Participants: Don Mackintosh, Patti Barnes
Series Code: HFAL
Program Code: HFAL000054
00:46 Hello and welcome to "Health for a Lifetime"
00:48 I'm your host Don Macintosh 00:50 and today we're delighted to have Patti Barnes with us 00:52 Welcome Patti! Thank you, Don 00:55 Now, you're a certified professional midwife, 00:57 and you've delivered now over what... 01:01 750 babies, you told me, 01:02 and you've been at this for how long? 01:04 About 15 years now. 01:06 You work as part of a team I understand. 01:08 We have wonderful doctor backup. 01:10 Okay, so you work with area hospital and physicians there... 01:13 And today, we're going to be talking about 01:16 having babies and different things. 01:19 What's one of the most important needs you see 01:21 when you work with people that are going to have a baby? 01:24 I see a very important need by needing prenatal care. 01:30 Okay, prenatal care and that's what we're going to 01:32 talk about today. Yes 01:34 Prenatal care... what is that? 01:36 What does that mean when you talk about prenatal care? 01:38 Prenatal care is caring for the mother and baby 01:41 in a way to help promote good physical and mental health 01:48 from conception to birth, 01:50 and that's around 38-40 weeks' gestation sometimes. 01:53 So, how often do you meet with them, 01:55 and what are you talking about with mothers 01:58 before they have their baby? 01:59 Well, we meet with them about once a month, 02:04 and then around 7 months we'll see them every 2 weeks, 02:08 and then the last month of pregnancy, 02:11 we'll see them once a week. 02:12 Do you want the dads to come in too? 02:13 Yes, we try to get the fathers involved. 02:15 And what do you say to them when they come in? 02:17 Well, they usually have a lot of questions, 02:21 and so I would think a big portion of it is 02:25 educating them as well. 02:27 You know, my wife is pregnant, and so we went in to see 02:33 the doctor and different things, and it was kind of unusual 02:38 for me to sit there in the waiting room with 02:40 40 or 50 pregnant ladies and they kind of looked at me 02:43 like I was a sore thumb that maybe I shouldn't be there. 02:46 Some of them looked ANGRY at me, actually... not angry, 02:49 you know... sort of like why did you get us into this 02:51 kind of problem or whatever... 02:55 So 38-40 weeks; so you said, what... 02:57 once every week after 7 months. 03:00 Well, the last month of pregnancy, 03:03 we encourage them to come once a week for prenatal visits... 03:07 Unless if we see a problem, we would see them more often. 03:12 Well what if someone says, "Well, this sounds interesting, 03:15 but it doesn't seem that important" 03:16 WHY is it so important? Or is it? 03:18 It's very important because during prenatal care, 03:22 you could rule out high risk situations that possibly 03:26 could be turned around, or refer high risk conditions 03:31 to obstetrical care... 03:33 And it's very important that during the prenatal period 03:39 that we could figure out what person would be in that 03:45 category of high risk, because it could 03:47 endanger the mother and the baby. 03:49 Do they run tests? Do they do different 03:51 things during that time? 03:53 Yes. For example, when a pregnant lady comes in to 03:59 see me and then we start off doing their blood work, 04:04 urinalysis, check their weight, and different kinds of things. 04:09 I think that you have a graphic about some of the things 04:12 that you do on prenatal care and we can look at that... 04:16 But what are the things that we're looking for then? 04:21 Okay, we check weight at each visit to make sure that 04:26 her weight gain is appropriate, and we check her blood pressure, 04:32 and her pulse because we need to know the baseline; 04:35 what her blood pressure normally is. 04:37 What it normally runs, how fast it is, 04:40 so that when they have the baby... If there's a problem 04:42 that we would know about it. 04:44 We check for edema, any swelling. 04:47 And, we do a Chemstrip urinalysis to check their urine 04:52 to make sure that there are no abnormalities, 04:54 or anything that would be a problem in the urine. 04:57 And, of course, we palpate the baby... 05:01 We check for kicking and fetal movement 05:05 because we want to determine how much the baby is moving... 