Virginia Apgar: An Advocate for Newborn Health

Virginia Apgar

The APGAR test, a standard newborn test developed in 1953 by Virginia Apgar, assesses an infant’s health immediately after birth. At 1 and 5 minutes post birth, the infant is examined and given a score based on the following criteria: heart rate, respiration, color, muscle tone, and reflex irritability. The term APGAR score is a mnemonic learning aid based on its inventor’s last name which stands for Appearance, Pulse, Grimace, Activity and Respiration. By the 1960’s, because of its readability and effectiveness, this score was used widely across the United States. Now, it is globally used and adopted by most doctors and midwives.

This pioneering anesthesiologist worked effortlessly throughout her career to save countless newborns. Born in New Jersey in 1909, she became passionate about medicine in High School. She completed an undergraduate degree at Mount Holyoke College in zoology with minors in physiology and chemistry. She also played on multiple sports teams, reported for the college newspaper, acted in local plays, and played violin in the orchestra. Her teachers were astounded at her capacity to succeed.

She went on to attend Columbia University College of Physicians and Surgeons (CUCPS) as one of nine women in a class of ninety. She received her medical degree in 1933 and began a surgical residency. The chairman of surgery at CUCPS highly encouraged Apgar to switch to anesthesiology. Anesthesiology, at the time, was given by nurses but surgeries became more and more complicated. This procedure then became a doctor’s specialty. Because the field was relatively new and unresearched, Apgar had the enthusiasm and grit to take it and run with it. And that is just what she did. In 1937, she received her anesthesiologist’s certificate and returned to CUCPS to become the director of the newly formed division of anesthesia and, in 1949, she became the first female full professor in CUCPS’ history.

This high position allowed her to research and study more in depth at Sloane Hospital for Women with laboring and new mothers. She soon realized that there was no developed way and standardized measure to asses the overall health of newborn babies. Mortality for children under a year old in the U.S. had been going down in this time, however, the rate of mortality for newborns remained the same. This was mostly due to the fact that doctors weren’t identifying the babies that were born at risk. Hence no necessary interventions could be put into play. This prompted the brilliant Virginia Apgar to develop the APGAR score in the 1950’s.

She went on, in 1959, to pursue a Masters of Public Health degree at Johns Hopkins University and soon after took a position at the March of Dimes Foundation directing its research into the prevention and treatment of birth defects. She was one of the first people to focus on the effects that premature birth has on an infant’s overall health. Today, the March of Dimes still works to prevent premature birth and is one of their top priorities because of the legacy Apgar left them with. Apgar published over 60 papers and continued to tirelessly work and research until her death in 1974.

David Rose wrote, on the 100th anniversary of her birth in 2009, “Virginia Apgar was an irrepressible and charismatic champion for babies whose wit and lively personality captivated everyone she encountered in her constant quest for improvements to maternal and infant health… it has been said that every baby is first seen through the eyes of Virginia Apgar.”

 

Source: www.amightygirl.com

The Golden Hour: Those First 60 Minutes After Birth Are in Fact Pure Gold

golden hour birth

The first 60 minutes after your baby is born are remarkably beneficial for bonding and attachment between mama and her new babe. What is the golden hour exactly? How can you maximize attachment and bonding in this hour? How long should skin-to-skin be established before those medical tasks and procedures are performed? These questions all point to this golden hour and its magical luster.

Congratulations! Your baby has been born. You have finally gotten a chance to gaze in their eyes for the first time after feeling all the pregnancy symptoms and baby’s movements. You are on the other side of labor and it feels so incredibly relieving.

That uninterrupted contact between mother and baby during the “golden hour” after birth is critical to the child’s growth and development. In the past, often times, the baby was whisked away from mother to perform all the essential procedures such as weight, bath, vaccinations (if consented by parents), diapering and swaddling. Mom would be waiting to receive her new bundle back once tasks were performed. Health care providers now understand and know that the more skin-to-skin mom can have with baby immediately after the birth, the better chance of bonding the mother will have and also the better overall experience the family will have as they embark on their new parenting journey.

