Choices Around Work

 This is the column where our readers can write in with their questions. We’ll field the questions to one or more experts in the subject and post the responses typically within 2 weeks. Write Us with Your Question!

Marcia Clark

Marcia Clark, Life and Legacy Coach


Q: I am 40 and pregnant with my first child who is due in March. I am having a hard time determining how much time to take off of work when baby comes. I love my work and am eligible for 3 months off. Being away from work for that long has both its pros and cons. How should I go about considering this important decision?

Our Expert who responded is Marcia Clark is a Legacy and Life Coach based in Austin, Texas and a Board Member of the Nonprofit Advanced Maternal Age Project.

A: First of all, congratulations! What a wonderful time in your life. Enjoy each moment!

How fortunate for you that you have a job you love. But I also know just because you love it doesn’t make the decision any easier…and possibly harder. Often times until we are faced with a situation it is difficult to know how we will react or what we really want. Some questions I have for you to consider are as follows:

  1. What are you most afraid of?
  2. What are you most excited about?
  3. When do you have to make the decision?
  4. What flexibility do you have, if any?
  5. What would it do for you to wait until the baby comes to make the final decision?
  6. How might you look at it differently after the baby comes?
  7. If you could create the ideal situation, what would it look like?

One of the tools I use with my clients is the Pain Gain Chart from where I received my coaches training, IPEC. It is a very helpful tool when trying to decide between two choices. I call it the dimensional “T” chart as it can offer much deeper insights. You can also continue to use it to “drill down” with each decision you make.

Here is how it works:

  1. On a piece of paper write across the top Pain and Gain.
  2. Then along the side write the two choices you are faced with. In your case, “Return to Work” and “Don’t Return to Work.” This will create four quadrants.
  3. Now begin within each quadrant and record the first thoughts that come to mind WITHOUT much reflection. i.e. the Pain of Returning to work in the top left quadrant, the Pain of Not Returning to Work in the lower left quadrant, continue with the Gain Sections.

See what enfolds for you. Often times you will discover things you had not thought of, one quadrant may emerge dominant, a clear decision may emerge, or a totally different solution may come to you.

Sometimes what blocks us is the pressure that we are making a decision that will have to last forever. Allow yourself the freedom to revisit your decision in the future. Life is about choice and endless possibilities. Whatever choice you make will be the right one for you! And that is what matters. Wishing you all the best!

Marcia Clark offers a complementary session in person or by phone to those who are interested in receiving life coaching and creating plans for their legacy. Contact her at coachingbyclark@gmail.com

Selecting a Midwife

This is the column where our readers can write in with their questions. We’ll field the questions to one or more experts in the subject and post the responses typically within 2 weeks. Write Us with Your Question!

Kelly Hamade, CNM

Kelly Hamade, CNM

Q: I am 37 and considering having a midwife deliver my first child and would like to know how best to select one that is a good fit for me and my husband. What questions should I ask them?

Kelly Hamade is a Certified Nurse-Midwife with OBGYN-North and Natural Beginning Birth Center in Austin, Texas. She has 3 children, 2 born at home and 1 in the hospital. 

A: Choosing a health care provider during pregnancy is a big decision. As with most things, one size does not fit all and it is always a good idea to weigh your options carefully. When considering a midwife, you should be aware that there are different types of midwives and their scope of practice, experience and education may vary. Midwives also attend deliveries in a variety of settings including home, birth center and hospital. Many work independently while others are employed in a group practice.

As you interview prospective midwives, some general points to consider include her training, education and experience, options for location of delivery (home, birth center or hospital), if they share an office rotation or call schedule with other providers – can you meet the other providers, insurance coverage and fees. You might also ask about requirements for prenatal childbirth education, length and frequency of prenatal visits, pain-management options for delivery and follow-up care after delivery. Discuss your desires surrounding your pregnancy and childbirth experience and inquire about their philosophies.

