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Upside down: Breech birth and the rabbit hole that is informed consent

Recently a friend shared her awesome birth story with me, and graciously allowed me to post it to the blog. Her baby was breech, and she was facing an unwanted cesarean. In the end, she had an experienced provider and a fast labor that allowed her to birth vaginally.

The thing is, the story is so exceptional. These days it's difficult to find a provider experienced and willing to deliver a breech vaginally. Why? In looking for research, I couldn't count the number of resources that kept saying it's too dangerous. But why is it dangerous? I found even fewer resources who were willing to spell out the risks.

Cesarean sections are living saving and can be necessary for breech babies. But when do they take the place of attempting vaginally? What are the options?

Cesarean sections are living saving and can be necessary for breech babies. But when do they take the place of attempting vaginally? What are the options?

If you cannot find all the facts to educate yourself on a major decision for your birth, are you really getting to make that decision at all? Is it really informed consent? Or has your provider made the decision for you? Have the insurance companies hamstrung our care?

In my last pregnancy, my daughter was breech at 37 weeks, and my OB was skeptical of her turning. (You can read her birth story and how she was turned by scrolling below.) When I asked why breech delivery was such a big deal, my doctor replied, "We used to do this all the time. What's changed is how insurance covers us as practitioners, hospital policies, and how we view these types of births."

So where do you go to find the full scope of information on breech birth? I've compiled a list of resources for you!

1) American Congress of Obstetricians and Gynecologists (ACOG.org)                                               When in doubt, go to the source of the entity that creates guidelines for OBGYN providers. While we are seeing a large gap in what is recommended and what is practiced, this will help you discuss directly with your provider. It gives guidelines for when a vaginal breech can be attempted, or indicators for when a cesarean may be necessary. (acog.org)

2) Coalition for Breech Birth (breechbirth.ca)                                                                                         Both the website and Facebook group are a wealth of resources, including a depth of published research studies and resource links for everything from breech birth videos, turning a breech baby, and chiropractic care. 

3) Spinning Babies (spinningbabies.com)                                                                                                Founder Gail Tully discusses physiological components that can attribute to a breech birth and the means of correction. She also fully explains the risks with breech birth, and when cesarean may be more appropriate. The issue of providers being able to keep hands off the breech baby as its born, or not being skilled enough in the case of a trapped head or nuchal arms, is what seems to be the biggest risk. It's not so much the presentation of baby, but the loss of education in handling emergencies.

4) Ina May Gaskin                                                                                                                                      I love Ina May Gaskin. Her books are a wealth of knowledge for midwifery, birth and the art of birth stories. She wrote an article for Peggy O'Mara's website, focused on natural living, mothering, and social justice. Ina May expands on the history of the policies regarding breech birth, as well as the changes in provider skills and care. It's a great read, and you can find it here: (www.peggyomara.com/2014/01/23/vaginal-breach-birth) 

 

Know your options. Have a supportive and experienced team. Have the best birth you can. 

Know your options. Have a supportive and experienced team. Have the best birth you can. 

These are my top four resources when researching breech birth. These four will keep you reading and falling down the rabbit hole like I have for the last month. When there is so much information to consider, take your time and have open conversation with your care provider. Finding all the facts is just one aspect of informed consent, but may the most important. 

Do you have another resource to share? Was your baby breech? 

                               

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Jacob's Birth Story: A fast breech vaginal birth

Before I begin my most recent birth story, I need to give some background information about myself. I am a Neonatal Nurse Practitioner and work at the same hospital that I receive my OB care; therefore, I have a close professional relationship with my OB providers. I also have a uterine anomaly called a bicornuate uterus. This means that my uterus is divided into two sections. This was discovered at my 13 week nuchal transluceny ultrasound with my first pregnancy. The complications associated with this anomaly are cervical insufficiency, preterm labor, preterm delivery, growth restriction, and breech presentation. The risk of breech presentation is due to the limited space for the baby to turn. Because of this anomaly, I was followed very closely by the high risk OB and had approximately 13 ultrasounds with my first pregnancy. My son was born by vaginal delivery after spontaneous labor at 37 weeks and 2 days. At every ultrasound he was head down.

With my second pregnancy, my son was in breech presentation at every ultrasound. I really became concerned about this around 26-28 weeks, given the limited uterine space and that my first son was always head down and this time my son was always breech. Everyone (both medical and non-medical) tried to reassure me that “there’s plenty of time for him to flip.” It was at this point that I began my research on getting a baby to turn. I googled, youtubed, and read a lot of articles and blogs. I tried anything and everything to get my baby to turn, with no avail. At 34 weeks I had a discussion with my OB about attempting an external cephalic version (ECV); however, I am not a candidate for this procedure given my uterine anomaly. It finally started to sink in that I was going to have a c-section. My OB decided not to schedule me for a c-section, rather we would wait until I went into labor in order to give me every opportunity for the baby to flip.

Breech presentations include:

  • Frank Breech (Bottom down, feet are up by the head)
  • Footling breech (One or both feet are by down)
  • Complete breech (Bottom is down and legs are crossed. Imagine baby sitting Indian style.)

During a casual conversation one day at work with the high risk OB director, I expressed my concern for having a c-section and how much I did not want to have one. He agreed that I was not a candidate for an ECV and what I thought was jokingly, he said,“Well you could always do a breech vaginal, the only problem is I would have to be at your delivery, and that might be uncomfortable for you.” My response was that I would not have a breech vaginal because of the risks associated with it. That was the extent of our conversation. I did not have any conversation with my primary OB about a breech vaginal delivery.

So what are the risks with breech birth?
- Placenta being compressed
- Head getting stuck
- Some incidence of large limb fractures
Biggest issue currently is finding a provider who is experienced and educated in delivering a breech!

At 37 weeks I went to my routine OB appointment, and again had a discussion with my OB about a C-section, and again expressed my feelings and anxiety about it. She was very empathetic, but tried to reassure me that it wouldn’t be as bad as I thought and also gently brought me to reality that this baby would most likely not flip at this point. I was 1 cm dilated and 50% effaced at this appointment and not having any significant contractions.

The next morning, at 37 weeks and 1 day, I woke up with some intermittent cramping back pain. It wasn’t very painful, but it was certainly noticeable. Shortly thereafter I began to have some lower abdominal cramping similar to that of a period. I didn’t time the cramping but thought something might be happening given that it was intermittent and not a consistent discomfort. At this point I didn’t want to call my OB, because I knew she would want me to come in right away given the breech presentation and I didn’t want to have my husband come home from work and call my childcare if this wasn’t, “the real thing.” But, I did get my (almost) 2 year old set up with breakfast and hopped in the shower, did my hair and makeup, and got myself all ready “just in case” this was it. I packed the car with our bags before heading out with my son. Throughout the pregnancy I constantly thought about the, “last day” that it would be just, “us.” My son loves ice cream, so I wanted to take him out on an ice cream date. We got to the ice cream parlor a little before noon just to find out they didn’t open until noon. We went next door to the grocery store to kill a little time. By this point the cramping was occurring more frequently, but not necessarily with more intensity. I stopped in the bathroom on our way out and that’s when I had my bloody mucousy show. It finally sunk in at that time that I was in early labor. We got our ice cream and I just sat and enjoyed those last minutes with my son before my attention was going to have to be shared.

Megan the morning of Jacob's birth.

Megan the morning of Jacob's birth.

We got out to the car around 12:15 and I called my OB to report my symptoms. As I expected, she told me to come to the hospital to get evaluated. I called my husband who was working an hour away and my sister who was going to watch my son. By the time my husband got home and we got out the door it was around 1:30. We weren’t in the car more than 5 minutes when the intensity of my contractions increased and I was unable to talk during them. The ride to where we were meeting my sister was about 25 minutes. Just as we pulled up my water broke. I called my OB again to give her an update and that we were about 20 minutes away. By the time we arrived to the hospital I could barely think or talk due to the pain of the contractions which were now about a minute apart.

I was immediately taken into a room (the PACU was full) and my OB checked me and said I was 6 cms. There were so many medical professionals in my room working diligently to get me prepared for my c-section since I had progressed into labor so quickly and was continuing to have very strong contractions every minute. That was when my OB told me that the hospitalist was on service and she has experience with breech vaginal deliveries and asked if that was something I wanted to consider. I could barely focus on her words so she decided to get me my epidural and get me comfortable before we had any further conversation. As soon as I got my epidural she checked me again and I was 9 cms (that was about 30 minutes after the first time she checked me). I had to make my decision very quickly after having a brief but serious conversation with the hospitalist. I knew in my heart that this was the right decision for me. My husband was against it, but said he trusted me and my OB and knew that I was very aware of the risks associated with this type of delivery given my medical background.