The American Academy of Pediatrics now recommends the following guidelines:

  • Healthy newborns should be placed directly “skin-to-skin” with mom until the first round of breastfeeding is established.
  • The medical caregiver and the nurses can conduct the first round of physical assessments on mother’s chest.
  • Conventional procedures such as weighing, baths, measuring, injections or blood tests should wait until after the first round of breastfeeding.
  • Baby and mother should remain together throughout the recovery period.

So what exactly are the benefits?

  • Giving birth generates changes in the mother’s brain chemistry and increases her desire to nurture. Taking advantage of this window is beneficial to both the mom and the baby.
  • Skin-to-skin contact and the baby’s suckling at the breast releases hormones that help the mother connect to her child and also encourages the uterus to contract and stop bleeding.
  • Nursing in the first hour, research has shown, improves infant survival rates and makes it more likely for the mother to continue breastfeeding

Expectant mothers can talk to their care provider about the standard procedures for this postpartum period. Your birth plan can also include these 60 minutes immediately following birth. Every mother and baby should have a chance to experience their “golden hour.”

 

Protein in Pregnancy: What’s the big deal?

Have you ever wondered just how important your diet is for your growing baby in your belly? Have you ever allowed craving after craving to drive your food intake? Have you ever felt like your body only wanted to eat carbs, carbs and more carbs? If you have answered yes to one or all of these questions, this blog post is for you.

Throughout pregnancy, a protein rich diet can make all the difference in maternal and fetal health. It can reduce risk factors for pre-eclampsia and gestational diabetes, and even improve your birth outcome. But how?!

When your baby is growing the fastest, during the second and third trimester, it is vital that your body intakes protein which contains amino acids. These acids are the building blocks for you and your baby. Most experts recommend consuming a minimum of 80 to 120 grams of protein per day while pregnant. It is also important to use salt to taste. Between 20-25% of your daily calories should come from protein. As explained in the chart below, albumin is made directly from the protein mom eats which in turn increases blood volume. When mom doesn’t get enough calories, the protein is burned up rather than being used to make albumin. This unfortunately drops blood volume. The result of high blood pressure is due to the kidneys producing an enzyme called renin which makes the blood vessels constrict. This down spiral of events often leads to early signs of pre-eclampsia and usually early induction of baby.

Adequate protein and salt for the pregnant mom are vital in an overall healthy pregnancy and an uncomplicated delivery. Best choices that include protein are as follows: meat and poultry, fish and seafood, eggs, dairy products, beans and peas, nuts and seeds, high protein grains, protein powder. If the mother will increase the amount of salt, protein, and calories that she eats, the blood volume will increase, and blood pressure will come down to a normal level. Sometimes, this could even mean eating an ounce or two of protein every hour. It is in fact possible to reverse pre-eclampsia risks with proper protein-rich nutrition. For more information on the link between nutrition and pre-eclampsia, see www.drbrewerpregnancydiet.com.

protein in the maternal diet

Fourth Trimester… Oh My! Tips for sanity and survival

fourth trimester

Congratulations. You have grown a baby. The 40 or so weeks of waiting are finally over and you are wondering what on earth to expect now. While your body is no longer housing a tiny human, something still feels off. The fog has not lifted. Your energy is low, your hormones are whack, and your stamina is half of what it used to be. Life seems to be filled with endless feedings, swaddling, burping, soothing and not sleeping. The days are blurry and the nights are endless. You have officially entered the fourth trimester. These next twelve or so weeks are a completely different marathon. Below are 6 tips that I felt helped me transition into motherhood with grace and kindness towards myself and my baby.

1. Take it easy the first few weeks. You will be back to “yourself” eventually but right now, your body is healing. Healing from pregnancy and birth. It will not feel “normal” anytime soon.

2. Never say “no” to someone offering help. People, in general, want to know how they can help. Let them cook meals, buy you Starbucks, clean your house, hold/feed your baby, carry your purse… anything. You don’t have to do it all. Even ask for help if you need it. You are not weak if you ask. You just made a human. That’s pretty damn strong.

3. Do not put pressure on yourself to get that pre-pregnancy body back during this trimester. It will not happen and you are setting yourself up for disappointment. Things are a little more shifty and squishy. It is ok. No one is judging you and if they are, you don’t need them in your life.

