Monthly Archives: August 2016

Margaux’s Birth Story

By Hannah Edens

All photos by Merritt Chesson Photography

“We’re not having a baby tonight, are we?” asked Chas, my husband, on the eve of our second daughter’s due date. Our family was exhausted from a cold and very busy weekend, and we were planning on getting at least a few more nights of good rest. “Are you kidding? I’ve had a throbbing pain above my pubic bone all day and can hardly walk but not a single contraction. We are not having a baby tonight. Go to sleep,” I replied.  Not 10 minutes later as I lay in bed, I heard and felt a pop. Three seconds later, a rush of warmth prompted me to jump out of bed and into the bathroom. There was no denying my water had just broken. I waddled to the living room to tell Chas the surprising news. We indeed would have this baby in the next 24 hours after all.


The midwife on call, Jessica, reassured me that most women begin labor soon after their water breaks, but I’d need to plan to come in to the Birth Center in the morning either way. Two and a half years earlier, I had been “in labor” 78 hours from the time I felt my first contraction to pushing out my first daughter at the WBWC.  I was a bit nervous things wouldn’t progress quickly enough since my body certainly took it’s time with #1, so I knew more than anything I needed to try to sleep while I still had time.


Four or so hours later, the familiar but quickly forgotten tightness of a contraction began. They were 15 – 30 min apart for a few hours and I was able to sleep in between.  My appetite actually prompted me out of bed around 3:30 AM, and I received some needed encouragement via text from my best friend, who happened to be awake and was my doula with the birth of my first. Then back to bed for another hour or two of spaced but increasingly stronger contractions. 



By 6:00 AM I could no longer lay still or sleep between the impressively strong pains, so I jumped in the shower. Again, I expected a full day of this and wanted to feel prepared and try to relax my body. Jessica was still on call to receive my 7:00am update that my contractions were 7 – 12 minutes apart. She told me I was welcome to come in whenever I wanted, but it was okay to wait until they were more like 4 – 6 minutes apart.

I gave my friend and country neighbor Jane a ring.  She’s also a nurse at the WBWC, who offered to be present as a doula if she wasn’t working that day.  Her presence was a relief because by 8 AM I was struggling to stand through the discomfort and was shocked with how quickly it seemed things were progressing.  I began to tap back into the breathing techniques I learned at a Birthing from Within class I attended 3 years prior.  Although my contractions remained about 6 minutes apart, the pain seemed really productive and the noises of everyone getting ready for their day around my house felt distracting. I was ready for the relaxing, quiet atmosphere of the Peach Room.



Despite a very busy weekend of deliveries, Tuesday, May 24th was exceptionally quiet. When I arrived at 9:00 AM, I was the only mama in labor. Carey greeted me with her student midwife, Kristen, and I welcomed two for the price of one.  Chas, my sister Katelyn, photographer Merritt, Jane, and nurse Asha rounded out the crew.  Some mamas prefer smaller crowds but as with my first, I really appreciated the support and witness of caring, knowledgeable folks around me.


The car ride over had sped things up, and I was at that point starting to moan through the pain that found me every 3 minutes. My first cervical check told us I was a “stretchy 7, zero station, fully effaced” and I was thrilled! I knew I’d have this baby before lunch, which was mind blowing and a bit intimidating.


My exceptionally long , 12 days past the due date, with a 9lb 3oz baby 2.5 years ago was epic – hard and empowering, and I couldn’t have been more proud of myself and thankful for midwife Emily’s commitment to us. But everything about this labor was different and while going so well, it was a challenge even still to remain focused, allow my body to take control, and not give up in the middle of such discomfort.  I was aware of how much freedom the birth team gave me to lead the delivery, and their silent confidence was reassuring.


I had a difficult time finding a position to labor in that helped ease the minute-long waves of pain, but someone offered to draw a warm bath. I had used water therapy throughout my many aches during pregnancy and welcomed the idea. I spent a half hour or so on my hands and knees, thankful for the weight of my perfectly basketball-esq bump to be lifted by the warm water. I was probably mid-transition when my arms started to give out and I switched to lying on my side. I was in full blown groaning pain and encouraged to push whenever I felt the urge. Eeek! I didn’t really feel the urge with my first; it was a conscious all out decision to be done and get her out. With that first experience, I felt incredible relief with , and it truly did not hurt very much.


