1. Holistic Approach to Pregnancy Shauna Braun Leah Crask

2. Pregnancy Basics Pre-pregnancy health Pre-pregnancy health Diagnosing pregnancy Diagnosing pregnancy Prenatal care Prenatal care Gynecological and general health Gynecological and general health Milestones Milestones Testing and screenings Testing and screenings Risk factors Risk factors Labor and Deliver Labor and Deliver Post Partum Post Partum

3. Pre-pregnancy Health Folic Acid Folic Acid Recent pregnancy Recent pregnancy Age Age Current medications incompatible with pregnancy Current medications incompatible with pregnancy Social and financial health Social and financial health

4. Diagnosis Prenatal Care S/S amenorrhea; morning sickness; frequent urination; tingling, tender, swollen breast; darkening areola; blue or pick lines under skin breast/abdomen; food cravings; darkening line navel to pubis (linea nigra) S/S amenorrhea; morning sickness; frequent urination; tingling, tender, swollen breast; darkening areola; blue or pick lines under skin breast/abdomen; food cravings; darkening line navel to pubis (linea nigra) Urine test in office or at home (OTC) Urine test in office or at home (OTC) Blood test Blood test Medical exam Medical exam Call your practitioner as soon as you suspect your pregnancy Call your practitioner as soon as you suspect your pregnancy Choosing a practitioner: obstetrician, family practitioner or nurse midwife? Choosing a practitioner: obstetrician, family practitioner or nurse midwife? Types of practice solo practice, group, combo, birth centered, independent CNM Types of practice solo practice, group, combo, birth centered, independent CNM

5. Obstetrician (Ob-gyn) Trained to handle every conceivable aspect of pregnancy Trained to handle every conceivable aspect of pregnancy Can also take care of all non-pregnancy female health needs (paps, breast exams) Can also take care of all non-pregnancy female health needs (paps, breast exams) Best for high risk pregnancy, better still an obstetrician who specializes in your type of high risk pregnancy. Best for high risk pregnancy, better still an obstetrician who specializes in your type of high risk pregnancy.

6. The Family Practitioner (FP) One stop medical services for the entire family One stop medical services for the entire family Trained in primary care, obstetrics and pediatrics after receiving MD Trained in primary care, obstetrics and pediatrics after receiving MD Ideally familiar with your family dynamics and interested in all aspects of your health Ideally familiar with your family dynamics and interested in all aspects of your health If complications- may send you to OB, but remain involved If complications- may send you to OB, but remain involved

7. Certified nurse-midwife (CNM) Emphasis on you as a person, rather than a patient, will take extra time to talk about feelings and problems Emphasis on you as a person, rather than a patient, will take extra time to talk about feelings and problems Oriented toward “natural” childbirth Oriented toward “natural” childbirth More likely to treat pregnancy as a human condition rather than a medical one More likely to treat pregnancy as a human condition rather than a medical one CNM is a RN who has completed graduate programs in midwifery and is certified by the American College of Nurse-Midwives. CNM is a RN who has completed graduate programs in midwifery and is certified by the American College of Nurse-Midwives. Trained to care for women with low-risk pregnancies and attend uncomplicated births Trained to care for women with low-risk pregnancies and attend uncomplicated births Sometimes may provide routine gynecological care Sometimes may provide routine gynecological care May work in a hospital, birthing center or do home births May work in a hospital, birthing center or do home births In most states CNMs can prescribe pain medication In most states CNMs can prescribe pain medication Less likely to include medication and routine medical interventions Less likely to include medication and routine medical interventions Studies show for low-risk pregnancies deliveries are as safe as MDs Studies show for low-risk pregnancies deliveries are as safe as MDs Select one that is certified and licensed. Select one that is certified and licensed.

8. Direct-entry midwives Trained without first becoming RNs Trained without first becoming RNs More likely to do at home births More likely to do at home births Some may also delivery at birthing centers Some may also delivery at birthing centers Those evaluated by the North American Registry of midwives (NARM) are called Certified Professional Midwives (CPM) Those evaluated by the North American Registry of midwives (NARM) are called Certified Professional Midwives (CPM) Other direct entry midwives are not certified Other direct entry midwives are not certified Licensing for direct entry midwives is offered in some states, for more info call Midwives Alliance of North America or check their website www.mana.org Licensing for direct entry midwives is offered in some states, for more info call Midwives Alliance of North America or check their website www.mana.orgwww.mana.org

9. Solo Medical Practice MD work alone using another MD to cover only when unavailable MD work alone using another MD to cover only when unavailable See same practitioner at every visit See same practitioner at every visit Most likely your MD will deliver your baby, but if unviable than a MD you’ve never met before will deliver Most likely your MD will deliver your baby, but if unviable than a MD you’ve never met before will deliver

10. Partnership or Group Practice OBs or FPs OBs or FPs Can see a different MD each time to get to know them all Can see a different MD each time to get to know them all May not like all equally and will be unable to choose who will attend birth May not like all equally and will be unable to choose who will attend birth Hearing different points a view can reassuring or unsettling Hearing different points a view can reassuring or unsettling

11. Combination Practice One or more OBs and one or more CNMs One or more OBs and one or more CNMs Same benefits and drawbacks as a group Same benefits and drawbacks as a group Some visits extra time and attention a midwife may offer Some visits extra time and attention a midwife may offer Access to CNM and security of MDs extra training and expertise Access to CNM and security of MDs extra training and expertise

12. Birthing CenterInde CNM CNMs provide most of the care MDs on call as needed CNMs provide most of the care MDs on call as needed Low-risk patients only Low-risk patients only May have to change practices if complications arise May have to change practices if complications arise May be transferred to hospital for emergency care May be transferred to hospital for emergency care Maybe deliver at home, hospital or birthing center Maybe deliver at home, hospital or birthing center Personalized pregnancy care Personalized pregnancy care Low-tech and natural delivery Low-tech and natural delivery Covered by most health plans, only some will cover births outside of hospital Covered by most health plans, only some will cover births outside of hospital Should have MD on call for emergencies Should have MD on call for emergencies

