Friday, September 11, 2015

Sandra Wood, APRN, CNM, is a certified nurse midwife at The University of Vermont Medical Center and clinical instructor at the University of Vermont College of Medicine.

There is a prevailing myth and cultural expectation that pregnant women go through pregnancy simply “glowing”. Following the birth, after some initial fatigue and adjustment, most women expect to adapt easily to the arrival of their baby. We envision the photo of the smiling mother and content baby. Having a baby is supposed to be one of the happiest times in your life.
However, some women find that they are struggling with emotions that they did not expect!   They feel badly about themselves if they are not “glowing” in pregnancy or are experiencing distressing emotions after the birth and find it hard to talk about. New mothers and soon-to-be-mothers may feel confused and alone.
Let’s put an end to that with some facts about “postpartum depression” – starting with the term itself.
Myth #1: “Postpartum depression” occurs within the first few months.
The terms “postpartum” and “depression” may confuse women who are struggling emotionally. It may not feel like depression and it may not be postpartum. Emotions can range from the sadness of depression to irritability to outright panic. The time frame can be from the first positive pregnancy test to the baby’s first birthday. The term “Postpartum depression” is inadequate. What we are talking about is “perinatal mood and anxiety disorders.” This describes emotional distress/ complications that may occur at any or all stages, including pregnancy, birth, and the postpartum period up to a year. It is not just “postpartum.”
Myth #2: Mothers with perinatal mood and anxiety disorders are sad and weepy.
Pregnancy, birth, and parenthood come with enormous physical, emotional, and relationship changes. As with any major life change, there is a range of pregnancy and postpartum emotions. All women experience some changes in mood and behavior in the transition to motherhood. It is a matter of how much the changes are affecting your life and functioning. Distress or complications captures the sense that something is not right.
Women may experience:
  • Being worried all a time
  • Being scared/panic attacks
  • Difficulty concentrating
  • Crying
  • Feeling alone
  • Feeling ashamed
  • Feeling guilty (this has a lot to do with a woman feeling that her symptoms are evidence of her worth as a mother)
  • Feelings as if you have lost yourself
  • Feeling numb, lack of feelings for the baby, not looking forward to the future
  • Having intrusive scary thoughts
  • Headaches, backaches, stomach aches, nausea – even the feeling like you are having a heart attack
  • Irritability
  • Low energy and feeling worn out, or alternatively being full of nervous energy
  • Loss of interest in sex
  • Overeating/no appetite
  • Trouble coping
  • Trouble sleeping or excessive sleep
Myth #3: Perinatal mood and anxiety disorders are rare.
Mood and anxiety disorders are one of the leading complications of being pregnant. Up to one in five women will experience perinatal emotional complications. This is more than gestational diabetes or preeclampsia, conditions for which we regularly screen.
Myth #4: Women with perinatal mood and anxiety disorders want to hurt their children.
Many women who are experiencing emotional distress or complications protest: “Oh no, I don’t have postpartum! I don’t want to hurt my baby or anything”  Perinatal mood complications are linked in the public mind to the media reports of postpartum psychosis. Postpartum psychosis is a rare, but serious symptom of a mood disorder that can indeed endanger the mother’s or the infant’s life.
Women and their families should know the symptoms of postpartum psychosis and report those symptoms to their health care provider. It can develop within the first weeks after birth and is considered a psychiatric emergency. Postpartum Psychosis is temporary but requires treatment and responds quickly to treatment.  Symptoms include:
  • Delusions, or strange beliefs
  • Decreased need or inability to sleep
  • Difficulty communicating at times
  • Feeling irritated
  • Hyperactivity
  • Paranoia and suspiciousness
  • Rapid mood swings
  • Seeing or hearing things that others do not
Unfortunately, this rare postpartum emotional complication has been sensationalized in the media. This poses a danger as women are afraid to admit that they are experiencing emotional distress and will not report symptoms because they fear that their baby will be taken from them.
Myth #5: Perinatal mood and anxiety disorders will go away on their own.
Women should be proactive in tackling perinatal mood and anxiety disorders. The first step is to understand what they are. Next, make a plan to promote nutrition, sleep, time for yourself, and social support (both personal and professional) during and after your pregnancy. If you or your family and friends start to notice symptoms, talk to your health care providers. That includes your nurse- midwife, obstetrician, and your primary care doctor. Ask for help and keep asking.
If your provider determines that you do have a perinatal mood or anxiety disorder, there are treatments available including therapeutic approaches and medications. It’s important to note that medications are available that are safe to use during pregnancy and breastfeeding.
My final thought to women reading this blog: if you are worried about how you are feeling or you are experiencing any of these symptoms: You are not alone. You are not to blame. With help you will be well. Transition to parenthood is difficult. Talk to your health care provider: there are effective treatments. Every baby deserves a healthy mom.
Online resources:
Must-read book:
  • “Life Will Never Be The Same: Real Moms Postpartum Survival Guide”
Sandra Wood, APRN, CNM, is a certified nurse midwife from at Champlain OB/GYN and The University of Vermont Medical Center as well as a clinical instructor at the University of Vermont College of Medicine.

