I called in. I asked her how many cases there actually were. She backed off and said she shouldn't have called it an epidemic but an outbreak. I told her I thought the cases were in vaccinated people. She said no they were unvaccinated. (Keep reading to see she and I were both right and wrong on that one.) She said this kind of bad information was the problem with the internet spreading false info. She accused parents of getting poor information off the internet and then being too frightened to do the right thing for their kids. So this morning I went to the internet to see what I could find out about measles in CA. Here is some info you should know.

Facts on California's measles outbreak
From the CDC web site:
"Measles causes fever, runny nose, cough and a rash all over the body. About one out of 10 children with measles also gets an ear infection, and up to one out of 20 gets pneumonia. For every 1,000 children who get measles, one or two will die."                

Also from our government:                                                
"HEALTH ADVISORY – February 19, 2014

14 Measles Cases in the State of California in 2014

Fourteen cases of measles with onset in 2014 have been reported to California Department of Public Health. (In all of 2013, 189 people have been reported to have the disease. This represents the second largest number of cases in the U.S. since measles was eliminated in 2000.)
Among the 2014 California cases, four case-patients had traveled outside of North and South America, with three traveling to the Philippines. Nationally, an increase has been noted in the proportion of measles cases with travel to the Philippines. Measles cases from recent years have reported travel to Germany, France, England, India, and China, among other destinations.

Of the 2014 California case-patients without international travel, three had contact with known measles cases, two had contact with international travelers and five are under investigation to identify potential sources.

Of the 12 cases with known measles vaccination status, 8 were unvaccinated (7 were intentionally unvaccinated and 1 was too young to be vaccinated). That means 4 were vaccinated and 8 were not. So a third of the cases were in vaccinated people and 2/3 in unvaccinated. Why are vaccinated people getting sick? Had they only had the initial vaccine and not the booster or did they fave both shots and the life-long immunity they said we would have isn't turning out to be true? 

Please note they are NOT talking about deaths or even tell us how severe the cases were; simply that they had measles.

The last large outbreak of measles in the U.S. occurred during 1989-1991, with 17,000 cases of measles and 70 deaths in California.

Let's compare this to influenza. For the 2013-2014 flu season the California Department of Public Health says there were 332 deaths in California. 

Efforts to increase immunization rates in the 1990s were successful and endemic transmission of measles in the U.S. was eliminated in 2000.

Here is what eliminated actually means. In 2000 there were 86 cases in the US and 19 in California. 

 In 2013-2014, a large measles outbreak in the Philippines has resulted in over 1700 cases and 21 deaths. This outbreak has led to measles importations to Australia, Canada, the UK, and in many U.S. states. Additionally, measles is currently circulating in most regions of the world outside of North and South America."

In 2013 there were 189 cases of measles in the US and 15 cases in California. There were NO deaths. Now I want you to think about the numbers of people you know in California who had the flu this year. We probably each know at least 15 people. Of the California measles cases, 11% needed to be hospitalized, so 17 people were seriously ill. Pneumonia was the reason for hospitalization for 4 of the cases. It is important for pregnant mothers to note that 2 of these hospitalizations were for pregnant women and 1 miscarried. Let's look closer. Ninety-nine percent were import associated. In other words there was contact with someone who brought the virus into the US from abroad or was in contact with someone who was in contact with someone who had been abroad. Another interesting item is that 8% of the cases were in vaccinated people. 

How Does This Compare to the Flu?

Let's see what Web MD says about the flu:

Here's a rundown of some important flu statistics, based on the best available data.

Percentage of the U.S. population that will get the flu, on average, each year: between 5% and 20%.
That is with the current flu vaccination rate. So what percentage of the US population is 159 measles cases? The US Census Record says there are 316.99 million people in the US. So last year's outbreak was .00005% of people in the US.

Number of Americans hospitalized each year because of flu complications: 200,000, on average.
Remember there were 17 people hospitalized for measles complications last year. The last big outbreak of measles occurred from 1989-1991. Each year there were approximately 18,000 cases in the US with approximately 3,600 hospitalizations. 

The number of people who die each year from flu-related causes in the U.S.: ranges from 3,000 to 49,000.
During the last big outbreak of measles in the US approximately 41 people died each year.

In the U.S., influenza and pneumonia were the eighth leading cause of death in males in 2009.

Number of flu vaccine doses available in the U.S. for the 2013-2014 flu season: Between 135 and 139 million.
That means that if all the doses get used they will have vaccinated 44% of the population for flu. The federal government wants a 90% vaccine rate for measles and they say are meeting or exceeding that goal! Less than 1% of young children are not vaccinated  and most of the unvaccinated kids are for economic reasons. So what percent of all the kids in the US are not vaccinated due to parental choice? I couldn't find that number. Obviously it is less than 1%. 

