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Women & Family Health : Healthy Pregnancy and Parenting

Welcome!

Pregnancy can be one of the happiest times of your life but with it can also come an overwhelming array of questions and concerns about what to expect. When it comes to parenting advice, let’s face it, there’s a ton of information available, but often it’s hard to discern what information is accurate or not. South Shore Hospital’s new Healthy Pregnancy and Parenting blog has been created by a trusted community of expert colleagues from our maternity team as well as other experts throughout our system of care. The main goal of the blog is to disseminate accurate, useful information focused on healthy pregnancy and parenting to the community at large.

The interactive platform of the blog allows readers to engage with our team of experts as well as other readers on a variety of pregnancy and parenting-related topics. 

Our Blogs

About Our Authors

  Amy Baron
  Becky Fay
  Chris Just
  Debbie Carlson
  Elizabeth Bwogi
  emilee
  Jessie Wilson
  Julie Honan
  Julie Paul
  Mary Hogan-Donaldson
  Nannette Landry
  Rebecca Dunk, RN, MPH
  Susan Scotti Smith
  Susan Yount
Archives
 
Wednesday, September 24, 2014
What Happens When You Get Pregnant Again after Your First Birth Didn’t Go As Expected?
by Julie Paul at 10:47 AM

Pregnancy%20test_resized.jpgMy first baby was an unexpected Cesarean section—and by unexpected, I mean it was never even a thought on my birth plan “radar,” if you will.  So, what was my first thought after I found out I was pregnant the second time? “Oh no, I don’t want another c-section!”   So, I guess one could say my initial feeling was less bliss and more a confused mix of fear and excitement.

First and foremost—I knew I did not want another cesarean, but what does that mean exactly?  Is it even possible to have a vaginal birth after cesarean?  If so, how can I make it happen?  Could I possibly do something differently to get a different result this time?  Can I still have a midwife?

First, in most cases, it is quite possible to have a vaginal birth after c-section—also known as a VBAC (vaginal birth after cesarean).  That being said, it is always a conversation you should first have with your provider, who is instrumental in helping you map out options, because he or she knows your case personally and is intimately involved with all aspects of your care.  There are certain circumstances when a VBAC is not possible, and because it varies from person to person, I won’t list them all here.  The good news is that having a VBAC never prohibits your freedom in choosing a midwife for your care during pregnancy and birth.

My experience the second time around began very similar to the first.  Again, in the middle of the night, my water broke.  Filled with excitement, fear, joy, and terror at that very moment, my new plan was to attempt a VBAC.  I decided to do things very different than the first time around.  I decided I wanted no pain medication, no epidural, and no Pitocin (a drug commonly used to induce labor).  I can’t say I was sure how to make that plan stick, but I placed that as a mental forefront goal. 

For the most part, my labor began as planned.  Though I had lots of back pain, the shower and massage seemed to help.  I didn’t feel like I needed an epidural, though I did settle on a bit of Nubain to help with pain.  It seemed to be just enough to get my cervix fully-dilated.

My ultimate plan seemed on track until the baby’s heart rate began to dip whenever I pushed.  It went so low in fact, that they needed to help me get the baby out sooner.  They gave me the option to try vacuum extraction, which helps guide the baby's head out of the birth canal and is sometimes used when the baby's health depends on an immediate delivery.  I opted to try the vacuum and episiotomy, an incision made to assist in vaginal birth, knowing that if that didn’t work, I would likely have another c-section.  Again, none of it was what I expected or hoped for, but a healthy delivery was of utmost importance.  The baby came out with a healthy scream soon after the vacuum was used—and that scream was joy to my ears.

The baby was put right on my chest—skin-to-skin (before it was actually referred to as that).  Now, though I would love to tell you that it was a picture-perfect moment, to honestly share the reality of that blissful day—along with my happiness, came a great deal of discomfort down below.  I felt like a loser at the time—I mean really, just giving birth means you should be the happiest person in the world, right?  But the pain had my mind preoccupied.  Like everything else, however, I went with the flow and it the pain subsided.

The best thing to take away from my experience is this:  go with the flow. Don’t be so fixated on a set plan, because more often than not, it won’t go the way you plan.  A healthy, safe mom and a healthy, safe baby should be the ultimate priorities.  Be educated, be prepared, and by all means ask as many questions as you’d like—but don’t be so fixated on the small details or your perfect mental plan—those thoughts can control you.  Instead embrace flexibility…realizing that labor and birth are not black and white; instead there’s a great deal of gray in the mix.  Above all—remember:  every labor and birth experience will be unique and special.