So we moved into the OR, which is where I had to deliver in case they had to do an emergency c-section. As was explained to me before making my decision, I labored down for about an hour before I started pushing in order for the baby to optimally move into the birth canal vs pushing him into position. I pushed for 18 minutes until I heard the most beautiful sound in the world which was that of my baby crying. He was placed skin to skin with me and I just cried tears of joy and relief. He weighed exactly the same as my first son, which was 6 lbs 13 oz. I had no tears and felt so wonderful during my recovery. Every day I thought about how different my recovery would have been if I had a c-section.

On the way to the hospital when I was contracting so painfully I thought to myself, “Why did I wait so long to call my OB? I should have called this morning! This pain is so unbearable I could have avoided this if I hadn’t waited!” Afterwards, I was so thankful that I did wait to call, because my delivery experience would have been so different. Everything happened to just fall into place to make this all possible. The OB that I had such extensive conversations with was on service at the hospital so she knew my anxiety about having a c-section, the hospitalist who will do the breech vaginal delivery was on service, I was in spontaneous labor with contractions every minute with very fast cervical dilation, and my baby was tolerating the labor. Had any one of these factors been missing or different, I would have had a c-section. I absolutely love my birth story and I hope you enjoyed reading it!

Jacob meets his big brother.

Jacob meets his big brother.

 

 

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So What's a Doula? Answers to the top three questions about birth work

Often when someone hears that I am a doula, the first questions about my field are:

Is that like a midwife?

That's for home births, right?

But then what does the dad do?

 

Let me address these questions, then I'll share exactly what a doula does for her clients.

 

Is that like a midwife?

Nope. A midwife is a medical professional that oversees your and baby's medical care through pregnancy and birth. Midwives are typically low intervention, and are great advocates for natural birth. A midwife can practice in a hospital, birthing center, or private home birth practice depending on the state.

Midwife checking on baby. Midwives can serve births at hospitals, birth centers, and at home. If you are having a low risk, healthy pregnancy, midwifery care may be for you.

Midwife checking on baby. Midwives can serve births at hospitals, birth centers, and at home. If you are having a low risk, healthy pregnancy, midwifery care may be for you.

 

A doula does not dispense medical advice, and it's out of their scope of practice to perform any medical procedures (temperature, cervical checks, manually feeling your belly for fetal position, etc.) Instead, a doula is a wealth of resources and knowledge. If you are faced with a procedure during your pregnancy and you are unsure of your options, a doula can help you to research the procedure and suggest questions to bring to your provider. We don't want to make decisions for you, but help to empower you in your decisions. We offer resources and support both prenatally and during birth.

 

When you begin to labor, you can call your doula to be with you whenever you want her. A doula can help you to labor at home longer and more comfortably (A well trained doula knows the signs in labor to transfer to the birthing location. However, whenever mama wants to go, is when we head in. We can also make transferring more comfortable too!) We are equipped with birth balls, rebozos, essential oils, and massage techniques. We can help with positioning, counter pressure for back labor, grabbing snacks, and making suggestions for other coping strategies. We are also there to support you emotionally, and can help with any mental blocks. Labor can be a crazy, emotional, messy time, and we are there to protect that space and see you through it. I reassure clients that she can release on me in a way that maybe she couldn’t with her mother-in-law around.

Airlia is sitting on the birth ball while I help keep heat and pressure on her lower back. Even while being monitored, there are ways to keep moms comfortable and not just in bed.

Airlia is sitting on the birth ball while I help keep heat and pressure on her lower back. Even while being monitored, there are ways to keep moms comfortable and not just in bed.

 

A midwife will usually come as you are heading in to active labor if you are birthing at home. If you are at a hospital or birthing center, they will be around to check in with you, but won’t likely be with you the entire time. They will be with you during pushing, and can aide with protecting your perineum with stretching or counter pressure. Your midwife is the other half of the equation to your birth team.  Midwife + doula + partner = Fully Supported Mama

 

That’s for home births, right?

You may be hearing about doulas from your crunchier mamas. While I do support mamas that choose to birth at home, I also happily support families that birth at the hospital or birthing center. If you are planning a natural birth, opting for medication, or scheduled cesarean, I fully support you in your best birth. That looks different to different families, and no mama is the same in what she needs to birth with confidence. What matters to me is that you have options, and are fully supported in your choices.

 

But then what does the Dad do?

Doulas do not replace partners. Dads, partners, and other support people all have a role to play in supporting the mama. As a doula, I care about their needs as well. I can offer tons of support to Dad who may be nervous about how the labor is progressing, and pull him in with tips on how to offer counter pressure on a sore back, show him how to use a rebozo on mama’s belly to help a posterior baby turn, and I can be the one running to reheating the rice pack so he can be with you. It’s a team effort, and I am here for both of you! 

 

Here’s the nitty gritty on what a doula does for you:

  •          Meets with you in the weeks before your due. Meetings are usually to go over any health issues, any problems from previous births, and any lingering anxieties or fears about the labor. This allows us to develop strategies to help you cope during labor, and to develop your birth plan. We want to get to know you, so we can better support you.
  •           Having your doula present can:

o   decrease pain

o    decrease the need for epidural or pain meds

o   Shorten labor

o   Improve parent-baby bonding

o   Lower rate of postpartum depression

o   Lower caesarian rate 

 

  • While we aren't birth photographers, we will happily snap photos and video of the birth if you'd like us to.
  •  Doulas can help with the first breastfeeding session, and can help support you in the early days as well. If you choose to bottle feed, we are happy to support you with that too!
  •  Once you are home from the hospital, your doula will check in with a postpartum visit. This visit is usually to go over the birth, discuss how you and baby are doing, and help with any issues you may be facing. Having a baby is life changing, and no one understands this more than your doula. Birth is beautiful, hard, emotional, transforming work.

 

So to recap, doulas offer non-medical support for birthing families, offering education and physical and emotional support through the birthing process. We support all kinds of birth, and can act as guide through the experience.

 

 I am honored I get to witness it. I am honored to serve the growing families in my community.

 

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Self-Care: A Case for Taking Care of Mom

It was a Thursday, and everyone in my house woke up on the wrong side of the bed. My oldest was whining, the baby was throwing herself on the floor in epic fashion. I was just done. I wasn't about to try to muddle through the mess that day. I texted a friend and we made plans to head to the aquarium in Baltimore for the day. (We had a membership; a thoughtful present from the grandparents!)

 

Our escape plan turned our day around. No more tantrums. No more whining. Just fun with friends and fish.

When in doubt, get out of the house!

When in doubt, get out of the house!

 

Both girls fell asleep on the car ride home. I pulled up to our house and began to unload the car. I picked up my sleeping four-year-old, thinking, "How did this girl get so dang heavy?!" and didn't think anything of it. I laid her on the couch, and went back for her sister. The rest of our evening was normal.

 

And then I woke up the next morning with a painful and swollen stomach. What did I do?!

 

I had ignored a big problem, that's what I did. After my second baby was born, I was sure I had a wide diastasis recti (gap in the abdominal muscles, DR) and was very weak in my back and core. I would struggle to sit up from a laying position. Any abdominal muscle strength I had was gone. I had asked my OB to check my stomach at my six-week appointment, and all he could tell me was that I didn't have a hernia. No guidance on what to do for the gap in my muscles, regaining any strength in my core, and recovery for my pelvic floor.

 

I knew I needed to exercise. I needed to heal this body that was battered by my pregnancies. But where was the time? Kids had to come first. Then errands. Who else would clean our house? I needed to get work done towards certification. I was too tired by the time the kids were in bed.

 

 I continually added to the forever growing list of reasons to put off dealing with me.

 

Until I hurt myself.

 

I couldn’t pick up my 18-month old. I couldn’t vacuum. I needed to rest until I could get in to make sure I hadn’t given myself a hernia. I hid in my bedroom for the weekend and rested. It felt so odd, but so good. I hadn’t been sleeping well for months, and the extra rest paid dividends. I added some arnica and essential oils in to my recovery. Ordered an abdominal brace in the hopes it'd be helpful.

My four year old snapped this while playing on my phone. I was resting on the couch, and couldn't help clutching my stomach. I hurt. Badly.

My four year old snapped this while playing on my phone. I was resting on the couch, and couldn't help clutching my stomach. I hurt. Badly.

 

Jump ahead: two doctor visits and an ultrasound later there was no detectable hernia. But they also couldn’t tell me why I was in so much pain and why I looked 5 months pregnant.  I also couldn’t get in to the physical therapy I was hoping for unless I did more testing. The results would determine if I could get in or not. I may have normal test results, which would exclude me from the therapy, even with the issues I had. Dude, totally lame.

 

I have taken matters into my own capable hands, and started finding tons of moms like me who have healed their bodies. They are on YouTube with awesome videos for healing diastasis recti and strengthening weak pelvic floors. I do my best to get in gentle and DR safe yoga every day. Even if it means the kids are crawling on me and dishes are undone. It makes my inner OCD twitchy, but I must keep in mind that my self-care needs to be a priority. If I am broken and hurting, I cannot serve my family. If I am exhausted and run down, my family feels that too.

