Midwife Matters

Pregnancy preparations, women's health, and care options

Partners in Pregnancy

HealthPartners is now offering Partners in Pregnancy:  A great alternative to traditional prenatal care.

Beginning Saturday, April 19, 2014 from 9am to 11am, the midwives will begin group prenatal care.  The group will consist of 8-10 women with October 2014 due dates.   The classes provide individual health assessments,  group prenatal education and social support.  There is ample opportunity to ask questions with lots of time Pregnant_redspent with the midwife.  This is a unique chance to connect with other women who are pregnant and going through similar experiences.  Partners are also welcome and the sessions begin and end on time.

Click HERE to find out more about Partners in Pregnancy.

For more information or to sign up please contact:

Ruth Sheldrake at 651-293-8114 or email her at:


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Nausea In Pregnancy: How To Cope

In her blog, Mary M. Murry, RN, CNM from the Mayo Clinic reveals some coping techniques for nausea and vomiting in pregnancy.  In the comments section women weigh in with additional suggestions and advice about what has worked for them.  As always, if you don’t know if something is safe to take in pregnancy ask your midwife first.

Some tips to deal with pregnancy nausea and vomiting

By:  Mary M. Murry, RN, CNM

Karin Marshall, CNM

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Is My Cervix Ripe?

As providers we often refer to a cervix as ripe or not at the end of pregnancy.  To many women this can be confusing and frustrating.  What exactly do we mean when we say your cervix is not ripe?  Here is what we are checking for:

  • Typically a cervix is 3 to 5 centimeters long throughout a pregnancy.  As you get closer to the end of your pregnancy the cervix can start to thin out, or efface.  When we check your cervix we can feel how long it is from an exam.  If a cervix starts out at 4cm and is now 2cm that is called 50% effaced.  When the cx is completely thinned out, then it is 100% effaced.  How do we know exactly what your cervix was before…3cm, 4cm or 5cm?  We don’t, we make our best estimate.  That is often why you will get different numbers from different midwives.  Don’t worry, you are not going backwards like it may sound sometimes!
  • Next we check the position of your cervix.  It can be posterior (meaning far back in the vagina), mid position or anterior (easy to reach, close).   Everyone is different, but most women tend to be posterior or mid during pregnancy.  As the cervix effaces and gets more ready for labor it will ordinarily be easier to reach or more anterior than it had been.
  • A cervix during pregnancy is firm.  It should feel somewhat like touching the end of your nose.  A sign that your cervix is changing can be that it has gotten softer.  As pregnancy/labor advances the cervix usually becomes softer, sometimes almost mushy feeling.
  • We also check where the head of your baby is, more commonly referred to as the station.  If it is engaged in the pelvis that is a 0 station, its head is at the ischial spines of your pelvis, which is the narrowest part of your pelvic structure.  Above the spines means the head is not engaged in the pelvis and is measured in centimeters but with a negative sign in front of it.  If the fetal head is 2cm above the spines, then the station would be -2.  As you move closer to the pushing stage of labor the fetal head advances past the ischial spines and it is again measured in centimeters but with positive numbers.  An example would be the fetal head is at a +1 station.  At a +5-6 station you can see the head at the entrance (introitus) of the vagina.  Up until the end of pregnancy the baby should not be engaged in the pelvis.  When we refer to the baby as ballotable, it means we can move the baby up and down in the uterus.
  • Lastly we check the cervix for dilation.  During pregnancy the cervix is normally closed.  The last few weeks of pregnancy, especially if you have been pregnant before, the cervix can start to open or dilate.  This is not necessarily an indication that you will labor early.  Some women are dilated several centimeters weeks before they go into labor.

We put all of these assessments into a score called a Bishop score.  Each one of the above parameters is scored and then we add them up and come up with how ripe or ready your cervix is for labor.  If you are a first time mom a ripe cervix is a score of 8 or above.  For moms who have had a baby before it is 6 or above.  The higher the score the more ripe or ready your cervix is for labor.

