Heather Pladna

Prenatal Visits: What’s a Fundus?

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What is a fundus

Congrats! You’re pregnant and you may have attended several prenatal appointments by this time. Each visit has been basically the same, you may have to provide a urine sample each time, chat with your healthcare provider about your concerns, and you get to listen to your little one’s heartbeat. But as you advance in pregnancy, usually around 24 weeks or so, your provider will add something to your typical routine. She will begin to take your fundal measurement. “Wait, what’s a fundal measurement?” you may ask. It’s the measurement of your fundus of course. “What’s a fundus?” Great question! 

By definition, a fundus is a “part of a hollow organ”. In the case of pregnancy, the fundus in question is your uterus. So, “measuring your fundal height,” what you may hear your provider call it, is simply just measuring the expansion of your uterus as your pregnancy progresses. This measurement doesn’t occur until around 24 weeks because in order to measure one’s uterine growth, or fundal height, the uterus has to be large enough to be palpated by your provider. It must be large enough to protrude above the pubic bone. 

Thankfully, the method used to measure your growing uterus is a painless and non-invasive process that involves your provider using a basic tape measure to determine the size of your uterus. She will begin by locating your pubic bone with her fingertips, where she will place the tip of the tape measure, and then she will run the tape measure up to the point at which she can feel the top of your uterus. Coincidentally, your fundal height often matches your gestational week within about 2cm, give or take. In other words, if your fundal height is 28cm, you are likely about 28 weeks pregnant. This measurement, in a healthy pregnancy, will increase at each visit. It will follow this trend at least until the very last few weeks where your baby may begin to burrow down further into your pelvis, in preparation for birth. At that point, your fundal measurement may actually decrease a bit. This would cause no concern. 

The fundal measurement allows your provider to know several things: 

  • how far along you are in pregnancy, which will help to verify your estimated due date
  • it assists in tracking your weight gain along with how your baby is growing 
  • it helps determine how large your baby may be
  • it provides an idea of how much amniotic fluid is in your uterus

Next time you head in to your appointment, don’t be overly concerned if your fundal height doesn’t line up exactly with the parameters listed above. Each pregnancy is different and each individual is unique. Your provider will be sure to tell you if there is a reason to be concerned. The fundal height measurement is generally a very reassuring and concrete way for you to witness your baby’s growth and your own bodily-changes throughout your pregnancy.

Your fundal height is an important part of the prenatal care puzzle. While variation from the “norm” doesn’t necessarily indicate anything is wrong, it does allow your provider to ask the right questions, order the right tests, and further help her determine how best to keep you and your baby healthy and safe during your pregnancy. Enjoy watching that bump grow! Happy pregnancy. 

 

Do I Need Cervical Checks in Late Pregnancy?

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vaginal exams in pregnancy

If you’ve had a baby before or even talked to friends who have, it’s likely you’re aware that many prenatal healthcare providers routinely perform cervical exams in the last few weeks of pregnancy. Questioning this practice could very well have never even crossed your mind. Maybe you’ve even been led to believe that the results of these cervical checks are an important piece of the information needed to determine how your pregnancy is progressing and how soon you may deliver your baby. The truth of the matter is though that while yes, a cervical exam can assess effacement and dilation, it is not a reliable predictor of when you may go into labor. Instead, these cervical exams are more of a relic of prenatal care of the past and are done out of routine rather than out of true clinical need. While cervical checks can be useful in the case of an upcoming induction to determine how favorably one’s body would respond, there’s no true evidence-based reason to do repeated routine cervical exams in a typical pregnancy. 

Aside from the lack of necessity, cervical checks do also hold some level of risk. The risks associated with cervical checks include possible infection as well as the potential for premature rupture of membranes (breaking of water prior to labor-onset). 

When any foreign object, in this case, the gloved finger(s) of a healthcare provider, is inserted into the cervix, there is a risk of infection. The act of entering an area that otherwise is biologically sealed off and meant to dilate in its own time, can be problematic. Bacteria from the provider’s hand or even from your own vagina can be pushed into the cervix and create an infection. Infection is obviously something one would want to avoid at any time but certainly during the last weeks of pregnancy.

