Labor of Love Articles

Moved Our Blog

2011-03-04T12:32:00.002-05:00

Jami my wonderful daughter and social network extraordinaire has redesigned our blog to be easier to view and find things within. Please visit it at Labor of Love Blog. Thanks!

Polly Perez is Amazing

2011-02-11T12:33:00.002-05:00

Do you know who Polly is? She is an amazing nurse, doula, childbirth educator, business woman, writer and speaker. I have had the opportunity to read her books, glean from her wisdom at conferences, sit and chat with her on several occasions and even co speak with her at the ICAN conference in Atlanta two years ago. She is a truly amazing woman. And did I also mention she is recovering from a brain attack as well? Truly amazing!

I remember years ago when she had her stroke, those of us who know and love her sent her hearts. She loves anything with hearts on it! I think that is because she has a big one!

Well today I got an email from her regarding he seeing that I had just doula'd for my 470th birth. I am probably at least 8 months from reaching my 500th birth- but the sentiment means the same none the less! It is really special to get such a note from a special woman!

"Teresa-

I have been reading that you are close to your 500th birth. It is was big achievement for you. I remember that time- it was exciting for me- one of my doulas send notes to many of my clients (unknown to me) telling that I just did my 500th birth in my practice. All of sudden I started getting cards from lots of clients. I put them all in a scrapbook and I still look at it often. Wonderful memories...

Together we have done 1000 births in our practices! I think that is a huge achievement for both of us- we have been around the block many times, right?

By the way feel free to use this note to you in any way that you want... (blog, Facebook, etc.) so that it can inspire new doulas..

CONGRATS on doing 500th births in your practice. Do let me know when that 500 birth happens!

Love, Polly"

Having Renee There Made A Huge Difference

2011-02-10T16:08:00.001-05:00

Renee was my Doula at my son's birth in September of 2010. I did not have a doula with the birth of my first son in 2007 - having Renee there made a huge difference. She helped keep me calm and focused on having a natural child birth. She graciously blended into the scenery and was supportive when I needed her and also seemed to fade into the background when I didn’t. She helped my husband support me in ways he didn’t know how and brought us closer in the process.

I would highly recommend her to anyone - she instantly became a mother/ sister figure and went with the ups and downs of birth. She was always there saying the right thing, making the right touch and offering that wonderful smile every time I needed it! She empowered me to do what I knew I could. Also, the pictures she took are also some of the most treasured photos I have of me and my son! She was spectacular - I would hire her again in a heartbeat and recommend her to anyone!

Dawn Benjamin

Renee provides labor doula services and also offers dual services of being her labor doula client's postpartum doula for those who wish for both services. She also teaches our "green baby" classes that focus on being eco friendly. She teaches Dancing for Birthtm classes as well.

Kudos for the Ladies of the Labyrinth!

2011-02-06T16:16:00.001-05:00

I knew I wanted to hire a doula very early in my pregnancy, but it was well into the third trimester when I finally started looking. After a brief phone conversation with Teresa, I knew A Labor of Love was for me. Teresa made me feel confident in my ability to choose the best birth for me and my baby. I attended the next Meet The Doulas Tea. I listened to each doula speak about herself, and I felt drawn to the Ladies of the Labyrinth. I hired them on the spot.

I met with the Ladies the next week for our first prenatal meeting. Teresa said she had a feeling she would be present for the birth even though she was not on call for my due date. The baby surprised us all when he decided to come the following week. I was just 37 weeks and 3 days, and the Ladies weren't even on call for me yet. Of course they still responded when I called.

Pam was the primary doula at the time, and Guina was the designated backup. At the time I called, both had just returned from long births. And so, just as she had predicted, Teresa came to be with me. I had a much different concept os "intense" at the beginning of labor than I had at the end, and I decided to go the hospital way too soon. Teresa met us there.

As soon as I arrived, my birth choices were already called into play. The first nurse I saw asked me to put on a hospital gown. It seemed such a small thing, so easy to comply with, so silly to argue over. But I imagined the look on Teresa's face if she saw me in it, and I stuck to my guns. My resolve was strengthened by even just the promise of her presence!

The rest of my birth experience plays out much the same way. I was at the hospital much too early, and statistically in greater danger of unnecessary medical intervention as a result. Every time the hospital staff did something to challenge my birth ideals, I stood firm. After the first twelve hours in the hospital, Guina joined us, and while her presence was very different, she still brought the same strength from inside me. I'm not certain that I would have been able to continue asking for (and getting!) what I wanted without the presence of my doulas.

The best way to describe my experience is that the Ladies supported me in being the best me, in birthing the best way that I could, in standing by the decisions that I made for myself and my baby. As a result, I beat the statistics and had a completely unmedicated vaginal birth in spite of being at the hospital for almost twenty-four hours. The Ladies made it possible not by making my choices or speaking for me, but by showing me how to draw on my own strength. It was the most empowering experience of my life.

Thank you, Ladies of the Labyrinth, not for showing me the way through my own labyrinth but for making me realize I already knew it.

Sincerely,

Brook Abrams

Why Don't We Allow Ourselves To Dream Big?

2011-01-29T23:44:00.001-05:00

Often times when I ask a mom what would make her birth ideal, she hesitates to answer me. I just read a prenatal form that is so like many others. She wrote, "I'm almost hesitant to answer this question and may gracefully back out of doing so at the risk of being disappointed if my "ideals" don't happen. " I can tell you that is almost verbatim what I hear often. I do hear things like short labor, no tearing, attentive nurses, etc... but most of the time there is hesitancy to answer what ideal would be to them. And they always follow up with the remark about being disappointed.

Now I have to agree that there are so many variable and unknowns in labor that it is hard to plan your labor exactly the way you desire it to be. But we all have an ideal labor in our minds. If you don't want to jinx it by stating it, that is one way of viewing it. If you don't want to create a standard by which must happen or you will feel like a failure, I get that too. But I believe we can not achieve that which we do not dream.

Dream big- dream realistic- but dream big! The same way we dream about other things- for instance, think about the things you dreamed about... the man or woman you married. Yea they may not have met everything on your check list- but by golly I hope they met most of them and exceeded in other areas you had no idea would be important! Your wedding... the things that were really important- your flowers or your dress or the location- did you dream about those? You may have had to have less flowers or a discounted dress- but I am sure your dreams were still met even with some compromise. We would never go into a relationship or a special day with the idea of being afraid of being disappointed by allowing ourselves to set our goals high.

I believe you must dream things to have them become reality! Dream big! Dream about what is an ideal birth. Who is there? What are you doing or not doing? Yea you can not change the gender of the child within you. You may not be able to control if you tear completely- but there are things you can do to avoid tearing. You may not be able to truly control the length or intensity of your labor- but the preparation you put into your pain coping and body mechanics and mind body connection can definitely have an effect on your labor.

So dream- allow yourself to imagine the perfect labor and birth. Start to visualize yourself in that labor and birth. Share what your dream is with others. Be prepared to make changes along the way if they are needed. But dream... I think it really does matter that you can see yourself achieving it beforehand. If you make good decisions along the way, you need not feel like you failed. You may be disappointed at times, but failure does not have to enter into the outcome at all.

Who Will Play the Roles At Your Labor

2011-01-29T19:26:00.002-05:00

Often couples are confused by the roles the different players will have in their labors. I thought I would offer some descriptive words of who does what in the usual labor. Some roles may overlap and others will not. I am sure there are responsibilities I may miss. Some nurses and midwives, when able to, offer similar labor support as a doula. Some midwives are more like a doctor in the way they practice. Each provider of support offers their expertise and personality into your labor.One doctor may bring laughter and encouragement when another only arrives to catch the baby. Often times one nurse has two patients and may be watching another while a birth is occurring or a nurse is on break. Some midwives may be sleeping after being up all night or busy with several moms in labor. Feel free to add more in the comments section. What did your partner, nurse, doctor, midwife or doula do for you?

Partner:

loves you
attends childbirth classes with you
practices pain coping skills learned in classes
is your companion
supports your choices
drives you to your birth location
gets your snacks, juice or ice
reminds you of the things you learned in class
massages
offers counter pressure
dances with you
walks with you
encourages you
helps set up your birth environment- music, etc,
offers kisses and hugs
cries and laughs with you
sits by you and holds your hand
pours water on your belly
reminds you of your birth goals
holds you when need support
stays with you throughout labor
catches the baby
cuts the cord
holds the newborn
takes photos
reminds you of the things you learned about breastfeeding

Nurse:

may support your choices but reminds you of hospital protocol
takes notes for medical records
brings you the forms you must sign prior to procedures
informs you of normal protocol for patients as they represent the hospital
brings you a hospital gown
places your IV if you desire
changes your linens and bed pads
monitors the baby via external or internal monitors
accesses your health- temperature, blood pressure, etc
does vaginal exams
places catheters and shaves you if needed for surgery
gets your ice
calls for anesthesia
gets your medication if desired
encourages you
sets up the birth tub if desired and offered
offers suggestions that may help- sometimes things you did not want - like medication
instructs you on guided pushing
holds your leg during pushing
assist the doctor or midwife during birth
catches the baby if the doctor or midwife does not arrive in time
cleans up after the birth and gets your ice pack
massages your fundus after the birth
records the time of birth
weighs and measures the baby
washes the newborn
does newborn procedures- shots, ointment, etc
may help you with breastfeeding

Doctor:

determines your health and well being during your pregnancy
may determine if you need to come to the hospital
assesses the baby's health in utero
writes orders for medical procedures
may do vaginal exams or may have nurse do most of them
is either patient or actively managing your labor
breaks your amniotic sac if desired
comes in for short visits when needed
determines if you need intervention
answers your medical questions
surgically delivers the baby if a cesarean is decided upon
arrives to catch when birth is imminent
does any repairs that are needed
cuts the cord if needed
delivers or catches the placenta

Midwife:

works with you prenatally to prepare for your birth
helps you uncover all of your options
supports your choices
determines your health and well being during your pregnancy
may determine if you need to come to the hospital
assesses the baby's health in utero
writes orders for medical procedures
is either patient or actively managing your labor
breaks your amniotic sac if desired
comes in for short visits when needed but may stay longer than a doctor if not busy
determines if you need intervention
may do vaginal exams or may have nurse do most of them
massages if not busy with other patients
answers your non medical and medical questions
offers ideas you may not have considered
guides you and your partner when you need it
reminds you of your birth goals
holds you when need support
encourages you
offers hugs
assists the doctor in surgery of the baby if a cesarean is decided upon
arrives to catch when birth is imminent but often will be more present in the last leg of the labor
does any repairs that are needed
cuts the cord if needed
delivers or catches the placenta
helps you with breastfeeding

Doula:

works with you prenatally to prepare for your birth
helps you uncover all of your options
cares about you personally
is your companion
supports your choices
rides with you to your birth location
gets your snacks, juice or ice
reminds you of the things you learned in class
massages
answers your non medical questions
helps you get answers to medical questions
offers counter pressure
dances with you
offers ideas you may not have considered
guides you or your partne when you need it
walks with you
encourages you
helps set up your birth environment- music, etc,
offers hugs
cries and laughs with you
sits by you and holds your hand
pours water on your belly
reminds you of your birth goals
holds you when need support
supports your partner
becomes your primary support if your partner needs a nap or meal
stays with you throughout labor
takes photos
helps you with breastfeeding

Quite a Journey

2011-01-28T17:55:00.002-05:00

I wanted to share a bit of a story of a woman's journey in labor and birth to help you see things from a perspective that is not the norm in our area. A highly interventive hospital does not mean lots of interventions if you make some other choices that help avoid just that!

This is a first time mom who started her labor right around her due date. Her labor started with a bang! Contractions started fairly intensely lasting about 45 seconds and coming every 3 to 4 minutes. She tried laboring in the tub at home for a while, but as they escalated and were timed at 2 to 3 minutes apart lasting a full minute, she went ahead and left to go to the hospital. She had been in labor for about 4 hours at this time.

Upon arrival to the hospital the exam showed she was about 3 to 4 centimeters dilated and the contractions had slowed down to 6 minutes apart. This happens often when adrenaline is pumping when change happens in labor. She nestled into her new surroundings and soon the contractions were back to 4 minutes apart. She was GBS+ so the antibiotics were started soon after her IV was placed.

6 hours later she agreed to having another exam and found out that she had dilated to 5 centimeters now and her baby remained high still at -2 station. Her bag of waters were bulging but still intact. She walked around in the room, moved a lot into positions that helped her cope- kneeling over the chair, swaying by the bed, walking around the halls of the hospital and even tried the tub. The midwife suggested no more exams since she did not want any further intervention. This was exciting news!

Nausea overcame her a few times and we were feeling assured progress was being made. She had gone from being quiet during her contractions to now needing to vocalize with them. We had a new nurse assigned to us since the first one's shift had come to and end. We would keep our midwife for another 12 hours before she would also be replaced. We felt like surely we would have a baby before then! Monitoring was occurring every hour for 15 minutes but now the suggestion that she lay down to do so was no longer acceptable. She remained standing swaying for these times or on her hands and knees.

11 hours had passed since the last exam and the idea of helping to move this along came up in the conversation with the nurse. Perhaps having an exam and determining if she was close, she would agree to having her water broken. She had been in labor for 24 hours now and only caught a few naps while in the tub over this whole time. The current midwife joined us and did an exam. She was now 7 to 8 centimeters. She broke the bag of water, something this mom had not wanted, but had been considering for over 4 hours now. There was meconium. This meant no more returning to the tub. But the last time in the tub had offered little respite.

Ironically we now get the original nurse she had had 12 hours ago as shift change occurs. And we get a new midwife as well. Two more hours past, now more than 27 hours since the first contraction and she is so spent that the idea of getting an epidural seems more feasible. She asks for medication for the first time. She knows she wants one more exam to make sure things are not close to the end before doing so. The new midwife says she feels more like 6 centimeters than the 8 we expected to at least be!

A bolus of fluids is soon accompanied with an epidural placement now 22 hours after arriving to the hospital and 28 hours since the labor began. And an IUPC is placed to "shower" away some of that thick meconium that the baby is surrounded by. Some napping occurs by everyone in shifts while we watch over the mom.

Six more hours pass before she begins to push her baby out. Two hours of pushing her son is born with the cord around his neck two times. Never in this labor did he ever show us any distress. There was a short moment of having back labor, but nothing besides the slow moving labor caused us to think this baby may be malpositioned- occiput posterior although an hour before she was pushing, the midwife had encouraged a little bit of spinning to line him up perfectly.

The baby boy was born strong and healthy. Although the neonatal team is always called when there is meconium, they soon left after seeing how great he was doing on his own. I sit and think about so many things about this labor and it causes me to want to share these things with you.

Did she go to the hospital too soon? If you say so in the hindsight or realizing how long before the baby came, we would all say yes. But if you do not go when contractions seem intense (and yes she understands now intense then and intense in the end was different!) and are 2 to 3 minutes apart, when do you go?

What kept her from all the interventions that usually plague a labor like this? Having a midwife helped! Having a supportive back up physician who suggested no more exams if she did not want intervention, helped a ton! Having a doula they felt like helped. The mom being well educated to birth was essential. She made wonderful decisions all along the way. She knew what she wanted and why she had made those decisions beforehand. She also knew that labor is unknown and had not made her plans so concrete that she would not be able to make the "next best thing" decisions along the way.

She waited to have any interventions until she had exhausted all of her other options- or all the options she could see as feasible. She knew this was possibly going to be the hardest work she had ever done and she prepared herself emotionally for this day.

We had a great supportive team. Although this hospital is not known for being super supportive of a natural birth, we had a team of nurses who never undermined her ability and found support essential to their nursing skills. Her husband and mother were also there to offer support and love.

This mom moved and stayed upright and active all along the way. She was open to new ideas but mostly listened to her own natural rhythms and patterns of movement that felt right for her. She developed her own rituals of labor that helped her to cope during contractions.

I have to wonder if this baby was occiput posterior or sunny side up. But I also wonder if this little boy knew that if he rapidly moved down the birth canal he could cause himself trouble. Never was Pitocin ever needed. Never did the contractions space in such a way to make anyone suggest this. Although I have seen some providers assume that the contractions are not strong enough and insist on doing so. The midwives here never did. But maybe he needed this long labor to stretch his cord and help him navigate the way down through the birth canal.

The mom used the term "threw in the towel" to express her own disappointment in choosing an epidural but in the next breath remarked she had probably gone a half an hour longer than she should have! The last hour before the epidural was placed she could no longer relax and she felt so hyper-stimulated by the contractions that she could not even focus on any supportive words offered to her. She had been tightening and drawing upward with her breath. It was apparent to us that this was not going to work toward her letting go and releasing the baby. Within a half hour of the epidural she indeed dilated 2 centimeters. I do think once she was able to fully let go she progressed.

Do I then think that means all women can benefit from getting an epidural. Absolutely not! In fact if she had gotten an epidural early, her labor may have stalled. If her labor had stalled, Pitocin would more than likely been used. If Pitocin had entered the labor, that nuchal cord could have been tightened by the artificially induced contractions and we could have ended up in the OR with a stressed out baby instead.

The mom even said she was sure with her next baby, as long as it was not longer than 24 hours, she would be able to do it without an epidural! And to that I have to agree. She was quite the warrior woman! I can not feel anything but admiration for this mother!

Oh and for those who wondered- he was an averaged sized little boy with a rounded head that showed no malpresentation swelling. He in fact was gorgeous and reminded me of the photos in journals showing what a normal newborn looks like! I look forward to the call in a few years hopefully inviting me back to this couples next birth!

