Women to Women

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A Publication of Family Nurse Midwife Associates

pt Group Offering Workshop
Ever sneezed, laughed or ....oops "leaked? Most of us have experienced this at one time or another, during pregnancy, after childbirth, pre or post menopause....or just because. The pt Group Physical Therapy for Women has a few ideas that can and will help you control this embarrassing occurrence. The pt Group has put together a short class that will teach you everything you ever wanted to know about your pelvic floor!!! Come to the next class to learn more about what we can do to help ourselves deal with urinary incontinence. Are you doing your Kegels correctly? Lauren Mazzei, MPT and Debra Manzi, MPT are both certified physical therapists that have specialized in Physical Therapy for Women, more specifically, pelvic floor dysfunction. Register early as class size is limited. Class is to be held Wednesday, November 02, 2005 from 6:30 -8:30 PM at our office. This is open to the public so invite a friend!!! Register no later than noon on Monday, October 31st.

Midwives Respond to Hurricane Katrina
The American College of Nurse Midwives has activated its annual Blankets for Babies Campaign to help mothers and their babies who have lost their homes due to Hurricane Katrina. Distribution centers have been set up by nurse midwives in Texas, Louisiana and Mississippi. Thousands of families are being offered shelter and support in Texas, and many midwives will be providing health care services to these families. They have graciously agreed to accept and work with local relief efforts to distribute donations. Our office will start accepting donations in our office beginning, September 19th and will be forwarding donations to Texas Health Care Nurse Midwives located in Fort Worth Texas. A box is available in our waiting room for donations.

Mirror, Mirror , on the Wall
Would it not be great if, just like in fairy tales, we could conjure up a Fairy Godmother to make us look and feel beautiful? Well... we all know the reality is not as it is in fairy tales. If it were, we would not remember them fondly. Unfortunately, when we look in the mirror, we tend to focus on the parts of our body we do not like and rarely do we see "the fairest of them all The truth is there are some lessons we can learn from fairy tales to like our bodies and ourselves allot more. You do not need a Fairy Godmother to transform into a princess. As a reminder of the Cinderella in you, style your hair, add a little makeup, dress up and get your photo taken. Put it somewhere you will see it every day. Better yet. be your own Fairy Godmother and wave a magic wand and give yourself an at-home day spa. What often looks like a frog on the outside may be a prince or princess on the inside. You have probably gotten pretty good at seeing the inner beauty in others, but may need some practice seeing the fairy princess in yourself. Try to do that by making a list of your best assets (fiery red hair can be spotted in a crowd, a good sense of humor, legs that can take you up five flights of stairs, the ability to make a child laugh even after their pet goldfish has died). keep this list with you those days you need to remember. Just like Rapunzel, we all have at least one amazing body part and usually more. Rapunzel,s beautiful hair was her prized possession. Yours may be your nice ankles or lovely eyes or maybe it is not a body part at all, but an ability to make others laugh or feel good about themselves. Rather than fret about what you do not like, show off your best assets. Every girl needs her beauty rest. When you do not get the rest you need, you feel more like Grumpy than Sleeping Beauty. Try to get at least 7-8 hours of sleep a night. If this is not possible, learn to take those very valuable catnaps. Your will love the energy and vitality your body gives you. It is dark in the woods. If you are always focused on the negative things about yourself, like your crooked nose or those little flaps of skin under your arms that flap in the breeze, you will never find your way out of the forest. Shine some light in your life by spreading sunshine in someone else,s. Help build homes for the homeless or walk dogs at the Humane Society or help someone learn to read. By focusing on what you are capable of in the world, you will develop a better respect for yourself as a woman. My what a big smile you have!! No matter what you see in the mirror today, you will improve your looks one hundred percent when you turn the corners of your mouth up and smile. There, now is that not better? Remember life may not be a fairy tale, but you can have your own happy ending by learning to value yourself and appreciate your body more.

What is a Midwife?
A midwife is a trained professional who provides complete comprehensive care and support during pregnancy, labor, birth and the post partum period to low risk women and their families. Routine gynecological care is also provided. Midwifery care is rooted in the knowledge that, for most women, pregnancy and childbirth is a normal and important life event. Midwives believe that unnecessary intervention is an interruption of a normal process, however, they support the appropriate use of technology. Nurse Midwives consults with and refers to specialists when necessary and are skilled in careful monitoring to detect abnormalities in pregnancy and birth. The philosophy of midwifery is based on respect for the birth process and the women,s ability to give birth. They work towards empowering women in their own individual pregnancy and birth by expanding choices and promoting health and normalcy in the childbearing years.