Monday, August 24, 2015

Thoughts from the Midwife:  

What Foods Help Grow a Healthy Baby?

Growing a healthy baby begins with eating a healthy diet. So, where do you start?
The basics are to eat a well-balanced, lower fat diet made up of protein sources, whole grains, fresh fruits and vegetables, dairy products, and plenty of water. Avoid empty calories in junk food, soda pop, desserts/sweets and substances such as alcohol, cigarette or marijuana smoking, or other recreational drugs.
As a general rule if you eat:
  • 3-4 servings of protein;
  • 4 servings (or more) of fresh fruit and vegetables of varying colors;
  • 2-3 serving of whole grains (rice, breads, pasta); and
  • 4 servings of dairy per day…
….You will have a well-balanced, nutrient-rich diet!
Protein is essential for baby’s growth, especially in the second and third trimesters: 70 – 80 grams of protein per day are recommended. Protein sources include: meat, fish, nuts, eggs, soy, and beans/legumes. A quick reference to help add up how many grams of protein you are already eating is this: 1 ounce of meat or fish (or ½ cup cooked beans) = 7 grams of protein. Generally, a normal serving of meat is about 3 ounces and is about the size of a deck of cards.
Other examples:
  • Hamburger patty: about 4 oz = 28 grams protein
  • Steak: about 6 oz = 42 grams protein
  • Chicken breast: about 3.5 oz = 30 grams protein
  • Canned Tuna = 40 grams protein
  • Egg (one) = 6 grams protein
  • Milk (1 cup) = 8 grams protein
  • Peanut Butter: about 2 tablespoons = 8 grams protein
Stay safe: Avoid deep sea fish, such as tuna steaks, swordfish, king mackerel, and shark as they can carry high levels of mercury, which are dangerous to growing babies.
Dairy products provide crucial calcium for baby’s bone development and also provide a source of protein. Lower fat dairy products provide the same amount of protein and calcium with less calories. One thousand milligrams of calcium each day is recommended and getting that from a food source means the dairy will be better absorbed by the mother’s body, rather than taking a supplement. Read the label of your dairy product to see how much calcium is present in one serving. Generally if you have four servings per day you are getting enough calcium.
Stay safe: Always eat pasteurized dairy products. Unpasteurized dairy can carry a type of bacteria called listeria, which can be dangerous to babies if a mother becomes infected from listeria.
Iron is also important to include in your diet. It helps mothers and babies build their blood volume. Iron is an essential element in the making of red blood cells. A mother’s blood volume expands by 50 percent during the pregnancy, and she is also providing iron to the baby to build his/her blood supply. Twenty-seven milligrams daily is what is recommended. Again, eating iron in food means it will be much better absorbed than by taking a supplement. Another easy way to increase the iron in your diet is to cook your food in a cast iron pan. The iron from the pan is absorbed by the food greatly increasing the amount of elemental iron in the food.
Stay safe: Always eat medium to well-cooked meat. Undercooked red meat may carry toxoplasmosis and raw or undercooked seafood may carry Hepatitis A. Avoid deli meats as well as they can carry listeria bacteria just as unpasteurized dairy can.
Sources of “heme iron” are also better absorbed than “non heme iron” sources.
Heme sources of iron:
  • Beef
  • Lamb
  • Pork
  • Chicken or turkey
  • Seafood
Sources of non-heme iron:
These are absorbed better with a vitamin C source (citrus fruits, strawberries, or broccoli for example)
  • Beans
  • Fortified Cereals (oatmeal, breakfast cereals)
  • Soy beans or tofu
  • Dark green leafy vegetables
  • Dried fruit
  • Molasses
Fruits and vegetables provide a multitude of vitamins and minerals. This is why eating a variety of colorful fruits and vegetables provides the full range of nutrition. They also provide fiber and fluids which are helpful for good digestion.
Whole grains such as brown rice, popcorn, whole wheat pastas and breads are preferred over white rice or white breads and pastas. Whole grains are absorbed more slowly by your system, preventing high spikes in blood sugar. White breads and pastas are absorbed quickly and act like a sugar in your system, causing rapid high spikes in blood sugar and leaving your blood sugar to crash later (which makes pregnant women more nauseated or overly fatigued or unsatisfied, wanting to eat more!). Whole grains also have more fiber than white breads.
A daily pre-natal vitamin is recommended to make sure a woman has adequate amounts of Vitamin A (not more than 10,000 IU), Iodine (220 mg), Zinc (60 mg), Folic Acid (400-800 mcg), and Iron (27mg). Other vitamins and minerals are also included in these prenatals.
There is such a thing as too much of a good thing as well. Appropriate weight gain is also important and only one vitamin daily along with a well-balanced diet is just right.
Weight gain recommendation is based on your BMI (Body Mass Index). Calculate your BMI by clicking here. 
  • BMI         < 18                           28-40 lbs
  • BMI         18-25                       25-35 lbs
  • BMI         25-30                       15-25 lbs
  • BMI         > 30                           11-20 lbs
A combination of a well-balanced diet and exercise will help you grow a healthy baby!
Marti Churchill, CNM, is a University Medical Center Certified Nurse Midwife offering Midwifery services at Champlain Obstetrics & Gynecology in Essex Junction VT.
Marti Churchill, CNM, is a certified nurse midwife at the University of Vermont Medical Center.