100 Ways To Help Achieve A Natural Birth

2011-01-17T11:57:00.001-05:00

100 Ways To Help Achieve A Natural Birth

Decisions in your early pregnancy:

Choose a care provider that supports and believes in natural birth. Ask when you are considered “late.” Their induction rate will tell you a lot!
Interview your care provider prior to confirming as their patient. Ask for statistics of moms who wanted to go natural, how many actually did.
Understand your provider's philosophy of birth- ask good questions in the beginning. This is an important relationship- don’t choose them on a referral- interview them!
Hire a doula, a birth professional with experience in labor and birth.
Interview your doula carefully. Does she have any hidden agendas about birth, is she trying to heal from her own birth through yours? What is her experience and training?
Choose a doula as early as possible in your pregnancy to have time to develop a relationship with her along your journey.
Take a childbirth class that supports natural birth and places an emphasis on providing you with tools for pain coping.
Consider the preparation for this birth to be as important an event to prepare for as other events like your wedding day. Don’t rush your education and preparation and try to make it fit into a tight, unrealistic learning schedule.
Choose a place to birth that supports natural birth and have the staff that understands it. They are less likely to offer to “fix” normal things if they support natural birth.
Find out your hospital’s cesarean and epidural statistics. Choose a location with a low rate for both.
Choose a care provider who believes in vaginal births for complex births like VBACs, breech and multiples. The more skill set they have the less likely to find a reason for a cesarean.
Choose a midwife. You are more likely to have natural birth with a midwife (not a “medwife”).
Choose a private childbirth educator. She is not paid to teach a particular way. Choose a class that encourages you to think about your fears and true choices.
Choose a birth location that allows laboring and perhaps birthing in water. Even if you do not think you will want to birth in water, having it as an option is helpful.

Considerations during your pregnancy:

Read books that support natural birth: The Thinking Woman's Guide to a Better Birth, Birthing From Within, Ina May's Guide to a Natural Childbirth, etc.
Watch movies of natural births (The Business of Being Born, Birth Day, Orgasmic Birth, etc.) and stop watching the Baby Story type shows that perpetuate interventions as normal.
Avoid TV shows and movies that depict highly medicalized births- garbage in, garbage out. Many times they choose subjects that are sensational and interventive births to focus on. Allow yourself to begin to see birth as normal and not painful.
Do prenatal exercises daily if possible, especially yoga and swimming.
Take other fitness classes - staying fit makes a huge difference in your labor. If nothing else, go for a long walk each day.
Surround yourself with people who support natural birth. They are not invited to your labor unless they can do so.
Do not listen to negative stories about birth - only empowering ones. Don’t let people share their horror stories- they do soak into your psyche.
Educate your partner on the advantages of a natural birth and have them attend the classes with you.
Take Spinning Babies classes, Dancing for BirthTM classes and others that help line up your baby for best positioning.
Don't cross your legs during your pregnancy- this helps to keep your baby from turning posterior.
Do exercises that encourage optimal fetal positioning. Help your baby align for an easier labor.
Replace your chair at work with a birth ball to help you have proper postures for aligning your baby.
Do not complain to your care provider about "still being pregnant" in the last couple weeks. This can encourage talk of induction. Embrace the time for your baby being born as one that your baby and body get to decide on without intervention.
Choose music that is soothing and helps relaxes you. Practice your relaxation with this music in preparation beforehand.
Examine fears you might have about birth and work through them with a doula, care provider, or friend knowledgeable in natural birth and in addressing those fears. Ignoring them does not make them go away.
Don’t be afraid to change providers later in pregnancy if needed If this marriage is not made in heaven- find a new provider!
Understand that most nay-sayers are speaking from their own fear and bad experiences and they most likely did not follow any of these steps to make their birth different. Just because your sister, friend or mother had a medicated birth, does not mean you will need medication.
Practice your pain coping techniques during your pregnancy--they will become natural if you practice them along the way. Practice them in different situations during the day...in the car, at work, while walking, while being busy, etc.
The pain coping techniques you find less helpful- practice more! If you can get them to be effective, the ones you love will be even more so.
Practice your pain coping techniques daily using ice water to help you learn to relax when you are under a bit of pain or discomfort.
Consider what you are eating carefully. You can grow a baby too big if you are eating unhealthy foods and too much quantity. Organic, unprocessed foods are best.
Some folks believe the only way you can have a natural birth is to choose a homebirth. But choosing the location for your birth and being totally comfortable with that decision is more important than it being home. Home would not be the right choice for some women. Choose a place you feel you can be vulnerable and safe.
Meditate. Yoga is a great exercise not only for the exercise portion but also for helping to get you centered and meditative about your labor… there is a body mind connection that is helpful.
Mantras that become rope to you help you to keep positive phrases in your mind and they will come naturally in labor to your thoughts if you practice them during your pregnancy.
Having a support system (doula, mothers, sisters friends) during your pregnancy to talk to when fears and concerns come up helps. Joining some groups that are made up of folks who are like minded during your pregnancy.
Listen to ONLY positive birth stories, even long arduous ones, but ones with positive 'energy'. Stop listening to those who want to share their horror stories with you.
Journaling is a great way to identify the concerns and fears you have and also affirming the ways you want things to unfold.
Learn to breathe in ways that help to control your breath in stressful and painful times- yoga is helpful in learning this.
Learn good body mechanics for pregnancy and labor will keep you injury free and help your body to perform tasks better.
Chiropractic care keeps your body and your baby aligned properly so you can birth more easily.
Prenatal massage is a great way to keep your muscles relaxed and this helps your baby to be comfortably aligned too.
Allow yourself to indulge in a hobby (art, baking, sewing). The ways you fill your days with fun and productive times is a great way to prepare for motherhood.
Read books that support your philosophy about life in general- not just about birth but parenting and the way you want to live your life.
Sing. Dr. Michel Odent encouraged his patients to sing to help expand their lungs in preparation for labor but also as a means of bonding with your baby.
Information and education for you and your support system is important- learn how to ask the questions you need in order to get the answers you need to make informed decisions.
Nutrition during your labor is important. Fasting during a race is ridiculous, so continue to snack and eat high carbohydrates during labor to keep your energy.
Understanding what you want and why will keep you on track to stay with your plan.
Go to bed when you are tired in the last weeks prior to birth. Don’t feel that you need to get a ton of stuff done and rob yourself of rest. When you go into labor it would be great if you are rested.
Make love in the last weeks of your pregnancy. This is not only a good release of oxytocin and prostaglandins, but it helps you to be connected to your partner.
Focus on the important in the last weeks and not the things that can wait or go undone. For instance not taking a breastfeeding class because you need to set up the crib is not prioritized properly. You will need to know how to breastfeed long before the baby will ever sleep in the crib.
Avoid having vaginal exams in the last weeks of your pregnancy. They increase the chance of infection and often only cause you to become anxious about your progress.
Consider the times in your life that you felt pain...what did you do to cope? Practice techniques that worked for you before, they will most likely work again.
Avoid induction of your labor. Ask for biophysical profiles to be done to determine the health of the baby in utero instead of just your gestational guess date. Consider some natural alternatives to induction that have less negative side effects.
Change your message on your voice mail to say you are resting and have not yet had the baby when friends begin to ask about how much longer you will be pregnant. Feeling like a watched pot only causes your anxiousness to boil over.
Plan something so special on your due date that you would hate to miss. This will allow you to not get too overly focused on a due date and begin to feel late when it comes and goes. Most first time moms go ten days over their estimated due date.
Don’t do your complaining to your doctor or midwife about non-medical, but often times normal, pregnancy complaints. Often times they will feel compelled to “fix” the problem. Fixing it sometimes means interfering with the natural process. Call your doula to complain. She will listen without judgment and may offer some ideas to help you.
Seek acupuncture treatments for coping with many pregnancy conditions that can interfere with being balanced for your birth.
Consider perineal massage to help you learn to relax your perineum and teach you about the elasticity of your body.

Considerations during your labor:

Labor at home as long as possible, having your support person come to be with you if you desire.
Be careful inviting too many to your birth. You may feel watched or feel like you need to be a hostess rather than a laboring woman.
Sit on a birth ball to facilitate gravity to help your baby move down and to keep your pelvis open during labor.
Choose candles, oils etc. in a scent that is relaxing and appealing to you. Bring those scents with you into labor. (Only electric candles are allowed at the hospital, but you can certainly use scented ones at home.)
Remember to trust in your body - it knows what to do. Allow it to open without fear.
"Ignore" early labor. Walk, sleep, eat - go about your daily business. Wait for the contractions to demand your attention.
Labor at home for a long time Stay until contractions are stronger, longer and closer together- 4 minutes apart and lasting a full minute for at least an hour (411).
Stay out of the bed in labor- stay moving!
Believe you can do this- negative thoughts will overcome your ability if you let them in! Fill your head with positive affirmations.
Submerge yourself in water… being in the tub will be the tester- if it is early your labor will stop- so rest. If it is active labor, the water will speed it up. All of the time it is relaxing- so get in the tub!
Keep your jaw and mouth loose in labor- use “horse lips” to stay relaxed. A loose and open jaw makes for an open cervix!
Determination makes you begin to see yourself successful. If you use phrases like, “I will …” vs “I will try…” you will see yourself being successful.
Prayer and spiritual centering helps you to bond with your baby and the power within you.
Talk to your baby. Parenting begins prenatally! Tell your baby your desires during your pregnancy and talk to him/her during labor- it is a dyad!
Trust the process of birth- there will be 300,000 women birthing on the same day as you. You come from generations of women who have done this!
Movement in labor is imperative- if you need to move the baby during labor – move the mom!
Optimism is needed. If you begin to have negative thoughts, try to remain optimistic. Give your support people cheat sheets of things you will need to hear in labor.
Confidence in yourself and those around you helps you to remain on track as well.
Reflection and meditation in labor is great. Go for a walk to clear your mind and refocus if you begin to loose your way.
Listen to your body in labor- if a different position feels good- move into it- if a position feels wrong- listen to your body and move! You get to choose!
Make your birth environment one that fits what a relaxed, safe place looks like to you. It will be necessary for you to feel safe and secure. Choose your location and make it your own with that in mind.
Wear whatever you want to wear or don’t want to wear- as some moms prefer to be naked. This is about comfort and you get to decide what that means to you.
Think about contractions like waves. The part that kicks your butt is the peak of the contraction- maybe 20 seconds. That means if contractions are coming every three minutes you only have six minutes of kick butt pain per hour. That is doable!
If you can sleep during early labor, sleep. Don’t feel compelled to “make things happen.” Rest, then when things do happen you will have the energy to do this!
Hydrate yourself if you think labor is beginning. Often times dehydration will bring on contractions that are not progressive.
Avoid having vaginal exams during labor. They increase your chance of infection and intervention. Labor is not a race. If you choose to have an exam, ask to not be told the number as it could be detrimental to you if you feel you are not progressing quickly enough.
Women have been doing this since the beginning of time. You are from that lineage of women- believe in birth, trust you were made to do this. Remind yourself that birth is normal. Birth is not broken and does not need to be fixed. Help your support team to understand you do not need to be rescued.
Use your “BRAIN” when asking questions: find out the Benefits, Risks, Alternative, consider your Intuitive voice and know what will be done Next if you agree to this procedure.
Ask, “Am I okay and is my baby okay?” before agreeing to an intervention that may interfere with your plans for a natural birth. Don’t fall prey to someone else’s agenda or time constraints.
Acknowledge the baggage you need to get rid of going into this birth- work to rid yourself of it and also acknowledge that those around you may carry baggage into your birth as well. Don’t accept their baggage as your own.
Allow those who are supporting you to take breaks so they can be able to continue to offer great support. Have them tag team with someone else to be able to rest when they need it. Having “fresh” support can help keep you “fresh” as well.
Make signs or small posters with affirmations and birth ideals for you to see and for others to see when you are in labor. Reminders help keep you on track.
Remove the clocks from the room. Don’t allow time to be your enemy, doing labor math will only make you feel like you are suffering instead of working. Expect a day of work the day you are in labor.
Labor is hard work, plan to work hard, sweat, be tired in labor- and see yourself as persevering during that work.Consider the times in your life that you worked hard, think about how you managed through that event and start to see yourself as a warrior.
See the team of you and your baby working together. Remember the benefit of a natural birth for your baby as well as yourself. Focus on the baby.
Have someone massage the parts of your body that hurt or need to be coaxed into more relaxation during your labor.
Music often soothes the savage beast. Although you may not think it is important, it may offer that back drop that keeps you from focusing on the noise around you that is distracting you in a negative way.
Avoid augmentation of your labor. If someone offers to speed your labor up, understand that doing so is not without consequences that may cause you to veer off your path.

Midwives: What is the Difference Between Them?

2011-01-16T20:01:00.003-05:00

There are basically three kinds of training for midwifery; CPMs, CNMs and DEMs. Although there are a few others designated. The midwives training is different as well as their licenses. I thought for clarity sake I would share them with you. Although the restrictions of the type of care they can provide varies from state to state. I have gathered this information from the websites that represent the different types of midwives.

North American Registry of Midwives shares this definition:

What is a Certified Professional Midwife (CPM)?

A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwives Model of Care. The CPM is the only international credential that requires knowledge about and experience in out-of-hospital settings.

This midwife has undergone training, has had a preceptor and apprenticed births and passed an exam that NARM requires. You can be assured she has had excellent training. These midwives provide care for home births only.

American College of Nurse Midwives offer these descriptions:

Certified Nurse-Midwives (CNMs)

The practice of nurse-midwifery was established in the United States in the 1920s by such early leaders as Mary Breckinridge and Hattie Hemschemeyer; since then nurse-midwives have been recognized for their contributions to reducing infant and maternal mortality, premature births, and low birth weight rates. Their skills as primary care providers are evidenced by their low rates of infant mortality, cesarean birth, episiotomy, and use of epidural anesthesia and their high rates of success in vaginal birth after cesarean. These facts are made more impressive when considering that 70% of women who receive care from nurse-midwives are considered vulnerable to poor health outcomes by virtue of age, socioeconomic status, education, ethnicity or location of residence.

Certified midwives (CMs)

The mechanisms to educate and credential certified midwives (CMs) were approved in 1994. These standards were developed in order to ensure that CMs are educated in a manner that is equivalent to the CNM. CMs are not registered nurses, but may hold other professional designations as health care providers such as a physician assistant or physical therapist. Licensed to practice in New York, New Jersey and Rhode Island, individuals choosing this career path are pioneers in the profession, much like the early nurse-midwives who practiced in the U.S.

These midwives practice in hospitals and birth centers. In some states you are able to have a CNM or CM provide care at a home birth.

Midwives Alliance of North America offers these definitions:

Direct-Entry Midwife (DEM)

A direct-entry midwife is an independent practitioner educated in the discipline of midwifery through self-study, apprenticeship, a midwifery school, or a college- or university-based program distinct from the discipline of nursing. A direct-entry midwife is trained to provide the Midwives Model of Care to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings.

Lay Midwife

The term "Lay Midwife" has been used to designate an uncertified or unlicensed midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, just that the midwife either chose not to become certified or licensed, or there was no certification available for her type of education (as was the fact before the Certified Professional Midwife credential was available). Other similar terms to describe uncertified or unlicensed midwives are traditional midwife, traditional birth attendant, granny midwife and independent midwife.

Licensed Midwife (LM)

A licensed midwife is a midwife who is licensed to practice in a particular jurisdiction (usually a state or province).

So, you need to determine what type of midwife is the right one for you. My well woman care is done by a CNM although I am beyond my childbearing years. I like care from a woman, although all midwives are not women. I also like the way the seem to take more time with me and understand the normalcy of womanhood. We know that midwifery is the type of care that the nations that have a better infant and maternal mortality rates. We know that usually midwifery offers less interventions. They view birth as a normal passage for a healthy woman. If a woman becomes high risk, her care is transfered to a physician.

My first grandson was born at home into the hands of a wonderful CPM, Debbie Pulley. She is the one who guided me in my calling as a doula. She is wonderfully trained and experienced. My youngest granddaughter was born in the hospital under the guidance of a wonderful CNM, Susan Fisher. She is a fantastic midwife who trusts births and provides wonderful care to her patients. One of my friends is the midwife who brought water birth to Atlanta. She is Margaret Strickhouser, CNM. She has changed birth in the metro area forever. There are now three hospitals in the metro area that provide water birth as an option they provide.

I have never been to a birth with a DEM, LM or Lay midwife. When women come to me and ask about midwifery care, I refer them to the ones I have done births with personally. I share the benefit of midwifery care. I warn that some midwives have had so many restrictions put on them that they practice more like physicians with their high levels of intervention. We often refer to them as "medwives."

You get to decide where to birth and who to choose as a care provider. Only you will know what the right location and person to assist you will be. I would like to remind you that midwifery is considered the model of care if you are a healthy woman seeking a birth with less intervention. Midwives at hospitals are able to provide you with the same medications that a physician provides. But the care you receive along your journey is often quite different due to the time and consideration they will offer.

Citizens for Midwifery – the only national consumer-based group promoting the Midwives Model of Care! CfM works to provide information and resources that promote the local midwife, as well as midwives and midwifery care across the country! Visit their website for more details on their resources. Citizens for Midwifery

Georgia has a wonderful resource at Georgia Midwifery Association in finding midwives to assist you with your care. There is also a great organization Georgia Friends of Midwives that is a consumer group that advocates the preservation and expansion of safe, accessible and affordable childbirth alternatives, including the informed choice of a midwife-attended birth in the home setting.

Gentle birthing to you in finding the best fit for your care!

Dear Warriors- A Letter From A Student

2011-01-14T21:49:00.002-05:00

Guina teaches an immersion two weekend series. This is a letter from one of her students. The editing done was only for brevity.

