Healthy Mama Childbirth

Muscle Rub Liniment

2011-12-16T15:49:00.000-05:00

As part of my on-going herbal course, I decided one of my formulations should be a muscle rub for that post-run soreness.

I used a formulation I found in my studies from Herbal Healing for Women by Rosemary Gladstar. She calls it a “Goldenseal/Myrrh Liniment.” I altered it slightly, to meet my needs.

I began by mixing the four powders it called for. (Amounts are in the text, and for copyright and respect, I will not list them here.) I bought my herbs from Mountain Rose Herbal, and highly recommend them. These are the herbs used: Echinacea Purpurea, Cayenne, Goldenseal Leaf, and Myrrh Gum.

I mixed the ingredients in a pint-sized canning jar, and they filled very little of it.

Finally, I filled the entire jar with 100 proof Vodka.

I gave the jar a good stirring until it seemed all the powders were well dissolved.

I then let it sit for a few weeks.

Overall, I was pretty happy with it's use. It's certainly messy, and even stains a little (I used a rag/washcloth to rub into my calves), but the massage alone helps.

Valerian Tincture

2011-12-16T15:38:00.000-05:00

Valerian Tincture

I’m catching up on my herbal coursework through Birth Arts, so the next few posts will probably be herbal-related. It’ll still be fun. I decided early on in the course that I needed to drastically decrease my stress levels. I’m still working on that, but there are many better days. As one of my stress helps, I decided to do a simple, a valerian tincture to help me sleep. Valerian is commonly used to aid sleep and relieve stress.

I order my herbs from Mountain Rose Herbal (highly recommend) unless I’m growing them, and my Valerian came from MRH. I also used 100 proof vodka. 100 proof gives the best balance of alcohol and water (in my humble opinion) which is why I use it.

I initially tried this tincture in a small dropper bottle. I’m not sure what possessed me to do so other than the fact that it used very little herb and it would be the size bottle I planned to use for the finished product.

It didn’t work out well.

I filled the entire little bottle with the Valerian, which became pretty tightly packed. Then I added all the vodka I could. (Yes, you can fill a bottle twice when it comes to herbs). I allowed it to sit for at least six weeks (I don’t have the dates written down now) and attempted to strain it. I couldn’t get the Valerian out of the bottle and got the equivalent of 10 drops of tincture from the bottle. I tossed it.

When I tried it again, I used a half pint canning jar, like you’d use for jelly. This time I decided to fill it about ¾ of the way full. I was afraid of using a good bit of my Valerian and not being able to get it out of the jar again. I again used the 100 proof vodka and filled the jar. I shook the jar well as I added the bottle (capping it of course) to get as much vodka as I could throughout the Valerian. I then allowed my working tincture to sit in a dark place. I shook it in the first couple of weeks daily or so, and as the Valerian swelled a bit, found that I didn’t need to shake it very often at all.

I started this on December 30, 2010.

On March 12, 2011, I got ready to drain and strain it. I had wanted it to sit at least six weeks, but had to find a time when it didn’t matter than my hands smelled like gym socks to strain it. (Good valerian has a very gym socks kind of smell.)

I started by getting out another half pint jar. I’ve found it easier to strain into a similar jar and then rebottle into a dark bottle than it is for me to strain into the dark bottle with dropper. This way I can use a large mouth funnel with my wire strainer, which works well for herbs of this size. I strain slowly, allowing the tincture to drip out, and I sometimes coax a little more by pressing lightly with a spoon. This is not a time to be rough and forceful, but to allow the tincture to come out on its own.

In the end, I was left with this much:

A much better amount than the first attempt.

Unfortunately, Valerian is a very bitter, strong herb. It truly does smell like dirty gym socks. I hate to say that I haven’t used it, but based on those pugent odors I have not. I feel I would need to add some things to it and use less Valerian to be able to get a treatment I could take.

Update on Life

2011-08-10T10:00:00.001-04:00

Yes I know, the blog has been quite quiet. And I’m sorry about that.

And I’m not sure it’ll get better any time soon.

Today I go for my second nursing orientation, and I start classes August 22. The program is a 2-year RN, so needless to say, I’ll be very busy with school for awhile. Each semester has three nursing classes, five weeks a piece, one right after another. Each semester except the last I’ll have a couple of additional classes: Anatomy, Physiology, etc. that will keep me busy. I’ll also be tutoring this year and am considering a nursing externship for later seniority in the local system. Last spring I took Nutrition, Math Reasoning, and Life Span Development. Over the summer I crammed and took Microbiology and Chemistry. I’m thankful I did so, as it’ll certainly help me coming workload.

So, where does this leave Healthy Mama Childbirth?

I’m still here, but I will probably not be taking any doula clients for the time being. I’ve found that as I look at EDD and on-call times, I don’t feel that I’d be able to provide the support necessary to be a good doula. I’m saddened as I turn down clients, but I know that it is best so they can get the support needed in this area.

I am still taking childbirth education clients and will be offering another Prepared Childbirth Series in the fall. I also still take private clients for flexible scheduling and course offerings.

I plan this year to begin lactation-related education online in preparation for the Pathway 1 IBCLC exam requirements. I had considered IBCLC previously, but thought it out of my reach since I wasn’t in the healthcare field. However, now as I find myself in nursing school, it’s back on the table for consideration. I’m also hoping in the near future to go through doula certification, though it’s certainly on hold until I can take clients. I’ll still be available to local doulas as a backup and hope to continue to be active in the local birth community.

I’m also honored to be the chapter leader of our local ICAN – ICAN of Greater Charleston WV. Please visit http://ICANGreaterCharlestonWV.weebly.com for more information about meetings.

As for the blog, I’m leaving it open, but please understand that I have little time at the moment to really devote to entries. I’ll do entries as the mood takes me (I hope), but regular updates – which were not often as it was – cannot be expected.

:-D Much love and happy birthing!

Co-sleeping, a failed account? Part Two

2011-06-03T10:00:00.001-04:00

Our night-time sleeping was very different from our naps. While he would refuse to nap longer than twenty minutes in a place other than mommy’s arms, he refused to sleep there at night.

Well, let me back up…

Like I said before, at about a month old he started having trouble sleeping at night. Cutting dairy really helped, but the biggest fix at that point was to co-sleep. We have a king-size bed (best investment ever), so instead of him sleeping in the Arm’s Reach, I just had him snuggle. Most of the time, I slept on my right side, with little man snuggling there between me and the co-sleeper. Sometimes, he slept between my husband and me, but with my husband’s sleep apnea, I was more comfortable with the other set-up.

While little man co-slept with us, I was amazed at how our sleeping patterns worked together. Even just having him in the room accomplished this. Babies have shorter sleep/wake cycles than adults, allowing them to wake, eat, and keep getting the calories necessary for growth. Short sleep/wake cycles may also have a protective effect in regards to oxygen levels and adjusting to life outside the womb.

The difference in sleep/wake cycles is what makes parents so tired with new babies, but here mothers have an advantage. Having baby in the room allows these sleep cycles to be synced: beneficial for both mama and baby. Some research suggests this may be protective against SIDS. And for the mother, the added benefit is waking more easily rather than from a deep sleep.

For us, here’s how it worked. Little man would feed and drift off to sleep snuggled in my arms. I’d drift off around the same time. A couple hours later, I would wake. My deep sleep cycle was shorter in response to his, so most of the time I felt pretty good. I would look down at little man, who was still asleep but begging to root around and stir. This gave me time to get ready for feeding. He would then feed and re-settle, much of the time never fully awakening. I would then drift back off as well. This synchronization may be part of the reason breastfeeding mothers get more sleep than formula feeding mothers.We had this great set-up until little man was about three and a half months old. He started by feeding. Then he would arch his back and squirm. He would touch and explore my face. He’d coo and squeal, discovering his own voice. As cute as it was, he was starting to go from tired at the beginning of the night feed to wound up by the end. Eventually he would drift off, but he was fussing more during the drift off period. Sometimes we would have to give up for a bit and try again later, as late as 11pm.

One night, probably a week or so after this change, I cleared out the Arm’s Reach. After he fed, I scooted him over into it. At first he fussed, but after a few nights, it was getting better. If the fussing seemed to be “sleepy-time fuss,” I let him be. If it was “I need mommy, I’m scared!” fusses, I’d pull him back over and snuggle. For awhile our sleep routine came to be starting out in bed, then the Arm’s Reach for part of the night, back in bed for the rest. I tried my best to read his cues and let him sleep where he seemed to settle the easiest. After a few weeks I noticed he was spending less and less time snuggling with me in bed and more and more time sleeping contentedly by himself in the Arm’s Reach. Along the way he had realized he was definitely falling asleep snuggled with a warm mommy, but he could coo and be cute and “fight it” a little longer by himself.

Knowing the independent part of his personality, this all doesn’t surprise me too much now how easily he self-weaned from co-sleeping. At the time I was surprised and even a little embarrassed. Co-sleeping was an important part of my nurturing parenting philosophy, and I felt I must not have done it right for him to have weaned so early.

But for us, this was exactly right. He was ready and let me know in his own way. Around six months he settled into sleeping in the crib at night since he was able to crawl out of the co-sleeper. I attribute his good sleeping habits now to the security he had sleeping then. Falling asleep at a young wasn’t scary; he wasn’t hungry, cold, or wet; and he knew mommy would be right there if needed.

Recently, we got to co-sleep again. We went to the Columbus Zoo, and little man was having trouble sleeping in the hotel room. My husband suggested we have him in bed with us, so we decided to try. He took his sippy, coo’d, explored my face, and drifted off with me sleeping on my right side again. It was uncomfortable, as a sleeping toddler is much more mobile than a sleeping two month old. But it was beautiful and I loved it. I miss our nightly snuggles, but I’m glad I listened to what he was ready for.

Co-sleeping, a failed account?

2011-06-01T10:31:00.001-04:00

I was so fortunate that prior to pregnancy I had learned about many safe sleeping practices, one of which was co-sleeping. In the end, we just decided we would “go with the flow,” and that crying out wasn’t an option.

I highly recommend that approach.

However, I really expected our co-sleeping story to be different than how it actually played out. I’ll go through our story and talk a little about why I think it worked for us.

Around the time my son was born, we were staying with our pastor and his wife (fun stuff like our new home not being ready on time necessitated that). At the same time, my husband’s mother and grandmother were in from Mexico.

It was a hard way to start out with a new baby. I was in an unfamiliar environment, with a slight pressure to perform. (Side note: I love my husband’s family, and the pressure didn’t come from them but from my own self-consciousness). My husband and I were sleeping is separate twin beds so I could recover from surgery and little man slept in a Pack N Play at my feet.

Not my ideal set-up to be sure, but necessary at the time.

Little man was swaddled for the first week, but after that we simply had light blankets covering him. We stopped swaddling because he started to hate it, probably as his startle reflex was calming down. He slept at naps and at night, which was unexpected.

By the end of his birth month, we had moved home. My husband’s family was still to be with us a few more days as we settled in. We put up our Arm’s Reach Co-sleeper with our King-sized bed.

Elias was still doing fine with our set-up of alone naps and nights until right before my husband’s family. He was starting to be more restless at night a bit irritable during the day. Where he had previously been a greater napper, sleeping three hours at a time, he was now cat-napping twenty minute sessions.

Finally, one night he literally refused to sleep. At 2am we had him in the car, trying to lull him done. He gave in but was up as soon as we were in the house. That night we pulled the swing into our room and let the rocking work its magic.

The next day I starting cutting dairy from my diet. I also held him for naps. He would nap without me holding him, but he napped much longer in my arms. At night, I started cuddling with him in our king size, using the Arm’s Reach as a table.

Later, I discovered Elizabeth Pantley’s No Cry Sleep Solution. I had heard of it, but at this point I finally bought it. I was desperate for something to help him sleep without me, but refused to try “crying it out.” We had seen a crying fit from him on the six hour drive from Washington D.C., and the pain and terror he was in was not going to “work.”

Pantley simply confirmed to me that all was actually ok with our sleeping situation. When he cat-napped, he wasn’t getting adequate sleep, making night times more difficult. I charted his sleeping habits and made my decision.

We’d keep going with the flow.

I started keeping track of his eating and naps (I kept a note pad on the armrest of the recliner) and continued to hold him for every nap, for the entire nap, until he was five and half months.

People thought I was crazy. I got nothing done during his naps.

Around five and a half months, we started trying the crib for naps only. I would rock him while he ate and then laid him down when he was fully asleep. At that point, being fully asleep was key; generally about ten minutes after he appeared to be “asleep,” he was ready to go down.

It worked. Within a few days, he was comfortable sleeping in the crib for naps. Night time was another story…

Should We Have ONE Certification Organization for Doulas?

2011-05-24T10:00:00.003-04:00

There’s been some talk lately (nothing new really) about having one national organization for certifying doulas. While it seems like it could be a nice idea, I have some concerns.

First, the good…

In terms of recognition, one doula organization could do some great things. Marketing and awareness for the consumer could be broadened. Recognition in media outlets may increase. We may gain respect as an industry – think of the recognition achieved by being an IBCLC as opposed to a lactation educator, etc.

Recognition for the consumer would be wonderful. With more women aware of doula care, it’s certainly possible many more women would be interested in exploring this in their own birth. If I fully embrace my idealist side, I’d even go so far as to say birthing practices would change en masse and we may see a turnaround in our cultural birth practices.

However, I think have one organization would certainly have some negatives. These negatives have the potential of out-weighing the positives.

Personally, I’m hoping to begin doula certification within the year. I’ve gone back and forth about doula organizations to certify with throughout my pursuit of this career. There is the possibility of doing a DONA training in our area in the fall; otherwise, I’m generally looking at doing distance learning or traveling three hours or more.

However, I’ve never been totally comfortable with certifying through DONA. I’ve had it recommended to me many times before (I’ve even blogged about deciding to certify with them). But it seems to be such an impersonal organization. I don’t want to join an organization simply because it is “premier,” (which is very true of DONA, and I certainly respect that), but there needs to be something more. Maybe I’m missing something, and more consideration will certainly follow before I make any decisions.

That little tangent discussion of DONA will be relevant later; I’ll come back.

I think for some, the biggest issue with having one certifying organization would be in the possible restrictions placed on its members. Most commonly, the restriction doulas complain about is involving “free birth” or unassisted birth. For me personally, I’m not sure I agree with having a doula (a trained support professional) at an unassisted birth, and I’m not sure I would take a client planning unassisted birth. However, there are doulas who would like to serve women and families in such capacity (I can think of one I know personally who is skilled in this area). And I think they should be allowed to do so (and encouraged! If you have such expertise and feel called to serve in such a way: do it!!)

I’m a little concerned that having one doula certifying organization would in some way “medicalize” the profession. Doulas are non-medical professionals, and I feel they should remain so. Doulas who are student midwives/midwives’ assistants walk a fine balance, and I don’t know how they juggle the two. But for the majority of doulas who are not in that situation, medicalization would harm the profession. I’d be afraid of “protocols” and “standard practice” and other such generalized guidelines that might interfere with the personalized care doulas are “famous” for. Doulas are uniquely available to hands-on at all times, without having to stop and chart or do a particular procedure. While many doulas do chart their notes, they typically wait until the birth is finished and the family is settled before hurriedly scribbling.

I’m not saying that I am afraid a certifying organization would begin to require doulas to do medical tasks. However, I do think that unfortunately some families already feel that doulas are part of the medical team, particularly in assisting the midwife. This assumption may cause them to not look further into the possibility of doula care. So many believe that doulas are only for homebirth, possibly stemming from that assumption of assisting the midwife.

So what should be done?

I honestly don’t know.

Back to my concern about DONA, one of the great benefits of the current situation in having multiple organizations is that there are many different philosophies. A common piece of advice for new doulas trying to pick a certifying organization is to “see which philosophy fits you best.” Losing this could be detrimental to the profession.

It also allows some to study and become experts in doula care and choose not to certify. There are a number who go this route, and they should be allowed to continue to do so. I think that families are able to interview doulas and decide for themselves who best to serve them, whether or not they are certified. I would be concerned that simply one organization would attempt to push out “rouge” and “uncertified” doulas.

Me, I’m choosing to certify. I do think that for me, especially among nursing professionals, having certification will be one step in showing my skills. But for all the other doulas out there, I don’t know that any one person/organization should be making that same call.

How do you feel?

Common Sense Labor Practices - the Walsh argument

2011-05-20T10:00:00.002-04:00

It looks like I’ll be finished reading Denis Walsh’s Evidence-based Care in Normal Labour and Birthing soon. I’ve really enjoyed it.

One thing I really like about this book is the underlying theme of using common sense to return to normal labor and birth. The author seems to come back to this idea at least once in each chapter, but I think it is best displayed in the argument surrounding the following topic: Movement in Labor and Birth.

Why is it that we seem to need randomized clinical trials to show us that moving and using gravity in upright positions would be good for birthing?

I was really struck when I was reading about this concept. Well, duh. Of course, even those promoting natural birth do forget about this. We try and try to prove that this works, but why is that we must prove something so common sense? Are we that far away from good birthing practices?

Quite simply: Yes. [insert a number of choice words]

As a culture, we have truly become a nation that absolutely relies on medical intervention. It’s pervasive. We go to the doctor with flu symptoms and find ourselves getting chest x-rays, bloodwork, and antibiotics (Let’s not forget that the flu is a virus. Antibiotics are for bacterial infections, not viruses). Our child gets a bad bump on the soccer field, and he’s in the ER for a CT scan (see this article).

Recently, we took my son to the doctor (not our pediatrician), for a suspected ear infection. Fortunately, he didn’t have one, but the doctor offered us a prescription for something just in case. When I declined, he replied that was fine, and that he offered because some people feel unsatisfied if they come to the doctor and don’t get something, even if nothing is wrong.

Novel idea, I know, but if you’re not sick, you don’t need something.

And this is much of what Walsh is arguing. If not sick, which pregnancy and labor should never be considered pathologies, then why are we doing randomized clinical trials to prove that natural labor needs natural things? (The same argument can then made against IVs, routine AROM, monitoring…)

I’m not making a new argument of course. I’m simply reiterating what many are already saying.