So where does all this fear come from? Most of it stems from one situation in New York where many people in one extended family became ill with measles. This family had chosen not to vaccinate due to philosophical reasons. They had family members who traveled to Europe and brought home an unwelcome souvenir. In total there were 65 cases of measles in New York. Here is the final word of why the the CDC is concerned:  "imported measles cases can result in large outbreaks, particularly if introduced into areas with pockets of unvaccinated persons."

From the National Vaccine Information Center:
(this is the organization which the medical establishment is talking about when they say crazy 
anti-vaccine people)  
"In 1960, three years before the first measles vaccine was licensed in the U.S., there were 380 deaths from measles recorded."            

Are vaccines safe or not?
Now let's explore the possible side effects from getting the MMR vaccine. Remember very little in life is 100% safe so with life there is risk. What are those risks?

From the CDC: 
"Moderate Problems
Seizure (jerking or staring) caused by fever (about 1 out of 3,000 doses)
Temporary pain and stiffness in the joints, mostly in teenage or adult women (up to 1 out of 4)
Temporary low platelet count, which can cause a bleeding disorder (about 1 out of 30,000 doses)

Severe Problems (Very Rare)
Serious allergic reaction (less than 1 out of a million doses)
Several other severe problems have been reported after a child gets MMR vaccine, including:
Deafness, long-term seizures, coma, or lowered consciousness, and permanent brain damage
These are so rare that it is hard to tell whether they are caused by the vaccine.
(Please note they give us NO numbers)

From the National Vaccine Information Center: 

"Common side effects from the MMR vaccine include low-grade fever, skin rash, itching, hives, swelling, reddening of skin, and weakness. Reported serious adverse reactions following MMR vaccination include seizures, brain inflammation and encephalopathy; thrombocytopenia; joint, muscle and nerve pain; gastrointestinal disorders; measles like rash; conjunctivitis and other serious health problems.

As of March 1, 2012, there have been 898 claims filed in the federal Vaccine Injury Compensation Program (VICP) for injuries and deaths following MMR vaccination, including 56 deaths and 842 serious injuries. (Again we have no numbers of doses of vaccines to help us understand what percentage of doses; or true level of risk. I'm not even sure if these numbers include multiple years.)

Using the MedAlerts search engine, as of July 9, 2012 there have been 6,058 serious adverse events reported to the Vaccine Adverse Events Reporting System (VAERS) in connection with measles vaccine since 1990, with over half of those occurring in children 3 and under.

Evidence has been published in the medical literature that vaccinated persons can get measles because either they do not respond to the vaccine or the vaccine’s efficacy wanes over time and vaccinated mothers do not transfer long lasting maternal antibodies to their infants to protect them in the first few months of life."

There are other theories about vaccines long term risks beyond immediate reactions. None of these, as far as I know, have been proven. Conversely I don't know that there are any long-term studies on vaccine safety. Questions out there which I feel bear looking into are the potential vaccine/autoimmune disease link. Especially after seeing that the CDC says one of the moderate immediate reactions can be pain and stiffness in the joints in teens and women. Autoimmune diseases are definitely on the rise. Is this caused by vaccines? The anti-vaccine group would like you to think so. As far as I know we have no scientific studies to definitively make that connection yet. I want long term studies done. I want studies done on bundled vaccines, not individual vaccines. I don't believe the scientific community has done enough research into the possible synergistic effects of bundling vaccines. I think the fact that we now have potential humans to do matched studies on right here in America is fantastic. I don't want studies with unvaccinated people from third world countries compared to people in the developed world. I want us to follow long-term some of the now unvaccinated US kids and a matched group of vaccinated US kids. Let's really find out some concrete answers. Until then I'm not sure anyone knows. 
What's a parent to do?
Parents need to make wise choices for their children. Are you planning to travel outside the US? Will you be having world travelers come into your home or be in contact with them in some other way, such as, airplanes, buses, trains, or hotel rooms? Perhaps you want to vaccinate. Perhaps 2 measles deaths in a 1000 cases is too high a risk for you to comfortably take as a parent. As doctors love to say (the doctor on the radio yesterday said it too) when it is your child 1 death is too many. Of course they NEVER factor in that, 1 death from a vaccine reaction is also 1 death too many for any parent. What is important to me is that you have solid information to make your own best choices. 

