Well Woman Check-ups and Annual Exams

The Nurse-Midwives at Women's Circle are dedicated to helping you stay healthy throughout your lifetime.

During your well woman exam, a comprehensive health history and physical exam will be done including a breast and pelvic exam. If you need a pap smear, which is a test done to screen for cervical cancer, it will be done at this visit as well. Depending on your age and risk factors, testing for sexually transmitted disease can also be done. Women who are forty years old or thirty five with a family history of breast cancer will receive an order for a yearly mammogram. Your annual exam is a great time to check on your general health as well. During your visit, you will receive guidance on exercise, nutrition and healthy lifestyle habits and other laboratory tests such as cholesterol screening, complete blood count and urinalysis may be ordered. If you are in your childbearing years, the midwife will discuss with you your plans for pregnancy and/or birth control needs, how to prevent sexually transmitted diseases, and healthy lifestyle counseling.

If you are past your childbearing years, your well-woman exam is a great opportunity to discuss concerns you may be having about menopausal symptoms and ways to get relief, keeping your bones strong and ways to stay healthy and fit.

In the past, pap smears were done on a yearly basis but the guidelines have now changed. The new guidelines call for routine paps to begin at age 21. Previously, it was recommended that women get their first cervical cancer screening within three years of first having sex or at age 21. The new guidelines also recommend women 30 and older should wait three years between pap smears once they've had three consecutive clear tests, and that women 65 to 70 should stop having paps entirely if they've had no abnormal test results in the last 10 years. If you have never been sexually active, a pap smear is not necessary. The change in the pap smear guidelines comes from research that shows screening too often can be harmful. Precancerous growths, commonly found in young women with HPV, will go away if left alone. Those growths that are removed can lead to damage to the cervix and present problems later when a woman becomes pregnant. At your well woman exam, the nurse-midwife will make sure you receive the care you need at the right time in your life!

Childbirth Book Recommendations

  1. Ina May's Guide to Childbirth [Paperback]
  2. Divine Delivery - Guided Meditations for Pregnancy and Childbirth
  3. Pregnancy, Childbirth, and the Newborn (4th Edition): The Complete Guide [Paperback]
  4. Childbirth Without Fear: The Principles and Practice of Natural Childbirth by Grantly Dick-Read
  5. Tune Your Brain: Pregnancy and Childbirth
  6. The Complete Breastfeeding Book: How To Make More Milk
  7. Prenatal Music for Life - Teaching Baby Before Birth and During Infancy
  8. Pregnancy Relaxation: A Guide to Peaceful Beginnings
  9. Labor/Birthing from the Inside Out [Audio CD]
  10. Easy Labor: Every Woman's Guide to Choosing Less Pain and More Joy [Paperback]
  11. Earth Mama Angel Baby C-Section Recovery, 1 CD
  12. The Thinking Woman's Guide to a Better Birth [Paperback]
  13. Giving Birth: A Journey Into the World of Mothers and Midwives [Paperback]
  14. Birth as an American Rite of Passage: Second Edition [Paperback]
  15. Spiritual Midwifery [Paperback]
  16. Birth Matters: A Midwife's Manifesta [Paperback]
  17. Ina May's Guide to Breastfeeding [Paperback]
  18. Birth Partner, Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions
  19. The Official Lamaze Guide: Giving Birth with Confidence, 2nd Edition [Paperback]
  20. Meditation a Foundation Course: A Book of Ten Lessons [Paperback]
  21. A Woman's Spirit: More Meditations for Women
  22. Hypnobirthing: Mongan Method: Natural Approach to a Safe, Easier, More Comfortable Birthing
  23. Meditations for Pregnancy: 36 Weekly Practices for Bonding with Your Unborn Baby
  24. Painless Childbirth: An Empowering Journey Through Pregnancy and Childbirth [Paperback]

Waterbirth / Hydrotherapy in Labor

Being as comfortable as you can during labor

Hydrotherapy, better known as using water to relax and provide pain relief in labor has been a method used by women intuitively for thousands of years. Warm water relaxes the muscles and eases tension and can be a great pain reliever in labor. The first documented water labor and subsequent birth happened in 1803 in France. In the United States the value of warm water in labor started to get attention in 1967.

Hydrotherapy use

For many women, hydrotherapy or the use of water as a non-pharmacologic pain relief technique is extremely desirable for labor. This can be a great tool for women who want to minimize their exposure to IV drugs or an epidural in labor. Hydrotherapy may be in the form of a warm spray of water from the shower aimed at the lower uterine segment to relieve the stretching sensations of the ligaments and areas associated with posterior presentations. Laboring in a tub can increase a laboring woman's pain tolerance making it easier to cope with labor . Tubs that maintain the water temperature at or around body temperature (98° F - 100° F) also soothe tired and aching muscles and ligaments – helping with further relaxation of the mother. Research reviewed in the article by Schorn, McAllister and Blanco show "the benefits of water immersion include faster cervical dilation resulting in shorter labors, increased relaxation and decreased pain". Cervical dilation was more rapid in one group (2.5 cm/hour) as compared to 1.25 cm per hour in a control group. Other studies have documented the great anxiety relief and fast pain relief mothers feel upon entering the water in labor. To be sure, warm water is soothing to the body and mind, and this relaxation allows the woman to feel less pain. Some studies cite up to an 80% reduction in the pain women felt when immersed in warm water.

Pregnant women often comment about how good it feels to float either in the tub or in a pool as the water supports the body. Buoyancy in the labor tub allows for an almost weightless feeling. Women who need to move during labor to enhance progress truly benefit from the ease of movement in a labor tub.