Pregnancy, labor and birth are normal the vast majority of the time. They require normal, common sense things. If they cease being so, then we’ll call for something else. Don’t do anything just to say that you’ve done something.

Preventing ALL Death and Injury?

2011-05-17T10:00:00.001-04:00

I’m currently reading Denis Walsh’s Evidence-based Care for Normal Labour and Birth. In my reading this week, I was struck by the chapter called “Fetal Heart Monitoring in Labour.” I understand that fetal heart monitoring is not proven beneficial, though it continues to be in widespread practice. I was familiar with much of the information presented, but the following reference caught me off guard.

Walsh discusses a number of studies and reviews throughout the book, and in this particular case, the review being discussed brings up one (of many) possibly disadvantages for continuous electronic fetal monitoring. Walsh quotes directly, as will I, the following: “[it] shifts staff focus and resources away from the mother and may encourage a belief that all perinatal mortality and neurological injury can be prevented.” (Reference below).

Can I just stop and say “WOW”?

Of course, it makes perfect sense. This attitude is pervasive in western culture. All death should be prevented until natural causes in old age. All other death is negligent and/or preventable by future technologies.

Again, WOW.

I come from this culture of course, and I struggle constantly with the idea. Late last year, my dad was diagnosed with prostate cancer. His prognosis was very good: he was (and is) in excellent health, and it was caught very early. He had surgery and has thus far done well without any other treatment.

My mother, of course, panicked with this diagnosis. Current research suggested to her that even with surgery and complete removal of the tumor, it only extended my dad’s life expectancy ten years. She was distraught.

Let’s put the above in perspective. This year, my dad will be 66. Ten years is 76. My dad (due to good health) probably had a previous life expectancy of 80.

Was surgery helpful? Certainly. Would my dad have died sooner without it? Yes, probably. He has a genetic risk for prostate cancer, so his cancer was likely vigorous. Does he have cancer now? Nope, not as far as we can tell.

Should my mom still be concerned about his life expectancy? Nope, not in my opinion. He will die eventually anyway.

That’s heartless sounding of course, but it’s true. Some of us will die from cancer. If we cure cancer, it’s likely some will die of other causes, beyond the “natural.”

My point is, as a culture, we are terrified of death. We string ourselves out at the end of life, struggling for each breath in some sterile hospital, without being allowed to die in dignity and grace surrounded by family and friends at home.

Unfortunately, birth is no different. Birth is a symbolic act of life beginning in another (though I would argue the life began long before, it just needed constant care in a different environment before birth). It is logical that once life begins, it will certainly eventually end. And as much as we would like to, many times we cannot prevent it, not should we.

I do not believe there will ever be a time when NO women and NO babies die in childbirth. That would be like saying there will never be any more SIDS or miscarriages. As tragic as these things are, they happen. They are a part of the life cycle.

Therefore, we need (as much as possible considering the culture we’ve been raised in) to attempt to lose this idea of preventing all perinatal mortality and injury. It will likely never happen. Our focus should be on healthy normal childbirth so we can recognize when it goes astray. When it goes astray from normal, we should focus on doing what we can, WITHOUT CAUSING FURTHER INJURY OR HARM to either the baby or the mother. After that, we should focus on supporting and counseling the family through a difficult life event.

Reference: Alfirevic, Z., Devane, D. and Gyte, G. (2006) Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database of Systematic Reviews, Issue 3.

Baby fever and putting it off...

2011-05-11T10:54:00.000-04:00

I have baby fever. It’s unfortunate that right now we can’t have another, so I’m going to lament and have myself a pity party.

As some may know, in January I decided to apply to nursing school with a local two-year R.N. program. Nursing had been in the back of my mind as an eventual pathway to midwifery, but I hadn’t truly considered it for awhile. The decision to apply was very much spur-of-the-moment, and to be honest I can’t remember all the reasons my husband and I considered when we made the decision I should apply. A primary concern of course was financial stability: we’ve struggled our entire married life, and I was not going to reenter full-time public school teaching unless I had to. (We did consider it, and I’m thankful my husband said he’d rather we struggle a way longer than put me through that). My husband is also going for nursing, though he’s not starting the program this fall with me. We felt that since I have a bachelor’s degree, I would get through the nursing program faster than he would. Then I’d be able to do a three day a week/full-time thing while he finished up the program himself. Three days a week would give me enough time home that I would still feel like a full-time mommy, at least as much as I am now working part-time and going to school part-time.

Of course, going to school full-time and then trying to find a job is really difficult pregnant and/or with a new baby. Not impossible, but…

I’ve considered the fact that I could probably take time off from the nursing program. Legally, I’m allowed a semester off (R.N. programs have some special requirements due to accreditation), though I’ve been told by the program director that I’m not allowed any time off. I could fight him on it, but I wonder if it’s worth it. I don’t want any difficulties going through, and I want to be finished and move on with my life. I also get his perspective; they’ve had a lot of concerns about the program’s accreditation with people not passing/dropping out. Rumor has it that of the latest class in the hospital partnership, only about half are making it to next semester. That’s got to be nerve-wracking as a program director to be staring accreditation worries in the face.

Also, I think about what I’m going to be looking at with my next birth. We want a large family, and I’ve already had one cesarean. I don’t want to have another and I’m really considering my options to ensure a VBAC this time. Out-of-hospital birth certainly seems to be the best option, but is it an option for me with my medical history? If I’m risked out of midwifery services, do I “free-birth?” (probably not, but it’s been on the table). How do I manage a hospital VBAC fight while struggling with clinicals? (and a family?)

Apart from the next birth, what about the next postpartum: I want to do everything I can to have a healthy postpartum transition this time around. Fewer stressors would equal reduced risk for me developing postpartum depression again. I was switching from working full-time to mothering full-time at the last birth, so being settled and having less life change is ideal.

Having a great start breastfeeding is also key in my mind: not being able to get out to find the help we needed was a huge factor in our failure to continue breastfeeding. Little man needed specialized care, and that simply did not get met. I would like to not battle with returning to school and pumping; arguing to pump at work seems to be a much easier battle.

So yeah, we’ve decided to avoid for the time being. Neither of us is very happy about it. We both have baby fever to the extreme, and the little man is not very little anymore. He’s talking now, and it’s really obvious that he’s a BOY rather than a little baby. It’s hard also when I consider that by the time I’m done with school, he’ll be almost FOUR. We had hoped to get them close together, so it’s a bit of a blow for us. Of course, we know that conception is not controlled by us, so I guess we’ll see if anything else comes up.

Until then, I’m burying myself in my birth studies, focusing on being the best nursing student, mothering my little man, and being a wife to my fabulous husband. These next two years (or so) better fly by.

Breastfeeding Presentation - A little encouragement for me and other birth professionals

2011-04-26T14:11:00.000-04:00

Hello all! I have been in a terrible hiatus lately as I over-prepared for my presentation. (Background: I'm now a pre-nursing major - officially nursing in the fall - and had a breastfeeding presentation for my nutrition class).

But right now I'm pumped at how the presentation went! I wanted to just share my thoughts, and I hope you'll find them as encouraging as I did.

Before the presentation, I was nervous about a number of things. I had a lot to talk about and not a lot of time. I knew this was probably one of very very few changes these pre-nursing and nursing majors would have to learn about breastfeeding, and I was determined to do it right. Besides the issues of a couple group members (yes, group project love), I had the issues of talking about breastfeeding without anyone shutting down because they felt guilty or didn't agree. I had a textbook that stated formula feeds once daily at three weeks were no big deal and didn't even discuss the supply and demand principle.

I had already come up against nervous nursing types before the presentation. We had asked at the beginning of the semester if we could have someone come in and demo breastfeeding for the class - we were shot down. While the professor was supportive, the dean was concerned about repercussions and denied the request. When the class learned of this, I got some fun comments - "Someone would do THAT?!" "I would be so embarrassed." etc. The typical.

My response: I knitted a breast hat for the baby doll and a breast model for our display. I also was lucky enough to be able to order to very cool breast model from Childbirth Graphics.

Our group had divided up the work, and I had taken the overview portion of the presentation. About a month before the presentation, one group member had a family emergency and dropped, so I took her part as well. In the end, my topic list was the following:

breast anatomy/physiology
latch
positioning
oxytocin
prolactin
supply/demand priniciple
maternal nutrition (calories and nutrients, tandem nursing, loosing weight, increasing supply, placentophagy).

And yes, you read the last one correctly. I was going to talk placentophagy (eating the placenta) to a bunch of nurses.

Needless to say I skipped breakfast that morning.

But....despite all this, I was very encouraged afterwards!

I started with the current recommendations (WHO and AAP) and compared the Healthy People 2020 Goals to the US and WV 2010 rates. I got some shocked looks that it was that bad - yes, it is that bad. (for reference, WV has a breastfeeding initiation rate of 52%, national average around 75%, goal of 82%.)

We talked about the breast, and I explained how latch works, how latch has to be effective to initiate supply and demand, how to tell a bad latch, how prolactin works, how oxytocin works, how you can use that information to understand how to increase suspected low supply, how demand at the breast is essential for supply, etc etc etc. A lot of nods, some lightbulbs going off about - maybe why it didn't work for them/someone they knew. I talked about maternal nutrition, about how much weight loss was average, how much typically began to effect supply, some considerations with what might be lacking in diet and what supplements were probably not necessary for the infant/mother, what things a mother might take to increase supply, and why some eat the placenta.

Yes, placentophagy got some gasps, but I told them that I wanted to address the topic so they could gasp now rather than with the mother who asked for her placenta. Also addressed that some mothers may want the placenta for other reasons besides encapsulation (culture respect) and they needed to be ready to deal with such a request.

I didn't get stoned afterwards.

In fact, I got a lot of questions and comments afterwards. "What about breast reduction - how does it effect?" "See, I had that problem too, that makes sense now." And on.

I'm so pumped about the feedback with this presentation; I can't even convey. I'm not naive enough (quite) to think that it's a huge impact - one class out of many, and many won't even make the nursing program in the end. However, there are a least a few nurses out there who know a little more about breastfeeding and who might be a little more supportive. Yes, unfortunately there are a lot of nurses out there who seem to know nothing about natural birth and breastfeeding. But there are those who do care...

And it's got to start somewhere right?

Some thoughts on my scar - Cesarean Awareness Month

2011-04-05T15:30:00.000-04:00

I've been thinking about my scar more often in the past few weeks - I guess it's part of the healing process. So, this weekend when I came across this post on Facebook from ICAN - "Today's CAM task: For those of you who have had a cesarean, find a quiet spot today, and touch your scar. Spend a few minutes with it. If your scar could speak, what would it say? Be gentle with yourself" - I decided it was time to put those thoughts into words here. Pictures do follow at the end, so be aware that they are not graphic, but raw and personal.

My scar is hideous. There are days I hate it. It's disfiguring and I will never be rid of it.

I was totally unprepared for the pain and numbness - both emotional and physical. No one ever told me I would lose feeling from my belly button to my pubic hair line. I didn't know that through the pervading numbness, my scar would sometimes be painful, even tingle.

I didn't know that some days I would hate my cesarean so much I could cry, while other days I'd acknowledge that under those circumstances, I'd probably do it all over again.

I can't handle the way my skin hangs in relation to the scar. My scar itself is tight, but all the numb skin and tissue is loose. It's embarrassing that my stomach hangs lower on the right side than on the left. I'm disheartened when I think that diet and exercise seem to do little good when the numbness seems to affect the ability to tone and tighten.

The scar itself seems to testify the disregard the surgeon must have had in repair. The right side of the scar is fading like a stretch mark; it's thin and light. The left side is raised and angry, and it extends out farther to my hipbone than the right side does. Sometimes my underwear seems to catch on my scar; sometimes I nick it shaving.

And yet...

I know the fire and passion I had for birthing and women's health rights before my surgery - it's shameful in comparison now.

Surgical birth, recovery, emotional healing - they have given me the experience and empathy I never could have hoped to have had before. I'm ashamed that this is what it took, but grateful to be here in these convictions.

Please go to: http://sites.google.com/site/healthymamachildbirth and click on the ICAN chapter link for more information about a support group coming soon.

June Class Series - Prepared Childbirth

2011-03-30T14:34:00.002-04:00

Healthy Mama Childbirth is pleased to present a June 2011 Prepared Childbirth Course.

The course will begin Tuesday June 7 and run each consecutive Tuesday of the month of June (June 7, 14, 21, 28) from 6pm - 9 pm at Perrow Presbyterian Church in Cross Lanes, WV.

Class topics:
...Class 1: The Third Trimester
Class 2: Regular Course of Labor
Class 3: Variations of Labor and Common Procedures
Class 4: New Baby Care and Postpartum Adjustment

This course is regularly offered for 120.00, but the June series is offered at half price! A 20.00 deposit is due at registration. Please contact healthymamachildbirth AT gmail.com for registration.

More information:
The Prepared Childbirth course is a full four week course designed for women and couples in the latter half of pregnancy. The course is suitable for women and couples in a first pregnancy, as well as those needing a refresher course.

The course focuses on presenting pregnancy, labor, and birth as normal parts of life rather than as times of illness or caution. Because of this, "typical" labor is presenting as a baseline for all other discussions of labor and birthing. However, participants will still become competent in the variations of labor.

Additionally, hospital procedures and interventions will be discussed in terms of benefits and risks, particularly in how they may affect the course of labor. High-risk mothers will also benefit from this focus on "typical" labor in light of how their experience may differ. Birth center and homebirth clients will also see how their choices affect what they can expect during labor.

Class content is presented in a variety of ways in order to meet the needs of adult learners. Participants can expect lecture, handouts, group discussions, guest speakers, displays, role play, physical models, rehearsal, demonstrations, relaxation, and review games.

Class Goals:

* to facilitate an appreciation that birth is a normal and healthy event
* to enhance communication between families and caregivers
* to provide means for partners to support birthing women
* to assist in creating a positive birth environment beginning in pregnancy
* to assist families in achieving a healthy pregnancy and birth
* to facilitate informed consent
* to enhance communication between the woman and her partner
* to assist individual values clarification, regarding your needs and wants for pregnancy, labor, birth, and postpartum

A little late, but better than never: A short analysis of the BMJ exclusive breastfeeding attack

2011-03-22T13:58:00.000-04:00

Yes, it's late. But I recently needed to look at studies and analyze them, and this was one I looked at (turned out I needed something else, but that's beside the point.)

The article is here for reference: http://www.bmj.com/content/342/bmj.c5955.full

I will refer to the full-text of the article, which is free. I will also refer to the citations used by the authors.

The article starts off with an odd statistic. It states that although the WHO recommendation is six months of exclusive breastfeeding, that 65% of all European Union states and the United States "elected not to follow this recommendation fully." This appears to sound as though those nations disagreed with the recommendation; however, the citation for the claim is simply an article on breastfeeding rates rather than policy. For the record, the American Academy of Pediatrics agrees with WHO and recommends six months exclusive breastfeeding. While the nation may agree it is best, and many women may try to follow the recommendation (initial breastfeeding rates are high), actual six months exclusive rates are low.

The article continues by attempting to discount the systematic review the WHO recommendation is based on - "the review included 16 eligible studies, seven of which were developing countries." This seems to be a primary point throughout the article (and many others that attempt to discount exclusive breastfeeding through six months) that while breastfeeding exclusively for six months is best in poor developing countries, it is not so for developed countries (because we have scientifically engineered stuff that is supposedly better than natural).

Breastfeeding adequacy is questioned later, as the authors cit a study by Wells and Reilly and state that "many mothers who exclusively breastfeed would not support their infant's energy requirements to six months." Unfortunately, no further information backing this up is given (unfortunately for them!). The study cited is actually only a hypothesis proposed for developing countries and the authors Wells and Reilly would like further studies to see if this hypothesis is true.

Later in the article, low iron levels are looked at. The authors cite a study that found lower iron levels in United States infants breastfeed exclusively for six months as opposed to four to five months. However, when I looked up this citation, the study also found that the differences were "statistically insignificant." The other studies cited here are ones linking iron deficiency to low cognitive performance and development; a valid point if the difference in iron levels had been significant and of concern.

The article then addresses food allergies, citing a study that found introducing gluten prior to three months and after six months increased the risk of gluten allergy. The authors claim this justifies introducing solids between three and six months. Unfortunately (for them), when i looked at this citation, the study only included infants deemed "at risk" for such an allergy, rather than infants as a whole. The authors the article then state that exclusive breastfeeding to six months is directly challenged by this evidence of higher risk for celiac disease.

The article's purpose is to demonstrate the need for randomized trials regarding breastfeeding rather than the current observational studies. Some may argue this is unethical, particularly in light of the author's own statement that early feeding practices directly influence the rest of a child's life.

Of particular interest, the article ends by addressing competing interests. While none of the four authors received "external funding in connection with the preparation of this manuscript," three of the four "have performed consultancy work and/or received research funding" from infant food and formula companies in the last three years. I think that is particularly telling in light of the article's flaws.

Thoughts on the birth battle

2011-02-16T10:07:00.000-05:00

Recently I have been becoming more and more disgusted watching the arguments in the birthing world. I'm sad part of me is less "green" about it all, because I certainly like the hopeful, optimistic me.

Part of this stems from my entering nursing school (well almost - I'll know by April if I'm accepted) in an effort to continue down my path to helping birthing women while trying to support my family. I feel like a spy in my classes with nursing majors, like I'm trying to figure out how the brain works to so blindly trust the medical model at the expense of common sense, mamas, babies, and families.

My conclusion: In many ways we're all guilty of the same blindness.

Both sides of the birth war use the same methods of guilt and anger, the same self-righteous attitude.

Before I get hate mail, let me be clear that I am certainly on the homebirth, breastfeeding, unassisted if you want it side.

But we're not free from the negatives - the failure to see some options as appealing to others even we will feel they're dangerous (so hard!). And to be honest, I don't know what we do about it - if anything.

It is absolutely true that we often make women feel guilty for not breastfeeding.

Mothers should feel guilty about not breastfeeding - just as they should feel guilty about giving a child a Coca-cola and a donut instead of milk and a banana.

But how do we prevent that guilt from turning into defensive rationalization and inability/refusal to change? How do we communicate with love, empathy, and understanding?

I think we have to start with these assumptions - we do not know all the reasons a mother may choose to do "X" and she is not at the same place we are.