For an appointment with Marti please call (802) 879-1802.

Friday, April 17, 2015

Knowledge Is Power

The doctors at Champlain OB/GYN have been getting a lot of questions about breast and ovarian cancer screening since this article appeared in the NYtimes last month.

Our physicians offer genetic testing, genetic counseling and the same surgical options that Angelina Jolie received, as well as non-surgical management.  If you have a family history of breast, ovarian, or uterine cancer and would like to discuss genetic diagnosis or management, please call the office at 802-879-1802 to schedule an appointment. or request an appointment via our website: .

Knowledge Is Power!

Friday, August 29, 2014

Heavy Periods or Abnormal Bleeding?  Novasure Endometrial Ablation may be the answer.

What is NovaSure Endometrial Ablation?

NovaSure® endometrial ablation is a quick, safe, and simple procedure to lighten or stop your periods, without the side effects of hormones or the risks of hysterectomy.

Why choose the NovaSure procedure for your heavy period?

  • The NovaSure procedure is safe: No pills. No hormonal side effects.
  • The NovaSure procedure is effective: For 90% of women, menstrual bleeding is dramatically reduced or stopped.
  • The NovaSure procedure is quick: NovaSure endometrial ablation is a one-time, five-minute procedure that can be done in your doctor’s office, usually for the cost of a copay.

How does NovaSure endometrial ablation procedure work to treat heavy periods?

NovaSure endometrial ablation, is a one-time, 5-minute in-office procedure trusted by over 2 million 1 women.  NovaSure® is an endometrial ablation (EA) procedure that can reduce or stop menstrual bleeding. It works by removing the endometrium, or the lining of the uterus (the part that causes the bleeding), with a quick delivery of radiofrequency energy.

NovaSure endometrial ablation procedure steps and how it works:

NovaSure: Heavy Period Treatment Step 1  Your doctor slightly opens your cervix (the opening to the uterus), inserts a slender wand, and extends a triangular mesh device into the uterus
NovaSure: Heavy Period Treatment Step 2 The mesh gently expands, fitting to the size and shape of your uterus
NovaSure: Heavy Period Treatment Step 3  Precisely measured radio frequency energy is delivered through the mesh for about 90 seconds
NovaSure: Heavy Period Treatment Step 4  The mesh device is pulled back into the wand, and both are removed from the uterus.

No part of the NovaSure endometrial ablation device remains inside your body after the NovaSure procedure.

Benefits and considerations of NovaSure procedure for heavy periods

NovaSure is Safe
No pills. No hormonal side effects.

NovaSure is Effective
For 90% of women, menstrual bleeding is dramatically reduced or stopped.

NovaSure is Quick
NovaSure endometrial ablation is a one-time, five-minute procedure that can be done in your doctor's office, usually for the cost of a copay.

NovaSure endometrial ablation can do more than just stop the menstrual bleeding. Many women who've had the NovaSure endometrial ablation procedure say they are now able to spend more time at work and daily activities, participating in more social and athletic outings now that they no longer suffer from heavy menstural bleeding. They also report improved energy levels, better moods, and a boost in self-confidence. And many also had a significant reduction in painful periods and PMS symptoms like irritability.*

Not all women are candidates for NovaSure Endometrial Ablation.