13. Gynecological and General Health Practitioner should be informed of all aspects of gynecological history to provide the best care. Practitioner should be informed of all aspects of gynecological history to provide the best care. Multiple 2 nd term abortions increase risk of premature delivery Multiple 2 nd term abortions increase risk of premature delivery Obesity- increased risk of gestational diabetes and high BP, difficulty dating preg. Obesity- increased risk of gestational diabetes and high BP, difficulty dating preg. Age Age –Over 35 > risk of Down’s elevated BP, diabetes, cardiovascular strain, miscarriage, preeclampsia, preterm labor, longer labor, interventions needed

14. Risk Factors Maternal Age Maternal Age Pregnancies too close together Pregnancies too close together Previous cesarean (c/s) Previous cesarean (c/s) Obesity Obesity Rh negative & incompatibility Rh negative & incompatibility Fibroids Fibroids Endometriosis Endometriosis Incompetent cervix Incompetent cervix Herpes & other STDs Herpes & other STDs Family history of genetic disorders or congenital defects Family history of genetic disorders or congenital defects Couples with history of 3 or more consecutive miscarriages Couples with history of 3 or more consecutive miscarriages Positive screening test Positive screening test Diabetes Diabetes High blood pressure High blood pressure Diabetes Diabetes

15. Milestones 5-8 weeks fetal heart rate (FHR) can be see via intravaginal ultrasound (U/S) 5-8 weeks fetal heart rate (FHR) can be see via intravaginal ultrasound (U/S) 9-13 weeks external genitalia developed enough to determine sex; FHR heard & seen with Doppler or U/S; U/S for dating 9-13 weeks external genitalia developed enough to determine sex; FHR heard & seen with Doppler or U/S; U/S for dating 18-22 weeks fetal movement, showing; level 2 U/S 18-22 weeks fetal movement, showing; level 2 U/S 25 viable if delivered 25 viable if delivered 32 + weeks Braxton hicks contractions, colostrum; usually head down; 32 + weeks Braxton hicks contractions, colostrum; usually head down; 36 weeks changes in fetal movement 36 weeks changes in fetal movement 37 weeks term, lightening and engagement, 37 weeks term, lightening and engagement, For more info visit http://www.smanutrition.co.uk/PlanningPregnancy/Pregnancy/dev elopment.htm

16. General Testing & Screening General Testing & Screening Every visit urine test for sugar & protein; fetal heart beat; fundal height; BP; weight Every visit urine test for sugar & protein; fetal heart beat; fundal height; BP; weight First month 1-4 wks: pregnancy test; blood type & Rh status; urinalysis; antibody for diseases i.e. rubella, STDs; genetics i.e. CF; pap; blood sugar First month 1-4 wks: pregnancy test; blood type & Rh status; urinalysis; antibody for diseases i.e. rubella, STDs; genetics i.e. CF; pap; blood sugar 10-14 wks: 1 st trimester screening U/S 10-14 wks: 1 st trimester screening U/S 15-18 wks: 2 nd trimester screening AFP (alpha fetoprotein)- spina bifida, downs, & other chromosomal abnormalities 15-18 wks: 2 nd trimester screening AFP (alpha fetoprotein)- spina bifida, downs, & other chromosomal abnormalities 7 mo 28-31 wks: glucose screening test; Hct & Hgb 7 mo 28-31 wks: glucose screening test; Hct & Hgb 8 mo 32-35 wks: GBS 8 mo 32-35 wks: GBS > 40 wks: non stress test > 40 wks: non stress test

17. Special Testing & Screening CVS or chorionic villis sampling- 1 st trim. test to detect chromosomal abnormalities ie- downs, tay- sachs, sickle cell, CF. Tube takes piece of chorion/placenta CVS or chorionic villis sampling- 1 st trim. test to detect chromosomal abnormalities ie- downs, tay- sachs, sickle cell, CF. Tube takes piece of chorion/placenta Amniocentesis needle takes amniotic fluid for genetics testing Amniocentesis needle takes amniotic fluid for genetics testing NST/ non stress test indicates if the fetus can remain in the uterus and how it may respond to labor, condition of placenta. NST/ non stress test indicates if the fetus can remain in the uterus and how it may respond to labor, condition of placenta. CST/ contraction stress test- same as above but with stimulated contractions. CST/ contraction stress test- same as above but with stimulated contractions. Biophysical profile- uses U/S evaluates 4 aspects of life- fetal breathing, fetal movement, fetal tone, amniotic fluid volume Biophysical profile- uses U/S evaluates 4 aspects of life- fetal breathing, fetal movement, fetal tone, amniotic fluid volume Umbilical artery Doppler velocimetry Umbilical artery Doppler velocimetry For more info visit http://hcd2.bupa.co.uk/fact_sheets/html/Screening_pregnancy.html

18. Birthing Options Family-centered care, not yet offered everywhere, but trending to. Family-centered care, not yet offered everywhere, but trending to. LDRP or LDR- labor, delivery, recovery and ideally post partum rooms. LDRP or LDR- labor, delivery, recovery and ideally post partum rooms. Birthing chairs- gravity can speed delivery Birthing chairs- gravity can speed delivery Lebyer Births- with out violence: soft music, soft lights, and warm bath. No longer routine unending and slapping baby’s bottom, umbilical cord cut delayed, direct to mother’s arms. Lebyer Births- with out violence: soft music, soft lights, and warm bath. No longer routine unending and slapping baby’s bottom, umbilical cord cut delayed, direct to mother’s arms. Water birth- concept of delivery under water to simulate the uterus environment. Baby is pulled out of the water and placed in the mother’s arms immediately after birth. Breathing doesn’t begin until infant is exposed to air, little risk of drowning. Only for low risk pregnancies. For more info and how to find a water birth http://www.waterbirth.org/spa/ Water birth- concept of delivery under water to simulate the uterus environment. Baby is pulled out of the water and placed in the mother’s arms immediately after birth. Breathing doesn’t begin until infant is exposed to air, little risk of drowning. Only for low risk pregnancies. For more info and how to find a water birth http://www.waterbirth.org/spa/http://www.waterbirth.org/spa/ Home birth Home birth Labor room, Delivery room, recovery room and nursery Labor room, Delivery room, recovery room and nursery For more info visit http://www.ahealthyme.com/topic/topic13265 or http://blueprint.bluecrossmn.com/topic/topic13265 For more info visit http://www.ahealthyme.com/topic/topic13265 or http://blueprint.bluecrossmn.com/topic/topic13265http://www.ahealthyme.com/topic/topic13265