What you want exercise with your kids to be like...

What you want exercise with your kids to be like...

What exercise with your kids actually looks like. Blurry cell phone photo, messy living room, and I am attempting to do pelvic floor exercises with my kids around. Mom on the floor = jungle gym.

What exercise with your kids actually looks like. Blurry cell phone photo, messy living room, and I am attempting to do pelvic floor exercises with my kids around. Mom on the floor = jungle gym.

I have been neglecting my own care, and have been trying to rectify that, even beyond the injury. Even just keeping in mind things like, have you washed your face? Read a book? Used essential oils today? All things that keep me grounded and take care of the introvert in me.

 

I’ll be writing and sharing more about healing my belly in the weeks to come. How do you take care of you, while caring for others?

 

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5 Ways to Cope with Morning Sickness: because no one enjoys nausea

When I became pregnant with my first daughter, I knew right away. Food tasted weird, and my usual go-to meals would give me heart burn or make me sick. Orange juice was the worst. It was years before I could drink it again without a mental connection to vomiting.

 

I had brutal morning sickness for almost six months of that pregnancy. I lost fifteen pounds and needed to go on medication for a while to be able to keep anything down. It made me nervous for my baby and about my nutrition.

 

I learned a lot from that pregnancy, and was much more educated and prepared for my second. When you know better, you do better. And in this case, you throw up less. Here are my five tips for feeling better when you are dealing with morning sickness:

 

1)      Eat!

It may seem counter-intuitive, but eating high protein mini meals will help keep the nausea at bay. When your stomach is empty is when the nausea is at its worst and will reek havoc when you do have your next meal.

Eat little nibbles constantly. A scrambled egg and piece of toast. A few apple slices and nut butter. Crackers and hummus. Trail mix.

Eat small meals around the clock.

Eat small meals around the clock.

Anything combining protein with some carbs will keep you going, and your blood sugar stabilized. This includes nighttime. Keep snacks on your night stand, and eat when you wake up to use the bathroom or adjust pillows.

Sharing my own personal truth here: eat what sounds good. Odds are if you actually crave that item, it’ll stay down. Even if it's Sour Patch Kids and McDonald's French fries. Do the best you can, but at the end of the day you need your food to stay down.

 

2)      Sea bands

Available at any drug store, these are bracelets with a small bead that applies acupressure to a specific point on the wrist. Used mainly for motion sickness, it did help take the edge off my nausea. However, if you are waiting to announce your pregnancy these are a dead give away.

3)      Essential oils

Oils are neatly packed power houses of help. The two to focus on are lemon and peppermint. Just smelling both kinds of oils will stop the nausea. When I was out running errands I'd put a few drops of peppermint oil on to a tissue, and kept it at the ready in my coat pocket. Lemon essential oil can be placed on the back of the neck and collar bone, using a carrier oil like coconut or almond. For a better explanation of how essential oils can help, check out Young Living Essential Oils (https://www.youngliving.com). ,

(I'm not an affiliate, but I like their oils and find the website to be a nice resource.)

4)      Magnesium

There's a lot I can say about magnesium and all of its benefits, but I'll try to limit myself for the sake of this post. It's very easy to become deficient in magnesium, especially when you're having a hard time eating already. By increasing your magnesium, you'll sleep better, decrease muscle aches, improve digestion and decrease your overall nausea. You can take magnesium orally with supplements like Mag Calm, but what's way cool is you can also increase consumption transdermally!  So if your worried that a supplement may not go down well, you can receive benefits by soaking in an epsom salt bath or making a magnesium lotion like this one: http://dontwastethecrumbs.com/2016/12/magnesium-lotion/

 

5)      Ginger!

Candied ginger. Ginger ale. Ginger tea. Ginger snap cookies. Preggy Pops. However you want it, ginger is pretty well known for its ability to stabilize a rocky stomach. Keeping ginger snaps or ginger ale handy can also help when blood sugar is low, and nausea is at its worst.

 

If nothing is helping, don't hesitate to talk to your provider. In some cases medication is necessary. If you ever have questions regarding your health, supplements, etc. please contact your provider.

 

What helped you the most with morning sickness?

 

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Baby Wearing: The Ins and Outs

When I was pregnant with my first baby, my doula and friend, Julie,  introduced me to baby wearing. She bought me a Boba as a shower gift, and let me borrow her Maya wrap. Baby wearing keeps your baby close to you, which is great for bonding, nursing, and generally surviving life with a baby. My babies would nap, nurse, enjoy the scenery as we walked the dog, and enjoy being, “held”, as I cleaned the house. Some days it was seriously how I managed to do anything!

 

I learned a lot about different carriers through the years, and through a lot of test runs have figured out what works for me and also for each individual child. Here's the skinny on each type of carrier, with some tips for each kind as well.

Ring sling: Made of large cloth swatches, secured with two metal, plastic, or bamboo rings.  These are great for fast in and out, and are great for hip carries. The only down side is you kind of feel like you need to keep a hand on baby, so you aren't totally hands free. It's much easier to use with an older baby that has head and neck control, but can still be used with a newborn. Slings have  a bit of a learning curve at first, and I needed help with getting started and fixing my sling when the fabric would get bunched.  

Ring Sling: Hip carries take the weight off of moms arms and core. 

Ring Sling: Hip carries take the weight off of moms arms and core. 

 

Soft structured carriers (Ergo, Boba, and Tula): Soft structured carriers (SSC) are generally easy to wear, adjust to almost all body types, and can be worn on the front or on the back as baby gets larger. These are great for baby naps, and allow your hands to be completely free. With a SSC you want to look for one with wide berth for hips; this prevents hip issues as baby grows and takes strain away from their back, unlike typical front facing carriers (bjorns). SSC can be used with newborns with special inserts depending on the brand. Ergo sells a newborn insert for their specific carrier, allowing it to be used from birth through toddler hood.

 

Soft wraps (Moby, K’tan): Best used during the early newborn weeks, wraps are soft and snuggly, and are great for naps, walks, etc. Your hands can be completely free, and with a little adjustment you can nurse while wrapped. It may take a few viewings on YouTube to get the wrapping right. A few styles of wrapping let you set up the wrap beforehand, so your wrap becomes an extra accessory. Bonus! The K’tan comes in different sizes. I'd suggest trying one out at your local natural baby store first.

 

Soft stretchy wraps work well up to 18 lbs, but are uncomfortable any heavier. Move onto a woven wrap or SSC after you're done with the Moby.

Moby Wrap: Front carries are cozy and can be pre-wrapped.

Moby Wrap: Front carries are cozy and can be pre-wrapped.

 

Woven wraps: These babies are the Cadillac of baby wearing. Super versatile, comfy for mom and baby. And. So. Beautiful! However, there's a catch. These wraps come with a hefty price tag, and there's a lot to learn about wrapping. My kids were always too wiggly and wanting up and down all the time for me to even be tempted to wrap. But by god, do I want one just because they are so stinking pretty!

Woven wrap: Lenny Lamb brand. Look how cool this is!

Woven wrap: Lenny Lamb brand. Look how cool this is!

 

 As with all the carriers, consider them an investment. They will last you through multiple children, and majority retain their resale value. If cost is prohibitive, buy used! (The straps will be soft and broken in.) Utilize your baby registry as well!

 

A few rules to remember when baby wearing:

1)      Chin is away from the chest. This ensures that the airway is open.

2)      Baby should be high enough that you can kiss the top of their head. Too low, baby could fall.

3)      Always keep buckles and straps done tightly. Wraps should always be secured with a double knot.

4)      Wait to wear baby on your back until they have good head and neck control.

Keep your babies close, and enjoy your carrier!

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A Postpartum Checklist: Planning Ahead for a Better Recovery

There's a thing about birth that other moms don't tell you about. Recovery can be hard. You're sore and possibly torn in your most sensitive spots, your organs are rearranging themselves after pregnancy, and odds are pretty good that you haven't had more than a few hours sleep at a time for days. Not to mention nursing, trying to maintain your household and take care of any older siblings too. This period can be really hard, and we don't always have family and friends around to help out.

Planning and preparing for post postpartum in the last months of pregnancy can make a huge difference in the time spent resting and healing versus stressing over the to do list.

Here are my favorite tips:

Food:

  • Stock your freezer with extra meals that can be thrown in the crock pot or oven. (Ask friends to set up a meal train or have people bring freezer meals as a part of your baby shower!)
  • Stock snacks that are shelf stable and nutritious. (Trail mix, protein bars, granola bars, muffins.) Bonus points if it can be eaten with one hand.
  • Bottles of water or good cups with straws for easy access during nursing. Keep them stashed around the house!