The premature rupture of membranes or PROM, the breaking of your water prior to the onset of labor, is another risk that cervical checks introduce. PROM can lead to longer labor, infection for the parent and/or baby, and possibly the need for induction. Cervical checks have been linked to PROM. In fact, a study done on this exact issue, revealed that people who had routine cervical checks starting at 37 weeks were three times as likely to experience PROM as those who did not have the routine cervical examinations. A second study (mind you, shockingly, only two studies have been done on this specific subject) showed that there was no risk nor was there a benefit to routine cervical checks. The potential reasons for the discrepancy are beyond the scope of this post but it certainly indicates the need for more research to be done on this topic and should act a red flag for this procedure. 

Whether there is truly a significantly higher risk of PROM and infection when having routine cervical checks or not, a procedure that carries no benefit should always be considered a potential risk and deserves to be weighed thoughtfully by the patient. If your provider does not need the information to plan a potential induction or for a valid reason that goes beyond simple routine, you may want to ask questions and consider if it’s a procedure you’re confident in having done. You always have a choice in the matter. Refusing a cervical exam is your right and a healthcare provider cannot compel you to consent to such an exam (or any other medical procedure for that matter). Informed choices only exist when “no” is an acceptable response. 

For more information, visit Evidence Based Birth.

 

Having a Baby? Don’t Forget the (Adult) Diapers!

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Postpartum adult diapers

If you are having a baby sometime in the near future, I implore you to invest in some disposable adult diapers. Maybe that seems rather strange; perhaps you’ve only considered that your new baby will need diapers. But believe me, as a mom who has given birth 6 times, you will thank me for coaxing you to purchase diapers for your own personal use. They’re truly the unsung hero of labor/postpartum supplies! I never imagined I’d be writing a post about how much I love wearing a diaper, but well, that’s motherhood for you.

“So,” you ask, “what’s the big deal? Why adult diapers?” The obvious reason that you’ve already presumed correctly, I’m sure, is for postpartum bleeding. Postpartum bleeding, or lochia, flows fairly heavily for the first few days after you give birth. They do have mattress-size maxi-pads for this, but are they good enough? The answer is a resounding no. Those pads, no matter how big they may be and no matter how much surface area they cover, just aren’t as good as a diaper. With a diaper, you don’t have to be concerned about the twisting and bunching that a pad tends to do or ruining your pants because of a leak. And you don’t have to bother with those awful
mesh underwear the hospital offers. Adult diapers have a much slimmer profile than a gigantic maxi-pad and they do a far better job absorbing fluids quickly. That means less chafing and irritation for your already-sensitive parts.

Adult Diapers aren’t just for postpartum.

The other reason, and the one that totally convinced me after experiencing it firsthand, is to absorb leaking fluids if your water breaks early in the labor process. When that occurs, it’s common to have a slow, constant trickle of amniotic fluid coupled with large intermittent gushes due to positional changes. A pad just isn’t made for such a large volume at one time, but adult diapers are made exactly for that type of flow! The difference in wetness protection is amazing. I was beginning to get pretty irritated in the early hours of my second labor while using a maxi-pad to absorb my leaking fluids. I (reluctantly) decided to give the diaper a try and I was so very thankful I did! It made a world of difference in comfort level. And if there’s ever a time to capitalize on comfort, it’s labor!

So, while you’re out picking up those items you’ll need for your “go-bag,” make sure to include a package of diapers for you! Some may say they’re not necessary, but I believe your comfort Depends on it (See what I did there?).

3 Quick Tips for Writing your Birth Plan

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writing your birth plan

Writing your birth plan can feel like a daunting task. You want to make it concise and straightforward while still including all the necessary pieces. Before you even get to that though, be sure you have a care provider who is supportive and open to birth plans. If you have mentioned a birth plan to your care provider already and you felt disparaged, run, don’t walk, to a new, supportive provider. Providers who feel that they are the final authority regarding your birth, have no place on your support team. You deserve better than that, you deserve to be heard and collaborated with, not brushed off or made to seem less than.