Women often want their cervix checked at the end of the pregnancy during their prenatal appointments.  This is where you will hear the report if your cervix is ripe or not.  I have seen many women with an unripe cervix go into labor over the next few days and vice versa – a woman with a very ripe cervix go for many more weeks until labor begins.  In other words it doesn’t really mean much, so you shouldn’t worry about it.

The one time an unripe cervix does matter is if you need to be induced.  In that case we would start the induction with a cervical ripening agent and get your cervix more ready for labor.  This however doesn’t happen very often.  We try to induce only women who have a medical indication for inducing labor.  In my next blog I will discuss cervical ripening and how that is done.

Karin Marshall, CNM


Want to be Like a Princess? Use Midwives!!

Duchess of Cambridge Kate Middleton just gave birth to her first child using Midwives!!130723150642-03-royal-baby-0723-horizontal-gallery

She had an unmedicated, 11 hour labor that was attended by a team of 4 Midwives.

To find out more click here.


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Delayed Cord Clamping is a Good Idea!

Research has shown that by delaying cord clamping for 1-5 minutes after birth, your baby will have multiple benefits. The blood in the placenta will transfer to the baby during  that delay of clamping the cord. This delay of cord clamping has benefits  beyond the first few days. Studies have shown the following:

1.  Iron stores in the blood that are given to the baby  dramatically reduce newborn and infant anemia.  This improves your baby’s nervous system development for as long as 24 months of age.

2.   The baby’s oxygen levels are improved.

3.   The best news it that it gives your baby a store of Stem Cells.   Stem cells provide long term benefits to prevent age related disease.

Babies benefit from these three simple actions:

  1. Placing your baby on the mothers abdomen after birth
  2. Keep the cord intact for the first few minutes of life
  3. Breastfeed your baby within the first hour of life


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Tdap Vaccine. Is It Really Safe To Get Vaccines During Pregnancy?

Tdap is tetanus, diphtheria, pertussis (whooping cough) vaccine.  In 2012 there were 4125 cases in Minnesota. There were so many it was classified as an epidemic.  The Center for Disease Control and the Minnesota Department of Health recommends every pregnant woman get a Tdap every pregnancy.arm-shot


1. Because of the Pertussis epidemic.

2. Because it offers the best protection for your baby.

3. Because giving the vaccine during pregnancy gets antibodies to your baby.

A recent letter from nine organizations in Minnesota including:  MN Department of Health, MN College of OB/GYN, MN Assoc of Pediatrics, MN Perinatal Organization, MN Nurse Midwives, MN OB and Neonatal Nurses and the MN Medical
Association state the following:

Women should receive Tdap vaccine during every pregnancy. 

Ninety percent of pertussis deaths are in infants younger than four months. Giving Tdap vaccine during pregnancy prompts prenatal transfer of pertussis antibodies, protecting the newborn during his or her first months of life. It also prevents post-partum transmission of maternal pertussis. Tdap is considered safe to give during pregnancy, regardless of the interval since the patient’s last tetanus booster or previous Tdap vaccination. The optimal window for administration is between 27 and 36 weeks’ gestation.

If a woman does not get the vaccine during pregnancy, the postpartum vaccine will offer some protection by not exposing the baby to Pertussis. The post partum vaccine will not offer the baby the important antibodies given through the vaccine during pregnancy.

Fathers, daycare providers, grandparents and other family who will be in close contact need one Tdap as an adult.  This is to prevent transmission to the baby.  They do not need one every pregnancy because they do not pass antibodies to the baby.

Please ask your provider about this important vaccine!

For more information please visit The Center for Disease Control and Prevention website.


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New Mothers Take Note

Every new mom should read this great article in The Atlantic on motherhood and dealing with a new baby.  Being a new mom  is wonderful, but it isn’t always easy either!

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Constipation in Pregnancy

Constipation is a common occurrence in pregnancy, especially early on.  It is caused by changes in your hormones that slow down your digestive tract causing things to move at a slower pace. Nausea may have also changed your eating habits in early pregnancy and this can also play a role in constipation. Ultimately you feel bloated and can have abdominal pain as well as difficulty passing stool. Thankfully there are some easy things to try to remedy this.

1.  Drink at least 8-10 glasses of water a day. Sometimes a glass of warm water (flavor it with lemons) in the morning can help you to have a bowel movement.

