Gestational Diabetes: Do I HAVE to drink that?

 

Short Answer:  Yes.

Long Answer:  You actually don’t HAVE to do anything you don’t want to do.  We won’t MAKE you do anything you don’t want to do.  This concept supports your autonomy as a patient.

However, you trust us to be the lifeguard of your pregnancy.  Throughout your pregnancy, we will monitor your blood work, vital signs, and the baby’s growth and development by using ultrasound, drawing your blood, listening to your baby’s heartbeat, and measuring the size of the uterus.  Trust us when we say that the second trimester glucose screen is very important to the health of both you and your baby.  We might even recommend it earlier in the first trimester if we are concerned about impaired glucose tolerance.

One complication of pregnancy that we screen for and treat is called gestational diabetes.  Gestational diabetes can occur in women of any size, even without a personal history of family history of diabetes.  Insulin is a hormone produced by the pancreas, and the body uses insulin to help transport blood glucose (sugar) from the bloodstream into the cells of the body.  The hormones of pregnancy can cause you to be resistant to insulin.  If you become resistant to insulin, your blood glucose levels become elevated and the glucose easily transports across the placenta to your baby.  This can cause the baby to grow very large, and at the same time it impairs the development of the baby’s lungs.  You can end up with a very large baby who, at the same time, has very immature lungs and needs help breathing after birth.

Maternal Complications of Gestational Diabetes:

  • You have a 70% chance of developing Type 2 Diabetes within 10 years
  • You are at a higher risk of high blood pressure or preeclampsia in pregnancy
  • You might require medication to help manage your blood glucose
  • You are at higher risk of miscarriage or stillbirth

 

Fetal Complications of Gestational Diabetes:

  • Your baby can grow very large
  • Your baby might experience a shoulder dystocia at delivery, which is an emergency situation where the head delivers but the large body is stuck behind your pelvic bones.  We might have to break the baby’s collar bone to help your baby deliver.
  • Your baby might require assistance breathing at delivery or in the first few days
  • Your baby might need to be observed or treated in the special care nursery for low blood glucose.

What happens if your one hour glucose screen comes back elevated? 

We will ask you to take a three hour glucose screen.  If the three hour glucose screen comes back elevated, you will have the diagnosis of Gestational Diabetes.  At that time, we will send you for a consultation with a Maternal Fetal Medicine physician called a Perinatologist.  These physicians are specially trained in high-risk pregnancy and obstetric ultrasound.  They can help us monitor the growth of your baby.  In addition, a diabetic educator will teach you how to test your blood glucose daily.  They will also teach you how to eat well to keep your blood glucose as stable as possible.  You will also be asked to increase your daily exercise, which will help your body be more sensitive to insulin and help you regular your blood glucose.

 

The glucose screen is usually done at the 24-28 week visit.  We ask that you eat normally that day, with good protein and not a heavy carbohydrate load.  Plan for the visit to take at least an hour because we have to draw your blood one hour after you finish drinking the liquid.  Pack a healthy snack with protein for the ride home.

 

So… yes.  Your midwives are aware that the glucose screen can cause nausea and discomfort.  You may not like the taste of the drink.  However, it is an important screening test that can help us provide the very best care for you and your baby.

 

For more information:

http://www.diabetes.org/diabetes-basics/gestational/

http://www2c.cdc.gov/podcasts/player.asp?f=11504&loc=WhatIsGestational

By: Kirsten Johnson | Certified Nurse Midwife

Birth Plans!

Should I write a Birth Plan?

Many women want to write out a birth plan to clarify the care they hope to receive while they are in labor.  A birth plan can be a short wish list or a long explanation of your circumstance, such as if you are adopting the child out or if there are known anomalies incompatible with life.

Is a Birth Plan required?  No.  The nurses, midwives, and physicians are highly trained professionals who will take care of you to the best of their abilities.  We have not performed routine shaves, enemas, or episiotomies for over 25 years, so you do not need to request that we refrain from these procedures.  We have many tools in our bag of tricks to help your labor progress well and hopefully avoid complications.

In addition, every woman and every labor is different.  It is a good idea for you to relax, let go, and accept the labor that comes to you.  There really is no other choice but to deal with the reality of the moment.  Your care providers will help you.  Honest.  That’s what we have chosen to do for our career.  We want the best outcome for you and your family.

I do recommend that my mammas write up a short, one-page wish list that gives the labor team a frame of reference of what experience you are hoping for in labor and delivery.  It is a good idea to designate one person to speak for you if you are unable to speak for yourself due to an intense labor.  It tells us if you have specific requests, such as dad cutting the umbilical cord or your desire to avoid an epidural or even GIVE ME THE EPIDURAL THE MOMENT I WALK IN THE DOOR!

