Health for a Lifetime

Prenatal Care

Three Angels Broadcasting Network

Program transcript

Participants: Don Mackintosh, Patti Barnes

Home

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!


Home

Revised 2014-12-17