The nurse midwives at Women's Circle understand and support your choice to use water to relax and minimize the pain you feel in labor. We encourage women in the earlier parts of labor to remain at home and use the tub or shower for pain relief and relaxation. On arriving to the hospital, women who desire to be mobile and use the shower are encouraged in this. Fremont Medical Center is currently building a new hospital where the labor rooms will have tubs in them to provide easier access to this valuable tool to help make your labor as comfortable and satisfying as possible.

Low Income Family Planning services

Birth Control Pill Counseling

Family Planning services allow women to determine when and how many children to have. Being prepared and planning your pregnancy results in better outcomes for you and your baby and keeps you healthier. Women's Circle has a strong commitment to providing family planning services for women of all income levels. We offer a sliding scale for birth control services and consultations. In the near future, Women's Circle will be partnering with Family PACT, a state funded family planning program which covers all the costs for these services for low income women. Services offered include consultation for oral contraceptive pills, Ortho Evra patches, Nuva Ring, Depo Provera injections, diaphram fitting, condoms/films/spermicide gel, Natural family planning (Rhythm method), Intrauterine systems including Paragard and Mirena. We also can provide consultation and referral for tubal ligation (surgical sterilization) and Essure (non-invasive sterilization).

Missed Birth Control - Emergency

Contraceptive Counseling and Pill Prescription

Emergency birth control can be used up to five days after unprotected intercourse to prevent an unwanted pregnancy. However, the sooner it is started, the better it works. If you are aged 17 or over, both Plan B and Ella are pills that are available over the counter without a prescription. The price you pay may vary from $10.00-$70.00. If you are under 17 or need a prescription you will want to call to talk with a nurse-midwife for advice and an appointment. In any case, it is important to schedule an appointment after using emergency contraception so you can choose a more effective, long term method of birth control. A Paragard IUD (intrauterine device) can also be placed and used as emergency birth control, is 99.9% effective, and can then stay in place offering you long term pregnancy protection. Emergency contraceptive pills reduce the chance of pregnancy by 89% when taken in the first 72 hours after unprotected intercourse, but are less effective as time passes. Some instances where emergency birth control may be a good option for you are : 

  • The condom broke or slipped off, and he ejaculated in your vagina
  • You forgot to take your birth control pills, insert your ring, or apply your patch
  • Your diaphragm or cap slipped out of place, and he ejaculated inside your vagina
  • You miscalculated your "safe" days
  • He didn't pull out in time
  • You weren't using any birth control
  • You were forced to have unprotected vaginal sex

All brands of the morning-after pill work by keeping a woman's ovaries from releasing eggs — ovulation. Pregnancy cannot happen if there is no egg to join with sperm. The hormone in the morning-after pill also prevents pregnancy by thickening a woman's cervical mucus. The mucus blocks sperm and keeps it from joining with an egg. The morning-after pill can also thin the lining of the uterus. In theory, this could prevent pregnancy by keeping a fertilized egg from attaching to the uterus. You might have also heard that the morning-after pill causes an abortion. But that's not true. The morning-after pill is not the abortion pill. Emergency contraception is birth control, not abortion. If you do not have your period within three weeks after taking emergency contraception, you may want to consider taking a pregnancy test. The morning-after pill offers no protection against sexually transmitted diseases or infections. You may want to consider STD testing if there is a possibility that unprotected sex put you at risk.

After using Emergency Contraception Pills your period may be different from usual; either lighter, heavier, early or later than normal. Some women experience nausea and vomiting from the pill, but usually taking the pill with food makes this less likely. Other mild side effects include: breast tenderness, irregular bleeding, dizziness and headaches. 

Emergency contraception is a safe and effective way to prevent pregnancy after unprotected intercourse. The nurse-midwives at Women's Circle want to help you prevent pregnancy when it is not desired and will work with you in these "emergencies" and then help you plan to find a birth control method that you are happy with and can rely on.

New and Innovative Birth Control Options

Birth Control Options For You

Women's Circle can help you find the right method of birth control to fit your needs and lifestyle. The nurse-midwives at Women's Circle want to support and help you to have a planned and desired pregnancy. Whether you have just had a baby or have never had a baby the nurse-midwives at Women's Circle are committed to helping you find a method that you feel happy and secure with. Women's Circle offers a broad range of all the latest methods of both hormonal and non-hormonal approaches and a personalized consultation with the nurse-midwife will help you find a method that works for you.

When thinking about birth control it is important to think about your life style and schedule. Some women feel confident about their ability to remember to take a pill everyday while others cannot handle one more thing to remember on a daily basis. Besides the birth control pill, of which there are many types and brands, there are other methods that you can use on a weekly basis like the Ortho Evra Patch. The patch is a low dose hormonal method where you apply a small adhesive clear patch to different areas of your body for three out of four weeks in the month. There is a monthly method called Nuva Ring, or "the Ring", which also is a low dose hormonal method that involves placing a small, plastic ring high in the vagina once a month. Another popular method, is called Depo Provera or "the shot", which is an injection that you receive once every three months. It is important to discuss side effects with your nurse midwife so you can make an informed decision and know what to expect after starting a method. In general, it is best to not use a hormonal method of birth control if you are a smoker.

