Is Your Doctor Evidence Based?

Finding an Evidence Based Care Provider—Special ‘Know Your Options’ Series

When it comes to finding a doctor, does it ever make you feel completely stuck? How do you know if they will be right for you?

Today Stephanie and I are talking about why we recommend finding an evidence based care provider and how you can tell if the person you’re interviewing (YES, you should absolutely be interviewing your doctors!) is practicing evidence based care. Stephanie is a doula, lactation consultant and certified childbirth educator so you will definitely want to soak in all of her amazing knowledge!

ob interview questions

Grab your free download — Guide to Finding an Evidence Based Doctor!

Still have questions? Submit them and we will do our best to answer all of them on our Facebook Live this week on 9/20/17 at 1pm CST. We’ll be discussing the major warning signs that your doctor might not be practicing evidence based care and answering YOUR questions.

Have you taken our quiz?! I have been so surprised by the results so far! Where Should You Give Birth Based on Your Personality?

hospital birth

 

Take Our Fun Birth Quiz!

This quiz isn’t meant to be a black and white set in stone determining factor of where you should give birth but it is meant to get you thinking about some of your daily preferences based on your personality and how they might play into your labor experience! Take the quiz and let us know what you think of your results! We’ll follow-up with some great educational content to help you prepare for an informed and empowered birth experience!

Quiz photos by Monet Nicole Birthing Stories

Fertility Awareness Method (FAM): Natural Birth Control

This guest post was written by Austyn Smith

The book “Taking Charge of your Fertility” by Toni Weschler provides deep insights into what happens in a woman’s body during a typical menstrual cycle. Learning about these changes in detail helps women become very in tune with their body’s physical signals of fertility (or lack thereof). In part one of this series, we discussed using Toni’s Fertility Awareness Method to help in troubleshooting infertility issues naturally, and ultimately achieving pregnancy. In part 2, we will discuss using this same method as a means for birth control.

Natural Birth Control After Baby

I have successfully used the Fertility Awareness Method (FAM) for natural birth control for over four years, and have loved it. It entails charting your body temperature, your cervical mucus, and your cervical position as a means for noting your fertile and infertile times, and then planning intercourse accordingly. Although this method is not for everyone, it can be a great option for women who prefer not to use traditional birth control or have adverse reactions to it (myself). Using this method does require a bit of planning and consistency in order to be effective, so it is ideal for the organized or schedule-driven mama.

Plan on charting two full menstrual cycles before you begin using this method so that you can get a true understanding of charting, how it works, what it all means, and identifying your own body’s cues and signals of fertility. During each cycle you will be taking a daily basal body temperature (you need a special thermometer for tracking), recording cervical mucus, and cervical positioning (optional). A sample chart of a typical cycle is below.

sample fertility chart

As a reminder, there are three phases of a typical menstrual cycle: the pre-ovulatory infertile phase, the fertile phase, and the post-ovulatory infertile (luteal) phase. I recommend re-reading FAM part 1 to review the basics of the signs of fertile and infertile phases, before continuing on. I also highly recommend reading the book in detail before trying this method in order to get a clear picture of the procedures in detail. At any rate, here is an overview.

Phase One: Pre-Ovulatory Infertile Phase Rules

The first phase of a cycle begins on the first day of bleeding during your period. During this phase, there are two rules to follow.

First five days rule

You are only “safe” to have intercourse during the first 5 days of a menstrual cycle if you have had an obvious temperature shift 12-16 days prior.

Having this shift means that ovulation has indeed occurred and the bleeding you are experiencing is not ovulation spotting or implantation bleeding. Remember sperm can live for up to five days in a fertile environment, so any time after these first five days consider yourself potentially fertile, even if you are still bleeding. You may consider yourself “safe” beyond the first five days if you then keep the second rule.

Dry Day Rule

Before you ovulate, you are safe on the evening of every dry day—meaning you do not have any cervical discharge during the course of the entire day. If you have been dry and then have intercourse, the next day you must be careful since semen may mask cervical discharge. If at the end of a day after intercourse you have been dry all day, consider yourself safe once again (remember, sperm cannot survive in a dry environment).

Phase Two: Fertile Phase

Ideally, you are only having unprotected sex when you know for sure you are in your infertile phase. If you do decide to have sex during your fertile phase, you will need to use a barrier of some type (like condoms—we are huge fans of these), or explore other areas of arousal and climax without penetration. A woman’s egg once released survives only 24-48 hours. However, if the uterine environment is right, sperm can survive for several days, so there is a range on either side of ovulation day where you must consider yourself potentially fertile. To err on the side of caution, assume most women have an 8-10 day range of fertility. As a basic review, the signs of fertility include:

  • Cervical mucus changes from dry to sticky, then creamy, then eggwhite (extremely fertile), to sticky or dry, and finally menstruation.
  • Cervical positioning changes from firm, low, and closed to soft, high, open, and wet and then closed and low again.
  • Basal Body Temperature Shifts: a spike of several tenths of a degree which remains high for 3 consecutive days will indicate that ovulation has occurred. Remember you need a special thermometer for tracking.
  • Ovulatory Pain: Some women experience cramping in the lower abdomen on one side indicating ovulation is occurring.