19. Labor and Deliver Birthing options Birthing options Mucous plug, bloody show Mucous plug, bloody show Rupture of membranes Rupture of membranes Back Labor Back Labor IVs IVs Fetal monitoring Fetal monitoring Labor Positions Labor Positions Pain Management Pain Management Types of Delivery: vaginal, cesarean, VBAC, forceps, vacuum Types of Delivery: vaginal, cesarean, VBAC, forceps, vacuum Stage 1 Labor Stage 1 Labor –Phase 1 Latent phase: effacement & dilation to 3 –Phase 2 Active phase: dilation of cervix to 7 –Phase 3: Transition: dilation to 10 INTENSE – Stage 2 Delivery Stage 3 Delivery of placenta Stage 3 Delivery of placenta For more info visit http://ehc.healthgate.com/GetContent.asp?siteid=1853D48C-AD5D-4ACB-A0C4- 9DCEEA0E6A98&docid=/hic/pregnancy/preg/labor

20. Pain Management During Labor Physical Therapy: massage, heat, pressure, counter-pressure, reflexology Physical Therapy: massage, heat, pressure, counter-pressure, reflexology Flower Essences Flower Essences Counter Pressure on back Counter Pressure on back Hydrotherapy Hydrotherapy Biofeedback Biofeedback Acupuncture, Acupressure Acupuncture, Acupressure Hypnosis Hypnosis TENS Transcutaneous Electrical Nerve Stimulation TENS Transcutaneous Electrical Nerve Stimulation IV & IM Narcotics: Morphine, Fentanyl, Demerol, IV & IM Narcotics: Morphine, Fentanyl, Demerol, Tranquilizers: Phenergan, Vistiril Tranquilizers: Phenergan, Vistiril Oral Narcotics for early labor Oral Narcotics for early labor Epidural, Spinal and other regional blocks Epidural, Spinal and other regional blocks General Anesthesia General Anesthesia Distraction: watching TV, music, meditation, breathing exercises, etc… Distraction: watching TV, music, meditation, breathing exercises, etc… Visit http://www.reddinganesthesia.com/labor.htm for more information. http://www.reddinganesthesia.com/labor.htm

21. www.mjbovo.com Early Labor Positions STANDING Helps work with gravity; contractions less painful; helps backache; may speed labor; aligns the baby with the pelvic angle; could become tiring, but less tiring if you lean forward supported by partner. STANDING Helps work with gravity; contractions less painful; helps backache; may speed labor; aligns the baby with the pelvic angle; could become tiring, but less tiring if you lean forward supported by partner. WALKING Same advantages as standing, plus may encourage descent of the presenting part WALKING Same advantages as standing, plus may encourage descent of the presenting part SITTING Works with gravity; may be able to rest; sitting cross-legged may open pelvic outlet; fetal monitoring possible; can slow labor after a long period. SITTING Works with gravity; may be able to rest; sitting cross-legged may open pelvic outlet; fetal monitoring possible; can slow labor after a long period. HANDS AND KNEES Helps relieve back pain; may rotate posterior baby; tiring for long periods HANDS AND KNEES Helps relieve back pain; may rotate posterior baby; tiring for long periods KNEES, CHEST SUPPORTED Same as hands and knees, but less strain on arms. KNEES, CHEST SUPPORTED Same as hands and knees, but less strain on arms. SEMI-SITTING Same as sitting; increases back pain. SEMI-SITTING Same as sitting; increases back pain. LYING ON SIDE Lowers blood pressure; excellent resting position; contractions may be longer LYING ON SIDE Lowers blood pressure; excellent resting position; contractions may be longer LYING ON BACK Least effective for progress of labor; may become hypotensive and the baby may become distressed; may increase backache; fetal monitoring can be done. LYING ON BACK Least effective for progress of labor; may become hypotensive and the baby may become distressed; may increase backache; fetal monitoring can be done.

22. Second Stage Positions FORTY-FIVE DEGREE ANGLE. Widens pelvic outlet; uses gravity to some extent; better for backache than lying down; (Legs pulled up may work well with epidural; back and shoulders elevated) FORTY-FIVE DEGREE ANGLE. Widens pelvic outlet; uses gravity to some extent; better for backache than lying down; (Legs pulled up may work well with epidural; back and shoulders elevated) LYING ON SIDE Lowers blood pressure; eases backache; easier to relax between pushes. LYING ON SIDE Lowers blood pressure; eases backache; easier to relax between pushes. HANDS AND KNEES Excellent for rotating posterior baby; reduces backache. HANDS AND KNEES Excellent for rotating posterior baby; reduces backache. SQUATING Uses gravity to help the baby descend and rotate; partner can support your back and arms; widens pelvic outlet. SQUATING Uses gravity to help the baby descend and rotate; partner can support your back and arms; widens pelvic outlet. LITHOTOMY Lying back with legs in stirrups; good for forceps or vacuum, extensive episiotomy, delivery of breech. LITHOTOMY Lying back with legs in stirrups; good for forceps or vacuum, extensive episiotomy, delivery of breech. SEMI-LITHOTOMY Same as lithotomy, with head and shoulders elevated SEMI-LITHOTOMY Same as lithotomy, with head and shoulders elevated For more info visit http://www.transitiontoparenthood.com/ttp /parented/pain/positions.htm

23. http://www.amazingpregnancy.com/weekbyweek/laborandbirth/jeannie/11.html

24. http://www.amazingpregnancy.com/weekbyweek/laborandbirth/jeannie/15.html

25. Alternative Health Care for Pregnancy

26. Alternative Pregnancy Health Care Herbs Herbs Acupuncture Acupuncture –Moxabustion Massage Massage Reflexology Reflexology Aromatherapy Aromatherapy Flower Essences Flower Essences Chiropractic Care Chiropractic Care Yoga Yoga Hydrotherapy Hydrotherapy

27. Western Herbs and Pregnancy There are many herbs known to be beneficial during pregnancy and post-delivery. There are many herbs known to be beneficial during pregnancy and post-delivery. Herbs are an excellent source of vitamins and minerals. Herbs are an excellent source of vitamins and minerals. Herbs can be made into teas or incorporated into foods. Herbs can be made into teas or incorporated into foods.