Dear Warriors:
Hi everyone! Doug and I wanted to let you all know that we welcomed Louis Livingston Frederick into the world on December 29, 2010 at 1:06 AM. At the end of this very long email, I will list some thing that I found helpful through the process.

Here's a little of the birth story for you:

I was some contractions Tuesday the 28th, but didn't think much of them, as I'd been contracting since 31 weeks. They weren't regular, but did seem more intense. Around 7:00 that night, the contractions were still irregular, ranging from seven to ten minutes apart. Doug left for a group bike ride around 8:15, and I ate Christmas leftovers, which was a big, heavy meal. Around 8:30, the contractions were 4 1/2 minutes apart, and pretty intense. I was sure this was more false labor, so I took a bath to make the contractions stop. The bath did help ease the contractions, but by the end of the bath, they were 3 1/2 minutes apart. I called Doug and told him to come home.

Once I got out of the bath, the contractions got stronger, so I got in our bed and was rocking back and forth on my hands and knees. Then, my water broke. Doug was still a couple of miles away on the bike, so I called a neighbor to come over. I called the midwife, and she said that if I wasn't planning on having an epidural, to come in whenever I wanted to. At first, I wanted to leave as soon as Doug came home. But, once he got home, I wanted to stay at home longer. We packed up the car with the birth ball, and my bag of massage and comfort items. My neighbor pointed out that the contractions were pretty close together (they were probably close to two minutes apart at this point), and that we should get going. Oh, and remember that big, heavy meal I had- it came up before we left. I still didn't want to go, and Doug had to tell me to get in the car. Now, I remember Guina saying something about not sitting in the car, but I didn't remember that at the time, and the car ride to the hospital was the worst part of the whole birth. Speed bumps become evil when you are in labor. Most of the pain was in my back, and sitting was excruciating.

We made it to Northside and checked in at the admissions desk at 11:15. There were 30 babies born in a twelve hour period that night, so my room wasn't ready yet. They told me to walk around the atrium until they called me back. All I wanted was to get to my room, get on my hands and knees, and let Doug massage my back. Walking did not feel good. Then, I went up to the desk and said "I feel like I have to poop." Those are the magic words, because they sent us straight back to the room, despite it not being ready. The nurses got me on the monitor and did all the paper work. I did not have an IV. The midwife came in and checked me (while I was standing up) and said to the nurse "she's rimming." I asked what that meant, and she replied "honey, you're nine centimeters... you're almost ready to push!" I got in the bed and was on my knees, but more like an extended child's pose than hands and knees. Doug was doing the hip squeeze, and the midwife asked if I wanted her to try something to give me some back relief. She injected sterile water into four points on my lower back, and it totally relieved the pain for a few minutes.

I started pushing around midnight, and was not in the best position, but nothing else seemed appealing, and I didn't want to move at that point. I was kind of crosswise in the bed, and the midwife just worked with me where I was. In hindsight, it would have been more productive to have my upper body higher, and I was not working with gravity. It took a little bit to figure out what I was doing too. The contractions spaced out to about three minutes apart, which was a nice break. Doug gave me water in between the contractions, which really helped. Pushing was very similar to running, and I needed the water to keep me going. Toward the end, someone raised a bar on the side of the bed so I could push up with my arms. It got very productive after that. She did a very small episiotomy, and then I had tear on top of that. Louis was born at 1:06- less than two hours after we arrived at the hospital.

Helpful hints:
If I had known I was in labor, I would have never had the big meal that I had. If you even think you are in labor, eat small meals. I wish I had more energy going into the process than I did.
We spent so much time preparing and packing my labor bag- we made a rice sock, and had tennis balls and a massage stick. Doug pulled the car up to the labor and delivery entrance, but we didn't want to take the bag out until we knew we were staying (I really didn't believe I was in labor). Doug never had time to go back and get the bag, so we didn't have any of the things we had prepared. It turns out that we did fine without them. I'm not saying not to pack a bag, but just know that you can have a baby without a rice sock!
I had let my fingernails grow out a little while I was pregnant because the hormones made them stronger. As soon as I held Lou, I wished I had cut them down before giving birth. I felt like I was scratching him, and the nail bothered him when he sucked on my little finger.
When I called the midwife, I made a point to tell her I planned to deliver naturally, so she knew what to expect. I also told her that I didn't want an IV, and that I didn't want to wear the hospital gown. I think that made things easier, and I had a nurse that was interested in natural childbirth. I don't know if that was a coincidence, or if Judy requested her for me. Also, when Judy walked into the labor room, she told me it was "clothing optional" and to take the gown (or whatever I had on at the time) off. I think giving birth is something that is best done in the buff anyway.
In the book Birthing from Within, she suggests talking to your baby as a pain relief technique. I did this, and asked Louis several times to come out quickly when it was time. He certainly did that!
Because Lou was born so early in the morning, they wanted me to stay a full two nights in the hospital. I really wanted to go home the afternoon of the 30th, but I stayed that night too. I'm really glad that I did because I ran into some nursing issues, and the nurses were a huge help to me. I would recommend staying the second night.(Also, I know Northside gets alot of flack from the natural birth community, but I have to say that their postpartum care was excellent. Louis didn't want to work so hard to get the colostrum and he lost 14 oz (over 10% of birth weight) by the second night. The pediatrician said that we had to supplement formula, and the nursery nurse brought us a supplemental nursing system. I had never heard of this before, but it allowed me to breast feed and supplement formula simultaneously. One nurse in particular really spent alot of time with me on nursing, which was a huge help. Also, my milk didn't come in until the fourth day, which was really frustrating. I was able to work through it (with lots of support from Doug, Mom, and a friend), and we've been breastmilk only since that fourth day.)
I would also recommend a breastfeeding class. I skipped mine because I was so tired during the third trimester. I think the nurses and the lactation consultant made up for what I missed, but it would have been helpful to have a more in depth knowledge before. It was also helpful that Doug was involved in all the breastfeeding conversations. His support has been invaluable.
I do really want to thank you for mentoring the class. I felt so prepared going into birth, and I think it made all the difference. Thinking back on the night of Louis' birth, I am reminded of the Innana story. I had planned to take all this stuff with me, and I had to leave it all in the car, and all I had was the wisdom from class, Doug, and a great midwife. I will recommend the class, and your doula service to anyone I know that is pregnant.

Katherine

Choosing Childbirth Classes

2011-01-13T18:16:00.001-05:00

Mothers Advocate offered a great article on choosing a childbirth class. Here are their questions- with our answers regarding our classes. My input is in italics and is in purple below.

Choosing a Childbirth Class
What to Consider When Looking for a Childbirth Class

A good childbirth class can not only prepare you for labor, it can expand your personal
philosophy of birth, lessen your fears and, most importantly, build your confidence in yourself
and your body. It is a good idea to contact a childbirth educator or two to find out what their classes
are like before you sign up.
Questions you might want to ask an educator:

• Are you certified to teach childbirth classes?
Our childbirth educators are all trained and certified to teach classes from a national or international organization. Pam and Guina are both mentors with Birthing From Within. Teresa did two trainings with BFW but chose to complete her certification with CAPPA as a certified educator. Pam is also certified with CAPPA. Pam and Teresa hold other teaching certifications. They both are certified with the Happiest Baby on the Block. Teresa also has her certification as a Lactation Educator with CAPPA.
• What do you believe are the most important ways a woman can prepare for a healthy, safe, and satisfying birth?
We believe gathering information, making decisions that are right for her and working through fears that may impede her labor are paramount. We all agree that staying healthy by eating properly and exercising to stay fit are important. We also teach and believe that having the baby in optimal fetal positioning is important. Choosing the right team is most important - the midwife or doctor, the doula or birth partner, preparing your partner and the birth location are all pieces of a very important puzzle!
• Is a specific childbirth method taught? If so, what is the method and how does it work?
We teach a montage of ideas that have been gathered from our training with Pam England and the Birthing From Within trainers, the exposure to other methods we have had including Bradley, Lamaze, Hypnobirthing, Hypnobabies as well as the work of Micheal Odent, Suzanne Kitzinger, Barbara Harper, Janet Balaskas, Gail Tulley and many others as well as our personal experience.
• What topics are covered? A childbirth class should cover the following:

The normal, natural process of labor and birth, and health-care practices that support it
Changes during late pregnancy and the stages of labor
A wide variety of coping strategies for managing pain in labor
The importance of labor support
Movement and positioning during labor and birth
Medical interventions and their indications, risks and alternatives
How to communicate with your health-care provider
Developing a birth plan
Breastfeeding and newborn care (we also offer additional classes with much more information on these subjects.)

We cover all of these topics and many more. You will learn at least 25 pain coping practices that will help you in labor.

• Will my partner learn how to play an active role in labor and birth?
Absolutely. They will learn what is "normal" and how to support you in the choice you determine are right for you.
• Does the class help participants create their own birth plans?
Yes. We work on a more fluid birth plan process. One that allows you to change your mind and one that allows some revisions as your labor unfolds. We prefer to call it an open birth plan or birth ideals.
• What is the class style?
There is lecture, discussion, hands on work with art, videos, physical interaction and lots of hands on practice. You will get a notebook with some work outside of the classroom suggested.
• How big is the class?
We limit the six week series to eight couples and the Immersion to six couples.
• How often will the class meet?
The six week series meets for six consecutive weeks usually and the Immersion is a Saturday- Sunday for two weekends. The refresher class is a Friday night women only and two Saturday sessions.
• What is the time and location?
Teresa's classes meet Saturday mornings in Lawrenceville. Pam's classes meet Sunday late afternoons in the Marietta/Smyrna area. Guina's classes are two weekends in Roswell.

Tips:
• It may be tempting to sign up for an intensive day-long or weekend session, but there are many benefits to a course that meets five or six times over the span of a few weeks. These benefits include having more time to absorb the information and getting to know other people who are approaching parenthood.
• Be wary if the childbirth instructor simply presents hospital rules. A good instructor is an advocate who shares all of the information you need to make truly informed decisions.
(Often times hospital classes are restricted to a curriculum that is approved by the hospital- therefore may be restricted to not giving you all of your options.)
• Make sure your partner knows that you need his or her presence in class just as you will need it in labor.
• You’ll likely get the most out of a small childbirth class; it will be more personalized and will allow for more questions and answers. Private classes are also available for couples with complicated schedules.
We offer private classes but believe the classes with other students offer a flavor that is rich with interaction that oftens will lend more information to be gathered and explored than in a two on one class situation. We also are often asked why we do not teach a weeknight class. We do not think most people learn well rushing from work, skipping dinner and being tired.

For more information on our classes visit our website A Labor of Love Doula and Childbirth Services, Inc. Email us at info@alaboroflove.org to get our class agreement to sign up for a class!

Guest Blogger: Reid Forrester of A Natural Path

2011-01-07T22:10:00.004-05:00

Maya Abdominal Therapy and Yoga:

Time-tested Tools for Getting the Body “In Tune” for Birth

You spent your life dreaming of the birth of your child.   You imagined that moment, after your hard laboring, when your child journeys from your body into your arms, as a moment filled with light and love, one of life's most amazing and joyous memories.

Come the day, you feel exhilaration as the “It’s time!” is messaged from your belly.   Your bags are packed, your spouse is primed, your birth caregiver is apprised, and the excited parents-to-be set out for their birth location.

Fast forward to hours later. You’re in the delivery room with your spouse holding your hand. You’re exhausted, dazed, and confused, having just had your baby pulled from your body. Your newborn is being poked and prodded nearby as your spouse is trying not to look stunned as your abdominal stitches from the c-section you just had are being laced.

What a stark contrast from the birth moment of your dreams!

As the days rush by your life is filled with the unrelenting challenges that only new motherhood can bring, combined with healing from a major surgery.    By the time your hormones begin to even out and the sleep-deprived haze of new motherhood wears off -- perhaps months later -- the myriad of questions starting with “What happened?” surface, no longer to be silenced.

Anger. Grief. Blame. Judgment. Self-condemnation. These are but a few of the intense emotions that may have been kept at bay.   Emotions difficult to give voice to and which make others so uncomfortable that they make no attempt to help soothe or validate.

And behind them all: Fear.    That you weren’t good enough. That you should have known and done better.   That your body was and is now and evermore...

Broken.

One in three women today in the U.S. have their babies by C-section. Sadly, this rate is over 20% more than the World Health Organization recommendation. Days could be spent addressing all the possible reasons, but in truth it would only serve to feed into the problem: the gnawing sense of disempowerment, victimization and ‘broken-ness’ that so many women begin to internalize when they are wheeled away from the hospital. Few resources are available to help women work through the mental and emotional anguish spawned by birth trauma; and even fewer offer solutions for helping the body heal so that she might never have to experience this again.

If any of this is hitting too close to home, consider doing some work both to shift the view of your body as broken and make an effort to embrace instead the idea that

The body is wounded but capable of healing
Just as a musical instrument is tuned in order to play well, the body can be brought in “tune” to prepare women for better birth outcomes, and
Time-tested tools are available for doing so

In many cultures empowerment and support before, during, and after childbirth is a given. Much work is done to make sure that babies are welcomed into the world and that pregnant women are protected from negative influence, well-supported, and properly welcomed into motherhood.    Women taking the time to properly care for and prepare the body for birth is commonplace -- and the knowledge of how to do so is readily available through other women in the community.
How unlike Western culture where living in community is but a shadow of it’s former self and stress is oftentimes a way of life.

We have many lessons to learn from the traditional medicine of other cultures.   It's fortunate that we have a few who have recognized the need to study and learn from traditional healers before such ancient wisdom becomes hopelessly blurred or even lost to Western influence. One such individual is Dr. Rosita Arvigo, an American-born woman who has spent more than 35 years following and later teaching the ways of Mayan Traditional Medicine.    She has spearheaded a growing movement to support traditional healers of Latin America, and preserve and spread their wisdom.   (The telling of her story is beyond the scope of this blogpost, but those who would like to learn more should read Sastun: One Woman’s Apprenticeship with a Maya Healer).

As an anthropologist of heart and by training, a student of Rosita’s, and a practitioner of the Arvigo Techniques of Maya Abdominal Therapy ™ I feel qualified to share some of the Mayan story:

In ancient Mayan times when a young girl first began to menstruate she was sent to a place called La Isla Mujeres, Island of the Women. It was there that the elder wise women, the Crones, would teach them the ways of womanhood and the secrets of Nature. This journey into deep community with other women was revered as a sacred rite of passage, bearing fruit and the passing along of much practical knowledge on caring for the body.

One such piece of wisdom was the understanding of the delicate nature of the female reproductive system and how to keep the uterus well-positioned. Unbeknownst to Western medical caregivers, it is well understood by many traditional healers of South America still today that when the woman’s uterus is tilted out of place it creates a domino effect of reproductive, digestive, hormonal, and circulatory challenges.   Strong awareness of uterine positioning was required for overall health and well-being, particularly for childbirth and post-partum well-being.   Use of herbal medicine and massage techniques were commonly utilized and whenever a young girl or woman had any kind of jolting and straining impact to the uterus and pelvic area, the village healer or elder women of her family immediately were brought to her side to check and reposition the uterus as needed. Second-nature common sense prevailed.

And, though much has been lost to modern scholars, the Mayans are said to have also had their own form of exercise to keep the body in balance- which is thought to have been much like the yoga of India practiced around the world today.

Like today, the Mayans used the number of physical poses to both build and keep bodily stamina and help maintain the balance between strength and flexibility to support optimal health naturally.   Many women around the world today benefit from yoga. It does the job of keeping the mental, physical, and emotional bodies in balance which for some, helps in their strivings toward peace and spiritual growth. Women have found yoga to be of specific benefit to help with infertility, pregnancy, and other reproductive health challenges.   It has been noted that Mayan women share two things in common with women in India:

1. They have easier and shorter births
2. They don’t struggle to the degree that Western women do with menopausal symptoms such as extreme hot flashes and mood swings.

In essense, the wisdom of these two traditions offer much hope for Western women who are seeking better birth outcomes and overall reproductive wellness. We have but to choose wisely our caregivers, open our minds, and embrace, trust, and utilize wisdom of the ages in order to find out how capable and powerful we can be in birth.

Reid Forrester of A Natural Path (www.anaturalpath.org) is a massage therapist who specializes in Maya Abdominal Therapy and Prenatal Massage. She is also a yoga instructor who specializes in Prenatal Yoga, Partner Yoga for Childbirth, and Yoga for Reproductive Health. Her office is located in Candler Park, near downtown Atlanta.

She will be co-teaching the upcoming class Vaginal Birth After Caesarean: Gathering Information and Making Choices with veteran VBACers and birth educators Pam Roe and Guina Bixler of Labor of Love on Saturday January 22nd from 1:30-5:30 pm. Those interested in learning more about this class please visit www.alaboroflove.org.

My Compliments to Dr Robbins

2010-12-24T19:30:00.002-05:00

I was delighted to work with Dr. Richard Robbins at my last birth. He knew this mom wanted a natural, lesser intervened birth. Her water broke and she waited several hours to go to the hospital. I arrived a few hours after she was there, not yet in labor. The Pitocin was started and I was there to meet her soon after. Dr. Robbins arrived a short while later and entered the room with the greeting of, "Hey Stud!" to the mom. I loved it. He chatted about how his wife had a natural birth with their first two but the third was a much longer labor and after several hours she chose the epidural. He mentioned that this baby was a bigger baby by a pound. This caused my client to ask if a pound made a huge difference. She asked this since the sonographer had said this baby was at least a pound bigger than her first one. Dr. Robbins said, "Nope! Should not be a problem at all!" He stayed a short while and when he left he said as he shook his hands in the air, "Let's keep these out and let you do what you are doing so well!" I wanted to kiss the man! He was so encouraging to my client!