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Tuesday, September 23, 2014
What Happens When Your Labor and Delivery Don’t Go as You Expected?
by Julie Paul at 07:26 AM

Labor_resized.jpgLet’s face it, when you are expecting, you’ve diligently planned for the day for nine long months—exploring all the right books and videos—even attending childbirth classes well in advance.  Actually, when I look back at that time, I didn’t think I could have been any more prepared if I tried.  

So, when my water broke at 37 weeks, I was truly excited and ready to get the show on the road.  There I was, awakened at 3 a.m. by a sudden “pop” sensation.  Jumping out of bed, I realized I was gushing fluid all over the wood floor (at the time I thought—hey, at least not on the bed!).  So being “well-prepared,” I immediately noted the color of my fluid and called my midwife.  Though a bit nervous, I was so excited with the anticipation of my baby’s imminent birthday!  

After taking a shower and getting a bite to eat, I arrived at the hospital a few hours later, where I met my midwife.  She didn’t check me right away to see if I was dilating, because I was already ruptured (my water broke), and checking too often, could increase the chance of infection.  So once I was monitored, I was encouraged to go for a walk and let the contractions get stronger…and yes, stronger they got!

It was around 9 a.m. when I had become really uncomfortable.  I had already checked off my organized list of planned approaches to pain during labor—used the labor ball, walked a great deal, took a shower…yet I felt still in need of pain relief.  So along came Nubain, a common narcotic painkiller that is used to help stimulate the brain to increase the threshold to pain.  Though I admit, it helped for a bit, I still felt I needed something stronger.  So around 2 p.m. and 4 cm dilated, I got an epidural to help ease the pain.

But wait … this wasn’t in the plan!  What about all my preparation?  The reality is, as prepared as I thought I was and as disappointing as it seemed at the moment to go off course—by using medication and an epidural—the reality was, I really needed those methods of pain relief. 

So once I settled into the notion of the all-encompassing philosophy:  “it is what it is,” I got comfortable and waited for that anticipated urge to push.  The baby, however, had other ideas.  His heartbeat kept dipping lower and lower—which meant I had to be flipped and tossed in many different positions to try to help influence the baby’s position.  This went on for a while.  While the unexpected chaos was happening, my temperature went up, and as fever set in, the baby’s heartbeat began to dangerously increase, indicating he was potentially getting an infection as well.

Again, this was not in the plan!  After I got treated for the infection, the baby was still showing signs of stress, which meant only one thing—Cesarean birth.  Of all the things happening that were not “in the plan,” THIS was by far the most disappointing moment on the list.  However, my head and heart both knew that the baby’s safety preceded any manmade agenda.  So, the cesarean section went well and four days later I went home with a healthy, bouncing baby boy.

In the days to follow, everyone kept telling me, “at least you had a healthy baby.”  Absolutely, of course I was thrilled beyond words about that—but the truth was that the actual labor and birth was not what I expected.  To be quite honest, it took a while for me to be ok with everything that had happened.  It was almost like I had to grieve for what didn’t happen.

As a midwife, I have encountered this many times.  Women need time to grieve when the birth doesn’t go as expected—and it’s perfectly normal.  If this happens to you, please don’t hesitate to talk with your provider.

So what happens when you get pregnant again after your first birth didn’t go as expected? How do you cope? Can you expect the same outcome?  … New blog post on this topic coming soon!

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Friday, September 19, 2014
Proper Prenatal Dental Care Achieves More Than a Nice Smile
by Chris Just at 08:03 AM

Dental%20Care.jpgMaintaining healthy oral hygiene should always be a priority but especially during pregnancy when the risk for periodontal disease is higher. First, nausea with vomiting in pregnancy gives stomach acids the opportunity to enter the mouth and erode tooth enamel; therefore, allowing cavities to form more easily. Second, pregnancy hormones help create the perfect environment within which gingivitis can occur. Here’s how: Estrogen and progesterone cause mucous membranes to become engorged; as a result, expecting women are more prone to annoying symptoms such as nose bleeds and bleeding of the gums. Swollen, bleeding gums are more susceptible to inflammation (gingivitis) which can lead to infection of the gums. In pregnancy, periodontal disease is even more concerning because the bacteria that causes the infection also increases the risk of preterm birth and having a low birth weight baby. 