But this faster, more furious transition period and soon-to-follow pushing HURT more! It was so interesting to hear my voice responding to the pain, and I think I shared with the team during a longer pause between contractions that I thought I sounded like a Viking. Ha!! Soon enough the urge came and through 3 or 4 contractions I propelled baby girl #2 out of me – all of her at once. I could feel the incredible force, which was confirmed by the onlookers and catcher. She let out a quick cry, was placed on my chest, held her next breath about 3 seconds longer than anyone cared for and started to turn blue. I, too, held my breath but a good strong back rub by the attentive midwives and she began to wail, clear and strong. My mama heart rejoiced!


All of the anxiety and pain was instantly gone when I could see her perfect little face and hear her sweet voice. The midwives were meanwhile concerned with what appeared to be a large amount of blood filling the tub and quickly got me to the bed to investigate. Thankfully the bleeding had already mostly stopped and I was in the clear. 



WOW. Just wow. 11:30 AM Margaux Frances Edens joined the outside, on her due date, and we couldn’t get over how “small” she was at 7lb 13oz. I kept telling myself, “It felt like the most polite birth,” because of how quickly she arrived and without complications. Our sweet baby has continued so effortlessly to do what we all hope they’ll do – grow, eat, sleep and poop.



We packed up our things and made it home for dinner at 7:00pm. All in a day’s work.


By |August 20th, 2016|Birth Stories|0 Comments

Birth Announcements

Welcome, Sweet Babies!




*Sebastian Fox Harmon – May 10 – 8 lbs., 3 oz.
Gerrit Octavius D’Tela – July 1 – 8 lbs.
*Emma Luna Alvarez Martini – July 5 – 7 lbs., 5 oz.
Charlotte Marie Boshart – July 6 – 7 lbs., 1 oz.
Henry Parnell Hansen – July 6 – 6 lbs., 2 oz.
Adeline Larson Romm – July 7 – 8 lbs., 10.5 oz.
*Stephen Benjamin Bridgers – July 8 – 8 lbs., 5 oz.
Iris Eden Wells – July 8 – 8 lbs.
Acelia Sherie Faith Murray – July 11 – 10 lbs., 7 oz.
*Tucker Whilden Nettles, III – July 11 – 9 lbs.
Charlotte Olivia Stanton – July 12 – 8 lbs., 11 oz.
Emory Renee Leary – July 13 – 8 lbs., 6 oz.
Liam Penland – July 13 – 7 lbs., 4 oz.
Baby Boy Arias – July 13 – 8 lbs., 5.5 oz.
Anderson James McKee – July 16 – 7 lbs., 15.5 oz.
Rowan Hygh Griffin – July 16 – 8 lbs., 11 oz.
Sullivan Louise Thac Huan – July 20 – 7 lbs., 1 oz.
Harper Suzanne Hetherington – July 20 – 7 lbs., 5.5 oz.
Charles Nolan Cartabiano – July 21 – 7 lbs., 5.5 oz.
Claire Jeannine Willett – July 22 – 10 lbs., 1.5 oz.
*Lydia Marie Jensen – July 24 – 8 lbs., 14.7 oz.
Cebastian Saga Benton – July 25 – 9 lbs., 13 oz.
Lyle Sullivan Fine – July 25 – 5 lbs., 13.5 oz.
Justus William Trapp – July 26 – 8 lbs., 11 oz.
Rio Lincoln Shen – July 26 – 7 lbs., 1 oz.
Samuel Stuart Swanson – July 27 – 7 lbs., 3 oz.
*Dalton Roy Tippett – July 27 – 8 lbs., 10.5 oz.

Grainger Conrad Fritsch – July 31 – 8 lbs., 1.5 oz.

July Stats:
44 Babies Born
Biggest July Baby: 10 lbs., 15 oz.

Smallest July Baby: 5 lbs., 13.5 oz.



*pictured above


 To be included in this celebratory list, please email Missy at missy@ncbirthcenter.org 
with your baby’s birth announcement information that includes 
their name, date of birth, and birth weight as well as a photo, if available.
If you would like to send us your birth story along with photos,
we are happy to include that in a future newsletter!



By |August 18th, 2016|Birth Announcements|0 Comments

What is Diastasis Rectus Abdominis?