Later after coming up to the labor unit again, he stopped by to see if she wanted to be checked. She asked did she need to be and he said, "Nope! Some women need to know how they are doing, but you are doing great! The baby looks great, the contractions look great, I don't think you need anything!" Wow, I again wanted to kiss him! He was affirming that she indeed was following her instincts and doing great without anyone interfering!

Later my client was feeling like things were not progressing the way she expected. This labor was making her doubt her ability to do this much longer without medication. Another specialist and her first nurse had mentioned some things that caused them to doubt her ability to birth this baby without surgery and this was entering her mind now. She had expected more progress and had only dilated four centimeters in six hours and she had specific pain that indicated that the previous mentioned issue with a cysts, may be causing her to not progress effectively. She did appear to be struggling beyond the labor pain she had had previously. We were all beginning to wonder if medication may prove helpful.

She asked to speak to Dr. Robbins and he returned with his sparkling eyes and genuine smile. He examined her and suggested that she give herself a gift of an epidural on this holiday morn. So, the IV fluid was started to bolus her to ready her body for the epidural. But before he mentioned this he confirmed that her labor was progressing just fine. He smiled and left the room.

Within ten minutes she was grunting and had strong urges to push. The nurse did a quick exam and confirmed she was not fully dilated but had already progressed a centimeter since the doctor's exam. She called for Dr. Robbins to return. He was in the room within minutes. He examined her and told her there was still some cervix but that she was doing a great job with her instinctive pushing! He told her if that felt better to do, do it! He called for a set up and sat on the end of the bed. The mom pushed for less than 10 minutes and he gently guided her daughter up for her to reach down and bring to her chest. He never guided her to do anything differently than what she was instinctively doing.

I have done births with the Roswell OBGYN Midwives before and know of these back up physicians and had some contact with them before. But I have to say, I was thoroughly impressed with this wonderful physician today! It is a pleasure to encounter a physician that believes that women know how to birth. It is great to see them step in to do as little as is needed and support the decisions a woman makes regarding her birth. It was a wonderful birth to behold!

Technology in New Ways

2010-12-15T11:22:00.002-05:00

I remember years ago when I still carried a pager, listening to the occasional cell phone ring in a restaurant and thinking, "why does someone need to be accessible all the time?" I thought it was rude and annoying. I even made a comment about how special that person must be to need to take a call during dinner! My how silly that all sounds now!

It reminds me of my mom criticizing my music when I was a teenager. I just thought, she is old and does not understand! Well now I am feeling a bit old. Yesterday I posted about teleconferences and virtual trainings and how I did not think they could be as an affective learning method. I still feel that way. But I was thinking of the folks who do teleconferences at work all day, who do a lot of virtual training and feel this is the way they learn best due to their busy schedules. Perhaps they learn differently than me. Who am I to determine the way they learn best? That is as silly as me saying my mom's music was not good. The older I get the better I love her big band music CDs!

Last week on Facebook there was an article about texting while in labor. I did not make any comments about it. Texting During Labor. I am thinking it would have to be a mom who had a medicated birth who could do this, but then I remembered I had moms doing this in some of the labors I have supported that were unmedicated. I think it is just the way some folks do things now! And I also thought if it was a distraction and helped her to feel surrounded by her village, why not?

My husband says I am on my phone tweeting, reading emails and texting all the time! And it was not long ago that I thought all of this was nonsense! I remember the first time a mom wanted to watch a DVD in labor. I thought, how in the world will she allow herself to get to that dreamlike laborl and place while watching a DVD? Well she and her husband curled up together in the hospital bed and laughed and laughed-- increasing her endorphins, and then the movie ended and soon after she was pushing. I thought, okay she just taught an old dog new tricks! Who was I to determine the way a woman needed to enter her own labor land?

Case in point: Thanksgiving we could not be with my son and his wife. My daughter came up with the idea to skype dinner together. We actually set up the computer on a table as an extension to our dinner table and ate at the same time. We had a lively conversation including talking about the meal- which many items were the same as what we were eating. It was not the same as having my son and his wife with us, but it certainly was doing the next best thing!

My husband does not text or tweet or even hardly post on Facebook. He does email because his business requires his ability to communicate that way, but he does not like doing so! I love it all! So, although I love to go to conferences and meet and chat and interact with others, I may not learn the way someone else does. I tend to not be shy in a crowd. I went to a book signing with my daughter recently whose story was published within the anthology of stories. I mingled easily, greeting and meeting and hugging folks. My daughter, much like her father, smiled and quietly blended in without much ado. We are different! She may actually enjoy a teleconference over attending one in person.

So, let it be said, that I understand that everyone is different. Folks like different things. I think about what Paul said in 1 Corinthians 9:19... " I have become all things to all people so that by all possible means I might win as many as possible." Teleconferences and virtual trainings may meet some needs and therefore impart information to some that otherwise would go without it. Winning those over to new information. So, let the virtual trainings and teleconferences begin! I will hang onto my pager mentality and attend my conferences in person for now!

Our Christmas Wishes To You!

2010-12-14T14:14:00.000-05:00

This digital greeting card generated with Smilebox

Conferences and Classes- How Do You Learn?

2010-12-14T09:54:00.003-05:00

In this information age every thing is becoming easier to do things virtually, I wanted to make Massaman Curry Chicken. I searched for recipes on line and even found a you tube of someone cooking and giving instructions. This was great! It would have been better if I could have gone to a quick cooking class- but even better if I could have gone to a Thai cooking class that was six weeks long, I could have learned how to make many more dishes that I am sure to love!

This week I received several invitations to go online to a few video conferences to hear about subjects related to my work. I did not choose to be a part of the virtual conference on breastfeeding, but instead I am attending a conference next year in NC on breastfeeding. These things are great if you can not get out of your home to attend a conference or live so far away from any where they may be offered. But are they a replacement for a real hands on experience? If you live a long way away from a city offering conferences and can not attend, it certainly may be the next best thing option.

For childbirth classes, we have been asked to teach a one day class and have declined doing so. We personally do not feel that if you are seeking a class for preparation, one day preparation may not be going to fully equip you for as daunting as labor and birth could be. There is so much you want to know and learn to be able to make great decisions along the way. We have a two weekend immersion class that is for those who are really too busy to take the full series. We struggled with how to make it jam packed and effective. But we feel we did so, although we are in agreement that it is not a full replacement for the six week series for most who need time to absorb and assimilate information in smaller increments.

I plan to attend two conferences this year because I understand that attending a training or conference is much more than just assimilating information from a speaker. It is about the interaction with others while doing so. It is about the questions that are provoked and the additional answers you get to hear from other's experiences. I know teleconferences may be able to impart some information that may be valuable. I understand that even watching videos to learn something can be useful. We recently had a doula client whose education and preparation for childbirth consisted of watching You Tube videos. That seemed to work for her. But for most folks it would not work for them. She did not have the birth she planned, but she is happy with it none the less.

I was happy with my Massaman Curry Chicken, but it did not taste like the same named dish at my favorite Thai restaurant. I do think I would like to take a Thai cooking class. I bet with the expertise of a fun and talented instructor, the hands on approach, the careful critique of my skills and being around others who are learning and making mistakes too will help my cooking finesse!

We teach a six week series for childbirth class- eighteen hours of instruction. And although this sounds like a long class- it goes by quickly and I still feel we do not cover it all! We teach a three hour breastfeeding couples class and this past month I was told I should have included a bit more for the moms who are returning to work. We can not cover everything in a class, thus the reason we suggest some great books to also read. Although we teach private classes, it is a consensus with our teachers that a group class is the best received by our students.

So, in this age of everything being done on your computer or on your television, please realize that there are a multiplicity of ways to learn but hands on- interactive with others- the ability to ask questions and reflect on others' answers is probably best for most folks. We still offer classes that you come to, sit and chat with others in like situations, laugh and interact, watch videos with added discussions, have fun and actually learn too!

You can certainly decide what works for you. But don't decide to cut your training short because you are too busy to invest in learning about something that impacts your business or life. If I had a dime for every time a new mom or dad told me, "I wish I had known.... " in regards to their labor and birth of their child, I would be able to sponsor many a 3day walker! You know how you can best learn. Information helps you to feel good about your choices because you know you did make good decisions based on the information acquired.

Can 6 Days Really Make A Difference?

2010-12-07T10:57:00.001-05:00

I have a client who had an initial early ultrasound and based on that test and her last menstrual period, giving her a due date of the 26th. When she had a second ultrasound a couple of months later, the technician said that the baby was measuring a week older due to length. So, the next person she saw in her care providers' office changed her due date- decreasing it by 6 days!

I discussed with her how important those six days may really be. In her practice they consider their patients late at 41 weeks and I knew she was shaving almost a week off of missing an induction! So, are six days really a big deal?

Your baby is considered premature if it is born before the completion of 37 weeks. Premature babies tend to need more nursery care due to "wet" lungs and do not often nurse as well as a full term baby. At that point they are usually just fine and need very little extra care. They often do not suffer the same issues as a very premature baby- more sickness in the first year, developmental delays, etc. I am amazed at the moms who seem to think as long as they have reached the end of the 36th week they are not considered premature. But it is the completion of the 37th week that is the key. So if your guesstimate of your due date is off by a week- you can see how inducing can cause some real issues for babies.

Remember due dates are estimates. But the ACOG statement says, "Most women give birth between 38 and 42 weeks of pregnancy. But very few babies are born on their due dates. It is normal to give birth as much as 3 weeks before or 2 weeks after your due date. " So, shaving a week off on the front end means increasing your chance of an induction that is absolutely not necessary and definitely has risks associated with having one.

So how accurate is an ultrasound for determining due dates? Here is a site that explains things extensively. Gestational age is determined using The Crown-rump length - "This measurement can be made between 7 to 13 weeks and gives very accurate estimation of the gestational age. Dating with the CRL can be within 3-4 days of the last menstrual period. " The Biparietal diameter or The Femur length can also be used. " Dating using the BPD and FL should be done as early as is feasible." So the earlier the more accurate!  The Abdominal circumference, "reflects more of fetal size and weight rather than age. "

So the sooner the US the more accurate. http://www.ob-ultrasound.net/joewoo3.html#5a , "You should always use the result of a scan that is done earlier on in pregnancy for 'dating' purposes as it will be more accurate. In the later part of pregnancy the measurements will be affected by growth variations and will no longer reflect the fetal 'age' correctly." So don't let them change your date based on a later ultrasound! "A scan is generally booked at about 7 weeks to confirm pregnancy, exclude ectopic or molar pregnancies, confirm cardiac pulsation and measure the crown-rump length for dating.

Remember that, "In the third trimester, fetal ultrasound does not accurately determine fetal age or weight." per http://www.webmd.com/baby/fetal-ultrasound?page=4  Also, "the effects of prolonged fetal ultrasound exposure have not been determined. So the U.S. Food and Drug Administration (FDA) does not recommend fetal ultrasound for nonmedical reasons, such as for identifying the sex of the fetus or as personal keepsakes."

Suite 101 states, "The reality is that all medical testing, including ultrasound used to determine the weight of your baby, is not 100% accurate. Not only is it recommended that you ask your provider about the accuracy of ultrasound testing to estimate weight before you make any decisions, but remember that the size of your baby may not be prohibitive in having a vaginal birth. It is important to be informed about ways to encourage labor to happen spontaneously and how to work with your body even if there is suspicion that your baby is big.

Read more at Suite101: Ultrasound and Weight of Your Baby: Reviewing the Accuracy of Ultrasound to Measure the Infant's Weight  Ultrasound should not be used to scare women into induction due to a "large" baby. Women give birth to large babies without incidence all the time! And the ultrasound measurement could be off by as much as two pounds!

I often ask a mom how she will feel if she is induced for a large baby and the induction fails. She is in the OR for a cesarean and the baby is delivered and weighs in at 7 pounds. This estimated over 9 pound baby did not loose two pounds during the labor!

A New Video by DONA on Doulas!

2010-12-06T16:17:00.000-05:00

DONA has created a new video regarding doulas. If you are curious about the role of a doula and a bit about her scope of practice if she is DONA certified, this video will help to enlighten you! Enjoy!

Doula Video

Overcoming Obstacles... Actually Obliterating Them!

2010-11-29T11:58:00.001-05:00

We have a client who was trapped by her insurance to not be able to seek the midwifery supported model of care and the water birth she had found was possible. She was working to try to make it happen when she went into labor two and a half weeks early. Then not only was she not getting the birth experience she had hoped for she ran into several other obstacles. But this story is not a bad one- indeed it is one about overcoming!

She started laboring around 10am in the morning and waited until she thought she was well into labor around midnight that night. It took her 2 and half hours in triage before they determined they were staying. This was the first obstacle of her labor. She knew when she found out she was only 2 to 3 centimeters dilated that it was too early to be at the hospital. She was in the midst of debating on going home when they examined her again after a couple of hours of walking. The exam revealed she was making progress so she stayed. What she was told was that she was 3 to 4 centimeters dilated now and also 70% effaced. I think if she had been told what was charted- and we found out later- that she was only 3 centimeters dilated and only 60% effaced, she may have gone home. But instead she is admitted.

The second obstacle was the doctor. She had been seeing a group of five doctors whom she had rotated through seeing over the last eight months. But instead she found out that they share call with another practice of six physicians she has never met or even had knowledge about this prior to tonight! So, she is about to meet a doctor whom she has had no contact with and has no idea what this physician's practice type is like!

She enters her labor room to be told that she indeed will not be allowed to not have the IV access she was hoping to avoid. She also will not be allowed to keep her yoga pants and tank top on but will be required to wear the hospital gown. She also will have a vaginal exam every two hours. These were not things that were part of her ideal birth at all! She agreed to the IV access after the doctor explained how important this element was but was not willing to agree to the other things- but did not tell the doctor at the time that those things were not going to be accepted.

The nurse came in later and the discussion regarding what she was going to wear was confirmed. She also told the nurse she wanted to be able to walk outside the room. This nurse was a new one and was taken a bit about by the determinativeness of the mom's remarks. She of course went to confirm walking outside the room was okay. Another obstacle hurdled! She did not ask the nurse, she told the nurse politely what she would be doing!

When the nurse arrived and said that she needed to be monitored, the mom asked for telemetry to be used. This nurse had no idea why that would be needed since she was only being required to be monitored every hour for 20 minutes. The mom said she was not getting back in the bed and being made to lay down again as she was initially. She said she was not moving from the rocking chair she was in. The nurse had no idea how to respond. She told her she would look for telemetry for the next monitoring but had to get this one done. So, although she did not agree- she did not fight it when we just slid her rocker with her in it toward the monitor. Another obstacle torn down!

When the nurse came to do another exam, the mom asked why. When she was told it was protocol- that was not a good enough reason and she declined. The nurse went to talk to the doctor who was off to do an emergency cesarean. The doctor said she would be in to talk to her. The nurse said it bought us at least another hour! When the doctor came in, abruptly turning on the lights in a dark candle (albiet electric) lit room, she said she needed to assess where the mom was in her labor. There was no watching the mom like a midwife would do. There was no reason given beyond that so the mom declined. The doctor figuratively threw up her hands and said the doctor coming on in 20 minutes would have to deal with this! She left just as abruptly as she had arrived! Wow, a huge obstacle detoured!

The next monitoring occurred while the mom was standing leaning over the bed. This is where she was when the nurse arrived. Her mom helped to hold it in place to get a good reading for the required twenty minutes. But no telemetry unit was brought! Then something magical happened. Our very green nurse had asked the charge nurse at shift change to assign the "natural birth friendly" nurse to this mom. When she arrived it was truly magical! She brought in the telemetry unit and got the new doctor coming on- again from the practice she had never met any doctors from- to agree to listening through a contraction and the minute after - only holding it in place- every thirty minutes. So instead of 20 minutes an hour we were looking at 4 minutes an hour!

The new doctor arrived. He entered the dark room and quietly met the mom. He discussed the reason he wanted to do an exam. He told her that if she was not changing, based on her ideal birth, he was going to suggest she go home! Now she had a real reason for an exam. His gentle exam showed she was indeed progressing and indicated she should stay. She had been 60% effaced with a posterior cervix and dilated to 3 centimeters. She was now 4 to 5 centimeters and 90% effaced with a midline cervix. She had made great progress! This doctor said nothing that was discouraging at all!

The idea of the bath, one that had been nixed by the first mom arose in a conversation I had with the new natural friendly mom. She said that there were rooms with jetted tubs but had never seen a mom be able to use them. When the first doctor had nixed the idea she said there were not properly equipped! Further inquiry meant they were not slip proof and did not have a thermometer. Also the water proof telemetry unit was lost. After some discussion on her parents going to get a mat and a thermometer and having the mom be willing to sit up or kneel to get the telemetry reading, the nurse went to find out if those obstacles were removed, could this mom move to one of those rooms! Wow, although this mom has done the early part of labor wonderfully without the need of water, the later stages of labor in a jetted tub will make a huge difference! This was a huge road block torn completely down!

She labored in the tub soon after.They managed to find a thermometer and use the doppler for monitoring the baby and her parents went to a local store for a bath mat! Give us what is required to make something work and we can do it! Later an exam was offered but declined. She did agree to another exam after getting out of the tub. She got out of the tub to walk.

The next exam came when she began to feel pushy. The doctor found an anterior lip and told her to not push. He also shared that he was on his way to the operating room to do an emergency cesarean. But this mom when she felt a strong urge decided to listen to her body!

She was on her hands and knees over the bed. The nurse told her she must turn over, but she declined. They grabbed another doctor who was on the floor to come and do the catch! He did not force her to turn over, and she gave birth to a little boy soon after! The funny thing about this is her practice of doctors, one of the doctors told her that at this hospital the only position to birth in was on her back with her legs pulled up to her ears! One more obstacle abolished! She also avoided an episiotomy that she suspected her practice may have found a reason to do.