Childbearing women who are under a midwife’s care generally have normal pregnancies without complications. Midwives are trained to recognize complications and variations of “normal” and often collaborate with other providers such as obstetricians, maternal-fetal specialists, chiropractors, massage therapists and lactation consultants. Talk with your prospective midwife about your risk factors. During the interview process, you may wish to disclose your age and any other concerns that may impact your pregnancy and labor. Inquire about any relative policies, protocols or guidelines that may affect your care. You may wish to research your options for genetic testing and find out which tests are offered, and which are recommended based on your age. Additionally, what other types of prenatal tests are offered or recommended based on your circumstances? Ask which conditions you are at increased risk for and how you will be screened. Find out the midwife’s policy in the event that a high-risk condition develops during your pregnancy, delivery or post-partum period. Are there other providers in their practice that are available to co-manage those complications or would you need to transfer to another group? Good luck and best wishes on your journey!

 

 

 

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Natural Labor Induction with Acupuncture

Sadie Minkoff

Sadie Minkoff L.Ac., FABORM

This is the column where our readers can write in with their questions. We’ll field the questions to one or more experts in the subject and post the responses typically within 2 weeks. Write Us with Your Question!

Q: I read that some women use of acupuncture to induce labor as an alternative to pitocin after 39 weeks of gestation. How does this work and is it safe?

Sadie Minkoff, L.Ac., FABORM and team at Sage Acupuncture in Austin specialize in Reproductive Acupuncture and Chinese Medicine. 

A: Acupuncture is often used as a safe and drug-free method for encouraging labor to commence. In fact, several studies have shown that acupuncture intervention is effective in facilitating a more efficient birth.

Labor induction, defined as when labor is “initiated artificially with drugs,” is actually a misnomer when used to describe how acupuncture works. Acupuncture supports the natural unfolding of the birthing process rather than an exogenous intervention forcing the body to do something it would not otherwise do.

  • In our experience, the best results come when acupuncture is used as a pre-birth treatment, preparing the body for labor gradually with one treatment a week starting at 36-37 weeks gestation.
  • This is the perfect time to reduce stress, and support energy and stamina for labor. Treatments are tailored to each individual woman’s body and pregnancy history, with a focus on ripening the cervix and positioning the baby optimally for labor.

As background, a 2004 observational study looked at the effect of pre-birth acupuncture (Medical acupuncture 2006 May; 17(3):17-20). Data on 169 women who received pre-birth acupuncture were compared to local population rates for gestation at onset of labor, incidence of medical induction, length of labor, use of analgesia and type of delivery:

  • In the acupuncture group comparing all caregivers (including midwives, OBs and specialists) the following were the overall statistics: 35% reduction in the number of inductions (for women having their first baby this was a 43% reduction) and a 31% reduction in the epidural rate.
  • When comparing midwifery only care, there was a 32% reduction in emergency caesarean delivery and a 9 % increase in normal vaginal births.
  • There was no statistical difference in the onset of early labor in those women receiving pre-birth acupuncture.

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National Cost for an IVF Cycle

Write Us with Your Question! Here’s a recent one we received.

Q: My husband and I are considering adding to our family. I am 42 and we have twins. I prefer not to have another set of twins. What are the costs for IVF using my own egg (roughly)?

Natalie Burger, M.D.

Natalie Burger, M.D.

Response from Natalie Burger, M.D., Texas Fertility Center:

A:  The national average for the cost of a fresh IVF cycle is $10,000 plus the cost of medication, which itself can range from $3,000 to $6,000.  As each situation is unique, some patients/couples may require additional IVF treatment steps that may add cost.

For instance, technology now allows us to genetically test embryos so that only chromosomally normal embryos are transferred into the uterus.  This increases the chance of successful pregnancy and significantly lowers the chance of miscarriage. This additional testing may add an additional $4,000 to $5,000 to the overall cost.

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Considering Foster Parenting

This is the column where our readers can write in with their questions. We’ll field the questions to one or more experts in the subject and post the responses typically within 2 weeks. Write Us with Your Question!

Q: My husband and I had our daughter when I was 39 and now that she’s three years old, we’d like to add to our family. Having been through a pregnancy and now raising a daughter who is genetically related to us makes us open to expanding our family by being foster parents and potentially adopting. What should are the steps for fostering?