Healing items for mama:

  •  Rice bag or heating pad for after pains. (And its true what they say, after pains get stronger after each baby!)
  • Witch hazel (Add to your Peri bottle to soothe angry tissue and stitches. You can use to make your own cooling pads, or you can purchase Tucks.)
  • Lavender essential oil. Add to the Peri bottle when you rinse, and the oil will help to heal any tears and help prevent infection.
  • Aloe, straight from an aloe plant! Will help sooth stitches. (Can you tell I've dealt with some nasty tearing?)
  • A boppy  pillow or hemorrhoid ring, because sitting on your sore bottom can be torture. As often as you can, lay down. Nurse on your side lying down or reclined. If you need to sit up for visits, don't be afraid to keep them short.
  • Earth Mama Angel Baby has a great line of products, including Happy Bottom spray, Postpartum Bath Herbs, and nipple cream. I loved them with my second baby! The bottom spray was heaven on stitches, and  the bath herbs can pull double duty. Save the liquid for your Peri bottle and use the herbal pack as a warm or cold compress, or use as a typical sitz bath.
  •  Padsicles! Ice packs feel awesome in those first swollen days and a padsicle can help with both swelling and irritation. Check out this recipe here: http://just-making-noise.com/pregnancy-notes-soothing-postpartum-pads-recipe/
  • If you had your placenta encapsulated, break those babies out! They'll start to help with healing and replacing lost nutrients.
  • Have extra large granny panties, in dark colors, because leaks are bound to happen. I suggest having a larger size to accommodate the large pads and ice packs in the early days after birth.
  • Have super comfy jammies. I had no shame and bought extra large sweat pants. I just needed comfort and room to heal; I really didn't care about being cute. (I may still have some of these in my drawer. A girl has to hold on to some things for a Maryland winter.)

Nursing:

  • Have some nursing tanks on hand, but in my humble opinion hold off on buying nursing bras until baby is born and nursing is established. I was shocked by how much my breasts changed. We are talking three cup sizes! Wait and see what your milk does before you go to the trouble of buying bras.
  • Have a good breast pump and parts ready to roll. You don't want to be sterilizing parts while engorged. (Ask me how I know.) if you're using a pump from a previous baby, ask for new parts from your hospital. My lactation consultant gave me a bag with new tubing, flanges, etc. for free! This is also a good time to make sure bottles, nipples and pacifiers are cleaned and ready for use.
  • This is where all the food prep will come in handy! Eat and a drink a ton, more than you think you might need to. Your body is doing a lot of work in repairing and also making milk for baby.

For Baby:

  • Besides all the usual items for baby, I suggest having a carrier or wrap for those newborn days. I love the maya wrap or a ring sling to help keep them snuggled while you keep your hands free.
  • Sleeping arrangements for baby to be close by, whether in a co-sleeper, bassinet, or pack n play, keep baby in the room with you. Everyone will sleep easier.

For the home:

  • Netflix. If you don't have it already, do it. There will be days where you will be nursing the baby non-stop on the couch. Binge watch and rest!
  •  Set up baby station baskets around the house. Any where you'll be spending time with baby, but also in places like your bedroom. Include a change of clothes, diapers, wipes, easy open  snacks, bottle of water, breast pads, toy/book to entertain an older sibling, and a magazine or book for you. I often found myself, “stuck”, under a nursing and napping baby while starving and thirsty. Having these in reach made things very easy. I felt like I had anything I could need within easy reach, without having to go up and down stairs for items. I seriously just used whatever baskets I had on hand around the house.

What was helpful for your family in the weeks following birth?

 

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Finding a Mama tribe, a MOPs testimonial

Before being a stay at home mom, before being a doula, I was a zookeeper. I loved my job. I worked with great people, and I got to be around amazing animals every day. I poured myself into my job. I came in early, I stayed late. I brought projects and research home a lot. But when I got pregnant I knew I couldn't do both. I couldn't be the keeper I was and be the mom I wanted to be too. Plus, we couldn't afford daycare. It would have been my entire salary for my baby to be in daycare. With no family around, we didn't have a lot of options.

 

So I made my plans, worked up until a few days before my due date. My co-workers understood when I called and let them know I wasn't returning. My manager was sad. (She was the best boss ever. I mean it.) I was sad to leave, but knew it was the best choice for our family. In some ways, I was ready to leave some of the stresses of my job behind and start a new chapter.

 

My daughter was born, and I was a full-time mom. With no clue what I was doing. FB groups helped, my doula, Julie Grove, was a godsend. (I seriously texted her at 3 am with a plugged milk duct. She was up with her baby too thankfully.) I felt adrift. I wasn't, “Jessica the Zookeeper”, everyone knew, and I felt like I fell down the proverbial rabbit hole of breastfeeding, diapering and sleepless nights. My friends tried to understand and were loving, but it's not the same understanding as someone who's in the same part of motherhood as you are. I seriously didn't know who I was without my job. What did it mean to be Jessica the Mom?

Who knew you could feel this tired?

Who knew you could feel this tired?

 

Along came MOPs (Mothers of Preschoolers).  My neighbor, Mandy, told me about it and gave me the time of the next meeting. It sounded great; other moms, hot food and coffee, and both of us out of the house.

 

I managed to get there about a month later, and I was crazy early. I think I was the first person in the parking lot. When leaders came to the church to open and set up, I was welcomed and congratulated on my baby. I met so many moms; homeschooling moms, working moms, new moms and veteran moms. Someone offered to hold Elena for me so I could eat. People were nice. I felt welcomed. I thought, “This could be good.”

october 2016 533.JPG

 

Four years later and MOPs Thursday's are my favorite days of the month. We have friends, we have support. These women have helped shape me as a mom and help me get comfortable in my new role.

 

Best lessons from MOPS:  it's okay to do things differently, forget cleaning your house, and you are the mom your kids need. Whatever that looks like. I'm not Jessica the Zookeeper, I'm Jessica the friend. They've seen me sleep deprived and melting down with my toddler. They have brought meals for my freezer after I had our second baby. We know each other's houses well. It's usually well established to help yourself to anything. Coffee is always on. (And when it's been especially rough, wine.)

Coffee + Friends = Sanity

Coffee + Friends = Sanity

 

 They've seen me take a jump and grow into my doula role. They've even been Guinea pigs and let me attend their births. (Thank you Airlia!)

 

It's a place to be real. I get a break and hot coffee. My kids get to play with friends and make crafts. So why am I sharing this on my doula blog? Isn't this the place where you talk about placenta smoothies and hypnobirthing? (Of course!)

 

But readers, we weren't meant to do this alone. We can't do everything for everyone, all the time. Sometimes we need to fill our cup. Sometimes we need to reach out from our usual circle to someone else in the same boat as you. We need a tribe, to support and bolster us. Otherwise it's a pretty hard and lonely gig as a mom. Sometimes we need help, all different kinds.

Don't do it alone mama!

Don't do it alone mama!

 

I love mops and all that they do! To learn more about MOPs International or find a MOPs group near you, you can learn more here:

http://www.mops.org

 

 

 

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What's in a doula bag?

As a doula, I'm there to serve you and your partner. I'll help you prep beforehand to iron out your options and what you'd like to see in your birth plan. The day of the birth I'll be prepped with a birthing ball and my bag. So here's the short and tall of what I keep in there:

  • Three rice bags (microwaved, the heat helps with pain in your back and round ligaments)
  • Ice packs (also helps with pain, but helps keep mom cool especially during pushing)
  • Sarong/rebozo (can be used for tons of cool stuff, everything from massage, gentle belly binding, help with squatting/positioning. Also pulling on the the fabric can help with pushing.)
  • Extra chapstick, hair ties, head band, gum and mouth wash. Just in case.
  • A fine tooth comb, can be used on pressure points along the palm of the hand. Also for effleurage along the back.
  • I carry only a few essential oils, but they're versatile power houses. I carry lemon, lavender, and peppermint. I don't like to put the oils on a mama, unless she uses them already. Labor is not the time or place to find out your skin breakouts with peppermint. Instead we can just put a few drops on a cotton ball or tissue. If the scent becomes bothersome we can easily and quickly flush it and the scent is gone.
    • Lemon: eases nausea, can help to emotionally energize
    • Peppermint: also helps with nausea, can help relieve a bladder by putting a few drops in to the toilet, can help with emotional balance.
    • Lavender: relaxing, can help to clear the mind and any anxiety or stress.
  • Tennis balls: used to massage and for counter pressure against hips and backs. We can use one at a time, or tie multiple in to a sock for a massage tool.
  • Lavender scented massage oil, coconut oil for massage.
  • Honey sticks (easy carbohydrate/glucose for when you need a boost, but may not want to eat.)
  • Snacks and extra food
  • Extra clothes
  • Extra large menstrual pads, in case you need them after your water breaks or during transport.

 

 

 

 

 

 

All my items are pretty simple. I want to be able to pack my bag quickly and get to my client. I also want to say my most important tool are my hands. Counter pressure, double hip squeezes, massage, and simple touch can be comforting during labor.

What would you have liked to have had at your birth?