05:07 Also, we check the uterus size and we check the uterus size by 05:14 measuring the fundal height. 05:15 The fundus is the top of the uterus. 05:19 So to see how tall it's getting, so to speak. 05:22 Right, how big the baby is growing. 05:25 For example, if she's 28 weeks in gestation, 05:28 then she should be measuring around 28 centimeters. 05:32 So "gestation" that means what? 05:34 That's 28 weeks pregnant. 05:35 ...28 weeks pregnant, then they measure, 05:37 and it should be about that... Around 27-28 centimeters. 05:42 Also, we palpate the baby; 05:44 the palpation determines the position. 05:50 "Palpation" - is this a fancy word for you feel where it is? 05:53 Yes, feeling the baby through the uterine wall. 05:55 Okay, and then you figure out what... 05:57 I notice that that is kind of an acronym... 06:00 "CHECKUP" is that right? Yes! 06:03 And that's how you remember it? Yes 06:05 So, if you're watching, you write down that word "CHECKUP" 06:08 By the way, I think you recently have written a book 06:11 about all this, haven't you? Um hm 06:12 Kind of putting those practical things down here... 06:14 I have a copy of it... 06:15 "The Ministry of Midwifery" 06:17 And you have a whole section on prenatal care in that book. Yes 06:21 It looks excellent, I saw that little "CHECKUP" as I was 06:24 looking through the material here. 06:25 Well, you mentioned one thing on that graphic 06:28 that we just looked at, check weight... 06:31 And I think you want to elaborate a little bit on that. 06:33 Why are we so worried about weight? 06:35 Well weight, I think is important for the mother to 06:42 watch her weight, but if she's on a good diet, 06:44 and has a healthy lifestyle, she doesn't need to be 06:48 concerned all that much or worried about it... 06:51 But, there is a normal weight gain, it's between 20-25 pounds. 06:58 Their weight gain is coming from the amniotic fluid or the water. 07:06 It is 1.5 to 2 pounds. 07:08 Then we have extra mass 4-9 pounds. 07:13 Increased blood and body fluid, about 4-8 pounds. 07:19 That's the blood of the mother 07:20 and the fetus together right? Um hm 07:22 And growth of the uterus around 2-3 pounds, 07:26 so this is just an average. 07:28 Her placenta 1.5-2 pounds, sometimes less. 07:31 And the baby 7-8 pounds, of course we could have a 07:34 6 pound baby or over 8 pounds. 07:37 But, the average weight gain is around 20-25 pounds. 07:41 Do some mothers get worried 07:42 that they're gaining too much weight? 07:44 Yes, most of the clients that come to me, 07:49 they know that I'm going to help them by encouraging 07:55 them on a good diet and a good lifestyle and exercise. 07:58 What about those mothers that are real nauseous 08:00 during the first part of their pregnancy, 08:02 and they're not able to eat too much? 08:04 What do you do with them? 08:05 What are some practical things you do with them? 08:07 Well, it's amazing how much 08:09 just by drinking a lot of water it helps. 08:12 I find that if they're well-hydrated, 08:16 they will have less nausea. 08:18 So drink more water if you're nauseous. 08:20 And get exercise, but there IS a natural remedy 08:27 that I find, it helps me when I travel. 08:29 You know, when I go on airplane flights... 08:32 It's ginger root. 08:33 Ginger root, that's not going to harm the baby? No 08:37 Oh no, it's medicinal. All right! 08:39 So that helps with nausea? Yes 08:42 All right, so ginger root and more water, 08:45 and drink water all day. 08:47 Well, we recommend about 6-8 glasses a day. 08:51 ...6-8 glasses which is, you know, that's what they say 08:54 for normal people too... to drink 6-8 glasses, right? 08:57 And just sipping on peppermint tea. 08:59 Hmm, peppermint tea? Um hm 09:01 That's an antiemetic, it relieves nausea. 09:06 Great, well, anything else for those prenatal moms that are 09:12 wondering what they should be worried with. 09:14 We've talked about weight. 09:17 Wait, back to this weight thing... 09:18 What's too LITTLE weight? 09:20 When do you start to get worried... 09:22 Do you ever get worried when someone doesn't gain? 09:24 Does anyone have a baby that doesn't gain, that much weight? 09:29 Well yes, it would probably be smokers... 