The second assumption, to me, is the hardest and the most important. We can talk until we're blue in the face about the risks of not breastfeeding (which as a note is proven more effective than presenting it as the benefits of breastfeeding - study) but without long-term cultural change we are not going to get there with everyone.

I hate this.

The idealist in me wishes I could help everyone, save every mama and baby from a bad birth, but I can't. No one can. We can try our damnedest and then we just have to hope. Things may not change now, but down the road these seeds may sprout and bloom. We just have to keep planting and watering and weeding.

Breastfeeding Misinformation begins with Doctors and Nurses

2011-02-02T14:01:00.000-05:00

As some of you may know, I have recently gone back to school. I've applied to a local RN Associate Degree program and am working on related coursework. One of my courses this semester is Nutrition and Diet Therapy, and as part of the course requirements, we're presenting group projects. Yes, pregnancy nutrition was taken by the time I got to sign up, but I managed to snag breastfeeding.

I started by scanning my textbook (which is required as we're primarily presenting the text information and supplying research to compliment). I came across this gem: "The adjustments [of breastfeeding comfortably] are easier if supplemental formula feedings are not introduced until breastfeeding is well established, after at least 3 to 4 weeks. Then it is fine if a supplemental bottle or two of infant formula per day is needed." [Contemporary Nutrition: A Functional Approach]

I had a few choice words and then set out to find the research to disprove it. I'm presenting that here.

First - The statement goes directly against current breastfeeding recommendations. WHO states that "exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding with appropriate complementary foods up to two years of age or beyond" (Citation) American Academy of Pediatrics goes this far: Supplements (water, glucose water, formula, and other fluids) should not be given to breastfeeding newborn infants unless ordered by a physician when a medical indication exists.” and “Pediatricians and other health care professionals should recommend human milk for all infants in whom breastfeeding is not specifically contraindicated and provide parents with complete, current information on the benefits and techniques of breastfeeding to ensure that their feeding decision is a fully informed one. When direct breastfeeding is not possible, expressed human milk should be provided." (Citation) Healthy People 2020 Targets are exclusively breastfeeding through 3 months - 46.2% and exclusively through 6 months - 25.5% (Citation)

Second: Formula Supplementation has been linked to early breastfeeding cessation: “Partial breast-feeding (supplementing more than one bottle of formula per day, measured at 1 month postpartum) was associated with shorter breast-feeding duration. This latter effect was minimized by frequent nursing (seven or more times per day), despite formula supplementation.” (citation)

And finally: “Clinicians who recommended formula supplementation or who do not think their advice about how long to breastfeed is very important may be sending signals that exclusive breastfeeding is not something that mothers should value highly. In addition, our results indicate that many clinicians do not feel confident in their skills to support breastfeeding and may have limited time to address the issue during preventive visits. As for mothers, experiencing problems with the infant latching on or sucking seems to be a risk factor for not exclusively breastfeeding.” (Citation - I found the full article through Ebscohost and cannot link it directly. You can comment/email me for the file and I will be happy to supply it.)

I'm excited to use the information I've found to disprove such a fallacy and educate other nurses. Let's hope they listen...

Modern Medical Birth Control - Risks

2011-01-10T10:33:00.000-05:00

Sometimes people wonder why I go through all the trouble of charting to avoid pregnancy when women have so many other birth control options.

I just wonder why they put themselves through medical birth control methods.

Let's look at the risks of some of the modern methods. By the way - It concerns me that I had to do extensive searches on each website to find this information. Some even hide the full side effects from the FAQs portion of their site.

Hormonal birth control pills and patches

Taken from the pdf file (download here) for OrthoTriCyclen - "The use of oral contraceptives is associated with increased risks of several serious conditions including myocardial infarction, thromboembolism, stroke, hepatic neoplasia, and gallbladder disease, although the risk of serious morbidity or mortality is very small in healthy women without underlying risk factors. The risk of morbidity and mortality increases significantly in the presence of other underlying risk factors such as hypertension, hyperlipidemias, obesity and diabetes."

OthroEvra (the patch) contains almost identical wording.

Seasonique (the three-month no-period pills) - "Vascular risks: Stop Seasonique if a thrombotic event occurs. Stop Seasonique at least 4 weeks before and through 2 weeks after major surgery. Start Seasonique no earlier than 4 weeks after delivery, in women who are not breastfeeding. (5.1)
• Liver disease: Discontinue Seasonique if jaundice occurs. (5.3)
• High blood pressure: Do not prescribe Seasonique for women with uncontrolled hypertension or hypertension with vascular disease. (5.4)
• Carbohydrate and lipid metabolic effects: Monitor prediabetic and diabetic women taking Seasonique. Consider an alternate contraceptive method for women with uncontrolled dyslipidemias. (5.6)
• Headache: Evaluate significant change in headaches and discontinue Seasonique if indicated. (5.7)
• Uterine bleeding: Evaluate irregular bleeding or amenorrhea."

Depo-Provera Shots - "Thromboembolic Disorders: Discontinue Depo-Provera CI in patients who develop thrombosis (5.2)

Cancer Risks: Monitor women with breast nodules or a strong family history of breast cancer carefully. (5.3)

Ectopic Pregnancy: Consider ectopic pregnancy if a woman using Depo-Provera CI becomes pregnant or complains of severe abdominal pain. (5.4)

Anaphylaxis and Anaphylactoid Reactions: Provide emergency medical treatment. (5.5)

Liver Function: Discontinue Depo-Provera CI if jaundice or disturbances of liver function develop (5.6)

Carbohydrate Metabolism: Monitor diabetic patients carefully. (5.11)
----------------------------------ADVERSE REACTIONS---------------------------
Most common adverse reactions (incidence >5%) are: menstrual irregularities
(bleeding or spotting) 57% at 12 months, 32% at 24 months, abdominal
pain/discomfort 11%, weight gain > 10 lbs at 24 months 38%, dizziness 6%,
headache 17%, nervousness 11%, decreased libido 6%. (6.1)

To ensure the patient is not pregnant at the time of the first injection, the first injection should be given ONLY during the first 5 days of a normal menstrual period; ONLY within the first 5-days postpartum if not breast-feeding; and if exclusively breast-feeding, ONLY at the sixth postpartum week."

Mirena (IUD device) (This was by far the most difficult to find information on. While others listed their "prescription inserts" with a bit of searching, Mirena asks that you talk to your health care provider for a full list of possible side effects) - "Call your healthcare provider right away if you think you
are pregnant. If you get pregnant while using Mirena, you may have an ectopic pregnancy. This means that the pregnancy is not in the uterus. Unusual vaginal bleeding or abdominal pain may be a sign of ectopic pregnancy.
Ectopic pregnancy is a medical emergency that often requires surgery. Ectopic pregnancy can cause internal bleeding, infertility, and even death.
There are also risks if you get pregnant while using Mirena and the pregnancy is in the uterus. Severe infection, miscarriage, premature delivery, and even death can occur with pregnancies that continue with an intrauterine device (IUD). Because of this, your healthcare provider may try to remove Mirena, even though removing it may cause a miscarriage. If Mirena cannot be removed, talk with your healthcare provider about the benefits and risks of continuing the pregnancy.

Life-threatening infection can occur within the first few days after Mirena is placed. Mirena may become attached to the uterine wall. If embedment happens, Mirena may no longer prevent pregnancy and you may need surgery to have it removed. Mirena may go through the uterus. If your uterus is perforated, Mirena may no longer prevent pregnancy. It may move outside
the uterus and can cause internal scarring, infection, or damage to other organs, and you may need surgery to have Mirena removed.
Common side effects of Mirena include: Pain, bleeding or dizziness during and after placement. If these symptoms do not stop 30 minutes after placement,
Mirena may not have been placed correctly. Your healthcare provider will examine you to see if Mirena needs to be removed or replaced."

Essure - permanent placement of coils within the tubes - "The most frequent adverse events and side e ffects reported as a result of the hysteroscopic procedure to place the Essure micro-inserts were as follows: cramping (29.6%), pain (12.9%), nausea/vomiting (10.8%), dizziness/lightheadedness (8.8%), and bleeding/spotting (6.8%). Hypervolemia occurred in <1% of cases. During the rst year of reliance on the Essure micro-inserts for contraception (approximately 15 months after micro-insert placement), the following episodes were reported as at least possibly related to the Essure micro-inserts: back pain (9.0%), abdominal pain (3.8%), dyspareunia (3.6%). All other events occurred in less than 3% of women." A number of women had to undergo a second surgery because the initial surgery failed to properly place the devices or they became dislodged."

Tubal Ligation - difficult to find direct information since this is not a device or pill, but a procedure. Some general information may be found at webmd - "Minor complications include infection and wound separation. These affect about 11% of women after mini-laparotomy, and 6% of women after laparoscopy.³ Major complications include heavy blood loss, general anesthesia problems, organ injury during surgery, and need for a larger laparotomy incision during surgery. These affect 1.5% of women after mini-laparotomy, and 0.9% of women after laparoscopy. Although fewer complications occur with laparoscopy than with other kinds of tubal ligation surgery, these complications can be more serious. For example, on rare occasions, the bowel or bladder is injured when the laparoscope is inserted. The general risks of surgery are greater if you have diabetes, are overweight, smoke, or have a heart condition."

I encourage women to embrace their fertility. I wonder why so many doctors (and women) feel that loosing a period - and therefore fertility - is a fine or even good thing (think about those "unnecessary period" commercials). Fertility has long been feared by some men and now by some women.

I've heard it said that bottles were invented by men to separate the woman from her child. Don't allow men to separate you from your fertility.

Where do we stop with the "high-risk" designations?

2010-12-20T11:05:00.000-05:00

The other day as I was scanning new books at my local library, I noticed one about high-risk pregnancy. I picked it up and glanced through it.

To be perfectly honest, I stopped when I saw the list of factors that may put you in a high-risk pregnancy.

I honestly think it would put more than 50% of the birthing population as high-risk.

Some are, to be certain, legitimate. Placenta previa, where the placenta covers all or part of the cervix, is more complicated than regular pregnancy and requires education and cesarean birth in almost all cases. I can understand the worries with existing diabetes (particularly if poorly controlled) or high blood pressure, even previous birth defects or preterm births.

But some of the others had me flabbergasted at the level of fear present in obstetrics today.

Pregnancy at less than 18 years old or more than 35 years old.

Low-socio economic status

Being underweight or overweight

Fertility treatments

Having a previous pregnancy loss (yes, singular loss. It's estimated that 10-20% of pregnancies end in miscarriage, but many may feel they have had a late, heavy period).

Having five or more pregnancies

ETC.

The list was quite long.

Why is there such fear? I'm afraid - BRUTAL HONESTY FOLLOWS - that our culture has gone so far away from death being a part of life that we are fearful from the point of conception that someone might die. We are willing to do anything to prolong life. Mothers, in particular, are pushed to self-sacrifice in order to give life to children (I am not talking abortion here. I am talking general pregnancy).

I had a miscarriage before I had my son. It was devastating and took a long time to work through. I still cry thinking about my lost little one; hearing of another's loss provokes the same pain. I lost a child and will always mourn that.

However, I fully feel there was a reason my little one should not have been born. It was his time in life to go. I won't speculate as to what the reason was (that leads down a dark path). It doesn't make it any easier to accept his death, but it is what it is.

I certainly agree that obstetrics has saved some lives that would have otherwise been lost. However, we cannot use that nor the fear of death as an excuse for the mistreatment women, babies, and families currently deal with in the system. In many cases. when presented with an unknown, watching and waiting is less deadly than the "well, we must do SOMETHING ANYTHING" attitude so prevalent in modern medicine. (Certainly we've all heard the scares regarding the current radiation levels we're subjected to with unnecessary ct scans and x-rays? I've been x-rayed for a stomach virus and high fever before. Also, think of the current MRSA superbugs in hospitals due to over-prescribing antibiotics, and the chicken-pox vaccine leading to increased shingles cases. It's got to stop somewhere soon)

We need to stop being so fearful and take back our health. For the vast majority of women, pregnancy and birth are times of health. Your best bet - see a care provider who believes this to be true rather than a care provider who believes pregnancy and birth are times where something could go wrong at any time and you need careful monitoring. Ask your WHY? questions and get second opinions. Loose the "all that matters is a healthy baby" mantra.

New book - look out for similar titles!

2010-12-20T09:57:00.000-05:00

Just came across a new book in our local library titled The Birth Partner Handbook.

Do not be confused!!!!

This is not The Birth Partner!

I highly recommend The Birth Partner. This new one (by a different author), not so much at all. Very much in the vein of whatever the doctor says must be right.

Educate yourself and get The Birth Partner instead!

How do you know when to go to the hospital/birth center in labor? An observation.

2010-12-13T13:49:00.000-05:00

Last night as I was waiting in the ER with my dad (minor surgical complication; he's fine), I observed the strangest thing - three women entered and were directed to the OB admission area. The strange part - none appeared to be in active labor. One in particular (only 37 weeks) sat for at least 10 minutes nearby without even a peep or a squirm. The other two (both 38 weeks) talked with nurses easily, filled out admission paperwork, and climbed into wheelchairs.

The thought in my head - Why are they here yet?!

In pregnancy, among the labor and delivery horror stories, I also often heard about the women who went in too early - "Oh don't worry, I got sent home 'x' times before they kept me."

Did no one bother to tell them that they can (and should) stay at home as long as possible?

I tell women (even those planning an epidural) that in normal labor, you should look for 4-1-1 before heading in. This helps reduce the interventions you may "need" and gets you to the hospital at the point when labor is more likely to keep going rather than stall. Getting to the hospital earlier may even get you there at a point when you can't yet have an epidural (depending on your hospital and anesthesiologist).

With 4-1-1, contractions are about 4 minutes apart, last about 1 minute each, and have been doing so for about 1 hour.

Disclaimer #1: Follow 4-1-1 unless you have another reason to go to the hospital ASAP - bleeding, foul smell with vaginal leaking, feeling something through the cervix/vagina, if you feel that labor is going too quickly, or if you are not yet 38 weeks. I'm not a doctor and don't pretend to be one :)

Disclaimer #2: Don't go to the hospital at all if you can help it! Find a good midwife and birthing center or a good homebirth midwife if you're low-risk in pregnancy. It's not just a "fad"; it's good medicine.

Traumatic Birth – or why some women may prefer cesarean birth

2010-12-06T11:28:00.000-05:00

Lately, I’ve found myself wondering why some women feel cesarean birth is better than vaginal birth. It’s been something I questioned before I was pregnant and was particularly confusing when I was confronted with my own cesarean.

For me, I always wanted a natural, med-free, intervention-free birth. It was devastating for me to be confronted with a cesarean. The recovery was particularly difficult, and the couple of times I “overdid it” really were painful and debilitating.

I’m looking at future pregnancies with fear, as complications during pregnancy are more common after cesarean – placental issues, tubal pregnancies, secondary infertility. The VBAC fight was never one I wanted to be faced with, but here I am.

So how could someone be not just satisfied, but even pleased, with this? I’m slowly beginning to understand.

Recently, I read an article about post traumatic stress disorder following birth; it’s on the rise. As a medical system, we need to acknowledge that in an age where 1 in 10 women suffer from postpartum depression, much less PTSD, that it is apparently not about “just a healthy baby.”

Women need to have the opportunity to mourn the births they have lost. The ideal birth, whatever it is for that particular woman, needs to be acknowledged, and if at all possible, pursued. For me – I lost my first birth to major abdominal surgery. For some, it’s losing the ideal of pain management when a planned epidural doesn’t work, or just being able to go into labor before the pressure of induction begins.

Many women see the cesarean as what saved them – whether it did or not. Maybe it saved them from another traumatic induction lasting 48 hours or more. Maybe it was a way of attempting to control the unknown. Maybe the recovery temporarily saved them from additional childcare and household responsibilities.

As a birth professional, I’ll be honest that I’m a little biased about the solution. But fortunately there are studies and guidelines to back me up. (I’ll list them at the end.)

Childbirth education should be expanded, encouraged, and absolutely available to all. It needs to involved couples working through both their fears and expectations. It must involve current research about normal labor processes and when interventions are medically necessary as opposed to simply routine. It should provide an opportunity for couples to build relationships with others in the childbearing year, expanding their network of support.

Doula care needs to be covered by Medicaid and private insurance. Having a labor doula can decrease the need for cesarean by up to 50%. Postpartum doulas can fill the role once done by the extended family – helping the new family adjust with each child added to the family.

Midwifery care should be more widely available, particularly in rural areas where OB presence is minimal. Low-risk women should be seen first by midwives and referred to OBs as necessary.

Women with negative birth experience should report these to their care providers with the intent that questions are answered and care is altered. It wasn’t too long ago that women and families decided it was unacceptable for fathers to be in the waiting room during the birth of their own children, or that women shouldn’t be forced to undergo “Twilight Sleep” and not be mentally and emotionally present at their own birthing.

It should be no different now that we refuse to accept the parts of the system that make us uncomfortable and that are not supported by rigorous research. What we’re comfortable with may be different woman to woman – med-free, highly managed, etc – but it’s time for individualized care again.

No woman should have to feel that major abdominal surgery was an easier and more acceptable solution that the birth route her body was made and designed for.

Studies and Resources:
Expecting Trouble – written by an obstetrician who feels 80-90% of women should have midwifery prenatal care and at least 70-80% should deliver with a midwife.

The Doula Book – numerous studies about the benefits of a doula – from childbirth satisfaction to birth outcomes.

Healthy People 2020 Guidelines - reduce cesareans, among many others

Post Traumatic Stress Disorder After Childbirth - particularly look at Ten Questions to Ask

Traumatic Birth News Article

Website Relaunch!

2010-11-30T13:38:00.002-05:00

Just relaunched my webpage. Please check it out and let me know what you think!

http://sites.google.com/site/healthymamachildbirth

Thanks!

FAQs about Doula Services with Healthy Mama Childbirth

2010-11-10T15:57:00.002-05:00

What is a doula?
A doula is a trained labor professional who provides support during labor and birthing. The word doula comes from the Greek, meaning “with woman.”