Then I want you to find a doctor who will listen to you as a parent, help educate you and then will allow you to make your choices without shaming you in any way; or worse yet fire you as a client. I want to take a moment to acknowledge one such local pediatrician, Dr. Renee Bravo. Here is what one of my "Whole"istic Mamas said about a recent visit. 

"Just wanted to share my positive experience yesterday. I've known Dr Bravo for probably 25 years & have been bringing my children to him since my 1st was born almost 11 years ago. I respect him & think he's a great person. Yesterday I brought baby #4 in for her 2 mos checkup. I was really nervous to tell him I didn't want vaccines for my baby since I'd unknowingly vaccinated my other 3 children & thought he might possibly hassle me like his associate did. When he asked about shots for this visit I declined & he said "no problem, whatever you want to do I'll support!" He said we could do delayed vaccines (he said he really likes Dr. Sears schedule), even more delayed, or none at all, just let him know. Then he said "you know you really only need most of these if you're traveling to a 3rd world country anyway." No hassle, no debate, just pure support. Yet another reason why I respect him!"

I know this was a lot to read but it is important that all of us base these kinds of parenting decisions on a real understanding of the facts. 

Next, since it is "going around", I wanted to give you info on how to tell if your child has measles and what your doctor can do. If you think you or your child has measles, or you have been exposed to measles, the sooner you go to your doctor the better if  you want to utilize their help. 

IMPORTANT: Do NOT go to your doctor without FIRST calling. Let them know you think your child has been exposed to or come down with measles. Ask IF they wish you to come in and HOW they plan to minimize risk to their other clients. Babies do not get vaccinated for measles until they are 12 months old. Therefore the kids most vulnerable to having difficulty fighting off the infection are not vaccinated.   

What do measles look like?
From the Mayo Clinic web site:
Description: a red, blotchy rash that usually appears first on the face and behind the ears, then spreads downward to the chest and back and finally to the feet.

Measles signs and symptoms appear seven to 14 days after exposure to the virus. Signs and symptoms of measles typically include:
Dry cough
Runny nose
Sore throat
Inflamed eyes (conjunctivitis)
Sensitivity to light
Tiny white spots with bluish-white centers found inside the mouth on the inner lining of the cheek, called Koplik's spots
A skin rash made up of large, flat blotches that often flow into one another
The infection occurs in sequential stages over a period of two to three weeks.

Infection and incubation. For the first seven to 14 days after you're infected, the measles virus incubates. You have no signs or symptoms of measles during this time.

Nonspecific signs and symptoms. Measles typically begins with a mild to moderate fever, often accompanied by a persistent cough, runny nose, inflamed eyes (conjunctivitis) and sore throat. This relatively mild illness may last two or three days.

Acute illness and rash. The rash consists of small red spots, some of which are slightly raised. Spots and bumps in tight clusters give the skin a splotchy red appearance. The face breaks out first, particularly behind the ears and along the hairline. Over the next few days, the rash spreads down the arms and trunk, then over the thighs, lower legs and feet. At the same time, fever rises sharply, often as high as 104 or 105 F (40 or 40.6 C). The measles rash gradually recedes, fading first from the face and last from the thighs and feet.

Communicable period. A person with measles can spread the virus to others for about eight days, starting four days before the rash appears and ending when the rash has been present for four days.
When to see a doctor

What if I think my child has measles?

More from Mayo
Call your doctor if you think you or your child may have been exposed to measles, or if you or your child has a rash resembling measles.

No treatment can get rid of an established measles infection. However, some measures can be taken to protect vulnerable individuals who have been exposed to the virus.

Post-exposure vaccination. Nonimmunized people, including infants, may be given the measles vaccination within 72 hours of exposure to the measles virus, to provide protection against the disease. If measles still develops, the illness usually has milder symptoms and lasts for a shorter time.
Immune serum globulin. Pregnant women, infants and people with weakened immune systems who are exposed to the virus may receive an injection of proteins (antibodies) called immune serum globulin. When given within six days of exposure to the virus, these antibodies can prevent measles or make symptoms less severe.


Fever reducers. You or your child may also take over-the-counter medications such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin, others) or naproxen (Aleve) to help relieve the fever that accompanies measles. Don't give aspirin to children because of the risk of Reye's syndrome — a rare but potentially fatal disease.

Antibiotics. If a bacterial infection, such as pneumonia or an ear infection, develops while you or your child has measles, your doctor may prescribe an antibiotic.

Vitamin A. People with low levels of vitamin A are more likely to have a more severe case of measles. Giving vitamin A may lessen the severity of the measles. It's generally given as a large dose of 200,000 international units (IU) for two days.