Some longer term methods that are great for couples who want more time in between children or simply don't want to have to worry for several years about getting pregnant are the IUD's (Intrauterine Devices). There are two types of IUD's. The IUD is placed in the office and is a simple outpatient procedure that usually takes about ten minutes or so. The Paragard IUD works without hormones and is effective for up to ten years. The Mirena is another type of IUD that is also very popular. It does involve a slow-release of a small amount of hormone over a five year period. In general, the IUD is an excellent method which is extremely effective and allows for worry free birth control that you do not need to do anything on a daily basis to maintain. Both types of IUD's are reversible if you decide you want to get pregnant sooner the device can be removed and you can usually conceive shortly after

There are yet more options for birth control to choose from depending on your needs and lifestyle. For those women desiring a permanent solution to birth control there are some great options. The excellent and skilled obstetricians that we work with can help you with either having your tubes tied (tubal ligation) which involves anesthesia and being admitted to the hospital. There is also a newer system called Essure that can be done at the obstetrician's office with local anesthetic. Some popular non-hormonal methods we can help you with are using condoms, spermicide foam, gel, films as well as a diaphragm fitting.

Your nurse-midwife can provide more information on these and other methods that interest you and help you leave our office feeling relieved and satisfied with your new method of birth control. We realize that effective, and safe birth control is important to the women and families we serve and encourage you to call Women's Circle today and schedule an appointment . You will be given the time and attention you deserve as you and your nurse- midwife decide what the best method is for you!

Circumcision Pros and Cons

To Circumcise or not?

Like so many questions facing parents of a newborn baby, the decision whether to circumcise requires some careful thought and weighing the pros and cons of the procedure and then making a decision that you feel good about. It is not easy decision for sure, but definitely an important one that will affect your baby into adulthood and for the rest of his life, no matter which way you decide. One of the most common arguments I hear for deciding to circumcise is that the father of the baby is circumcised and the mother /father wants the son and father to both look the same. I also hear that it is just plain easier to clean and that there is less infection with circumcision. Let's think about these important points and feel free to click below for more information on the subject.

History of circumcision

As you may have heard, circumcision, the cutting of adhesions and retraction of the foreskin covering the glans of the penis has been done for centuries in many different cultures and religious traditions: from Ancient Egypt to mark the passage from childhood to adulthood, in the Bible in Genesis God told Abraham to circumcise himself, Ouch!, as well as all of his household and slaves as an everlasting covenant , in Africa as a rite of passage from a man into a warrior; in Judaism as a testament of faith. Interestingly, until 1870 or so circumcision was fading out of style and not many people thought it necessary anymore. From 1870-1910 there was a trend to prevent boys from masturbating and therefore circumcision since it produced long lasting pain and punishment in this area and was thought a good way to stop it. In the early 1900's one of the leading advocates of circumcision was John Harvey Kellogg, of Kelloggs Corn Flakes. He encouraged boys to eat Kelloggs corn flakes to prevent masturbation and also thought circumcision was helpful with this too.

The American Medical Association and the American Academy of Pediatrics do not endorse circumcision as a routine procedure for newborn male infants and wish for health care providers to help parents to understand the potential risks and benefits of the procedure.

The potential benefits:
May protect against penile cancer later in life, prevents inability to retract foreskin by cutting it away, may decrease urinary tract infections later, may decrease sexually transmitted diseases later, may lower cervical cancer in sexual partners later, easier to clean however when child is mature foreskin can be retracted and cleaned easily if not circumcised.

Potential harms:
Meatitis or inflammation of opening of penis from procedure, painful and traumatic procedure can make baby irritable and interfere with bonding, 38% rate of complications including hemorrhage, infection, surgical injury and death rarely, the evidence for reduction in sexually transmitted diseases and urinary tract infections is weak and has been disputed by the American Academy of Pediatrics, interferes with function of foreskin which is to protect the glans penis and heighten sexual pleasure and sensitivity.

Holstic Midwifery Model of Care

Your care at Women's Circle addresses you as a whole person

The midwifes will honor and support your individual physical, emotional and spiritual needs. We want to honor your journey as a woman no matter what stage or life you are in and help you be as healthy and well as possible. The midwife always takes the time to listen with her heart and her mind to give you the best care. 

During pregnancy, you will form a close bond with your midwife and get to know her and she will get to know you. The midwife is there to support and keep you healthy on all levels. In the realm of physical, you will receive preventative care during your pregnancy and other times that is aimed at preventing problems and disease. In the event that you have any medical complications during pregnancy or other times, you will be referred to a supportive obstetrician/gynecologist or your care will be co-managed by the midwife and obstetrician team. In cases where you need medications, only the safest will be prescribed, especially during pregnancy. The midwife is very knowledgeable about ways to take care of minor problems using nutrition and homeopathy which are both safe and effective and can help avoid medications in many cases. 

Your midwife wants to make sure you are feeling well on an emotional level as well and takes the time to listen and offer advice that may help you deal with difficult life issues you are facing. The midwife is very knowledgeable about people and resources in the area that can help you when you are going through a difficult time and will do all she can to help you feel stable and empowered as a woman.

On a spiritual level, the midwife recognizes that we are all spiritual beings and that it is helpful to nurture this vital part of ourselves whether it is through a church community, meditation, yoga, or just being conscious of your spiritual nature. Being pregnant and being a woman is part of our spiritual journey and realizing this connects us to our true nature which is rooted in light and love.

In all aspects of the care you receive at Women's Circle your wider connection to friends and family is nurtured and supported to the extent that these relationships are positive and helpful. During pregnancy, the midwife will help you as a couple prepare for the challenges of parenthood by helping you work with your strengths and weaknesses and help you grow into your new roles as parents. The midwife works with you and your partner towards realizing your very best individual and combined potential.