I am so incredibly honored to have been with this woman in her labor. She was strong, spunky, opinionated but polite, unyielding in the face of opposition and full of determination! Her labor from the first contractions that were getting her attention to birth had been 36 hours long! She never wavered in her fortitude, never asked for medication and never complained about continuing her journey! She was unrelenting on having the birth she desired! I stand amazed by women like this!

Another Dot to Dot

2010-11-27T12:52:00.001-05:00

One of my doulas recently had this birth experience. Ironically with the same group of midwives as mine but at a different hospital. Let's read about the dots she made sure she followed.

Labor began in the early hours of day one. She calls this the start of labor because she could no longer sleep through the contractions. She left for the hospital a little more than 9 hours later. Her contractions were 2.5 minutes apart for just at an hour and she was feeling some pressure in her bottom.

When she arrived to the hospital and was checked she was found to be 4 centimeters dilated, the baby was low at 0 station and she was fully effaced. Although disappointed that she was not further along, all the signs to go to the hospital had been apparent and she was doing great with the news.

7 hours later another check showed no change and the midwife suggested breaking her water. Ironically there was also discussion that since her water was not broken and her contractions had spaced out to six to seven minutes apart, she could opt to go home since this was being diagnosed as non progressing prodromal labor. The mom declined having any intervention but also wanted to stay.

2 hours later there was a discussion regarding having her water broken to help her progress. She declined the intervention. She was really tired and this labor was still quite irregular. A little more than four hours later after again no change after her third exam- now 12 plus hours at 4 centimeters, she agreed to take some Ambien to help her sleep. Fatigue is overwhelming. She took the Ambien and slept between contractions that were now spaced to10 minutes apart. The concern was that with contractions were so spaced out that it was doubtful that any change had actually occurred. But at 5:30am the mom was feeling pressure again.

Hopeful but doubtful, the midwife was called and did her fourth exam. This exam showed she was dilated to 8 centimeters! How in the world? Everyone has been told you must have contractions closer together to bring change- but this mom showed this was not always the case! The midwife discussed breaking her water once more. The mom declined.

After having a very strong urge to push she was found to be complete within the hour of the last exam. She began pushing after about fifteen minutes of getting to know how to listen to her body's urges. And with spontaneous and gentle pushing while remaining on her hands and knees- over the bed, she birthed her baby after two hours of pushing. The baby was just under 8 pounds.

This mom also had terrible back labor most of the labor- although the midwives could never note that the baby was occiput posterior. When they were able to determine position, the baby was in a perfect position.

So why the difference between the two dot to dots? One had a mom with a baby really high and this baby never dropped into the pelvis. Later it was determined that the baby was a bit transverse entering the canal. Also this mom had some medical issues- tumors on her ovary that may have been a culprit in making the baby enter that way. The first mom also was "stalled" at eight centimeters and was not ever considered prodromal due to that point. Whereas this mom's "stall" came when she was not officially determined to be in active labor. Also her baby was low and had already gotten down into the small part of the pelvis- 0 station. The first mom's baby was only at -1 during the contractions and rested at -2 station- meaning never even entered the canal.

But what is essential to note is both moms did not skip any steps. They felt compelled to decline procedures that they were not either ready to have done or did not want to have done yet. Both moms chose patient midwives. Both moms labored at home for quite some time. Both moms chose to have a doula attended labor. One chose to have her water broken after an 8.5 hour "stall" and the second mom chose to not have her water broken until 18 hours after arriving to the hospital. I hate to use the word "stall" as I do think both of these labors could be considered plateaus for these moms. I do think a baby not dropping into the pelvis for 8.5 hours is an indicator that the baby is having a hard time getting down and therefore may be a signal that the baby is not coming vaginally.

Dot to Dot... Don't Skip One

2010-11-26T13:17:00.001-05:00

Recently after a birth, I was very sad and very happy at the same time. I had a client who did everything right. She prepared for her birth by taking great classes with Pam. She read the right books and considered all of her options for her birth. Her partner was fully supportive as well as her mother who was in attendance. Although she chose a practice based on her insurance limitations, she chose the midwives within those limitations. She stayed healthy and emotionally balanced during the pregnancy. She labored at home through the night and into the morning with irregular contractions. She went by the midwives office for a labor check before heading to the hospital. She stayed active and upright during most of her labor. She never complained about pain or wanting to quit. And she still ended up with a cesarean birth. What happened?

She was in labor just under 20 hours and had been dilated for 8.5 hours to 8 centimeters and did not change further. These are the events that led to her surgery. Her midwife came in at one point (7 hours before her cesarean) and suggested she may need a cesarean. But this mom knew that jumping to that conclusion would be like skipping a number in a dot to dot puzzle. If you do that you will get a different picture in the end. She told the midwife no- let's try this a bit longer. She did agreed to have her water broken. The baby was still very high and the thought was that the bag of amniotic fluid was creating an inability to have the head put sufficient pressure on the cervix. I asked the midwife about the presentation of the baby but she could not tell since the baby was so high. The presentation via the belly exam externally showed the baby was lined up beautifully. The mom had no back labor to suggest a posterior baby either. So breaking the bag of fluid was done and the midwife suspected that the head was a bit transverse.

Two hours later there was still no progress so the midwife offered that an epidural may be needed. The mom said, no let's try some other things first- no need to skip a number in the steps. We tried some new positions. No change was made. Two more hours later the midwife came in and suggested some Pitocin. There was some discussion as to whether she could use an internal monitor first to see the strength of the contractions before Pitocin was added. The mom really wanted to avoid Pitocin. She felt the contractions may not be strong enough. I was glad she was at least considering this rather than forcing the mom to the OR for a cesaean. An IUPC was placed and indeed the strength of the contractions were fine. There was no need to add Pitocin. Another skipped step avoided. There was no further change.

The mom had some nausea and was attempting to keep herself well hydrated. The midwife suggested an epidural. Since sometimes dehydration interferes with dilation, the bolus of fluid before an epidural may be the next step. A decision was made to hydrate her and get another exam before getting the epidural placed. This was a step many moms would have skipped, but this mom was willing to do this. Two hours later no change was made.

Anesthesia was called and came to place an epidural. Once the epidural had been in for a little more than an hour, an exam showed no change was being made. Sometimes a mom can try everything and an epidural offers that last bit of relaxation that allows the pelvis to open and the cervix to go to complete. It can keep a mom out of the operating room. But this was not the case. But the epidural had spaced out the contractions. So although the midwife again suggested she could head to the OR, the mom agreed to adding Pitocin to see if this step would help. Again, no step missed.

Pitocin was added. But after an hour of Pitocin, two hours after the epidural, no change had occurred to her cervix and the baby was beginning to have dips in her heart rate. The team of the midwife and the doctor now said she needed to have a cesarean. Sad, exhausted, disappointed and also sure that all the dots had been followed- all the steps had been followed... and this was the next best thing to do.

So, sad but at the same time proud of this mom who did not skip a step. She did not jump to the end result in a hurry or feeling bamboozled. She was fully supported the whole way. Was there something we could have tried? If so I do not know what it could have been. We could have waited longer- would that have made a difference? Perhaps. But most would agree that after almost 9 hours with no change, we can think that perhaps this was the cesarean that was really needed.

Oh the baby was under 7 pounds- so not a big baby at all. We did have some ovarian tumors that could have been the culprit. They could have been causing some dysfunction to her passage way. But we will not ever really know. What I do know is this warrior mama worked hard and made great decisions along the way. For that she can be very proud of the work she accomplished!

To get the correct results when doing a dot to dot puzzle- you must not skip a dot- you can not skip a number- you need to follow the steps carefully. All births do not unfold perfectly or give you the results you desire, but following the next step without jumping a step will insure you are not making a decision without exhausting all of the options along the way.

Preparation Meets Expectations For This Mom!

2010-11-24T21:53:00.001-05:00

Praveena shared with her fellow childbirth students this email that she so also graciously shared with our blog! Great births don't usually just happen- they take preparation and selection. Praveena prepared by centering her mind, exercising her body, opening her spirit and mind in her childbirth class and selecting a great supportive team. Guina Bixler was her doula- she chose the Ladies of the Labyrinth and Guina was the lucky doula on call during her labor. Andrea Perry, one of our apprentice doulas accompanied Guina. Margaret Strickhouser was her midwife- Intown Midwifery. And she birthed at Atlanta Medical Center.

Things that helped during pregnancy:

Taken 5 days before birth

Prenatal Yoga (Cannot imagine my labor without yoga experience).
5-10 minute Massage by my husband everyday..We took a massaging class at Northside Hospital for 32$..
Fruit rich diet and lots of water
Mom's presence (I am grateful to my mom for being with me during this time of my life and taking care of me and the baby in me!!!!)
Teresa's "Birthing from within" classes
Good midwife to assure and reassure you.. Margaret is the best!!!!

My Labor

My contractions began around 3:30AM on Nov 6th. You will not miss the contractions. They will be like menstrual cramps and spasms in your abdomen...

I informed Uday about the onset of labor around 5:30AM and asked him to take good rest as we were going to have an action packed day before us..

Teresa's words - Try to be as normal as possible were ringing in my ears all through my labor.. So I asked Uday to book an appointment with PicturePeople. We went to picture people for a maternity photo session at 11:00AM for two reasons. That was my final chance to take a picture with the beautiful belly and I wanted to do something that would force me to be normal and moving.. Mall is a very good place to rest in between contractions. The photographer at PicturePeople that day was very amused and worried to take pictures as he had to wait to take pictures as I was going through my contractions during the session!!!When the contractions were getting closer and stronger, I preferred to be home. I spent my time packing my labor bag. I also opened all the gifts from my baby-shower and imagined my baby wearing and playing with those gifts. I survived the contractions for another three hours that way.

I brought some egg-plants to cook around my due date.. So my mom made an awesome curry with them and I had good lunch. One of my biggest concerns during labor were:
- How can we muster the energy to go through labor with out food or water?
(Margaret lets you eat and drink through the labor. Again lucky to be with Intown-Midwifery!!!..Also, it is a good idea to stay home as long as you can so that you can eat what ever you want.. I wanted organic milk during my labor but did not get them in the hospital. Had to wait for my milk for almost 2 hours. So be well prepared with all your favorite snacks in your labor bag.
- It would be embarassing to poop or pee in the water.
Believe me..This will be the last thing on your mind when you are going through labor..Since, you will be drinking lot of water to be hydrated, you will pee many times in the pool.. But since urine is sterile (Ladies of labyrinth clarified this for me during our prenatal session)

My mom was with us to help me with my baby. In India, we go to the hospital with the on set of labor. Since we did not do that until later in the evening (almost until 12 hours of labor) my mom was very worried. It is very difficult for a mom to see her daughter in pain.. I could say this from experience now :)

So, I was hesitating to go through a contraction in front of my mom as it would worry her...I called my doula, Guina Bixler around 4:00PM asking for help. She was at my home by 4:30PM. My mom was relieved to see Guina and I was relieved to see my mom relax. Uday and Guina timed my contractions for the next 45 minutes and decided that it was time to go to the hospital.

We went to the hospital around 6:00PM. That was the last time I had my eyes open, when entering the hospital. I refused to take a wheel chair. From then on..I might have opened my eyes for probably 5 minutes in the next 6 hours. I was in a state of trans or meditation..just listening to my body..feeling the contraction, the pain and breathing.

Do not let anyone treat you like a patient. I was able to walk even when I was 7cm dilated.. It was my doula who asked me to take the wheel chair at last..

The nurse asked me in the triage room about pain medication and I told her not to offer me any pain-relief medications.

As Teresa said, everyone would hit the wall of great doubt.. It happened in my case also.. When the time to push came..I was asking for epidural.... I guess, I assumed to be done with the pushing state in 3 pushes..but it did not.. A good mid-wife who trusts in the birthing process and is patient with you is very important. If anyone gives you the impression that you are on a clock, you could ask them to leave the room.

Water birth is the best thing that could happen to you in your active labor. Andrea, the apprentice doula gave me hip squeezes during the contractions and the intense contractions became manageable with those squeezes.

I was lucky to have Margaret as my mid-wife and cannot thank her enough..especially for what she has done twice. When I was not pushing the way I should, she shook me, grounded me and asked.. PRAVEENA..Are you afraid to PUSH? That got me thinking.. I tried to push, the way I should after that..but needed some help. Secondly, She GUIDED me physically for the pushes. I used my "powerful squats and lunges" from the prental yoga tool box and pushed successfully. Uday later told that the mid-wife and doulas were surprised that I was doing those squats without guidance. It was probably because I was listening to my body to give the biggest opening possible.

Margaret's experience, Guina's kind words, Andrea's hip squeezes, Teresa's wisdom, Uday's emotional support and my mom's loving presence..all these made my labor and birthing, a very good and memorable experience.

I had action packed days at work on Nov 4th and 5th. We had a get-together and festivities until 1:00AM on Nov 6th and my labor began at 3:30AM. So I literally had 2 hours of sleep in 48 hours. I was hoping to catch some sleep during the early contractions but was not enough..It is a wonderful time to bond with your baby after the baby's arrival and saving some energy for that time is a wise thing to do.. I was very excited and at the same time very tired after the labor due to lack of sleep. I enjoyed the time with my baby to the fullest after catching sleep for couple of hours. So my advice for mom's nearing their due date is to take GOOD REST EVERY DAY because the big day can be any day!!!

Labor and birthing is a natural process. Do not give into self-sympathy on the big day. Try to be as normal and active as possible during the early labor. If you listen to your body during contractions, you could make the maximum use of them to near the birthing event soon and meet your baby.

Cheers,
-Praveena

Evidence Based Medicine Re: Your Membranes Releasing Prior to Labor Beginning

2010-11-18T00:50:00.001-05:00

What does this mean? The internet offers these definitions:

Definitions of Evidence-based medicine on the Web:

Evidence-based medicine (EBM) aims to apply the best available evidence gained from the scientific method to medical decision making. It seeks to assess the quality of evidence of the risks and benefits of treatments (including lack of treatment).
en.wikipedia.org/wiki/Evidence-based_medicine
Heath care whose policies and practices are derived from the systematic, scientific study of the effectiveness of various treatments
en.wiktionary.org/wiki/evidence-based_medicine
The practice of medicine or the use of healthcare interventions guided by or based on supportive scientific evidence. Also, the avoidance of those interventions shown by scientific evidence to be less efficacious or harmful.
www.qaproject.org/methods/resglossary.html
The practice of medicine with treatment recommendations that have their origin in objective tests of efficacy published in the scientific literature rather than anecdotal observations.
www.grg.org/resources/glossary.html
An approach to practicing medicine that involves consideration of results of clinical trials that are relevant to the disease or condition being treated when making decisions about how to treat patients.
www.ecri.org/patients/references/Pages/Clinical_Trials_Patient_Reference_Guide_Glossary.aspx
is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. ...
www.hse.ie/eng/about/Who/Population_Health/Health_Intelligence/Health_Intelligence_Work/Evidence_Based_Health_Care/Glossary_of_Terms/
For many in the medical field, evidence-based medicine includes only those treatments that have been shown to be effective through a narrow lens, especially double-blind studies. ...
www.hyperbariccenter.org/glossary.html
Evidence-based medicine (EBM) is the integration of best research evidence with clinical expertise to aid in the diagnosis and management of patients.
www.azdoqit.com/LS4/Glossary%20of%20EHR%20Terms.doc

Before you decide to just go with the flow on what the practice of which you are a patient, ask yourself... is this just the way they do things?-- the way they have always done things?-- or are they staying current on what the studies actually show is proven? Interventions that are often suggested are often done because that is the way they have always been done-- no matter if they are actually causing more harm than benefit.

It would benefit you in asking the question of "Why must it be done this way? What would happen if we did it differently? What do the studies indicate regarding this procedure? What if I want something different?"

Today I received an email from a mom whose practice told her in her previous pregnancythat they wanted her come in within two hours of her water breaking. She was full term and GBS-. When she spoke to them about why- they told her their rational was: she was not contracting and had no signs of labor. Because they only give you 24 hours from your water breaking to have a baby vaginally, they knew she needed to come in and start medication to induce labor. When she came to the hospital, she still showed no signs of contracting and hadn't dilated so the

decision was made to start Cervidil and then later, Pitocin.

I wonder where the "they only give you 24 hours to have the baby" came from...She asked me if that made sense. I told it it was not evidenced based. There are several practices that go with this protocol: " Some believe that labor should start within 24 hours or the risk of infection outweighs the risks of i nduction of labor.

Others feel that the risk of infection remains low for the next 72 hours and waiting gives the benefit of avoiding the 'cascade of intervention' that may occur with induction of labour - by this time, most women will have gone into labour, anyway. In either case, the risk to the baby is very small and either way to go is reasonable."

Another website stated,"When the membranes rupture prior to labor, after 37 weeks of pregnancy, most women will go into labor spontaneously.

86% of women will labor within 12-23 hours
91% will labor within 24-47 hours
94% will labor within 48-95 hours
6% of women will not be in spontaneous labor within 96 hours of PROM.

Most maternity units therefore practice what is called ‘expectant management’. The mother is asked to wait either at home or in the unit for 24-48 hours to ‘see what happens’, knowing that the majority of women will start to labor without any further intervention. During this time they will be asked to report back if the color of the fluid changes or they feel unwell.

After this time most units would encourage induction of labor as the longer the time interval of ruptured membranes, the higher the risk of infection.