Your doctor will explain the risks of all treatment options. NovaSure endometrial ablation is for premenopausal women with heavy periods due to benign causes who are finished childbearing. Pregnancy following NovaSure can be dangerous. NovaSure endometrial ablation is not for those who have or suspect uterine cancer, have an active genital, urinary or pelvic infection or an IUD. NovaSure is not a sterilization procedure. Rare but serious risks include but are not limited to thermal injury, perforation and infection. Temporary side effects may include cramping, nausea, vomiting, discharge and spotting.

1.Hologic Inc., Data on file, 2014.
*Cooper J, et al. A randomized, multicenter trial of safety and efficacy of the NovaSure system in the treatment of menorrhagia. J Am Assoc Gynecol Laparosc. 2002; 9:418-428.

Tuesday, August 26, 2014

Make Way for Baby: 8 Tips for a More Comfortable Labor & Birth

People often track a woman’s labor progress by how much her cervix is dilating (opening), but much more is happening during labor.
With each contraction, a woman’s uterus pushes her baby down into her pelvis, and the baby tucks and turns to find its way through. A woman feels intense pressure and stretching as her baby moves down. Ligaments – loosened during pregnancy –allow the pelvic bones to move and make more room for the baby.
Most women worry about labor being long or difficult. Small minorities of babies become stuck in a tough position during labor, or have heads bigger than their mother’s pelvis, and are eventually born by cesarean. A majority of babies can and will fit through the pelvis, given enough time and support. If we look at labor from the baby’s perspective – as a challenging journey through a woman’s curvy, tunnel-like pelvis – there are several things women can do to enhance comfort and encourage their baby’s progress toward birth.
During pregnancy
Be active
Aim for at least thirty minutes ofmoderate activity daily – it doesn’t have to be all at once.  Walk, jog, or swim. Try yoga, which combines stretching and strengthening with breath awareness, a great a mind-body preparation for labor. Staying fit will give you the strength and flexibility to move around during labor to help your baby move through your pelvis.
Eat well
Healthy eating will help you grow a healthy-sized baby. Choose plenty of vegetables and whole grains, and beans, nuts, lean meat, dairy, eggs for protein. Try to eat smaller meals at meal times and snacks with protein in between. Ask your provider about recommended weight gain for the full pregnancy, and try to stick to your goal. If money is tight you may qualify for the Women, Infants and Children (WIC), a government program offering financial assistance for buying food.
Sit smart
Watch posture during long hours at your desk or in the car. When a woman sits lying back or hunched over with her pelvis tilted back, her lower back forms a comfy hammock for her baby and the baby is more likely to lie with its back against her back, looking up toward the ceiling. A baby who stays in this “posterior” position during labor has a harder time squeezing through the pelvis. You can encourage your baby to settle in an “anterior” position, facing down toward your tailbone, by sitting upright with hips above knee level and your pelvis and belly tilted forward. Tuck one pillow behind your lower back, and if necessary, another pillow under your buttocks.
Take a birthing class
Childbirth classes teach pain-coping practices, labor positions, and helpful comfort measures. This knowledge may help minimize stress and fear and provide you with tools for coping with pain and unexpected events during labor.
During labor
Walk, move around, and change positions
If you listen to your body, you will often choose the best position for your baby’s labor progress.  Sway back and forth leaning on a partner “slow dancing,” try hands and knees position, or bounce, or do figure eight circles on a birthing ball. Change positions every few contractions to create more space for the baby to navigate through the pelvis.
Rest, reenergize and hydrate between contractions
After each contraction take a deep breath, and on the exhale release tension and let the body soften. Sip a drink or some ice chips to stay hydrated. If you’re hungry ask your provider if you may have light snacks. When fatigued, try positions that allow for maximum rest during breaks. Relaxation allows the baby to settle lower into the pelvis as labor progresses.
Ask your provider about your baby’s position
A baby who is face down in the “anterior” position usually has an easier time fitting through the pelvis than a baby who faces “sunny side up” in the “posterior” position. Contractions push the back of a posterior baby’s head against the back of its mother’s pelvis (sacrum), rather than straight down through the pelvis and into her cervix. The baby takes longer to engage in the pelvis, the cervix takes longer to dilate, and the mother experiences more back pain. If a baby is “posterior,” nurses, midwives, and doctors can suggest positions that will help encourage rotation. Sometimes a provider can turn the baby by gently rotating its head during an internal exam.
As you are pushing
Keep changing positions and resting between contractions
Just like earlier in labor, try to change positions every fifteen minutes during pushing. Sitting on the toilet, squatting, hands and knees, lying on each side, or lying on your back with knees pulled wide and back can all be helpful positions to push your baby down and out.  Use your breaks between pushes to rest – some women even fall asleep for a moment!
A baby makes its final twists and turns with the final pushes, and at last emerges into the world.  Labor is hard work, it hurts, but women and babies are strong, and we know that with time, support and encouragement they can do it.
Author:  Cory Simon-Nobes, APRN, CNM, is a certified nurse midwife at Champlain OB/GYN and Fletcher Allen Health Care.

