Prior to beginning any treatment for infection you should always be evaluated by your midwife to be sure that you do have a breast infection and not something more serious.
Suggestions for prevention or treatment of a mild case of yeast
1. air dry your nipples after each feeding
2. avoid plastic lined breast pads that trap milk and irritate skin
3. change nursing pads after each feeding
4. wear cotton bras and wash them daily in very hot water
5. thoroughly wash pump parts that come in contact wit your breasts and boil them in water for 5 minutes daily
If the above suggestions have not prevented or provided relief, try the following:
*Grapefruit Seed Extract, take as directed. This comes in a liquid tincture found at nutrition stores or pharmacies: Whole Foods, Pharmaca and Vitamin Cottage. Adding suggested amount of drops to juice will make it taste better!
*Acidopholus or Pro-Biotics, take as directed, available in nutrition stores and pharmacies
*Gentian Violet Daily-swab nipples and babies mouth (different swabs), once at bedtime for four days only.
*One dose of 200 mg Diflucan followed by 150 mgs by mouth for ten days. If no relief in 48 hours it is probably not fungal and is most likely bacterial. Diflucan is prescription only.
*All Purpose Nipple Ointment (30g) (APNO). Apply after each feeding. Rinse nipples before & after feedings with a warm washcloth. APNO is available at Walgreen’s Pharmacy at Boulder Community Hospital, Pharmaca on Pearl Street and Pharmaca at Table Mesa. This ointment is prescription only.
Here are some suggestions that may help turn your baby to head down!
Most babies are head down or “vertex” at 30 weeks gestation, but not always. At Boulder Nurse Midwives we begin checking the position of your baby at 30 weeks gestation and every visit thereafter. We use a technique called Leopold’s maneuver which means that the midwife will feel your baby’s position with her hands. Baby’s can be breech for a variety of reasons. The baby may not be ready to turn head down yet! This may be very normal and usually babies will turn head down by 35 weeks all on their own. Breech babies can also be in this malposition because of the woman’s uterine shape or there may be a septum or fibroid in the uterus that prevents the baby from rotating. Usually, if the reason is septum or fibroid related, we know this already by ultrasound diagnosis, but not always. Sometimes breech position is related to a short umbilical cord or how the baby is entangled in the cord. If we suspect that your baby is breech at 32-33 weeks we will suggest that you try the following to help your baby rotate:
- Frozen fruit or vegetables applied to the baby’s head. This does not hurt your baby but they sometimes move away from the cold.
- Acupuncture (Moxy)
- Chiropractic (Webster Technique)
- Deep water swimming doing flips or hand stands in the swimming pool. (The theory is that the bottom can come out of the pelvis and this helps the heavier head be able to rotate downward).
- Pelvic tilts (Laying on your back and lifting your hips above your shoulders)
- spinningbabies.com
- Please ask your Nurse-Midwife for referrals to acupuncturists and chiropracters who have experience working with pregnant women.
If your baby has not turned by 36 weeks gestation you will be offered to schedule a ECV (external cephalic version)
This procedure is done at Boulder Community Hospital at approximately 37-38 weeks gestation. The ECV involves an attempt to externally turn the baby under the direction of an OB/GYN MD & Nurse Midwife. We have women be NPO (nothing to eat or drink except sips of water) 8 hours prior to the procedure. Upon admission to the hospital we will confirm position via ultrasound and make sure there is adequate amniotic fluid. The nurse will monitor your baby’s heart beat with a non-stress test and start an IV with a blood draw for a current CBC, platelets and T&S. If there is an emergency, the anesthesiologist needs to see the platelet number in order to safely administer spinal anesthesia for an emergency Cesarian section birth. We give women a medication called Terbutaline to help relax the uterus for the procedure. This medication makes your heart feel racy like you would feel if you had drunk a couple of cups of coffee. It can also cause some women to have a little headache. We watch the baby’s heart rate carefully with ultrasound throughout the procedure and if the baby’s heart slows we stop the procedure immediately and let the baby recover and stop all attempts to turn the baby. We put oil on the belly and the CNM usually lifts the baby’s bottom out of the pelvis while the OB/GYN attempts to move the head downward. We usually try a front flip or back flip or both depending on the baby’s position. Some women want this procedure done under epidural anesthesia to help with discomfort but the procedure is very short in duration so it is usually very manageable with breathing techniques. The pressure and pain from the ECV is no worse or long in duration than a labor contraction.