In addition to this most maternity units also encourage antibiotics for prolonged rupture of membranes, after varying lengths of time, depending upon research evidence and local policies. These are usually given orally before labor and intravenously during labor, to reduce the risk of infection.

Some units also give the mother the choice of immediate induction of labor after SROM. Whilst this is done to reduce the risks of infection, it is important to acknowledge the risks of intervention and failed induction which could result in Caesarean section."

Medscape states this: "Most patients (90%) enter spontaneous labor within 24 hours when they experience ROM at term. The major question regarding management of these patients is whether to allow them to enter labor spontaneously or to induce labor. In large part, the management of these patients depends on their desires; however, the major maternal risk at this gestational age is intrauterine infection. The risk of intrauterine infection increases with the duration of ROM. Evidence supports the idea that induction of labor, as opposed to expectant management, decreases the risk of chorioamnionitis without increasing the cesarean delivery rate.^4,5

Hannah et al studied 5041 women with PROM who were randomly assigned to induction of labor with intravenous oxytocin or vaginal prostaglandin E2 gel versus expectant management for as many as 4 days with induction of labor for complications.⁶They concluded that, in women with PROM, induction of labor and expectant management resulted in similar rates of cesarean delivery and neonatal infection. However, induction with oxytocin resulted in a lower risk of maternal infection (endometritis) when compared with expectant management. Additionally, the women in the study viewed induction of labor more favorably than expectant management.

Other smaller studies have shown results with higher cesarean and/or operative delivery rates when the cervix was unfavorable.

At term, infection remains the most serious complication associated with PROM for the mother and the neonate. The risk of chorioamnionitis with term PROM has been reported to be less than 10% and to increase to 40% after 24 hours of PROM.⁷This points out the importance of appropriate management strategies for PROM at term.

Since risk of infection at term with ROM is small during the first 24 hours, expectant management and waiting for spontaneous labor may be considered in selected patients for the first 12-24 hours if a patient desires expectant management. The use of expectant management after the first 24 hours is questionable.

Digital vaginal examinations should be avoided until labor is initiated; however, fetal presentation should be documented to avoid discovering malpresentation of the fetus long after admission for ROM. All patients with ROM should be asked to come to the hospital to ensure fetal well being."

So, it appears rushing to the hospital within two hours of your water releasing and then being induced- it is considered induction if you are not dilated to at least 3cm- is a bit over zealous on a woman who is not GBS+ and is full term. Especially since this mom wanted a low or non interventive labor and planned to go without medication for pain. (She did go without pain medication by the way!)So, given this information, one might consider asking, "How about letting me wait and be given an expectant management of labor- and given at least 12 hours to see if things start on their own?"

Experience

2010-11-14T15:26:00.001-05:00

Today I was adding the numbers of births each labor doula in our group has done over the years. These were births where they offered labor support. And within our group I was totally amazed to figure out that we have more than 1000 births of experience. Experience is not the only reason to hire a doula. There are a lot of factors to consider: how you feel when you are around her, how vulnerable you feel you can be with her, how your partner feels about her, and many more factors that are as individual as you are. But with our group you hire a doula or a team of doulas (Ladies of the Labyrinth), but you get the whole gamete of experience. Because when a doula is at a birth, she knows she can call any of the more experienced doulas in our group for insight and guidance in a situation with which she may not be familiar. I can guarantee you that there is no more experienced doula group in Atlanta than our group. I hope you will consider us when you are selecting someone to be guiding and supporting you in your labor!

Where Do You Get Your Breastfeeding Advice From?

2010-11-13T18:09:00.004-05:00

I wrote a review of this study a year ago: Pediatricians Are Not A Good Resource for Breastfeeding Advice and Support and shows how most pediatricians do more to sabotage than to support the breastfeeding relationship between mothers and their babies. Today I want to share another resource you may find helpful.

Today I got an email from a new mother who had gotten poor advice from a pediatrician in regards to breastfeeding. This pediatrician is actually one that I find to be very supportive in many ways of the breastfeeding dyad. But this piece of advice was purely her own personal view not one that is supported by evidenced based medicine. I just wish moms would ask a pediatrician the hard questions regarding the advice they offer. Is this medical advice? Is this your personal parenting advice? Is this evidence based? Just as I encourage you to go to the Coalition for Improvement of Maternity Services to find out if your OB/GYN practice is really a supportive one for your care during pregnancy, I encourage you to visit the NBCI to read about how to insure your pediatrician is supportive of breastfeeding. Dr. Jack Newman is a foremost authority on breastfeeding worldwide! There are more resources out there that do a great job regarding breastfeeding information- LLLI being one of them. But be careful when getting advice that does not feel quite right to you- do your research and ask more questions!

A New Mom Shares

2010-11-11T13:46:00.001-05:00

Mothers and Mothers-to be,

We are blessed with a beautiful baby girl on early hours of Sunday.

First, thanks to Teresa for all the wisdom about motherhood that she has passed on to us. I had a natural birth and I believe it happened only because of Teresa and her wonderful team.

Girls, please make a note of this. If you want a natural birth and want to enjoy your birth experience, have a DOULA with you. She is your mother when you are going through labor and can guide you through the process especially when you are overwhelmed with pain and anxiety and are clueless of what is going to happen.

I want to thank Guina for her wonderful support, her soft voice, soothing touch, helpful guidance and advice. Margaret {Strickhouser, midwife at Intown Midwifery}, Teresa, Guina and Andrea {apprentice doula} were like God sent angels for my little one's entrance into this world. I cannot thank Andrea enough for her heavenly touch.. She has magic in her hands!!! I had an instant relief the minute she gave me the hip squeeze when in pain and cannot imagine my labor without her.

April {one of her fellow students in Teresa's classes} is right about practicing the pain-coping techniques. They come in handy only if you practice them regularly. Cat-cow stretches and powerful squats are best for your labor positions. Please keep practicing them.

I would be more than happy to share my experience with you guys if you have any questions.

God bless Teresa and her team for making motherhood an awesome experience, a blessing for woman to meet and greet her INNER-SELF.

Cheers,
-Praveena

The Holistic Stages of Labor

2010-11-09T11:17:00.003-05:00

This is a wonderful article that helps a woman and her care providers understand her labor better than the medical model of the stages of labor. I think if you can embrace this information, you will find yourself learning how to listen well to your body and as a provider learn to watch a woman and understand what she needs.

The Holistic Stages of Labor

Written by Whapio Diane Bartlett

Embarkation

(Pre-labor and Latent Labor)

Labor is a Journey. The preparation has often been elaborate, conscious and consuming. There is usually an all-important ritual of Arrangement preceding the actual event. We call it nesting and Mother has moved about in a final flurry of activity, taking care of all last details…clothes are washed, food fills the freezer, house is ship-shape…all is in order.

Nesting is part of Embarkation. Mother senses that labor is soon. Perhaps contractions and the loss of a bit of the cervical mucus has offered a hint that the journey is about to commence.

Then it does begin and Embarkation is also the time when a woman realizes that labor is truly here. Mother is excited, maybe a bit nervous, concerned for the welfare of her loved ones having made sure that they will be well taken care of while she is gone. As the Journey is launched she may call all her family to her to bid them goodbye or, depending on her custom and constitution, she may silently take leave with her partner and companions. Usually, at this time she alerts her chosen caretaker. If she is birthing at home, she notifies her midwife who may or may not arrive immediately depending on the mother’s preference. If she is planning to give birth in a hospital or birthing center, she may notify her chosen caregivers and remain at home until other changes occur. Often, moms wish to spend time acclimatizing to the sensations the body offers before they actually connect with their birth attendants. Most moms are aware that labor is still in early phases and are excited and managing their energy very well.

During this time the Mother often feels like talking and sharing impressions as she is pulled away from ordinary reality. She may be chatty and relate information about each contraction or each sensation. She usually stays centered as she is stretched and molded; her sensations become stronger, more intense, powerful. Most Moms experience this as varying degrees of pain. The waves of contractions repeat with increasing intensity and frequency and the Mother is swept toward the Unknown.

In modern parlance this time would be considered pre-labor and the latent stage of the First Stage of Labor. Physically, the cervix is beginning to efface and dilate and this stage lasts until the Mother reaches 4 to 5 cm dilation. Contractions are usually 30 to 45 seconds long and 5 to 10 minutes apart. As Mother comes closer to the chasm that separates her from ordinary reality, contractions build in intensity and become coordinated and rhythmic. It becomes apparent that the Mother is being called away – she is less and less present in ordinary reality with each successive contraction. Her chatty persona disappears, replaced with a growing seriousness.

As she feels herself pulled toward the Veil she will probably want to connect with her caregivers. She may feel the need for the presence of the midwife or doctor because she understands that she will be leaving ordinary reality, taking a definitive step into the unknown, and she wants her caregivers to be aware and ready to witness.

Entering the Veil

(First Stage, Active Labor)

The Mother reaches a point in her traveling where it is time for her to go alone. The endorphins released by her body during her embarking have begun to change her consciousness and she enters, more deeply, the realm of the altered state. She travels to the edge of her normal reality, parts the Veil and goes beyond. The Veil is my nomenclature for the curtain that separates ordinary reality from the deep altered state. Brain wave patterns have begun to slow down and change from Beta (ordinary reality) to Alpha (the bridge into the subconscious) in the Embarkation phase. Now, in the next stage of labor, brain wave patterns slow down even more and mother has access deep into Theta (the subconscious). The aloneness reflects the fact that women move into a place of self-direction that seems to emanate from a grounded yet altered place in them. The Veil is that stage of labor that heralds the change to this new place. This doesn’t mean that a mother wishes to be alone and that others are not relevant. Rather, it signals the shift into a more self-directed realm.

Mothers may approach the Veil several times before deciding to move through. Circumstances may also prevent the mother from moving through. Constant questioning, especially about mundane affairs, and interruptions in mother’s rhythm serve to bring mother back to ordinary reality.

At the Veil, Mom no longer feels chatty and often the experience of something more serious and profound presents itself. She begins the process of separation and while the mom is aware of details and specifics occurring in the room, she becomes less interested in them.

There is often a palpable smell in the air or a subtle but perceptible color change in the room that marks the presence of the mother at the Veil. Many caregivers can calculate the flow of labor by these signposts, making yoni exams redundant at this point. I have experienced color changes and find this to be very reliable and helpful for me as I witness a mother’s journey.

In conventional terms, the Mother has achieved 4 or 5 cm dilation and the character of the labor changes. Contractions begin to be about 60 seconds long and about 5 minutes apart. Mother may seem to act a bit more spacey and unfocused to caregivers in the beta mindset.

Between the Worlds

(First Stage, Active Labor)

During this time the Mother craves privacy, silence, warmth and the intimacy of the dark. She looks to her Guardian to know that she is safe and that no one will breach the sacredness of her travels by distracting her or leveling any expectations on her. But most importantly, she looks to her Partner to see if he* is with her. She reaches for him to bring him into the vortex and together they speak a silent language as the sensations between them become more powerful and intense. No one may disturb them; they are Between the Worlds. They become tuned to rhythm of this process and perhaps to the spirit and soul of their child. They may have visions, see colors, hear the voice of their child. Whatever their experience, it is unique and relevant to them as partners, parents and family.

This place Between the Worlds is the trance-like altered state where the opportunity exists to access the mystical state of transformation. Profound realizations may occur; new truths may become evident. Non ordinary reality may bring forth new information and new perspectives that forever alter the consciousness of the individual and the family. Mother is no longer in Beta, way past Alpha and moving through the deepest states of consciousness…Theta and Delta (beyond the subconscious to unconscious). It is important not to interfere with the birthing couple and it is seldom necessary.

Mother stays upright, moving with her labor, moving with her contractions. They become longer and stronger – from 60 seconds to 75 seconds, almost to 90 seconds. At this time her dilation moves from 5 cm to 8 or 9 cm. Labor is considered hard now and often painful…at the least, strong and intense. Mother has coping strategies. She is not lost. She has what it takes to find her way. She doesn’t usually need words…simple reassurance in the form of present companions who give her privacy and offer safety, although sometimes quiet murmurings of respect and affirmation may afford the mom an understanding that you are there if needed. Sometimes humming or soft singing, from another room, may provide the mom with any needed reassurance. Mother may wish touch, eye contact, the healing powers of water…or none of the above. I’ve learned to make no assumptions. Now, I follow the mother and the journey. Again, the Art of Midwifery is inherent in being able to provide for the needs of any women, whether she wishes company or aloneness, eye contact or someone in the next room. The Art is being able to individualize your presence to the preferences of each woman. I often take a position in the corner, quietly witnessing, though not observing or intruding on the birthing couple‘s privacy. After all, what could possibly be wrong if the caregiver is knitting in the corner.

Mother climbs higher as she plunges deeper.

The Summoning

(End of First Stage — Transition)

Mother becomes aware that she is nearing the peak. She is deep in a vortex, past anything she has ever known.. She has been continuously opening to wisdom, opening to revelation and now she comes face to face with the apex of her labor. This is what she has come for – accessing the new spirit, the new person that is her child and her Partner’s child, and bringing this soul to Earth. She hears the Summons, she summons her child and together they make their way back. This is often the most precarious part of the journey. Mother must summon all her reserves and she may want to know that her Partner is totally present and supportive. She assumes her caregiver is following their course and holding everything steady on the other side of the storm. Mother is braver and more courageous than ever before in her life.

Transition is considered the most intense time for Mother. Contractions are long and hard – 90 seconds plus and coming 3 or 4 minutes apart. She is reaching toward 100% dilation or 10 cm. This is as open as a woman can be. Of course things may seem hectic and often the Mother flounders briefly during this supreme openness. She may say that she cannot go on or that she wants to go home. She may have a wild-eyed look and seek the presence of others. She may ask for help but I have noticed this is not the authentic need for someone to do something, rather it is the calling out to be witnessed in this hardest phase yet. Sometimes the presence of another person, especially one she loves and trusts, will restore calmness. And sometimes, the presence of another will allow her to feel safe and she will then rage to the end of the universe. Her personal tempest may take her far from ordinary reality. She will become the storm, become wild and incredibly powerful. Caregivers and partners may be amazed, even intimidated. Mother will find her way however it takes.

It’s important to note that birth does not look any particular way. Some moms are calm, some are wild. Some labors are fraught with pain, some are totally bearable, some are even orgasmic. I am not suggesting that any style of birth is better or more conscious than another. What I am saying is that when the mom is in her authentic power, no matter how that may appear, her birth is normal, natural and perfect for her. I am also saying that when a mom is imprinted by cultural or caregiver mores or prevented from accessing her instinctual wisdom, her experience of birth may be unbearable, agonizing, out of control, humiliating and shameful.

At this time, a woman often needs to find her own way. She needs to hear the Summons in her own language and on her own terms. When she does, the journey toward home can be initiated. Any distraction at this time can be confusing and dangerous but I have witnessed women be flexible and powerful and rise above danger and distraction with astounding regularity. During this time of openness, women find their way, find themselves, find their power and their will and commune with forces greater than they have ever experienced.

Again, the art is to witness yet not to disturb the process.

The Quiescence

(The Resting Phase)

This is the period of great stillness and peace that occurs after transition. All becomes calm and quiet and the Mother knows that IT has happened. She knows she has found what she is looking for…her still place in the tempest and access to the soul of her baby. Both mother and baby are tranquil and serene, drifting toward the shores of home. She may choose to rest in the arms of her Partner or create a still place to recoup her energy. She is not finished with her travels – she must manage the breakers ahead – but right now she is in peace.

This is one of the most important parts of labor.

For many years there was no acknowledgment of this stage of labor in our culture. Once a Mother achieves complete dilation she is usually encouraged to begin to push out her baby. But in the holistic paradigm, this stage, which usually lasts about 20 to 30 minutes (but can be as short as 5 minutes or can last hours), is Mother’s time to regroup and collect her energies for delivery. Labor seems to stop; contractions literally stop or slow down and the Mother may fall asleep or fall into a quiet, meditative trance. Everyone waits in the hush until contractions resume.

What happens during the Quiescence is more than resting or regrouping. When you have climbed the highest mountain and finally reached the Summit what do you do…run right back down the other side. Of course not. Would you simply rest up for the journey down. Of course not. You may open your eyes and look! You would see what you have come this far to envision. You would possibly have a sacred and holy moment, set apart from all other moments in your life. You may receive.

This may be the pinnacle of the altered state. Brainwaves may shift to Delta, the slowest and deepest of our known patterns, which allows us access to the realms of the unconscious…the realms of profound knowing, meditative understanding and peak experiences. This is the realm of transformation.

In this case, mother receives understanding and knowing pertinent to this new human being that she is birthing. She receives wisdom that is easily accessible at this great altitude and in this momentous altered state. We lament that we are not accorded the blueprint with which to raise our children but that is not entirely true. There can be a veritable download of information about her child…the blueprint. This is a key part of the journey and mothers wish to be respected and afforded solitude to experience this phase of labor.

This stage is different for each woman and for each labor but in a labor where the Mother is not required to perform to any expectations or has any strong programming about exactly how labor should unfold, I have noticed that this interval lasts about 20 to 30 minutes. At the end of this period, contractions begin and the Mom is often startled into wakefulness. She is now ready to head down the mountain, carrying precious information. She is heading to shore on the incoming tide.

The Tides

(First Stage of Second Stage)

Mother puts her feet on the ground again. However, the resumption of contractions does not mean the mother is planning or ready to push out her baby at this time. During the time of the Birthing Tides the mother is alive with wonder and she is aware that her body is bringing her baby down the birth canal. She feels the sensations of baby moving, she feels a quickening and an alertness that allows her to shuttle back and forth through unconscious, subconscious and ordinary reality. She knows something is different, she knows birth is imminent but she’s not in a hurry. She is coming down the mountain with a steady step…revitalized, reflecting, remembering what she has seen.