Phase Three: Post-Ovulatory Infertile Phase

During this phase remember the Temperature Shift Rule.

Temperature Shift Rule

You are “safe” the evening of the third consecutive day your temperature is above the coverline.

Review how to chart temperatures and calculate coverline here. Essentially, the first day there has been a temperature rise by 2/10 of a degree, and has stayed elevated for 3 consecutive days, you can be sure you have ovulated. Highlight the previous 6 temperatures, and identify the highest of those. Draw your coverline on the chart that is one degree higher than the highest of those temperatures.

You are considered infertile at 6pm on the third consecutive night your basal body temperature is above the coverline. If your temperature is on or below the coverline during those 3 days, you must start over once your temperatures are back above the line. Remember, sex is still okay, only you must use a barrier method.

There are a few exceptions to these rules that will throw your body off a little bit—being sick, traveling, breastfeeding, or sleeping poorly for instance. So definitely review the book in detail before trying out this method.

Monitoring and charting fertility signs not only helps women understand their fertility in a very detailed manner, but can also serve as a diagnostic tool for infertility, as well as a means of natural birth control. It can be a great alternative for women who do not want added hormones, surgery, or the pressure of remembering to take a pill for birth control. I have found great success in using the Fertility Awareness Method both to prevent pregnancy, and to achieve pregnancy when I want to conceive. You may find a copy of Toni Weschler’s book here, and more information and community resources about using the Fertility Awareness Method at Taking Charge of your Fertility or ovagraph.com.

Lower Back Pain During Pregnancy

Lower Back Pain during Early Pregnancy & Beyond

This guest post was written by Dr. Heather Allen. Dr. Allen received her Master of Physical Therapy from the University of Texas at El Paso in 2001 and graduated with her Doctor of Physical Therapy from A.T. Still University in 2009. She is a licensed physical therapist in Texas. Dr. Allen has a varied clinical background with experience in neurological rehabilitation, cardiovascular rehabilitation, and women’s health. Dr. Allen’s current focus is teaching in academia.

It is estimated that at least 80% of the general population will experience low back pain at some point in their life. It is extremely common for a woman to experience low back pain during her pregnancy. This is due to the changes that occur to a woman’s body during pregnancy. First, our center of gravity is altered due to the weight and location of the baby, especially during the third trimester. Secondly, our body produces more Relaxin (a hormone that allows our joints and ligaments to loosen in preparation for childbirth). Thirdly, our abdominal muscles are stretched due to the growing baby and these muscles are unable to provide normal stability. Finally, our movement patterns are altered with all activities of daily living.

Treatment Options for Lower back Pain

Treatment options are limited during pregnancy since it is best to err on the side of caution. Most pain medications are contraindicated during pregnancy. The general rule of thumb regarding treatment modalities is to avoid any modality other than heat or ice near the baby. A recent study by Keskin et al. (2012) indicated that TENS was more effective than exercise and acetaminophen for pregnancy related low back. Therefore, a TENS unit may be a possible treatment option. This is one that we have used and love!

Whether you are pregnant or not, correct body mechanics are very important. If you are picking up a small light object from the floor, you should use a golfer’s lift technique (how a pro golfer picks up a golf ball from the ground). If you are picking up something heavier such as a toddler, you need to squat down and keep the object close to you. It is important to lift with your legs, not your back. If you are carrying an object, you should keep it close to your body. It is important to sit in a chair that has good lumbar support. After sitting for more than 30 minutes, you should stand up and walk around the room. Our bodies are meant to move, and if we stay in static positions for too long, it will make our low back pain worse.

babymoon retreat

Sleeping During Pregnancy

Towards the end of pregnancy, it is very difficult to find a comfortable sleeping position. After 20 weeks, a woman should no longer sleep on her back or stomach. This can be a challenge for women who normally sleep in these positions. When you are sleeping on your side, you can put pillows between your knees and a pillow behind your low back. Some people also find it comfortable to hug a pillow(s) in this position.

Exercises for lower back pain in pregnancy

There are a variety of exercises that can be helpful throughout pregnancy. Walking is a great way to exercise throughout your pregnancy. Swimming and water aerobics put minimal stress on your low back. Standing back extensions can be very helpful to maintain our lumbar extension. It is important to perform core exercises such as pelvic tilts in standing or sitting. You can perform alternating arm and leg lifts in quadruped. It can also be helpful to trade in your desk chair and recliner for a birth ball. We love this one!

