Summer Newsletter 2015

Are you missing Bella Vie? Are you wanting to connect? Come to a Bella Vie event! We would love to see you!

SUMMER PLAY DAYS IN THE ORCHARD

Every Thursday from July 23-September 24th, 1030am-1pm

Come on out to Bella Vie and play in the beautiful orchard. There is shade, sun, and fun. This is a casual meet up in the orchard located behind Bella Vie. Bring a blanket or a few lawn chairs, a snack or even have a picnic. Meet up with other Bella Vie families, or bring a friend. All are welcome!

FAMILY BUILDING BLOCKS RIVERFRONT FAMILY FEST
Saturday, August 1st, 10am-2pm, Salem Riverfront Park
Come visit the Bella Vie booth at the Riverfront Family Fest. This is a fabulous educational and fun event for kids. There will be lots of free activities about health and safety. Hope to see you there.

BELLA VIE ANNUAL FAMILY POTLUCK PARTY
Saturday, August 15th, 4-7pm
Join us in celebrating our anniversary with the Annual Bella Vie Family Potluck. Mark your calendars and join us in reuniting with other Bella Vie families. Come enjoy the food, community, activities for the kids, and lots of fun. Look for the event on Facebook soon and don't forget to RSVP. We can hardly wait to see you and your sweet family!

Join us in welcoming our newest midwife, Annie Ziemba, CNM.

An Introduction and a Focus on Well Woman Care
By Anne Ziemba
I was called to midwifery while walking through campus during college, when I saw a flyer for a doula training. I had no idea previously that such a career existed. I was instantly drawn to provide emotional and physical support to women and their partners while becoming parents. The psychosocial aspect of becoming a mother was also compelling to me and I spent the remainder of my college education studying the history of the Western medical tradition’s approach to female sexuality, reproduction and motherhood. I studied anatomical prints from four hundred years ago, analyzed modern-day Glamour magazine articles and tried my best at reading postmodern feminist philosophy. I was, and am, fascinated by the complicated and diverse experience of motherhood within our society. I truly enjoy walking with women from contemplating pregnancy to learning to breastfeed and am honored to be part of their journeys.

The first birth I attended was in rural Tennessee with one of The Farm midwives, who brought me as her assistant. I was fortunate to witness the type of care this woman received and the way she birthed as a first impression. What I saw remains with me today. Ina May Gaskin’s Spiritual Midwifery was my most-read book for years and I was ecstatic to have a hands-on introduction to that model of care. I pursued a Certified Nurse Midwife degree in Chicago, Illinois, where I was living with my partner. During my training and education, I became a midwife’s assistant in an urban homebirth practice and for over two years I learned by doing with three wonderful homebirth midwives across the city. In addition to being a student midwife in local hospitals, I was mentored by the homebirth midwives so I was able to experience a diverse range of labors and births.

My passion has always been for home and birth-center birth, where there is more attention paid and ability to care for the complete experience of pregnancy and birth, the emotional, physical and social. As a midwife I highly value the background, relationships, desires, fears and individual needs of each woman I encounter. Though birth was what pushed me to become a midwife, in my training I also provided well-woman care and learned much more than I had anticipated about how midwives can promote reproductive and general women’s health. Many midwives, depending on their experience and training, can provide women’s health care services, including pap smears, lab work, contraception, breast exams and annual visits.

I am excited to bring options for general women’s health care to the women at Bella Vie. Many women seek healthcare only for specific needs, such as pregnancy, however, preconception health care is very important and beneficial to a healthy pregnancy and birth. Likewise, after pregnancy can be a great time to keep up regular visits to a midwife for general health assessment, not to mention family planning options and pelvic floor health. Bella Vie can provide a full range of services and referrals as needed.

Gentle well-woman care is a model in line with the midwifery model of care, meaning that client autonomy, informed consent and partnership in their own health care are of the utmost importance. We practice with awareness of the prevalence of sexual, physical and emotional violence against women and seek to empower clients while providing a safe space for them. An annual visit with a midwife will include, for example, the option of a pap smear or pelvic exam when indicated, but is it always the woman’s personal choice after discussion that guides decision making. At Bella Vie, we are lucky to be a part of families often for years and we want to optimize the health of our community’s women not just during pregnancy but throughout their lifetimes.

We are excited to announce a renewed focus on this aspect of our services. Here are some recommendations for general well-woman care you might consider seeing one of our midwives about:

Cholesterol screening: recommended every 5 years from the age of 25, finding out your blood cholesterol levels can provide the opportunity to alter exercise and diet to reduce cardiovascular health risks

Thyroid labs: Increased attention is being paid to hypo- and hyper-thyroidism. A lab draw can provide great information about how your thyroid is functioning

Contraception: From Natural Family Planning to the mini-pill to Nexplanon to the IUD to condoms and back again, midwives can counsel, prescribe and insert a full menu of contraceptive options

Reproductive health: In addition to testing for sexually transmitted infections, midwives can also provide assessment and help with sexual function and dysfunction. Promoting safe, healthy, enjoyable sexuality is a core component of providing reproductive health care.