4. An hour or two goes by VERY quickly. Especially realized when a newborn baby is eating that often. At the end of the day, if you are wondering where the day has gone, know that you kept your baby fed. That is a big feat in itself. But everyday, try your best to do at least one thing for yourself. Eat a cookie. Walk slowly around the block. Ask for a massage from your partner. Take a bath. Read something (googling articles about your baby doesn’t count).

5. These first three months are all about SURVIVAL. Forget ALL. THE. RULES. and trust your instincts. If you hold your baby all day for him/her to nap, fine. If you get take out for 12 weeks straight, great. If you rock or nurse your baby to sleep, job well done. There is no “right” way to parent. Your mama instincts are powerful. You have everything you need inside of you to care for your baby. Silence the judge-y noise.

6. Believe the saying “the days are long but the years are short.” Although it feels like you’ll never have poopless days, you will. Try your very best to enjoy the little moments of sweetness. The coos and giggles. The messes and madness. These times are tiring times, but bound to make our hearts and lives oh so full.

You got this, mama. I believe in YOU!

“Motherhood: All love begins and ends there.” –Robert Browning

New Childbirth Classes in Baltimore

birth classes baltimore

We have had the honor of providing childbirth classes in Baltimore since 2014. There are many reasons we love and use the Birth Boot Camp curriculum to prepare couples for an amazing birth. The materials are unmatched and the curriculum, which is updated with current statistics and research yearly, is the most modern and comprehensive we have found.

Since the program was launched in 2011, it has had amazing growth. Birth Boot Camp childbirth classes are now taught throughout the United Stated, as well as in Canada and Guam. The latest, and potentially most exciting change, has just been announced.  In addition to the comprehensive 10-week childbirth series, Birth Boot Camp will now offer 5 new classes to meet the different needs of birthing couples.

homebirth baltimore

 

 

Training Couples for an Amazing Out-of-Hospital Birth

This class gives you all the tools and information you need to know about the nuts and bolts of labor.  We will discuss the stages and variations of labor and tools to keep labor pain and discomfort at a minimum.  Waterbirth, labor positions, and relaxation techniques are also addressed. This 4-series class is $220 and includes a beautiful color workbook.

 

 

infant care class baltimore

 

 

Homecoming: Life with a New Recruit

Get parenthood off to a great start with this 2-series class.  Topics include: postpartum health, newborn procedures, babywearing, breastfeeding, and safe sleep.  This class includes a workbook and a 3.5 hour breastfeeding video download, which discusses feeding positions, common challenges, and pumping and returning to work.  The fee is  $115

 

 

food and fitness

 

Food & Fitness

Aside from preparation, staying low risk increases the likelihood of meeting your birth goals.  Join us for this 3 hour workshop to discuss how eating well and preparing your body can be the most effective way to remain low risk.  We will discuss nutrients that are crucial to a maternal diet as well as exercises and stretches to promote flexibility and stamina, giving you the most comfort during pregnancy and birth.  This class includes a workbook.  The fee is $95.

 

 

Classes coming in January 2018 include:

Coping Strategies for an Amazing Birth

Training for an Amazing Hospital Birth

 

We proudly provide our childbirth classes in Baltimore at The Womb Room in Hampden.  To learn more about our classes or to see our class calendar, click here.

 

Is Placenta Encapsulation Safe for GBS+ Mothers?

placenta encapsulation and GBS

Is Placenta Encapsulation Safe?

Recently, The Centers For Disease Control (CDC) released an alarming single case report, in which a newborn was found to have a recurrent infection of group B Streptococcus agalactiae (GBS, group B strep), that was attributed to the mother’s consumption of placenta capsules. This has many people asking, ‘Is placenta encapsulation safe?’ We will navigate the findings of this case report, explore how this occurred, and discuss placenta encapsulation safety.

 

What are the findings of this case?