To prevent these risks, keep in mind the following 6 simple tips for proper prenatal dental hygiene:

  1. Brush your teeth and tongue twice a day with a fluoride toothpaste and a soft toothbrush.
  2. Swish and gargle twice a day with an anti-microbial, alcohol-free mouth rinse.
  3. Floss, floss, floss – every day!
  4. Eat a healthy, calcium-rich diet and avoid sweets and carbonated beverages.
  5. Maintain your twice yearly dental appointments (more if necessary).
  6. Dental caries can be treated in pregnancy and local anesthesia is safe to use. Postpone routine x-rays until after the pregnancy; however, if you need an x-ray because of a dental issue, just be sure your dentist covers you with a lead apron to protect your baby as well as a lead collar to protect your thyroid.

According to the American College of Obstetricians and Gynecologists, in 2007-2009, over 50% of women reported that they did not visit a dentist during pregnancy.  Don’t be part of that statistic. Take time to engage in healthy dental care to prevent periodontal disease and protect yourself and your baby. For more information, visit the American Dental Association’s pregnancy information at http://www.mouthhealthy.org/en/pregnancy/. Happy brushing, swishing and flossing!

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Thursday, September 18, 2014
Postpartum tranquility. Savor the moments. Wait…what?
by Susan Scotti Smith at 05:49 AM

Mother%20and%20Baby.jpgYes, that’s right, postpartum peace and tranquility. Ok, well, as much as can be realistically attained. This blog post aims to share some tips and tricks to get you and your new family off to the best possible start. I’m writing as a Certified Nurse Midwife but also as a mom of four. I’ve lived and learned and hope to help you avoid some common pitfalls that can take a toll on a new mom and family. 

As midwives we send many moms home from the hospital with their new little bundles of joy. We often give instructions for postpartum rest that seem stern and strict. We know you want to be active, that you feel great and, of course, that you “can’t sit still”. BUT, you will likely be trading off feeling good for a short time now, for feeling run down and exhausted down the road. Sleep deprivation and the trials that come with parenting a newborn will have a cumulative effect and in a month or two you will likely wind up paying the price for being a “rock star” and bringing your five-day-old to the neighborhood BBQ. If you jump back into your activities full swing too soon you will find yourself feeling run down and exhausted at two or four months out. Just like there is no trophy at the end of your natural childbirth, though I highly recommend it, there is no badge awaiting you for being out and about soonest after giving birth; no one is waiting with balloons when you arrive to preschool drop-off with your two-day-old.  And, while you will definitely get accolades from strangers at Tedeschi’s when you tell them your baby is “only five days old!”, that’s nowhere near enough reward when, at five months postpartum, you find yourself crying at four in the afternoon because you just. want. to. lay. down.  

Following are my top tips for postpartum families.

Create your cocoon.  You can do this before your birth. It’s as simple as creating a space for your recuperation. A clean room and bed, clean clothes and linens ready for your arrival. Ideally this is a bedroom or somewhere you can shut the door to the household chores. Have your fridge stocked with healthy snacks (fruits, raw cut up veggies, peanut butter/crackers, cheese, yogurt, trail mix) and have a large pitcher for water at your bedside. If you have access to a dorm size fridge this can come in very handy for keeping things at your fingertips. The more you have on hand the less you will need to ask for help—this “asking for help” can be a stumbling block for some moms (who me?).  A few chairs are helpful for the rare visitor (see below: limit visitors). Ideally you will remain in your cocoon until you are recuperated. The less you venture “out” (even in the house) the less likely you are to try to jump back into your routines of cleaning/cooking/whatever it is you do. Staying in your cocoon will keep you on task recuperating and keep you in the proper mindset. During my recuperations, I napped whenever I was able, talked on the phone—a good way to connect with family and friends on your terms, read People magazine medical journals, cleaned out the TiVo, read stories with younger kids, wrote thank you notes, designed a birth announcement…did I mention sleep?

Have help.  Arrange for help to care for the NEW MOM and to assist with housework and childcare if you are welcoming a sibling. Partners are able to do a good deal of this, though outside help of either a close family member/friend or a professional postpartum doula will make for an even smoother transition for the new family. As a new mom your only responsibilities should be caring for yourself, your newborn and your immediate space.  All meal prep, laundry, vacuuming, bill paying, getting gum out of hair, butt wiping, floor mopping, dog feeding, you get the idea, should be done by *someone else*.

Limit visitors.  When I say limit I mean don’t have any or, if you insist, be as strict and selective as you possibly can with the people you allow into your cocoon. The days after childbirth can be very stressful on the new family as you adjust and as mom heals. The sleep deprivation and mom’s hormonal changes make for emotional ups and downs. Even sitting and chatting with a close friend can takes its toll. It’s impossible to know a perfect time for visiting so it’s best to put most off for a week at least. If you’re very up front and clear about this before the baby arrives it will be better received at the time.  Most will be understanding, and those that aren’t are likely the ones that need the message the most. Please realize the magnitude of importance of this time for you and your new family. You’ll never have these moments again, put yourselves first and keep this special time for yourselves.

