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Hello and welcome to "Health for a Lifetime" I'm your host Don Macintosh,
and today I'm delighted to be talking with Patti Barnes
Welcome Patti! Thank you Don Now you are a certified professional midwife,
is that right? Correct And how long have you been doing that? About
years years... So you've seen a few babies born!
How many about? About over now. And do you have children of your own?
I have children. And how old are they? Genesis is , and Jason, he's .
All right, well great! So you have a wealth of experience as a mother,
and as a midwife, and with the time as well. You work with a team, I understand,
you have some physicians and people that work with you as well where you are practicing.
Today we're going to be talking about postpartum care.
What does that big word mean? Postpartum care is right after the birth thru
weeks, and we do postpartum care on the mother right
after delivery. We go back the rd day to check her and the
baby again. Then we see her in weeks,
and then we would like to see her again at weeks.
So right afterwards, then weeks... days, weeks and then weeks... Okay, got it!
You know, one thing before we get into that, you and I were talking and maybe we can just
discuss this a little bit. What if someone has had several pregnancies,
and maybe the last one or maybe their first one,
or whatever it was, was a cesarean section or a C-section,
and they want to have a vaginal delivery or a regular birth,
can that ever happen? Yes, they are actually encouraging VBACs.
They call it "vaginal birth after cesareans. "
This was proven in a Flamm Study, . Okay, so it is possible then to have it again.
Okay, so does it mean you just naturally have to have another one? Right
So, if your physician is a younger OB-GYN they're going to be more open to that.
Have you ever, as a midwife, delivered someone that was a cesarean before?
Yes, but we encourage the VBACs to be delivered in the hospital
Just in case there is a rupture. Yes And like we said, it's very rare,
but I know they are estimating about $, could be saved a year by giving them a trial
of labor, vaginally $, across the nation... okay
Let's go back to postpartum care... You know, we talked about when it is,
days, weeks, and then weeks again, right? Immediately after the birth too. Um hm
But what do you do then? What do you do immediately after the birth,
and walk us through that; what does it entail? Okay, well immediately after the birth,
we check the uterus to make sure that it's firm,
and the baby will be nursing right after the birth
to contract the uterus. The uterus releases oxytocin, it's a natural
oxytocin to cause the uterus to contract...
So that's a hormone or something? Yes, and it causes the uterus to go back to
size called uterine involution, back to its pre-pregnant
state. So we check the uterus to make sure it's firm,
and check for bleeding; make sure that there is very minimal bleeding...
And we make sure that the mother is breastfeeding, the baby has latched-on and they're bonding.
Let's go back to that... checking the... what did you call it, the fundus...
The top of the uterus is the fundus. And that's the top of the uterus,
and how do you make sure it's firm? You just feel the top of the uterus to make
sure that it's firm...
So, like if I had a uterus, which I don't, which I'm fairly certain, I'd be touching
it right up here above my belly button?
Well after the baby is born, it's usually about
fingers below the umbilicus. Okay, so my belly button...
and I just take fingers and below that there should be what there?
The top of the uterus. What does it feel like? It will feel just like a hard...
I want to say grapefruit or something. Okay, and if it's not there, what do I do?
If it's real loose and boggy, it will feel loose,
but you probably have a bleed. A pretty good bleed. Okay, what do you do?
Well, what we would do is what they call... "bimanual compression" where you clamp it
yourself, and you hold it until it gets firm.
You can give... if you use herbs to control bleeding.
And of course, in the hospital, they'll give Pitocin
or a drug to clamp the uterus. So that's like the oxytocin but it's a medication.
So you check and make sure and if it's NOT, then you probably have a bleed or something...
and you have to be careful about that. Anything else then? Any education or
different things that you tell moms afterwards... Well, we make sure that they are well-educated,
what to look for; if they have fever, pain, excess bleeding.
Check the baby; make sure that the baby is nursing well...
How do you know if a baby is nursing well? Well, we wouldn't leave until the baby has
latched-on, and nursing well, and we want to make sure
that the mother who had the baby can get up and void,
have a shower, and everything works normal before we leave.
We wouldn't leave her until everything is fine, she's fed.
Okay, back to that breastfeeding thing... How do you know that it has attached well
or whatever? Latched-on... the baby is latched-on.
I pretty much can figure that out, but what do you mean exactly?