Our core consists of our low back muscles, abdominal muscles, and pelvic floor muscles. As previously mentioned, our abdominal muscles are severely affected by pregnancy. Many pregnant females experience diastatsis recti (vertical separation of the abdominal muscles). The pelvic floor is an often-forgotten component of the core. One purpose of the pelvic floor is to support the internal organs above it, and thus it is crucial to strengthen this muscle group during pregnancy with Kegel exercises. Likewise, strong pelvic floor muscles can assist during delivery.

A women’s health physical therapist can be an excellent resource for treatment of low back pain during pregnancy. Likewise, physical therapists are trained to provide customized exercise programs, posture analysis, and body mechanic training. A physical therapist can also determine if a maternity support belt would be of benefit to you.

Sources: Keskin, E.A., Onur, O., Kiskin, H.L., Gumus, I.I., Kafali, H., & Turhan, N. 2012. Transcutaneous electrical nerve stimulation improves low back pain during pregnancy. Gynecologic & Obstetric Investigation, 74, 76-83.

Pelvic Floor Health and Resources for Pregnant & New Moms

This guest post was written by Alina Horrocks who holds a Doctor of Physical Therapy.

I am a mother of 3. I am also a physical therapist. My background is mostly acute (hospital) care. I’ve shifted from working full-time as a PT, to being a stay at home mom. When I became fully immersed in the “mom world” and was meeting other fairly new mothers, I was surprised at how many of these women were having pelvic floor issues (mainly incontinence).

In my experience as an OB/GYN patient, none of my providers really took any time to explain the importance strengthening the pelvic floor or the correct way to do it. In talking to several friends, that has been their experience as well. Many ended up seeing a Women’s Health specialist PT for incontinence issues postpartum, and they were very surprised at what they didn’t know about their own body and how simple the treatments are.

Women’s Health & Physical Therapy

Having had the advantage of going to PT school, I at least knew a little about my pelvic floor and the Women’s Health specialty within the world of physical therapy. It is a fairly new but growing specialty. But even in school, the amount of curriculum dedicated to Women’s Health and/or pelvic floor issues was minimal. I’ve had to really do a lot of my own research and take some extra courses to learn more.

A systematic review published in 2014 found that “PFMT (pelvic floor muscle training) during pregnancy and after delivery can prevent and treat UI (Urinary Incontinence)”. This research shows the benefit of exercising the pelvic floor, but the problem is that our current healthcare culture doesn’t promote much preventative education in this arena.

What I want all mothers and mothers-to-be to know

I think many women just accept the fact that some urine leakage after having a baby is expected. Many women do experience this, yes….BUT that doesn’t have to be the case. Urine leakage is a dysfunction of the pelvic floor and there is treatment available!

There are physical therapists that specialize in Women’s Health that can help with all kinds of things (urinary and bowel incontinence, breast cancer, lymphedema, pelvic girdle pain, pediatric pelvic health, male incontinence and pelvic health, sexual dysfunction, pregnancy and postpartum, to name a few…). However, you may have to seek them out. The American Physical Therapy Association (APTA) has a Section on Women’s Health (SOWH) where you can look up therapists who’ve been specially trained and certified – look for someone with a WCS after their name (Women’s Health Clinical Specialist). For more info, go here.

Performing a pelvic floor contraction

Think about pulling the whole area from your pubic bone to your tail bone “up and in”. Another description I’ve heard is to “stop the flow of urine”, but actually I think a more accurate description is to “stop the passing of gas”. The contraction needs to include the muscles around the vagina as well as around the anus. You should not be holding your breath or contracting the abs. If you have difficulty doing this or are unsure if you are doing this correctly, you may want to seek out a Women’s Health specialist.

high risk pregnancy

Exercise your pelvic floor

  • Quick flicks – contract your pelvic floor as hard as you can.
  • Sustained contraction – contract your pelvic floor and hold the tension starting for 5 seconds and working up to 10+ seconds.
  • Elevator – contract and lift up your pelvic floor little by little, like you’re going up floor by floor in an elevator. When you get to the top, or your maximal contraction, don’t just completely release the tension. Instead, control and let down the contraction little by little (or floor by floor) until you are completely relaxed.

You can perform these exercises sitting, standing, or lying down. Like any exercise, start small and build up. I recommend 2-3 sets of 5-15 reps of these exercises a day. Perform these consistently, maybe there is something already in your daily routine where you could incorporate your pelvic floor exercises. For example, when you brush your teeth, take a shower, cool down from a workout, nurse your baby, or watch commercials during your favorite TV show. Practice these both during pregnancy and after.