09:35 And that's something to worry about... 09:41 Yes, I would classify them as a high risk situation, 09:48 but I wouldn't recommend fasting, 09:51 because I feel like the baby needs 3 meals a day, 09:55 and the mother. 09:58 But you can tell, you know, how well the baby is growing 10:01 by prenatal visits. 10:04 You know, like I said, measuring the uterus, the fundus, 10:10 and palpating the baby. 10:13 So, you said that a baby is there for what... 10:16 38-40 weeks for pregnancy, is that right? 10:20 Usually it's from conception to birth is 38-40 weeks, 10:25 sometimes 42 weeks. 10:26 What about the first 10 weeks, 10:29 what's happening with the baby, what's developing, 10:33 and what can the mom do or not do that's going to 10:36 help that be good or not good? 10:38 Well around 8 weeks, most of the pregnant moms 10:44 don't even realize they're pregnant, 10:46 and that is the most critical time. 10:48 Eight weeks is the most critical time. Um hm 10:49 It's when the cells are RAPIDLY dividing, 10:53 and they need to be very careful around teratogens 10:57 which would be x-rays, drugs, fumes... 11:04 All those different things... 11:05 Fumes, any kind of fumes; carbon monoxide... 11:11 Paint, no paint, but later on that's okay? 11:15 Well, I would say, if you're doing any painting, 11:20 you would want it to be well-ventilated. 11:22 Well-ventilated... so why is that so important, 11:25 what's happening around 8 or 10 weeks with the baby? 11:27 That's all dividing, but what's really... 11:30 The baby is developing very rapidly, 11:32 and you just need to concentrate on eating healthy, 11:38 and making sure that nothing goes into your body that 11:41 would be damaging. 11:42 So this idea of having cravings and different things 11:45 when you're pregnant... do you have to just rise above that? 11:47 And say I'm going to eat that even though I feel like it? 11:49 Yes, you cannot trust your cravings. 11:54 Pickles and ice cream! 11:55 Pickles and ice cream... do you hear that a lot? 11:58 Well, no not really, but most of the people 12:02 that come to me really they want me to encourage them 12:07 on a healthy diet. 12:09 So, instead of the water... excuse me, 12:12 instead of the ice cream, we should have water 12:14 or something like that? 12:15 What's so important about water? 12:16 The reason why they need to drink so much water, 12:20 and we encourage hydration is because the amniotic fluid 12:26 that's surrounding the baby is reproduced every 3 hours. 12:30 So they change the water in that little swimming pool 12:33 for the little guy or gal, every 3 hours? 12:35 Yes, at least 30% of it... 12:38 But I can tell you we're talking around 1,000 mL of fluid 12:43 that's surrounding the baby and that's the protection 12:46 for the baby, the amniotic fluid. 12:49 That's the bumper. Yes, it protects the cord 12:52 from being compressed, and the baby can move 12:56 all different positions and still be protected. 13:02 So, you don't want them swimming on ice cream and pickles! 13:05 No! You want water! Water! 13:07 We've been talking with Patti Barnes 13:09 She is a certified professional midwife; 13:12 delivered over 750 babies. 13:14 Maybe you're pregnant, or know someone who is, call them up! 13:17 Join us when we come back, and we're going to talk more 13:19 about what we need to be looking at, 13:22 and being aware of before we have a baby. 13:24 Join us! 13:27 Have you found yourself wishing 13:29 that you could shed a few pounds? 13:30 Have you been on a diet for most of your life 13:33 but not found anything that will really keep the weight off? 13:36 If you've answered "yes" to any of these questions, 13:39 then we have a solution for you that works! 13:42 Dr. Hans Diehl and Dr. Aileen Ludington 13:44 have written a marvelous booklet called... 13:46 "Reversing Obesity Naturally" 13:49 and we'd like to send it to you FREE of charge. 13:51 Here's a medically sound approach successfully used 13:54 by thousands who are able to eat more and lose weight 13:57 permanently without feeling guilty or hungry 14:00 through lifestyle medicine. 14:02 Dr. Diehl and Dr. Ludington have been featured on 3ABN 14:05 and in this booklet, they present a sensible approach 14:08 to eating, nutrition and lifestyle changes 14:11 that can help you prevent heart disease, diabetes 14:13 and EVEN cancer. 