2. Try to add fiber to your diet by eating fresh vegetables and fruit, beans and whole grains daily. You may also try fiber bars or fiber supplements but be sure to drink plenty of water with these.

3. Pick up some whole flax seeds or whole millet and sprinkle these onto your food. It is tasteless and adds bulk easily to your diet.

4. Get some exercise every day, this will often stimulate your bowels into action.

5. If constipation continues you may try a stool softener such as colace that helps moisten the stool for easier passage.

If you continue to have problems or have not had a bowel movement for more that 3 days you should talk to your provider for further assistance.


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Perineal Massage…A Great Idea!!

One of the biggest fears for women about to give birth is the possibility of experiencing an episiotomy or a tear during their delivery. Statistics show that 40% to 85% of women experience a tear during birth. This tear typically occurs in the perineum, which is the area between your vaginal opening and your rectum. This is the area most likely to require an episiotomy or cut, during labor. Having stitches after childbirth can sometimes lead to pain and discomfort, which most women would prefer to avoid. One method shown to improve outcomes is called Perineal Massage.

Multiple studies have been completed and evidence has shown that perineal massage reduces the likelihood of perineal trauma (mainly episiotomies and significant tears). In addition, women report less perineal pain or discomfort during their recovery. By beginning perineal massage and stretching about one month before delivery, you enable the perineal tissue to expand more easily during birth. In one review, those performing perineal massage for as little as once or twice per week from 35 weeks to delivery were less likely to experience perineal trauma and pain. These results were especially evident for women who had not given birth vaginally before.

So what exactly is perineal massage?

This type of massage involves using two fingers to stretch the perineal tissues. It can be performed by you or your significant other. Ideally, this should be done once or twice daily for 10 minutes, beginning 4-6 weeks before the birth of your baby.

  • Your hands should be clean, and nails trimmed, and a lubricant such as vitamin E oil or water soluble jelly should be used.
  • Lying comfortably back with your knees bent and legs apart, you should practice relaxing the muscles in your perineum. Place your thumb or your partners finger, about 1 to 1.5 inches inside your vagina. Press downward toward your anus and to the sides until you feel a slight burning, stretching or stinging sensation.
  • Now, hold that position for 1 to 2 minutes.  After that time you can gently and slowly begin massaging the perineum while pulling the tissue forward (similar to what the baby’s head will do during delivery).
  • Use this time to practice slow, deep breathing. This should continue for about 10 minutes each day, or as much as possible. After 1 to 2 weeks, you should notice an increase in the perineal ability to stretch with less burning.

Another good idea is to practice Kegel exercises. This helps tighten your pelvic floor muscles, keeping them strong. Do a Kegel while you are performing the perineal massage. You can feel how tense and tight this muscle can become. Consciously release them while you are doing the massage. Practicing Kegel exercises helps improve muscle tone and strength.

Good communication, and gentle understanding is required if a partner is helping perform the massage. However, knowing that you are doing something that may improve your outcome, is free, doesn’t hurt, and is easy to do, makes this a great way to prepare for your delivery.  If you have any questions or concerns, please feel free to contact your midwife.  They will be glad to discuss your concerns and provide further tips in preparing for your delivery.  Best of luck!!


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Early Childhood and Family Education (ECFE)

ECFE is a Minnesota Department of Education program that offers joint parent/child classes for children from newborn to kindergarten in every school district in Minnesota.  It is a wonderful way to connect with other parents in your neighborhood, engage in fun activities with your children and talk about family and parenting.

I took my first ECFE class when my oldest son was 6 weeks old.  It was a new parent class so everyone in the class was a first-time parent of a newborn.  Parenting a newborn is an intense experience and having a group of people who are going through that same experience at the same time was an invaluable source of support.   Several of the mothers I met in that class are still some of my closest friends.

I took several more ECFE classes in the next few years.  The classes felt like a moms group, preschool class, social hour and resource for all my burning child-related questions wrapped in one.  I looked forward to them every week.

Even though my kids are in elementary school now I still refer back to things I learned from ECFE.

Check out the ECFE website for more information and classes.



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