After Childbirth - Postpartum Period

Your first hours of recovery

As amazing and wonderful as it may be to finally hold your new baby and have the task of giving birth behind you, this is also a time that you need to rest and regain your strength and energy. The postpartum period begins after having your baby and continues as your body returns to its pre-pregnant state lasting a minimum of six weeks. During this recovery time, it is important to get plenty of rest and good nutrition. Breastfeeding will assist your uterus to contract and resume to the usual size of a small pear. Breastfeeding is also great because it helps you lose the baby weight you put on in the pregnancy very quickly and effortlessly. 

Some very common experiences that you may experience during this time but will go away soon are: Sweating a lot especially at night as your body releases fluid retained from the pregnancy. 

Vaginal discharge (lochia) will continue for up to 6 weeks following the birth. It should lessen in color and amount. If it returns to a heavier, bright red bleeding with or without cramps you should call the office. Use maxi pads rather than tampons during this time

Hair Loss - This usually ends within 2-3 months after giving birth and results from major hormone shifts.

Hemorrhoids - Usually subside in 2-3 weeks. If they were not present before your pregnancy, there is a good chance they will completely disappear. In the meantime, prevent constipation by drinking lots of water and eating plenty of fruits, vegetables and whole grains. Over the counter preparations such as Witch Hazel on cotton balls, or Tucks, Hydrocortisone cream, or Preparation H may be helpful.

Mood Swings - Hormonal changes, fatigue (not enough sleep), and the new responsibilities that come with having a new baby can all contribute to mood swings, irritability, and crying spells. It is important to get as much rest as possible during this time. Sleep when the baby sleeps and take advantage of opportunities to take naps. If you are feeling more than just a little moody or have thoughts of harming yourself or baby you please call the clinic to speak with the nurse midwife or go to the nearest emergency room. 

The Hospital

After you have your baby at the hospital you will rest and recover for a minimum of one day and if it is your first baby you will stay for two days. If you have a cesarean section you will stay a minimum of two days. If you need a cesarean section, an obstetrician will oversee the remainder of your care.

It is recommended you stay home the first two weeks focusing on taking care of both yourself and your new baby. Light housework such as meal preparation and laundry are fine. Let others help you during this time and rest as much as possible. It is best for both of you to stay away from anyone who has a cold or is not feeling well. It is also a wise idea to have anyone who holds the baby wash their hands first since a baby's immune system is not fully mature to fight off illness. 

We will see you in the office at 2 and 6 weeks after the birth of your baby. We are here for you all the time in between, if you have any concerns or questions.

Birth Setting Options

Homebirth, Hospital and Birth Center

Besides deciding on who will take care of you during pregnancy and your birth the place you choose to give birth is one of the most important decisions you will make while you are pregnant.

The place you are in when giving birth affects the care that you receive, the relationship with your family and caregivers, the amount of information you will receive, the choices and options you have during labor and birth and the degree to which you are involved with decisions about your care. If you are a well and healthy childbearing woman you can consider giving birth in a hospital, an out of hospital birth center or your home. It is important to choose a place of birth that offers care that is consistent with the best available research about safe and effective care. 

You want your birth environment to enhance your ability to give birth, as some environments may interfere with this natural process. It is ideal if the place of birth you choose has supportive staff able to comfort you and provide information to you and your family during this process. Each birth setting whether it be a hospital, birth center or homebirth practice has its own philosophy of birth, style of practice, type and number of caregivers, and varies regarding whether your insurance will cover services.

Hospitals

Hospitals have a lot of safeguards in place but also more interventions than other birth settings. Narcotics and epidurals are available, in early labor you can generally eat and drink as you please but in advanced labor most women prefer liquids or ice-chips. One advantage to having your baby in the hospital is that you can stay "away from home" and recover for one or two days. In general, hospital births are covered by insurance companies.

Homebirth

Many women choose homebirth for the privacy, intimacy and personal control it affords. A home birth typically has the lowest rates of medical intervention, and offers the best chance for a woman to birth without interruption by routine procedures. Insurance varies as to coverage for homebirths.

Birth Center

Freestanding birth centers are independent of hospitals. They often represent a compromise between the comforts of home and the equipment available in hospitals although any emergency or need for surgery will need to be transported to a hospital. Many offer birth tubs and the opportunity to labor in water. Most insurance companies will reimburse for a birth center birth.

Childbirth –A Rite of Passage

Bringing your baby into this world

The birth of your baby is one of the most exciting and magical moments in you and your family's life. All of the waiting and wondering what your baby will look like, what noises and expressions they will make is all of a sudden there before your eyes. It is a moment when time simply stands still. Your nurse midwife will encourage and support you so that you can embrace and enjoy this moment. Your partner and family are invited, with your permission of course, to participate in this process and to welcome the newest member of your family. The nurse-midwives at Women's Circle realize that your huge efforts and accomplishment in bringing your baby into this world are testimony to the fact that you can absolutely accomplish anything you put your mind to. Childbirth is one of the most challenging, but also one of the most rewarding experiences in a woman's life and can be an amazing tool to draw strength from to help you achieve your goals and dreams in the rest of your life. 

 

Natural Child Birth

At Women's Circle, the nurse -midwives are here to honor and value you and your choices. Some women prefer a natural child-birth, that is laboring without drugs or an epidural. For women who prefer to avoid any drugs, we applaud and appreciate your efforts and will help you to achieve this goal. There are many tools to help you with this: Lamaze or some type of childbirth education classes are very helpful as you want to be prepared for dealing with the contractions of labor. Women's Circle offers classes to help you meet your needs with learning ways to cope without drugs in labor. At your prenatal visits, we will discuss your upcoming birth and birth plan which will help you feel less anxious going into labor. The less anxiety and fear you have about the process the less pain you will feel. Time during your prenatal visits is devoted to talking about your birth plan and how to cope with labor and what labor is like to reduce your fear and anxiety, making it easier for you when labor starts. In addition, when you are at the hospital the nurse midwife and nursing staff will work with you to find different positions to help you feel most comfortable, walking if you are in early labor, and using the shower which helps soothe and relax you in labor and lessen your discomfort. Your goal of natural childbirth is something we want to help you with and feel just as pregnancy is a normal part of life so is giving birth, very special to be sure, but very normal and natural as well.