Co-Contractions

Once you are confident you are correctly contracting the pelvic floor, try doing it while pulling your belly button into the spine (contracting the transverse abdominis). Also, try contracting your pelvic floor while walking or going up and down steps.

Find a Physical Therapist

Try doing these simple exercises on your own and if more help is needed or other issues arise, a physical therapist can really help. Most states these days don’t require a prescription from a doctor to see a physical therapist so you can go directly to a specialist for an evaluation.

Our bodies go through so much during pregnancy! And we give so much to be mothers! My hope is that we can create more awareness in our communities on ways women and mothers can take care of themselves and also to let them know there are people to help.

This guest post was written by Alina Horrocks. Alina graduated from Texas Woman’s University in Houston, TX with a Doctor of Physical Therapy in 2010. She has worked primarily in the hospital setting, helping inpatients regain and improve functional mobility. She welcomed her third child last year and is now using her professional and personal experience to help other moms take care of their bodies during pregnancy and beyond.

Don’t Forget Dads After Pregnancy Loss

This guest post was written by Sasha Ruscheinski to share about her and her husband’s experience with miscarriage. The rainbow dad tee can be found here

When my son, Lincoln, was 15 months old, my husband and I decided to try for our second child. We had no idea the journey we were about to go on. Within eight months, we had lost three pregnancies. The first was a missed miscarriage at 10 weeks, the second was an ectopic at 6 weeks and the third was another missed miscarriage at 6 weeks. It was excruciating and has forever changed me. I had been very lucky in my life and had never really experienced a loss. I am married to the only person I have ever dated, so I had never even experienced a lost love before. There were many nights where I would lay in bed and just sob. It felt as though my heart was going to burst through my chest. Losing those babies really took a toll on me. Being able to talk freely about my feelings really helped during the grieving process. I had friends texting me daily to see how I was doing, I was sent flowers on the due dates of the babies we lost and was given a beautiful necklace by my closest friends. Even hugs from friends and family always lasted a little longer. The support I received was amazing and really helped me get through it. When a woman miscarries the support is usually given to her, but what about dad?rainbow dad

I know the saying goes “when a woman becomes pregnant she becomes a mother, when man holds his child he becomes a father”. Yeah, that may be the case for some, but I know that the instant we got a positive pregnancy test my husband started dreaming about our child. He started to envision our life with this new family member. I know that our losses crushed him. He never saw them coming. With the first baby we lost, I had had a feeling that something wasn’t right, but my husband always kept telling me that everything would be okay. It was at our first ultrasound, on his birthday, that we found out the baby hadn’t made it past seven weeks. I will never forget that look on my husband’s face when the tech told us. It was pure anguish, yet the first thing he did was grab me. Men carry such a heavy burden when you miscarry. They are grieving the loss of their child, but they also have a partner that needs major support.

Recognizing Rainbow Dads

Our rainbow baby, Britton, was born on November 16th, 2016. It was one of the best days of my life. Since his birth, I have been drawn to all things rainbow and when I saw the Rainbow Dad shirts from Bryn, I knew I needed to get one for my husband for Father’s Day. When I first picked up the shirt, I looked at the beautiful rainbow and the words “rainbow dad” and I had this wave of emotion just hit me so hard. Even as I write this, my heart is tightening and I can feel tears coming. I had always just seen myself as a rainbow mom and Britton as my rainbow baby. I can honestly say that during our (I initially wrote “my”) miscarriages, I didn’t really give much support to my husband. Our losses completely consumed me, so I never stopped to think that maybe they consumed him as well. I think it is very easy to forget about dad; I know I did.

rainbow dad and mom

Mama BearTee from Loved by Hannah and Eli

This rainbow dad shirt made me stop and think. It made me ask my husband about what it was like for him when we lost our babies… a question I had never asked him before. My husband would be the first one to say that his main concern was me; he wanted to make sure that I was okay. He let me cry when I needed to, let me be angry when I needed to be and just sat there in silence with me when I needed it. I wish that I had been able to do that for him, since I know he suffered in silence. I wish I had sat down with him and let him fall apart the way he let me. I wish he was given the same amount of support that I was given. I know he is at a new place in his grieving process, but I know he needed me back then.

People come to me a lot for my advice when they are going through a miscarriage. My advice is always directed at the woman and making sure to give her support. Moving forward, I am going to make sure to remind them to not forget about the dad the way that I did. Dads need to be given the chance to fall apart as well and have someone there to comfort them. So often men want to be the fixers. They want to be the strong man and support their wife. I asked my husband what he would say to another man who lost a baby and his words were simple: it is okay for you to
grieve, too.

rainbow baby pregnancy announcement

The Birth Hour also makes Rainbow Kid and Rainbow Mom shirts if you want to match as a family!