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Using Water During Labor and Birth

          Humans have an integral relationship with the element of water.  It runs through our veins, we are born of it, and it is necessary for our survival. We are drawn to it for escape, adventure, release, and cleansing. As a woman is preparing to give birth, water is a means of release from the weight of her growing belly, and the means to ease her aching muscles. Water is a great coping tool in labor, whether through a shower or tub. (For the sake of this paper we will only be mentioning the use of a tub.) The use of water in labor can aide in pain management by increasing relaxation, decreasing strain on muscles, and creating freedom of movement.

 

         The mother’s ability to relax her muscles during labor can affect the length of labor and the intensity of contractions. The more a mother fights and tenses her muscles the worse contractions may feel. Especially in active labor, the mother may need as many coping strategies as possible. The birthing tub offers a great respite, and a simple way to relax. The birthing tub is often called, "The midwife’s epidural”, for its effectiveness (Drichta, Owen p. 257). The warmth of the water helps to ease the pain felt from contractions, relaxing muscles of the pelvic floor and back, and creates a mental space that creates privacy (Drichta p. 258). It is recommended to maintain water temperature at 96-98 degrees. Using higher temperatures could cause increased blood pressure, dehydration and lethargy (Drichta p. 258). The bath is also deeply engrained as a place of mental release in daily routines. Our bathtubs are typically places of retreat to relax, and the mental association during labor holds true.

 

          Labor is a physically demanding process. From hours of walking, lunging, squatting, intense contractions, and the possibility of little sleep can make for a grueling marathon on the mother’s muscles. The warmth of the tub eases both the pain of the contractions and the work of her remaining muscles (Drichta p. 257). Being in a large tub that covers her belly, the mother is buoyant and freed from the gravity of dry land. Her pelvic muscles are relaxed and her cervix will continue to dilate, often with more ease as she relaxes. A mother that is able to relax and mentally release her tension, will have an easier time laboring than a mother that is fighting each contraction.

 

        Being weightless allows the mom to assume positions that could be too taxing on land, such as deep squats using the side of the pool, that will help baby to descend and turn. She's able to easily move from one position to the next in response to her labor, while remaining warm and relaxed. The ease of movement allows the mother to find her own rhythm and coping responses that she would not have had if she was limited to a bed. Her ability to move through labor gives the mother more control and autonomy during the birth. She's able to push in the position that suits her, catch her own baby, and bring baby to chest without outside help or others manipulating her body. She has full confidence and control.

 

          Relaxation, decreased strain on muscles and freedom of movement are gained for the birthing mother with the use of water during labor. The three work together as a pain management strategy, addressing both mental and physical tension that could hinder a birth. The birthing tub is used at its greatest advantage during late stage active labor throughtransition. It is recommended that for every hour spent in the tub, the mother spends at least thirty minutes out of the tub. This is to ensure that contractions do not slow down, as can sometimes happen. Often contractions may just feel less intense, but are still actively working. According to Water BirthInternational, “Getting back in the water after thirty minutes will reactivate the chemical and hormonal process, including a sudden and often marked increase in oxytocin.” (Harper p. 2) As with other labors, hydration is of the utmost importance. Keep a drink with a straw nearby so the mother can drink at will. The birth can be completed in the water as well, depending on location (some hospitals only allow laboring in the tub) and as long as the labor is not having any complications (ex:meconium, shoulder dystocia).

           

 

                                                     Works Cited

Drichta, Jane E., CPM and Owen, Jodilyn, CPM. The Essential Homebirth Guide for Families Planning or Considering Birthing at Home. 2003. Simon and Schuster.

 

Harper, Barbara. "Guidelines for Safe Waterbirth.”Waterbirth International. p. 2

https://www.youtube.com/watch?v=aQVM36r1rvw#action=share

https://www.youtube.com/watch?v=U6KHW7TNiCk#action=share

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Yoga During Pregnancy

Pregnancy brings up a lot of changes for the mother to be. Her body can feel foreign with hormone surges changing everything from her taste buds to her pelvic ligaments. Her mind can be bogged down with worries regarding the pregnancy and coming birth. Her spirit can be tired and troubled. Never has a woman needed more support physically, mentally, and spiritually then when she is pregnant. Since the rise of yoga practice in the West, the poses and meditation have been adjusted to pregnancy, creating a genre of yoga known as prenatal yoga. This particular yoga variation can aid in maintaining balance in the body and mind through adapted toning poses. Prenatal yoga promotes proper posture and relaxation, creating a supportive outlet for the pregnant practitioner.

              Toning poses encourage movement and flexibility, which is beneficial during a time that can become cumbersome to move and joints can become painful. Child’s pose, Cat-Cow, and supported Butterfly pose can ease backache caused by the shifting in the spinal column. Due to changes in weight, the counter balance of the body is pulled forward (Silverstone p.108). By maintaining muscle tone through yoga, the body's ability to protect the core is increased, relieving typical pregnancy muscle aches. The movements of yoga are balancing to the body, and can ease other pregnancy issues. Performing balancing stretches on each side of the body promotes circulation throughout the extremities, and can improve sleep if performed before bed, alleviate morning sickness, and prepare for birth (Silverstone p. 81, 123).

              Proper posture is a main tenant in yoga practice, starting with, “good alignment of the spine from a solid leg base and relaxed stretching intensified by deep breathing.” (Freedman p.12) By practicing and utilizing proper posture throughout the day, balance in the spine and pelvis is maintained. The muscles of the pelvis create a hammock for the womb, and can affect presentation. (Freedman p. 8) Fetal positioning can make a huge difference in how labor develops. A baby facing in the posterior position in the womb may have a slow descent, and can also cause painful back labor (Spinning Babies). Poor fetal position can also cause very slow dilation, often resulting in unnecessary interventions.

Photo by piranka/iStock / Getty Images
Photo by piranka/iStock / Getty Images

             The ability to cope through painful or stressful labor can make a huge difference in the birth experience for the mother; feeling overwhelmed and helpless versus calm and ritualized. By practicing meditation and deep relaxation in yoga throughout her pregnancy, the mother is essentially teaching  her mind and muscles how to relax. An individual can't expect to go through the paces of everyday life without mindfully taking the time out to fully relax the body and empty the mind. Without regular practice, the mother to be cannot expect to relax while laboring (Mongan p.119). By creating a peaceful mental space, both mother and baby can birth together in a relaxed confident atmosphere. The mother knows her body, has tuned into her baby, and can relax and go inward; an ability that is key to letting labor and birth progress.  

              By practicing prenatal yoga regularly, mothers can address pregnancy related issues and prepare for birth through postures, regular meditation and relaxation. By connecting to her body and her baby, the practitioner can have a more enjoyable and healthy pregnancy.

Works Cited

The Kind Mama: A Simple Guide to Supercharged Fertility, A Radiant Pregnancy, a Sweeter Birth, and a Healthier More Beautiful Beginning. Alicia Silverstone. 2014. Rodale Books.  P. 81, 108, 123.

Yoga for Pregnancy, Birth, and Beyond. Francoise Barbira Freedman. 2004.  DK. P. 8, 12.  

Hypnobirthing: The Mongan Method. Marie F. Mongan M.Ed. M.Hy. 2005. Health Communications.

P. 119.

www.Spinningbabies.com. “Maternal Positioning”. 2016.

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Birth Balls, Best thing ever

Birth balls, commonly recognized as exercise balls, have been used for many purposes over the last ten years, including physical therapy, abdominal exercise, and most recently to aid pregnancy and labor. Its shape and durability allow it to be used by a variety of weights and heights, and in multiple positions. Birth balls can aide in pregnancy and labor to improve fetal positioning, fetal descent and maternal comfort.

Fetal positioning can make a huge difference in how labor develops. A baby facing in the posterior position in the womb may have a slow descent, and can also cause painful back labor (Spinning Babies). Poor fetal position can also cause very slow dilation, often resulting in unnecessary interventions. In some cases, the baby may have a difficult time turning and become stuck, requiring surgery or forceps delivery (Spinning Babies). Fetal positioning can be improved by having good posture. Often pregnant women are sitting on cushy couches or less than ergonomic driver seats, causing poor posture (Spinning Babies). By sitting and resting on the ball, the posture is upright and forward leaning, engaging abdominal muscles while relaxing the pelvis area. The back is comforted and strengthened by ball use, supporting the pelvis. With proper alignment and a relaxed pelvic area, the baby will have room to position properly, and begin to drop into the pelvis (Spinning Babies). It also encourages the baby to settle into an anterior position that is optimal for labor (Spinning Babies). Often a posterior baby can be encouraged to turn during labor by sitting on the ball.