Annual visits: Remember when there was a town doctor you saw for years and years growing up? The midwives at Bella Vie can see you and your teenaged-year daughters for annual “check-ups” to assess general health and address any health concerns. We think this long, one-on-one relationship is a great model for health care.

The Gentle Pap: Pap smears are recommended every 3 years until age 30 and every 5 years after that, in most cases with no history of abnormal results. We provide long appointments, comfortable beds to recline on, informed consent and encourage clients to participate in their own exams and assessments to the greatest extent they are comfortable with.

Fertility/preconception: Midwives can do initial lab-work and assessment if you are having difficulty conceiving. We also can provide preconception visits to talk about your cycle and ideas for optimizing health in anticipation of pregnancy.

Madeline Lutz, one of our student midwives, has completed her apprenticeship and recently moved back to Georgia. We wish her the best in her midwifery career and in life. She will be missed!

Pelvic Floor Health for Women

by Jen Holland

Most women I know don't give a second thought to what shape their pelvic floor is in until they are pregnant or postpartum. Perhaps they have noticed increased incidences of incontinence, less sensation during intercourse, or a pelvic organ prolapse. Some are hoping to optimize their pelvic floor health in order to have a better birth. Most practitioners and well meaning friends will suggest that you “do your Kegels” to build strength in the pelvic floor muscles in order to avoid or alleviate these issues, and to support overall pelvic floor health. Sound familiar?

Your pelvic floor is made up of muscle groups, which support your pelvic organs (bladder, uterus, and rectum), support the baby during pregnancy (and help her tuck her head into an optimal position for birth), and help control the release of urine and feces. The state of your pelvic floor is determined by a number of factors, some obvious and some not so obvious, including:

Pregnancy and childbirth
Your standing and sitting posture
How much time you spend sitting in a chair
How (and how much) you exercise
The type of shoes you wear
Straining to have a bowel movement
History of traumatic or punishment-based potty training

Contrary to popular belief, most of us don't actually have an overall weak (hypotonic) pelvic floor. For some of us, the problem is HYPERtonicity, or overly tight pelvic floor muscles. In fact, most women have a combination of hypotonic and hypertonic muscles in their pelvic floor. Our bodies are excellent at compensating, so your strong muscles will try to do the work for your weaker muscles. For most of us, doing your Kegels really just means what bay area yoga instructor Leslie Howard refers to as “indiscriminately gripping whatever muscles you can find down there.” The tight muscles get tighter, and the weak muscles continue to let the tight ones do their job, and pelvic floor imbalance is reinforced. Kegels can actually make the problem worse.

So what can you do instead of Kegels in order to support the health of your pelvic floor?

If you have tight muscles, you have to help them learn to stretch and relax before you can get the weak ones to learn how to fire. Here are some tips and exercises you can do to begin to regain your pelvic floor balance and health:

Squat! Squatting is a wonderful stretch (and strengthening exercise) for the muscles of the pelvic floor. Make sure your toes are pointing forward rather than out to the sides, and use a rolled up blanket or towel under your heels if they aren't able to touch the ground.
Pay attention to your posture. When you are sitting, sit on your sit bones rather than slumping back onto your sacrum. When you are standing, align your hips over your ankles, your shoulders over your hips, and your ears over your shoulders.
Breathe. The average adult takes around 20,000 breaths per day. Breathing deeply can act as a massage for your internal organs and muscles (including the muscles of your pelvic floor!), along with feeding every cell in your body much needed oxygen, and removing cellular waste via carbon dioxide.
Incorporate relaxation into your day, every day. Due to stress and lack of mindfulness, a lot of us hold on tight all day long – with our shoulders, jaws, and even with our pelvic floor muscles. Spending even one minute every day on mindful relaxation can help you learn where you are holding your tension, so that you can learn how to release it.

Once you begin to release the hypertonicity in the muscles of your pelvic floor, you are ready to move on to strengthening exercises.

Use a stool in the bathroom. Your body is designed to eliminate in a squatting position. Using a stool under your feet in the bathroom can help reduce straining, which can put too much pressure on your pelvic floor muscles. Watch this video to find out about how toilet posture affects your health: https://www.youtube.com/watch?v=pYcv6odWfTM
Untuck your tail! It is so common to be told, from a young age, to tuck your tailbone down and pull in your tummy. Even yoga teachers say this. This is not natural posture, and can lead to hypertonicity in the posterior pelvic floor, lower back pain, sciatica, and stress incontinence.
Move your body. Get up out of your chair. Put on a good pair of minimal shoes (or go barefoot in the grass!) and walk, letting your arms swing naturally. Climb a tree. Take a yoga class. Natural movement changes the shape of your pelvis, forcing the muscles to work in different ways.
Visit a pelvic floor physical therapist or holistic practitioner. A trained practitioner can help you discover which muscles you are using when you do pelvic floor work, which ones are not doing their job, and what to do about it. This is often covered by insurance.
Take a pelvic floor health class. I offer regular classes on pelvic floor health in the Bella Vie classroom space. These classes are designed to help you learn what shape your pelvic floor is in, and what you can do about it.

For more information, go to my Facebook page Starlight Yoga and Birth Services, and subscribe to my events to be notified of upcoming pelvic floor health classes.