Health and Well-being

How Often Do You Need a Pap Test (and did you know midwives can do paps?)

By Rachel Fox-Tierney, LM, CPM

With the beginning of the new year and a newly renewed health insurance plan, my health insurance company sent me a glossy infographic from the CDC letting me know what I can do to "Prevent Cervical Cancer with the Right test at the Right time."  Little do they know that I have in-home Pap tests available to me as a "perk" of being a Birthstream midwife, so I will not need to "talk to my doctor today!"  But the letter was a good reminder to answer the question I often am asked by Birthstream families about when they should get a pap test.

What is a Pap test and why do we do them?  Pap smears, also called Pap Tests, are done to check for early changes in cells in your cervix that could indicate a risk for, or the presence of cervical cancer. HPV (human papilloma virus) screening looks for the specific high risk HPV strains that are associated with increased risk of developing cervical cancer. 

"While in general, the risk of cancer is very low for women in the US, representing only 1.5% of all deaths related to cancer in women, it’s not zero." reminds Aviva Romm, MD.

The American Cancer Society estimates that in 2017 in the US there will be an estimated 12,820 new cases of invasive cervical cancer, and 4,210 cervical cancer-related deaths.  Most cases are present in midlife, in women who have not had regular screening or did not follow up with screening guidelines after an abnormal pap.  If you're not sure what your last pap results were, contact your midwife or doctor and have them send you a copy of the results.

Many of us grew up referring to the pap as our "Annual Exam" because women were recommended to have paps every year.  New guidelines no longer recommend yearly paps.  In part because cervical cancer progresses very slowly, and in 93% of the time requires the presence of one of the high risk HPV strains, so HPV status now plays a bigger role in determining frequency of screening.  But also because, more frequent testing has the possibility of over-treatment which can impact pregnancy and birth.

So how often should YOU have a pap?  According to the American Cancer Society's Guidelines from 2012 (and they haven't changed since then):

  • Women under the age of 21:  NO Paps and NO HPV screening, "HPV is very common in women younger than age 30. Since most HPV that is found in these women will never cause them health problems, it is not useful to test young women for HPV. Most young women will fight off HPV within a few years." according to the CDC.
  • Women 21 -29 years old:  Paps every 3 years, unless abnormal, and NO HPV screening, unless pap is abnormal.
  • Women 30-65 years old:  Paps every 3 years, unless abnormal, or Pap test plus HPV screening every 5 years, IF HPV negative .  Women who are HPV+ will need more frequent pap screening.
  • Women who are over 65 years old:  NO paps or HPV screening, IF they have had normal paps for the previous 10 years and no pap with serious pre-cancerous cells for 20 years.

Individual Considerations:

  • Women who have had a total hysterectomy (uterus and cervix removed):  Stop screening, unless hysterectomy done as a cancer or pre-cancer treatment.  You should consult your MD.
  • Women who have had a hysterectomy without the removal of the cervix:  Screening according to age and risk guidelines above.
  • Women who are high risk for cervical cancer because the have a suppressed immune system or were exposed to DES medication in utero:  May need to be screened more often.
  • Women who have been vaccinated for HPV:  Should be screened according to their age and individual risk guidelines.  The HPV vaccine does not protect against all strains of HPV.
  • Women who are HPV+: Should get pap + HPV screening yearly.

We discuss these guidelines with all of our clients so together we can determine what is the best screening schedule for them given their personal and family history.   We provide pap screening as part of our midwifery care when needed prenatally or postpartum, but we also offer pap screening at any time in a woman's life.

We often get asked,"Can people who aren't Birthstream clients get paps done with you?"  Our answer is, "Of course, because once they use our midwifery service for paps or Well Woman care, then they ARE our clients!  People don't need to have babies with Birthstream in order to enjoy the benefits of in-home Well Woman care!"  

Sometimes medical providers will encourage Pap Screens and describe them as preventative care.  But remember, Pap tests are not really "preventative care", they are "early detection screening tools."  Preventative care is eating a whole food-rich diet, getting walks in the fresh air, having tools for stress management, avoiding smoking and other high risk behaviors, and most of all telling your body what an amazing job it is doing!

There will be some people who do all of the "right things" and still develop cervical cancer because sometimes despite our best efforts we have outcomes that we don't want or expect.  I have cared for people who have developed cervical cancer but have come to the other side, cured in body as well as healed in spirit.  It is possible some times.  So I encourage people to get screened appropriately knowing that I will midwife them through any abnormal results...but likely as is most common, the report will say"within normal limits" or rather as we like to translate "healthy and wonderfully normal cervix!"

If you are interested in having your Pap screen done by a Birthstream midwife, please contact us to schedule an appointment in the comfort and convenience of your own home!


Postpartum Care: Not just for home birth families anymore!