How do you know if it has latched-on well? The baby will be nursing...
Okay, and no air or different things in there. Yes, you would know because it wouldn't be
crying. It would be nursing.
Plus, let me just say this... It wouldn't hurt... when the baby is nursing
right, it wouldn't hurt her.
Oh, it doesn't hurt the mother. Yeah Because if it doesn't have a good latch on,
then she could say, "Well, this just doesn't feel right. "
So, what should the mother then be watching for,
I mean, you're there right after the delivery... Do you do the Apgar score then right after?
Is that part of postpartum care? Yes What are they checking on an Apgar score?
Okay, we check at minute, and then at again. And what are you checking?
We check the baby's color. We make sure that the baby is breathing well.
The heart rate is or above, and the normal rate is anywhere from -...
And we also make sure the respiration is good. The baby should be well-flexed and not limp...
And of course, we make sure the baby is warm. We put a warm towel on the baby and cap on
its head. So babies can get cold pretty easily;
it's very important to do all that. Yes, it's hard to hold their heat in for the
first hours, and that's why we encourage the baby to be
extra warm. What about when a baby gets yellow? Jaundiced?
Or jaundiced, whatever you call that. Jaundice is fairly normal in newborn babies.
And why is that? What's going on? Because we have an elevated Bilirubin,
the excess Bilirubin and the weakened or the immature
liver of the baby is having trouble... Can't handle it...
And around days, the third day is the peak; in - days then it should be fine.
But usually the jaundice isn't a problem. I know in the hospital when I was in nurses'
training, they put me in this little nursery thing,
and there were like babies in there, and they had a
bunch of them under these little lamps or different things.
Do you do that at home? We use sunlight.
Sunlight... put them by the window? Yes, and nursing is a benefit.
It helps flush excess Bilirubin, and also activated charcoal.
What about circumcisions? Well, if they want to have circumcisions,
we always recommend the th day, like the Bible says, because the vitamin K
factor is the highest in the baby.
And they do that in the hospital? No, they have their own pediatrician if they
choose to have circumcision, they would go to.
Many times new moms like to call the doctor and check things out or maybe they call you
very often. When should they call their pediatrician?
Okay, well they should call their pediatrician when
they don't see stools or urination in - hours. That's constipation then?
They could be bound up, that's why? Well after delivery, we just want to make
sure everything works.
It might be but it might not be. It might be that something is not developed
properly. Difficult breathing. Baby's color is blue.
Jaundice with lethargy... Remember we talked about jaundice as...
Yellowing skin and all that. But is fairly normal, but if you have jaundice
with lethargy and failure to nurse, then there's a problem.
So lethargy - that means just like what? Just being out-of-it? Yes
It just lays around and you have to wake ...sleepy baby, doesn't want to nurse.
Vomiting; fever over . under the arm, or umbilical cord red or swollen with odor.
Okay, so there might be an infection. Might be an infection.
Okay, so these are the reasons that you need to call
the doctor then right away. Yes And, we show them how to watch for signs,
and how to take care of the umbilical cord; make sure that it stays... Well how do they
do that? Well, we make sure it stays above their diaper.
Every time they change a diaper, clean it real well with alcohol.
So none of the fecal material gets on it causing an infection from that.
Keep it above their diaper so they don't urinate on it.
Look for any pus or any swelling, or red irritation or odor.
So as long as you keep it clean... it usually falls off about the th day.
So these stools that the baby has right off the bat,
they could be a little bit something to deal with, can't they? Yes
So what advice do you give to them so they don't develop
a rash or different things... Or if they do what
I've seen some pretty bad cases of diaper rash.
Well, just to check them and to make sure that they
change their diaper often and not leave the urination or the messy stools on their
bottom. But if they develop a diaper rash,
they could use... there are some natural remedies like blended-up oatmeal...
Blended up oatmeal... Um hm Just like into powder and that's real soothing
and healing for the diaper rash. Open to air? Yes, that's fine.
What would you say, cloth diapers better than regular ones
Yes, % cotton. % cotton... So wash those diapers!
That's better than the other. Yes, supposed to be less irritating,
but I know the others would be more convenient. They are very convenient.
Well, I know you've written a new book called... "The Ministry of Midwifery"
Is that right? Yes And it says it's a manual here as well.