The CDC report discussed findings about a newborn who experienced a recurrent group B strep infection. GBS is a common bacterium, found in a person’s intestines or lower genital tract. Group B strep is present in about 25% of pregnant women, and is usually harmless. If transmitted to a newborn during birth, it can cause a rare but serious, illness known as group B strep infection. Because of this, it is standard practice for obstetricians and midwives to test expectant mothers for GBS, to determine if colonization is present. In this CDC report, the maternal GBS culture taken at 37 weeks was negative, meaning the mother’s lab test showed no colonization. Very shortly after birth, the newborn exhibited signs of an infection and lab results revealed the infant tested positive for group B strep. The infant was treated with antibiotics and hospitalized for about eleven days. Five days after the newborn’s release from the hospital, the baby again presented with GBS symptoms and tested positive for the same strain of group B strep. The baby was treated and was again released from the hospital after antibiotic therapy. At this point, it was discovered that the baby’s placenta had been encapsulated. The mother had been taking the placenta as capsules from three days postpartum. The capsules were tested and found to contain the same GBS strain that had infected the newborn. The mother’s breast milk was tested and did not contain group B strep, thus breastfeeding was ruled out as a potential source of reinfection. The authors of this report infer that ingestion of the GBS positive placenta capsules may have elevated maternal group B strep intestinal and skin colonization, facilitating transfer to the infant. The authors conclude by stating ‘placenta encapsulation process does not, per se, eradicate infectious pathogens; thus, placenta capsule ingestion should be avoided.’

 

So, How Did This Happen?

According to the report, the mother hired a company to pick up the placenta from her hospital and encapsulate it. The encapsulated placenta was returned to the mother three days later, and she began taking her capsules until it was suspected that they may be a source of group B strep. The encapsulator, who remained unnamed in the report, prepared the placenta from a raw state, dehydrating it at temperatures ranging from 115°F–160°F. According the CDC, heating at 130°F for 121 minutes is required to reduce bacteria present in placental tissue.

There are three problems with this case contributing to the placenta capsules testing positive for GBS, possibly re-infecting the newborn, and demonstrating unsafe processing practices.

 

The placenta was dehydrated from a raw state: This placenta was not heated to an adequate temperature, and possibly not for a long enough period of time to kill pathogens, like group B strep. Proper encapsulation protocols, require a specialist to steam the placenta, at 160°F, and then dehydrate it at 130°F for twelve hours. This method drastically reduces the occurrences of potentially harmful bacteria remaining present in the placenta. If the placenta referenced in this case was processed properly, it would almost certainly not have tested positive for group B strep.

 

Infection was present in baby: It is not a contraindication to encapsulate a placenta if a mother is found to have GBS. But if there is in an infection occurring in the infant or mother following birth, the placenta should absolutely not be encapsulated or consumed. Responsible and properly trained encapsulators will always inform their clients about any and all contradictions to placenta consumption.

 

The placenta was not processed in the client’s home: Another concern, is that this placenta was picked-up from the mother’s birth place and processed in a location other than her residence. It is impossible to know what type of preparation space the specialist worked in, if proper food safety protocols were followed, and if precautionary guidelines and decontamination practices for handling potentially infectious and biologically hazardous materials were utilized.

 

So, Is Placenta Encapsulation Safe?

A placenta from a normal, healthy infant and mother, when processed correctly is almost always safe to consume. With proper preparation, placenta encapsulation and consumption possesses almost no danger to a mother or baby.

 

Final Thoughts

Though startling, this report is only a single case study, and represents the findings and extrapolated assumptions of the authors. This is not an official CDC recommendation pertaining to placenta consumption. The report should serve as a caution for businesses offering encapsulation remedies and for families searching for placenta services. The Nurturing Root steadfastly believes that a placenta should ONLY be processed in a client’s home, using the traditional method, which steams the placenta first, to eradicate possible pathogens. It is crucial that you are able to witness the sanitation protocols implemented by your specialist, and know for certain, that the placenta being encapsulated is yours, it is processed correctly, and it is not contaminated by another source. We strongly encourage you to read this post, that lists six tips to consider before hiring a placenta encapsulation specialist. The Nurturing Root has encapsulated over 650 placentas, to date, with a 100% safety record and we have received only overwhelmingly positive reviews from our families. We believe in absolute transparency in the encapsulation process. Please feel free to contact us with any questions or concerns you may have about the CDC report or placenta encapsulation safety. Ohio families contact us here, and Maryland families, here.

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