Her contractions may become strong and intense and her uterus is doing something very different than when she was ascending to the top. Her cervix is completely open and her contractions begin moving the baby through the birth canal and closer to her perineum. She may have small urges to push with each contraction but more often than not she will just let the contractions sweep the baby down without pushing with them. She may feel the intimation of pressure and pushing but the momentous urge to fiercely bear down is usually not present yet. In her wisdom she understands that she does not need to push hard at this time. Rather she needs to wait until her baby is there. Mother is focused, receptive, alive and alert. She is still Between the Worlds, but she is a new woman. Alive and active, mother says to all – “Stand back. I’m about to have a baby.” She finds her own position, her own rhythm. Her eyes are trained on the shore; she is coming back, bearing a great gift.

The time of the Birthing Tides generally feels good to women. No matter how tiring or exhausting her journey, the Mother experiences a second wind, a new spurt of energy and excitement. The birth now becomes more of an active event – the receptive state of Between the Worlds gives way to the active state of the Birthing Tides. Most Moms are galvanized into a place of intense power. Sensations are considered strong and powerful rather than painful. A Mother who is alert, erect and under her own authority will instinctively know what to do. She will find the appropriate place, position and rhythm for the work she is doing. She will absolutely know how to birth her baby.

Mothers generally tend to vocalize during labor. In the early parts – Embarkation – the Mom is often chatty and responsive to the environment. As labor progresses and Mom reaches the Veil (active labor – 5cm) she becomes quiet and responds to her own inner environment. Her vocalization may change to sighing, humming, ohming or ahhhing. As she moves Between the Worlds these sounds escalate in their depth (not pitch) and in their intensity. The Mother may begin to sway and moan and give herself completely to the primordial quality of this powerful experience. During the Summoning she may call out loudly to the Universe, to her partner or to the soul of her child – usually remaining deep and grounded but occasionally reaching out to share the intensity of this journey with her companions. Sometimes the Mom may ask for reassurance during this time, sometimes she goes even deeper into her own realms. During Quiescence a hush prevails. Then as the Mother begins to navigate the Breakers her sounds change. Louder and deeper still, the sounds that emanate from the birthing Mother are the sounds of opening; a channel is being cleared and everything moves out of the way.

It is also relevant to note that some women go from their Quiescence directly into the next stage, The Breakers. In some births I have noticed that women, usually moms having their second or third+ children, wake from the Quiescence already with the baby on the perineum and ready to begin pushing.

The Breakers

(Second stage of Second stage — Pushing)

At this point the baby’s head reaches the perineum. It can be felt by the mother, it may be visible to her partner if her position makes that available. Mother knows her baby is right there. The sensation of the baby on the perineum will bring on pushing contractions from the mother if necessary. Usually mothers seem to be at one with the power of the waves and push with them but I have witnessed a few women who never actively push during their labors. The uterus does everything. Mothers articulate with these birthing contractions and the birthing song that began in early labor crescendos into magnificent aria. The mother’s voice may actually guide the baby to the end of the tunnel. These universal sounds may spur the baby on through his or her journey and create the natural excitement and tension that comes with reaching a goal. At this point, close to Crowning, the Mother experiences a rush of adrenaline. With the speed of light she is in two worlds. Her oxytocin birth trance is still palpable and she is cognizant of her earthly reality. She is back and is ready to bring her baby to dry land.

I have noticed that almost all women engage the same position for birth. Women who are left alone and not told what to do…universally and naturally seem to do this…

KNEEL on one knee.

During their time Between the Worlds, most women are upright and flowing with labor. Many women sway with contractions and will lean forward during the majority of the contraction. This is natural wisdom. In labor, the uterus moves upward and forward and women naturally move with the uterus, facilitating the process. Some women will even hold their uterus up and forward with contractions…never having been guided or encouraged to do this. During Quiescence, women seem to relax. They may float in the tub or sit back. They may even lie down on the side. When contractions resume full-on during the time of the Birthing Tides, women are usually upright again…walking, swaying, leaning. As this time becomes more intense and melds into the actual Breakers a woman instinctively knows her baby is near and will begin to hunch down and get closer to the floor. Finally, when the breakers are in full swing, women invariably bring down one knee and take a kneeling position with one knee on the floor, the other bent. A mother will never drop her baby out on the ground. She will crouch on the floor, one knee down, one bent and facilitate the birth of her child. Her partner usually crouches in front and above her, like the Archangel, protecting and witnessing, claiming his family. The caregiver is nearby…waiting to be called closer if needed. Most mothers birth their babies solo. Babies generally don’t come barreling out of the uterus when the mother is present and instinctually engaged in her birth, so no one needs to catch. Mother’s hands know what to do…as always…and assistance is seldom needed. Baby comes through mother’s hands and she places her baby gently on the birth mat prepared for the baby on the floor.

A note about other positions…

Women will sometimes go from a kneeling position during the Breakers to a hands and knees position. This is popular position because the laboring mom can get the weight of the baby off her back and has her arms to support her as she leans over. A mother will only do this if a caregiver or partner is facilitating the actual delivery because a mom instinctively knows that her baby is now behind her and she cannot receive her baby herself. Often moms confide after the birth that the hands and knees position made sense in the moment but that they were sorry to have missed the birth of their child. Someone else ended up catching the baby and many moms I have known will not choose this position again.

Women seem to dislike a supported squat. They are totally dependent on someone else to hold them up during birth, usually the partner, and then the partner does not easily see his child born. Also it often puts the mom in an awkward state…needing to depend on someone to hold them during birth when they instinctively understand that this is not really necessary. I realize that supported squat is a caregivers position for a mom rather than a position that she would naturally choose. Also, in a supported squat, I have seen women have difficulty arching their back for the fetal ejection reflex that Michel Odent speaks about.

Semi-sitting, the most culturally popular position for childbirth, is the most difficult position in which to birth a baby. It’s a matter of sacred geometry. When a women is sitting on her coccyx, which is exactly where she is sitting when leaning back, she is occluding the birth canal. In labor, the coccyx will naturally roll out of the way so the baby can fit through. When mom is sitting on it, great force may be required to move the baby over the coccyx. That translates as hard and heavy managed pushing with the legs to the ears and often a lot of yelling and coaching. Even though it is psychologically preferred to lying on the back or in stirrups I have never seen a mother choose this position, or need to. Actually, from the physiological stance, lying on the back is an easier position for labor because the coccyx can move out of the way with less effort than when the mom is sitting on it. Moms do not like lying on their backs in labor because intuitively they know it’s not natural and it creates more work for the uterus which moves forward and upward.

Women opting for a water birth may sometimes remain in the semi-sitting position. This works in water because as the baby is borning, mother can easily raise herself up and let the coccyx move and the baby come to crowning.

Lying on the left side is chosen by moms who are wanting to be in their beds or are confined to bed for some reason. It seems to work very smoothly as it equalizes pressure on mom’s bottom but women report that there’s something very awkward about needing to have your leg held up during your birth.

What I learned from birthing women is that they will instinctively find the position that works best for their labor….usually the kneeling position. Whatever position a woman chooses…semi-sitting or hands and knees or kneeling…it is the natural position in the moment. There is no one correct position for birth. It is as individual as each woman and each labor. My experiences have been that women most often choose a kneeling position when not culturally imprinted.

The distinction between the two stages of Second Stage of Labor:

In clinical practice, we have acknowledged only one aspect of second stage. In this holistic model we notice that mothers don’t usually push until the head is on the perineum and we have delineated two stages of labor. The first stage of second stage, The Tides, occurs after transition and includes the time between full dilation and the arrival of the head on the perineum. This stage encompasses the time that the uterus naturally brings the baby through the birth canal. The other stage, The Breakers, characterizes the time when the baby is visible and the mother has a compelling and involuntary urge to push. Sometimes she will feel her uterus pushing gently during the Birthing Tides. She does not push with it…it’s not necessary. In fact, encouraging or managing a mom to push during this time before the head is on the perineum may cause undue damage to her vaginal tissues, pop capillaries and disorient the mom who instinctively knows her baby will come down with privacy, time and the ability to find the appropriate position. During The Breakers she will use her own effort with that of the uterus to birth her baby. I have been taught by women that it is not necessary tell a mother to begin pushing or to guide or manage a mother in pushing. This overrides her instincts and unless something is terribly wrong, her instincts will always be her best guide. Pushing before the head is visible… known as managed pushing…is a dubious achievement at best. It can be humiliating to position a woman on her back or bring her legs up to her ears and exhort her to push her baby down and out. It is instinctively incorrect, it seems overbearing and generally, from my experience, unnecessary.

(Certain variations, such as moms with babies in a posterior position, often do need assistance with pain relief and with pushing techniques…more on that later.)

Emergence

(Birth)

At the time of Crowning the largest part of the baby’s head has now passed through the Birth Gate. Mother is often ecstatic and totally energized.

She may cry out as if to announce her return. An adrenalin response occurs in the mother and she rises up slightly from her kneeling position and arches her back. This has been called the fetal ejection reflex by Michel Odent and this rising up allows her to facilitate crowning and the baby moving through the last part of the birth canal. This adrenalin surge, that co-exists with the flow of oxytocin, is responsible for the alertness of the mother and baby during this time. A mom may feel somewhat overwhelmed as she transports from one dimension to another but she is never at a loss for what to do. She simply births her baby. As she kneels to birth, her partner may be facing her, ready to catch his child. Perhaps another pair of hands, those of the midwife or caregiver, are ready to assist, and then again, perhaps not. Assistance is normally not necessary. Mother is not out of control, birth is not chaotic, there is no hysteria or confusion. Birth is accessible and a woman does what is natural.

It is an absolute fact that a woman does not particularly need anyone to catch her baby. She may desire another pair of hands in her field or she may desire someone to catch her child but women do not particularly NEED anyone to catch their babies. The myth that someone must check for the cord or perform head traction to free the baby is simply not true. Cords seem to resolve themselves…in fact one third of all babies I have seen born have had the cord around the neck and generally nothing was needed to be done. Head traction or assisting the baby is usually not necessary either and may, in fact, cause a problem or delay.

The Return

(Immediate Postpartum)

Baby slides into a new world. A transformation has occurred. Both mother and child experience a period of re-integration and re-organization. This stage may take about 5 to 10 minutes and is similar to the Quiescence in it’s calmness and quietude. Mother and baby are stabilizing – reorganizing molecular structure – and neither may do anything that is visibly apparent for a few moments. Baby is changing from fetal circulation to neonatal circulation, initiating respirations, smelling the environment, feeling air for the first time, listening, seeing, and experiencing his or her first impressions of this planet. Mother is seeing this planet through new eyes. She will usually sit quietly for a few moments allowing herself to return. She then reaches out to touch her baby. Usually the partner sits by, watching, with tears of awe.

This is the moment of earthly bonding. Oxytocin, the hormone of love, runs high…higher than at any other time in labor and the family falls into love with each other. Mother recognizes her child, partner claims his family. The bonding occurs first on psychic and spiritual level, then the mother reaches to pick up her baby.

Mothers have taught me that it is not appropriate to interfere with this important stage of birth. This is an incredibly high and holy moment and if we truly understood birth and the ramifications of returning from an altered state…the re-integration…we would protect the privacy of the mother and baby at this time more than any other. I have noticed that mothers are often not ready to hold their babies immediately after delivery. They need a moment, or two, or five. They need to experience their baby in an authentic and instinctive manner. We need not hand a baby to a mother and please, never remove a baby from the mothers field.

Acquaintance

At this time Mother has picked up her baby and begun to become acquainted. Mother and Father are in awe; in awe of their baby, of each other, of the amazing realms through which they have just traveled. With a sense of wonder and reverence they approach their baby. Initially they may be crying and speechless, still wrapped in the mystical cocoon of the Vortex. This may soon give way to expressions of delight as parents caress and speak to their baby and each other. The period of Return and of Acquaintance are times when distractions should be kept to a minimum in order to respect the initial bonding between parents and baby. Stethoscopes, flashing cameras, suctioning devices, hands and voices other than the mother and father can be disruptive and inappropriate during these vital first few minutes, especially if the parents want the sanctity of the bonding process honored.

As the Acquaintance comes to an end (usually after about ten minutes) and mother and father have explored their new child, the mother may feel the placenta descend and feel that it may be ready to be birthed. If so, she will signal for the bowl and perhaps wish the caregiver to come closer. However most women I have worked with have not desired to birth their placentas until after the next stage.

From the Tao…‘The midwife does her work by doing nothing.’

From close by, without interrupting or being in the mother‘s field, the midwife or caregiver can assess the newborn, assess mom’s placental separation and bleeding, assess and meet the immediate needs of anyone in the room, stabilize the environment and be the silent witness during these first minutes and stages after the birth.

Communion

This is the point at which the parents choose to share their new baby with others in the room. Children, grandparents, friends, attendants are invited to come closer and greet the newborn. At this invitation, the caregiver may move into the space of the Mother and family. Momma and baby are alert and receptive. Father is processing the experience and claiming his family. Baby may show interest in nursing. Congratulations are offered and a quiet celebration ensues. The Return, Acquaintance and Communion together last about 20 to 30 minutes and comprise the immediate postpartum. While they are short in duration they are very different stages of birth, each with a unique and important experience that impacts the development and well-being of the family.

Completion

(Immediate postpartum, Delivery of the Placenta)

About 30 minutes after the birth, the mother will often turn her attention to her placenta. At this time, the placenta is out of the uterus and sitting in the yoni. It is easily birthed at this time with very little fuss and concern. The midwife may hold the bowl and assist the mother in positioning herself to release the placenta.

The mother has had her bonding time and has had initial communication with her loved ones and she now settles herself down to nurse and fortify herself with something to eat and drink. The family is stable and safe. Perhaps the midwife has finished that baby hat by now and may offer it to the parents before she withdraws.

Babies tend to be alert for the first hour or so after their birth. Then they generally drift deeply into sleep, having nursed and fallen in love. Mother has birthed her placenta and received nourishment and witnessing from her loved ones. This is now the time, after about an hour, while her baby sleeps, for the caregiver to return to the scene and assist the mother in accessing her body and her bleeding. Mother may wish to shower and assess her bottom, the birthing room is tidied, phone calls are made. Perhaps mother calls for more food and wishes to talk, perhaps she wishes to rest. As this finishing winds down over the next while, mother and partner draw together and prepare to enfold their baby, and each other, in sleep.

The midwife enfolds all as she writes her notes or closes her eyes in silent vigil.

Weaving the Story

(Postpartum)

During the next days and weeks the vortex remains open. Mamatoto…motherbaby…are establishing their relationship and rhythm. The altered state is still apparent but beginning to close. How quickly it closes depends on how soon the mother returns to her ordinary reality. During this time, family and caregiver revisit the events of the birth. This is a crucial time of witnessing and articulating the journey to each other. Mother has an opportunity to review her altered state with her companions and formulate her wisdom. Partner is incorporated into the experiences and the parents share their insights.

The Weaving goes on forever. Families and caregivers form a special bond and as time progresses and children grow often the birth wisdom continues to be revealed and understood. Being present with families in the postpartum is as relevant as being present in pregnancy and birth. Also, this is the stage when parents let me know what worked for them and what didn’t. This is time of open and candid communication as parents taught me how to better midwife them.

As I continued to facilitate women and families in birth, more was revealed. As I gave up my preconceived ideas about birth, and witnessed what actually happened, women were free and delighted to share a new paradigm with me. And while I realized that this account of birthing does not represent the mainstream in birth today, it is my experience and the experience of many of the women I have attended. As a constant student of birth, I offer thanks to them.

*While I use the pronoun ‘he’ to refer to a partner, in no way do I wish to marginalize same-sex couples. Nor do I wish to minimize single moms who have done more for liberating women than any group I can think of. My practice has been mostly with non-same-sex, married couples so I use what I am most familiar with.

Resources for this article:

Women Giving Birth by Astrid Limberg and Beatrice Smulders

The Scientification of Love by Michel Odent

Birth Reborn by Michel Odent

A Plea for the Reform of Second Stage of Labor by Constance Benyon.

Steady, Steady, Hold, HOLD!

2010-11-08T11:45:00.001-05:00

Sunday at church Steve Gooch was preaching. He was talking about "re-uping" to the initial pledge we made to God. He shared a scene from Braveheart after Mel Gibson had completed his freedom speech and how he led the charge to battle.

It is quite timely as I had just completed the last class of my childbirth series and in it we do an exercise called "Warrior." I always mention Braveheart and the battle preparations. It is not so much so that women will be ready to battle the medical community- but instead to battle the voices within them that try to seed the great doubt that they will often face in labor. This great doubt is definitely watered by the nay sayers- our friends, our family and often our medical support system. But we also carry the seed within us. The fear of the unknown and the fear of us not "performing" the way we hope or the birth unfolding in a way that is out of our control is always within us.

I love the way in the previous scene Mel discusses running from the enemy and how you will still be alive for a while but it will be without freedom. And is that really living. He encourages them to fight even if they fail because they will be fighting for something that is worth dying for. Often times women will choose to give up some of their dreams for their births and instead allow others to take away their freedom. They will perhaps have birth outcomes that will make them disappointed or depressed but more often feeling a bit controlled and manipulated.

I love teaching the classes I teach because I feel we give women options. We open their eyes to what is possible. We help women find courage to fight for the freedom in their births. We also teach that sometimes things are not within our control but that does not mean you are without the ability to make your own decisions as that birth unfolds in a different path than you chose initially.

I leave you with this video clip of Braveheart. I hope you will move into your labor feeling courage and confidence within you... holding steady to that which is right for you.