Does it cover the things we've been talking about today? Yes
So you could have a reference for that. We've been talking to Patti Barnes
She is a certified professional midwife. And when we come back, we're going to be talking
about other issues that you face with a newborn;
breastfeeding, all these different types of things.
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write today. Welcome back, we've been talking with Patti
Barnes She is a certified professional midwife,
and we're talking now about what the mother has to face
after the baby is born; so-called "postpartum care"
Is that what we call it? Does the mother need any help? Yes, she does.
We always recommend that hopefully the father can
stay home and help her, or she can have her mother
come to help her for at least weeks. Also, I find that a lot of church members
will bring in meals for the next weeks postpartum. So the biggest thing is to bring in activities
that they normally would have to do on their own;
cooking meals and different things, take care of those things for them. Yes
And, you know, I want to just point out that you
asked me to ask that question, right? Someone might be watching and say,
"Boy, that's a pretty insensitive comment by that
man, to say - do they need any help" But you did ask me to ask that question, didn't
you? Yes Because you promised to take
off work when your wife has a baby. All right When can she return to a normal lifestyle...
And again, this is something we talked about we needed to talk about.
Usually after the -week period, because -weeks postpartum is actually when
the placental site is healed over... Because when the placenta comes out,
after the placenta detaches, there is a space where the placenta was
and the bleeding takes place. So there's the potential for bleeding and
different things if you get too vigorous and exercise and different
things How soon can you start exercising afterwards?
Right after the -week period. Right after the -week period, but up until
that point you kind of take it easy.
Can you walk? Oh yes, you can walk. Your uterus starts returning to normal around
the th day. days to weeks
What about taking the baby out; taking the baby to church,
to the store or to different places - when can they do that?
Well, when they feel like getting up and around, usually after the rd or th day.
The rd or th day... Um hm, they are up moving around slowly.
So, the first week maybe afterwards, they can go back to church or different things?
Well, I recommend taking it easy for a couple of weeks,
and just not overdoing it. And as far as exposing the baby to the public,
you just want to make sure that the baby is not exposed
to a lot of sickness or whatever. Don't have all the people in your church or
whatever club you go to hold the baby?
Just say, "Hey, leave the baby alone for a while"
Well, you just don't want to overexpose the baby.
Okay, so then weeks that that placental site is healed.
I guess another big thing that maybe a change especially
for new moms but others is probably breastfeeding. Is it something that's a must,
or is it something you can do without? Well I, of course, encourage breastfeeding.
We see a lot of benefits toward breastfeeding. Now, colostrum is the first milk that comes
in. And how long does that last?
About or days first, and then the rich milk comes in,
but it contains the antibodies to protect from germs.
Of course it's more convenient than bottles, breastfeeding...
You don't have to get up in the middle of the night
and sterilize, you know. How often are you feeding the baby?
Oh, around every - hours. And, helps protect against allergies.
Again, helps uterine involution, so you go back to
your pre-pregnant weight sooner. If you're breastfeeding. Yes
And messy diapers are not as unpleasant, in other words...
Breastfed babies maybe wouldn't have an unpleasant... A foul odor because that's their mother's
milk not some foreign thing that
they're trying to deal with. Correct Okay, so every hours... I mean...
Maybe you remember breast feeding your children different things...
Did you find that a great burden, or did you just ENJOY getting up every hours?
Well, this is just after the baby is first born...
Of course you need to nurse it often to establish your milk supply...
And then after it's well-established, you can help maintain a schedule, maybe every
- hours. Okay, so wait-a-minute, how long does it take
to establish that it's well supplied, like you
were saying. Well, when you first have the baby,
we encourage nursing often to bring the milk in...
And like I said, it's usually around the third day
that the milk comes in; they're just getting colostrum at first.
And then once the milk comes in they'll have, what they call, engorgement,
which is like - oh my, to have SO MUCH milk! But, we encourage them to just keep nursing
through, and you can help with engorgement maybe by
doing hot and cold compresses. Some people say WARM heat feels better,
and some people say ICE feels better. So they just experiment which one would feel
better to them. And just with nursing, they can get through
that, and usually after the first week or two.
What about breast pumps? Breast pumps, some people use if, let's say,
they have mastitis which is a breast infection,
and they get high fever or chills, just like they have the flu, they feel awful...
And it's usually from breast infection, and a weakened immune system.