Response from Sharon Munroe, founder/executive director:

Family photo

Sharon, Jasmine (at her third birthday) and Grandma Barbara.

A:  There are choices for adding to a family through foster care, domestic and international adoption. Here are the steps we took to add to our family through foster care:

  1. My husband and wanted to learn more about fostering and adopting and went to an orientation with our state agency “CPS” in January 2010.
  2. In March of that year we were selected to begin training in Texas’ PRIDE Program with the hope of being certified as a foster and adoptive home and being able to care for a child. (Many similar training and placement programs exist in our city and across the country, including those with private agencies.)
  3. In that six-week period, we had lots of homework, including paperwork to complete, home and fire inspections, a first aid and CPR training class and of course, a home study. Early in the process, we also had the mandatory criminal background checks.
  4. A Home study is next. During that visit, we talked with a social worker about a variety of topics including our own childhoods, and our values and plans for the placement. Importantly, we were asked about our support network and how our families, friends and neighbors would react to a foster placement and adoption of a child.
  5. Once we were certified as a foster and adoptive family we waited fora call. The waiting was hard.
  6. We received a call from our local child protective services office and received our foster daughter and paperwork.

(She was eligible for adoption 1.5 years later and we adopted her at age 2. She is shown celebrating her third birthday in the photo.)

You can learn more, and find out if foster or foster-to-adopt is the right way to build or expand your family at the State of Texas website, or your state’s Child Protective Services website.

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Proactive Fertility Planning

This is the column where our readers can write in with their questions. We’ll field the questions to one or more experts in the subject and post the responses typically within 2 weeks. Write Us with Your Question!

Q: I am 30 and starting a doctoral program soon, which I know is at least a five-year commitment. I am not yet married and know that I would like to complete my degree and be married prior to starting my family. Having never been pregnant before, what evaluations and tests can be performed to test my fertility?

Natalie Burger, M.D.

Natalie Burger, M.D.

Response from Natalie Burger, M.D., Texas Fertility Center:

A:  It is common for women these days to put off family plans until they become more settled in their career and life.  However, it’s important to not ignore the fact that, as we get older, we have fewer good eggs left.

Checking an AMH (antimullerian hormone) level is a easy way to give you information on your relative egg quantity – i.e. do you have a lot or only a few eggs left.  If the test shows a low result, it’s important to talk with a fertility specialist promptly to understand your options.  This blood test can be done on any day of your menstrual cycle and even if you’re on the birth control pill.

To safeguard your fertility, it’s important to also continue regular exams with your gyn provider, who can monitor you for any new gynecologic issues.  Also, avoid smoking as this can prematurely diminish your egg count.  Practice safe sex so that you don’t expose yourself unnecessarily to infections that can cause scar tissue.

Overall, it’s important to be proactive when thinking about fertility – this will help you to optimize your chances when you are ready to start a family.

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On Parenting Styles

This is the column where our readers can write in with their questions. We’ll field the questions to one or more experts in the subject and post the responses typically within 2 weeks. Write Us with Your Question!

 Q: Getting ready for my first child to be born, I’ve heard about many styles of parenting. How do pediatricians feel about these styles?

Dr. Kibler

Dr. Elise Kibler, Capital Pediatric Group, Austin

Response from Elise Kibler, M.D., Capital Pediatric Group

A:  Parenting styles can vary significantly.  There are a number of different parenting styles.  In my opinion, parents need to be flexible with their parenting style.  Children of different ages and maturity levels will need different parenting styles.  Different situations over the course of a day may call on different parenting styles as well.

Attachment parenting encourages parental proximity to the child, consistent caregiving by parents, and protective parenting style which meets the basic needs of the child.  Parents usually sleep in the same room as the child as well.  This is a good style to support when the child is young and fully dependent on the parent.

 

Another parenting style is authoritative parenting.  With this style of parenting, parents respond to concerns and questions from their children.  They are also willing to adjust plans based on the needs and wishes of their child.  Parents do have rules that their children are expected to follow, but parents are flexible and adjust to the situation at hand.  Discipline involves supporting their children when they are making good decisions rather than being overly negative.  This parenting style encourages independence and is appropriate for children beyond infancy.
 