Braveheart Battle Scene

Jaundice and the Newborn

2010-10-29T15:38:00.001-04:00

Folks come to me all the time talking about their baby being separated from them to go under bilirubin lights. Occasionally someone insists on bringing their baby home and they use light therapy there or even use the bilirubin blanket. I wanted to share what is actually the issue with bilirubin levels in an infant and some protocol that has been shared with me. I just feel you need to know the facts- know the Pediatric Guidelines and know what you can do to help your baby and your breastfeeding relationship not be interrupted.

Ellen Penchuk, IBCLC, RLC a fellow internet friend of mine shared this:

"A 17 bilirubin level is considered in the moderate range. Human milk allows for a slower decline of levels. The slower decline in breastfed babies is because bilirubin actually has a physiologic role in the body as an antioxidant.

Is the baby breastfeeding 10-12 times a day? How frequently is the baby stooling? What color are the stools? Bilirubin is excreted in the meconium. Once the tarry stools are gone the threat of rising levels is diminished. By day 6 the stools should be yellow, seedy and frequent.

Supplementation with artificial baby milk is not recommended for moderate levels and can work against breastfeeding management. The normal feeding patterns will be disrupted as the formula will be slower to digest (sic) and he will no longer be feeding frequently.

Perhaps she may wish to share the AAP’s protocol with her pediatrician:

http://aappolicy.aappublications.org/cgi/content/full/pediatrics;114/1/297

and the Academy of Breastfeeding Medicine’s protocol:

http://www.bfmed.org/Resources/Protocols.aspx "

What La Leche League International Says is, "Newborn Jaundice: More than half of all newborns become jaundiced during the first week of life. In most cases, this is a normal part of adjusting to life outside the womb, but occasionally jaundice is a sign of other, more serious health problems. Sometimes it’s the treatment of jaundice that presents challenges for new breastfeeding mothers and their babies.

What causes jaundice? Most babies are born with higher-than-normal amounts of red blood cells. When these cells break down in the days after birth, they produce a yellow pigment called bilirubin, which circulates in the blood. When the bilirubin arrives at the liver, it is changed into a form that can be transported to the intestines and from there, carried out of the body in the stool. However, a newborn baby’s liver may not be able to process bilirubin efficiently in the first days of life, so the excess bilirubin is deposited in the skin, muscles, and mucous membranes of the body, which then take on a yellowish or golden color.

Why be concerned about jaundice? When a baby appears jaundiced, the doctor may order a blood test to measure how much bilirubin is in baby’s blood. Physicians then consider two basic questions: Are the levels of bilirubin in the blood high enough to cause harm? When blood levels are high, bilirubin may enter the brain and damage the nervous system. Physicians are especially concerned about high levels on the first or second day of life, levels that are rising quickly, and high levels in premature or sick infants. Doctors monitor newborns' bilirubin levels so that they can treat jaundice before it causes harm. Is the jaundice physiologic, meaning a result of the normal process of adjusting to life outside the womb, or is there another more serious cause? When bilirubin levels are high at birth or in the first day or two of life, the jaundice may be related of other health problems. It’s important to identify these early, so that the underlying problem can be treated. When bilirubin levels rise slowly over the first three or four days, the baby probably has normal physiologic jaundice, which is usually harmless.

Breastfeeding and jaundice Jaundice seems to occur more frequently in breastfed babies, especially those who do not nurse frequently in the first days of life. Newborns who nurse every hour or two have frequent stools, and this eliminates bilirubin from the intestines more efficiently. Jaundice also seems to last longer in breastfed babies. Researchers are not sure why. There may be a substance in mother’s milk that affects the way the body eliminates bilirubin. As a result, healthy breastfed babies may still show signs of jaundice at two or three weeks of age. Babies with jaundice should continue to breastfeed. Frequent breastfeeding during the first days of life will help baby’s body eliminate bilirubin.

Babies who are not breastfeeding well are more likely to be jaundiced. They should be encouraged to nurse more often and more effectively.

• If your baby is jaundiced, try to nurse more often— at least 10 to 12 times in 24 hours. Breastfeed every 1-1/2 to 2 hours during the day, with one 4- to 5- hour period of sleep at night.

• If your baby is sleepy, wake her and encourage her to nurse longer and more often. (See box below.)

• If your baby is not feeding effectively at the breast (or if you’re not sure), check to see if baby is latched-on and sucking well.

Stop breastfeeding? Sometimes a physician will suggest that a mother stop breastfeeding for 24 to 48 hours and give her baby formula to see if this will bring down the bilirubin levels. This used to be common advice. More recently, physicians and other health care professionals recognize that interrupting breastfeeding for a day or two can lead to an early weaning—and a baby who is deprived of the many benefits of breastfeeding. There are other ways to treat bilirubin levels that are high or rising rapidly. These treatments are less likely to cause problems with breastfeeding.

Give water supplements?Mothers are sometimes told that giving baby bottles of water will help to "flush out" the jaundice. This is not true. Bilirubin is eliminated in baby’s stools. A baby whose tummy is filled with water or sugar water will nurse less often and thus is more likely to have problems with jaundice.

Treating jaundice Your doctor may suggest using phototherapy to treat your baby’s jaundice. Phototherapy uses special lights to break down the bilirubin that is stored in baby’s skin so that it can be eliminated more easily. The baby is placed under the "bili-lights" wearing just a diaper, with his eyes covered to protect them. The baby remains under the lights continuously for a day or two, although parents may remove the baby from the lights for feedings. Once the baby’s bilirubin levels begin to fall, the lights are no longer needed.

One of the problems with phototherapy is that it interferes with mother and baby being together and interacting freely in the first days of life. So if phototherapy is necessary, it is important to do everything possible to help a mother to continue to feel close to her baby and continue to breastfeed.

Here are some ways for you to keep your baby close during phototherapy:

• If you are still in the hospital, the phototherapy unit can be set up in your room, so that you can talk to your baby, touch her, and breastfeed her frequently.

• If the baby is hospitalized but you, the mother, are not, you can stay with your baby in the nursery.

• Your doctor can order a home phototherapy unit, so that your baby can receive the light treatment without being hospitalized.

• Your doctor can arrange for your baby to receive phototherapy using the Wallaby phototherapy unit. This is a fiberoptic blanket that wraps around the baby’s trunk and provides continuous light treatment. The baby’s eyes do not have to be covered, and you can hold and breastfeed your baby without interrupting the treatment.

Working with your doctor There is no one "right" way to treat jaundice in a breastfed baby. The American Academy of Pediatrics suggests that pediatricians discuss several treatment options with parents. Here are some questions to consider:

• Is it necessary to treat the jaundice at this stage? Could we continue to monitor the baby’s bilirubin levels, encourage the baby to breastfeed more frequently, and re-evaluate the

situation in 24 hours?

• If phototherapy is needed, what can be done to keep mother and baby together and breastfeeding?

• If a doctor suggests that you stop breastfeeding and give your baby formula, ask about alternative strategies, such as using phototherapy to treat the jaundice while you continue to

breastfeed.

In most babies, jaundice is short-lived and harmless. There may be times when it is necessary to treat the jaundice, but in these situations, parents and health professionals should remember that frequent breastfeeding in the first days of life helps ensure successful breastfeeding in the weeks and months to come. The goal is a healthy baby who continues to breastfeed.

How to Wake a Sleepy Baby

• It’s easier to wake a baby in the stage of light sleep: eyes are moving under the eyelids, baby is making sucking motions or moving his arms and legs.

• Dim the lights so that baby will open his eyes.

• Undress baby down to just a diaper.

• Hold baby in an upright position. Talk to the baby. Gently rub his back, hands, and feet. Walk your fingers up and down baby’s spine.

• Wipe baby’s forehead and cheeks with a cool, damp cloth.

How to Help Your Baby Breastfeed More Effectively

Check baby’s latch-on. Babies who are latched-on well get more milk from the breast. Baby should be facing mother and pulled in close to her body. The baby opens her mouth wide as she goes onto the breast and takes a large mouthful of breast tissue. The baby’s chin is pressed into the breast and the lower jaw is as far back from the nipple as possible. Baby’s lips are flanged out, not tucked or pulled in. If baby is not latched-on well, take the baby off the breast and try again. Check for effective sucking. The baby moves her jaw, not just her lips, as she sucks. After the initial let-down, baby will swallow after every one or two sucks. This active swallowing should continue for ten to twenty minutes per breast. Keep baby interested. Encourage baby to breastfeed longer by using breast compression when her sucking slows or stops. Hold the breast between your thumb and your other four fingers, close to the chest wall. Bring the thumb and fingers together, firmly compressing the breast, but not so hard that it hurts. This will start the milk flowing again, and the baby will respond with more sucking and swallowing. Keep up the pressure on the breast until baby’s sucking slows. Then release the breast compression. Baby may start to suck again. If not, shift your hand around the breast to a new position and compress the breast again. Repeat this technique until the baby gets sleepy or fussy, and then repeat on the other breast.

Is the baby getting enough milk at the breast? Beginning on the third or fourth day after birth, babies should have at least six to eight wet cloth diapers (five to six disposables) and at least three to four bowel movements in twenty-four hours. Get help. A lactation consultant, or La Leche League Leader can assist you as you evaluate your baby’s latch-on and sucking and find ways to encourage your baby to breastfeed better.

For breastfeeding information, to order publications, or to find an LLL Leader near you, use our Web site at www.lalecheleague.org Or phone 800 LA LECHE (9-5 Central Time) 847-519-7730 (24-hour messages) ©

L A L E C H E L E A G U E I N T E R N A T I O N A L

1 4 0 0 No r t h Me a c h am Ro a d • S c h a umb u r g I L 6 0 1 7 3 . 4 8 0 8 USA • 8 4 7 . 5 1 9 . 7 7 3 0 • f a x 8 4 7 . 5 1 9 . 0 0 3 5 • 1 . 8 0 0 . LA. L ECHE l l l i@l l l i . o r g

1689-27, March 2005

A Trio of Praise

2010-09-26T18:55:00.001-04:00

This is a letter I got from a woman who hired Pam Roe to be her labor doula, took Pam's classes and Teresa's breastfeeding classes and hired Jennifer Fargar as her postpartum doula. Pam was sick and Guina Bixler filled in as her doula. This is the letter she sent regarding our services:

"We have been absolutely thrilled with all of the services that we have received from Labor of Love. At first, we didn't see how we could possibly need 6 weeks of three hour classes to learn about birth...but we loved the class and felt that we learned so much. Pam was an excellent teacher and we really wish that she could have been at our birth too. Please let her know that we are thinking of her. We felt so prepared and confident once we completed the class.

Guina was a breath of fresh air coming in the door for our birth. I had just told my husband to "shut up" and was afraid I might think the same when Guina arrived....I was wrong! She was great and knew exactly what to say and what to do! She was wonderful to work with. I know that all of the knowledge and support from Labor of Love was a huge contributor to me having such an amazing birth experience. Please feel free to share details of my experience with others.

The breast feeding class was great and opened our eyes to so much more than we thought possible. Our baby is a pro-eater...so no problems with breast feeding so far!

Jennifer was such a great help after Carson arrived. I had so many questions for her and having her knowledge was a huge plus. She also helped me master several techniques such as side lying breast feeding that has definitely made these first two weeks easier.

As soon as I get my next positive pregnancy test...the Ladies of the Labyrinth will be booked!

Please let me know if I can serve as a reference for future clients. I look forward to working with you all again. Also, we hope to take a Wee Hands class in the near future.

Thank you.

Erin"

I have to say, these are the types of letters that make me smile and realize our company provides excellent services across the board! Thanks Erin for your kind words! If you want to hire doulas who are in the most experienced category in all areas, please consider us!

Info on hiring us!

2010-09-11T13:41:00.005-04:00

“I am interested in hiring a labor doula. What do you need to know and what do I need to do next?”

First, you have made a great decision regarding including a labor doula at your birth. The studies show :

¨ tends to result in shorter labors with fewer complications

¨ reduces negative feelings about one’s childbirth experience

¨ reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans

¨ reduces the mother’s request for pain medication and/or epidurals

¨ Feel more secure and cared for

¨ Are more successful in adapting to new family dynamics

¨ Have greater success with breastfeeding

¨ Have greater self-confidence

¨ Have less postpartum depression

¨ Have lower incidence of abuse

According to DONA these are the things that a doula provides:

¨ Recognizes birth as a key experience the mother will remember all her life

¨ Understands the physiology of birth and the emotional needs of a woman in labor

¨ Assists the woman in preparing for and carrying out her plans for birth

¨ Stays with the woman throughout the labor

¨ Provides emotional support, physical comfort measures and an objective viewpoint, as well as helping the woman get the information she needs to make informed decision

¨ Facilitates communication between the laboring woman, her partner and her clinical care providers

¨ Perceives her role as nurturing and protecting the woman’s memory of the birth experience

¨ Allows the woman’s partner to participate at his/her comfort level

We provide a bimonthly Meet the Doula tea so you can attend to:

¨ Meet all of the doulas and educators within our company

¨ Have a chance to hear about our services

¨ See a short video about doulas

¨ Have an opportunity to mingle and talk to each doula who is of interest to you
¨ Send us your due date, location for your birth and your phone number for our sign in if you plan to attend the tea. Send it to info@alaboroflove.org

When you contact our company we provide:

¨ A packet of information that details all of our services

¨ Contact information for each doula with fees associated with each doula

¨ You can also email any doula by contacting her by using her first name@alaboroflove.org and can email the team of the Ladies of the Labyrinth with the email lol@alaboroflove.org

If you are unable to come to the tea:

¨ Call the doula who is of interest to you and chat to determine if she sounds like she may be a good fit

¨ Set up an interview with the individual doulas who may match your needs

¨ Contact the Ladies of the Labyrinth to see if one of their interview/prenatal nights or days is available to meet two of the doulas and then contact the last doula for a phone call to see if they may be a good fit as well

Once you determine the right doula for you:

¨ Send in the last page of the labor doula agreement with the retainer

¨ Contact the doula to let her know it is on its way to our office

¨ Set up a prenatal with her if you to be done near your 36 week mark

¨ Put a reminder on your calendar to send in the final payment to reach our office by the beginning of the 38^th week when your doula begins to be on call

¨ If you choose the Ladies of the Labyrinth, set up the dual doula meeting based on the scheduled times and set up an individual prenatal with the remaining doula

Stay in touch with your doula:

¨ We love to get emails about your pregnancy progress

¨ We love to assist you with questions of a non-medical nature to help you have a smoother journey

¨ We love to hear your desires and dreams for your birth

¨ We love to have you visit our blog: www.alaborofloveblog.org and read information that may help you in your pregnancy, labor and postpartum period

¨ We love to have you sign up for classes we offer and hear about the classes you are taking

¨ We love to share and offer input on books that you may find helpful in gathering more information

“I am interested in hiring a postpartum doula, what is the next step?” Most of the labor doula ideas are the same for a postpartum doula.

According to DONA these are the things that a postpartum doula provides:

¨ Offers education, companionship and nonjudgmental support during the postpartum fourth trimester

¨ Assists with newborn care, family adjustment, meal preparation and light household tidying

¨ Offers evidence-based information on infant feeding, emotional and physical recovery from birth, infant soothing and coping skills for new parents and makes appropriate referrals when necessary

When considering a postpartum doula:

¨ Where you live is important as some doulas do not go to all areas

¨ What hours are you considering needing

¨ What days of the week are you desiring

¨ We do not provide overnight care since a postpartum doula “mothers the mother” and night time care is really being a night time nanny- we believe if a mom is taken good care of during the day, she can handle her nights

¨ We do provide night care for moms with special needs- postpartum depression issues, surgical births or multiples if it is needed

How and when do you hire a postpartum doula:

¨ Ideally we like to be hired prior to the birth of your baby, but often times couples do not anticipate a need until after the baby has arrived

¨ Setting up an interview where she comes to your home is helpful although you can also hire a postpartum doula at the Meet the Doula Teas

¨ You mail the agreement with the retainer that pays for the first 5 hours and contact the doula to set up the times you need if your baby has already arrived

¨ Each week you receive an e-bill to alert you to the hours worked and the balance that is to be paid each week for her services

¨ You mail this to our office, it delays things if you give it to the doula herself

¨ If you have hired a doula prior to your baby’s arrival, contact her after you have had the baby and let her know the baby has arrived and when you want her to come

¨ Ideally we need a 48 hour notice on both when you want the doula to arrive as well as if you need to reschedule her arrival on a prescribed time

“I am interested in some classes you offer. What is my next step?”

Preparing for your birth, for being a parent and for breastfeeding is an essential step.

¨ Information is power and preparing for a new event gives you valuable information

¨ Our classes are very hands on with not only information but how to put that information into practice

¨ We offer a variety of classes to choose from based on your needs

How do you find out about our specific classes and when they are offered:

¨ Our online calendar on our website is updated frequently. You can access it at http://alaboroflove.org/calendar.html

¨ You can contact us to get the informational packet which has a list of our current classes, dates and prices

¨ We offer childbirth classes that are done in a group setting on two different days and times and also a 2 weekend immersion. For those who just can not get into a group session, we do offer private classes held in our class spaces in three different locations around town We also offer a Birthing Again class for repeat birthers who took some type of class the previous pregnancy.

¨ We offer several specialty types of classes and most are held at least quarterly.

How do I get signed up?

¨ Email us for an informational packet and fill our the class agreement and send payment for the class to hold your spot

“I still have questions. Who and how do I contact someone?”

Teresa Howard is the owner of Labor of Love Doula and Childbirth Services. You can call her at 770.241.2078 or email her at info@alaboroflove.org. Also visit our main facebook page http://www.facebook.com/Laboroflovedoulaandchildbirth to enjoy a great community full of information! Thanks!