Monday, August 4, 2014

From the Midwife: What is Healthy Weight Gain in Pregnancy?

 Baby weight – it’s a topic that has worried expectant mothers and fueled celebrity magazines for years. How much weight is normal to gain? Let’s change the question. What expectant moms really need to be asking is: how much weight gain is enough for a healthy baby?It’s normal for all women to gain weight during pregnancy. Typically, you will put on 2-4 pounds in the first trimester. Weight gain picks up after this. You will want to aim to gain ¾ to 1 pound weekly from the second trimester on.
How much weight you gain depends on you. Every woman is unique and so too is every pregnancy. Taller women, for example, may be advised to gain more weight. Ask your midwife what is right for you.
Here are some general guidelines from the American College of Obstetricians and Gynecologists:
If you are…
  • Normal weight before conceiving, gain 25-35 pounds.
  • Overweight before conceiving, gain 15-25 pounds.
  • Underweight before conceiving, gain 28-40 pounds.
  • Carrying twins, gain 35-45 pounds.
Where does all that weight go?
It will ease your mind to know that weight gain is caused by the following:
  • Baby (approximate weight gain is 7-8 pounds)
  • Placenta (approximate weight gain is 1-2 pounds)
  • Amniotic fluid (approximate weight gain is 2 pounds)
  • Breasts (approximate weight gain is 1 pound)
  • Uterus (approximate weight gain is 2 pounds)
  • Increase in blood volume (approximate weight gain is 3 pounds)
  • Body fat (approximate weight gain is 5 pounds)
  • Increased muscle tissue and fluid (approximate weight gain is 4-7 pounds)
That adds up to 25 pounds!
Does that mean it’s OK to give in to food cravings?
Yes and no. Estrogen, an appetite stimulant, will rise in your blood stream around your 13th week of pregnancy. You will be hungry. Be sure to indulge your cravings, but keep it in balance so as not to crowd out more nutritious foods. You do not want to contribute to excessive weight gain.
How many calories should I consume?
A full-term pregnancy (forty weeks) requires about 80,000 calories, which comes out to an extra 300 calories per day. This may differ from woman to woman depending on age, activity level, and pre-pregnancy weight. Eating extra protein is also recommended way to get the extra calories in. Shoot for 70-80 grams of protein per day.
Author: Marti Churchill, CNM,  is a certified nurse midwife at Champlain OB/GYN and Fletcher Allen Health Care. 

Wednesday, July 9, 2014

We are excited to announce that Champlain OB/GYN has added Certified Nurse Midwifery to the practice. 

Our goal, as always, is to provide comprehensive services, and appropriate and effective care.  We are confident that the FAHC Midwives are the perfect addition to our practice because we are all committed to offering you the most advanced and complete care that is personalized to your needs.  The FAHC midwives are the longest standing midwifery group in Chittenden County with many years of experience and they are well known for their individualized family-oriented prenatal care.   The physician and midwifery collaborative care model at Champlain OB/GYN will give you a balance of natural and medical perspectives during your pre and postnatal care in a convenient, comfortable and relaxed practice.  You will have the same or similar testing and treatment options available to you and you will still deliver your baby in the hospital setting.  
Your care will be primarily with the Midwives.  They will see you for your monthly, bi-monthly, weekly, and bi-weekly visits.  Champlain OB/GYN physicians will see you for any ultrasounds, problem visits, or consults that the Midwives recommend.  The on-call schedule for delivery will consist only of Midwifery call and the FAHC physicians will offer assistance if needed.  Your 6 week post-partum visit will be performed by a physician at Champlain OB/GYN.
We value the relationships that we have created with you and we understand that with any change there are many questions and concerns.  We would greatly appreciate you allowing us to answer your questions about this transition, please ask any questions or voice any concerns at your next visit, or call the office.
Champlain OB/GYN Physicians and Staff