14:15 Call of write today for your free copy of... 14:17 "Reversing Obesity Naturally" 14:19 and you could be on your way to a healthier, happier YOU! 14:22 It's ABSOLUTELY free of charge, so call or write today. 14:28 Welcome back, we're talking with Patti Barnes 14:31 She is a certified professional midwife, 14:33 and we've been gaining from your information... 14:37 You delivered now over 750 babies, 14:39 and when we were talking before the break, 14:41 we were speaking about prenatal care. 14:43 It's really important to have that... 14:45 to be involved in talking with 14:48 people that have seen so many babies. 14:50 Education is very important. 14:52 Do you do a lot of education when you're in the homes? 14:54 Yes, we educate the mother and the father 14:57 for labor and delivery. 14:59 And of course, we want the fathers to ENCOURAGE 15:02 their wives in obtaining good prenatal care, eating right, 15:06 and exercising. 15:07 I was looking at the section on prenatal care here in your book, 15:11 and once thing that I noticed was that you spent 15:14 considerable time talking about 15:15 a urinalysis or mentioning that. 15:17 Well, what's important about getting the urine tested 15:19 for a mom that's expecting? 15:21 A urinalysis can reveal a lot of things, 15:25 but we mainly concentrate on... 15:28 for example - protein in the urine, if she's spilling protein 15:32 We want to make sure that she's 15:33 eating enough protein for the baby... 15:37 What are some good sources of protein? 15:39 Well, we have a food chart; we're going to talk about that. 15:44 And also leukocytes which would be to rule out 15:50 infections... 15:51 White blood cells. Right, white blood cells. 15:53 The fighters. Um hm 15:55 And if you're showing leukocytes with nitrites, 16:00 then you could possibly be fighting a bladder infection, 16:04 or "UTI" urinary tract infection. 16:06 So can you give antibiotics during pregnancy? What do you do 16:09 Well, the doctors will usually prescribe... 16:14 Take care of that; do something. 16:15 Cranberry juice work for that? 16:17 Cranberry juice, and we encourage drinking 16:19 drinking a LOT of water. 16:20 A lot of water! Um hm 16:22 Can't go wrong there. 16:23 No, you can't go wrong there... 16:24 And also, we check for glucose because we want to rule out 16:28 gestational diabetes. 16:30 Gestational diabetes... that means diabetes 16:33 during pregnancy. 16:35 Now if someone has gestational diabetes, then what do you do 16:40 as a nurse... I know you have the physician 16:42 working with you and different things, 16:43 but what do you do as a midwife with that? 16:46 Well, if they are spilling sugar in their urine, 16:51 first we go over their diet and make sure that it's 16:55 just maybe they had too much sugar that day or something, 16:59 and we would try to correct it with their diet. 17:02 If not, then of course, they would be referred 17:05 to obstetrical care where they would do other things 17:10 to rule out any problems. 17:12 Before we went to the break, you were talking about 17:15 that list of things... "CHECKUP," 17:17 and one of the things there was edema. 17:19 What is edema and why is it on your list? 17:21 What has that go to do with... 17:23 Well, edema just simply means "swelling" 17:27 And we have dietary eliminations for edema - 17:34 like the restriction of pork because we find that 17:39 pork is a very big irritant for fatty, salty, 17:48 and has other harmful things in it that could encourage edema 17:55 and cause a rise of hypertension or high blood pressure. 18:01 So, out of meats, if they're going to eat any meats, 18:03 one especially avoids pork. 18:05 Yes, especially to avoid pork as I find that's the biggest 18:09 offender of the edema. 18:11 Also, caffeine and other stimulants could encourage edema 18:17 ...fried fatty foods, any spicy foods and sugar. 18:23 Also, we try to encourage them 18:28 to eat plenty of fresh fruits and vegetables 18:32 to get a proper protein balance, 18:34 and replace lemon in the place of vinegar 18:40 because vinegar is an irritant... 18:43 and fresh lemon cleanses the blood. 18:47 Garlic, parsley, onions and cucumbers 18:50 are very good for edema as blood cleansers... 