28. Herbs and Pregnancy Aloe Vera Aloe Vera Angelica Angelica Autumn Crocus Autumn Crocus Barberry Barberry Black Cohosh Black Cohosh Celery Seed Celery Seed Cinnamon Cinnamon Devil's Claw Devil's Claw Goldseal Goldseal Hyssop Hyssop Juniper Juniper Male Fern Male Fern Mandrake Mandrake Parsley Seed Parsley Seed Pennyroyal Pennyroyal Pokeweed Pokeweed Rosemary Rosemary Rue Rue Sage Sage Southernwood Southernwood Tansy Tansy Thuja Thuja Wormwood Wormwood Yarrow Yarrow There are some herbs which are not safe to use when pregnant. These herbs can stimulate the uterus. There are some herbs which are not safe to use when pregnant. These herbs can stimulate the uterus.

29. Herbs and Pregnancy Raspberry Raspberry Nettle leaves Nettle leaves Oats Oats Dandelion root Dandelion root Alfalfa Alfalfa Yellow dock Yellow dock There are many herbs which are helpful during pregnancy and have been used by women for generations. There are many herbs which are helpful during pregnancy and have been used by women for generations.

30. Herbs for Morning Sickness Some herbs can work well for morning sickness but should be taken under the guidance of an herbalist Some herbs can work well for morning sickness but should be taken under the guidance of an herbalist –Chamomile –Ginger –Peppermint –Black Horehound

31. Herbs for Labor Golden Seal Can be taken during labor to assist the uterus but should never be taken during pregnancy.

32. Acupuncture Regular treatments throughout pregnancy can: Enhance the mother’s health Enhance the mother’s health Prevent complications Prevent complications Influence the development of the baby Influence the development of the baby Help relieve morning sickness Help relieve morning sickness

33. Acupuncture for the 1 st Trimester During the 1st trimester acupuncture can help to relieve: Fatigue Fatigue Migraines and headaches Migraines and headaches Bleeding Bleeding

34. Acupuncture for the 2 nd Trimester During the 2nd trimester acupuncture can help to relieve: Heartburn Heartburn Hemorrhoids Hemorrhoids Stress Stress Edema Edema Elevated blood pressure Elevated blood pressure Excessive weight gain Excessive weight gain

35. Acupuncture for the 3 rd Trimester During the 3 rd trimester acupuncture can help to relieve: Sciatica Sciatica Backaches Backaches Public and joint pain Public and joint pain By 32-34 weeks acupuncturist will begin to encourage a head-down position By 32-34 weeks acupuncturist will begin to encourage a head-down position Last 4-6 weeks treatments will be focused to normalize and optimize labor Last 4-6 weeks treatments will be focused to normalize and optimize labor

36. Moxabustion If a baby is in the breech position many acupuncturists will use moxabustion to turn the baby. This technique has been used for centuries in China. Moxabustion is a long stick of moxa or the herb mugwort that is lit and produces a gentle, smoldering heat. Moxabustion is a long stick of moxa or the herb mugwort that is lit and produces a gentle, smoldering heat. Moxa is held by an acupuncture point on the little toe. Moxa is held by an acupuncture point on the little toe. This is most effective when used at 32-36 weeks of pregnancy This is most effective when used at 32-36 weeks of pregnancy Should only be used with healthy pregnancies Should only be used with healthy pregnancies Can also be used in the treatment of nausea Can also be used in the treatment of nausea

37. Prenatal Massage There are some specific positions for prenatal massage to keep the mother comfortable and to limit pressure. Lying on side Lying on side Lying on stomach with specially designed pillows cutout at the stomach so the mother can lay flat and be relaxed Lying on stomach with specially designed pillows cutout at the stomach so the mother can lay flat and be relaxed Propped up while lying on back- after 22 weeks lying flat on your back can cause pressure on deep blood vessels, reducing circulation to mother and baby. Propped up while lying on back- after 22 weeks lying flat on your back can cause pressure on deep blood vessels, reducing circulation to mother and baby.

38. Benefits of Prenatal Massage Emotional support and nurturing touch Emotional support and nurturing touch Relaxation and decreased insomnia Relaxation and decreased insomnia Stress relief on weight-bearing joints Stress relief on weight-bearing joints Neck and back pain relief Neck and back pain relief Assistance in maintaining proper posture Assistance in maintaining proper posture Preparing muscles used during childbirth Preparing muscles used during childbirth Reduced swelling (edema) Reduced swelling (edema) Lessened sciatic pain Lessened sciatic pain Fewer calf cramps Fewer calf cramps Lessened headache and sinus congestion Lessened headache and sinus congestion Aiding circulation, keeping blood pressure in check Aiding circulation, keeping blood pressure in check Relieve depression and anxiety Relieve depression and anxiety Help stabilize hormone levels Help stabilize hormone levels Increase flexibility (helpful in the last trimester) Increase flexibility (helpful in the last trimester) Help to relieve cramps, constipation, nausea and indigestion Help to relieve cramps, constipation, nausea and indigestion Helps to prevent stretch marks Helps to prevent stretch marks

39. Prenatal Massage Precautions Massage is generally not recommended in the first trimester Massage is generally not recommended in the first trimester Avoid during morning sickness (an increase in circulation can intensify morning sickness) Avoid during morning sickness (an increase in circulation can intensify morning sickness) Avoid if the mother has excessive swelling in the arms or legs, fever or vaginal bleeding Avoid if the mother has excessive swelling in the arms or legs, fever or vaginal bleeding Avoid deep work on the abdomen Avoid deep work on the abdomen Avoid deep pressure applied to the area between the ankle bone and heel and the webbing between the thumb and index finger (these areas are related to the uterus and vagina and pressure can promote/induce labor Avoid deep pressure applied to the area between the ankle bone and heel and the webbing between the thumb and index finger (these areas are related to the uterus and vagina and pressure can promote/induce labor

40. Reflexology and Pregnancy Reflexology is based on the idea that points on the hands and feet correspond with specific organs and systems in the body. Therefore pressure is applied to certain points and the related area of the body is stimulated and cleared of congestion. Reflexology also promotes deep relaxation thereby encouraging the body’s natural healing process.