What help do you give as a labor doula?
I provide emotional, physical, and informational care throughout the entire course of labor. I can give you information about labor and birth to help you make informed choices, reminding you of what you have learned in classes and of your desires for labor and birthing. I provide emotional support in the form of encouragement and constant presence. I can give you suggestions to help your individual labor progress well and help you have a healthy birth. I support you physically with comfort techniques, such massage and counter pressure. I also support your partner, giving him suggestions and help for taking an active role in your labor support, allowing him to take breaks, and giving him informational and emotional reassurance regarding the birthing process. I will help you labor at home if you desire. I may also help you know when to go to the hospital or birthing center, or when to call the midwife.

What support do you not give as a labor doula?
A doula never provides medical care. I am however trained in medical interventions and can explain how they work as well as the pros and cons.
I do not replace your partner; instead I support the couple. I will help as much or as little as the couple desires. Your partner has emotional investment in you; a doula usually does not. This is both a pro and a con. Your partner’s emotional investment in you allows him to truly understand you and provide care. A doula’s lack of emotional ties allows her to be objective and unbiased in your care.

What are the benefits of having a doula? From The Doula Book (Klaus, Kennell, Klaus).
“In studies of over 5000 women involving comparisons of outcomes with and without such support [as a doula], we have seen a major reduction in the length of labor, a greater than 50 percent drop in cesarean sections, [and] a remarkable drop in the mothers’ need for pain medication.”

Why can’t I just rely on my doctor for everything?
You can, and you should, rely on your doctor for medical advice.

Unfortunately, many doctors don’t seem to have the time necessary for support. Are your prenatal visits less than 30 minutes? Do you have long wait times to see the doctor? If these are YES, then you probably have unanswered questions. Most simply don’t have the time to address basic needs such as what you eat, how you manage stress, or how you plan to arrange life post-partum.

Many women find that their doctor is not present during labor. Most doctors do not come until the pushing stage. Your doctor may not be on-call when you go into labor, and someone you may never have met may be catching your baby.

A doula is the only trained professional who will be present with you throughout your labor, birthing, and early postpartum period.

Aren’t the nurses there to help me? What about my husband/partner?
Yes, the nurses are there to help you, but the help they may be able to provide might not be what you need or expect. Nurses are responsible for a number of patients, limiting their time to spend individually with you. Additionally, their responsibilities also include a variety of clinical tasks and paperwork. A nurse will certainly help you when she is able, but you will likely find you need information, comfort, and support “NOW” rather than when the nurse is finished with another laboring mother.

As for husbands and partners – while many men feel confident before labor begins, they often find this confidence wanes as labor progresses. They may resent the fact that they have to put aside their own needs and fears to support a laboring woman. Additionally, most men lack the experience and training necessary to continually provide comfort, support, and coping techniques required for a laboring woman. Many men, no matter how well trained in childbirth education classes, find recall and actual practice of techniques more difficult than they imagined.

It is normal for men to feel this way, and doulas are there to both validate the partner’s feelings and give him the support to in turn support his partner, the laboring mother. A doula can offer the informational and emotional support the partner needs. Some partners become overwhelmed just when the laboring mother needs to most support; a doula can allow him to take a quick break while still meeting the laboring mother’s needs.

What if I want an epidural? Are you going to try to make me feel bad or talk down to me?
No! I firmly believe that each woman (and couple) needs to make the choices they are most comfortable with at the present time. I feel my job is to help you make an informed choice – I want you to know and understand all the benefits and risks “common” procedures (such as epidurals and IVs) have.

I do support natural, unmedicated childbirth, and I feel that every woman is more than capable of having that kind of birth. But I won’t think you’re a failure if you don’t have an unmedicated birth. The thing I believe is most important is a safe, satisfying, healthy birth. Some women have it with epidurals, some don’t. Some women have it with natural childbirth, some don’t.

How do you feel about hospital birth? Do you think all women should have home births?
I operate fully under ICEA’s motto of “freedom of choice based on knowledge of alternatives.” Therefore, I fully support women and families in the choices they make in childbirth from elective cesarean to home birth, whether I would personally make the same decision or not.

I fully support home birth. I also fully support each family as they make the decision of birthing location based on both the knowledge of facts and personal needs and comfort levels. Many women in the United States choose to birth in a hospital or birthing center.

Is doula support covered by insurance?
Usually no. However, some families have been able to use funds from their health savings accounts for doula services. Most families find that doula services are worth the price.

I offer payment plans for my services. I also offer some services at an add-on price. However, all basic doula services – prenatal visits, on-call period, labor and birthing support, postpartum visit, and phone/email consultation – are included in the basic price.

Also, because I am currently in the process of certification through ICEA, I offer my services at a lower price than a certified doula.

FAQs about Childbirth Education with Healthy Mama Childbirth

2010-11-10T15:56:00.000-05:00

Why can’t I just take a hospital class?
By and large, hospital classes are not designed to give you all the coping strategies I will. Hospital classes operate under this statistic – more than 80% of women get epidurals. Hospital-based childbirth educators may not be allowed to tell you that “routine” procedures such as IVs may be politely refused or modified (in this example, a heparin lock may be placed for access without compromising mobility).

Additionally, hospital classes are usually much larger than independent classes. Smaller classes allow for discussion and addressing individual concerns and needs.

A true prepared childbirth course should present you with all options. This is allows you to give true informed consent, particularly in situations when you may choose to have an IV or epidural, for example. This component of true informed choice makes an independent childbirth education class your best option.

Why are your prepared childbirth courses six weeks?
I believe that part of the reason we fear childbirth is because we don’t understand it. Our great-grandmothers learned pregnancy, birth, and breastfeeding from their mothers. Women understood that labor and birthing were skills to be learned. They learned from observation.

We’re beginning to understand that these skills still need to be learned. These skills take time, and learning such as this can’t be rushed. Rushing the information results in more difficult recall and less ease of use during birthing.

Besides information, my classes are designed to allow ample practice time as a place to simply “try out” a variety of techniques. I also aim to give each couple the time to discover your needs and beliefs surrounding birthing – time you may not have otherwise set aside.

Why can’t I just rely on my doctor for everything?
You can, and you should, rely on your doctor for medical advice.

Unfortunately, many doctors don’t seem to have the time necessary for routine questions. Are your prenatal visits less than 30 minutes? Do you have long wait times to see the doctor? If these are YES, then you probably have unanswered questions. Most simply don’t have the time to address basic needs such as what you eat, how you manage stress, or how you plan to arrange life post-partum.

Childbirth education gives you the skills necessary to communicate your needs and concerns in an effective manner during your prenatal visits. It also gives you the skills to find additional information outside the doctor’s office (not “Dr. Google” either!)

When you are an informed consumer, you are better able to ask questions during office visits. Childbirth education empowers you and allows you to have a better relationship with your doctor.

Aren’t the nurses there to help me during labor? What about my husband/partner?
Yes, the nurses are there to help you, but the help they may be able to provide might not be what you need or expect. Nurses are responsible for a number of patients, limiting their time to spend individually with you. Additionally, their responsibilities also include a variety of clinical tasks and paperwork. A nurse will certainly help you when she is able, but you will likely find you need information, comfort, and support “NOW” rather than when the nurse is finished with another laboring mother.

As for husbands and partners – while many men feel confident before labor begins, they often find this confidence wanes as labor progresses. They may resent the fact that they have to put aside their own needs and fears to support a laboring woman. Additionally, most men lack the experience and training necessary to continually provide comfort, support, and coping techniques required for a laboring woman. Many men, no matter how well trained in childbirth education classes, find recall and actual practice of techniques more difficult than they imagined.

Childbirth education prepares you for this reality ahead of the game. This gives you time to consider how you will deal with labor and to practice techniques that you can use. It also gives you information about normal labor and possible variations ahead of time so you are better prepared for what you encounter.

What if I want an epidural? Are you going to try to make me feel bad or talk down to me?
No! I firmly believe that each woman (and couple) needs to make the choices they are most comfortable with at the present time. I feel my job is to help you make an informed choice – I want you to know and understand all the benefits and risks “common” procedures (such as epidurals and IVs) have.

I do support natural, unmedicated childbirth, and I feel that every woman is more than capable of having that kind of birth. But I won’t think you’re a failure if you don’t have an unmedicated birth. The thing I believe is most important is a safe, satisfying, healthy birth. Some women have it with epidurals, some don’t. Some women have it with natural childbirth, some don’t.

Some women find that childbirth education allows them to “compromise,” delaying an epidural when they originally hadn’t thought that to be an option. It also gives them more options to try in the event the epidural “doesn’t take all the way,” a phenomenon that occurs sometimes when using this method of pain management.

Am I going to look stupid doing some kind of crazy breathing that my friend says didn’t help her?
Nope! I do believe that breathing patterns and techniques help with labor, but again it’s about comfort level. Personally, I can’t currently do proper yoga breathing; it’s too slow for me. Instead, I slow my breathing down to a comfortable, relaxing level. This works for me, and it’s the point of the breathing in yoga.

We will discuss your comfort level and current ways of managing stress. Your current methods can then be adapted for labor, and we can build on these with others that may work for you.

How do you feel about hospital birth? Do you think all women should have home births?
I operate fully under ICEA’s motto of “freedom of choice based on knowledge of alternatives.” Therefore, I fully support women and families in the choices they make in childbirth from elective cesarean to home birth, whether I would personally make the same decision or not.

I fully support home birth. I also fully support each family as they make the decision of birthing location based on both the knowledge of facts and personal needs and comfort levels. Many women in the United States choose to birth in a hospital or birthing center.

Is independent childbirth education covered by insurance?
Usually no. However, some families have been able to use funds from their health savings accounts for childbirth education. However, most families find that it is are worth the price. I offer a variety of classes, including customized private classes. Also, because I am currently in the process of certification through ICEA, I offer my services at a lower price than a certified childbirth educator.

Another Care Provider in Pregnancy - Chiropractor

2010-11-08T15:47:00.000-05:00

I was unfortunate enough this weekend to pull out my back again (and follow that up with church nursery), so I was at the chiropractor's today. It reminded me of when I pulled my back out during pregnancy, so I thought I'd share.

I feel there is no reason a pregnant woman should have to deal with "regular" backaches during pregnancy. We all act like this is totally normal, but it isn't.

Backache during pregnancy is easily treated (or at least managed) by a chiropractor. I pulled my back during the second trimester. Once it was remedied with a few trips to the chiropractor, I had no more back pain the rest of the pregnancy - even putting on those fifty pounds. (And reminder, I'm only 5'2"!)

Chiropractic care in pregnancy will help return your body to proper alignment. A good chiropractor will also help you with posture and sleeping positions that will help your body to stay pain free. The adjustments aren't painful.

At the start of the injury, you may find yourself at the chiropractor's office a few times the first couple of weeks. This is pretty normal as your body takes the time to settle into the new alignment. The chiropractor will then start to spread your visits out more. After my back was feeling great, I saw the chiropractor once a month as a check-up and slight adjustment.

I recommend pregnant women not wait until the injury is severe, or even until there is an "injury." Back pain should be looked into immediately if possible to lessen the number of adjustments needed for health.

See a good chiropractor that you feel you can trust. It's preferable (in my opinion) that you see one who has an in-house massage therapist or two; massage helps the adjustments settle in and take hold rather than moving back into the painful position.

Also, see a chiropractor who is experienced with pregnant patients. A good chiropractor will tell you if they are or not. When I was going to have the Webster technique (a chiropractic technique to assist in turning a breech baby), my chiropractor told me that while he was trained in it and comfortable seeing pregnant women for other therapies and adjustments, he hadn't done the Webster technique since college. He helped me find someone in the area who was trained and experienced in the technique - and I respect him greatly for being honest with me and helping me.

You might be surprised that your insurance will usually cover chiropractic care. My current insurance, as well as the insurance I had while pregnant, cover up 20 visits a year with my co-pay. You may want to check with your insurance to see if these visits need to be preauthorized, or ask the chiropractor's office staff when you call to make an appointment.

Please feel free to contact me if you'd like to see a chiropractor in the Charleston, WV area. I've seen a few and am happy to recommend them! I have no affiliation with any offices other than being a satisfied client.

Maternal Satisfaction and Pain

2010-10-27T15:31:00.000-04:00

If I were to do a poll about labor concerns, most people would say what they fear(ed) most about childbirth was the pain. What’s more, when most people just think of a word they associate with childbirth, the first to come to mind is pain.

(As a side note: how sad is it that joy, family, or wonder are not the first words. Instead it is pain, epidural, loss of control…)

I digress – pain and its management are very central in childbirth education models (especially in Western thought). There are many different theories of pain – all worth studying.

But the research that surprised me the most indicated that pain is not chief when it comes to satisfaction in childbirth.

Are you surprised too?

Then, of course, since its good research, it didn’t surprise me so much and it even began to make a lot of sense.

It didn’t matter so much as far as pain and its management. Women with epidurals were just as likely as women without medical pain management (drugs) to feel dissatisfied with their birth over these points – information provided, concerns recognized, and support received.

Let me break that down again – women with epidurals were dissatisfied with their birth if they felt the doctor and nurses didn’t give them enough information, didn’t address their concerns, and/or didn’t give enough support.

In fact, research seems to indicate that patients are more likely to sue if they feel they are not being communicated with and included in decision making. (see below for citation)

Can we all collectively say “Wow”?

This totally knocks the old “all that matters is a healthy baby” out of the picture. Also out the door is the idea that an epidural is the “Cadillac” of pain management.

Insurance companies, doctors, nurses, hospitals, clinics, politicians, feminists, women, and men should all be jumping all over this.

Why is it not happening?

Because this model of care in addressing all concerns, providing all information, and giving all levels of support requires a lot of time. If I were better with numbers, I’d run them to see if it confirms my suspicions – it’s cheaper to pay high malpractice premiums than it is to take fewer clients in order to spend more time with each one.

I’ve said it before, but it bears repeating – OBs (and some midwives as well as general practitioners for regular health matters) do not spend enough time counseling patients on preventative medicine and healthy lifestyle choices. How many of us were asked about our eating during our pregnancy, unless we were “gaining too much weight”? How many heard that exercise could be continued but to take it easy, without regard for our current level of fitness?

I’m getting off track – pain, however central in our minds before labor, appears to take a lower position of importance during labor.

Yes, it’s still painful.

Yes, we still want to know how to deal with it – either with coping techniques or drugs.

But for women with or without epidurals, even those with absence or pain or sensation, still have a greater need for this – information and the support it gives.

Once we recognize that and true informed consent happens, it will change everything about birthing in America.

The article that is the main focus of this: http://www.ajog.org/article/S0002-9378%2802%2970189-0/abstract Results: Four factors—personal expectations, the amount of support from caregivers, the quality of the caregiver-patient relationship, and involvement in decision making—appear to be so important that they override the influences of age, socioeconomic status, ethnicity, childbirth preparation, the physical birth environment, pain, immobility, medical interventions, and continuity of care, when women evaluate their childbirth experiences. Conclusion: The influences of pain, pain relief, and intrapartum medical interventions on subsequent satisfaction are neither as obvious, as direct, nor as powerful as the influences of the attitudes and behaviors of the caregivers.

Article concerning likelihood of lawsuit: Communication gaffes: the root cause of malpractice claims. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1201002/

Another article regarding pain management and maternal satisfaction:
Abstract – Maternal Satisfaction and Pain Control in Women Electing Natural Birth – I think this one comes to the wrong conclusion that “survey results suggest that concerns about epidurals and their effect on the baby, greater than anticipated labor pain, perceived failure of requesting an epidural, and longer duration of labor may have accounted for these findings [of being less satisfied with birth].” I think further study is needed, but that it is good to point out what the study did certainly find: “88% of women who requested an epidural for pain reported being less satisfied with their childbirth experience than those who did not, despite lower pain intensity.” http://journals.lww.com/rapm/Abstract/2001/09000/Maternal_Satisfaction_and_Pain_Control_in_Women.14.aspx

Hypnobabies Sale!

2010-10-27T13:06:00.000-04:00

Hypnobabies sale!

Friday, October 29th to Friday, November 5th.

All products at www.Hypnobabies.com website store are 20% off, (excluding MP3s).

Use the "Shop Online" menu in the top right corner of the site's home page and use the ordering code FB-FALL

Breech Birth?

2010-10-25T14:44:00.000-04:00

What options do you really have for breech birth? And will your doctor tell you about them?

I consider myself educated about birth and research-based practices. I studied all I could before I was pregnant and while I was pregnant.

So why did I agree to an elective c-section?

I thought I had no other option.

It frustrates me, angers me, saddens me to learn now what options I did have, but at the time had no way of finding out.

I feel lied to, mislead, coerced even.

It hurts that I feel so taken advantage of.

The situation: I made my doctor very aware throughout my pregnancy of my intention for a drug-free natural birth. This was usually met with a well-meaning but slightly condescending comment that I “really had no idea of how my labor might go, that it might be as long as 12 hours and I may change my mind.”

This should have been my first clue – a doctor should always support any healthy practice. This includes encouragement and even giving further resources. A doctor should never discourage a healthy practice. (How many of us would go to a doctor who told us starting an exercise program or diet was really hard and that we might want to change our mind once we started?!)

Late in pregnancy when he was stubbornly breech, I wish my doctor would have given me other options rather than a scheduled cesarean before my due date. Yes, I should have looked into options on my own as well. However, ethically, a doctor should give you all information. Period.

What could these options have been?

Switch to a practitioner trained in vaginal breech birth. There is at least one in the area (I know this now and with I had known then). Research says that vaginal breech birth is just as safe as cesarean breech for the baby and presents fewer complications for the mother. I believe it is unethical not to provide this information.
Wait until I went into labor to do a cesarean. It seems that we are so focused on the pain of labor (next post will discuss a bit of this) that we forget that labor is beneficial for both mother and baby. Babies benefit from the contractions of labor; they help push fluid from the lungs in preparation for breathing. Both mother and baby benefit from the natural hormonal cocktail (which is very different from the unnatural Pitocin many get) – lactation is facilitated and the baby is better prepared for the sudden environment change. Bonding is initiated. These benefits cannot be overlooked or ignored – they equate fewer NICU stays and better lactation success. Additionally, there is some, however slim, chance that a breech baby may turn during labor. Again, it is unethical for a practitioner to neglect to mention these facts.