Fetal descent is defined as entrance of the presenting portion (usually the head) into the birth canal. Descending takes time and hard work from both mom and baby.The use of gravity and squatting positions are helpful in this process, but can be taxing on the mother’s muscles over a long labor. The birth ball is a great tool in this scenario, as it allows mom to sit in a squatting position, allowing the use of gravity and an open pelvis to bring the baby down, but also allows for rest. The mother can also lean forward while sitting, and receive a massage or counter pressure. The ball can also be hugged while deeply squatting on the floor. It allows mom a greater balance and ease in the position, one that can be utilized in the pushing stage.

The birth ball is a great comfort tool for mothers in labor. It allows the mother to rest while still engaging an open pelvis. The birth ball can be a great break from walking, while still remaining active (Birth Arts Handbook p.187). It allows the mother to do pelvic circles and rhythmic movements that help her ease the pain of contractions. These movements often help the baby to navigate the turns in the pelvis before crowning (Birth Arts International p.187).  The birth ball also creates a counter pressure against the perineum and buttocks that can ease the sensations of early transition, which can be a difficult time for the mother. Having the birth ball as a comfort tool the mother can find a coping mechanism and rhythm through her contractions. By having support and a rhythm to help her cope, the mother can navigate her labor and have a mental place to return to when labor gets hard.

By utilizing the versatility of the birth ball, a mother can improve fetal position, while encouraging fetal descent and increasing comfort during labor. By improving these aspects of birth, unnecessary intervention can be avoided, as well as the use for drugs. This can greatly improve outcomes for mothers and babies, especially in a hospital setting where the mother is out of her comfort zone.

Works Cited

Birth Arts International, Certified Doula Education Program. Demetria Clark. 2000-2015. P.187

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What will my doula do at my birth?

So what will my doula do at my birth?

 

I will encourage you.

I will come as soon as you need me. Day or night.

I will remind you of what you felt was important in your birth plan.

I will help you modify those plans when's thing change.

I will massage your shoulders and back.

I will show your partner how to do a hip squeeze when you have back labor.

I will help you find positions that will help you feel comfortable.

I will heat up rice packs and keep ice packs on standby.  

I will feed you and your partner. You guys have to stay nourished.

I will bring essential oils if you'd like them. Peppermint is great for nausea.

I will bring a bag of tricks and a birthing ball. That ball is the best thing ever.

I will support where you want to birth.

I will politely but firmly ask for another nurse if you have Atila the Hun on shift at the hospital.

I will remind you that you can do this when things get tough. Because you already are!

 

Birth is hard work, but you can do it!

 

 I will help you with everything I have, because families deserve to be supported and loved on.

 

This is what I want Living Heart Doula to be about.

This is my pledge to you, as your doula.

You got this mama.

You got this mama.

 

 

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Let's change it up!

I've been taking stock of the blog, and I realized I haven't found a steady writing voice.  I'm not sure whether to stick to the firm educational prose or the funny personal stories with tidbits of the knowledge I've picked up while training and having my own babies.

 

It's a lot easier to write casually, and I'd be able to post more frequently.

 

Im still getting grounded in the blogging aspect of my doula business, and I would love feed back on what you readers enjoy. In the meantime, expect more blogs with less essay formatting.

 

Let's see how it works for a while.

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Why You Should Hire an Encapsulator

After my first birth my body felt like it was hit by a truck. My muscles were achy, my belly was rubbery, and I was nursing a pretty bad tear. The baby blues were strong. I cried at the drop of a hat; looking at my beautiful Elena, thinking about how hard the birth was, how much I loved my husband for helping. I was overwhelmed with it all. Time went on, my body recovered and we managed to survive our first stent as parents.

 

I learned how consuming placenta can help in postpartum recovery, it can lessen the hormonal baby blues, help with milk production, help replace the nutrients lost in birth, and help the body to heal any trauma/injury. I was determined that with my next birth, I’d make the postpartum period better. I'd rest more instead of entertaining visitors, I'd make awesome witch hazel pads for healing, and I'd get my placenta encapsulated.

 

Fast forward two more years. I'm pregnant with my second baby and getting close to my due date. I was getting things in line for the birth. Cloth diapers prepped? Check. Doula set up and birth plan ready? Check. Postpartum supplies? Check. Placenta encapsulation? Oops! Somehow it fell to the bottom of my prepping list to check out my local encapsulators and get everything lined up. When I finally got around to it, we were a few weeks out from the birth, and our budget was looking tight. I felt like it was out of reach to hire out, but I'd heard of other crunchy mamas doing it themselves. How hard could it be right?

 

I did a little digging around (thank you google and Pinterest), and had my instructions pretty well laid out. I could totally handle cleaning my placenta and drying it out. Putting it in the capsules was going to be time consuming, but no huge deal right? Positive attitude all around! My hubs did tell me I was on my own on this one. Handling bodily organs isn't his thing. I felt totally confident I could handle it.

 

Sophia was born September 7, 2015, Labor Day. You can read her birth story below. Her birth was awesome, super peaceful and empowering. But I tore really badly. Yet again. I was in a lot of pain coming home from the hospital, and was looking for relief.  I was super excited to sleep in my own bed, and snuggle with my newborn.

Sophie is here!

Sophie is here!

 

But I had to deal with my placenta.

 

So in the fog of newborn haze, with a broken yoni, I stood at my kitchen counter with my placenta and supplies. It was the last thing on earth I wanted to do. I had a huge placenta too, that baby would have made a year’s worth of happy placenta pills. I started cleaning it and getting it into slivers. And it was taking me forever.

(Photos Courtesy of The Nurturing Root, Carmen Calvo)

I wish I could say I powered through and got it done. But I didn't. Instead I took a handful of my placenta slivers and saved them in the freezer and buried the rest of my placenta under a mulberry tree out back. Instead of encapsulating, I just used a small sliver of placenta in a berry smoothie. I had to tell myself it was going to help me, and I chugged it down. I couldn't taste it! Nothing gross, and I can happily report it helped with my baby blues. Not nearly as bad as the first round. I only used the slivers a few more times, and just kept the rest in the freezer on standby.

 

So what did I learn?

 

Take the time to hire someone to do this job for you! It's a big job, time consuming and needing attention to detail. Save your energy for the squishy newborn and wild toddler.

 

Photo Courtesy of The Nurturing Root, Carmen Calvo

Photo Courtesy of The Nurturing Root, Carmen Calvo

I'd like to share the business information of our local encapsulators, so you can encapsulate your next placenta:

 

Eimile Hannes

Helping Hannes Doula

http://www.helpinghannesdoula.com/

 

Brittany Hotem

Northern Maryland Doulas

http://www.northernmarylanddoulas.com/

 

Deborah Bailey

Doulas of Central Maryland

http://doulasofcentralmaryland

 

Carmen calvo

The Nurturing Root

Http://www.thenurturingroot.com

 

 

And for more in depth information on placenta consumption:

http://placentabenefits.info/articles.asp

http://www.mamanatural.com/why-eat-your-own-placenta/

http://www.placentawise.com/

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Pregnant in Sumatra

Being pregnant brought lots of joy and excitement to my life. Living in Sumatra with my Indonesian husband while pregnant brought some worry and fear as well. Fear of a serious medical complication in a developing country, fear of being far from my own mom and loving family members, fear of not being able to stick to my guns about what I wanted and knew was best for my pregnancy and son’s birth in a completely different culture and environment. In spite of the fear and the unknown, I tried to focus on the positive and the potential for amazing things to happen.

My mom shipped What to Expect When You’re Expecting and Ina May Gaskin’s Guide to Breastfeeding halfway across the world and I scoured the internet for what American mommies were doing so that I could try and blend as best as I could the two distinct cultures that my baby would be born into.

I loved the way many Indonesian moms practice attachment parenting simply because there is no alternative. Who would leave their infant in another room of the house to sleep? A centipede or snake could bite it! Or a tiger could attack! (Just kidding….mostly). Also, most houses simply don’t have another room in the house to make into a nursery nor do they have money to buy a crib. So we bought a baby hammock instead of a crib. Car seat? More babies are used to riding on motor bikes. Diapers? The hot, humid weather plus the cost mean that these are usually a luxury item that not all babies wear but that are becoming more common now especially in cities. Slings and baby carriers? Indonesian moms have been strapping their babies to ‘em in Batik sarongs and going about their day since forever. Breastfeeding? Again, a lot of women in villages usually do not work outside of the house nor are they able to spend money on formula so nursing is the best option for them. Natural childbirth? My mother-in-law delivered six children in her house with a midwife. No pitocin or epidurals available! Cry it out? I am not exaggerating when I say that the entire Indonesian family will do anything – anything – to comfort a baby at the first whimper or sign of discontent. While times are also changing here and all mother and baby stories are different, these were the impressions of labor and infant care that I witnessed and saw as common.

 

34 Weeks

Thankfully, I had an incredibly easy and manageable nine months with just one bout of morning sickness. My baby boy grew and kicked while I practiced yoga, deep breathing, Kegels, everything I could think of to stay calm, relaxed and prepared in order to envision a healthy, natural birth. My mantra was “I am a flower, I am a fountain.” I would say it every time I worried that my body would not open to push the baby out or that my breasts would not produce milk to nurture him.

