Evidence on Vitamin K

Do I give my baby Vitamin K? This is a question parents are faced with answering before the birth of their baby. Let’s walk through it together.

What do we know about Vitamin K Deficiency?

We know that Vitamin K deficiency is a relatively rare, but very serious condition. Vitamin K is the nutrient that causes the blood to clot, without it internal bleeding can occur. Often by the time the bleeding is detected it is too late to repair the damage. Giving baby Vitamin K after birth is standard procedure. However, its important to weigh all options and make a decision that best suits your family.

Vitamin K Administration Options

Avoid all Vitamin K

Benefits: Parents wishes are observed.

Risks: The baby may become deficient and develop internal bleeding. If not caught in time the condition can cause fetal demise.

Vitamin K injection

Benefits: The most effective way to prevent vitamin K deficiency. Quick one time inject that occurs at birth. Most insurance covers this injection.

Risks: Pain at injection site. Swelling or bruising. Small chance of infection due to injection.

Oral Vitamin K

Benefits: Allows for spaced out dosages of once a week for 6 months or more. Also avoids injection pain or risks of swelling, bruising, and infection.

Risks: Not as effective in prevention of deficiency at the injection. Must be given over many months, and is usually paid for out-of-pocket. Currently, there are no FDA approved supplements.

Potential Challenges

• Accessibility:

  1. Not every birth setting offers each option.

• Affordability:

  1. Insurance does not cover oral vitamin K, often it's paid for by the family.

• Awareness:

  1. Many families are not informed of all their choices.

Questions to Consider

1. Do I understand the pros and cons of each choice?

2. Do I know which benefits and risks matter the most to me?

3. Do I have all the support I need to make this decision?

4. Do I feel unsure about my choice?

Pain Medications in Labor

We research our blood pressure medications, our supplements, and our food. Why, then, do we go into labor and birth without an understanding of our pain medication options? Furthermore, what are the effects of the medications on labor, birth, breastfeeding, baby, and recovery?

Medication options:

Epidural

Epidurals are a very common medication for labor pain. Epidurals are named after the epidural space that is parallel to the spine where the medication is administered. A catheter is placed in the back so medication can be given as frequently as needed. Epidurals block pain signals below the waist, yet many people still feel pressure sensations.

Risks: There is a fair bit of variability in the quality of the epidural. Not every person will feel it evenly on the left and right sides. In addition, in a small group of women (1 out of 100), some will not feel the effects at all. Epidurals can limit the mother’s freedom of movement, they also require IV fluids and a urinary catheter. There is a risk of various side effects including, low blood pressure (12 out of 100), itching, headache, difficulty urinating (15 out of 100), nausea and vomiting, fever (12 out of 100), back pain. More rarely side effects of severe headaches (1 out of 100), breathing problems, infection, seizure, and nerve damage may occur. Labor with an epidural typically lasts longer than unmediated. There is an increased risk of assisted delivery (14 out of 100), episiotomy, and c-section associated with epidurals.

Nitrous Oxide

Nitrous oxide, sometimes referred to as laughing gas, is an inhalant administered through a mask. The goal is to inhale the gas 30-45 seconds before a contraction starts. Many describe the effect of the gas as allowing you to ignore the pain, rather than unable to feel it. This is less invasive than IV medications and epidurals, it takes less than a minute to work, and is often quickly made available.

Risks: Side effects include, drowsiness, nausea, dizziness, and vomiting. May not have the freedom to move about during use.

Opioids

Opioids are pain medications administered via IV into the bloodstream. This generally allows for the laboring parent to move about freely.

Risks: Opioids can cause nausea, vomiting, decreased respiration, itching, constipation, urinary retention, and may make the mother drowsy. Some of this medication will cross the placental barrier and cause side effects on the baby including, changes in the baby’s heart rate, drowsiness. These side effects on the baby can impact the baby’s ability to breastfeed after birth.

Types of Opioids:

• Fentanyl

• Demerol

• Nubian (nalbuphine)

• Morphine

• Stadol (butorphanol)

Natural pain relief:

The following are natural ways to promote relaxation and therefore pain relief. These can be used with little to no side effects or risks to the mother or baby.