By Lindsay Mumma, DC


As a chiropractor, I see many pregnant and postpartum women in my office.  The topic of diastasis rectus abdominis (DRA) comes up fairly regularly, as many of the women I treat present with this condition.  I also serve as a Regional Director for the organization BIRTHFIT, and we’re working to educate women about their bodies during the preconception, prenatal, and postpartum period, so I end up talking DRA quite frequently.

I first heard about DRA from a Dynamic Neuromuscular Stabilization course in 2009. It actually had nothing to do with pregnancy, but was demonstrated via videos regarding poor loading techniques in those with Cerebral Palsy or simply folks who could not effectively manage their own intra-abdominal pressure system.  DRA is a stretching of the connective tissue that holds the two rectus abdominis (six-pack) muscles together; it occurs from repetitively using poor loading techniques (not stabilizing your body when lifting an object), but also in rapid expansion of the abdominal tissues, as in pregnancy.  There are some thoughts on how to prevent/correct/heal DRA, but there isn’t a lot of consistency.  It can be hard to sift through the info, especially when you’re a new mom.  Since I’ve been studying DRA, I’ve learned quite a bit about it, and have seen which methods work and which have been less than ideal.  While some of this will be a little science-heavy, I’ll try to keep it relatively concise.


Image courtesy of momsintofitness.com



To keep things simple: if the diaphragm is not stacked on top of the pelvic floor in all postures, then the body is set up for some amount of dysfunction.  This occurs when posture isn’t ideal, but also when a person sucks in their stomach or holds tension in their abdomen.  This prevents ideal diaphragmatic breathing, wherein the diaphragm lowers and the abdomen expands 360 degrees, which would set the diaphragm on top of the pelvic floor easily.  This is unfortunately where most fitness programs regarding DRA are currently failing.  They’re missing the big picture when it comes to stability of the torso being established by the diaphragm.


In the ideal breathing and postural pattern, the abdomen is solid and stable without having excess tension of the musculature.  Stability is created by the diaphragm.  The diaphragm rests parallel to the pelvic floor (relatively speaking considering both are rounded structures), which gives an almost piston-like stabilization of downward motion of the diaphragm resulting in eccentric activation of the pelvic floor.  (Eccentric contraction means a muscle is lengthening under load rather than shortening, as it does in concentric contraction.  An example would be in a typical bicep curl: bringing the weight towards your body would concentrically activate the bicep; lowering the weight would eccentrically activate the bicep.)  With this type of breathing, intra-abdominal pressure (IAP) creates a stable environment and the transversus abdominis muscle (TrA) gets some eccentric contraction with every breath.  This type of breathing also helps improve pelvic floor functioning.  Most programs are encouraging participants to concentrically activate TrA, which destabilizes the IAP system and does nothing for the pelvic floor (1).


I see coaches and other healthcare professionals posting on their social media accounts and blogs about engaging the TrA by pulling them in. (Some even recommend physically pulling the rectus muscles together and doing small crunches! YIKES!) They encourage their clients or patients to bring their belly button toward their spine or hold their stomach tight or pulled in. This does, in fact, engage the TrA, but it isn’t the best way to stabilize the abdomen, and doing so won’t heal a diastasis.

Diastasis during pregnancy – this picture was taken during a 
curl-up/crunch type move (not recommended in those with DRA)


So why is that advice so bad? First, it’s based on flawed research that’s outdated. Second, it doesn’t allow for proper use of the diaphragm. Third, it actually contributes to poor loading techniques of the entire abdomen, which can lead to (or worsen) a diastasis.  DRA has very recently become a buzzword that nearly every coach, yogi, fitness professional, PT, or chiropractor who works with women is talking about. Unfortunately, most of them don’t have great information, and they’re spreading around the bad info like wildfire. 


Why doesn’t everyone agree?  In comes the outdated research.  A 1999 study by Hodges and Richardson concluded that in subjects with low back pain, they did not activate TrA as quickly as those without low back pain.  The conclusion was drawn that we therefore must train people to activate TrA in an effort to decrease low back pain (2).  But the opposite was true.  Subjects were trained to activate TrA prior to loading their spine, but they still had low back pain.  People obviously got better at activating TrA, but still couldn’t functionally stabilize, because they’d simply isolated one muscle in a broken series.  Further studies have gone on to show that multiple muscles do not engage properly in those with low back pain (3). This is because the body works as a unit, made up of many parts that need to function together.  If one or more parts isn’t working, the entire system falters (4).  Fixing the individual muscles doesn’t actually fix the system.  The same is true for healing DRA: simply activating TrA won’t fix it.