By Rachel Fox-Tierney, LM, CPM

In many countries around the world, new mothers and babies have several midwife visits in the first 4-6 weeks postpartum as a standard benefit of their health care system.  Cross culturally, for 40 days post birth, new mothers are expected to rest and eat special healing foods.  There is wisdom in this 40 day rest time.  Physically, women are better healed and able to resume family and community activities when their six week rest time is completed.

Unfortunately, in the United States new mothers are viewed by society as "back to normal" within a few days after giving birth.  Most American women do not get any preventative medical care during the first 4-6 weeks after birth.  There is little support or evaluation of their physical or emotional adjustment until their 6 week OBGYN visit.

What I truly appreciate about the postpartum care is the fact it was a home visit. In my culture, a month bed rest postpartum was a mandatory custom. It was believed that it would help with postpartum depression and our health in the long run. So without this home visit postpartum care [with my first two hospital births and American postpartum care schedule], I found myself having to sacrifice and assimilate to Western culture by taking a newborn to physician’s office for postpartum checkup. With postpartum care offered by Birthstream Midwifery, I was able to maintain my dignity as Woman of Color and kept my cultural customs in regards to postpartum. I felt so much love and respect. One of the most memorable things I had about the postpartum care was witnessing the beautiful interaction between my midwives and my newborn. How delicate and respectful they were with my newborn when they were performing newborn screen, to the point where my newborn was not traumatized at all. As a third time mom, that ceased my worries and concerns. I would recommend it to all families.
— Client who had two hospital births followed by a home birth with Birthstream

In addition, new mothers are expected to leave the house within a few days of giving birth to get pediatric care for their new baby at a time when they are not yet healed from this major life transition.  It is not surprising then, that as many as 1 in 7 to 1 in 5 women experience postpartum mood disorders in this country.  Although midwifery care alone cannot prevent all postpartum mood disorders, many families have reported that they have felt better emotionally or are able to get the care they needed from mood specialists sooner than after previous births.

My postpartum care with Birthstream was best experience ever. I was able to avoid postpartum depression as I was cared by very supportive and knowledgeable midwives. Birthstream offers their [home birth] clients placenta capsules which was one of the reason I was able to get back on my feet way sooner [than after first birth]. When I had any question or problem they would respond very quickly or even stop by on their way just to provide herbs needed to heal. All of the midwives are very loving and wonderful women, they truly care for you and your baby. If I ever have another child I will definitely call Birthstream.
— Client who had two home births, second with Birthstream

Midwives who attend home births have always included extended (or from our perspective basic and necessary) postpartum care for 6 weeks.  Typically, midwives provide 4-6 visits in the first 6 weeks, some at home and some at the midwives' office.  Birthstream Midwifery Service is unique in that we visit 6 times in the first six weeks and all care is provided in the comfort and convenience of the family's own home.

I felt like you were very available and knowledgeable. You really allowed us as new parents to get situated with a new baby in the way we felt most comfortable and fully supported that, which made the transition as a family much easier. You were also so patient and sweet with our other children.
— Client who had two hospital births, a home birth with another midwife, and last baby at home with Birthstream

In the past few years, several families who planned hospital births have contacted Birthstream to request the kind of postpartum care they would have received if they were giving birth in their home country or the kind of care their home-birthing friends have received with us.   Some families who had standard American postpartum care with previous babies felt that the patchwork of postpartum care that they had to piece together themselves didn't work out as well as they had hoped.

We understand!  Postpartum care from skilled midwives was what all of the Birthstream midwives experienced after we gave birth.  This is the kind of care that we think is beneficial to health and well-being for mother and baby and an essential component of comprehensive midwifery care.

By popular demand, Birthstream created a special Postpartum Care package just for families who give birth in the hospital:

·     One meeting during pregnancy to meet and discuss postpartum care plans.

·     Six scheduled postpartum visits for mother and baby: Day 1, 3, 5, Week 2, 4, and 6...or a personalized schedule, if preferred.  Visits average 60-90 minutes in your own home.

·      24-hour availability for urgent concerns.

·      Breastfeeding support.

·      Postpartum Herbal Kit:  Healing Peri-wash herbs, Manuka Honey, and Happy Ducts tincture for breast health.

·      Keepsake with baby footprints.

·      Placenta encapsulation available for an additional fee.

During each of the 60-90 minute visits, we include a newborn exam and new mother exam.

  • The Newborn Exam includes:  checking baby weight, assessing heart rate and rhythm, evaluating breathing, assessing feeding and diapers.  If there are concerns that we cannot address, we refer to a pediatrician of your choice.
  • The New Mother Exam includes:  checking blood pressure and pulse, assessing postpartum bleeding (lochia), assessing tissue healing (especially if sutures placed), supporting lactation and evaluating emotional and psychological adjustment to new parenthood.  If there are concerns that are outside of our scope of care, we can refer to physicians/specialists.

We have limited space in our calendar for families choosing this Postpartum Care package.  Please contact us if you are interested in finding out more or scheduling a consultation visit.

