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Healthy Beginnings: Recommendations for Pregnancy and Birth
Vanderbilt’s Michelle Collins talks about what you can do to prepare for healthy pregnancy. Michelle discusses the role of nitrous oxide as a resonable alternative to an epidural and other birthing considerations.
Laura Osterman: Welcome to this edition of the Vanderbilt University Health and Wellness Wellcast. I am Laura Osterman with Health Plus. I am here today with Michelle Collins, Associate Professor of Nursing and Director of the Vanderbilt University School of Nursing, Nurse-Midwifery Program. Thank you for joining us today.
Michelle Collins: Thank you.
Laura Osterman: Can you give us your introduction as to what midwives do.
Michelle Collins: At Vanderbilt, there are two groups of certified nurse-midwives; one is housed under the school of medicine and the other is house under the school of nursing and they have different missions. The School Of Medicine Nurse-Midwifery Practice, their mission is to help in the training and education of medical students and residence where as the School Of Nursing Nurse-Midwifery Practice, their mission is more focused towards the education and training of nurse-midwifery students. Both have different patient populations. So, if you are a patient of the School Of Medicine Midwifery Service, you would not be seeing the school of nursing nurse-midwifes; they are total separate practices.
Laura Osterman: Can you tell us what kind of care do midwives offer?
Michelle Collins: Certified nurse-midwives are educated as both nurses and midwives. We care for women throughout the life span. So, from the onset of the period called menarche through menopause and beyond, those women fall under our care. So, for instance, if women need reproductive healthcare and need contraception, testing for sexually transmitted infection, abnormal Pap test, followup, or if they need care during pregnancy, or if they need care for hormonal changes and menopause, we would handle all of that, so well-woman exams annually as well as primary care.
Laura Osterman: How does healthy lifestyle play a role in healthy pregnancy?
Michelle Collins: There are many things a woman can do to help have a healthier pregnancy. One of the largest is appropriate weight gain, and we used to, in the old days, I would say people would tell the pregnant woman gain 25 to 35 pounds, and really now the Institute of Medicine has made more specific recommendations for weight gain, and particularly because we have a rising problem with obesity in this country. So, your provider should discuss with you what the appropriate amount of weight gain for you as in your pregnancy. If you are underweight, it is a little bit more than 25 to 35 pounds. If you are overweight, it is less than 25 to 35 pounds. So that is the really important thing because women who gain too much weight in pregnancy tend to have more problems with their pregnancy and can have more untoward outcomes at the end. The other thing is what you eat? So, things that you do not want to eat are raw, seafood like sushi, cheeses that are very soft and when you cut into them, they sort of ooze out, so like Camembert and Brie. You would not want to eat swordfish, shark, King mackerel, and tilefish while you are pregnant because those all have a lot of mercury content in them, and even tuna fish; it is better to eat light tuna fish than white tuna fish because white albacore tuna has more mercury in it than does light tuna. So, up to about 10 ounces of light tuna per week is fine. You want to stay away from a lot of hot dogs and bologna because those things are full of nitrites , which are not really healthy for pregnancy. You want to make sure you are getting enough calcium in your diet as well. So, a nice even balanced diet taken with your prenatal vitamins as well to supplement and making sure you are getting enough calcium will help to have a healthier pregnancy.
Laura Osterman: Can you tell us more about how Vanderbilt has been a leader in offering nitrous oxide?
Michelle Collins: Nitrous oxide for labor analgesia has been used for 100s of years in Europe; and in the United States, it has been used mostly by the University of California in San Francisco for about 35 years. In June of 2011, the Vanderbilt started to offer nitrous oxide labor analgesia here. What it is, women know it as laughing gas and this is the same gas you would use at the dentist only in a different concentration. They use it at a higher concentration at the dentist and in continuous form. We hand the mask to the patient. She decides when she wants to inhale the gas whether with every contraction or between contractions or with every other contraction; she controls the analgesia which is a really important component of it, that it is patient controlled. About 20% of our patient elects to use the nitrous oxide and it does not take the pain completely away, but it takes the edge off the pain and that is what a lot of women are looking for.
Laura Osterman: Can you give us a recommendation of websites that might have useful information?
Michelle Collins: There are some resources for patients on the website of the American College Of Nurse-Midwives, which is ACNM.org, and you can also find the midwife in your area on that website if you are not close to Vanderbilt. Also March of Dimes websites has a lot of information for pregnant women, and there are some other governmental websites that contain good information for women particularly on the nutrition things I was talking about.
Laura Osterman: Do you have any final comments about care offered at Vanderbilt?
Michelle Collins: Certified nurse-midwives are here at Vanderbilt have really a great collaborative relationship with our physician colleges, and we enjoy rich relationship that is pretty unique to Vanderbilt, and it is a good model of how advanced practice nurses and physicians can work together and collaborate for the best care of the patient.
Laura Osterman: For more information on healthy pregnancy, we have included a list of recommended websites along with links at the bottom of this page. Additionally, Health Plus offers Babies and You, a prenatal education program to encourage early and consistent prenatal care. Educational sessions on various topics are offered monthly and upon completion of the program, $50 for your new baby will be added to your paycheck from Babies and You. Visit the Health plus website for details about this program and more. Thank you so much for joining us here today.
Michelle Collins: Thank you.
Laura Osterman: Thanks for listening. Please feel free to leave us any comments on this Wellcast on the form at the bottom of this page. If you have any story or suggestions, please email it to us at firstname.lastname@example.org or you can use the “Contact Us” page on our website at healthandwellness.vanderbilt.edu.
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