A little more science-y stuff for you nerds to salivate on: statistics show that 30-70% of all pregnant women will have some amount of diastasis; it’s practically considered a normal variant of pregnancy (5).  However, what’s NOT normal is when the diastasis stays beyond 8 weeks postpartum, which can occur in as high as 60% of cases (5). Unfortunately, many health professionals completely disagree about what to do with this separation.  Surgical intervention is risky, and doesn’t boast superior outcomes to conservative treatment in the literature.  A large part of that is because there isn’t a ton of literature on the subject.  Here is the conclusion drawn from a systematic review in 2014 in the Journal of Physiotherapy: “Based on the available evidence and quality of this evidence, non-specific exercise may or may not help to prevent or reduce DRAM during the ante- and postnatal periods” (6). It doesn’t sound too promising, does it? There’s junky information out there, and no studies seem to come to any obvious conclusions.  Non-specific exercise may help, but it may not.  And one of the most common things that practicing clinicians can agree upon is that DRA contributes to various ailments such as low back pain, urinary incontinence, or pelvic pain.  But a study from 2015 showed that there was no correlation between women with DRA and a higher incidence of lumbopelvic pain (7).


So if the evidence is inconclusive, and more research needs to be done, then where do we go from there?  Well, my vote is to go where the research is sound. 


While it isn’t specifically associated with pregnancy or postpartum, there is a decent amount of research coming out of the Prague School regarding the use of Dynamic Neuromuscular Stabilization and improving the functionality of the core, which includes conditions like DRA.  The exercises in the studies are all based on developmental kinesiology (something else that’s been studied immensely), which means they’re based on how babies learn to move.  You know what babies have?  Relaxed muscles, no low back pain, and a stable midsection (after they’re 4.5 months old, because babies are born with diastasis that they learn to heal through stabilizing their midsection through breathing and movement – learn more about that in this blog series). 


What the studies conducted by those implementing DNS have discovered is that patients without a properly functioning diaphragm have aberrant movement patterns and low back pain (8).  They’ve also discovered that the diaphragm doesn’t just function in breathing, but also plays a huge role in stabilization of the trunk (1).  And they’ve discovered that improving the stabilization and respiratory function of the diaphragm leads to improvement throughout the body (9).  Given this information, I start all of my patients with simple breathing exercises.  Getting their breath out of their chest and into their abdomen requires that they relax their belly.  This is easier for pregnant women, but much harder for postpartum women to do.  Relaxing your belly means you can’t suck it in anymore.  This means that others can see any extra weight you’re attempting to hide, which is hard for a lot of people.  But it’s the only way to fully utilize the diaphragm, which is the beginning of stabilizing the abdominal system. 


Additionally, I give women (and men, because you’d be surprised how many men are walking around with DRA and don’t know it until they come into my office) exercises similar to movements you’d see a 7.5 month old baby doing – stabilizing on their side and beginning to move toward turning.  (Check out the full functional progression by Dr. Erica Boland from BIRTHFIT WIsconsin. )


The hardest thing for people to do is to let tension go from their belly.  But that’s the fastest way to begin to stabilize the midsection, which is unstable in the event of DRA.  It allows you to naturally stack your diaphragm on top of your pelvic floor, which gives you a stable base as well as naturally better posture.  This is also a great starting point for improving pelvic floor awareness and function. Given that the pelvic floor is the base of the core, it’s pretty important to get the entire system working well together rather than just isolating a few muscles. 