When you’ve spent your first days postpartum well, you will heal physically from your childbirth and will be ready to resume your normal activities in short order. It’s best if you start small with venturing out and getting back into routines of home and childcare. Pay attention to your body. Any increase in vaginal bleeding can be a sign that you’ve been overly active and you may need to cut back again. Please take care in building up your activity level slowly. In a few weeks you will get through your days with good energy and without a hitch…a rock star! Enjoy your new bundle of love! (If you’re not feeling the whole “bundle of love” thing…call us!)

The information in this blog post is meant for women recuperating from a normal vaginal or cesarean birth, and is designed for educational purposes only. Information is not provided as medical advice or as a substitute for professional medical advice or care. Always seek the advice of your physican or provider with any questions relating specifically to your case and care.

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Tuesday, September 16, 2014
Birth Preferences
by Julie Paul at 07:13 AM

Pregnantwoman.jpgHave you ever Googled the phrases ‘birth preferences’ or ‘birth plan’? I just did and got 189,000,000 hits.  No wonder pregnant women get confused when they consider writing a birth plan. If this is your first baby, how are you supposed to know where to start? There are so many different options and everyone has an opinion of how your birth should go. This is an opportunity for you to learn more about pregnancy and birth. It can be a bit overwhelming so let’s review some of the more basic questions.

  • What is a birth plan?  Simply, a birth plan is a list of what you may or may not want for yourself and your baby during labor, birth and postpartum.
  • Would I benefit from a birth plan?   It is always a good idea to start educating yourself about the labor and birth process. Even if you don’t have a formal document, the process can be very helpful.
  • Where do I want to have my baby?  Women can have babies at home, birth centers and hospitals.  A birth center is a location (usually separate from the hospital) where healthy; low-risk women can have a natural childbirth. If you are unsure where to have your baby, talk with your provider.
  • Who should care for me during my pregnancy and birth?  The different type of providers include:  obstetricians, certified-nurse midwives (CNMs) and certified professional midwives (usually attend home births).  An obstetrician is a medical doctor with expertise in high and low risk pregnancies.  Obstetricians mainly practice in hospital settings but occasionally you may find one in a birth center.  Certified Nurse-Midwives are experts in normal care for healthy, low-risk women (which most women are!).  You will find midwives in hospitals and birth centers.
  • How do I prepare for a normal vaginal birth?  Ideally this starts before you are even pregnant.  However, let’s just assume you are already pregnant. Eat right, exercise and don’t do drugs or alcohol. Most important- trust in the process and yourself!
  • How will I manage the labor pain? Labor pain can be managed by changing positions, using the labor ball, get in the bath tub or shower. Using water while you are in labor can be very comforting.  Eat what you want and drink often- water that is. Get enough rest! I can tell you- you are stronger than you think! Most women can do it without anything. However, in the event that you may need something—pain medication or epidurals (only in hospital) are available.
  • Should I breastfeed?  How you feed your baby is very personal. Do the research—what are the benefits of breastfeeding? Here are just a few:
    • Protects your baby from illnesses like asthma and ear infections
    • Increases bonding
    • Protects your baby from developing allergies
    • Protects against obesity
    • Lowers risk of SIDS (sudden infant death syndrome)
    • May boost your child’s intelligence
    • Reduces mom’s risk of breast and ovarian cancer
  • What is skin-to-skin?  This happens when the baby is put right on your chest right after the birth. Skin to skin can help regulate the baby’s temperature and help promote breastfeeding and bonding. This is a great time to celebrate everything you just did!
  • Is delayed cord clamping a good idea?  Delayed cord clamping is when the baby is still attached to the umbilical cord just after birth. This allows your baby to get an extra boost of blood volume to help prevent anemia. Sometimes the cord will be cut right after birth—if your baby needs extra support.

Once you have done your research, bring whatever questions you still have to your provider. They can help you develop a realistic plan and get your 3 page document down to one. A birth plan is a great way to start asking the right questions. The most important thing to keep in mind is that a birth plan is a list of desires. Birth doesn’t always go the way we want it to go. The best way to approach labor is with an open mind.  Finally, there are many different paths you can take when having a baby, however, the goal is always Healthy Mom and Healthy Baby.