The risks include placental disruption possibly leading to abruption and fetal intolerance from cord entanglement leading to a potential emergency C-section. If there are signs of fetal intolerance we stop the procedure immediately.
You will be monitored for about 2 hours following the procedure to ensure that your baby looks well oxygenated on the monitor. The statistic that we typically quote for success with this procedure is 50%.
If the procedure is unsuccessful we recommend scheduling a C-section between 39-40 weeks. We do not recommend vaginal breech birth even with providers who feel skilled in this area due to increase risk to your baby.
If your water breaks and your baby is breech this can become an emergency because the cord is more at risk of prolapsing. The head usually acts like a cork on the cervix in vertex presentation and prevents this from happening but with breech babies the bottom does not tend to settle down in the pelvis as easily. This is why we recommend C-section between 39-40 weeks and to call immediately should labor begin or if your water breaks.
Talk with your Nurse-Midwife if you have additional questions or concerns. If you feel a big rotation with your baby please call the clinic and we can check to see if the baby has turned. If your baby is now head down you should obviously stop all exercises to turn the baby from breech to vertex and begin focusing on Optimal Fetal Positioning exercises to now attempt to get the baby in a good Occiput Anterior position!
Merrilynn Artman, CNM, MS
This article will explore the benefits of doula care in conjunction with midwifery care. The combination of midwife and doula services are beneficial and offer the same philosophy of care without being redundant.
Some women will come to me and ask the question, “should I hire a doula?” Boulder Nurse Midwives believes in labor support during labor and delivery and we do what we can to be present during a majority of the labor and delivery process. We (the midwives) provide comfort measures and suggestions that help the labor process to include rest, hydration, nutrition and change of position. We have jacuzzi tubs in every room and also birthing balls. Aroma therapy is available and we also provide acupressure and massage when needed. The nurses in labor and delivery are also very supportive and some of the best “doulas”. Your midwife may, however, need to leave your room on occasion to answer a page, discharge someone from postpartum or we may have multiple people in labor. We do have a back up midwife call system in case people are needing constant labor support from the midwives. We ask that women and their families are vocal about their needs for support.
The benefit to doula care is the constant support and expertise that doula’s can provide to you at home and in the Boulder Community Hospital Birth Center. Doula’s are able to go to your home and be present with you in early labor and the midwives are unable to provide this service. The doula then advises you to come to the Birth Center in a timely way and she stays with you at the birth center providing comfort measures along side the nurse-midwife. When doulas are present the nurse midwife often takes the “back seat” in providing comfort measures but is still involved and present.
The other question that arises is “If I have a doula do I still need a midwife?” The answer is yes! The benefits of midwifery care during pregnancy are many. Our appointment times are long and we have plenty of time and availability to make sure all of your questions are answered and that everything is progressing normally with your pregnancy. We believe in non intervention unless it is necessary for the health of the mom and baby so you will often see less unnecessary interventions with a nurse midwife practice. When we need to open our “tool box” we use the least interventive methods first. (Please see our article on The Art of Labor Induction and Augmentation.)
There are also doulas who provide support postpartum. This service can also be very beneficial to women. Postpartum doulas help women with breastfeeding, nutrition, rest and monitor for signs of postpartum depression.
Some women do not have the resources to pay for doula care and if this is an issue for women, we offer referrals to doulas who have a sliding scale or that want to volunteer their time to support laboring women. There are studies that show that constant labor support is beneficial and leads to lower Cesarian section rates and less interventions.
It is important that you feel comfortable in your environment and with your labor support group in order for your body to labor well and effectively. We recommend that you interview doula groups similar to the way you interview your midwife or doctor providing you care so that you feel that the group is a “good fit”. Our resource page is growing and offers contact information for various doula groups at http://boulderbirth.com/resources.html