Bring a Friend and Meet the Midwife Tea
Have a friend or relative that wants to learn more about midwifery? If so, take the time to invite them to this very special morning scheduled for Friday, October 21st at 9:00 AM. Sit down with your midwife and guest and enjoy a hot cup of herbal tea and light refreshment and share experiences and ask general questions about midwifery and childbirth. Tours of our office and the Family Birth Place can also be accommodated after Tea Time. There will be limited seating so registration is required no later than 4 PM on October 19th. Future teas will also be held. Dates and times will be posted on our website as they are scheduled.

Payment and billing policies
Although our practice participates with most insurance carriers and a majority of services are covered, it is ultimately the responsibility of the patient to know their own policy and to pay for any services not covered under their particular plan. We would also like your assistance in helping our office reduce the cost of mailing statements by asking that you pay your co-pays at the time of service. Our office accepts cash, check and credit cards. We do understand that at times, you may leave your home without your checkbook, et. If so, ask Sue for a payment envelope and remit your payment within the next day or so. These measures will greatly reduce this unnecessary overhead expense and by doing so we can use these funds to purchase more educational handouts and books for our library.
Please let Sue know immediately of any changes in your insurance carrier. It is the patients responsibility for any charges not paid due to untimely filing due to incorrect insurance information. We realize most employers change carriers quite often, so please make sure you bring your most updated card with you when you arrive for your visit.

Natural Family Planning Workshop
Mary Ann Newhouse from Catholic Charities will be offering a Natural Family Planning Workshop on Wednesday, November 09th at 6:30. This workshop will help you get in tune with your natural fertility signs. It is packed full of information with time available to ask questions. Registration is required no later than 5:00 PM on Monday, November 07, 2005 by calling 724-527-9159

Parents Prayer - Author Unknown

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Now I lay me down to sleep I pray my sanity to keep For if some peace, I do not find, I am pretty sure I,ll lose my mind I pray to find a little quiet Far from the daily family riot May I lie back-and not have to think about what they are stuffing down the sink or who they are with, or where they are at and what they are doing to the cat I pray for time all to myself (did I hear something just fall off the shelf?) To cuddle in my nice, soft bed (Oh no, another goldfish...dead) Some silent moments for goodness sake (Did I just hear a window break?) And that I need not cook or clean (well heck, I have the right to dream) Yes now I lay me down to sleep I pray my wits about me keep But as I look around I know- I must have lost them long ago!!!

Birth Balls Now Available
Our office now offers for sale Birth Balls for your convenience. These balls can be purchased for 35.00 and checks can be made out to Jan Mallak

Nurse Midwifery Week
In honor of Nurse Midwifery Week which is October 3rd through October 07, 2005, our practice will be hosting a patient get together evening on Thursday, October 6th. This will be an opportunity to bond and network with other patients Evening will begin at 6:30 with a group picture to be taken at 6:45. The practice will provide the cake, drinks and paper products. All attending are asks to bring a healthy dish to share with others. By attending this event, you are demonstrating your support for midwifery!!! Let,s have a strong showing this year by making the time to attend!!! A wonderful gift basket will be given away as a door prize. If you have a digital camera, please bring it along to snap off some pictures to post on our website. For more information, call Sue at 724-527-9159

Exchange Page Up and Running
Thanks to Ron at Integrated Health Systems, our website www.JDMH-midwives now has an Exchange Page available. This page enables patients to post any maternity or baby supplies they wish to give away or sell and also to list any items you are in need of. If you would like to post any items, please either do so on our webpage or e-mail the office at susanklosky@hotmail.com. Please remember to let us know of any items which become unavailable, so we can remove them from the webpage.