A third style of parenting is authoritarian parenting.  In this style, the child is expected to follow strict rules established by the parents.  This set of rules is set by the parents and non-negotiable.  Failure to follow the rules results in punishment.  This style of parenting plays a role in certain situations, but requires a high level of maturity on the part of the child to comply.  Certain rules require an authoritarian style of parenting such as “don’t open the door for strangers”, “no drugs or alcohol”, and “no hitting or biting”.  Parents need to pick their battles.  When authoritarian style of parenting is used constantly or restricts a child’s ability to make their own decisions it can lead to insecurity and anxiety.
 
Permissive parenting involves letting the child do whatever they want without regard to the needs or wants of other people.  These parents are still responsive to their child and play the role of a “friend” more than an authoritative figure.  This may serve a role from time to time such as on birthdays and special occasions.  My children periodically have a “special day” where they can pick what they want to do and where they want to go.  Although the child has a sense of total control, it is important to allow options that are feasible and desirable for the parent as well.  For instance, if the child wants to go to a place that is not safe or too far away the parent will ask the child to pick another option? Giving the child a sense of control periodically can be very healthy for a child and allows them to cope with situations such as getting shots at their check-up where they lost control.
 

Uninvolved parents are not responsive to their children, do not provide limitations, and are basically absent in their child’s life.  This style of parenting plays no role in a healthy parent-child relationship.

 
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Treating Allergies While Prergnant

Sadie Minkoff

Sadie Minkoff L.Ac., FABORM

This is the column where our readers can write in with their questions. We’ll field the questions to one or more experts in the subject and post the responses typically within 2 weeks. Write Us with Your Question!

Q: My nasal allergies are much worse now (at 4 months pregnant) than they were a year ago. What are some ways to feel better that won’t potentially harm me and my baby?

Sadie Minkoff, L.Ac., FABORM and team at Sage Acupuncture in Austin specialize in Reproductive Acupuncture and Chinese Medicine. 

 

This is a great question! We treat many pregnant women suffering from allergies. Not only because we live in Austin, the “allergy capital of the world” but also because when you are pregnant, your mucus production increases and your immune system is often more sensitive.

Here are 5 Tips to Help you Feel Better Naturally:

  1. Try a daily nasal wash like the Neti pot, to decrease sinus congestion and inflammation.
  2. Take a shower in the evening to wash away any residual pollen or dust from the day.
  3. Stay well hydrated and get as much rest as possible to keep your immune system strong.
  4. Reduce or eliminate dairy (goat dairy is less congesting than cow), as well as refined sugar, which contribute to inflammation and increased phlegm accumulation.
  5. Last but not least, acupuncture is a great support for allergies and for prevention of sinus infections. It is recommended for many pregnancy-related symptoms such as sciatica, insomnia, nausea, digestive upset, stress, fatigue, and yes, allergies.

Research has shown that acupuncture has a positive effect on the immune system as well as relieving the uncomfortable symptoms associated with allergies, including: sinus congestion, sneezing, runny nose, headaches, scratchy throat, and fatigue.

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Healthy Eating During Pregnancy

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Margaret Connor

Margaret Connor, MPH, CHC

Q: I’ve always had a pretty healthy diet but now that I am pregnant, what vitamins, minerals and other nutrients are critical to include for optimal health for me and my baby?

Response from Margaret Connor, MPH, CHC, The Wellness Pantry

A: It sounds like you have already helped yourself and your baby by eating healthy before your pregnancy began, which is terrific. Now let’s examine how our metabolic needs do increase during pregnancy. The following vitamins and minerals play a special role in your health and that of your child’s during pregnancy (and often postpartum as well). One exciting detail to consider is that the absorption of nutrients across our intestinal barrier typically increases during pregnancy, so eating good sources of these vitamins and minerals will go a long way towards keeping you equipped with the necessary nutrients.