Bring your birth plan to one of your prenatal visits to discuss with your midwife or physician.  Then when you have a final draft, bring a printed copy for the nurse caring for you in labor and delivery.  That way, your entire team is on board with the plan and works with you!  Remember to keep it short and flexible.

Some ideas of what women specify in a birth plan:

  • Who will be present for the birth?
  • Are you bringing a doula?
  • Will there be siblings present?
  • Do you want mobility or do you want to stay in bed?
  • What activities or positions do you plan to use (walking, birthing ball, standing, tub, squatting, etc)?
  • What is your plan for pain relief (massage, hot packs, position changes, hypnobirthing, Lamaze breathing, jacousi tub, medication)?
  • How do you feel about fetal monitoring?
  • Who will care for the baby?
  • What is your plan to feed your baby?
  • Do you want to wear your own clothing and listen to music?

 

You can always google “birth plans” on the internet for more ideas, remembering to keep your wish list to one page!

-Kirstin Johnson, Certified Nurse Midwife

Preventing Pertussis or “Whooping Cough” in the newborn.

whopping-cough-babies-2160x1200

 

Pertussis, also called “Whooping Cough” is a bacterial infection that you or your baby can catch when an infected person coughs or sneezes.  Infected droplets can travel through the air, and if you inhale the droplets you can become infected with pertussis.  Whooping cough begins like a cold, with a mild fever and runny nose.  Most adults do not have severe symptoms, but they can pass pertussis on to a newborn very easily without realizing it.

Whooping cough is especially dangerous for a newborn because their immune system is not fully mature and they cannot fight this infection.  Babies cannot get the vaccine for pertussis until they are two months old.  Even after they start the vaccinations, they are not fully protected by the vaccines until they are a year old and have had three vaccinations for pertussis.  Whooping cough in a newborn is a very serious illness, and it often requires that the baby be admitted to the hospital for breathing problems or pneumonia.  Some babies who get whooping cough do not cough at all – they just stop breathing.  Newborns can die from whooping cough.

The entire family can help protect your newborn from whooping cough.  All teenagers and adults who are around your baby should get a pertussis booster, called Tdap.  The Tdap shot is a tetanus vaccine that includes pertussis.  If you are pregnant, the best time to get the Tdap vaccine is between 27-36 weeks of pregnancy.  Your body will have time to make antibodies against pertussis.  These antibodies are passed through the placenta to protect your baby.  You can protect your baby with antibodies long before your baby is old enough to get the pertussis vaccine.  After the baby is born, the antibodies are passed through your breast milk.

For more information:  http://www.cdc.gov/features/pertussis

-Kirstin Johnson, Certified Nurse Midwife

Who needs sleep?

What is the one thing we spend the most time doing?  Sleeping!  Sleeping is a very important part of our life and contributes to our health.  Getting a good amount of sleep gives our body time to rest, and our brain time to make new connections.  When we don’t get enough sleep we can see the effects in many areas of our lives:  difficulty concentrating, poor attention, poor judgment, decreased ability to learn, depressed mood, and even obesity, heart disease, and a depressed immune system.

Do you think your children are getting the sleep that they need to be successful in school and in relationships with friends and family?  A National Sleep Foundation study recently found that 85% of teens do not get adequate sleep!  Adequate sleep means 8-10 hours every night for a teenager and 9-11 hours a night for a school age child.

Poor sleep has become a larger problem over the last 20 years.  What can you do to help ensure your child gets enough sleep?  Here are a few sleep tips to try:

  1. Maintain a consistent bedtime.  It is important for your body to always get up and go to bed around the same time, trying to limit fluctuations to 1 hour or less.  This includes the weekends, holidays, and summer break.  For older kids, avoid naps.  Naps make it more difficult to fall asleep at bedtime.
  2. Make sure the room is cool, dark, and quiet. Use your bed only for sleep, not for playing or punishment.
  3. Eliminate caffeine or nicotine from your diet, especially after noon. The effects of caffeine on sleep can last for 8 hours!
  4. Try to spend some time outside in the sun during the day. Spending time in a dark house confuses the brain into thinking it is nighttime.  Natural light during daytime is the best way to make sure your circadian rhythms are on track.
  5. Make up a relaxing bedtime routine. Try to always follow the same schedule so your kids know what to expect.  Some good ideas are a shower, story time, listening to calm music, or writing in a journal.
  6. Eliminate one of the biggest enemies of sleep from the bedroom: The Screen!  Looking at screens, especially screens from phones or tablets actually make your brain believe it is day and not night so your brain doesn’t release the sleep inducing hormone melatonin.  Studies have shown people who have tvs in their bedroom get less sleep on average each night.  It takes longer to fall asleep and you are less likely to stay sleep when there is a TV in your bedroom.  Remove technology from the bedroom!

Try the above tips and see if you and your children start getting better sleep.