Monday, June 2, 2014

From the Midwife: How to Handle Sibling Adjustment

The addition of a new family member – whether it is your first child or your fifth – affects everyone. Understanding that the older siblings need time to adjust is crucial.  The ease of the sibling’s transition has more to do with their personality and ability to transition to any change in their life than it has to do with their gender or the number of years between them. Bringing a new baby into your older child’s life may be one of the most challenging things s/he has had to deal with up until now, but it eventually will also be one of the greatest gifts you can give them.
Take some time helping to prepare them ahead of time can help them set up appropriate expectations and allow for feelings to be shared.
  • Tell your child about your pregnancy when you tell your friends. They should hear about it from you directly and not ‘overhear’ it or learn about it from someone else.
  • Bring them to some prenatal visits to meet your birth provider, hear the heart beat, and be able to ask questions.
  • Describe what life will like in the early days with the baby: they will sleep a lot, cry, breastfeed, need to be held and have their diaper changed.  You will need to spend a lot of time with the baby. The baby won’t be able to play with them and they won’t need to share their toys – in the beginning.
  • Try spending some time around a new baby with your child – at daycare or with a friend or family member with a new baby.
  • Share pictures, videos and stories about the birth and babyhood of your older child. Tell them about their birth and what they were like as a baby. Express how excited you were when they were born and how everyone wanted to see them and hold them.
  • Talk about how much you love them and not matter what you will always love them.  This may seem obvious to you but stating it out loud, a few times in different ways is important for your older child to hear.  Losing your love is what they fear the most.
  • Teach them how to hold a baby and practice holding and gentle touching with a baby doll.
  • Include them in any preparations they can – giving them choices whenever possible: such as which outfit should you bring the baby home in (A or B), picking out a gift for them to give the baby, choosing the color of the new car seat, etc.
  • Read books together about pregnancy, birth, adoption and new baby siblings.
  • If you are considering having your older child present at the birth – talk with your midwife about this. Many families have found this to be a very positive experience but it is not necessarily right for every family. Extra preparation should happen around what to expect at the birth, watching videos of birth and the child will need their own support person who can take them out if they become over whelmed. Saving an age appropriate job for them is special such as cutting the cord or putting on the baby’s hat.
Once your new baby is here there are ways to help your older child adjust:
  • Plan a birthday party for the day you get home. Have a frozen ice cream cake in the freezer or have a family member or friend get one for that day, have balloons, and a “0” candle. Sing Happy Birthday to the baby and have the older sibling give the baby a gift AND have the baby give them one.  It brings home the meaning of what a BIRTH day really is while creating a celebration for the whole family.
  • “Love bomb” the older sibling. Have people special to the older child be around more in the first week or two to fill in for the attention that you would normally give him or her.
  • Set aside time each day (away from the baby) for each parent to give uninterrupted one-on-one time with the older child. Even 10 minutes of focused attention has an amazing effect of showing them how you still love them and they are important. Let them chose the activity and you follow their lead.
  • Listen – really listen  – to how your child feels about the new baby and the changes in your family. If they express negative emotions, acknowledge them.  Help your child put words to their feelings. Never deny or discount their feelings.
  • Create ways for them to express negative feelings – draw an angry picture, act out feelings towards a doll or roar like a lion – but hurting is not allowed!
  • “Baby” your older child if that is what they crave. This may help stave off regression in other areas that are less acceptable to you. You may think your older child will become more independent when the baby comes home but often it is not the case.  Expect less independence and you may get more.
  • Remind visitors to pay attention to the older child (and not just the baby)
  • Have a few extra treats/gifts in the closet in case friends bring gifts for the baby and the older child feels left out.
  • Find jobs and creative ways the older child can help you: baths, dressing, pushing the stroller, putting silverware away from the dishwasher, helping vacuum, running to get the book to read while you breastfeed, etc. Follow your child’s lead on this and be careful not to overdo it. Any chance you can give the older child choice and power in their life, the more they feel in control – and less likely to act out for attention and power.
  • Talk about the ways being older is beneficial – they can chose what to eat, can go to the park and play, having friends, etc.
  • Read books together about families in transition – any time you can talk about and acknowledge their mixed up feelings & that they are all normal and ‘ok’ the better they can negotiate the roller coaster of change.

Marti Churchill, CNM, is a certified nurse midwife at Fletcher Allen Health Care.
Marti Churchill, CNM, is a certified nurse midwife at Champlain OB/GYN  and Fletcher Allen Health

Tuesday, May 13, 2014

Frequently Asked Questions About Midwifery

Champlain OB/GYN is excited to add Certified Nurse Midwifery care to our practice. All changes bring questions, so we’ve asked the Fletcher Allen midwives to answer a few commonly asked questions.


I’m confused, I thought midwives delivered babies at home.  Do they deliver babies at Fletcher Allen?