I’m starting very much to question going back to my current OB/GYN for future pregnancies – even though I have heard he will attend VBACs. I feel he neglected to tell me so much that I wonder what he might leave out of his VBAC “standard of care.”

I’m always looking for VBAC and breech birth information in the area, and would love to hear about VBAC and breech supportive providers – even homebirth midwives. (which, judging from the research I found for my last post, is looking to be more and more of an option)

A little end note: I would love to get my hands on this film – A Breech in the System.

Research regarding heparin in pregnancy

2010-10-20T15:47:00.000-04:00

Had to do a quick post on this because I am very excited!

As you all know, I had a stroke at 20. In the following months, I underwent a lot of bloodwork and tests to attempt to determine the cause. In the absence of any other risk factors, it appears that chronic migraines and birth control pills were the cause. (Did you know that chronic migraines in women increase the stroke risk? I didn’t.) I tested negative for every single known clotting disorder.

However, I was still on prophylactic heparin during pregnancy and post-partum. I don’t mind the shots; you get used to them. I mind that it forced me into OB care. (Prophylactic – giving a medication or treatment as a preventative or just in case. It’s not treating any problems already there; it’s simply trying to prevent them.)

I just found a slew of articles against prophylactic heparin therapy during pregnancy!

I’m not pregnant again (yet), but I am so excited to have these at my disposal. I wonder where they were two years ago when I needed them and searched and searched. But I’m sure glad to have them now.

Links:
Thrombophilia and pregnancy complications: cause or association? http://www.ncbi.nlm.nih.gov/pubmed/17635737

Anticoagulant therapy for deep venous thrombosis during pregnancy http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD007801/frame.html

Aspirin plus heparin or Aspirin Alone in Women with Recurrent Miscarriage (http://www.nejm.org/doi/full/10.1056/NEJMoa1000641)

Safety of Withholding Heparin in Women With a History of Venous Thromboembolism http://www.nejm.org/doi/full/10.1056/NEJM200011163432002

A Beginner's Guide to Charting, Part 4 - Putting it all together

2010-10-20T12:56:00.000-04:00

Let’s review some things first. The part of your cycle where estrogen is dominant is the first part – the part before ovulation. Progesterone is dominant after ovulation – the last part of your cycle. Estrogen causes lower BBT and higher fertile quality cervical fluid. Progesterone causes a temperature shift to higher temps and a drier (non-fertile) cervical fluid.

During one’s period at the beginning of the cycle, you cannot get pregnant. When we talk about your period, I mean true bleeding and shedding of the uterine lining that is built up during the progesterone phase. You may have heard, however, of women getting pregnant during “their period” – however, this is not a true period with shedding of the lining. Rather, it is an episode of “break-through” bleeding after a long estrogen period. Anytime you are charting and have not had a temperature shift to confirm ovulation, you should assume you are still fertile – even if it has been thirty or more days of a low pattern.

How can this happen? Many times stress is the culprit here. My cycle around my wedding was 43 days long; I didn’t ovulate until a week and a half after the wedding on cycle day 25. Job stress can contribute; as can sudden increases in exercise training (exercise on its own should not inhibit ovulation and fertility, unless you are training for the Olympics and not giving yourself enough rest time. Let’s just go ahead and bust that myth).

Additionally, you can have an annovulatory cycle, a cycle without ovulation. My wedding cycle was simply a very long cycle, but you can have cycles where it seems like your body simply starts over. This is ok if it happens every once in a while, and is quite normal. However, if you only have annovulatory cycles, or have many more of them than fertile/true cycles, you should check with a doctor or midwife. Just like with really long cycles, you should use protection (if trying to avoid pregnancy) or keeping going (if trying achieve pregnancy) until you have that temperature shift. It can be hard to tell when your body will go ahead and ovulate on super long cycles or annovulatory cycles.

Here’s one of my pregnancy charts – Elias chart. You can see how we achieved pregnancy. Any time we made love before the fertile period was just for fun; same for any time after the fertile period. That fertile window is what you want to focus on. This is especially important for anyone who naturally has short cycles or long cycles. If you don’t ovulate on day 14 (again, many of us don’t), you’ll want to analyze your cycles to understand the best time to try.

What about if you are trying to avoid getting pregnant? This is one of the things that I really loved about charting when I first started. Traditional birth control – shots, pills, barriers, spermicides – require that you use them throughout the cycle because they don’t tell you when you are fertile. By knowing when you are fertile, you can limit the use of these methods. (Of course, taking birth control pills 5 days out of your cycle is not going to work!) My husband is not a fan of condoms – many of us aren’t. Knowing my fertile days allowed us to only use condoms during those days; we were free to go without any other time of my cycle.

If you are trying to avoid, there are a few rules/guidelines to follow. You are free during a true period (see above!). You are free three days after a temperature shift with dry-up of cervical fluid (they have to go together). You are free anytime you do not have fertile quality cervical fluid, though the closer you get to expected ovulation, the more careful you will want to be. The best advice – chart for at least three cycles before relying totally on this method to avoid pregnancy.

There are so many other things we could discuss about the finer points of charting, but it would take a great deal of time. I suggest that everyone own a copy of Taking Charge of Your Fertility, or at least check out a copy from the library. It’s an invaluable resource and well worth it.

Again – I have no affiliation with Ovusoft, etc. I simply like and use the software. Thanks.

A Beginner's Guide to Charting, Part 3

2010-09-29T11:39:00.000-04:00

For some reason, women are often embarrassed about their bodies. I don’t consider myself a feminist, but it does amaze me when I see the difference in how men and women view their most intimate parts. Men usually have no problem discussing size, use, and bodily exploration, but women many times even have difficulty just calling theirs by name – vagina. This has me thinking of a scene from the movie 500 Days of Summer – Summer starts screaming “penis” in a crowded place, laughing at others’ embarrassment. I wonder how different the scene would have been if she were screaming “vagina.”

With this all in mind, we’ll be talking about the next part of charting: assessing cervical fluid. Some women are uncomfortable and embarrassed by this, but I don’t believe they should be. No man is embarrassed by his semen.

Cervical fluid (sometimes called cervical mucus, a term I find offensive because it sounds like the stuff I have in my nose during an awful cold. As a side note, why is it that so many terms relating to female reproduction are so offensive – incompetent cervix, spontaneous abortion, habitual abortion, etc. Nasty nasty.). Cervical fluid is a really beautiful thing. It helps protect the vagina from bacteria, lubricates it in preparation and fulfillment of lovemaking, and serves as a carrier and assistant to sperm. It changes throughout the cycle in response to hormones, sometimes fairly quickly. Cervical fluid tells so much about the cycle that it can be used without BBT for charting – though it is very helpful to know both.

During infertile points in the cycle (remember that women, unlike men, are fertile only a few days of their cycle), cervical fluid is usually minimal. Some may describe feeling dry, or “sticky.” When checking cervical fluid at this point, many women describe infertile cervical fluid as yellowish and the consistency of dried rubber cement – remember in elementary school art class how it balls up when rolled between your fingers? This is a very accurate description.

As a woman begins to approach her fertile period, the cervical fluid usually changes. At this point it may be white or clear. The consistency is thin, and it may stretch a little between the fingers. Some women describe feeling “a little wet” all day. (This probably contributes to the increased sex drive many experience before ovulation.)

In the days right before ovulation, the cervical fluid goes through another change. It becomes very slippery. It can be described as looking and feeling just like egg whites (many even call it egg white cervical fluid or EWCF). It stretches a good bit between the fingers without breaking. Many women say they feel “very wet” or “slippery” throughout the day. Sometimes this kind of cervical fluid even slips out when you use the toilet, causing you to not notice it.

Knowing your cervical fluid is very valuable whether or not you’re trying to conceive. Many women go to the doctor or take unnecessary treatments, believing they have an infection because something is coming out of the vagina. Knowing the normal appearance of your cervical fluid can help prevent this; it can also help you find something early on.
Charting cervical fluid is valuable as well for trying to conceive. While temperature doesn’t change until after you ovulate, cervical fluid changes as you approach ovulation. This is why I look to chart both. The cervical fluid lets me know I’m approaching ovulation; the temperature shift confirms ovulation occurred. Also, you can have cervical fluid changes without ovulating – your body geared up and got ready to ovulate, but something happened and it didn’t actually release an egg.

Knowing that you are approaching your fertile period allows you to know when to use barrier methods of birth control, abstain from sex, or try try try for that baby! Cervical fluid dries up after ovulation (or in the event you don’t ovulate, after the hormones drop off before you have break-through bleeding).

There are two ways of checking cervical fluid: outside and inside. Checking outside entails using toilet paper or your fingers to check cervical fluid on the lips of the vagina. Roll it around between your fingers to get the feel of it before you look at it. Check the appearance of your fluid; see if it stretches. Note the color. Record your findings. The advantage of outside checking is that many women feel more comfortable with it and it seems simpler. The disadvantage is that you may miss fertile quality fluid near the cervix and misinterpret your point in your cycle.

Checking inside involves putting two fingers into the vagina as far as the cervix. Draw a bit of fluid from the cervix and check it in the same way as you would check outside. I believe it is valuable to note both inner and outer checks. Be aware of your body, and learn what it can teach you.

Some guidelines and tips for checking cervical fluid:

Check the same way each time. Just like checking temperature, consistency is key. Don’t check outside one day and inside the next. If you are going to check both ways, do so at the same time every day.

Try to check at the same general time of day each day. It doesn’t have to be exact like when you check your BBT. However, you should try to pick a general time – say afternoon – so you can be consistent and remember to do it. Many women check as part of their toilet routine. This allows you to check throughout the day and around the same general times of day.

Don’t check when aroused or right after lovemaking. Arousal fluid and semen can obscure your assessment. You can also note that your fluid was “semen obscured” if you are unsure.

A great website for seeing cervical changes is this one: My beautiful cervix. Look at it and appreciate the beauty in how your body was designed.

Next post: putting it all into practice and some general tips.

A Beginner's Guide to Charting, Part 2

2010-09-21T13:29:00.000-04:00

The first step to charting is the easiest – taking your temperature. It is a little more involved that just sticking a thermometer in your mouth whenever; so let’s look at the why’s and how’s.

Basal body temperature is one of the most important things in charting. In fact, you can do it alone (without what I’ll talk about in the next post) and get a pretty good idea of what is going on. I would even suggest that you just do your temps for a month before going into the rest of charting – ease yourself in.

In the first part of your cycle, before ovulation, your temperature is generally “low.” Average temperatures may range from 97.0-97.7, though yours may be different. The number is not what’s important – you’re looking for a pattern of lows. My general pattern for pre-ovulation temps is around 96.8-97.0, lower than “average.” However, it’s my pattern.

Right around ovulation, generally the day following, you should have a temperature spike followed by more “high” temps until your period. They might range from 97.7-99.0, but again yours may be different. Mine are usually 97.3-98.1. If mine go any higher and stay, I can usually guess that I’m pregnant and I buy a test. That’s my pattern. You’re trying to find your pattern.

How do temperature patterns show ovulation? (It’s all too convenient I know). Before ovulation, estrogen is the reigning hormone in the reproductive cycle. One of the “side effects” of estrogen is a lower body temperature. Therefore, while in the low pattern, it is usually safe to assume you haven’t ovulated.

After ovulation, progesterone takes over. One of the “side effects” of progesterone is an increase in body temperature. For some women, this increase is gradual, but most of us get a nice “spike.”

How do you determine what temp to chart? You can’t just take your temp whenever and however you want to; it changes too much throughout the day to give your resting temperature. Fortunately, it’s easy to get that BBT – no math involved.

1. Take your temp as soon as you wake up, first thing in the morning. This sounds harder than it is, and takes just a little getting used to. You need to take your temp the very first thing in the morning – before you get out of bed, kiss your husband, say good morning, stretch, etc. When your alarm goes off, reach for the thermometer, stick it in, wait for the beep. Period. Doing anything beforehand will likely alter your temperature. In order to see a good pattern, you want it to be as accurate as possible.

2. Also time is important. You want to try to take it at the same time every day. When I worked full-time as a teacher, I got up at 6:00. On the weekends, I just kept my alarm at 6, took my temp, and fell back asleep (remember that I wanted you to get a thermometer with memory? This is why!). Now, my husband gets up at 6, usually disturbing me, so I take my temp then.

3. Take your temp after at least three hours of sleep. It generally takes three hours for your body to settle down to its resting temp. Some may take longer. While at least three hours is the rule, for accurate charting you really want to be getting close to the same amount of sleep each night. An hour or half may not make much of a difference, but going to be at 1 instead of 11 probably would. If you’re unsure if your sleep was disturbed, the best thing to do is take the temp anyway and make a note. If that particular temp matches your pattern, keep it. If it doesn’t match, mark it out with an X.

4. Take your temp the same way with the same thermometer each time. Don’t change your thermometer (if at all possible) until the start of a new cycle. Different thermometers (even the same kind/brand) may read slightly differently, making a pattern hard to see.

Most women when they start out charting choose to take their temp orally. In this case, you want to try to take your temp in the same part of your mouth under your tongue every time. Different parts of the mouth are warmer than others, particularly if you sleep with your hand on your face or something like that. If you sleep with your mouth open, it may difficult for you to temp accurately. You can try for a couple of cycles if you like, or you can just try the second way.

You can temp vaginally. A vaginal temp will give you the most accurate temp; it doesn’t hang open at night (we hope!) and it doesn’t get warmer if you sleep with your hand on your cheek. Vaginal temping also gives you a little break when you’re on your period – unless you’re really dedicated (I’m not!). It’s really not difficult or gross; just stick the thermometer in and wait for the beep.

I’ve temped this way for years. I temped for a year orally before I switched. (And yes, it’s the only thing I use that thermometer for and it gets an alcohol bath!). My temps are generally a couple points higher this way and my pattern is much more stable – thus easier to read.

If temping vaginally makes you feel funny, just wait until the next post. Learn to be comfortable with your body and life will be a whole lot easier!

A Beginner's Guide to Charting, Part 1

2010-09-14T13:09:00.001-04:00

Also see necessary definitions.

Let’s talk a little first about what charting is and why I think all women should do it. Charting is a component of natural family planning (NFP) and the fertility awareness method (FAM). Charting allows you to analyze your fertility signs and determine your fertile and non-fertile days.

If you remember your 6th grade sex ed class, you remember how easy it seemed to get pregnant. Not quite so. Men are fertile all the time. Semen is always being produced; it always has sperm (in healthy men of course). Women on the other hand are not always fertile. We are not constantly releasing mature eggs to be fertilized at any time of the month. Most of the time, women are fertile for about five to seven days of any given cycle.

Why is this important? I’m no feminist (well, some would probably consider me one…), but I feel the birth control and birthing industries are to entirely male-dominated. Culturally, we consider it a woman’s responsibility to take birth control pills, even though women are not fertile all the time. Some even consider it a woman’s responsibility to make sure her partner wears a condom – even though that’s not her equipment shall we say. Birth control pills are costly, both financially and physically. There have been too many women who have had adverse effects from these supposedly “safe” pills. (I’m one; you’ll hear me rant about it all the time.)

Understanding your fertility through charting is non-invasive – unlike pills, spermicides (do I really want something that toxic in me!? In there!?), shots, patches, and surgical procedures. The United States has one of the highest incidences of surgical sterilization FOR WOMEN in the entire the world.

Understanding your fertility gives you more understanding about your body than taking something. This goes beyond trying to conceive. It can help you determine when your period is to be expected, when you can safely have unprotected monogamous sex, and where to start in diagnosing hormonal problems. It also gives you an intimate understanding of how your body works.

For today, we’ll just look at the supplies you’ll need. They are really simple and overall cheap. I’ll also let you know my personal preferences here.

1.A good thermometer. The heart of charting is based on your BBT. This is the resting temperature of your body – the next post will talk about how to determine it.

I like a digital thermometer that has a memory function. You need one that goes at least to the tenth decimal (97.6), but I like one that goes to the hundredth (97.68). The one that I’ve used is a BBT from Walmart. I bought my first years ago when I first started charting, and it lasted until I got pregnant. To be safe, I bought another after I started charting again post-partum. It’s white with a pink tip, and is specifically a BBT thermometer. It’s been very accurate, and it beeps when then temp is read after 60 seconds.

I tried a regular thermometer that was ready and beeped after 9 seconds. I found that it wasn’t very accurate for me. There are some that say that you must have a BBT thermometer to be accurate for those lower temperatures; that regular thermometers are just looking for fevers. I don’t know, but personally I’ve found that my BBT worked better for me. It’s worth saving your money buying one good thermometer than buying two after you don’t like the first. You’ll want this thermometer to be only for your charting.

2. Pencils and downloaded charts such as these:

(If you choose to do the next supplies, you won’t need the pencils and paper charts unless you want a backup).

Charting, in a way, is like graphing in high school math. You mark specific number points and connect the dots. You’ll want a pencil in case you make a mistake. The nice thing about pencil and paper charts is that they are relatively low-cost. I don’t regularly use them, though I have if I’m out-of-town and can’t use the next option – computer required.

3. Charting software: such as Ovusoft, Fertility Friend, and others.

The first thing you should know about charting software is this: you must be smarter than your software. Buying (or using free) software is not a substitute for understanding your own fertility and how to chart it. This is especially important when you are first starting out.

For example, most charting software starts out assuming you have a 28-day cycle, the average. It will make predictions based on those values. These predictions may very well be incorrect if your cycles are not average. However, the longer you use the software, the more it will understand your personal fertility.

I personally use Ovusoft. I bought it in 2007, and paid a one-time fee. In 2009 while I was pregnant, our computer crashed and I lost the software. Fortunately, customer service was able to send me the activation code. I downloaded the software again and started using it at no additional cost. It’s a very user-friendly software. The book that goes with it cannot be recommended HIGHLY ENOUGH! Every woman should own a copy of Taking Charge of Your Fertility. It’s explains the finer points of charting – things I won’t get into on a post.

I’ve also used Fertility Friend. It’s a nice simple software, online-based. And it’s free (though additional features are available by subscription). I highly, highly recommend putting it on the FAM setting if you do use it. The others are less accurate, especially in your first few cycles. Every once in a while, even on the FAM setting, Fertility Friend gets confused and doesn’t give you accurate assessments. This is where you need to be smarter than your software.

