Monday, July 12, 2010

Measuring Tapes and Pregnancy

If I had a nickle for every time a client said to me that they'd been told by other people they looked "big" or "small", I'd be a rich midwife today and would be writing this blog from some cruise ship somewhere.

For some reason, when a woman gets pregnant, it seems to give everyone license to make comments about her physical appearance. "Oh wow, you're so big! Are you having twins!?" or "Gosh you are really small, are you sure your baby is growing okay?" These are probably two of the most common statements that women bring to me during their visits to our clinic. Some bring it with fire in their eyes with the look that "the next person who makes a comment about how I look...loses a body part!" Some come with concerned looks and need us to reassure them about the growth of their babies. And others come with tears.

Change in body image is a process women must go through in pregnancy, and people need to realize that they aren't being helpful by their comments. I'd love it if just once, someone would go up to a pregnant woman and say..."wow, you look great! You look just right for your gestational age!" Okay....well maybe the last part isn't going to happen, but consider saying the first comment to a pregnant woman. She'll love you forever.

So how do you know if your baby is growing okay during your pregnancy. The most common and the easiest method used by care providers is the measurement of fundal height. Simple in method, and yet seems to have pretty good reliability in helping spot a baby who may be growing too slow, or even too fast. At every visit after 20 weeks (measurement prior to that seems to have little value), the care provider measures from the top of the woman's pubic bone to the top of her uterus (fundus) or vice versa . The number of centimeters of that measure is usually within 3 cm either way of her gestational age. Meaning if I measured a woman at 28 weeks, I would expect to get a value anywhere between 25 to 31 cm. But many factors can skew this number. Things that can cause a variation in the measurement are - different people measuring, full bladders, long babies, curled babies, short moms, tall moms, good abdominal muscles etc. If you get an odd measurement, your care provider will reassure you of the normality and the things that can cause skewed measures. Often they will suggest that if at your next visit the measurement is still off, they will send you for an ultrasound. An ultrasound will be able to identify any present or potential concerns by looking within the baby's environment as well as measure the baby specifically.

Why not do an ultrasound every visit? Wouldn't that be more reassuring, catch things faster? Well in fact, there are care providers out there who have access to ultrasound and will do so. But there are issues regarding regular and frequent ultrasound use for well babies (another blog in the making I think). Instead, measurement of fundal height appears to be an inexpensive, reliable, non obtrusive method for the care provider to "check in" with your baby's growth.

So, next time someone says to you that you look so big or so small, whip that measuring tape out of your purse or pocket and suggest if they know so much, perhaps they'd like to measure!

Tuesday, July 6, 2010

Getting started

Have you ever had a project that you think will take just a few days, that ends up taking a few months? Well we've recently experienced this as Esther, Sara and I began the process of setting up our new midwifery practice. Seemed simple enough initially. We all had solo practices, all we needed was an office, some furniture, a website and voila...good to go. How naive we were.
We found our beautiful new office in January. We are now at Ironwood, 5rd and Steveston Highway in Richmond. Great office. Lots of room, free parking! A bonus! That was easily settled by February. Move in April 1......did I say move? We started with 3 chairs, one old computer table, and a massage table. No phone, no fax, no computer, no other furniture! I called it the minimalist visit with clients. Very slowly, for some reason moms kept having babies while we were trying to move in, we finally got furniture in place, a phone, a fax, a computer and even a receptionist! We are now finally settling in, although I like to say still fung shwaying the place! We'd love for those of you that have worked with us in the past to drop by and see, and for those of you looking for a midwife, the time was never better to see us.
And the final piece in all of this brand new move......the website. Launched today. Still with a few tweaks, and pictures needed, but basically done. We hope you like it, and feel free to give us some ideas of what you'd like to see.
We hope to blog quite regularly. Talk about the practice, timely topics, or anything you would like to hear about from us. Even if you're not having a baby, hopefully we'll have something interesting for you to read and ponder.