Many people think “home birth” when they hear the word “midwife,” and are surprised to learn that midwives deliver babies in the hospital. In fact, Certified Nurse Midwives (CNMs) have practiced at Fletcher Allen for over forty years, and have delivered thousands of babies in Fletcher Allen’s Claire M. Lintilhac Birthing Center! The Fletcher Allen midwife team is available 24/7 and provides prenatal, postpartum and well-woman care in the office, and labor, birth and initial postpartum care in the hospital.


Most midwife-attended births in the United States take place with Certified Nurse Midwives in hospitals, just like at Fletcher Allen.  CNMs are healthcare professionals who specialize in assisting normal, uncomplicated births. They are Advanced Practice Registered Nurses with graduate education in midwifery. They have graduated from an accredited nurse-midwifery education program, which includes a university degree as well as hands-on clinical training by practicing CNMs. They also have passed the national certification exam of the American Midwifery Certification Board (AMCB).  In Vermont most home birth midwives are either Certified Professional Midwives or Naturopathic Doctors, who go through different education and certification processes. 


Why would a woman choose a midwife?


Many women choose to give birth with the help of midwives because of a desire for individualized care and a unique birthing experience. The word “Midwife” literally means “With Woman.”  The midwifery model of care is evidence-based, promotes listening to women and respecting their desires, and minimizes the use of medical interventions unless necessary or requested by a woman. Midwives believe a woman and her family deserve the knowledge they need to make good health choices for themselves. A midwife does not simply tell a woman what to do, since what is right for one person may not be right for the next. Instead, a midwife offers information and helps each woman decide what is best for her and her baby, building a healthcare relationship grounded in trust and respect.


Midwifery care also produces improved health outcomes. National research indicates that women who choose a Certified Nurse Midwife have lower rates of induction of labor, cesarean birth, and perineal trauma, and higher rates of breastfeeding.  CNMs can prescribe medications and order diagnostic procedures when appropriate and medically indicated. 


Midwives use the same schedule of prenatal appointments and routine testing in pregnancy, but they tend to spend more time with women during prenatal visits, and more time by a woman’s side in labor – supporting her and watching for any health concerns.  They provide exceptional, individualized care to women across the lifespan, through pregnancy, birth, postpartum and beyond.


What if I have a complication that requires an obstetrician?


As a practice based in an academic medical center, the Fletcher Allen Nurse Midwives collaborate seamlessly with Obstetricians, Maternal Fetal Medicine specialists, and Pediatricians when needed. If a woman has a complication during pregnancy, the midwives will consult with collaborative obstetricians at Champlain OB/GYN and Fletcher Allen. During labor or prenatal assessments in the birthing center, they may consult with Fletcher Allen Obstetricians, who are available in the hospital 24/7.  If need arises for a cesarean, vacuum or forceps-assisted birth, a midwife stays with the woman and her family in a supportive role, and a Fletcher Allen Obstetrician delivers the baby.


Do I have to have an un-medicated birth if I use a midwife? I think I might want an epidural.


Midwives offer a variety of pain relief options in labor, including massage, relaxation, use of a tub, and epidural anesthesia if desired. Using a midwife does not mean a woman must have un-medicated childbirth. Approximately 45% of Fletcher Allen midwifery patients desire or need some form of anesthesia during their births, and epidurals are readily available.


I’m hoping for a natural childbirth. Will a midwife stay with me in labor to help me get through it?


One of the hallmarks of midwifery is labor support. The Fletcher Allen midwives set up their call days in 24-hour shifts to help provide continuity of care during long labors, and have the next day off so they are able to stay up to provide support. Midwives are directly involved providing care during labor, encouraging movement and position changes to promote labor progress, and using hands-on support, hydrotherapy, and gentle words to guide pain coping. The Fletcher Allen midwives stay attuned to their staffing and their total number of patients so they can provide direct support as much as possible, when desired.


If you have additional concerns please talk with us at your prenatal visits!  The birth of your baby is also the birth of you as parents and the growth of your family.  Sometimes navigating this transition can feel overwhelming. The Doctors and Midwives want you to feel safe, supported and informed about your care.

Monday, May 5, 2014

Acupuncture at Champlain OB/GYN:

What to Expect

Many first-time patients are concerned that acupuncture needles will feel like hypodermic injections at the doctor’s office. They won't. Acupuncture uses sterile, single use, hair-thin, flexible needles that are hardly felt when inserted. Using gentle stimulation to move qi, a unique sensation called de qi is felt. Patients often describe de qi as a heavy, achy pressure, or spreading, traveling feeling. You may also feel an "electrical" sensation moving down the meridian pathways, though this is less common. Most patients find these acupuncture sensations deeply satisfying and leave the treatment feeling both mentally and physically relaxed, often with uplifted spirits. 

How Many Treatments Will I Need?