How do you tell if it is measles or chicken pox? 
Also from the Mayo Clinic site:

Chickenpox infection usually lasts about five to 10 days. The rash is the telltale indication of chickenpox. Other signs and symptoms, which may appear one to two days before the rash, include:

Loss of appetite
Tiredness and a general feeling of being unwell (malaise)Once the chickenpox rash appears, it goes through three phases:

Raised pink or red bumps (papules), which break out over several days
Fluid-filled blisters (vesicles), forming from the raised bumps over about one day before breaking and leaking
Crusts and scabs, which cover the broken blisters and take several more days to heal
New bumps continue to appear for several days. As a result, you may have all three stages of the rash — bumps, blisters and scabbed lesions — at the same time on the second day of the rash. Once infected, you can spread the virus for up to 48 hours before the rash appears, and you remain contagious until all spots crust over.

The disease is generally mild in healthy children. In severe cases, the rash can spread to cover the entire body, and lesions may form in the throat, eyes and mucous membranes of the urethra, anus and vagina. New spots continue to appear for several days.

What if my child has Chicken Pox?

Most children do not need to see a doctor other than to tell you they have chicken pox. When do you need to see a doctor?

From the CDC:
For people with chickenpox at risk of serious complications, call a health care provider if the person:
is older than 12 years of age
has a weakened immune system
is pregnant
develops any of the following:
fever that lasts longer than 4 days
fever that rises above 102°F (38.9°C)
any areas of the rash or any part of the body becomes very red, warm, or tender, or begins leaking pus (thick, discolored fluid), since these symptoms may indicate a bacterial infection
extreme illness
difficult waking up or confused demeanor
difficulty walking
stiff neck
frequent vomiting
difficulty breathing
severe cough

Good luck with your decision and good parenting!

Sunday, December 29, 2013

How to Not Gain My Trust

Dear Doctor,

You will not gain my trust by pigeon-holing me at an unrelated professional public event and in a loud confrontational tone telling me I don’t know what I am talking about. Do you realize how disrespectful it is to assume that if people just knew what you know they would obviously agree with you?

You will not gain my trust by going on and on with rarely a break long enough for me to get in a word. This was not a respectful rational dialogue between two equally intelligent individuals. Instead it was an overly emotional barrage of highly charged personal experiences bound up with concern for your own children.

You will not gain my trust by not being considerate of time and place. Did you give any thought to the fact that you were in the middle of an organization that has worked very hard to establish trusting relationships between often competing parties by keeping our focus on the ways in which we agree, respectfully sharing information, and focusing on a common goal? Did you take a moment to consider that I was about to get up in front of a room full of people and speak? Luckily I am confident enough to be gracious to you, while not backing down in my defense of parents who you feel make the wrong choice about vaccine, and immediately after still get up and give a caring, warm introduction for a woman I greatly admire. Did you know that about me? No because you don’t know me at all.

You will not gain my trust by not being conscious of who else is around you and how they might be affected by our exchange. Did you know that it was mortifying to me that the evening’s presenter, a professional who inspires me, was listening to you? Did you never give it a moment’s thought that sitting all around you might be parents who have chosen not to vaccinate or are following less traditional vaccination schedules? How do you think this made them feel? Do you think you gained their trust?

As I said to you that night you are obviously sincere in your concern about the potential for children to become ill and die because of parents choosing not to vaccinate. I can tell you care deeply. I too care deeply. It is very important to me that I give out as accurate information as I can to parents and prospective parents. What they do with that information is up to them. I believe in their abilities to make good choices for their children. In the past when it has been brought to my attention that I may have printed inaccurate statistics I have gone back and taken a second look at my original information and, with guidance by far better statisticians than I, I have made corrections as needed. Based on the discrepancies between your numbers and mine I am reviewing my original measles outbreak post, my sources and the original numbers, and will be posting an up-date. I will also be working on a post as to how the medical establishment as a whole lost our trust. Unfortunately you, dear doctor, did nothing to re-gain mine.


Friday, November 1, 2013

A New Path Down an Old Road

Like many mothers, the road I started down after the birth of my son has taken me places I never expected. I have reinvented myself many times in the process or perhaps the road has reinvented me. Threads from my past lives weave together and my tapestry gets richer and deeper, mellowing with age.

Many years ago my body lay broken upon the jagged shores of my deepest passion, riding horses. Just as with the birth of my son I was once again confronted with the limits of the medical model. In this case if they couldn't visualize it with their many tests, quantify it, and label it, it didn't exist therefore they had nothing to offer me as a path back to health. They would happily prescribe pain medication for the rest of my life or refer me to a psychologist because the pain was obviously in my head not in my back. My search for a way out of pain led me to a deeper understanding of many modalities; acupuncture, chiropractic, watsu, myofascial release, spinal decompression, Feldenkrais body work, hormone balancing, and craniosacral therapy. All have been instrumental in my journey toward a pain free life.