41. Benefits of Reflexology during Pregnancy Morning Sickness Morning Sickness Nausea and headaches Nausea and headaches Pain and discomfort Pain and discomfort Loss of bladder control Loss of bladder control Backaches Backaches Stress and Anxiety Stress and Anxiety Sleeplessness and Fatigue Sleeplessness and Fatigue Digestive Problems Digestive Problems Constipation and diarrhea Constipation and diarrhea Swollen or puffy ankles and legs Swollen or puffy ankles and legs Cramps Cramps Gestational Diabetes Gestational Diabetes Heartburn Heartburn Help to turn posterior babies Help to turn posterior babies Help to turn breech babies Help to turn breech babies Induce labor Induce labor Reflexology can help to relieve the following complaints during pregnancy:

42. Reflexology During Pregnancy Precautions Go to a Reflexologist who is experienced with treating pregnancy Go to a Reflexologist who is experienced with treating pregnancy Generally recommended that if the mother has not received reflexology treatments before pregnancy she should wait until week 18 to begin treatments Generally recommended that if the mother has not received reflexology treatments before pregnancy she should wait until week 18 to begin treatments Some medical conditions (such as septicemia) could reduce the effect of treatment Some medical conditions (such as septicemia) could reduce the effect of treatment Any unusual results of treatment should be referred to a medical doctor (i.e. vaginal bleeding) Any unusual results of treatment should be referred to a medical doctor (i.e. vaginal bleeding)

43. Aromatherapy During Pregnancy Aromatherapy can help with many emotional discomforts during pregnancy as well as some of the physical discomforts.

44. Benefits of Aromatherapy Aid in relaxation Aid in relaxation Assist in dealing with stress Assist in dealing with stress Help ease aches and pains as the pregnancy progresses Help ease aches and pains as the pregnancy progresses Help alleviate tiredness Help alleviate tiredness Help reduce stretch marks by keeping the skin well nourished Help reduce stretch marks by keeping the skin well nourished Help the mother feel good about herself Help the mother feel good about herself Provide some relief from varicose veins Provide some relief from varicose veins Help the mother stay in touch with her body Help the mother stay in touch with her body

45. Aromatherapy During Pregnancy The way essential oils work is by entering the blood stream through the skin. They are mixed with carrier oils in order to not avoid irritating the skin. When a women is pregnant less essential oils should be used, making the carrier oil less concentrated (advised to use only 5 drops per 1 once of carrier oil). Essential oils can also be used by inhaling the scent such as through a diffuser or on a tissue.

46. Tips for Using Aromatherapy During Pregnancy Massaging abdomen, breasts and thighs with essential oils can reduce stretch marks (use a carrier oil such as avocado oil which is very nourishing for the skin) Massaging abdomen, breasts and thighs with essential oils can reduce stretch marks (use a carrier oil such as avocado oil which is very nourishing for the skin) Add 3-4 drops of an essential oil to a warm bath for relaxation (avoid hot baths during pregnancy) Add 3-4 drops of an essential oil to a warm bath for relaxation (avoid hot baths during pregnancy) Put 5 drops of essential oils on a tissue and inhale Put 5 drops of essential oils on a tissue and inhale Use in a couple drops in a spritzer with water Use in a couple drops in a spritzer with water

47. Aromatherapy Oils for Use During Pregnancy Benzoin Benzoin Bergamot Bergamot Lemon Lemon Neroli Neroli Sandalwood Sandalwood Spearmint Spearmint Grapefruit Grapefruit Ylang Ylang Ylang Ylang Mandarin Mandarin Orange Orange Tea Tree Tea Tree Lavender (avoid in 1 st trimester or if history of miscarriage) Lavender (avoid in 1 st trimester or if history of miscarriage) Patchouli Patchouli Vetiver Vetiver Rose Rose Tangerine Tangerine Jasmine Jasmine Chamomile Chamomile The following oils are generally considered safe for pregnancy (though there are many conflicting points of view and some say to avoid all essential oils or stimulating essential oils in the 1 st trimester):

48. Aromatherapy Precautions During Pregnancy Basil Basil Cedarwood Cedarwood Clary Sage Clary Sage Cypress Cypress Fennel Fennel Jasmine Jasmine Juniper berry Juniper berry Marjoram Marjoram Myrrh Myrrh Peppermint Peppermint Rosemary Rosemary Thyme Thyme Pennyroyal Pennyroyal Oregano Oregano The following essential oils should be avoided during pregnancy: Lavender, rose, chamomile and geranium should be avoided in the 1 st trimester or if there is a history of miscarriage otherwise they are generally considered safe to use Lavender, rose, chamomile and geranium should be avoided in the 1 st trimester or if there is a history of miscarriage otherwise they are generally considered safe to use

49. Flower Essences and Pregnancy Flower essences are herbal remedies which contain the energetic healing pattern of flowers infused in water and preserved with alcohol. Flower essences interact with the human energy field to harmonize the emotions, clear and calm the mind and bring about a sense of peace and well-being. (Flower Essences for Pregnancy and Childbirth by Peggy Rada, September 1999)

50. Usage of Flower Essences During Pregnancy Flower Essences: Can be used throughout pregnancy and labor Can be used throughout pregnancy and labor Have no side effects Have no side effects Can be used by everyone Can be used by everyone Can be used alongside other treatments or therapies Can be used alongside other treatments or therapies

51. Taking Flower Essences During Pregnancy There are several ways to take flower essences: Place several drops on the tongue, two or more times a day (most common)Place several drops on the tongue, two or more times a day (most common) Place on the insides of wristsPlace on the insides of wrists Place a drop on the forehead (most common with babies and children)Place a drop on the forehead (most common with babies and children) Added to bath waterAdded to bath water

52. Benefits of Flower Essences Help gain and keep inner balance Help gain and keep inner balance Support decision making Support decision making Restore peace of mind Restore peace of mind Help both parents face changes Help both parents face changes Encourage bonding between mother and child Encourage bonding between mother and child Soothe emotional oversensitivity Soothe emotional oversensitivity Help relieve backaches and sleeping problems Help relieve backaches and sleeping problems Keep the parents calm and collected before and during the birth Keep the parents calm and collected before and during the birth