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Monday, September 15, 2014
Calling Moms: We Invite You to Share Your Midwifery-led Birth or Pregnancy Story
by SSHMaternity at 05:55 AM

momandbaby.jpgEvery birth story, just like every baby—is unique and special. It’s nearly impossible for women to forget the details of their birth(s) because each story is such an intimate part of one’s life. Because every story is important, as National Midwifery week approaches in early October, we want to put a special emphasis on sharing personal stories and the women behind them.

We would love to hear from you! Knowledge is power, and sharing your experience helps others make informed decisions, while giving clarity and peace to women embarking on their own journeys. Your submission will be added to a special gift drawing that will take place at the end of National Midwifery week. Be as brief or as lengthy as you want and feel free to include photos of you and your baby—if you wish to share. Some thoughts to keep in mind as you write:

  • What contributed to making your midwife birth a positive experience?
  • How did you handle any fear and/or stress, if any?
  • Did you feel there were any outside pressures that influenced your decisions during pregnancy?
  • If you’ve had multiple births, what were differences that contributed to having a positive experience?

Help be a voice in the community and share your journey with others. If you’d like to share your midwife experience with the SSH Babies community, please send us your story in a private message. Upon submission, you will automatically be added to a drawing to receive a special gift and your story could be included as part of our upcoming Midwives week celebrations!

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Friday, September 12, 2014
“I can hear you dilating”: A Midwife Listens
by Chris Just at 05:54 AM

Midwives%20with%20baby.jpgOnce a month, the midwives of South Shore Hospital host a free program, Meet With the Midwives, an open forum for expecting moms and support persons to become introduced to the team of certified nurse-midwives, learn about midwifery care, and find answers to their questions as they consider the option of choosing a midwife as their provider.

Being a midwife myself, I was looking forward to attending the June 11th program, as an observer, to see what kinds of questions came up from the attendees.  As I entered the room I was pleasantly surprised to see it packed with at least 20 expecting women, most of whom were accompanied by a birth partner. As we all introduced ourselves, one woman explained that she was pregnant with her seventh baby and all six of her other children were born with midwives. She couldn’t say enough in praise of the care she received.

In addition to the expecting women, their companions, and the midwives, there was a new mom in attendance with her one-week old baby that was born naturally (without the use of pain medication) despite a birth weight of 11 pounds, 6 ounces!  She was a patient of one of the midwives and her presence was a highlight of the evening.  This new mom was so immensely happy with her birth experience she felt compelled to share her story, even if it meant leaving her house so soon after birth.  She spoke at length about her appreciation for her midwife and how respected and supported she felt during her prenatal care and birth.  She reported how grateful she was that her caregivers avoided mentioning the word “epidural” per her request, to help her achieve her goal of having an un-medicated birth.  She then comically shared that Nannette, her midwife, told her at one point during labor, when she especially needed encouragement, “I can hear you dilating.” 

Everyone in the room chuckled at that line because it was funny to imagine being able to hear someone dilate - an impossibility, right? …..Or is it??

OK, it’s true that one cannot literally hear the cervix dilate but did you know that a midwife can acquire a significant amount of information about one’s labor and birth just by listening?

  • A midwife hears the deep sound of a woman’s groans as her contractions become stronger and more frequent, a sign that her labor is more active and dilation is occurring more rapidly. 
  • She listens for the soft rustle of the sheets as a woman’s toes begin to curl, often a sign that labor is more advanced and she is getting closer to having an urge to push. 
  • She hears the resistance in a woman’s breath as she begins to bear down, ready to birth her baby.
  • She can tell by the sound of a baby’s cries if all is well.

Most of all, however, a midwife will listen to YOU!  She will ask you what kind of birth you are looking for and support your choice, as long as it’s safe, of course.  Some people believe that a midwife only attends “natural” or un-medicated births but that is not true.  If you are planning to use an epidural, no problem – you can still have a midwife.

Shared decision-making between provider and patient is a national maternity care initiative that helps improve outcomes and increase patient satisfaction.  Shared decision-making is when your midwife or OB offers you options for your care, fully describes evidence-based risks and benefits for those options, listens to your preferences and supports your choices as long as they are medically reasonable.  Having a voice in your own care is empowering and will help you feel more in control of your labor and birth.  Having a voice means someone is listening. 

Educated in the disciplines of nursing and midwifery on a master's level, South Shore Hospital’s 10 + nurse-midwives are members of the American College of Nurse-Midwives and certified by the American Midwifery Certification Board. They see patients both at affiliated community OB/GYN practice settings, including Crown OB/GYN and Atrius, and on our main campus at South Shore Hospital. To gather more information about the South Shore Hospital Midwives, be sure to attend the next Meet With the Midwives program.  No registration is required.

 

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