I often say that while my home birth with Birthstream three years ago was perfect in every way, it was the six weeks of postpartum care — for both me and the baby — that was the best part.

With our older two children, it was a real struggle in the days and weeks after birth to get the baby and ourselves out of the house and to pediatrician and subsequent OB/GYN appointments. I clearly remember the stress it created with our first child, when I was struggling with breastfeeding and in desperate need of sleep, to have to haul her to the doctor for her regular checks, when really what she (and I) wanted to be doing was lying in bed, working on nursing. As a new parent, hearing my daughter cry in the car seat on the way to the doctor’s office was really difficult for me. I worried about my child contracting some ailment from another child in the pediatrician’s waiting room. I often returned home feeling defeated after realizing the pediatrician did not know very much about breastfeeding and to positively facilitate that relationship. Visiting the pediatrician felt like a marked intrusion on our attempt to bond and figure out life together as a family — but, of course, I wanted to make sure my baby was doing okay, so we went.

When we had a second child 21 months later, it was even more logistically difficult to get everyone out of the house for all the appointments in the first six weeks, and many tears were shed in the process. (By my children, but many by me.)

With our third child, we had a beautiful home birth, and it was a wonderful gift to be able to climb into my bed with our newest arrival immediately after her birth. But what was equally wonderful is that, for every check on the baby and me after that, I was welcome to stay in my bed with my baby! It was so freeing to not have to interrupt nursing and sleeping to get ready to drive to the doctor’s office. The wonderful midwives at Birthstream were able to do all of the baby’s assessments, as well as mine, for the entire six weeks. It truly made the postpartum period infinitely more lovely and less stressful than having to leave the house.

Also, the level of care my baby and I received was extraordinary. The midwives are all kind, loving, respectful, and incredibly knowledgeable. I certainly would have benefitted from their vast array of breastfeeding pointers with my first child! Every check that the pediatrician (or my OB/GYN) would have done, they did, just that this time I was in my pajamas.

It was also wonderful how much the midwives included my husband and young children in the visits. Every member of the family felt very included in the process of checking on baby and Mama. The midwives became a part of our family, and I will forever be grateful for all they did to help make this such a beautiful time in our lives.

No matter where you opt to give birth, I cannot recommend more highly utilizing Birthstream for their postpartum services. Their care for you and baby at your house will allow for the most seamless transition into your life as a new family.

I would add a line after the pajamas: The midwives were also available via text or phone call for any questions I had during this time, which provided an extra level of support and reassurance that I would not have had using a pediatrician or my OB/GYN.
— Client who had two hospital births, followed by a home birth with Birthstream

Natural Healing: Garlic Lemonade Recipe by Rachel Fox-Tierney, LM, CPM

Although the sun was out today and the flowers are starting to bloom, we are only halfway through cold and flu season, so this seemed like a perfect time to share this favorite recipe for Garlic Lemonade.  (Actually, I had intended to publish this in the fall, but since I had bronchitis during the holiday season, I was busy making many batches of this recipe for myself and focusing on recovering rather than writing!)

First, I'll say this IS my favorite remedy for nearly everything...with food poisoning and intestinal distress being the the notable exceptions for obvious reasons.  Garlic is antiviral, antibacterial and antifungal.  So all of your bases are covered when your little (and big ones) start a new school year and suddenly spend the first 3 months with a new ailment every other week!  When my oldest was little, we had many tears while I  "strongly encouraged" him to eat raw garlic on a spoonful of honey.  He was usually a good sport but fortunately I found a version of this recipe in a book by Aviva Romm, MD and Midwife  by the time he was in kindergarten.

I have used Garlic Lemonade with all the many typical childhood ailments throughout the years...colds, flu, coughs, ear infections, chickenpox and sore throats (including strep once), often in conjunction with other herbal medicines, but sometimes alone.  My boys have had it so often and recognize that it is my universal remedy for everything that once my younger son was playing a quiz game and was asked, "How do you cure homesickness?"  He said, "Garlic Lemonade" without hesitation and clearly without knowing what "homesickness"meant!

Professionally, I often recommend this recipe to my midwifery clients.  It is safe during pregnancy, although some women find it unappealing if they are overly nauseous.   I recommend it during all their colds, flu, and sinus infections, but also any time they have breast or vaginal infections.  Usually it is received with skepticism, but afterward I frequently hear, "That wasn't as bad as I thought it would be!"  Every year, I get asked for the recipe from  former clients at least a dozen times who remember drinking it during pregnancy for various ailments.

In addition, Garlic Lemonade can be taken with conventional treatments such as antibiotics, OTC medicines, or herbal or holistic medicines, with rare exception.  As always, ask your midwife, primary care provider or children's pediatrician if you have any questions or concerns.  Enjoy and feel better soon!


Garlic Lemonade Recipe