Our lives lead us many places. Mine lead me to Cayucos to the door of CranioSacral Therapist, Celeste Varas de Valdes. The combination of her amazing ability to "read" my body, the gentleness of her touch, and the profound response of my body as I floated out of pain were incomprehensible to me. How could this be? I told my husband she was a wizard. How could she hardly touch me and have such an amazing healing effect?

Celeste encouraged me to read John Upledger's book "Your Inner Physician and You." Upledger is the founder of CranioSacral work. Actually I believe he may be a re-discoverer of a wisdom known through the centuries and across many cultures. I bought the book but consciously chose to never open it. I wanted to learn on an experiential level. It is easy for me to get in my head, to get caught up in intellectual learning. I wanted this to be clean unfettered learning through my own body's experience.

As my body began to heal I became more drawn to the how and whys of cranio work. Celeste patiently answered my questions. Next my path brought a chance to learn more at a California Midwifery Conference. I attended an all day workshop by Carol Gray introducing cranio work for pregnant moms and infants. After that I was convinced I wanted to learn more about how to incorporate this modality into my doula work. Time, expense and timing, i.e. life, kept this from happening.

A few years later I was offered an opportunity to watch at the hands-on part of an Obstetric 1 CranioSacral Training at Sukha Wellness Center in Avila. I was graciously allowed to try putting my hands on one of my pregnant clients who was there for demonstration purposes. I was astonished at all that I could "feel" going on inside her; the blockages and tensions. I put my hands on clients all the time, hugs, massages, counter pressure, or just holding a hand. This was completely different. It was tuning into a vibration and letting her body gently move me in a dance. The crazy part is she was lying completely still upon a massage table. No one else looking could see the swirling movement under my hands as her body gently unwound.

Interesting, but now what? I was busy going down a new path, working on earning my La Leche League
Leadership and learning as much as I could about breastfeeding. The more I immersed myself in the world of breastfeeding the more concerned I became. Listening to so many postpartum mothers who were struggling to breastfeed; to do what should have been a simple natural act. Something that every mare I helped foal never had a problem doing. Rarely, a mare will reject her foal completely, but no mare who allows her foal to latch has problems. Foals don't have latching or sucking issues. If you feed the mare right she has plenty of milk and the foal has no problems transferring that milk from the teat to his tummy. So why were so many of our mothers caught up in the pumping, bottling, exhaustion merry-go-round?

I am a question asker. If something doesn't add up for me I ask people I trust, who have more knowledge than I, why this doesn't add up. Lactation Consultant, Julie Merrill, kindly loaned me the book "The Impact of Birthing Practices on Breastfeeding" by Kroeger and Smith. I read that book cover to cover and in its pages I discovered all the research explaining why. I immediately incorporated what I learned into educating my class and doula clients. I was inspired to try harder than ever to support pregnant mamas in ways that would keep them off the self defeating merry-go-round. That didn't feel like enough to me. More moms needed to know. So I helped create and present the community event, Beating the Booby Traps.

Wait! This is supposed to be about cranio right? Took you right down the path with me didn't I? With an out of work husband there was no time or money to think about cranio. Then last May, with the financial help of LLL and labor and delivery nurse, Janell Todd, I attended La Leche League Conference. One lecture I chose to attend was given by Alison Hazelbaker assessing Tongue-tie, a condition which wrecks havoc on breastfeeding. It was presented over 2 days. The first day all the SLO Leaders went. The second day I think I was the only one who continued. I don't know why I went. She said she was going to present how to tell the difference between a real tie and a "faux" one. I thought it would just be more assessment tools. Well her assessment tool was to do CRANIO work on the infants and after several sessions re-assess for tongue function. Turns out she was a CranioSacral Therapist as well as a Lactation Consultant. An incredibly high percentage of tongue-ties were fixed with this gentle non-surgical technique. The pieces all slid into place for me. Now I knew what I wanted to do. It isn't enough to try to help moms say no to procedures which can impact their births and their breastfeeding. It isn't enough to give technical and emotional support to moms struggling unsuccessfully to feed their little ones. I want to actually help the babies and now I know how. I need to become trained in CranioSacral Therapy for infants. These babies are literally crying out for this kind of work.