The preparation that goes into creating a birth plan involves researching common practices in your choice of birthing location and then teasing out those things that are most significant to you and what learning what the potential alternatives may be. By educating yourself about the birthing process and the choices you have, prior to being in the throes of labor, you are increasing your chances of having the birth you desire. You will feel empowered and confident on the day of your child’s birth because you have informed yourself and you’re not simply at the mercy of the professionals and protocols surrounding you.

Marsden Wagner, doctor and author of the book entitled Creating Your Birth Plan: The Definitive Guide to a Safe and Empowering Birth, dives deeply into the details one may want to include in a birth plan. This book is highly recommended for you if you’re preparing to sit down and get your birth plan on paper so you can present it to your provider. The purpose of this post is to outline some quick tips from the book on how to best present your wishes and increase the likelihood of you and your care provider aligned regarding these wishes.

Keep your Birth Plan Flexible
Make it known in your birth plan that you fully understand your list of desires are a wish list for your ideal outcome. While you do anticipate having a smooth labor and delivery and you do expect your provider to respect your wishes, you’re also not blind to the fact that the process is not totally predictable. Wording such as “Unless there is an emergency…” or “If circumstances allow…” relay this message clearly.

Be Brief
A one page birth plan is the goal, but no more than two pages maximum is best. This helps to ensure that everyone on your birth support team will be able to read over and recall what you have listed. If you have specific details that go beyond what is necessary for your care provider/nurses to know, it’s a good idea to have a longer version with those details for your partner, doula, or other advocate to familiarize themselves with so that they can be addressed as needed throughout the labor process. A bulleted birth plan is best, making it easier to read.  Full paragraphs can be daunting for busy L&D staff.

State your Plan in the Positive
Rather than presenting your birth plan as a list of things you do not want done, phrase things in the positive. Keeping your phrasing positive helps decrease resistance from caregivers. Try stating what it is you do desire followed by the intervention or procedure you’re hoping to avoid. For instance, “I wish for my perineum to remain uninjured in the labor process; however, if the situation arises, I prefer to tear naturally rather than have a surgical cut.”

These three basic guidelines should really help jump start the creation of your birth plan. Having solid parameters for how to present your birth plan so it meets the least resistance among your care team is a huge step in the direction of a desired labor and delivery. While many considerations remain as far as what exactly you may want to include in your personal plan, knowing how to get those ideas on paper is the first phase of drafting your birth plan. You’re encouraged to purchase or borrow a copy of Dr. Marsden Wagner’s book, Creating Your Birth Plan: The Definitive Guide to a Safe and Empowering Birth for a full and detailed process for creating your birth plan.

Why get Chiropractic Care During Pregnancy?

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chiropractic care pregnancy

Pregnancy does a number on the body! From pushing organs up and out of the way to affecting
one’s posture to restricting full-range-of-motion. There’s no question that pregnancy can be the
root of discomfort. Thankfully, there is hope! Chiropractic care during pregnancy can help keep
the spine, pelvis, and hips healthfully aligned in order to prevent or put a stop to aches and
pains you may have believed to be unavoidable. It could even make for an easier labor.

The gold standard for chiropractic care during pregnancy is the Webster-technique, named after
Dr. Larry Webster who originated this technique that prioritizes pelvic alignment and has been
shown to improve pregnancy, labor, and delivery outcomes. When considering chiropractic for
your pregnancy, please look for a Webster-certified chiropractor. This particular method of
chiropractic has a variety of benefits.

Easing Common Pregnancy Discomforts
Many women deal with various discomforts or pain during pregnancy. Low-back-pain is very
common as is hip-discomfort. Pubic-symphysis-pain, which can at times be extremely
uncomfortable, is also seen frequently in pregnancy as the pubic bones shift to allow room for
baby. Chiropractic can help in reducing pain associated with pregnancy by assuring that all the
bones affected are kept well-aligned and by reducing or negating spinal pressure which, left
untreated, can lead to pain.