• Doulas or continuous labor support

• Relaxation

• Herbs

• Aromatherapy

• Hydrotherapy

• Positioning

• Food/drink

• Intimacy

• Massage/ comforting touch

• Verbal reassurance

Cascade of interventions

Each intervention that disturbs the normal physiology of labor and birth increases the risk of adverse outcomes for both mother and baby. This includes common interventions like continuous electronic fetal monitoring, IV fluids, restriction of movement, restriction of food or water intake, limitation of labor positions, induction or augmentation, episiotomy, instrumental delivery, and c-section. A common example used is a laboring woman who is not given anything but ice chips to consume begins to have labor slow down. To combat this she is given a medication called Pitocin to augment (increase) her labor contractions. Often Pitocin can make labor more painful and harder to adjust to. Understandably that woman will likely request an epidural. The combination of the Pitocin and the epidural may lead to a dropping heart rate in the fetus during contractions. For the safety of both mom and baby, a c-section is usually done. This is how the small intervention of restricting food can end up in a c-section. The moral of the story is to avoid medical interventions unless they are medically necessary.

Resources & References

Informedhealth.org. (2018). Pregnancy and birth: Epidurals and painkillers for labor pain relief: https://www.ncbi.nlm.nih.gov/books/NBK279567/

Lothian, J. (2014). Healthy birth practice #4: Avoid medical interventions unless they are medically necessary: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235054/

Protect Oregon Families & Support Oregon Midwives

Do you want to help increase access to midwifery care in Oregon?
Please write a letter in support of House Bill 2388 and submit it through the Oregon Legislative Information System (OLIS) testimony portal by 3 PM on Wednesday, February 24th at: https://olis.oregonlegislature.gov/liz/2021R1/Testimony/HHC

How to write your letter:

Address your letter correctly
“Dear Chair Prusak and Members of the House Health Committee,”
Letters should be sent to the House Health Committee members by submitting through the online portal: https://olis.oregonlegislature.gov/liz/2021R1/Testimony/HHC

Keep it simple and no more than one page
Don’t introduce complex issues such as the HERC (OHP) coverage guidelines on out-of-hospital or VBAC that are beyond the scope of this bill.

Introduce yourself and what you want in the first sentence or two
For example:
I am a mother of two in Albany and had both my babies at home with midwives. I am writing to ask you to vote yes on HB 2388 to improve access to midwifery care.
-OR-
I am a midwife and small business owner in Bend and have been in practice for 9 years. Please vote yes on HB 2388 so that the mothers I work with can have insurance coverage for the safe and cost-effective care I provide.

Focus on 2 or 3 of the following key points and share your personal story

• Midwives provide excellent and safe care

  • Share your personal story of midwifery care

• Midwifery care provides large cost savings to insurers and health systems but many families still can’t access midwifery care because about half of Oregon insurers (both private and OHP) provide limited or no coverage for birth center or home birth midwifery care

  • Share your personal story of insurance barriers to midwifery care and the cost of midwifery care.

• HB 2388 would increase access to midwifery care for Oregon families whether they choose to give birth in hospital, birth center, or home with Licensed Direct-Entry Midwives, Certified Nurse Midwives, or Naturopathic Physicians.

  • Share your personal story of what improved access to midwifery care would mean to you or your community.
    

In closing, repeat your request and express gratitude
For example:
Please vote yes on HB 2388 so that all Oregon families have access to midwifery care. Thank you for the work you do to support the health of mothers and babies.

Include your full name and address with zip code
Include your credentials if you have them (LDM, CNM, ND etc)

Taken from email authored and sent by Silke Anderson President of the Oregon Midwifery Council

Preparing for the Newborn

Here are some ideas for parents to do during pregnancy to be ready to parent and care for their newborn.

Recommended Newborn Supplies:

1. Burp cloths

2. Diapers & wipes

3. Breast pump/bottles (if choosing to bottle feed)

   1. Check for local classes on newborn care and infant feeding.

4. Bassinet/co-sleeper bed/Moses basket

5. Baby clothing- sleepers, onesies, hats, mittens

6. Car seat

7. Muslin swaddle blankets

8. Nose Frida/suction bulb

9. Olive/coconut oil- for diaper changes and skincare

10. Thermometer

11. Tylenol/Ibuprofen

12. Baby Carrier- learn about babywearing options

Decisions to Consider: 

1. How would you like to diaper?- cloth, disposable, or mix of both.

   1. Consider diaper laundry services in your area. 

2. What are your infant feeding preferences?- Breast/Chest feeding, formula, or mix of both.

3. Where the baby will sleep initially?- With you, by themselves, mix of both.

   1. Consider co-sleeping safety.

4. Who will be your baby’s pediatric provider?- find a care provider in the prenatal period.

5. Consider childcare/daycare in the prenatal period if planning to return to work.

Optional but Recommended: 

• Infant CPR/BLS class

• Meal planning/meal train

• Postpartum doula care

Resources:

• Books

  • La Leche League- Womanly Art of Breastfeeding

  • La Leche League- Sweet Sleep

  • Dr. William Sears- The Baby Book (book)

• Websites

  • La Leche League- https://lalecheleagueoregon.webs.com/ 

  • Hand Expression of Milk- https://med.stanford.edu/newborns/professional-education/breastfeeding/hand-expressing-milk.html

  • General Newborn Care- https://kidshealth.org/en/parents/guide-parents.html 

• Videos

  • Paced Bottle Feeding- https://youtu.be/UH4T70OSzGs 

  • How Breastfeeding Works- https://youtu.be/v8ug9_0kjyo

  •  5 S’s (calming a newborn)- https://youtu.be/crdQy8zliZw 

  • Newborn Behavior- https://youtu.be/a4WGVOzTR4A 

• Local Resources: 

  • Local WIC- https://www.oregon.gov/oha/ph/healthypeoplefamilies/wic/Pages/index.aspx 

  • Postpartum Doulas- http://www.midvalleydoulas.net/ 

  • Baby Babywearing- https://www.facebook.com/groups/the.babywearing.network/ 

References 

Jordan, R., Farley, C., & Grace, K. (2019). Prenatal and Postnatal Care: A Woman-Centered Approach (2nd ed). Wiley Blackwell. 

Whalley, J., Simkin, P., Keppler, A., & Durham, J., (2011). The Simple Guide to Having a Baby. Meadowbrook Press. 

Warning Signs in Pregnancy

Call your midwife immediately if you are experiencing any of the following symptoms;

• A headache that doesn’t go away, or gets worse.

  • Starts suddenly and causes severe pain. 

  • Doesn’t go away with water or medication.

• Episodes of dizziness or fainting.

• Fluid or blood leaking before the baby is born. 

  • Or filling more than one pad an hour after the baby is born. 

• Thoughts of hurting yourself or baby. 

  • Feelings of hopelessness, extreme worry, overwhelming thoughts, or feeling out of touch with reality. 

• Vision changes.

  • Bright spots, flashes, blind spots, or blurriness. 

• Fever or temperature of 100.4°F (38°C) or higher.

• Trouble breathing or shortness of breath. 

  • Chest or throat may feel tight. 

  • Trouble catching your breath. 

• Chest pain or a fast heartbeat. 

  • Tightness or pressure in the chest. 

• Severe belly pain that doesn’t go away. 

  • Sharp, stabbing, or cramp-like sensation. 

• Severe nausea and vomiting (not morning sickness). 

  • Unable to eat for 24 hours or drink for 8 hours.

• Slowing or stopping the baby's movements.

• Any swelling, redness, or pain in extremities.

• Swelling of face or hands.

• Overwhelming fatigue or exhaustion. 

  • Unable to complete daily tasks. 

• Or any time you are worried or concerned about you or your baby’s wellbeing. 

References

ACOG. (2020). Urgent maternal warning signs. Retrieved from: https://safehealthcareforeverywoman.org/council/patient-safety-tools/urgent-maternal-signs/#link_acc-43-45-d 

Delaney, S. (2020, Mar 12). Warning signs in pregnancy. [webinar] Midwives College of Utah. Retrieved from: https://prezi.com/v/1n_pscl5efvc/mdwf-2010-warning-signs-in-pregnancy/

2021 Bill for Equitable Access to Birth Options & Midwifery Care

If you are a midwife, had a midwife, looking to have a midwife, or simply wish to support others in their birth choices then now’s your chance! Coming up in February House Bill 2388 will be up for debate. The point of this bill is to increase access to community birth attended by midwives and naturopathic doctors. It does this by ensuring access to insurance coverage for midwifery care and birth center fees.

This bill has a whole coalition of members in support, but we need you! Really. Seriously. This little piece of paper has the potential to make a world of difference for many families.

Imagine being forced to give birth in an unfamiliar place, with unfamiliar people. The loneliness and fear you might feel, perhaps you leave with a bundle of joy and at the same time walk out with a whole lot of trauma to sort through. Now imagine putting the power back into that person’s hands. That’s what this bill is about.

How can you help?

• Share, promote, scream at the hilltops! Let’s get people’s attention here folks.

• Join us on February 22 & 23 for a virtual lobby day.

• Write, call, or contact your representatives in support of this bill.