Again money and time were blocking my path. Thank you to David and Mary Sage Sennewald of Sukha who gifted me a partial scholarship so I could attend CranioSacral I last month. Thank you to Alyssa Nixon and baby Finley for birthing before October 17th!

So now what? Well this path looks fairly long and I'm already finding roadblocks but I am determined. I've attended 2 study groups since the 4 day training. I ordered my books on-line yesterday. I think I have found a used massage table so I can practice on my family and friends. I can't even begin the Obstetric or Pediatric training until I have passed Cranio II and Somato Emotional Release. I'm trying to find a way to get my anatomy studies done without having massage therapists "in training" practice on me. This is something I know my body can not handle. Then there is the legal stuff about setting up a business which involves touching people. Yesterday I was so depressed. All I could see were the roadblocks. Today I'm cracking open the pages of "Your Inner Physician and You".

Celeste's Keep In Touch: http://www.craniosacralthpy.com/

David and Mary Sage's Sukha Wellness Center: http://sukhawellnesscenter.com/

Wednesday, July 24, 2013

Thank you!

Recently I received this lovely card.

Thank you for your thoughtfulness, your patience, your wisdom, your encouragement, your expertise, your attention to detail...

Thank you Jennifer for starting our little family off on the right foot! We are eternally grateful to you for all that you have done-and continue to do-for our family!!

Steve, Laurie & Ruby Jo

Wednesday, June 26, 2013

Some Truth about the Strength of Women

I recently ran into the quote on Facebook. I liked it so much I chose to use it as a cover on my Labor of Love Facebook page. Then I went searching to learn about Laura Harm. I immediately ran into this article; "Why Some Birth Quotes May Be Damaging to Women" on the Midwife International web site.  After carefully reading their post and the comments left by others I was drawn to leave this comment.

I have been a doula in San Luis Obispo for many years supporting women in the hospital and at home through medicated, un-medicated and cesarean births. I recently saw this quote and chose to put it on my doula facebook page. For most women birth IS painful. For most women it requires them to surrender in some form. Surrendering to your process where ever that process may lead, even into an operating room, IS the strength I see in this quote. Women ARE strong.The strength it takes to endure a surgery at the end of a long labor, the strength it takes to hold yourself together for the sake of your baby during an emergency cesarean, the strength it takes to surrender to the power of the process of dilation, the strength it takes to push a baby out of our bodies and into the world. This strength inspires me each time I am lucky enough to witness a birth, any birth. I make no distinction in my respect for birthing women, medicated, un-medicated, vaginal or surgical. ALL women are strong and need strength no matter how their baby arrives. I wish women could stop dividing themselves into groups. I wish women could stop feeling they are being judged and stop judging themselves. Filtered through our own souls this quote, like art, will mean something different to each of us. I am sorry it is painful for you. I wish you could see the beauty in this quote that I see. The acknowledgement that ALL women no matter how they birth are strong. You were strong.

I would like to know how YOU feel about this quote. I encourage you to read their article. Look deep into your soul. How does this quote make you feel? Who have you been judging?
Please post your comments here or on my Facebook page.

Wednesday, June 5, 2013

Acupuncture; Keeping a Pregnancy Healthy

I believe my son owes his life to an acupuncturist. My husband and I had been together for 10 years and actively trying to get pregnant for the last 2 without any luck. By using a combination of herbs and needles I was pregnant within 2 cycles of walking into Dr. Yu's office. I willingly drank the nastiest tasting herbal tea ever, in order to maintain the pregnancy for the first trimester. Nine months later when I pushed out a beautiful, strong, healthy baby boy I knew I had acupuncture to thank for this precious life in my arms.

I'll let you in on a little secret about me. I am scared of needles. I have real fears, (think fainting here) around having my blood drawn or getting a shot. What you need to know is that the sensation of having a thin flexible acupuncture needle placed in no way resembles getting poked by a regular needle. There isn't anyway I could have stood it if that was what the sensation was like. 

Since my successful pregnancy I have come to use acupuncture for many health issues, from injuries, to chronic pain, menopause and illness. So far it has never failed me and  I asked Carla Nerelli, L.Ac., of SLO Family Acupuncture to write a blog piece for my Creating a Healthy Pregnancy series focusing on all the ways acupuncture can support a woman during pregnancy. Carla has a special interest in pregnancy and babies and is thrilled to work with young families. She is new to SLO so I am happy to introduce her to the community through this post.