FOLATE – You’ve probably heard your OB mention this as a valuable supplement that you might have been taking even before you became pregnant. The evidence that folate reduces the risk of neural tube defects is so compelling that the U.S. started fortifying grains with folate in 1998. The current recommendation is for women with child-bearing potential to be taking 400 micrograms/day and for pregnant women to take 600 micrograms/day. Good dietary sources of folate include broccoli, spinach, lentils and other beans. FUN FACT: Did you know that folate is actually Vitamin B9?

IRON – This is the most common deficiency we see in pregnancy and it typically appears in the second or third trimester. During the first trimester, your body’s increased metabolic demands for iron are balanced out by the fact that you are no longer menstruating each month. However, your body’s demands for iron will increase during your pregnancy and as such, your doctor will likely be keeping a close eye on your levels. On average, 13-40 mg/day of iron supplementation is recommended. Most prenatal vitamins (which we actually take during pregnancy) contain about 30mg. If you are found to be iron-deficient, or anemic, your doctor will place you on a higher dose and recommend that you continue supplementation postpartum. The best dietary sources of iron are read meat, poultry, fortified cereals and beans. Iron is best absorbed from food when it is eaten with foods containing Vitamin C.

CALCIUM –  Calcium is required for your baby to grow healthy bones and teeth. Some studies have also shown  that calcium supplementation during pregnancy can lower your risk for pregnancy-induced hypertension and preterm delivery due to preeclampsia. It is recommended that pregnant mamas get 1000mg of calcium per day. The average daily intake for most women is about half that amount. As a result, most prenatal vitamins provide calcium supplementation. Good dietary sources of calcium include dairy products, sardines, collard greens, sesame seeds and tofu. To be honest, with the exception of dairy (which I don’t tolerate) that can be a tough list of foods to find palatable during pregnancy. Just do what you can.

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Newborn Tests

We have begun a new column where our readers can write in with their questions. We’ll field the questions to one or more experts in the subject and post the responses typically within 2 weeks. Write Us with Your Question!

 Q: What newborn care is given typically at the time of birth and what are the tests and checks done on a healthy newborn during our hospital stay?

Dr. Kibler

Dr. Elise Kibler, Capital Pediatric Group, Austin

Response from Elise Kibler, M.D., Capital Pediatric Group

A:  When a baby is born, the healthcare providers should allow time for immediate skin-to-skin between mother and baby.  Skin-to-skin time is the best way to warm and comfort a baby, encourage bonding, and stimulate milk production.  They should assist the new mother in establishing a good latch and supporting breast feeding.

Two injections are given to the baby shortly after birth – the vitamin K and Hepatitis B vaccine.  The vitamin K prevents bleeding in the newborn period.  The Hepatitis B vaccine prevents a liver infection that can affect newborns.

When at the hospital, the infant has its breathing and temperature monitored by the nurses periodically and is checked daily be the pediatrician.  A pediatrician will look at the baby from head to toe.  We check to make sure the eyes developed well, soft spots are open and in good position, check the heart and lungs, and also look at the hips to ensure that the ball and socket joint developed well.  We also look for rashes, tongue-tie which can affect a latch, and other congenital abnormalities.

During the second day of life, hospital staff will check the newborn’s hearing.  This is required by state law.  It will not be done at a home birth and is usually not done in a birthing center.  If that is the case, it should be arranged later by the child’s pediatrician.

During the second day of life, the hospital staff will also check the newborn’s jaundice level.  Jaundice is caused by the buildup of bilirubin which is a protein in the blood stream.  It is typically flushed out by the liver once the child’s gut matures and starts eating and stooling at full speed which is usually starting on the 5th day of life.  The level of jaundice should be checked by the hospital before the baby leaves and then followed up by the pediatrician between one and three days after discharge (depending on the level).  Getting outdoors helps clear this jaundice and can be beneficial in allowing the newborn to make vitamin D as well.  Ask your pediatrician more about vitamin D and the best way to make sure your child will get enough.

A heel prick to obtain blood sample will also be done on the newborn.  This is called the newborn screen or metabolic screen test.  It tests for 30 different congenital and metabolic abnormalities that are important to pick up in the newborn period.  It is done on the second day of life and repeated when the baby is two weeks old.

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