Citations


(1) Kolar P, Sulc J, Kyncl M, Sanda J, Neuwirth J, Bokarius AV, Kriz J, Kobesova A.
Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment, J Appl Physiol. , 2012;42(4):352-62
(2) PW Hodges and CA Richardson. “Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds.” Archives of physical medicine and rehabilitation 80 (1999): 1005-1012. http://www.ncbi.nlm.nih.gov/pubmed/10489000
(3) Stuart McGill, “Laying the Foundation – Why we need a different approach,” Ultimate Back Fitness and Performance, ed. Stuart McGill, 9-27. Canada: Wabuno Publishers, Backfitpro Inc, 2004.
(4) Dionne, C. “How Are We Still Getting It Wrong: Abdominal Hollowing vs. Bracing”. Breaking Muscle. Accessed 4/27/15. http://breakingmuscle.com/mobility-recovery/how-are-we-still-getting-it-wrong-abdominal-hollowing-vs-bracing
(5) Kimmich N1, Haslinger C, Kreft M, Zimmermann R.[Diastasis Recti Abdominis and Pregnancy]. Praxis (Bern 1994). 2015 Jul 22;104(15):803-6. doi: 10.1024/1661-8157/a002075. [Article in German]
(6) Benjamin DR, van de Water AT, Peiris CL.Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014 Mar;100(1):1-8. doi: 10.1016/j.physio.2013.08.005. Epub 2013 Oct 5.
(7) Fernandes da Mota PG, Pascoal AG, Carita AI, Bø K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther. 2015 Feb;20(1):200-5. doi: 10.1016/j.math.2014.09.002. Epub 2014 Sep 19.
(8) Kolar P, Sulc J, Kyncl M, Sanda J, Cakrt O, Andel R, Kumagai K, Kobesova A.
Postural Function of the Diaphragm in Persons With and Without Chronic Low Back Pain. , J Orthop Sports Phys Ther, 2012;42:352-362, Full text displayed with permission of the Journal of Orthopaedic and Sports Physical Therapy, and the Sports Physical Therapy Section and the Orthopaedic Section of the American Physical Therapy Association.
(9) Kobesova A, Dzvonik J, Kolar P, Sardina A, Andel R.
Effects of shoulder girdle dynamic stabilization exercise on hand muscle strength. , Isokinetics and exercise Science. , 2015;23:21-32, 0959-3020



By |August 18th, 2016|News|7 Comments

Avocado, Pomegranate, and Jicama Salad

Ingredients

Salad
1 (10 oz) bag baby spinach leaves
1 medium Hass avocado, peeled and sliced
1/2 cup pomegranate seeds
1/2 cup finely shaved jicama
1/2 cup walnut pieces

Creamy Avocado Dressing
2 large Hass avocados
1/4 cup freshly squeezed lemon juice
1 cup sour cream
1/2 cup extra virgin olive oil
1/2 tsp Worcestershire sauce
1/3 cup minced onion
2 cloves garlic, miced
1 tsp salt
Dash black pepper

Directions
Place all dressing ingredients in food processor and blend until smooth
Divide spinach into two bowls
Arrange avocado, pomegranate, jicama, and walnuts on top of spinach
Drizzle with Creamy Avocado Dressing

Source: Ovia Pregnancy

By |August 18th, 2016|Recipes|0 Comments

Spotlight: Lydia Dominic, CNM


     If you’ve been with WBWC for a while, you might recognize our newest CNM, Lydia Dominic. She was a labor and delivery nurse here from 2009-2012, and now she is returning in her new role as midwife!
  
     Lydia earned her BSN from Case Western Reserve University and began her 14-year nursing career in 2002.  She dedicated most of her nursing career to maternal-child health.  Upon graduating from nursing school, she served as a Peace Corps volunteer in Nepal, providing health education on multiple topics, including neonatal resuscitation.  She then returned to Ohio and began working on a medical/surgical unit.  She spent the next several years gaining experience in caring for women and babies in a hospital setting, first as a postpartum nurse, and then then as a postpartum nurse, and then as a labor and delivery nurse.
    
    In 2009, Lydia and her husband moved to North Carolina. Lydia’s desire to witness birth as she felt it should be – guided by the woman’s desires and intervening only when necessary – led her to join the staff at WBWC as a labor nurse. While working at both WBWC and Wake Med, she found herself drawn to WBWC’s model of care.  In fact, she gave birth to her own son in the peach room!
   
     In 2012, Lydia and family returned to Ohio, and a year later, she began midwifery school at Case Western. She completed her MSN in 2016. Her graduate school experience included a mission trip to Guatemala, and clinical rotations in a hospital-based birth center, and a homebirth practice.

     Lydia is ecstatic to return to WBWC to continue to care for and empower women and their families. Her midwifery career has been off to a great start so far – she caught five babies on her first call shift!

In her free time, Lydia enjoys hiking, cycling, and being with her friends, husband, and son.

By |August 18th, 2016|Staff Spotlights|0 Comments