Most people associate acupuncture with treating pain and other physical ailments. But, did you know it could also be part of creating optimum pregnancy health? Acupuncture is an ideal form of treatment as it offers women drug-free relief from a multitude of problems that can arise during pregnancy and childbirth  creating a thriving environment for a growing baby, and keeping mother and baby healthy and happy.
Common Conditions Treated During Early Pregnancy
Pregnancy is such a beautiful time in a woman’s life. It is a time to celebrate, glow, flourish, and most of all, get excited for the new family addition. Pregnancy is one of the most natural cycles in human life. Unfortunately in today’s society pregnancy can often come with some uncomfortable and mood-ruining aches, pains, and other conditions. Acupuncture is a very safe, gentle, and pharmaceutical-free way to deal with most of these common ailments.

Prevention of Miscarriage
Morning Sickness
Migraines and Headaches

If a woman has a history of miscarriage, it is recommended they come in for weekly treatments at least through week 9 to help prevent a miscarriage and secure the pregnancy.

Common Conditions Treated During Mid-Pregnancy
Not only can acupuncture help treat issues that may arise during pregnancy, but it also helps to create a healthy and comfortable pregnancy.

Digestion Irregularities
Increased Immunity
Anxiety, Stress, and other Emotional Issues

Your baby’s health, as well as your health and comfort, are of the utmost importance. To aid in your well-being and relaxation, SLO Family Acupuncture exclusively uses massage tables that are specifically made to accommodate your growing belly during pregnancy.

Common Conditions Treated During Late Pregnancy
As the due date approaches, weekly acupuncture treatments can help prepare the mother for a smooth, healthy, and efficient labor and delivery by helping to alleviate anxiety and stress, relax the pelvic floor musculature, ripen the cervix, and ease the baby into a comfortable, optimal birth position.

Low back pain
Body Aches
Leg Cramps
Varicose Veins
Breech Presentation
Delayed Labor

Safety During Pregnancy 
Although acupuncture during pregnancy is completely safe, it is important to go to a qualified, licensed acupuncturist who specifically treats pregnant women since there are several acupuncture points that are contraindicated to use during pregnancy.  San Luis Obispo Family Acupuncture is happy to treat women in all stages of pregnancy. Treatment strategies and recommendations are on an individualized basis. In general, monthly treatments are considered ideal to sustain a comfortable and healthy pregnancy.

Centrally located near Downtown San Luis Obispo, SLO Family Acupuncture is happy to treat women from all over the Central Coast, Paso Robles to Santa Maria and everything in between.

Visit Carla's website for more information about creating a vital pregnancy! To reach SLO Family Acupuncture call 805-242-6852 or email.

Call about SLO Family Acupuncture’s Pre-Birth Acupuncture Summer Special for babies due in June, July, or August 2013!

Sunday, May 12, 2013

From a New Mother

Beautiful Ruby Jo
I receive many sweet cards and thank yous after births. I treasure them all. Here is one from a mother who came to me fairly sure she wanted an epidural and a husband who was wishing that she wouldn't. We spent many hours together in their home eating, talking, learning and sharing. Of course her birth didn't go anything as she had envisioned. Here is what she wrote to me several months afterwards.

"Thank you Jennifer for all of your encouragement, support & empowerment that helped to bring out the strength I doubted I had to bring Ruby into this world without drugs & very little intervention. I honestly never expected to be able to make it through the birth without an epidural. I feel strong & have never felt more proud of this accomplishment.

Your support before, during & after the birth will always be remembered & appreciated. Thank  you for all that you do for the families in our community. We are lucky to have you!


Monday, April 29, 2013

A Window into My Birth Classes

My classes weave heart learning, intellectual learning and physical practices together in a careful balance of caring, fun, creativity and stimulating thoughts. As a doula in San Luis Obispo for twenty years I know women birth best when all of these areas are nurtured to expand and grow during pregnancy.

Birth rehearsals are always a fun part of class! I do a class devoted to LOTS of different labor/birth positions. Then at another class I ask each mom the position she imagines giving birth in and that is what we practice. This pregnant mama chose the classic hospital birth position because that was where she was planning to birth. Getting over a woman's natural shyness or sense of modesty is an important part of the process. What a good sport she was to let her photo be taken. We were all having such a good time we failed terribly at holding still for the camera.

Creating an atmosphere which allows couples to feel safe is important. When we turn on music, light candles and practice focused relaxation or visualize giving birth women tune into their own intuition about their body and birth. They in turn can communicate to their partners what they can do to help them through the process.

Potlucks are part of the process! To break bread, talk and laugh together builds community. Pregnancy is a time of growth and connection between partners and the world of parenting. Nothing beats a home environment for learning about birth no matter where you are planning to have your baby. For this St. Paddy's Day class couples where greeted by the smell of fresh baked Irish Soda bread. Dads brought Guinness beer and moms supplied plenty of good healthy greens to eat.