Sleeping_angel

BE A CHAMPION! PLEASE IMMUNIZE!

Community Health Association of Spokane Valley Clinic

It is National Vaccine Awareness Month and that means… it’s time to talk about immunizations.

I will keep this short and sweet as we want to stay focused. Please come in and talk to a provider at any time if you have any questions or concerns about vaccination so we can discuss why they are safe and so important for you, your family and your community.

 

  1. Starting in September CHAS will have flu shots available for anyone who comes to any of our clinics. We will be here and ready to go to help keep you healthy thus If you have an appointment prior to the start of September you can come back in at anytime for a nurse visit to get your annual flu vaccination. If you are wondering “Do I need a flu shot” this post from a nurse who questioned her need for the vaccine while pregnant  may be just for you. http://www.voicesforvaccines.org/nurses-vaccinate-to-protect-families-and-patients/

 

  1. Please ask our medical staff at every visit if you need any vaccines. We should check every time you come in so we take every opportunity to keep you protected and healthy. If you don’t ask, who will? One question and 30 seconds of your time could save your life or the life of someone you love.

 

  1. For Teens- In 2014, nationally, 4 out of 10 teen girls and 6 out of 10 teen boys had not even started the HPV vaccine (Gardisil) series making them vulnerable to cancers caused by HPV. Your teenager also needs to shots to protect them from meningitis and a TDaP to protect them from tetanus and Pertussis (whooping cough). Please start asking about HPV and if your teen starts this vaccine series, please remind them to finish it.

 

  1. Be a Champion! This month, I encourage everyone to be a champion for vaccine Please look up just one vaccine, any one of your choice and become passionate about it for your community. Be familiar with the results of getting such an infection and how not getting immunized can impact your community. Please go to http://www.immunize.org/vaccines/ this site will give you discussion points about each illness, pictures of what the illness looks like, and tons of resources to access so you can learn everything you need to know about vaccination. Let’s work together to make our community as safe as it can be. Please look at this resource  http://www.voicesforvaccines.org/ too as it helps you see each illness through the eyes of families and individuals affected by each preventable illness.

Healthy Choices for Kids.

Do you know why there’s so much talk these days about obesity in children?

Children who are overweight when they are young have a much harder time losing weight when they are older than adults who were not overweight as kids. If you make improvements in your child’s diet and increase the amount of physical activity he gets now, you will have a much better chance of keeping him healthy as an adult.

Here are a few ideas to make changes in your family’s diet:

  •   Drink water!  (no juice, no soda)
  •   Eat at home!  (don’t eat out more than once or twice a week)
  •   Keep cut up fruits or vegetables around so your kids will snack on them instead of chips
  •   Eat together! Keep the TV off!
  •   Make sure you have 20-30 minutes to eat together (eating too fast makes it easy to over- do it)
  •   Eat 3 meals a day! (skipping leads to overeating )
  •   Keep junk food out of your house!
  •   Make salads with vegetables, not eggs, meat or cheese
  •   Toss your salad to use less dressing
  •   Treat yourselves sometimes!

Here’s some suggestions to increase physical activity in your family:

bike-helmet-child

  •   Ride a bike
  •   Go for a walk after dinner
  •   Dance
  •   Swim
  •   Play sports
  •   Walk when you talk on the phone
  •   Take a martial arts class
  •   Limit TV and video games to 1-2 hours per day

 

Good luck and enjoy the rest of your summer.

Talking with baby

Community Health Association of Spokane Valley Clinic

 

Did you know something as simple as talking to your baby can help them be more successful in school?  75% of your baby’s brain development occurs in the first 2 years of life.  You are your baby’s first teacher!  The more words they are exposed to during this time the better.  Simple things like telling your child what you are doing, “Mommy is making your bottle now,” and pointing out things you see, “Look at the big red ball,” help their language develop.  You may be tempted to turn the TV on and let your baby be exposed to language that way.  Unfortunately, studies have shown this actually makes their language development worse.  Instead, turn the tv off and talk directly to your baby throughout the day, making eye contact with them, and giving them a chance to respond.  This helps with language and communication skills that are needed throughout life.

Books and songs are another way to help develop their language skills.  Sing simple songs over and over again, and you will quickly see that they will begin to recognize the song.  Exposing them to books is a great opportunity.  You might find your 6 month old baby has no interest in sitting down and reading a book, but let them explore books.  They will probably start by sticking it in their mouth, but soon they will start looking at the pictures, and before you know it they will have their own favorite book.  Your baby may not want to sit on your lap and read the entire book.  That’s ok!  Flip through the book with them.  Point out different pictures.  Practice animal sounds.  Your baby will enjoy the time spent cuddling with you, while also building a foundation for their developing language and a love for reading.

By Ashlee Mickelson, Physician