4. Your fingers. Yep! But I’ll explain this in later posts.

For the record: I have no affliation with any of the products mentioned here.

A Beginner's Guide to Charting, Definitions

2010-09-14T13:06:00.000-04:00

Basal body temperature (BBT) – your body’s resting temperature, almost always lower than 98.7

Cervical fluid or cervical mucus – the fluid within the cervix that is created by the body as a carrier for semen. The fluid changes as ovulation nears to allow conception to take place.

Charting – keeping track of BBT and cervical fluid throughout cycles and using that information to determine fertile and non-fertile days.

Fertility awareness method (FAM) – recognized by the FDA as an aid to conception, also used by many as a method of “birth control”. Based on BBT and cervical fluid checks. May or may not involve abstaining during fertile days (can use “back-ups” such as condoms)

Fertility Friend – an online based charting method, free for basic service, monthly fees required for “premium services”

Natural family planning (NFP) – a method of “birth control” recognized by the Catholic church, involves abstaining during fertile days. Based on BBT and cervical fluid checks

Ovusoft – a charting software, requires one-time payment for the software. Not available for MACs. Currently testing a web-based version.

More definitions to be added as needed!

Benefits of Red Rapsberry Leaf

2010-09-07T16:23:00.000-04:00

As you know from my last post, I’m taking an online herbal course.

One of the best traditional, natural “treatments” I’ve seen for all women is Red Raspberry Leaf (various Rubus species). Let’s break down the why’s and how’s.

Red Raspberry Leaf is a uterine tonic. This means simply that it helps tone the uterine muscle. For pregnancy, this has been reported to shorten labors (a 2001 study published in the Journal of Midwifery and Women’s Health). This is probably due to the fact that the tonic action strengthens the muscle so as to assist the uterus to contract more efficiently. Contrary to what some may worry, it won’t start labor – as a uterine tonic, it doesn’t make your uterus contract; it helps it do the work (see suggestions and contraindications below).

Because it has these tonic capabilities, some midwives recommend women drink an especially strong infusion during labor and during the immediate post-partum period. It is thought that Red Raspberry Leaf will improve post-partum hemorrhage by assisting uterine contractions. Some women report that “after-pains,” those painful post-partum contractions usually associated with second (and more) babies, are lessened or eliminated.

These reasons alone are enough – but what about the rest of us who aren’t pregnant?

The uterine tonic action of red raspberry leaf can also improve women’s cycles. If you experience painful periods, especially associated with severe cramps, heavy flow, and passage of clots, it is certainly worth it to try Red Raspberry Leaf. The tonic action may assist your body in shedding the lining without needing to cramp.

Some midwives report that Red Raspberry leaf helps prevent miscarriage. (Other report that it is contraindicated in the first trimester, see below). It also reported to ease morning sickness during pregnancy and diarrhea any time due to its tonic work in the intestines and stomach.

What about benefits besides the tonic action?

Like Dandelion (yeah, the stuff that grows in your yard!) and Red Clover, Red Raspberry Leaf is high in calcium and potassium (it also has vitamins A, B, C, and E, and phosphorus). The need for calcium in women’s diets is well-documented. For pregnancy, this increase in calcium not only supports the rapid growth necessary; it also may help with those awful “charley horses.” For postpartum and women otherwise enjoying their fertility through regular cycles, the calcium and potassium support regular bone health. Remember that nutrients we are able to obtain through food sources (and herbals, because after all they are food too) are better absorbed by the body than the best over-the-counter supplement.

Some research indicates that Red Raspberry Leaf also increases milk production. Others report that it can help lower blood sugar levels in diabetics. It may also be used to treat flu and fevers.

So, how does one take it?

I believe, like so many other supplements that you can buy capsules of Red Raspberry Leaf. However, I much prefer to take it as an infusion. You might think of an infusion as a very strong medicinal tea. You can buy Red Raspberry Leaf tea bags, but they tend to be expensive and may be mixed with other herbs or otherwise weakened. I bought my leaf from Frontier by the pound.

For pregnancy, I personally would suggest you take the infusion daily. You may want to make a strong infusion for labor. Some women have even made an infusion and frozen it to have the ice cubes to suck on during labor!

For general womanly health, I would suggest taking the infusion at least during the second half of your cycle (easy to do if you chart your cycles, otherwise take it for about two weeks before you expect your period).

Here’s how I suggest you prepare it.

Generally, you should use 1 tbsp dried herb per cup of water (2 tbsp fresh per cup). This is true for Red Raspberry Leaf. If you are planning to take it during pregnancy, I suggest you make a quart (4 cups) a day and sip on it throughout the day. The directions below are for a quart.

Boil 4 cups of water in a small pot. Take 4 tbsp of dried Red Raspberry Leaf and put it in the bottom of a jar. Pour your 4 cups of boiling water over the Red Raspberry Leaf and allow it to sit for 20 minutes. (Some say to infuse overnight. I have tried both and can’t really tell a difference.) Refrigerate and enjoy. You can sweeten it taste – honey is good – or even mix it with fruit juice, which I what I usually do.

Contraindications? and other suggestions.
Some sources tend to be on the conservative side and recommend against Red Raspberry Leaf during the first trimester; they are worried that it may “over-stimulate” the uterus and cause miscarriage. From my research, this seems very much to go against the way Red Raspberry Leaf works as a tonic. However, you may want to abstain from the infusion during the first trimester, for your peace of mind more than anything else. I believe your stress level and peace of mind affect your pregnancy; do what you feel is best.
I found once source that indicated that the infusion was contraindicated during breastfeeding, though it did not explain its reasons. Nearly all other sources indicated that the infusion promoted lactation (and therefore would not be contraindicated). Again, use your own judgement.

These are some of the sources I used in writing this entry:
From Susun Weed – Her wonderful Herbal for the Childbearing Year along with this webpage: http://www.susunweed.com/Article_Pregnancy_Problems.htm

An article by Chandramita Bora: http://www.buzzle.com/articles/red-raspberry-leaf-tea-benefits.html

An online source that quotes Susun Weed: http://www.truthseek.net/Raspberry.html#anchor_147

http://www.brighthub.com/health/alternative-medicine/articles/81895.aspx

Various herbals such as those by David Hoffman and The Earthwise Herbal by Matthew Wood

Rosemary Decoction

2010-08-31T16:17:00.001-04:00

I’m taking an online herbal course for doulas and midwives through BirthArts.net. I decided the other day that for one of my assignments, I’d try a rosemary decoction for a hair rinse. I’m using rosemary because I’ve got fairly dark hair. I’m hoping for a few things from this – that it’ll strip some of that left-over “wash-out” color that’s there, and that it’ll help with the grease that seems to plague me this time of year. As I go more into the course, I’ll be sharing some of my other assignments that are specifically for the childbearing year.

I started out by going into my garden and gathering some rosemary. I needed four tablespoons worth of rosemary for the two cups of water I was going to use – two tablespoons for each cup. Here’s my rosemary. (The extra that I gathered went for chicken at dinner!)

I put a pot on with the water and measured out my rosemary. Once it was starting to boil, I turned it down to simmer. The rosemary needed to simmer for twenty minutes.

Here’s the rosemary after just a couple of minutes.

Here it is after about ten minutes.

(I did dishes while it simmered…little man was napping and I was taking all my opportunities to get stuff done!)

After it simmered, I strained off the rosemary and had just my decoction. I used this measuring cup because it was what was handy to run down the hall with to get a quick shower.

I didn’t let it cool very much, which I certainly will the next time. I usually take a shower in the evening, so next time I plan to make the decoction in the morning and let it sit.

For my shower, I decided it would do me no good to use my regular shampoo and conditioner with the rinse. I grabbed some of my son’s shampoo instead, which is the BEST stuff for little ones. We have used California Baby’s Sensitive shampoo and bodywash for him since he had a bad outbreak of eczema. He hasn’t had an issue since. (For the record, before we switched, we had used Burt’s Bees which is great, but has scents in it like everything else. The stuff from California Baby is totally unscented and awesome – and I have absolutely no affiliation with them)

After I used the shampoo, I rinsed with the rosemary decoction. I could have gotten by with just a cup, especially since my hair is currently really short (thank you bad hairdresser!). I let my hair dry naturally, because that’s what I always do.

This is a bad picture of my hair before the shower and rinse.

This is my hair as it was almost drying, before I did anything to it.

This is after quickly running a straightener through it. There’s no product in my hair. It’s the softest it has ever been. Awesome. I also fixed up my bangs a bit.

What is my role as a doula and childbirth educator?

2010-08-25T13:18:00.000-04:00

As a member of the childbirthing profession, I am a member of a number of listserves and email groups online. This week, one of the groups erupted with such a discussion that the current moderator stepped down and the group is going to have to re-form anew.

The topic: epidural kits and discussing epidurals in the classroom.

Some argued that having epidural kits “normalized” the idea of an epidural and made it easier for couples to get one. Others argued that without discussing epidurals, you are not actually providing informed consent. I take the second stance.

I have come to the conclusion in my own life that decisions that are best for me may not be best for others. Decisions that are good for me NOW may be different than decisions I made in the PAST or different from the decisions I may make in the FUTURE.

What does this have to do with childbirth education?

I do not think the focus of all childbirth education should be a natural birth at any cost. I don’t think we’re ready for it here in the U.S.

Please, don’t get me wrong. I think every woman that absolutely can do so, should have a natural childbirth. It’s good for her and for the baby.

But if we focus childbirth education as an all-or-nothing, we lose the women who may be on the fence. When we alienate women, we only hurt ourselves. (This, I think, is a failure of the feminist movement. But that’s a whole ‘nuther ballgame).

There are plenty of women out there who think that they cannot possibly cope with the pain and other distresses of childbirth. These women need to be empowered, not made to feel that they are less of a woman if they have an epidural in their birth. If they are empowered with information, maybe next time they have a natural birth in the hospital (as difficult as that may be). Then maybe they have a homebirth.

The woman who grows as a result of all her childbearing decisions will be the biggest advocate for natural birth. This is especially true among her close friends and her DAUGHTERS.

I have been trying to think about it that way as I formulate my classes. I want to support women in whatever birth they choose, even if it’s not the birth I would have.

“You had an epidural? How did you feel about that?”

“Stadol? That helped you get through?”

“You did everything you could to breastfeed this one? What do you think about breastfeeding the next one?”

Women are nasty enough to each other as it is. Don’t let that come over into the curriculum realm…

A lot of times, I think, we as childbirth educators and doulas forget that this is not our birth. Two wise women on another list this week talked about this concept in a great way.

From Polly Perez -

The Difference in Feeling Responsible TO and FOR

When you feel responsible TO others....

You show empathy, encourage, share, confront, level, are sensitive, listen.
You feel relaxed, free, aware, high self-esteem.
You are concerned with relating person to person, feelings, and the person.
You are helper/guide.
You expect the person to be responsible for themselves and their actions.
You trust and let go.

When you feel responsible FOR others....

You fix, rescue, control, carry their feelings, don’t listen.
You feel tired, anxious, fearful, liable.
You are concerned with the solution, answers, circumstances, being right, details.
You are a manipulator.
You expect the person to live up to your expectations.

There is such freedom in that! (This kind of freedom is why I got out of teaching public school. I’m not wholly responsible for this kid’s A or F. His parents and he are responsible as well.)

My job as a doula or childbirth educator is to inform. As a doula, I consider this to be very secondary unless the couple also hires me as an educator. I can’t make anyone want to learn and find out and question. If you’re not satisfied with every single thing your care provider suggests, I can point you in the right direction and show you where to find information for your truly informed consent. But I can’t make you read it. And I can’t make you ACCEPT it. As a childbirth educator, I can present that information to you, but again, I can’t make you ACCEPT it.

We need to keep informed choice at just that – CHOICE.

As a side note, but very related to the idea of choice, here’s an article about the availability of midwives and how it changes maternity care for the better. Note – it doesn’t say choosing a midwife, but just that the choice is available. I think all women with normal pregnancies should be seen by midwives, but again, we’re not there yet…How I hope we are soon!

Access to Midwifery Care Improves Outcomes

Birth in America - affecting the whole family

2010-08-16T21:37:00.000-04:00

I believe the pervading culture of medical birthing in America has directly attacked families. As childbearing has been increasingly hospitalized and medically controlled, families have become smaller and smaller. Breastfeeding has decreased. Many couples are even choosing to have no children at all.

Why, as a culture, would we ever accept someone else dictating how big or small our family should be?

This is, in effect, what has happened with America today. Of course, my OB has never directly said to me, “You should only have two kids. Maybe three if the next is also a boy and you want to try for a girl.” But in his advocating a cesarean section for a first-time mother with a frank breech baby could easily dictate my family size.

How can this be?

Think about it this way. What if I were a regular birth consumer, one who takes her care providers advice at face value without probing? What if I then find out my OB doesn’t support VBACs, or he finds a way to “risk me out” of one? After a second cesarean section, my recuperation is probably more difficult – I have another child to deal with the second time. Breastfeeding is also more difficult, and the first section had complicated matters enough that I hadn’t continued breastfeeding the first. Maybe, as a regular consumer, I don’t even try the second time. I may do formula again, driving up our personal living costs, and taxes – we receive WIC vouchers. Even if I do pull through and breastfeed, think of the unnecessary stress and hardship a second cesarean, probably not done for any reason other than a previous cesarean, would put me through.

Why would I ever put myself through this again for even one more child?

As a culture, we need to realize that many times birth is traumatic and unnecessarily so. Women who have a traumatic vaginal birth for their first child are much more likely to request an elective cesarean for their next birth. If traumatic birth seems to be the only option, why voluntarily go through it again? The United States has some of the highest rates of permanent “birth control” in the world. Obviously, plenty of women are deciding it’s not worth it.
And I think the mode of birth can (though of course not always) have a direct impact on childREARing.

Again, think about it – we know that women who have traumatic births are at substantially higher risk for post-partum depression than women who are satisfied with their birth. Though women who have emergency cesareans may come to accept it or say it was for the best, I truly doubt you could say those women ever come to the point of feeling satisfied about that mode of birthing. Traumatic vaginal births fit in here as well. A woman may decide her nightmare of an induction was “medically necessary,” but it will never feel her with happiness.

And, women who have post-partum depression and/or traumatic birth are at higher risk for abusing their children. I’m not in any way attempting to justify child-abuse in any situation; we need to acknowledge these facts.

I believe that it doesn’t have to go as far as that even to affect the family. You can think of it like a continuum. Even if a woman doesn’t get to that point of actual physical abuse (or emotional abuse) or even to the point of post-partum depression, that dissatisfaction with the birth can subconsciously effect the way you raise your children.

As more and more births took place in the hospital, more and more women chose to enter the public workforce. Women go back to work for a variety of reasons, including both financial necessity and needing a “break” from the kids. At the same time women really begin entering the public workforce you see communities like The Farm with Ina May Gaskin where women chose to work within the family to provide extra income. While there is much more to that phenomenon than birthing, we can’t forget that birth certainly must play a role in it.

Birthing is not something you can just forget about and get over.

It’s coincidence that if you tell a woman you’re pregnant that you will hear every detail of her birth and pregnancy. This is the way it should be. Pregnancy and birth are life changing events every single time they take place.

Unfortunately, it seems that most of these details are negative. These negatives are by no means a small portion of the birthing population. It’s not that the few women who have bad experiences are the only ones speaking up. The vast majority of women seem to have negatives associated with their birth and pregnancy – scares in pregnancy, misdiagnosis, traumatic births, repeat cesareans.

Now you may say that families are smaller and more women working outside the home because of the advent of birth control. However, birth control methods have been around for thousands of years. Women knew and understood their fertility, when they were possibly fertile and when they weren’t, and they used herbs and timing to enhance or even suppress their fertility. Women in some cultures even used herbal preparations to bring on permanent sterility.

We also acknowledge that more children meant more workers for farming. We forget that more children also meant more mouths to feed, more bodies to clothe, more girls to provide dowries for, more boys to find apprenticeships in an already struggling household.

And families were still large.

I believe that if we fix the birthing environment in America, women and families will feel freer to have more than just “one of each.” There will be plenty of families who will still desire only one or two or three or even none and feel complete as a unit, but those families who desire more will feel free to have as many as they desire.

Children are a joy and a blessing. Feel free to complete your family.

For further reading - I have heard very good things about the following book. I'll admit that I haven't read it; I started it and got too emotional. It hit too close to home.

Weight Gain in Pregnancy...How much is enough?

2010-08-04T17:13:00.000-04:00

American women are probably some of the worst regarding obsession with weight, and it’s unlikely that this obsession will diminish any time soon.

But this obsession among pregnant women needs to stop. Now.

I’m amazed at this phenomenon among pregnant women, particularly among women who otherwise are focused on having a healthy pregnancy. We scrutinize ourselves religiously – “Am I putting on too much weight?” though we never ask if we’re not putting on enough… We brag that we haven’t gained any weight by week ‘x’ in our pregnancy. Our friends even join in – “I would be sooo happy if I were as small as you are at ‘x’ week in pregnancy!”

Excuse me?

Maybe we’ve forgotten the facts. Or maybe we haven’t heard them.

For the woman of average weight/BMI pre-pregnancy, an increase of 25-35 pounds is considered normal. 25 pounds is the absolute minimum for the average woman. Underweight women should gain even more. Personally, I think these values are a bit conservative.

Let’s look at where this weight comes from. At 40 weeks, you should be looking at the following increases:

Baby - 7 to 8.5 pounds (at least!)
Placenta – 2 to 2.5 pounds
Amniotic fluid – 2 pounds
Increase in the uterus – 2 pounds
Breast increase – 1 to 4 pounds (we forget that our breasts are not fully developed at puberty. They don’t fully develop until lactation.)
Blood volume increase – 4 to 5 pounds
Tissue fluid – 3 to 5 pounds (a little swelling is supposed to happen!)
Fat stores for breastfeeding – 4 to 6 pounds

I think fat stores of only 6 pounds are too low if you’re breastfeeding. For me, personally, it would not have been adequate. I put on 50 pounds while pregnant (yes, 50, just so you know it’s not a misprint), and would have lost every bit and more if we had continued breastfeeding.