53. Flower Essences for Pregnancy Alpine Lily- especially beneficial the physical experience of pregnancy and weight gain Alpine Lily- especially beneficial the physical experience of pregnancy and weight gain Borage- uplifts spirits during pregnancy Borage- uplifts spirits during pregnancy California Wild Rose- for difficult pregnancies or births California Wild Rose- for difficult pregnancies or births Centaury- overwork or exhaustion Centaury- overwork or exhaustion Chamomile- to balance emotions Chamomile- to balance emotions Cherry Plum- for extremely stressful pregnancy Cherry Plum- for extremely stressful pregnancy Fairy Lantern- for young mother challenges Fairy Lantern- for young mother challenges Shooting Star- to prevent miscarriages Shooting Star- to prevent miscarriages Pear- inner peace Pear- inner peace There are many flower essences which can be beneficial during pregnancy. A few are listed below:

54. Chiropractic Care and Pregnancy Chiropractic care involves adjusting misaligned joints of the body, especially the spine, to promote overall health.

55. Use of Chiropractic Care During Pregnancy Chiropractic care is safe during pregnancy when provided by a chiropractor trained to work with pregnant women. Chiropractic care is safe during pregnancy when provided by a chiropractor trained to work with pregnant women. Chiropractors should use tables that will adjust to pregnant women’s bodies. Chiropractors should use tables that will adjust to pregnant women’s bodies. Chiropractors should avoid unneeded pressure on the abdomen. Chiropractors should avoid unneeded pressure on the abdomen. Many trained chiropractors will provide exercise and stretches that are safe to use during the pregnancy. Many trained chiropractors will provide exercise and stretches that are safe to use during the pregnancy.

56. Reasons for Chiropractic Care During Pregnancy Changes in the body can result in misalignment of the spine or joints Changes in the body can result in misalignment of the spine or joints To help establish balance and alignment with the pelvis To help establish balance and alignment with the pelvis Increase the amount of room in the pelvic cavity for the developing baby Increase the amount of room in the pelvic cavity for the developing baby Position the baby for delivery Position the baby for delivery

57. Chiropractic Technique for Pregnancy The Webster Breech Technique Developed by Larry Webster of the International Chiropractic Pediatric Association Used to release stress on the pregnant woman’s pelvis and cause relaxation of the uterus and surrounding ligaments. Used to release stress on the pregnant woman’s pelvis and cause relaxation of the uterus and surrounding ligaments. Making it easier for a breech baby to turn in the womb naturally. Making it easier for a breech baby to turn in the womb naturally. Facilitates safer deliveries for mother and baby Facilitates safer deliveries for mother and baby There has been a high success rate reported There has been a high success rate reported

58. Potential Benefits of Chiropractic Care During Pregnancy Reduce chance of miscarriage Reduce chance of miscarriage Controlling vomiting and morning sickness Controlling vomiting and morning sickness Increased rate of full-term delivery Increased rate of full-term delivery Reduce labor and delivery time Reduce labor and delivery time Relieve back, neck or joint pain Relieve back, neck or joint pain Prevent cesarean section or vaginal breech delivery Prevent cesarean section or vaginal breech delivery Can be used to induce labor Can be used to induce labor

59. Yoga and Pregnancy Many women find that yoga helps to relieve pregnancy discomfort and teaches healthy relaxation skills in order to better prepare mentally and physically for the coming birth.

60. Yoga Tools and Benefits for Pregnancy Yoga exercises- ensure a smooth pregnancy and relatively easy childbirth Yoga exercises- ensure a smooth pregnancy and relatively easy childbirth Breathing or Pranayama- help ensure abundant supply of oxygen Breathing or Pranayama- help ensure abundant supply of oxygen Mudras or Bandhas- stimulation of these gestures have effects on the reproductive organs Mudras or Bandhas- stimulation of these gestures have effects on the reproductive organs Meditation- helps resolve neuroses, fears and conlfcits, as well as create a deep awareness which help the mother connect to the child Meditation- helps resolve neuroses, fears and conlfcits, as well as create a deep awareness which help the mother connect to the child Deep relaxation- Yogic sleep (Yoga nidra) effective for physical and mental relaxation and childbirth preparation Deep relaxation- Yogic sleep (Yoga nidra) effective for physical and mental relaxation and childbirth preparation (from www.healthandyoga.com/html/preg.html)

61. Yoga Positions for Pregnancy The Swan The Swan –Good release posture –Takes the weight off the back –Stretches hip joints and opens pelvic area –Opens chest area, encouraging deeper breathing Tadasana (Mountain Pose) Tadasana (Mountain Pose) –Helps relieve pregnancy related back ache –Helps with tiredness by encouraging deep breathing ( www.yogauk.com/YogaUK/inspiration/pregnancy.htm)

62. Yoga Positions for Pregnancy Continued Trikonasana (Triangle Pose) Trikonasana (Triangle Pose) –Helps with fluid retention in feet and ankles –Be careful not to over stretch muscles especially near the end of pregnancy (muscles and joints are more stretchy during pregnancy because of the release of relaxin in preparation of birth) Recovery Position Recovery Position –Relaxation postures such as the recovery position oppose the effects of stress –Use any number of blocks or cushions for comfort (www.yogauk.com/YogaUK/inspiration/pregnancy.htm)

63. Precautions for Yoga During Pregnancy After the 1 st Trimester women should not perform and poses on their back because these can cut blood flow to the uterus (some women are comfortable with these poses and should take care to listen to their bodies). After the 1 st Trimester women should not perform and poses on their back because these can cut blood flow to the uterus (some women are comfortable with these poses and should take care to listen to their bodies). Avoid poses that stretch the muscles too much, especially the abdominal muscles, since because of the pregnancy hormone relaxin. Avoid poses that stretch the muscles too much, especially the abdominal muscles, since because of the pregnancy hormone relaxin. Take care when performing standing poses, use a chair or the wall for extra support. Take care when performing standing poses, use a chair or the wall for extra support. Bend forward from the hips and allow as much distance as needed to make breathing easier. Bend forward from the hips and allow as much distance as needed to make breathing easier. Twist more from the shoulders and back to avoid putting pressure on the abdomen. Twist more from the shoulders and back to avoid putting pressure on the abdomen. Listen to the body carefully and adapt poses to the body’s physical changes. Listen to the body carefully and adapt poses to the body’s physical changes. If there is discomfort stop the exercise. If there is discomfort stop the exercise.