• Reach out to Silke Akerson CPM for more ways to support silke@oregonmidwiferycouncil.org

Please use the following link to sign up. Once you are signed up we will be in touch as we formalize meeting times with legislators:

https://docs.google.com/forms/d/e/1FAIpQLScRnnYqVI2nbzwM5QxgHmgTJ6kPenKoIeYysAngliXh0fDcwg/viewform?usp=sf_link

The bill is House Bill 2388, and you can read more about it here:

https://docs.google.com/document/d/1JC9pwSdDR4biXm02Xw27BwYqHkpm6oHCvorroGFdUj4/edit

and here:

https://olis.oregonlegislature.gov/liz/2021R1/Downloads/MeasureDocument/HB2388/Introduced

Emergency Birth Kit

The following is a list inspired by a fellow midwife who hands these kits out to underserved families.

Birth Kit

• Large Backpack

• 2 pairs of large women’s underwear

• 5 washable menstrual pads

• Peri bottle

• Rain poncho

• Emergency blanket

• Meal bar

• Electrolyte drink

• Bottle of water

• Bottle or prenatal vitamins

• Toothbrush

• Toothpaste

• Bar of Soap

• Bed Pad

• 2 Pairs kitchen gloves

• Gallon Ziploc bag(for placenta)

• 2-4 Hand towels

• Washcloth

• 4 safety pins for diapering

• Baby sling or carrier

• 6 Washable diapers

• 1 disposable diaper

• 2 t-shirts or onesies

• 2 flannel receiving blankets

• 2 baby nighties

• Bunting bag

• Baby hat

• 2 pairs of small socks

Family Cloth Kit

• Ziploc bag for holding kit

• Bar of laundry soap

• Peri bottle

• Hand towel

• 12 clothespins

• 12 feet paracord

• Bar of handsoap

• 15 5x5 flannel family cloths per person

Hygiene in Pregnancy

Dental Hygiene: Research has demonstrated that there is an evident relationship between oral health and hygiene and infant health. The following are some guidelines for good dental hygiene: 

• Brush your teeth with fluoride toothpaste twice a day for two minutes. 

• Floss your teeth once a day.

• Maintain regular dental cleaning every six months and attend to dental problems as they arise. 

Vaginal Hygiene: The vagina is equipped to be self-cleaning, with the use of natural discharge. This discharge can look different depending on where you’re at in your cycle and changes often in pregnancy. Healthy discharge doesn’t have a strong smell or color and shouldn’t cause itchiness or soreness. When the vagina is healthy it's full of good protective bacteria. This good bacteria helps keep out any bad bacteria that might cause issues like infections or inflammation. It also helps the vagina’s pH balance, which is naturally acidic, even. 

• Washing Your Vagina: 

  • Soaps, perfumes, antiseptics, oils, gels, and douching products are never a good idea for washing the vaginal area. These products can kill the good bacteria and through your pH balance off. 

  • When washing your vagina simply use clean running water once a day. Some people find washing more often during their period is needed. 

• Perineal Hygiene During Sexual Intercourse:

• Using a condom during sex can prevent STIs like chlamydia, gonorrhea, genital herpes, genital warts, syphilis, and HIV. 

• Some lubes can affect the bacteria and pH balance of the vagina. 

• Clothing and Vaginal Health: 

  • Try to avoid underwear fabrics like lace, nylon, and spandex. Cotton underwear is the best option for vaginal health as it allows airflow and it absorbs excess moisture. Also, health-wise, no underwear is a valid and healthy option. 

• Toilet Habits: 

  • When wiping, go from front to back. Never back to front, as this can drag bad bacteria into the vagina. 

Tips for Infection Prevention:

• Use proper handwashing. Hand washing means using clean running water and soap to scrub your hands for 20 seconds or sing the Happy Birthing song twice. Use proper handwashing after coughing, sneezing, blowing your nose, using the restroom, handling animals, or have been in a public place. Use alcohol-based hand sanitizer when hand washing is not available. 

• Keep fingernails trimmed and clean. 

• Take regular showers and practice body and facial hygiene. 

• When coughing or sneezing direct it into your elbow and face away from people around you. 

• Considerations during COVID19 pandemic:

  • Wash your hands or use hand sanitizer frequently. 

  • Wear a mask when in proximity to other people not of your household. 

  • Stay home if you or your family is sick. 

Resources:

• The V Book, by Elizabeth Stewart (Bantam Books, 2002)

• CDC: Hygiene Etiquette & Practices- https://www.cdc.gov/healthywater/hygiene/etiquette/index.html

• CDC: Handwashing & Nail Hygiene- https://www.cdc.gov/healthywater/hygiene/hand/index.html

• NHS: Keeping Your Vagina Clean & Healthy- https://www.nhs.uk/live-well/sexual-health/keeping-your-vagina-clean-and-healthy/

• NHS: How to Keep Your Teeth Clean- https://www.nhs.uk/live-well/healthy-body/how-to-keep-your-teeth-clean/#:~:text=Brush%20your%20teeth%20with%20fluoride,brushing%20stops%20plaque%20building%20up. 

