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!