Friendships blossom as moms blossom. Connections are strengthened through a private Facebook group and moms are invited to join my "Whole"istic Mamas group to continue these supportive relationships after babies come.

Thoughtful discussion flows after simple creative drawing or word association exercises help everyone tune into their interior life. 

Crafting concrete personal positive affirmation cards to post around their homes help couples stay positive and empowered as the big day draws near.

The reading homework in Special Delivery is helpful to fill in any missing pieces. Reading birth stories from Ina May's book fills women with the knowledge that women ARE designed to do this work and they can do it too! Notebooks full of additional information are loaned to be used as much or as little as desired. My extensive library of books and movies are also available to my clients. 

I enjoy teaching a mixed group of in and out of hospital clients because of the thought provoking discussion. A balanced respectful discussion leaves everyone feeling more confident in their choices.

A mix of real props to see and touch, communication practices and role playing in my Becoming an Educated Consumer, If a Problem Arises and Facing Our Fears classes take the fear of the unknown away and teach couples what choices may come their way during their birth. Accurate unbiased consumer information is key to creating the birth you want.

My years as a doula have taught me beautiful positive births are possible everywhere!

And then there's love. Lighting my birth mama candle sets the mood for an intimate chat about the role oxytocin, the love hormone, plays in labor and what you can do to encourage it to flow. Simple tools that speak to the 5 senses enhance birth energy and are easy for partners to master. Tuning into our partners through touch, dancing, and simple massage teaches the partners their most important labor tool, loving connection.

The last 2 classes are devoted to parenting. What could be better than answering all the questions expecting parents have about parenting a newborn?

I love teaching new parents about all the amazing things their new baby will be capable of right from the start.

I demonstrate how to get breastfeeding off to a great start and invite all my clients to join me as I lead La Leche League meetings.

Graduation Potluck means learning from the experts; couples who have become parents in the last few months. Telling their birth stories in the sharing circle help couples process their birth. Sharing the highs and lows of their labors gives a realistic window into birth for the waiting couples. Giving real world common sense survival tips on how to get through the first weeks of parenting is mutually beneficial, expectant parents become more prepared and new parents get to see how far they have come in just a few short weeks.

The private Facebook group serves many purposes, simple communication of class logistics and reminders, potluck sign-ups, or recipe sharing.

Pregnant mamas are encouraged to find and post their own images of power, flexibility, and strength to help them keep the faith during labor.

I post many inspiring images and quotes, as well as, links to the latest studies. After the classes end we all post words of encouragement as moms wait for the big day to finally arrive.

And of course baby photos! Each baby is welcomed by all. The leaders in the class give pep talks to the moms still waiting while the waiting moms send warm wishes and way to goes to the couples who have already birthed.

Reunions are fun! Whether the group chooses a park, a home or the beach, joy and pride fills the air.

Themed reunions seem especially delightful for everyone.
Now it's on to La Leche League meetings and "Whole"istic Mamas park days for the mothers. All of my class and doula clients are invited to join my Becoming a Family support group; the only parenting classes for moms AND dads in the county.

Let's connect and talk about when, where and how you can begin classes!

Sunday, April 28, 2013

Listen to National Experts: What the Birthing Women of San Luis Obispo Need to Think About!

These posts originally appeared as my Food for Thought series on Facebook. I wanted to provoke the women of San Luis Obispo county into thinking about their birth and parenting choices. By quoting directly from books I wish to stimulate discussion and encourage women to seek out information and become more educated. My hope is you will empower yourself through this process.

“Our lives begin to end 
the day we become silent about things 
that matter.”

~ Martin Luther King, Jr. 
from his unforgettable
 "I Have a Dream" speech

Doctor or midwife: How to choose which is right for you.

Baby Bonding and Attachment: Getting Parenting off to a good start.

Saturday, April 20, 2013

A Parenting Poem

If I had my child to raise over again,

I'd finger paint more, and point the finger less.

I'd do less correcting, and more connecting.

I'd take my eyes off my watch, and watch with my eyes.

I would care to know less, and know to care more.

I'd take more hikes and fly more kites.

I'd stop playing serious, and seriously play.

I'd run through more fields, and gaze at more stars.

I'd do more hugging, and less tugging.

I would be firm less often, and affirm much more.

I'd build self-esteem first, and the house later.

I'd teach less about the love of power,

And more about the power of love.

It matters not whether my child is big or small,

From this day forth, I'll cherish it all.

    From 100 Ways to Build Self-Esteem & Teach Values by Diana Loomans (c) 2004 New World Library