Post Partum Depression Resources
	Excela Health at Westmoreland	1-877-771-1234
	Indiana Hospital Moms Support Group	724-357-7075
	Post Partum Support International	1-805-967-7636

Birth Rituals from Around The World
Here is a composition of some unusual pregnancy and Birth Rituals and Folklores from around the world:

Mexico -They should avoid all conract with anything death related. They are forbidden to attend funerals or burials or visit cemeteries
Uganda-Mother is instructed not to drink water while standing to prevent baby being born with squinted eyes
Bolivia-Do not do any knitting during pregnancy to avoid the umbilical from being wrapped around the babies neck
Inuit-If mothers begin a project such as sewing she should finish it so her labor will not be long. They also believe that you should not blow bubbles or your membranes could rupture.

When the Weather Outside is Frightful
When the weather conditions become treacherous we would prefer to have our patients safe at home than outside trying to navigate bad roads. If conditions become severe, we will re-arrange our schedules so that we can see patients when conditions improve. We will however take the time to check in with everyone. If conditions are questionable, please call ahead to verify your appointment.

When Was the Last Time Your Bought a Refrigerator?
by Jan Mallak, 2 LAS, ICCE-CD, CD-PCD (Dona)
Or a living room set? Or a new car? Or a house? If you have ever invested in a large purchase before, you probably were a "consumer during the process. You most likely shopped around for the best deal that included considerations like : cost, availability, treatment by sales personnel, ability to see/drive or tour et. Many aspects go into your decision-making. And before making the final decision, there,s generally a lot of information gathering and questioning to determine the choice. You have been preparing for your new baby. It involves a lot of important decision making throughout the pregnancy, during the birth and for many years as parents. Being a good consumer when it comes to your children is part of the protective role you will find as a parent. Ensuring their safety is paramount every day, every hour, every minute. One way of accomplishing this is through education and information gathering. Many educators call childbirth classes the couples "first parenting class Why? Because it gives you an opportunity to learn, apply your skills and meet the challenges before you. Education means empowerment. Like how you feel when you go into the dealership to buy a car with facts and figures in hand. You,re ready to wheel and deal and feel confident that you,ll leave with a good deal. The investment of learning really pays off big, as they say. So if you are expecting a baby, why not consider coming to the childbirth courses offered by the midwives? It will help you to develop as a consumer by providing you with the information you need to make the right decisions for you and your baby. An Early Pregnancy class is offered for those in the the beginning and a Crash Course is offered for those near the end The Early Pregnancy Class is two Wednesdays in a row from 7-9 PM and the cost is 40.00. It covers the physical and emotional aspects of the early months which helps women to make healthy choices then and as the pregnancy continues,

The Crash Course is a childbirth preparation class offered two Wednesdays in a row from 6-9 PM and the cost is 75.00. Its focus is on labor progress and pain management skills. There are lots of useful tips, tools and techniques provides to really "fill your birth tool bag?. A highlight of the class is birthing ball practice as well as many hands-on activities. Hope to see you in class... see the schedule below:

Early Pregnancy Classes
October 19th and October 26th
December 14th and December 21st
February 8th and February 15th
April 19th and April 26th
June 14th and June 21st

Childbirth Crash Course
November 30th and December 7th
January 18th and January 25th
March 15th and 22nd
May 10th and May 17th

Register by calling Sue at 724-527-9159 or Jan at 724-327-6063
www.JDMH-midwives.com

Please mark www.JDMH-midwives as one of your favorite pages and log onto to keep up with any changes within our practice. Want to help promote our practice? Well, it is only one click away. Simply forward our website address along to those in your address book. Reminder that the newsletter is posted on the website about 2 weeks before you will receive it in print.

National Ovarian Education Month
In honor of the new national declaration of September as National Ovarian Cancer Education Month we wanted to share with you some of the signs and symptoms of ovarian cancer. Unfortunately, ovarian cancer is hard to detect in the early stages, but knowing the subtle symptoms can help women discover this problem earlier so they can receive appropriate health care. There is no good screening test for ovarian cancer, so regular yearly gynecological exams with attention to symptoms are important. The following list of symptoms is from the National Ovarian Cancer Coalition,s website (www.ovarian.org) It is good place to look for further information.
Ovarian cancer is difficult to detect, especially, in the early stages. This is partly due to the fact that these two small, almond shaped organs are deep within the abdominal cavity, one on each side of the uterus. These are some of the potential signs and symptoms of ovarian cancer:

*Unexplained changes in bowel and/or bladder habits such as constipation, urinary frequency, and/or incontinence
*Gastrointestinal upset such as gas, indigestion, and/or nausea
*Unexplained weight loss or gain
*Pelvic and/or abdominal pain or discomfort
*Pelvic and/or abdominal bloating or swelling
*A constant feeling of fullness
*Fatique
*Abnormal or post menopausal bleeding
*Pain during intercourse

When the symptoms are persistent, when they do not resolve with normal interventions, like diet change, exercise, laxatives or re

st, it is imperative for a woman to see her health care provider. Persistence of symptoms is the key

Passive Smoking - A Silent Epidemic that Affects Children
The very first health reports done on smoking focused more on the effects of tobacco smoke on the smoker. In the recent years, the dangers of passive smoking on children is now being reported and continues to be a silent epidemic in the pediatric population. The effects of smoking on the fetus is well established. Mothers who smoke have a higher rates of obstetrical complications ranging from miscarriage to premature rupture of membranes. Premature delivery is not uncommon among smokers. Fetuses exposed to smoke have decreased fetal breathing which correlates to decreased lung function once born. Those delivered even at full term, have a tendency to have lower body weights. SIDS is more prevalent among smokers. Recent studies on SIDS states that passive smoking is the most modifiable factor in prevention. The rate of SIDS is double among smokers than non-smokers,
As children grow this exposure to smoke can increase rates of otitis media, bronchitis, wheezing and asthma.

Reminder from the Pap Police
The busiest of holidays in rapidly approaching and we would like to remind everyone to call to schedule your yearly gynecological health screenings before they arrive. For your convenience, we have evening hours available. Keep forgetting to call our office during the day when you are so busy? If so, just e mail us at susanklosky@hotmail,com with your availability and we will provide you with a date and time. These visits are very important so set aside time to schedule it

Max's Early Arrival
Max,s Early Arrival It was 17 days away from Max,s due date of June 20th when my water broke. I went to the hospital that night, not really having contractions yet. I was only 1 cm dilated when I arrived, but almost completely effaced. I walked around all night, used the exercise ball, rocking chair, and shower to help to relax me. By morning I was only 2 cm. I labored some more and was at 3 cm a few hours later. I stayed at 3 cm for quite awhile despite all of my efforts. I finally reached 4.5 cm at around 1:00 PM and stayed there for a while. We tried the breast pump to stimulate the body,s natural oxytocin, but when I was checked again, I was still at 4.5 cm. Gretchen and I decided that I should receive some pitocin to bring on the contractions. Thanks be to God, less than one hour later, I was having very strong contractions. It turns out I was 9 cm and almost ready to push. My husband used the "Release cue from the Hypnobabies program, putting his hand on my shoulder every time I had a tough contraction. Gretchen and the nurses put cold washcloths on my forehead, which felt great. By 3:45 PM, I was ready to start pushing. I pushed for an hour in various positions until Max was born at 4:45 PM with a full head of dark hair. Throughout the birthing, I listened to the hypnobabies CDs, told myself that it was not pain, only pressure, and used my husband as a source of comfort and relaxation. Maximilian Kolbe Paladina was delivered without any pain medication with the help of hypnobabies and my wonderful birthing team which included my husband, Gretchen and all of the nurses. He is an absolute joy and a true blessing from God. Proud Mom Julia and Baby Max, Aliquippa

Health Tip:

To help boost your metabolism learn to eat breakfast every day within 30 minutes of arising and eat 5-6 smaller meals throughout the day instead of 3 larger meals.

Appointment Scheduling
Please remember that the time you are scheduled for is time set aside just for you. Our office does not overbook unless there is an emergency. Please try to arrive on time for your appointment and provide our office with suffiencent notice when you can not keep your appointment, so we can make that time available for some one else. We try very hard to remain on schedule and not to have our patients wait to be seen, so your cooperation on keeping set appointments is very important.
Also remember that the midwives do labor support and deliveries can happen at any time. Our office tries very hard to reach everyone to reschedule their appointments when the midwife will not be available. Providing us with cell phone numbers and other alternate numbers makes it much easier to reach you. If you are coming straight from work for an appointment and we do not have a work number for you, you are welcome to call ahead to verify that we are still running on schedule.