Smoother, Quicker Labor and Delivery
Regular chiropractic adjustments during pregnancy can lend to a smoother and quicker labor
and delivery. Through keeping your body in ideal alignment and in turn, helping baby into an
optimal position, labor and delivery are less likely to have complications. Chiropractic has even
been cited as helping move a breech baby into a head-down position. Chiropractic primes your
body to push baby down and out so you don’t expend unnecessary energy and time during
labor waiting for your body to make the adjustments needed to help baby out.

Improved Nervous System Function
Keeping one’s spine in alignment through regular chiropractic care helps to keep the nervous
system functioning properly and can improve overall health. Having improved nervous system
function allows the body to more readily adjust to all of the internal changes pregnancy causes
and can help to keep you more comfortable and physically healthier throughout pregnancy.

Recovery after Delivery
Chiropractic care shouldn’t be limited to pregnancy alone, it also works wonders at helping you
recover after delivery. By seeing a chiropractor shortly after delivering your baby, your body will
become realigned more quickly and you’ll feel better sooner. This is particularly helpful when
you have a new baby to care for and no time to deal with pain or discomfort.

If you’re dealing with discomfort during pregnancy or just simply looking to keep yourself healthy
and properly aligned while growing your baby, chiropractic is the way to go! Optimizing your
health and bodily-alignment during pregnancy benefits both you and baby Seek out your
nearest Webster-certified chiropractic provider and make that appointment today, you will be
thankful you did.

 

If you are in the San Antonio area, check out the San Antonio Birth Network for our preferred chiropractors.

Delaying Baby’s First Bath: Shown to Increase Breastfeeding Rates

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There are a number of things that can be implemented or avoided to increase breastfeeding
rates for new babies. These things range from baby being held skin-to-skin for at least the first
hour immediately following birth, to opting not to send your newborn to the hospital nursery, to
having a birthing team that is supportive of breastfeeding, among a host of other
recommendations. This past January, something additional was added to the list: delayed
bathing.

Recently, a study at the Cleveland Clinic, has determined that there is a link between delaying a newborn’s first bath and an increase in exclusive breastfeeding rates. While the traditional hospital-protocol has baby
being bathed very shortly after birth, this study of about 1,000 newborns showed an eight
percent increase in exclusive-breastfeeding rates for babies whose baths were delayed by at
least twelve hours following birth.

The reasoning behind this correlation is thought to be three-fold: scent, increased skin-to-skin contact, and temperature regulation.

Scent
There have been prior studies that point to the idea that the scent of amniotic fluid left on baby’s skin after birth is similar to that of mother’s breast. By leaving the baby unbathed, this allows baby to use its own familiar scent as a guide to locate and take to mother’s breast for the first
feeding. This provides for a solid-latch to the breast and for successful breastfeeding-initiation.

Increased Skin-to-Skin
What may seem very obvious but is still significant, is that keeping baby with Mom after birth
rather than sending baby away with a nurse for a bath is that Mom and baby are able to have
that much more skin-to-skin contact. It is now widely known that keeping baby directly on Mom’s
chest after birth and even for the months succeeding birth definitely lends to an increase in
nursing and milk production. So, having that extra time to hold baby skin-to-skin directly after
birth can make a big difference in the long-term success of that breastfeeding relationship.

Temperature Regulation
While the increase in skin-to-skin alone also lends to helping baby’s temperature remain
regulated, the absence of immediate bathing also has an effect. One may think a warm bath
wouldn’t cause temperature issues, however it does cause a decrease in temperature which is
not ideal for a newborn. A decrease in temperature of even just one degree diverts energy and
oxygen to increasing temperature. Both that energy and oxygen are better-spent on other bodily
processes such as feeding and healthy respiration.

This study has prompted the Cleveland Clinic to rewrite their newborn-bathing protocol and now
they encourage parents to wait at least twelve full hours for baby’s first bath. Even in a case
where parents prefer an earlier bath, the hospital asks that bathing be delayed for two hours
after-birth. It is encouraging that something so simple is linked to an increase in exclusive
breastfeeding. At a time when new parents may feel like it’s difficult to keep up with all the
recommendations, this is one that takes no effort and even provides extra newborn snuggles.
It’s a win-win situation for all involved!

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