64. Hydrotherapy and Pregnancy Hydrotherapy is the use of water for therapeutic purposes. Hydrotherapy is self-applicable, reliable, safe and pleasant to experience.

65. Hydrotherapy for Pregnancy Paddling- run 6 inches of cold tap water in a bath. Walk up and down the bath raising feet out of the water with each step. Start with 30 second and build up each day until reaching 2 minutes. Paddling- run 6 inches of cold tap water in a bath. Walk up and down the bath raising feet out of the water with each step. Start with 30 second and build up each day until reaching 2 minutes. Pelvic Splashing- splash lukewarm water around legs, squat and splash around hips, between legs and on the abdomen. Reduce the water temperature over 3 days until the water is cold. Step out of bath into warm towels and dress quickly. Pelvic Splashing- splash lukewarm water around legs, squat and splash around hips, between legs and on the abdomen. Reduce the water temperature over 3 days until the water is cold. Step out of bath into warm towels and dress quickly. Benefits- assist with increased pressures of pregnancy, stimulate circulation in the venous system and improve muscle tone. Influences the internal muscles better than stretching and conditions softer tissues, making them less likely to tear or need surgical intervention. Benefits- assist with increased pressures of pregnancy, stimulate circulation in the venous system and improve muscle tone. Influences the internal muscles better than stretching and conditions softer tissues, making them less likely to tear or need surgical intervention. (http://www.positivehealth.com/permit/Articles/Womens%20Health/mitch48.htm ) http://www.positivehealth.com/permit/Articles/Womens%20Health/mitch48.htm

66. Hydrotherapy During Labor Splashing or Spraying the Face- use an atomizer or dip hands into cold water and direct to forehead and eyes Splashing or Spraying the Face- use an atomizer or dip hands into cold water and direct to forehead and eyes –Benefits- stimulates the cranial nerves, helping concentration and reducing anxiety Cold Compress of the Neck- place a towel wrung out in cold water around the neck Cold Compress of the Neck- place a towel wrung out in cold water around the neck –Benefits- Steadies and deepens breathing, relieves tiredness Hot Compress on Lower Back- place a hot towel against the lower back and pelvis Hot Compress on Lower Back- place a hot towel against the lower back and pelvis –Benefits- encourages relaxation of the pelvis between contractions The Birth Pool- float in water, briefly at the beginning of labor and then increase the length of time as the labor progresses (Giving birth in water is an option) The Birth Pool- float in water, briefly at the beginning of labor and then increase the length of time as the labor progresses (Giving birth in water is an option) –Benefits- eases pressure on the spine, body is decompressed- interrupting the intensity of labor pains, giving birth in water is less stressful on the perineum (http://www.positivehealth.com/permit/Articles/Womens%20Health/mitch48.htm ) http://www.positivehealth.com/permit/Articles/Womens%20Health/mitch48.htm

67. Common Hydrotherapy for Pregnancy A warm bath (thought not a hot bath) A warm bath (thought not a hot bath) Prenatal water exercise classes Prenatal water exercise classes –These exercises help maintain muscle function and improve circulation and the water helps bare some of the weight of the pregnancy.

68. Doula or Labor Support Person Trained and experienced in childbirth Trained and experienced in childbirth Provides physical, emotional and informational support to woman and their partners during labor and birth Provides physical, emotional and informational support to woman and their partners during labor and birth Provides help and advice on breathing, relaxation, movement, and positioning Provides help and advice on breathing, relaxation, movement, and positioning Assists in gathering information about labor options Assists in gathering information about labor options May attend prenatal appointment with the mother and assist the mother in developing questions to ask the provider May attend prenatal appointment with the mother and assist the mother in developing questions to ask the provider Provides continual emotional reassurance and comfort Provides continual emotional reassurance and comfort Do not diagnose medical conditions, perform clinical tests or give medical advice. Do not diagnose medical conditions, perform clinical tests or give medical advice. Goal is to help women have a safe and satisfying childbirth experience Goal is to help women have a safe and satisfying childbirth experience

69. Possible Benefits of a Doula Decrease the chance of a cesarean Decrease the chance of a cesarean Decrease the length of labor Decrease the length of labor Reduce the need for pain medications Reduce the need for pain medications Facilitate a normal, natural, non- intervening birth experience Facilitate a normal, natural, non- intervening birth experience http://www.childbirth.org/articles/labor/value.html www.dona.org www.childbirthsolutions.com/articles/pregnancy/doulacontributions/index.php

70. References and Resources 1. http://www.abcbirth.com/ http://www.abcbirth.com/ 2. http://www.ahealthyme.com/topic/topic13265 http://www.ahealthyme.com/topic/topic13265 3. http://www.amazingpregnancy.com/weekbyweek/laborandbirth/jeannie http://www.amazingpregnancy.com/weekbyweek/laborandbirth/jeannie 4. 4. http://ehc.healthgate.com/GetContent.asp?siteid=1853D48C-AD5D-4ACB-A0C4-9DCEEA0E6A98&docid 5. Eisenberb, H. & Hathaway, S. What To Expect When Your Expecting 3 rd Ed.. Workman Publishing Copyright 2002. NY, NY 6. 6. http://hcd2.bupa.co.uk/fact_sheets/html/Screening_pregnancy.html 7. www.mjbivo.com www.mjbivo.com 8. www.longs.com www.longs.com 9. www.mana.org www.mana.org 10. http://www.reddinganesthesia.com/labor.htm http://www.reddinganesthesia.com/labor.htm 11. http://www.smanutrition.co.uk/PlanningPregnancy/Pregnancy/development.htm 12. http://transitiontoparenthood.com/ttp/foreducators/arthome.htm http://transitiontoparenthood.com/ttp/foreducators/arthome.htm 13. http://www.waterbirth.org/spa/ http://www.waterbirth.org/spa/