As it were, I lost 31 pounds the first month postpartum. I had a very high supply and a healthy, hungry baby. If I were average weight pre-pregnancy, had put on only 25-35 pounds, and lost like that postpartum, I would have plummeted into the underweight category and put myself (and my son as long as I was breastfeeding) at health risks. It’s not worth it to look skinny.

In all my research, I have found little to no evidence in order to be concerned with weight gain above the guidelines of 25-35 pounds (apart from gestational diabetes) as long as you eat well. If pregnant women eat healthy – fruits, veggies, whole grains, lean protein, good fats and oils – they will gain the amount they are meant to gain. Our bodies, in the vast majority of cases, know what to do.

Inadequate weight gain increases the risk of preterm birth and small-for-gestational age infants. Maternal and fetal risks increase in these cases. Having a small baby does not equate easy birth. Smaller babies may have more trouble feeding, even bottle feeding, and a harder time sleeping well and keeping adequate body temperature. Is it worth it to be skinny a few months later?

Even if total weight gain is adequate at the end of pregnancy, inadequate gains during either half can increase your risks. Inadequate gains in the first half of pregnancy can increase your chance of a small-for-gestational age baby; inadequate gains in the second half can increase your risk of preterm birth.

So eat! Eat well! Eat only when you’re hungry and eat nutrient rich foods. Your weight gain in pregnancy is meant to provide for your little one both now and later.

It’s supposed to be this way.

A couple of notes:

Of course, I’m not advocating that you eat whatever you want, as much as you want, whenever you want. Obesity and excessive weight gain during pregnancy present their own sets of risks. However, I’m a firm believer in the theory that if you eat well, you’ll gain what your body is meant to gain.
The facts in this entry are taken from ready the following nursing textbook. This blog is factually based and any opinions present are based directly on my knowledge of current research and personal experience. The source is – Maternity and Women’s Health Care. By Lowdermilk and Perry

Servant Heart

2010-08-01T14:21:00.002-04:00

Everyone questions their ability from time to time. I’ve been doing it a bit more often since last weekend’s Homebirth Meetup.

It’s easy to be intimidated. Many of these women are much more experience in birthing and breastfeeding than I am. Even the ones who may just be getting started at least have personal experience to lean on.

Now, I’m confident in my skills. I’m confident of my learn-while-doing abilities. I’ve been fortunate to acquire plenty of book knowledge and am just waiting to try it out.

But I have other experience that others don’t have. I’ve spent my life in the servant role.

My younger brother has severe autism and mental impairment. He now has 24-7 in-home care, but there were definitely some long hours when he and I lived at home. You do what you have to do so his needs are taken care of.

I’m a mother. We could, of course, leave it at that. When I think of the mother role, I often think back to a scene that happened a few months ago. We were at our friends’ home, having dinner, when an unexpected guest showed up. “I’m starved! I haven’t eaten all day!” And he sat down to devour some dinner with us. I turned to my husband and whispered, “what so special about that? I can’t tell you how many days I’ve had to do that with our son. It happens.”

But, of course, guys don’t deal with that kind of sacrifice as often or as naturally as women seem to do.

Women deal with those kinds of things all the time, whether we’re mothers or not. We’re the ones pitching in to take care of siblings, watching church nursery, working extra so our partners can go back to school, putting off our own dreams for whoever else needs them.

Those of us who find that this lifestyle comes easily often find ourselves in servant roles – teachers, nurses, caregivers, stay-at-home moms. I spent years, before becoming a stay-at-home mom, teaching middle and high-school students the finer points of English language and literature.

And I can’t discount those experiences. In many ways, they are just as valuable as personal birth experience.
I already know how to serve. I know to provide as much comfort as possible. I know I can’t take it personally when the person I’m serving rejects something I try – I just try something else. I can keep my cool through hours of crying. I’ve had students throw-up in front of me (while I was pregnant no less). I’ve changed countless adult diapers. I can put off my own bodily functions for an amazing amount of time. I know my limits, when I need take a well-timed bathroom break to breath, regroup, and keep going.

I can do this…

A Personal Story of Postpartum Depression Part Two

2010-07-22T18:19:00.002-04:00

I finally decided to get treatment in April 2010, while we were in Mexico attending my brother-in-law’s wedding. I had several breakdowns on the trip and finally had the opportunity to really talk to my husband about it.

When we got home, I called a local therapist for an appointment. The first meeting went well, and she suggested I go to my family doctor for a prescription since that had helped me in college. I did, and things seemed to get better for awhile.

I stopped attending the therapy sessions though for a couple of reasons. I knew that the stresses of life and of my marriage certainly had contributed to the problem of my depression, but I didn’t like feeling that I was defending my husband during my counseling sessions. If I said that I trusted him, that we were working together, and that things were getting better, I felt that should be enough. Pushing him to come to counseling as well would not make things any easier for either of us if it wasn’t something he was comfortable with or ready for. Beyond that, it was difficult for me to get childcare and a way of getting to the therapy sessions. In the back of my mind I kept thinking about the cost, as we were already struggling to pay bills.

I continued to do well for awhile without therapy, relying on my own coping skills and the medication. I was on a fairly low dose, but looked forward to doing well without medication.

I’m not there yet.

In the past few weeks, my symptoms have reemerged. I found myself up at night, either forgetting to eat or binging, snapping at my husband constantly, and sitting on the recliner all day. It took me a couple weeks to notice the problem, but I quickly got in to see my doctor again. He suggested a medication increase or medication change. I asked to have blood work done first to rule out thyroid problems or anemia, which he was happy to do.

Fortunately, my blood work was clear, so last night I increased my dose as directed.

Unfortunately, I was up half the night.

Without sleep, I feel much the same. I can’t get anything done during the day due to exhaustion. I eat constantly, or forget to eat, because my brain is half down trying to cope. I’m irritable because I’m tired. I understand that medications can take 2-4 weeks to adjust, but this is madness. I don’t like being on medications either way, and being on a medication that I feel causes just as many problems, well, it doesn’t work for me.

I resolved one thing last night while I was lying awake – to look into alternative therapies for postpartum depression. That’s my goal for the next couple of days.

A Personal Story of Postpartum Depression Part One

2010-07-17T11:36:00.000-04:00

It has certainly been a long couple of weeks for me, as you can see evidenced in the relative lack of blog posts.

So, in an effort to make good come out of this time, I'm going to talk about a very personal struggle.

I was diagnosed with depression in May 2010, nearly ten months after my son was born. For that ten months, I suffered in silence. I want to share the story of my struggles so other women won't have to do the same.

Going into the postpartum period, I knew I was at high risk for postpartum depression.

I had been diagnosed with depression before, when I was in college.
My previous depression was linked to a drop in progesterone - it would now probably be called premenstrual dysphoric syndrome because it centered around my periods.
I was under a lot of stress at the end of my pregnancy - I was quitting my job to stay at home, our income would be less than half of what it was previously, we were moving, our house wasn't finished, and we were having marital problems.
I didn't have the birth I wanted. I had prepared for a natural, normal birth and got a c-section for a stubbornly breech baby (he's still stubborn, I love him). I wasn't in the emotional state (see above) where I could devote energy into changing providers and having a vaginal breech birth
Our breastfeeding was terribly unsuccessful. I tried and tried, but we didn't have the help we needed.

I felt guilty about what I perceived to just be "bad days." I would sit around the house, letting dishes and laundry sit, starting at but not even watching the TV. He was such an easy-going baby, and I didn't understand why I was having such a hard time.

Some days I had no appetite. I had to remind myself to eat, though I usually didn't realize it until my husband got home and was ready for dinner. Other days I felt like I couldn't stop eating. I was starving and constantly had something in my hand.

When it got worse, I found my sleeping was affected. I couldn't fall asleep, couldn't stay asleep. I had always been a morning person, but soon found myself unable to get out of bed in the morning. I would lie awake for hours at night, my mind running wild with all the things I needed to the next day. Few of them got done.

The biggest clue was my personality. I'm certainly prone to frustrations, but have never been one to lose my temper. Now I found myself yelling for little reason, crying often and being unable to stop, and feeling the great need to throw and break things.

In my previous depression, I had struggled with thoughts of suicide. Unfortunately, those returned. One day I had to leave the kitchen because I found myself staring at a knife, just thinking about it.

During this time however, I kept telling myself that it couldn't be postpartum depression because I had a lot of good days. I had days where everything was fine. I still liked to be with friends, to go out, to have fun. I hadn't lost interest in my favorite things, at least not all the time.

To be continued...

What to do?

2010-07-05T12:03:00.000-04:00

I have been encountering more and more often this idea in friends that the doctor knew best and their body couldn't possibly have done it on its own.

I honestly don't know how to deal with this mentality.

Yesterday the story I heard involved cesareans done for fear of too large babies. First baby was born vaginally with no problems, but four weeks before the due date. Second baby labored through but never descended so they rushed down for a section. Third baby was a scheduled section because "we figured out she was just too small to birth a regular sized baby."

Now at this point the family is beyond childbearing. I chose to smile and nod, sympathize quietly.

I felt no reason to ask if with the second baby they had attempted position changes to have gravity help move the baby down. Whether they had waited for the urge to push. Whether they had an epidural that interfered with feeling and the birthing muscles.

It wouldn't have helped this mom. There are no future babies; no way to go back and change things.

But would it have helped her daughter?

I was one of those that grew up hearing the horror stories of her mother's births. I had been a vacuum-extraction baby, after the first vacuum broke. After my brother's birth, my mother was sent to Cleveland Clinic for birth floor repairs following bad tears with the two of us (that were probably improperly repaired). My mother dealt with it without drugs, but "purple pushing" had certainly done a number on her. It was the only kind of birth she knew.

In these situations, when do you offer information? I don't want to cause pain, to damage a friendship or relationship when later I may be able to offer more help. But I also don't want women to go through life and childbearing without the knowledge that it can be powerful. Without the knowledge that it can be fulfilling rather than terrifying.

What do you do? Comments are very appreciated.

Choose your care provider carefully

2010-06-27T13:34:00.002-04:00

I was afraid of my doctor while I was pregnant.

Let me clarify. I don’t have white-coat hypertension where I get nervous at doctors’ offices. I didn’t (and don’t) believe that my OB was incompetent or that he didn’t have good intentions. I was just always afraid that what he as an OB, a trained surgeon, wanted for my birth was different from what I wanted.

We all want a healthy baby. No one who wants natural birth goes in saying that natural vaginal birth is more important than a healthy baby. Our friends and family who say “the most important thing is a healthy baby” seem to forget that sometimes.

I believe that there is (most of the time) more than one way to “just a healthy baby.” As a culture, it seems like we’ve gotten into this all or nothing approach with birth. You can have “just a healthy baby” in any manner it takes. Or you can risk it all for that natural vaginal birth.

This “don’t you just want a healthy baby” thing had gotten me really scared of my doctor. I was afraid that in his effort to just get me from point A, healthy pregnant lady, to point B, mommy with a healthy baby, he was going to use methods I didn’t agree with.

To this day, I have no idea how things would have turned out had I been going for a vaginal birth there at the end. (reminder – breech baby = me scheduled c-section)

I wish that I had taken more time at the beginning to shop around with providers and saved myself that trouble.

I wish that as I continued to be afraid of his “doctorness” that I had looked for someone I was more comfortable with.

I wish I hadn’t let that fear of unknown limit me to an OB.

I played it safe. Since my hematologist, family practitioner, and OB admitted that they didn’t know how I would do pregnant post-stroke, I took their guidance and was on a low dose of Lovenox (a blood thinner) throughout pregnancy. Now that I’ve done my research a bit more, I’ve found there’s no research to back this practice up. It doesn’t mean it’s the wrong approach, but it also doesn’t mean it’s the right approach. Taking the route that seems safest doesn’t always turn out that way.

At the very least, I should have looked around in pregnancy to find out all my options. Would there have been a practitioner willing to closely monitor my blood? Would there have been a practitioner who had a client with a similar history; what was her course of care? Would there have been a midwife willing to take me, even just prenatally?

Even with all that I thought I knew, I made the grand mistake of limiting myself to what I felt was the easy way.

I’m not saying in the least the OB’s are bad. That they are incapable. I’m not even saying that my choice to be with that particular OB was the wrong one.

I’m saying that unfortunately, I’ll never know for that pregnancy because I didn’t explore my options.

Don’t limit yourself to a practitioner based on any of these things:
• They seemed nice at the first prenatal
• They deliver at the hospital/birth center I like
• They work with midwives/OBs so they must be good
• They have good office staff
• They’re available on my due date
• Etc etc etc!

Don’t compromise! Don’t limit yourself to the first or second or whatever practitioner you come across just because you feel they are “good enough.” Yes, you can always change later. But once you’re with a provider, it’s easy to convince yourself that it’s just too hard to switch even if you’re not satisfied. Make the switch if necessary, but try to get the right provider the first time.

It’s worth your piece of mind to have the practitioner you feel most comfortable with.

Why do doctors even use due dates?

2010-06-21T16:59:00.002-04:00

Probably the most common method of calculating a due date is to use the “last menstrual period” or LMP. Once a woman finds out she is pregnant, an OB or midwife simply asks when the first day of her previous period was. This becomes day 1 of the pregnancy; day 240 is her estimated due date or EDD. (Of course, they have handy wheel for this calculation.)

The biggest problem with using the LMP is the wide variance of cycle norms for women. LMP due date calculation depends absolutely entirely on every woman having a 28-day cycle and ovulating on day 14 of that cycle, without fail, every single cycle of her life.

Please, stop laughing. They do this.

Yes, there are many doctors and midwives who very much believe this method is accurate, or at least simple. It’s certainly a convenient method and it has an air of mathematical certainty.

Unfortunately for them (and us), very few women fit into this category of 28 day cyclers. There are women who seem to have short cycles – less than 28 days. Chances are that these women also ovulate earlier in their cycle, throwing off LMP due date calculation for them. There are women, like myself, who have long cycles and ovulate later than day 14. Personally, I average about 35 days per cycle, and usually ovulate somewhere around day 21. (Side note – if you want to learn about an FDA approved aid to conception that will help you learn your personal cycle norms, check out the fertility awareness method – not to be confused with the rhythm method.)
Then of course there are those of us who have no earthy idea when our LMP was. Maybe we have irregular cycles – 28 days then 45 then 24 then… Maybe we were breastfeeding or otherwise newly postpartum and our usual “regularity” hadn’t yet returned. For those of us with no idea, there is the ultrasound method of determining EDD.

When the doctor asked me my LMP, I told him I didn’t know. Actually it was October 30 (I know because I had one of the worst periods of my life and took two days off work sick as a dog, unable to get out of bed longer than the time it took to clean up every few hours.) I had been using the fertility awareness method and not only did I know my LMP, but I also knew our conception date – the only possible one within a week before my estimated ovulation date. All other “baby-dancing” days were well outside the possibility of fertility. Calculating my EDD based on what I knew about my cycle, I arrived at August 12.

Of course, my OB didn’t know any of this. He didn’t believe charting had any value. When I told him that I didn’t my LMP, he simply scheduled a dating ultrasound early first trimester. Dating ultrasounds require that an ultrasound technician measure different parts of the baby and compare those to established growth charts. Throughout pregnancy, these measurements can vary by at little as millimeters; you can guess how important it is that your ultrasound tech be a really good one.

Our early ultrasound measured my son to be due August 15, a due date that wasn’t humanly possible with the conception date we had. But a later due date is always better than an early one.

Some OBs don’t stop at that early ultrasound or LMP for determining EDD. They continue to change the EDD throughout the pregnancy based on further ultrasounds (and sometimes fundal height, but that’s a whole ‘nother ball game).

Ladies (and gents!), don’t let this happen to you! It is error and is not based on science in the least to continue to change the EDD.

Ultrasound dating, as I have mentioned, depends on technician skill as well as these growth charts. What we tend to forget is that 50% on a growth chart does not mean normal or perfect. It simply means that your child is larger than 49/50% of children, and smaller than 49/50%. 80% means you have a larger than average child, but not necessarily than anything is wrong, just as 30% or even 10% simply means you have a petite child. (The worry stems from not staying around your percentile as you age or suddenly increasing or decreasing as you age.)
At 32 weeks gestation, my son measured around 4 lbs 2 oz, or 80% and up on the growth chart. However, the ultrasound equipment registered this not at 80% for 32 weeks, but at 34 weeks gestation.

Fortunately, my OB didn’t change my EDD based on this late pregnancy ultrasound. I know women who have been in this situation though and did have their EDD changed. Their OBs didn’t account for the possibility their child would be larger (or smaller) than average.

Having a due date change can be a serious problem. Normal pregnancy, as by ACOG definition, can last from 38-42 weeks. Yes 42 weeks. However, in practice, due dates are set in the middle of this range at 40 weeks. You can still have a normal pregnancy and go past your “due date”; OBs’ own organization admits this.

Most women though aren’t “allowed” to do go past their EDD. Once they begin to approach their EDD, even if this was moved from a later estimate, the induction talk may begin. Women are more often than ever finding themselves against going into labor on their own before 40 weeks or facing induction at 40 weeks. (The number of inductions in the US has doubled since 1992.)

My suggestion: A due month (and arguing with your doctor if necessary). I plan on using the due month with my next pregnancy. The due month is a simple concept (I didn’t come up with it and I’m not sure who did). It’s based on that ACOG definition of normal pregnancy – 38 to 42 weeks. A four week period – your due month. For my son, my due date was August 12. I should have just said that he was coming “sometime in August.”

Believe me, using this method, even just with family and friends, is beneficial. Towards the end of a pregnancy, well-meaning family and friends begin to ask how long the doctor is going to “let you go.” As the EDD approaches, the questions change. “Isn’t he going to induce you?” “What’s happening? Is something wrong?”

Save yourself a wee-bit of anxiety (as much as possible at least) and give them just a ball-park, a taste.

“Oh, Junior? He’s coming when he’s ready, sometime end of April or mid-May. No worries.”

Our changing bodies...doula perspective on pregnancy bodies

2010-06-11T13:15:00.006-04:00

Today, I may have the opportunity to maternity shop with a friend, K, for another friend’s pregnancy – friend J. It got me thinking about the changes my body went through pregnant, and about all the different perspectives on those changes.