Epidural

The nurse- midwives at Women's Circle recognize that all women are unique and have their own individual preferences. We are here to support you and your family with what is right and good for you. Some women prefer to use IV medications or an epidural in labor and we fully support your choice in doing so. IV medications can help you relax with your contractions and sometimes ease the discomfort of labor enough to bring you to the point where you are ready to have your baby. An epidural can also be a great help when a mother is exhausted or unable to relax or cope with labor contractions. Since labor and birth are natural processes, it stands to reason that any interference with medications can sometimes have undesirable effects on this process. The nurse-midwives at Women's Circle are committed to providing you with accurate information to help you make well- informed decisions when it comes to childbirth and medications. 

 

    

Home Birth

Could home birth be an option?

Birthing at home is recommend for you if:
You are having a healthy pregnancy with no complications
You want to avoid an episiotomy, cesarean section, epidural and other similar interventions
You want to share the experience with your family and friends
You want to be free to move around, change positions, take a shower, and eat or drink freely during labor

Home birth is about:

Safety and Security
Reduced risks by avoiding unnecessary interventions
Reduced infection rates by avoiding hospital germs
Comfort and Personal Privacy
Freedom in choice of positions and intermittent monitoring
You have the authority to decide who is allowed in your birthing space
Water birth option to ease discomforts
Birthing stool and birthing ball available
Alternative pain relief
Family Intimacy
Partner involvement encouraged in some cases partners may catch the baby
Easier bonding and breast feeding
Sibling involvement as desired

Deluxe Care

Individualized care where the focus is on you and your choices
Extended prenatal and postpartum appointments for comprehensive care
Breast feeding teaching and support as part of integrated mother baby care

A Practical Choice

Most insurances accepted/affordable payment plans
Professional and compassionate Certified Nurse-Midwife and birth Assistant-Doula support
Familiar environment with support people of your choice

Water Births: Know the benefits

Benefits for the Mother:
Warm water is soothing, comforting, and an effective pain reliever
Immersion in water often helps lower high blood pressure caused by anxiety
Water reduces stress-related hormones, allowing the mother's body to produce endorphins which serve as pain inhibitors
Water causes the perineum to become more elastic and relaxed, which decreases the chance of needing stitches and/or episiotomy

Benefits for baby:
Provides and environment similar to the womb easing the transition Eases the stress of the birth, increasing baby's reassurance and self-security

"Midwives attend the vast majority of births in those industrialized countries with the best perinatal outcomes…"
-Coalition for Improving maternity services, the mother-friendly childbirth initiative, 1996

FACTS

  • There is ample evidence showing that laboring at home increases a woman's likelihood of a birth that is both satisfying and safe

  • Studies repeatedly document the safety of planned midwife attended homebirth for healthy low-risk women and their newborns. This is especially related to the reduced exposure to infection, the decreased use of interventions at home, and the easier flow of labor and birth that occurs within the familiar and comfortable surroundings at home.

Childbirth Classes

Childbirth Preparation Classes, Yuba City - Marysville

Taking a childbirth preparation class is a great way to prepare for the upcoming labor and birth. By learning about what happens to your body in labor you will have a better understanding of the process, have less fear in labor and be overall better prepared to cope in labor and have a more positive experience. That being said, as women our bodies and physiology are designed for the process of labor and birth to happen successfully or we would not exist as a species. Some women do very well in labor by simply letting go and relaxing, using prayer or just having faith in the process. 

Childbirth classes are always encouraged in any case and can give you a big advantage especially if this is your first baby. Fremont Hospital offers a free, all day hospital based class that will orient you and your partner to the labor and delivery area, the process of labor, hospital routines and procedures, breastfeeding helps, relaxation and breathing techniques to help with labor pain, as well as an overview of pain relief options in labor including IV medicines and epidural anesthesia. The best time to take this class would be in the third trimester or end of your pregnancy, this way the information is fresh in your mind to help you in labor when you need it. Please call Fremont Labor and Delivery 530-751-4165 for more information and to sign up for a class later in your pregnancy.

Another free and helpful class offered at Fremont Hospital is a Breastfeeding Preparation class that can be helpful to first time mothers and also moms who have encountered difficulties with nursing in the past to be more successful this time around. There is also a free Infant CPR class can help you prepare and deal with life threatening emergencies such as choking with your new baby. 
Call 530-751-4165 to sign up for these classes and more information.

Preconception Care at Women's Circle

Before you get pregnant

The staff at Women's Circle are committed to helping you have the healthiest pregnancy and baby possible. If you are thinking about becoming pregnant or are planning a pregnancy, now is the perfect time to talk with the midwife to make sure you are doing all you can do to be healthy going into your pregnancy. Your partner can also take steps to ensure that he is as healthy as possible before you get pregnant too. Some important things you and the nurse-midwife will discuss at your pre-conception visit are:

  • Determining if you have any health problems that could impact your pregnancy. Any health conditions you face should be well managed and under control before you become pregnant which will make the pregnancy healthier and less complicated, i.e. . diabetes, high blood pressure.