Throughout my pregnancy, I had deep concerns about being pressured into a C-section here as the modern hospital where I received prenatal care seemed to have so many. I received an ultrasound at every monthly visit, which seemed so unusual and unnecessary. I was told I had low amniotic fluid and should take strange medicine not approved by the FDA along with placental extract thought to prevent miscarriage. All the medicine my OB-GYN tried to get me to take was discarded and I trusted my gut and stuck with my prenatal vitamin. I asked if I could try different labor positions and he was totally against it saying that I needed to stay attached to a monitor. While I stayed with this doctor, part of me wished I was in the middle of our house in the village with a bidan (trained midwife) so that I could avoid all of the interventions. But I knew that my family in America and my husband here trusted the hospital and wanted the security and safety assumed to be had there.

My due date was March 19th, 2015. The doctor wanted to induce the very night of my due date without waiting at all (this after being told earlier in my pregnancy inexplicably that my due date was 4 days earlier than the one previously given). I refused and went home resolved to wait a week before going back to the doctor. I walked around the neighborhood endlessly, ate all kinds of spicy food like curries and sambal (chili sauce - unavoidable in Indonesia!), and did squats and meditation. I began doubting myself and of course just wanted what was best for the baby. I knew that his movement could slow down as the time approached but I went to the doctor on the night of March 25th to check that everything was ok. They admitted me, hooked me up to the monitor and it felt like there was no going back. I wanted to move and walk like I read about. I wanted to get on all fours and stretch. I wanted to go in the water and take a bath. I was repeatedly told in a language not my own that I could not. I was scared and if not for my husband’s presence and support, I would have felt hopeless and entirely alone. I had brought prayer cards and a rosary and listened to Christian music on my phone while praying that he was safe and all would be well. They started me on a pitocin drip after an invasive internal examination from the doctor. I experienced mild pressure but no contractions all night and tried to rest.

The morning of the 26th, they increased the pitocin and the contractions came fast and strong. They felt erratic and unstoppable with no rhythm. I had been offered no pain medicine and was forced to stay in bed with no ability to change positions. I was even ridiculously told to keep my legs closed! At one point during the four hours of endless contractions with absolutely no progress or relief, a complete stranger, the mom of another laboring woman from the room across the hall, came into my room to stare at me as a strange foreign woman and talk to my mother-in-law. I wanted to scream “Get out!” but settled on telling my husband that I was in no way comfortable with random people in my room.

In the end, at noon after not even dilating one centimeter on the pitocin, the doctor suggested that I go for a C-section, which I firmly believe was his desired route all along. But by that time, I could not handle the rigid rules, the pain or the hopelessness of the situation anymore and just sought relief and the certainty that I would meet my baby boy soon. The five minutes in the Operating Room leading up to the procedure was the sweetest and most meaningful time of the whole labor. My husband bravely came into the room with me (something that I think not many Indonesian husbands do!) and we talked about seeing our son. He smoothed my hair, held my hand, kissed my cheek and I could not believe how calm and reassured I felt after the trauma of the night and morning before.

 

Sweetest Moment

Upon waking from a nap after the procedure, I had found my voice and my conviction that baby was not allowed to be far from me or receive any unnecessary treatment. I found it difficult to speak up for myself but had absolutely no qualms about speaking up for my son. My postpartum experience was extraordinary and even better than I could have anticipated. As soon as he was brought to me, he nursed and we were skin-to-skin. I breathed and soaked in every moment. We shared a surprisingly spacious and luxurious family room; he did not go to the nursery except for his bath and hospital photos. When I felt he had been gone too long, I immediately called for him to be brought back. The nurses and my experienced mother-in-law helped him latch and brought him to my bed every time they thought he was hungry. He received no supplementary sugar water, formula or pacifier as per my express instructions. When I had slightly high blood pressure and seemed tired, the nurses suggested he stay in the nursery but I refused to let them take him away and he slept by me instead. The second day in the hospital during my recovery, they brought a complimentary massage therapist to give me an hour massage. Absolutely heavenly! I was fed such nutritious fish, veggies, rice, broth, porridge and fruit. By the time we were released from the hospital, I was confidently nursing him.

We brought him home and I had the whole “it takes a village” experience with my in-laws staying with us to cook and clean. Our sweet baby boy slept between my husband and I, and I nursed and changed wet diapers in bed throughout the night – as we still do! And he takes his naps in his hammock. The all-in-one changing table, bassinet and play pen is still collecting dust in storage.

 

Baby in a Hammock

Although the birth experience was incredibly different than expected and I did not have a doula with me, Jessica’s constant support and advice via messages and care packages kept me sane, grounded and feeling more in control and knowledgeable. I can’t even imagine how helpful she would have been if she were actually by my side!

 

Indonesian-style Baby Wearing

By: Kristin Abt

 

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Bradley Method for Natural Birth - Staci M.

Tuesday I was 40w 7d. Around 5pm I was relaxing in the living room and decided to try some nipple stimulation (I'd been having Braxton hicks and lots of pressure on my butt for months). And I think the nipple stimulation actually worked! Started having pretty consistant head butting type contractions anywhere from 4-8 min apart/40-55 seconds long for a couple hours. Then they slowed to around 12 min apart. So I listened to my sister and napped from about 12-5am (or tried to nap) between contractions. They stayed about 12 min apart for that whole time and my husband did counter pressure for me on pretty much all these earlier and night time contractions. Got up around 5:45am.

Photo Courtesy of Paper Moon Photography Credit: Danielle Bean

Photo Courtesy of Paper Moon Photography Credit: Danielle Bean

Took a hot shower and had 4 harder contractions in the 20 min shower. Got out and the kept coming one on top of the other and they were anywhere from 1-2 min! Super long and hard!! I was totally making caveman noises so decided we should go (around 6:30). The contractions were one on top of the other the whole 10-15 min drive! (More scary caveman noises) had a "I am freaking pushing" contraction when we pulled out front of emergency. Trav ran for the wheelchair and I got in it we left our car in the red zone with hazards on, door open, and my purse in the car!  I said,"Close the door!" Trav said,"Fuck that!"

Some nice front desk guy at kaiser ran out and escorted us up to L&d, and another lady took our keys out of our car and closed the door. Had some serious pushing contractions in the elevator on the way up to the 3rd floor. Luckily there was an l&d nurse in there who reminded me to blowwwww as best I could and not push. They got me in a room and I got on the bed. Trav sprinted down to move the car and sprinted back in like 5 min. Had another pushing contraction, after it stopped they checked me and I was fully effaced and dilated, (Trav got back at this point and Emma was practically near crowning.) I pushed 4-5 times for the midwife and out she came! Wow! It was crazy and amazing! #41w1d #bradleybaby2 #thankgoodnessnotraffic

Staci with Adam and Emma. Proud Bradley mama!

Staci with Adam and Emma. Proud Bradley mama!

 

 

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How to Heal a Tear - Postpartum Care

It is one of the things we fear will happen during childbirth: tearing. It can make a huge difference in our postpartum recovery. While there is a ton of great information circling on the web on how to prevent tears, sometimes things are out of our realm of control, like a rapid descending baby, nuchal hand, presentation or episiotomy. Having stitches in sensitive places is no fun, but here are some tips to help with comfort and healing your yoni well.

 

Keep your legs together. I never realized how often I sit Indian style, until after I had Sophia. Avoid large steps and anything that makes you stretch or separate the tissue. Lay down and rest as much as possible, keeping your legs together.

Rest with legs together as much as possible. It eases tension on the healing site.

Rest with legs together as much as possible. It eases tension on the healing site.

 

The peri bottle is your best friend. Use that peri bottle! With every trip to the bathroom, use that peri bottle a lot, and change up the temperature of water you use. Warm water can help with blood flow to the area, and cold water can feel really refreshing. Adding some extras to the peri bottle also helps to speed healing and increase comfort. A squirt of witch hazel and a few drops of lavender essential oil are great astringents and promotes tissue repair. Lavender can also keep infection at bay. Feel free to be liberal with witch hazel, it feels amazing on frozen pads or just plain old Tuck's from the drugstore.

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Aloe and Manuka honey are great soothers and aide in tissue repair. Use 100% pure aloe, avoid the green goop you'd use for a sunburn (these have added preservatives that could irritate). Take stalks from an aloe plant and squeeze the liquid out and apply using clean fingers. If you don't have a plant, you can find pure aloe at most natural vitamin stores. It may seem odd to think of putting sticky honey on your stitches, but it will melt against your body temperature and liquify with the lochia blood. Honey is amazing at healing all kinds of skin wounds, including burns and cuts. You can apply by putting a thin layer on the top of a pad, or placing a layer of honey onto a piece of nori and placing right onto the tear.