• Women's Health: Douching- https://www.womenshealth.gov/a-z-topics/douching

References

Boggess, Kim. (2008). Maternal Oral Health in Pregnancy. Obstetrics & Gynecology, 111, 976-986. https://doi.org/10.1097/AOG.0b013e31816a49d3 

Lewis, F.M.T., Bernstein, K.T., Aral, S.O. (2017 April). Vaginal microbiome and its relationship to behavior, sexual health, and sexually transmitted diseases. Obstetrics & Gynecology, 129(4): 643-654.

Prenatal & Postnatal Care 2e. "Conditions Affecting Oral Health" (pp 250-251).

Work In Pregnancy

Laws and Rights 

• When to Notify Your Employer: There are no laws on when to announce your pregnancy. Some parents wait until after the first trimester, others notify right away. Either way is completely fine. Just remember that you want your employer to hear the news from you and not around the workplace. 

•  Employee Rights: Thanks to the passing of The Pregnancy Discrimination Act of 1978, parents have protected rights in the workplace. This act prohibits discrimination on the basis of sex, pregnancy, childbirth, or medical conditions for any employment-related purposes. Fringe benefits like insurance are also protected by this act. 

• Programs to Support Workers During Pregnancy and Postpartum:

  • Family and Medical Leave Act: Allows eligible employees to take 12 unpaid work weeks off in a year for the birth of a child or care of a newborn. 

Safety Considerations

• Being on your Feet for Long Hours: Besides being tiring, long hours on your feet can reduce blood flow and cause varicose veins or other discomforts. Take frequent breaks for sitting, and consider wearing compression stockings to increase blood flow. 

• Lifting: Research shows that bending at the waist more than 20 times per day or lifting objects more than once every 5 minutes, may increase risks for some adverse birth outcomes. Take breaks whenever possible and sit down frequently. When you are lifting remember to use proper posture and avoid bending at the waist. The CDC recommends following these simply lifting in pregnancy guidelines: https://blogs.cdc.gov/niosh-science-blog/files/2013/05/ClinicalGuidelinesImg-NewLogoFinal.jpg 

• Possible Exposure: Some workplaces have exposure to certain elements that may be harmful to your pregnancy. This could include chemicals, toxins, sickness, trauma, or undue stress. I encourage conversations with your employer about reducing or eliminating exposure to these elements. 

• Stress and Emotional Considerations: Pregnancy is a time of great change and transition both physically and emotionally. These changes can impact everyone differently and it's important to listen to your body and do what you feel is best for you and your family. 

FAQ

• Can I keep working in pregnancy? Yes! Many parents continue working throughout pregnancy. However, listen to your body and do what feels right for you, your baby, and your family. 

• When should I cut back/stop working? The short answer is whenever it feels right to you. Some people work right up until birth, others prefer to take a few weeks off before their due date. 

•  How long should I plan to take off work after birth? My recommendation is also to take as much time as is reasonable for your family. Many family’s take around 6-12 weeks off work.

Resources:

1. March of Dimes: Being Pregnant at Work: https://www.marchofdimes.org/pregnancy/being-pregnant-at-work.aspx#

2. Mayo Clinic: Working During Pregnancy: https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy/art-20047441#:~:text=Most%20women%20can%20continue%20working,task%20might%20jeopardize%20your%20pregnancy.

3. Stanford Children’s Health: Work and Pregnancy: https://www.stanfordchildrens.org/en/topic/default?id=work-and-pregnancy-85-P01244

4. Family and Medical Leave Act: https://www.dol.gov/agencies/whd/fmla/faq#13 

References

Pregnant at Work: https://www.pregnantatwork.org/healthcare-professionals/

National Institute for Occupational Safety and Health (NIOSH). (2019 Nov 15). Reproductive health and the workplace. Retrieved from https://www.cdc.gov/niosh/topics/repro/physicaldemands.html

U.S. Department of Labor. (n.d.). Family and Medical Leave Act. Retrieved from https://www.dol.gov/agencies/whd/fmla 

U.S. Equal Employment Opportunity Commission. (1978). The Pregnancy Discrimination Act of 1978. Retrieved from https://www.eeoc.gov/statutes/pregnancy-discrimination-act-1978