18:55 And you're going to hear me say "lots of water" 18:58 through this whole thing. 18:59 Lots of water and garlic! 19:00 My wife is going to love that; she loves garlic. 19:05 Anything else? 19:06 Getting fresh outdoor exercise, 19:11 but usually... honestly Don, I hardly have any problem with 19:18 any of my pregnant ladies having edema... Is that right? Um hm 19:23 I might have, just toward the hot summer months, 19:28 we might see a little bit, but as far as edema because of 19:34 hypertension or health reasons, I hardly have that because 19:40 most of the pregnant ladies that come to me... 19:42 they know that I'm going to encourage them 19:44 in a good diet and lifestyle... 19:47 What is the problem, though, with edema? 19:50 What is the problem with swelling? 19:51 I mean, what's the big deal? 19:52 So what if your ankles get a 19:53 little bigger and your appendages? 19:56 Well, if it's coupled with if you have swelling, 20:01 and high blood pressure, blurred vision, headaches, 20:08 then you're getting signs of preeclampsia or toxemia. 20:14 Okay, preeclampsia, what does that mean? 20:15 That would be before, you know that's preeclampsic... 20:21 toxemia simply just means poison in the blood, 20:26 and you could cause problems as to prematurely separate 20:33 the placenta if the blood pressure gets too high, 20:36 and cut off oxygen supply to the baby. 20:40 So this is a big thing to worry about if you start to see 20:42 swelling or different things. 20:43 You don't want that happening. You don't want that going on. 20:47 You mentioned fried and fatty foods... 20:50 What does that mean? How does that work? 20:52 Well fried fatty foods, of course, raises your 20:55 cholesterol level and it clogs up your blood 21:00 vessels which will cause a rise of blood pressure. 21:04 When you say "spicy food" what do you mean by that? 21:06 Like what kind of... Hot pepper, just spicy foods 21:14 like hot sauce. 21:17 Um hm, you want to avoid those kinds of things. 21:21 All right, and then fresh fruits veggies, all that type of thing. 21:26 We can't go wrong encouraging them in fresh fruit, 21:31 and a lot of vegetables. 21:34 You know in your book, you mentioned as well 21:36 that you want to palpate or check the belly of the lady, 21:43 I noticed you brought a belly here and you want to show us 21:47 something about that... should I hold the belly? Sure 21:50 Let me just look at this here. 21:55 Do I have this the right way? Yes. 21:57 And this must be the belly button. Yes 21:59 It's actually a real button too, isn't it? 22:01 It's a real button. 22:02 It's an outie not an innie. 22:04 So what is it that you do here when you palpate? 22:07 When we palpate the baby, 22:09 we are determining what position the baby is in, 22:12 and what we're looking for is this baby to be 22:14 in a head-down position or a vertex... 22:17 It's called vertex position with the baby's head down. 22:19 This baby is head down. 22:21 The head is right here. Okay 22:22 And, I feel the back on this side. 22:25 And then where are the legs? 22:27 Oh, you can kind of feel it. 22:30 Is it this easy on a real lady? No 22:32 It's different because this isn't a real lady. 22:37 And the bottom is up here. 22:40 Well, you're feeling through amniotic fluid, 22:43 and we do have some amniotic fluid under here. 22:45 Well, you're going to open this up in a minute 22:47 and show me right? Yes, I'll show you. 22:49 So then what do you do? How do you check? 22:50 You had talked about checking the fundus height... 22:53 Yes, I'll show you... 22:54 We start at the symphysis pubis, top of the pubic bone. 22:58 Okay, pubic bone. And we measure centimeters. 23:04 And we go up to the top of the uterus... 23:07 Remember I told you, the top of the uterus is the fundus... 23:10 And, how many centimeters do you see there? 23:14 ...40 Wow, she's ready to deliver! 23:17 Yikes... not on the show, please 23:23 So, she's full-term. All right. 23:26 And also by determining the position of this baby, 23:30 we can feel that the back is over here, 23:36 so we would listen over here for the fetal heart tone. 23:38 and I notice that you have a ... what would you call it? 23:41 A stethoscope or a fetoscope? This is a fetoscope. 