  • Review your family medical history to see what, if any, diseases or genetic risk factors there are to give you the most information before you become pregnant

  • Helping you quit smoking to help your baby have a healthy birth weight and strong lungs and you have a healthier pregnancy

  • Reviewing prescription medications to see if they are safe in pregnancy which can help prevent serious birth defects

  • Your past pregnancies and any complications that we can prevent going forward like miscarriages or pre-eclampsia

  • Any history of mental health problems to make sure you are getting the help you need before you become pregnant to help you cope and manage your emotions better in pregnancy

  • Exercise and nutrition to help with reaching your ideal body weight before you become pregnant 

    One of the most important nutritional steps you can take at least three months before you get pregnant is to take an over the counter vitamin called Folic Acid 400 mcg/day. This prevents some very serious birth defects known as neural tube defects that can occur in the brain and spinal cord.

  • Avoiding alcohol, drugs and substance abuse helps your baby's brain and mind develop and form the way it is supposed to. We can connect you to area people and resources to help you with any addictions and problems with substance abuse.


Determining if there are any toxic substances at home or work and reducing your exposure will help prevent birth defects and promote healthy brain and intelligence in your baby
If you are not ready to be pregnant at this time, we will discuss all of the many available birth control options so that you can delay pregnancy until you are healthy and ready.

 

Midwife Labor Support and Doulas

Women Supporting Women

Women have been supporting each other in labor as long as women have been giving birth: a long, long time. These women supporting women over millennia have sometimes been our friends, sisters, mothers, midwives. Women realize intuitively that when they are in labor the presence of another woman is comforting and supportive and helps them cope better. In fact, research has shown just having a woman present with you throughout your labor reduces the amount of pain you feel, the need for pain medication and epidurals, reduces interventions like vacuum and forcep extractions and cesarean births, and helps you have an overall more satisfying birth experience. (Hodnett et al., 2007). It is amazing and simple, but very true. As women, we can relate to each other well in labor and do not need any special training as long as we are there to be supportive we can make a big impact on helping each other to have a more positive and empowering birth experience! Women's Circle Nurse-Midwives encourages you to invite a female support person to be with you throughout your labor. Of course, fathers are especially welcome and encouraged to be an active part of the birth team. Sometimes, fathers feel overwhelmed with the intensity of labor and appreciate having another support person available to take over when they need a break or to provide reassurance. Although, having too many people in the room during your labor can be distracting and stressful and is discouraged. Pick your birth team wisely: Include people that are going to be positive and supportive and it is best not to have more than two or three people with you.

Doula

A Doula is a person who is professionally trained to provide support and comfort to you and your partner throughout labor and birth. Labor and contractions are normal to her and she is well trained to help you cope using different positions, encouraging you, and helping you relax so you are more comfortable during the process. During your labor and birth process, a Doula can help remind you that what is happening is normal and natural and be very reassuring. She will support your choices in labor and try to provide accurate information so you can make informed decisions. A Doula does not provide medical or nursing tasks, but is available to support you emotionally and physically and can help you make sense of what is happening during your labor and birth process. A Doula can help provide reassurance and support to your partner that labor is happening as it should. A Doula is usually another woman who will provide continuous support to you during labor and therefore offers great benefit in reducing the pain you feel, the need for medications, and decreases the likelihood of interventions such as vacuum extraction and cesarean section delivery. A Doula will usually stay with you until after the birth, help you process and remember your experience, make sure you are comfortable and that breastfeeding is off to a good start.

The Nurse-midwives at Women's Circle will make every effort to be with you as much as possible during your labor and birth experience but realize we may not be able to be with you continuously and encourage you to have a female support person with you throughout labor whether it be a friend, loved one or a Doula as it will greatly benefit you, your partner and overall experience!

Potential Harms of Routine Ultrasound

Ultrasounds That Are Not Medically Indicated

Many of our clients at Women's Circle are very excited to receive their first ultrasound and are interested in having "fun" ultrasounds done to identify the gender of the baby or just to get more pictures. We want our families to understand that ultrasound in pregnancy has been adopted into wide use without proof of safety and that there has been research that documents harm to unborn babies, particularly related to growth, neurological and speech problems. Furthermore, research has shown that in low-risk, healthy pregnancies there is no clear benefit or advantage to having an ultrasound done.

During your pregnancy if there is a medical indication an ultrasound will be ordered. In your fifth month if you would like, an ultrasound will be offered to check on development and growth and sometimes you are able to also find out the gender at this time. We encourage you to read and inform yourself about the risks involved in receiving an ultrasound and discourage you from getting any ultrasounds done that are not medically indicated. Both the World Health Organization (WHO) and National Institute of Health (NIH) warn against routine ultrasound in pregnancy as it offers no benefit in healthy pregnancies and can potentially cause damage to the developing fetus.

 

FDA - Risks/Benefits

Ultrasound imaging has been used for over 20 years and has an excellent safety record. It is non-ionizing radiation, so it does not have the same risks as x-rays or other types of ionizing radiation. Even though there are no known risks of ultrasound imaging, it can produce effects on the body. When ultrasound enters the body, it heats the tissues slightly. In some cases, it can also produce small pockets of gas in body fluids or tissues (cavitation). The long-term effects of tissue heating and cavitation are not known. Because of the particular concern for fetal exposures, national and international organizations have advocated prudent use of ultrasound imaging. Furthermore, the use of diagnostic ultrasound for non-medical purposes such as fetal keepsake videos has been discouraged. 