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Next up, is getting air and possibly sunlight onto the area. Nothing breeds infection like moisture, so for some part during the day rest on a towel without undies and pads. If weather and privacy permits get sunlight onto the area. Not always realistic considering our suburban neighborhoods, but if you can, do it.

 

Herbal sitz baths are amazing, and I wish I knew more about them with my first birth. I highly recommend Earth Mama Angel Baby Postpartum Bath Herbs and Happy Mama Bottom Spray. All ingredients are certified organic, and available online to purchase here:

http://earthmamaangelbaby.com/categories/postpartum.html.

The herbal packs can be used as a compress, and the liquid can be used in sitz bath, Peri bottle, or frozen into pads. If you are not able to snag a sitz bath from the hospital, you can also just soak your bum in the tub, using only an inch or two of water (enough to put your stitches in). 

I love this company, and their products. Put them on your baby registry and have them on hand before baby is born.

 

Adding a vitamin E supplement to 600 mg/day. It will help your skin to repair. 

 

Ultimately the best thing you can do, is to rest in bed with baby. Severe tears heal faster with bed rest. Get help in any way you can; hire a post partum doula, ask friends for meals, and minimize household responsibilities to the bare minimum. Take this time to heal! 

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Hypnobirthing

With my second birth, I used hypnobirthing during my labor. You can read more about my birth story in the post below. I had heard a bit about hypnobirthing on some group forums, but was really introduced to it by a nurse I had during my hospital stay after the birth of my first daughter, Elena. The nurse and I were comparing notes on natural child birth, and she mentioned that she used hypnobirthing with her fifth baby.

"It was the most peaceful, painless birth. I'd think it was a crock if I hadn't done it myself."

Intriguing to say the least! Something that could make child birth painless without an epidural sounded amazing. So here's what I learned:

There are two schools of hypnobirthing; Hypnobabies and Mongan method hypnobirthing.  Instruction is typically done in a class with certified instructors, with subtle differences in what is taught. For instance, a Hypnobabies class may teach specific hypnosis techniques for analgesia/pain relief where hypnobirthing may teach guided meditations for deep relaxation (helping to avoid the tension that leads to pain). Either way, here is the point of hypnobirthing: release your mind of fear and tension, and your body will use its natural ability to birth without excess pain. The more you tense, the more you feel pain, and the longer your body takes to birth. By relaxing your mind and body, the cervix can open much more easily. We are mammals after all. If we feel fearful, our mind tells the body, "I can't birth here, it's not safe."

The best way to utilize the practice, is to do just that. Practice. It does take repetitive practice to train your mind and body to relax. In our busy lifestyles of constant running, it can be difficult to turn ourselves off. To go to a quiet place and just be still. The more you can do this, the more effective the tracks will be in aiding relaxation during labor. I visualized a quiet place that I stumbled upon on Pinterest. (I know. Pinterest is so good at that, great pieces to inspire labor and bathroom redecorating.)

This was my safe place during transition. Who wouldn't want to be here?

This was my safe place during transition. Who wouldn't want to be here?

 

 

 

I used this as my safe place when labor got hard, and I could retreat to somewhere else mentally.

 

So did hypnobirthing give me a pain free birth? No. I had labor pain like any other birthing mammal, but my mind and body were relaxed the whole time. I was wonderfully prepared for my birth, and didn't feel the same kind of pain I had with my first. I would describe it as intense, but I was able to cope. Sophia's birth was peaceful, and I can't wait to do it again.

 

Other perks of practicing hypnobirthing:

1)I slept amazingly well. I slept like a rock when I did the tracks right before bed. Goodbye insomnia!

2) I noticed a decrease in freaky pregnancy dreams. Could be a coincidence, but it's worth trying.

3) The tracks were a great break during a stressful day. I ended a recording feeling calm and focused. Something I needed when my three year old was losing her mind daily in the last weeks of my pregnancy.

4) Others have reported less anxiety and being able to better cope with anxiety using the techniques.

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Sophia Grace's Birth

I was due August 30, and as expected due dates go I took it with a grain of salt. I had done this once before, and figured my body would be better tuned and ready to go this time around. I was perfectly happy in my pregnancy, some pelvic pain but no third trimester horror stories. No rush to get it over with. Plus, I was enjoying the last weeks with Elena, just her and I before the chaos of bringing another baby into our home hit us.

The last three weeks of my pregnancy I had a ton of pressure and Braxton hicks contractions. I seriously felt like I was going to go into labor any minute. Days passed. Then weeks passed. My due date came and went without any incident. Braxton hicks gave way to prodromal labor, and a few arguments with my ob on not inducing. Sophie was fine, she knew when to be born. I made a deal with my doc that if we hit 42 weeks that we'd schedule induction. That being said, I walked a lot of laps in the mall, around Target, basically anywhere that had air conditioning to save me from the August heat. A week,"overdue", my doula suggested doing a fear release and doing some deep relaxing. Keeping the tension and fear of induction wasn't going to help labor to start. I found a great MP3 on YouTube, followed it up with a hypnobirthing recording (Another post to follow on hypnobirthing). I went to bed incredibly relaxed, and hoped something would start the next day.

At 4am on September 7, I was awoken by very strong contractions. It was Labor Day; the irony wasn't lost on me; it had been a running joke from every passerby that stopped to ask when I was due. These contractions were strong, to the point I couldn't ignore them or get back to sleep. I put on a hypnobirthing recording to get my mind and body centered and relaxed. I was so happy that labor has started on its own, and I was going to have the birth I had so desperately wanted. By 5 am, I couldn't keep still in the bed and Alex woke up, asking if I was okay. I let him know labor was definitely underway, and that I needed to call our doula, Julie.

Julie got there about an hour later, right as our three year old daughter Elena woke up. Elena was happy to see Julie and didn't seem to notice too much with me. My friend Lorraine picked up Elena shortly after, so I could labor. Elena shouted bye as she ran out the door; she loves Lorraine and her kids, so I knew she'd be happy and taken care of. Julie relaxed with me in my bedroom, rubbing my back as we listened to music. I kept the room dim, lit by LED candles.(They look great, and I didn't have to worry about blowing them out if we had to leave quickly.)

We spent the day laboring at home, eating, walking outside before the summer heat cranked up, eating Panera, and watching movies and Game of Thrones. I spent time in the shower and bath tub to relax; the water felt amazing! I spent a lot of time on the birth ball, or leaning against the counter in my kitchen. The whole time Alex and Julie just loved on me, rubbing my back and belly, encouraging me. I felt so peaceful and relaxed; a definite perk with the hypnobirthing mindset. I was aware of what was going on around me, but I had no idea where I was in my labor. I had no clue if I was get close to the end, or if I had miles to go.

Fast forward about another twelve hours. I was heading into transition, contractions were intense and the pressure from my bag of water was insane. I tried resting on my couch, and literally prayed for it to pop. Thoughts of,"Maybe I should go to the hospital, they'll pop it for me," came into my head, promptly followed by, "You gotta be getting close. You're actually considering that." I had a strong urge to go the bathroom, shook all the way up the stairs,and once I got there my water broke.

"Oh, thank God!"

The release of pressure was a huge relief, and I just sat there and breathed. I started to feel the baby descending, and started making my way down stairs to head to the hospital. The urge to push backed off a bit, so we stayed home for a few more contractions. I was sitting on the ball, shaking, when Julie pointed out that I was definitely in transition. Time to go! Luckily the hospital is only a few blocks away. I rode in the front passenger seat backwards to the hospital, while Alex drove and prayed I didn't have the baby in the car.

Hospital staff knew we were on our way, and got us into a room quickly. I declined a hospital gown; I wanted my own comfy maternity dress. They checked me, and I was measuring 7 cm.The travel and being at the hospital had back tracked my progress a bit. I was laboring on the bed on all fours, the only position that felt good to me. After checking me, my next contraction felt like I had to push and I couldn't even control it. I literally roared, and Sophia was crowning. The sweet nurse, Nikki, had her head and asked Julie to hit the button on the wall, summoning the rest of the birth team. My ob was out of town, so the attending doctor came in. He yelled at me to lay down so they could deliver me; I yelled back," No!". 1) there was no way I could move and 2) I didn't want to. There's more than one way to catch a baby. Next contraction, Sophie was out, caught by Nikki before the staff could even fully get in the room.

Sophie was beautiful and healthy. She was born at 10:40pm, September 7, weighing 7 lbs 14oz and measured 20 inches long. I labored at home for nineteen hours, and she was born after twenty minutes at the hospital. I had no interventions or medications. I felt peaceful and in control of my birth. I was loved and supported through it all, and the nurses at Carroll Hospital Center are rock stars. My doula Julie is amazing; she's loving and intuitive, and I can't imagine having a baby without her. My husband Alex is the best, he loved me through it, and supported me in birthing the way I wanted to. Unhindered. Supported.

To learn more Julie, you can find her at charmcitydoula.com

 

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