The benefits of acupuncture are cumulative, so more then one treatment is necessary. For acute conditions you can expect to have 5 to 10 treatments, but you will usually begin to feel relief after the first few. Chronic conditions may take longer to respond, depending on the type, severity, and duration of the condition. Preventive treatments, treatments for general well-being, or seasonal "tune ups" may also be scheduled on an as-needed basis.

Is Acupuncture Safe?

Yes. Acupuncture is safer than taking Tylenol and is used by millions of Americans every year. Acupuncturists are required to undergo extensive education, including detailed study of human anatomy and training in Clean Needle Technique. Nieve is certified by the National Certification Commission for Acupuncture and Oriental Medicine and is licensed by New York and Vermont state. As required by law, Nieve uses pre-sterilized, disposable, single-use needles to ensure your complete safety.

Acupuncture for Menstruation

For many women, their menstrual cycles can be irregular, painful, and even debilitating.  Pain, of any kind, is your body's way of telling you there is an imbalance. Acupuncture, herbs, and dietary changes, can help you return your cycles back to health as well as provide pain relief. The following are some of the conditions/symptoms that acupuncture effectively treats:
  • Dysmenorrhea (pain during period)
  • PCOS
  • Amenorrhea
  • Bloating, gas
  • Painful breast swelling
  • irritability, emotional instability

Acupuncture for Fertility

Many women have spent most of their adult lives trying to avoid pregnancy, now when they want to get pregnant, they are finding it more difficult than they ever imagined. Acupuncture, combined with herbs, nutrition and lifestyle guidance can balance conditions that may impede conception. Clinical studies show that Acupuncture enhances fertility by more than 50% and can increase the efficacy of assisted reproductive therapies such as IUI and IVF by 40-60%.
Below are a number of ways Chinese Medicine can help to enhance fertility and increase the efficacy of IUI/IVF:
• Improve the function of the ovaries to produce better quality eggs
• Regulate hormones to produce a larger number of follicles
• Increase blood flow to the uterus and increase the thickness of the lining of the uterus
• Enhance relaxation and decrease stress
• Prevent the uterus from contracting (this is a holding treatment typically done post-transfer)
• Lessen the side effects of drugs used in IVF
• Strengthen the immune system
• Improve quality and quantity of semen to create stronger embryos
• Decrease chances of miscarriage

Acupuncture for Pregnancy

Pregnancy is a time filled with magic and wonderment and when we are less inclined to take medication.  Acupuncture during pregnancy is an extremely safe therapy throughout all stages of pregnancy and an effective natural method to treat a range of symptoms, including the following:
  • Nausea/vomiting
  • Heartburn
  • Sciatica
  • Pain
  • Insomnia
  • Anxiety/restlessness
  • Headaches

Acupuncture for Birth

Acupuncture is a powerful yet safe way to assist the birthing process. By stimulating and regulating hormones, such as oxytocin, acupuncture can be used to:
  • encourage labor
  • dilate the cervix
  • stimulate,  strengthen and regulate contractions
  • increase blood flow to the uterus 
  • encourage baby to descend
  • turn breech or malpositions
  • ease pain

Acupuncture for Postpartum  

Postpartum is often overlooked and under appreciated. Plenty of time should be given for rest and recovery. Birth is exhausting and can leave a new mother blood deficient. Acupuncture, herbs, proper dietary changes, and of course plenty of rest can restore lost nutrients and blood.

Other Conditions Commonly Treated with Acupuncture also available at Champlain OB/GYN

  • Pain and Athletic Injuries
  • Facial pain - TMJ, trigeminal neuralgia
  • Low back pain
  • Neck pain
  • Migraines
  • Headaches
  • Sciatica
  • Old injuries and Painful scars
  • Stress, Fatigue, and emotional Disorders
  • Panic Attacks
  • Anxiety
  • Chronic Fatigue
  • Stress-lines on the face
  • Early signs of aging
  • Insomnia
  • Fibromyalgia
  • Pregnancy related conditions
  • Gynecological Disorders
  • Fertility Support
  • Menstrual Cramps/PMS
  • Menopausal Symptoms
  • Digestive Issues
  • IBS
  • Crohn's Disease
  • Reflux Esophagitis
  • Chronic constipation
  • Ulcerative Colitis
  • Respiratory Illnesses
  • Allergies
  • Asthma
  • Sinusitis
  • Common Cold
  • Tinnitus
  • Vertigo
  • Addiction
  • Nicotine
  • Substance Abuse Support
Author:  Nieve Shere M.S. LAc. ;  Shere Family Acupuncture at Champlain OB/GYN