23:43 And you put this back over there? Right 23:47 What do you do, put your head on it or something? 23:49 Yes, and then we listen for the heart tones. 23:53 I don't suppose I would hear anything here 23:54 on this one though, right? I don't think so. 23:57 And now let's say the head is up here, 24:00 right up here and you have 40 weeks 24:06 and it's time to deliver, what do you do then? 24:09 Well hopefully, we would have determined the position 24:13 before it was 40 weeks. Okay 24:15 You don't want to deliver a breech. 24:17 That's what it's called, a breech, 24:18 if the feet are coming out first. 24:21 Can you make it turn around? 24:23 Well, I was going to say, my backup doctors do 24:27 what they call "an external version," 24:29 and that's done under an ultrasound. Oh, I see 24:34 So they can kind of move it around sometimes. 24:38 Yes, externally they would move it head down, 24:41 but they would like to do that before 40 weeks, around 37 weeks 24:47 and then they know where the cord is and everything 24:48 when they do that or they try to. The ultrasound - right. 24:51 Excellent! Do you have anything else you want to 24:54 show me here... while we have the belly here? 24:57 Do you want to show them the inside? 24:58 Sure, yeah... I want to see the inside, why not 25:00 Okay, let's look there. 25:02 WOW! Deliveries are not this easy, are they? No 25:05 This must be the what... amniotic fluid? 25:07 That's supposed to be the amniotic fluid, and the baby. 25:09 All right, and then let's put that over there... 25:12 And this is the baby right there. 25:14 He looks kind of flexible too, good. 25:17 All right! Well, you know, as you're dealing with moms, 25:22 and you're talking with them, anything else that you 25:26 like to stress for the first-time mom? 25:31 What types of things... Do they ever get anxious 25:34 as they're coming up to their delivery? 25:35 What kind of things do you talk about? 25:38 Yes, there are a lot of concerns for the first-time mom. 25:42 They need a lot of emotional support... 25:45 not just from their husbands but from their families, 25:49 and we try to inform them, as much as possible, 25:53 especially for the first-time moms... 25:55 They're called "primips" 25:57 Primips... do you call them that? 26:00 No, just to the doctors. 26:02 But for the first-time mothers, they really need to be 26:06 educated and I really encourage a lot of education so that 26:12 they know just what is going on; 26:14 what problems to be aware of and what to expect, 26:17 and that pregnancy is not a sickness or a disease 26:22 and that they CAN do it. 26:25 I had a lady come to me, a pregnant mother, 26:27 who came to me who was not informed, 26:29 and she told me that her first birth was just a disaster 26:34 because she just really didn't know what was going on... 26:36 And when she went into labor and went to the hospital 26:42 and it was during transition that was just about... 26:49 you're just about finished when you're in transition, 26:51 and you know your cervix dilates completely; 26:54 you're just about ready to push the baby out, 26:56 and she wasn't aware of that; nobody informed her. 27:00 Transition is the hardest part of labor. 27:03 So she thought "When is this going to end?" 27:05 Yes, and she just said, "I cannot do this anymore," 27:08 and she said something just clicked in her mind, 27:10 and she WASN'T going to. 27:12 She was not going to have that baby... 27:13 She said, she decided she was going to just leave! 27:18 So she ran out of the hospital! 27:21 At transition-time. Wow! 27:23 With 2 doctors and several 27:25 nurses chasing her. I imagine! 27:27 She was just about ready to push the baby out. 27:30 So it's VERY important to let people know what's happening... 27:34 to educate them, and I suppose you do 27:36 that with the dads as well. Yes, we do. 27:39 We've been talking with Patti Barnes 27:41 She is a certified professional midwife. 27:43 And, we've learned what we need to be saying, 27:46 what we need to be doing BEFORE we have a baby, 27:48 and what we need to be eating, all of these different things. 27:51 She has written a new book where all this is summarized. 27:54 We hope that what you have learned will give YOU 27:57 and that NEW ONE health for a lifetime! |
Revised 2014-12-17