We would encourage them to nurse often on that side,
and if they are having a problem keeping the baby awake
to nurse as much as it needs to, then we would have them use
the breast pump to empty that breast. So they empty it so that the
what is it - the solution to pollution is dilution,
or whatever... you just move things through there. Yes
And that milk is okay for the baby? Yes, it is fine.
And we also, I find what helps for mastitis is
doing charcoal compresses. Charcoal compresses... so you just would take
some charcoal and what would you do, is this in
your book too? Yes I believe it is.
And then how do you do that? You just make a paste, put it in a cloth and
just do a poultice. Do a poultice, and you leave it on for how
long? About minutes.
minutes at a time. Yes And then how many treatments would you do?
Just probably or a day. And that draws all the infection out or works
on that. Any common problems people have with breast
feeding besides mastitis?
Well just, for the first-time mom, it might be
a little bit rough getting started just because it's new to her and we just encourage her
to stick with it even though it might feel a
little bit painful at first, the pain goes away.
Also, we have some mothers that may complain of
cracked or sore nipples, even bleeding... And what we recommend is, again, maybe doing
some heat, and take a vitamin E capsule and pop it over,
put some oil on the *** area, the vitamin E,
right before the baby nurses, and it's soothing and healing also.
Now, if a mother doesn't breast feed, how long does it take for her to quit producing
milk? You know, like for instance...
You know what I'm saying, you understand the question. Yes
Okay, I'm not real sure how long it takes for it to dry up,
people vary, but you can do things, I guess naturally
to help, like they say cabbage leaf will help dry up milk.
So you wear that kind of like a poultice on that area. Yes
Anything that you can take to increase milk production?
Yes, you could take a combination of herbs to help increase the milk supply.
Equal parts of dill seed and anise seed and fennel seed.
Do you have that written down in your book as well?
Yes, I believe I do. Those can be some real helpful things.
Well what role, if any, does the husband play in all this?
Of course he plays a BIG role. We encourage him to just be a part of this
pregnancy in every way - to help encourage the wife
in labor/delivery. He will be there, and massaging, comfort measures,
an active part And also postpartum, encouraging her,
and helping her with changing the diapers, and bathing the baby.
Of course, she's going to need help with house cleaning
and feeding... And all those different things. Let's go back to breast feeding just for a
minute... How often do you switch ***
or how much on one side or the other? Usually they nurse about - minutes on each
side. Okay, so the baby will feed for - minutes,
and then you will switch the other side. Right And what about water?
Does the baby need water or anything else to drink besides milk?
Well if they are breast feeding, mother's milk has
all the water the baby needs in breast milk, so there's really no need to give the baby
water. Okay, so they have what they need. Yes
And, how long do you usually tell moms that they
can safely breast feed? A year? months? Is that a matter of preference?
Yes, it's usually a matter of preference... how long they feel comfortable breast feeding,
or when they feel that the baby needs something other than breast milk.
I'm sure you get many, many calls for deliveries, and different things, but do you get a lot
of calls after you have ministered in this way in homes?
Yes, we get a lot of calls even after delivery, well-after their postpartum period just to
keep in touch, and to ask questions, just concerns
of other members in their families. Have you ever led anyone to the
Lord as a result of your ministry working as a Christian midwife?
Yes, I'm thankful that the Lord has a big part in this ministry.
We pray with all our clients, and we encourage them in the Lord...
And we have had good success with Bible studies, and just openness.
Now does your husband... I notice you said the word "we"
...does you husband and then your daughter's name is Genesis, I think,
and then your son's name is Jason, do they see this as much their ministry as
you do? Yes, I couldn't do this without their encouragement
because they play an active role, and every time the phone rings in the middle
of the night, and just encouraging me to
do seminars... and being away from home so much.
Yes, your son is kind of your right-hand-man... Yes, he is.
He brings those things and I know that your daughter,
as well, speaking with her just really sees this as a part of
her ministry as well. Well thank you so much for coming and sharing
with us. We've been talking to Patty Barnes
She is a certified midwife. She has had over deliveries.
She has a delightful new book called... "The Ministry of Midwifery"
a manual that goes through many things that we covered
that take us through the pre-birth process all the way through delivery, then postpartum
care, all these different aspects.
It's a REAL blessing. We hope that what you have learned has been
helpful, and we hope that as a result of today's program,
you'll have life and have life abundant!