Please click on the links below to find out more about this extremely important issue:

https://midwiferytoday.com/mt-articles/ultrasound-harm-good/

https://consensus.nih.gov/1984/1984UltrasoundPregnancy041html.htm

https://midwiferytoday.com/mt-articles/questions-prenatal-ultrasound/

http://americanpregnancy.org/pregnancy-health/keepsake-ultrasound/

http://www.alternamoms.com/ultrasound.html

Pregnancy Tips from the Midwife

Midwife Healthy Pregnancy Tips

Maintain your good health

 

  1. Eat a variety of healthy foods. Choose fruits, vegetables, whole grains, calcium-rich foods, and foods low in saturated fat. Also, make sure to drink plenty of fluids, especially water. Avoid caffeine in soda and coffee. A decaffeinated soda once a week or so is fine.

  2. Get all the nutrients you need each day, including iron. Getting enough iron prevents you from getting you get the nutrients your baby needs. Some good iron food sources are beans, chicken, raisins, apricots, iron-rich breakfast cereal, and leafy green vegetables.

  3. Take a multivitamin or prenatal vitamin with 400 to 800 micrograms (400 to 800 mcg or 0.4 to 0.8 mg) of folic acid every day. Folic acid is most important in the early stages of pregnancy, but you should continue taking folic acid throughout pregnancy.

  4. Ask your nurse-midwife before stopping any medicines or starting any new medicines. Some medicines are not safe during pregnancy. Keep in mind that even over-the-counter medicines and herbal products may cause side effects or other problems. But not using medicines you need could also be harmful.

  5. Avoid x-rays. If you must have dental work or diagnostic tests, tell your dentist or doctor that you are pregnant so that extra care can be taken.

  6. Protect yourself and your baby from food-borne illnesses, including toxoplasmosis (TOK-soh-plaz-MOH-suhss) and listeria (lih-STEER-ee-uh). Wash fruits and vegetables before eating. Don't eat uncooked or undercooked meats or fish. Always handle, clean, cook, eat, and store foods properly.

  7. Don't eat fish with lots of mercury, including swordfish, king mackerel, shark, and tilefish. 12 ounces of canned or chunk light tuna may be eaten every week as this is a lower mercury level fish.

  8. Gain a healthy amount of weight. Your nurse-midwife can tell you how much weight gain you should aim for during pregnancy.

  9. Don't smoke, drink alcohol, or use drugs. These can cause long-term harm or death to your baby. Ask your nurse-midwife for help quitting and area resources.

  10. Get about 20-30 minutes of moderate-intensity aerobic activity most days of the week. If you worked out regularly before pregnancy, you can keep up your activity level as long as your health doesn't change and you talk to your nurse-midwife about your activity level throughout your pregnancy. Learn more about how to have a fit pregnancy. 

  11. Don't take very hot baths or use hot tubs or saunas.

  12. Get plenty of sleep and find ways to control stress.

  13. Get informed. Read books, watch videos, go to a childbirth class, and talk with moms you know.

  14. Ask your nurse-midwife about childbirth education classes for you and your partner. Classes can help you prepare for the birth of your baby.

  15. Stay away from chemicals like insecticides, solvents (like some cleaners or paint thinners), lead, mercury, and paint (including paint fumes). Not all products have pregnancy warnings on their labels. If you're unsure if a product is safe, ask your doctor before using it. Talk to your nurse-midwife if you are worried that chemicals used in your workplace might be harmful.

  16. If you have a cat, ask your nurse-midwife about toxoplasmosis. This infection is caused by a parasite sometimes found in cat feces. If not treated toxoplasmosis can cause birth defects. You can lower your risk of by avoiding cat litter and wearing gloves when gardening.

  17. Avoid contact with rodents, including pet rodents, and with their urine, droppings, or nesting material. Rodents can carry a virus that can be harmful or even deadly to your unborn baby.

  18. Take steps to avoid illness, such as washing hands frequently.

  19. Stay away from secondhand smoke.

Pregnancy Care at Women's Circle

Your comfort and well-being throughout your pregnancy are an essential part of our care

Whether it is your first baby or maybe you have been pregnant before, most women share many of the same concerns as they enter pregnancy. Even if it is a planned, desired pregnancy there is always a little bit of shock and surprise as it becomes a reality and wondering is it really the right time. Rest assured, there is never the "perfect" time to be pregnant and bringing new life into the world.

At Women's Circle, your comfort and well-being throughout your pregnancy are an essential part of the care we provide.

In the first trimester (first 12 weeks)
many women experience common discomforts such as nausea/vomiting, fatigue, tummy pain, and emotional upsets . Helping you to ease through this period of pregnancy by counseling you in nutritional and herbal helps, offering you reassurance and support as to what is normal and most important your nurse-midwife is able to tell when things are not normal and able to take further action to get you the help you need. The nurse-midwife is part of a larger medical support network and can refer you to a helpful and supportive obstetrician(a physician who specializes in complicated pregnancies) in case any complications arise. In some cases, a prescription medicine may be needed to help you with severe nausea when other helps have failed and your midwife will be able to help you with this if need be.

In the second trimester (13-27 weeks)
most women feel a sense of relief as the growing baby has risen up higher in the tummy and is not pressing on the bladder so much. Also, the body is adjusting to the hormonal changes of pregnancy and women generally feel better and have more energy in this stage. Many new parents are excited during this time because it is at this time if an ultrasound is chosen to be done that it can provide the most information as to how the baby is developing and when it can be seen whether you are carrying a boy or girl. 

The third trimester (28-40 weeks)
is the time when your baby gets bigger in size and where the finishing touches are done to help your baby thrive after they are born. It is a time of great excitement and anticipation. 