71. References and Resources Acupuncture 1.http://homepage.powerup.com.au/~shentherapies/preguide.html http://homepage.powerup.com.au/~shentherapies/preguide.html 2.http://pregnancytoday.com/reference/articles/acupuncture.htm http://pregnancytoday.com/reference/articles/acupuncture.htm 3.http://www.asny.org/news6.asp http://www.asny.org/news6.asp 4.http://www.baby2kids.ie/Pregnancy/Complementary_Medicine/Acupuncture___Pregnancy/body_acupun cture___pregnancy.html http://www.baby2kids.ie/Pregnancy/Complementary_Medicine/Acupuncture___Pregnancy/body_acupun cture___pregnancy.htmlhttp://www.baby2kids.ie/Pregnancy/Complementary_Medicine/Acupuncture___Pregnancy/body_acupun cture___pregnancy.html 5.http://www.healthypages.net/articles.asp?newsid=897 http://www.healthypages.net/articles.asp?newsid=897 6.http://www.ukparents.co.uk/archives/acupuncture.shtml http://www.ukparents.co.uk/archives/acupuncture.shtml 7.West, Z. (2002). Acupuncture in Pregnancy and Childbirth. New York, New York: Churchill Livingston. Aromatherapy Aromatherapy 1.Fawcett, M. (1993). Aromatherapy for Pregnancy and Childbirth. United Kingdom: Element Books. http://elements.eyesis.co.nz/aromatherapy_and_pregnancy/ http://elements.eyesis.co.nz/aromatherapy_and_pregnancy/ 2.http://www.aromaweb.com/articles/aromatherapyduringpregnancy.asp http://www.aromaweb.com/articles/aromatherapyduringpregnancy.asp 3.http://www.childbirthsolutions.com/articles/pregnancy/aroma1/index.php http://www.childbirthsolutions.com/articles/pregnancy/aroma1/index.php 4.http://www.homemakingcottage.com/family/mother/aromatherapy_in_preg.htm http://www.homemakingcottage.com/family/mother/aromatherapy_in_preg.htm Chiropractic Care 1.http://www.americanpregnancy.org/pregnancyhealth/chiropracticcare.html http://www.americanpregnancy.org/pregnancyhealth/chiropracticcare.html 2.http://www.dcdoctor.com/pages/rightpages_wellnesscenter/pregnancy/chirocare.html http://www.dcdoctor.com/pages/rightpages_wellnesscenter/pregnancy/chirocare.html 3.http://www.icpa4kids.com/pediatric_chiropractic_articles_chiropractic_care_in_pregnancy.htm http://www.icpa4kids.com/pediatric_chiropractic_articles_chiropractic_care_in_pregnancy.htm

72. References and Resources Doula 1. http://www.childbirth.org/articles/labor/value.html http://www.childbirth.org/articles/labor/value.html 2. http://www.childbirthsolutions.com/articles/pregnancy/doulacontributions/index.php http://www.childbirthsolutions.com/articles/pregnancy/doulacontributions/index.php 3. http://www.dona.org http://www.dona.org Flower Essences 1. http://www.essences.com/vibration/feb01/pregnancy.html http://www.essences.com/vibration/feb01/pregnancy.html 2. http://www.fleursdevie.com/html/body_article_pregnancy.htm http://www.fleursdevie.com/html/body_article_pregnancy.htm 3. http://www.floweressences.de/birth.htm http://www.floweressences.de/birth.htm 4. http://www.flowersociety.org/pregnancy_conception.htm http://www.flowersociety.org/pregnancy_conception.htm Herbs 1. http://www.allaboutmoms.com/herbs.htm http://www.allaboutmoms.com/herbs.htm 2. http://www.birthmattersmidwifery.com http://www.birthmattersmidwifery.com http://www.birthmattersmidwifery.com 3. Gardner Goodson, J. (2000). Healing Yourself During Pregnancy Freedom, California: Crossing Press. 4. http://www.gardenguides.com/herbs/preg.htm http://www.gardenguides.com/herbs/preg.htm 5. http://www.motherlove.com/faq_usefulherbs.html http://www.motherlove.com/faq_usefulherbs.html 6. Weed, S. (1986). Wise Woman Herbal for the Childbearing Years. Woodstock, New York: Ash Tree Publishing. 7. Weschler, T. (2002). Taking Chare of Your Fertility. New York, New York: Quill.

73. References and Resources Hydrotherapy 1. http://www.babydirectory.com/cgi-bin/showPreg.pl?HYDROTHERAPY http://www.babydirectory.com/cgi-bin/showPreg.pl?HYDROTHERAPY 2. http://www.positivehealth.com/permit/Articles/Womens%20Health/mitch48.htm http://www.positivehealth.com/permit/Articles/Womens%20Health/mitch48.htm Massage 1. http://members.efn.org/~djz/birth/add1095/partnermass.html http://members.efn.org/~djz/birth/add1095/partnermass.html 2. http://pregnancytoday.com/reference/articles/prenatalmassage.htm http://pregnancytoday.com/reference/articles/prenatalmassage.htm 3. http://pregnancytoday.com/reference/articles/prenatms.htm http://pregnancytoday.com/reference/articles/prenatms.htm 4. http://www.aarogya.com/Complementary/Massage/pregnancy.asp http://www.aarogya.com/Complementary/Massage/pregnancy.asp Reflexology 1. http://www.clarewright.co.uk/preg_birth.htm http://www.clarewright.co.uk/preg_birth.htm 2. http://www.familiesonline.co.uk/article/static/118/ http://www.familiesonline.co.uk/article/static/118/ 3. http://www.women24.com/W24/Display/w24Article/0,,1-9-10-30_3849,00.html http://www.women24.com/W24/Display/w24Article/0,,1-9-10-30_3849,00.html Yoga 1. http://www.babycenter.com/expert/pregnancy/pregnancyfitness/5699.html http://www.babycenter.com/expert/pregnancy/pregnancyfitness/5699.html 2. http://www.healthandyoga.com/html/preg.html http://www.healthandyoga.com/html/preg.html 3. http://www.yogauk.com/YogaUK/inspiration/pregnancy.htm http://www.yogauk.com/YogaUK/inspiration/pregnancy.htm