I miss pregnancy. I felt so beautiful while I was pregnant. I loved every kick that kept me up or made my ribs sore, every run to the bathroom to pee – again, every stare as I waddled through the summer.

Of course, those stares were hard to deal with at first. I was huge by the end of my pregnancy – I’m 5’2” and weighed nearly 200 pounds on August 10, the date of our cesarean. I had put on 50 pounds during the course of the pregnancy, almost all of it after 20 weeks. I was quite a sight those last few weeks.

Even in early pregnancy, I got big quickly. For reference, this is me at the end of college.

I was probably 10 pounds heavier than this at the time I got pregnant – not skinny, but not too overweight either.

This is me at about 12 weeks pregnant. This first picture is trying to suck in, the second is relaxed.

By this point I was entirely in maternity pants, past the point of doing the hair-tie trick with the button of my jeans, and could still fit into a few of my looser t-shirts. All my work clothes were maternity and I was in sweaters trying to hide it from my students a little longer.

Now, many women don’t show at all until after 20 weeks. Either way is normal and beautiful.
This is me a few days after our anatomy ultrasound at 19 weeks.
Obviously there was no hiding it at this point. My students had found out three weeks prior to this picture that I was expecting.
By May as I was just entering the third trimester, I looked like this.

I know many women who don’t look this big at the end of their pregnancy. Very normal. By the end of May, this is how I sat at the doctor’s office:
It was the most comfortable by the time I was this big.
At the end of July when I was about 36 weeks, this was me:
Thanks to elle effect for these gorgeous bump pictures! I was stretched to the max and loving every minute. I specifically asked Lauren, our photographer, to not edit out my stretch marks. I earned those.
Finally, this was me a few days before the cesarean at 39/40 weeks.
I was huge and finally starting to feel it.

I think a lot of it has to do with your personal build and your husband/partner’s build. My husband is 6’5” and solidly built. I knew I would have big babies and was very comfortable with my body’s ability to deal with that. But being on 5’2” myself, this meant my baby had nowhere else to go but out almost immediately. In fact, in late pregnancy when he was breech, he got stuck under a rib. That rib is still out of place. Just a fact of life that my body is more compact.

I hope seeing these pictures can reassure those women who find themselves in my position in life – a small woman carrying a big baby with nowhere to go but out! You are beautiful darling!

Believe it, live it, and you’ll feel it.

Book Review: When You Were Inside Mommy

2010-06-08T18:27:00.002-04:00

Usually book reviews on blogs are for newer books, but when I came across this one, I felt all moms needed this for their children. My son is participating in the Kanawha County Public Library’s summer reading program and this is one of the books we read this week.

This book is very simple and straight-forward. It has lovely illustrations of a young family with their new son.

But the best thing about this book is the way it’s written. It’s from the point of view of the child’s mother. My favorite thing is that it uses the correct terms for pregnancy. The child is told that he grew inside mommy’s uterus or womb. He was fed and got air from his umbilical cord. Simple really, except when my seventh graders last year didn’t know there was such thing as an umbilical cord.

The book talks about how Mommy and Daddy waited and waited until “the muscles of her womb started squeezing.” Then they knew this was the time. How beautiful that this baby was worth waiting for!

The baby is born in a hospital (my own complain, but it is true of most births so I’ll give her that), coming out of “a special opening in her body that can stretch wide.” Love this!

I think this book is a must for basic pregnancy education for any child; we plan on buying my little man a copy.

I believe it’s never to early to start talking to your kids about pregnancy and childbirth. Remember this is a normal part of life and treat it as such. It’s nothing to hide or tell kids that you’ll “tell them when they’re older.” Start now and they’ll understand it’s all normal and beautiful, not scary or dirty.

If you’re in the Kanawha County library system, you can check the book out there. I got mine at the Cross Lanes branch, but you can always request it!

However, I just think you should buy it – here: Amazon.com - When You Were Inside Momm y

Just as a note – I have no connection with this book. I just felt that all women should know about this book.

Certifying Organizations for Labor Doula - A Dilemma

2010-06-03T17:11:00.001-04:00

Had a good conversation with a dear friend the other night about certifying as a doula and childbirth educator. I’ve been putting off certification primarily due to monetary issues – we just can’t afford to put me in a program right now.

But I’ve also put off certification because I’ve had trouble deciding which organization to go with.

Initially, when we could afford it, I was going to certify through DONA. The closest course was in Toledo, so I was going to drive the six or so hours, in February. Before I signed up and paid my down payment, I found I was pregnant. Driving to Toledo in February while pregnant is simply a bad idea.

While I was pregnant, I discovered CAPPA and liked that organization pretty well. CAPPA also seemed to offer trainings a big closer to home, so I began to concentrate my planning in that direction.

Then I stumbled across Childbirth International, which is still my favorite organization for a variety of reasons. Overall, I think their program is very thorough; it’s been described as a mini-midwifery course. I like it that the course is entirely distance based and offers a variety of payment plans. I appreciate that I’m not required to become a member of any organization or maintain that membership in order to keep my certification. Once I’m certified, that’s it – doula for life.

My only problem – Childbirth International is just not nearly as well know as some of the other organizations – think DONA and CAPPA.

So, back to the conversation with my friend, a midwife who practiced in our area before it was time for a family move. I trust her judgment in the birthing business. We talked about area midwives for me down the road when my husband and I are ready for another and the conversation of course turned to me becoming a doula.

“K---, I’m going to just go ahead and put my services out there as a doula and childbirth educator. I feel I’m ready even though I’m not yet certified. But I do want to be certified on down the road. Who do I go with?”

Almost before the question was out of my mouth, her reply – “DONA.”

She had good reason – if my aim for certification is so that I have more client recognition, then I should certify with the most well know organization. Otherwise, why certify? I’ve done so much self-study, and have personal experience, that I don’t need certification in order to get the basics needed to begin attending and providing my services at births.

(I do, just to be clear, feel that all doulas should keep learning and studying, even after certification. A good doula is always adding to her knowledge.)

My friend agreed that Childbirth International has a great program, but that the problem of being less well-known is a factor to be considered.

So I guess I’m back to where I started – DONA. Spent part of the morning downloading the certification information to read through. (Also downloaded the information for ICEA’s childbirth educator and to become a board certified lactation consultant. Aim big.)

Now if we can just get the money together, I’ll be content to drive to Charlotte or Cleveland or D.C. I just want to help women as they’re birthing babies!

BTW: What do you all think? I’m content with DONA’s program, but really like what I’ve seen of Childbirth International. Do I go with recognition anyway?

The Power of Suggestion in Birthing

2010-06-01T09:06:00.002-04:00

Does anyone else believe in the power of suggestion?

Not necessarily hypnosis (that’s a whole ‘nother post…), but simple words uttered without a care that get stuck in your brain and circle around and around until you find yourself thinking them as well. I certainly had this with my son.

I knew before I got pregnant that I would have a big baby. My husband is 6 foot 5 inches and solidly built. Me – I’m only 5 foot 2 inches – we won’t talk about my build. I had no worries about having a big baby. I firmly believe that my body (and others’ bodies) will only grow a baby it is able to birth. I believed this before I got pregnant, I believed it during my pregnancy, I believe it now.

So what happened?

I always had a fear of C-sections. A fear that I would have one, not because I wasn’t strong enough or woman enough for a vaginal or anything like that, but that something would happen beyond my control that would force me into a C-section. I did what I could during pregnancy to avoid a C-section: eating well, educating myself, birth plans, planning to wait to go to the hospital, etc. At my anatomy ultrasound, I looked at my chart (as I carried it to check-out. It’s my chart and I have a right to know what they don’t think I’m smart enough to understand), and I found that I had an anterior placenta and that my son was breech. At nineteen/twenty weeks, I had no worry about the breech issue; he had plenty of time to turn. The anterior placenta worried me slightly – what if we needed to do an external version?

I think here that too much education got the best of me.

I’m not saying this would happen to everyone, that you should avoid being educated or anything like that. However, I know myself. I let things get worked in, and worked in well, until they burrow into my soul and consume my thoughts before I fall asleep or when I first wake up.

I’m not sorry that I knew these things. I’m sorry that I let them get the best of me.

By thirty weeks, I could tell he had settled into position. I was huge, but I felt great, and I could feel his outline through my belly. He was going to be big.

At thirty-two weeks, I consented to a growth ultrasound. Due to my clotting history, I was at higher risk for IUGR (inter-uterine growth restriction), but I knew I was not having a small baby. I wanted to peek to see if he was still breech – hey thirty-two weeks is plenty of time – and to ease any worries my doctor might have had.

He was still breech. I was devastated. I thought for sure he was head-down, that what I was feeling on the left side of my rib cage pushing that lowest rib was his bony little butt or knees or something, anything other than his head. It was his head. He was frank breech.

I threw myself into getting him to turn. I drank orange juice and put my butt in the air. I rocked on my hands and knees, over a birthing ball. I played music down low – he kicked the speakers. I swam. I walked. I had chiropractic massage and the Webster technique three times a week, nearly passing out each time due to the weight of my uterus pressing down as I lay on my back.

All the while, I was constantly things from others. “He’s too big to turn.” “C-sections aren’t that bad. Why are you so worried?” “My cousin’s friend’s mom’s sister’s baby was breech. He stayed that way.”

At thirty-seven weeks, he was still breech. We scheduled an external version – against my doctor’s advice. I was given a 10-15% chance of success – first time mom, low to average fluid, and anterior placenta. It didn’t work.

He was stubborn. I have that lowest left rib out of place and a nasty C-section scar to prove it.

I think that truly I let that first breech reading and those words get the best of me.

Yes, it’s certainly possible that he would have been breech anyway. I honestly feel he was meant to be breech. Maybe he needed that position for whatever reason. Maybe I needed that experience to better serve doula and childbirth education clients.

But I still feel I let it get the best of me. There at the end, I felt totally resigned to having a C-section. I knew in the back of my mind that he still had a chance to turn, even during labor, but I schedule a C-section anyway. I knew that I had a chance of a vaginal breech birth with a different care provider, but I didn’t even bother to look around. I scheduled that C-section, two days before my due date.

“He was just too big to turn,” I told myself. “He got too big too soon. If only I had seen it earlier.”

But that’s probably just a lie that I told myself. So what if he was big. There are other big babies, bigger than mine, that don’t get stuck breech. Breech babies that do turn during labor, if given the chance. Breech babies born vaginally.

Next time, I aim to counter those suggestions more often. Practice my hypnosis (again, whole ‘nother post!) more vigilantly, talk out those suggestions, surround myself with more natural birthers, change practitioners, whatever I need to do.

I need to protect the suggestions that get in so the only ones that circle and circle my brain this time are the ones that say, “I trust birth.” “Birth is a natural and safe experience, for me and my baby.”

When will doulas get the recognizition they deserve?

2010-05-27T17:17:00.001-04:00

Now if only they could recognize that doulas should be able to easily bill insurance, we’d be in good shape.

I’m talking about this article – “Doula becoming a household name.” As part of the healthcare bill, doulas are going to receive $1.5 million for community-run doula programs. I’m honestly not too sure how I feel about this. Oh, it’s certainly great, no doubt about it. I think these programs should receive any assistance they should get, that private organizations and businesses should be funding these all over the place.

I just wish out of all that healthcare legislation that doulas were recognized as an integral part of the birthing process. Granted then midwives would also receive recognition, putting the U.S. in conjunction with developed nations across the world.

Are we ready for it? I hear all the time from women how they “just couldn’t do it.” Couldn’t breastfeed. Couldn’t give birth without epidurals. Without Pitocin to speed things up or get things started. Without being cut open.

It’s not that we can’t do it. We just don’t have the help. In countries where breastfeeding is the norm, there’s naturally more support, more encouragement, more information. Where birth is something women just do, women are strong and know it.

I’m not knocking women who have c-sections and don’t breastfeed. That’s me, honestly. My son was stubbornly breech – I have the rib out of place to prove it – and I wasn’t mentally or emotionally in the place where I felt I could switch providers to attempt a vaginal breech birth.

We attempted breastfeeding, and oh we tried, and never got the latch. After a month of pumping every two hours around the clock, constant engorgement, a bad round of mastitis that was originally dubbed the swine flu separating me from my son for three days, bleeding and bruised nipples, and the beginnings of post-partum depression, I just couldn’t do it anymore.

I regret it every day. I regret my c-section every day. Every time I make a bottle of formula, dog-food smelling stuff, I think that I wouldn’t be doing this to my son if I could have just stuck it out some more. But I couldn’t. I can’t change that.

I can move forward though. I can empower other women to have the births they want, to raise their children the way they want to. This is what I aim to do.

So I guess providing money to community-based doula orgs is a start. It’s certainly better than nothing.

Let’s get this party started…

We're getting through to this one!

2010-05-21T12:59:00.002-04:00

Last night, my husband came home from his work with a non-profit, exhausted. Very usual night for us, talking about his day and mine, when he suddenly says:

"Hey! I told a girl today she needed to use your Hypnobabies program!" (My program? I'm impressed...) "Yeah, she's 10 weeks pregnant and already has a midwife and a doula [yes 'already' he's such a smart man] and she said she wanted to have a natural birth this time, so I told her about how you used Hypnobabies. She looked it up and said there were free ones to try, so she'd start there."

He's so smart. I love this man.

BTW: if you want to purchase Hypnobabies, do so here: Hypnobabies Home Study

An Introduction

2010-05-20T18:42:00.003-04:00

Hello all!

Thanks for joining me in this journey! I hope that you find the words here inspiring, informative, and entertaining.

As I've gone on my journey into the pregnancy and birth business, I've found myself up against some very entrenched ideas regarding childbirth and what women are capable of doing. I can't count the number of times while I was pregnant when I would hear "And the doctor let you do that?" Let is a very funny word, and seems to imply that a pregnant woman is suddenly unable to make decisions regarding her care and the care of her unborn baby. It's tragic that pregnancy in this country (and of course many others) is viewed this way. I hope this blog helps you fight such ideas.

I used to be pretty mainstream I guess. At least it wasn't until I was in college that I was even interested in birth. I already knew that I wanted to marry young and have more than 2.3 kids (which I guess isn't too mainstream after all), but beyond that i was content to wait it out and see from there. I was engaged at 19 and between that and finished up my education I had enough on my plate.

However, soon after I landed my first job, it seemed there were other plans for me. I had been on the pill since I was sixteen, due to a diagnosis of irregular cycles. When I was put on birth control pills, my gynecologist ran no tests, did no exam. My mother was given the prescription, we filled it, I took the pills. It caught up with me when I was 20. I was only 4 and 1/2 weeks in to my first teaching job when I had a stroke. My only risk factors: chronic migraines and the pill. I wasn't even a smoker - we've all seen the commercials - and there I was in a hospital bed with no feeling on my right side.

Of course, post-stroke, the pill is permanently out of the question. Soon to be married, I was faced with finding something else for family planning - which we felt was important until we got settled and my husband could get work. I vaguely remember my mom saying she used to "chart her cycles" so I googled it and came across a fabulous book that should be required reading for every woman - Taking Charge of Your Fertility by Toni Weschler. (my copy is loaned out somewhere, a much loved book) This book began my wise woman revolution.

I started just charting my cycles. I got up diligently to take my basal body temp, I tried to decipher my cervical fluid, I search for my cervix. Soon I began looking at Ovusoft (oh how you have changed my friend) for answers. As I began to post and read regularly, a new world opened up. Here were women who birthed at home and had labor/post-partum support. They were highly educated and weren't afraid to ask their doctors - "WHY?" "Why that intervention?" "Why now?"

These women were empowered. I was to become one of them.

I read everything I could find and started the path (many times over) to doula certification. Of course, it seems life (and money) has constantly gotten in my way. The day will come.

Search Engine Optimization and SEO Tools

Healthy Mama Childbirth

Muscle Rub Liniment

Valerian Tincture

Update on Life

Co-sleeping, a failed account? Part Two

Co-sleeping, a failed account?

Should We Have ONE Certification Organization for Doulas?

Common Sense Labor Practices - the Walsh argument

Preventing ALL Death and Injury?

Baby fever and putting it off...

Breastfeeding Presentation - A little encouragement for me and other birth professionals

Some thoughts on my scar - Cesarean Awareness Month

June Class Series - Prepared Childbirth

A little late, but better than never: A short analysis of the BMJ exclusive breastfeeding attack

Thoughts on the birth battle

Breastfeeding Misinformation begins with Doctors and Nurses

Modern Medical Birth Control - Risks

Where do we stop with the "high-risk" designations?

New book - look out for similar titles!

How do you know when to go to the hospital/birth center in labor? An observation.

Traumatic Birth – or why some women may prefer cesarean birth

Website Relaunch!

FAQs about Doula Services with Healthy Mama Childbirth

FAQs about Childbirth Education with Healthy Mama Childbirth

Another Care Provider in Pregnancy - Chiropractor

Maternal Satisfaction and Pain

Hypnobabies Sale!

Hypnobabies sale!

Friday, October 29th to Friday, November 5th.

All products at www.Hypnobabies.com website store are 20% off, (excluding MP3s).

Use the "Shop Online" menu in the top right corner of the site's home page and use the ordering code FB-FALL

Breech Birth?

Research regarding heparin in pregnancy

A Beginner's Guide to Charting, Part 4 - Putting it all together

A Beginner's Guide to Charting, Part 3

A Beginner's Guide to Charting, Part 2

A Beginner's Guide to Charting, Part 1

A Beginner's Guide to Charting, Definitions

Benefits of Red Rapsberry Leaf

Rosemary Decoction

Recommended Reading for Pregnant Women

What is my role as a doula and childbirth educator?

Birth in America - affecting the whole family

Weight Gain in Pregnancy...How much is enough?

Servant Heart

A Personal Story of Postpartum Depression Part Two

A Personal Story of Postpartum Depression Part One

What to do?

Choose your care provider carefully

Why do doctors even use due dates?

Our changing bodies...doula perspective on pregnancy bodies

Book Review: When You Were Inside Mommy

Certifying Organizations for Labor Doula - A Dilemma

The Power of Suggestion in Birthing

When will doulas get the recognizition they deserve?

We're getting through to this one!

An Introduction