Throughout your journey in pregnancy, the nurse midwives at Women's Circle will be there to provide supportive, compassionate care that will keep you healthy and feeling your best while keeping you well informed and helping you make choices about necessary and optional tests and procedures. Most importantly, the nurse midwives at Women's Circle trust and appreciate that pregnancy is a normal, healthy part of a woman's life and want you to have the best experience possible!

Prenatal Care with a Nurse Midwife

Prenatal period is from the time your baby is conceived until your baby is born

Having regular check-ups with your nurse-midwife is important to make sure that you and the baby are staying healthy and if there are any problems to take care of them early. Babies born to mothers who do not get prenatal care are three times more likely to have a low birth weight and five times more likely to die than those born to mothers who do get care.

One of the main differences between seeing a nurse-midwife rather than an obstetrician or doctor for prenatal care is that the midwife has more time to spend with you at your visits, can get to know you as a person and offer advice and guidance in nutrition and breast-feeding as well as work on educating you to help prevent health problems during your pregnancy. An obstetrician or a doctor is highly trained and skilled at handling complications during pregnancy, while a nurse-midwife is highly skilled and trained at caring for low-risk, healthy pregnant women. Your nurse-midwife views your pregnancy as an experience of health and a natural, normal physiologic process. Your nurse-midwife is highly trained to detect if you are experiencing problems and will refer you to an obstetrician if your pregnancy becomes complicated. Nurse- midwives help women understand the choices and options available to them and are encouraged to make their own decisions and actively participate in their own care. Women have reported that they are more satisfied about their ability to make decisions when they are assisted by a midwife as opposed to an obstetrician.

A good time to schedule an appointment with your nurse-midwife is 4-6 weeks after your missed period or earlier if you are having any concerns. At your first visit, your nurse-midwife will want to know information about any health problems, surgeries or medications you are or have taken, as well as your family health history. A complete physical exam with a pelvic exam will be done and if you need it a pap smear will be taken along with cultures for infection. You will be given a lab-slip to do pregnancy blood-work and urinalysis and if you need it a prescription for prenatal vitamins will be provided. The best nutrition and a healthy lifestyle will be discussed and encouraged. If you are at least 12 weeks along, we will be able to hear your baby's heartbeat with a Doppler. This is a great opportunity for you to ask any questions or concerns that you may have. You will spend approximately 45-60 minutes with the nurse-midwife at your first visit.

At your return visits, you will spend about 30 minutes with your nurse-midwife. Your blood pressure, weight and urine are checked to make sure you are staying well. The nurse-midwife will measure your belly to make sure the baby is growing nicely. After twelve weeks in your pregnancy, we are able to hear your baby's heart-beat and will check it at every visit. After 20 weeks in the pregnancy, an ultrasound appointment will be offered to you to check on your baby's development and you may be able to find out if you are having a boy or girl. After your first visit, we will see you every four weeks and when you are 30 weeks you will be seen every two weeks. The last five weeks of your pregnancy you will be seen every week. Throughout your pregnancy if you have issues or concerns we welcome you to call our clinic in between clinic visits. 

Seeing you early in your pregnancy and regularly after that can help you and your baby have the best start possible. The nurse-midwife will help you stay on course to have a healthy, safe and satisfying pregnancy experience and can refer you if there are any complications.

The History of Midwives & Childbirth

Midwives have been taking care of women as long as human beings have been on the planet.

The first midwives to be mentioned in the literature are in the Bible in the book of Genesis: "And it came to pass, when she was in hard labour, that the midwife said to her, Fear not…". Just as the name midwife literally means, "with woman", midwives have been helping women bring new life into the world throughout the ages.

The history of midwives in the United States is first documented with the arrival of colonists in the New World. Of course, Native American families relied on midwives but this history is not well documented. Midwives were a vital part of colonial community life and therefore were well respected and received housing, land, food and a salary as payment for their services. Midwives in colonial times also contributed by caring for the sick and the dying, had vast knowledge about herbal therapies, and also cared for animals. Pioneer women crossing the plains in covered wagons were cared for by midwives as they gave birth and settled the Western part of the country. Mormon history documents the honorable and heroic functioning of midwives during the journey from Illinois to Utah in 1846-1847. Before the 1900's midwives were very popular and highly regarded by women and their families. Of course prior to 1900 more than 95% of babies were born at home with midwives including the likes of Thomas Edison and George Washington. In the early 1900's midwives faced a highly competitive atmosphere as male physicians sought to replace female midwives to increase their business interests. It did not help that many of the practicing midwives at the time were poorly educated, not organized as a group or union, and held low social status as women which made it difficult to compete and survive in the marketplace. Despite, a tremendous effort by the medical community to wipe out the practice of midwifery, many small community or " granny" midwives continued to practice and provide needed care to women in rural and poorer areas of the country throughout the 1900's. 

As it became clear that physicians alone could not handle all of women's healthcare and childbirth needs states began to recognize the legal practice of midwifery and provide licensure, regulations and training programs. Since the early 1900's the profession of midwifery has grown tremendously and many types of midwives now serve and support women, some of which have different educational backgrounds and training. Midwives care for women in hospitals, homes, and birth centers around the country and world and remain committed to providing safe, satisfying, and personalized care. Nearly 10% of all babies are born to midwives in this country today and that number is growing. On Nov. 1, 2011 was the 246th year anniversary of the first formal training school for midwives , Shippen Medical School, which later became part of the University of Pennsylvania. In 1765, Dr. William Shippen opened the first formal training for midwives at what is now the University of Pennsylvania . Midwives' beliefs that childbirth is normal and inherently within the domain of female competence may have prevented women from seeking formal training, especially from men. Few women were literate, many could not afford schools, and the Puritan philosophy did not encourage education for women.