How do we obtain choices in childbirth?

I've talked a lot about choices in childbirth in this blog. I've encourage women to choose paths for themselves and own those choices.  Right now though,  I want to talk about how we exercise our rights and give voice to our choices. More than that, how we keep choice from being just a buzz word and a mere illusion that is really system of control to placate us.  

Now the childbirth educator in me says that the key is education. Get as much evidence-based information as you can. Really educate yourself on pregnancy, labor, and birth. Educate yourself on hospital procedures. Educate yourself on postpartum topics like baby care, breastfeeding, and vaccination. However, the warrior in me knows it's not that simple.  Yes, knowing your options is by far the best way to be able to know what choices you want to make and how to make them, but it does very little in preparing you for intricate system that seeks to narrow your choices by simply removing them. So what if you learned there is a such thing as hotdogs and decide you definitely want hotdogs if the chef has completely taken them off the menu. In that scenario lets just say hotdogs are VBACS (vaginal birth after cesareans) and the chef would be insurance companies, hospital policies, your doctor, etc. Are you getting my point?

So what does the warrior in me say? Fight. Advocate. Talk. TAKE ACTION. (Sorry, I really didn't mean to shout. That was the warrior in me) How do we take action? You may ask? Well voting comes to mind, but really that's another blog post. For now lets stick with consumer advocacy.  Many years ago there was shift in what birth looked like in hospitals. Women and families rebelled against protocals such as twilight sleep, separation of family members from the birthing room (in particular husbands), routine drugs and pain medication, and more. We can affect change again by demanding it. Demanding that the standard of care practiced by the people we hire, our doctors, midwives, and their staff,  is evidence-based medicine. Demanding transparency in maternity care data reporting. Demanding an overhaul of the insurance system. We can affect change in policy and procedures by putting our money, time, and efforts where our mouths are. Writing our congress person. Joining grassroots efforts. By signing petitions and organizing and/or participating in demonstrations. Sharing our stories and donating money to efforts that support our causes. The list goes on and on.

I really hope this post didn't come off as preachy. It's just that I've had this idea rattling off in my head for a while and our recent elections have really awaken something within me. There is a huge difference between knowing your rights and exercising them. In the same vein, knowing your options and keeping them on the table are two different things as well. Although many women equip themselves to fight for their choices in birth while in labor, I'm thinking that if we fight collectively for them now we could spend that energy in labor concentrating on something really radical: Birthing our babies. Our way.






1. 'Definition of Twilight Sleep". MedicineNet.com. http://www.medterms.com/script/main/art.asp?articlekey=10221(November 7, 2012)

So you want a Natural Birth. Now what?

You're pregnant and have decided to have a natural birth. It's the first trimester and while you may think you have plenty of time to prepare there is NO time like the present! So in that vein I've decided to put together some helpful tips that I sincerely hope you all find useful. 

1. Explore the reasons why you want a natural birth, examining your fears, expectations, and influence:  So many times when I ask a potential doula client or clients in childbirth preparation class why they want a natural birth I get the same basic answer: Fear. You may think that's strange. How could fear motivate anyone to have a natural birth? But I assure you, it can and it does. I hear; "I'm afraid of needles". "I'm afraid of being numb".  "I'm afraid the risks of epidurals". "I'm afraid of getting a cesarean section?"  Fears like these can wreck havoc on the best laid plans because if you've made your birth choices with fear as the motivator you've already given power to negativity. I truly believe the only way to make a true decision in life is do so freely. Otherwise the fear has made the decision for you. Address your fears and motives. Place importance on the positives. Educate yourself and see what your desires truly are after you've done so.

 It is also good to take time to explore any triggers of your past. Did you have a traumatic experience? A history of depression or abuse? Pregnancy, not just labor and birth, can trigger the memories and pain of these past events. Speak to your care provider, a therapist, your partner/husband, family member, friend, or doula about it. Choose someone you can trust and someone who will actively listen, having your best interest and goals in birth in mind. It's not a good idea to live alone with these feelings and let them fester. 

2. Properly educate yourself and limit negative influences:  Right now, in 2012, properly educating yourself on natural birth, hell on childbirth in general, goes beyond the $150 hospital birthing course we sometimes so eagerly sign up for. It can be unsettling to learn the last place you can gain true perspective on birthing choices would be at your hospital, but it's true. If your goals are to birth your baby without medication, vaginally (whether medicated or not), or with minimal intervention and augmentation then picking an independent childbirth preparation course is really the best way to go. You can pick an educator who specializes in specific methods (bradley, hypnobabies, lamaze) or one who doesn't have any of those specific affiliations. I would urge you to speak to more than one, interviewing them if you will, and ask specific questions; does your course cover comfort measures, relaxation exercises, variations of labor and birth? Do you cover hospital procedures, unexpected outcomes like cesarean section, etc? 

Now, as for limiting negative influences, this can be tricky. Once you start showing everyone has an opinion. Many people share that opinion with you whether you've asked for it or not. There are some who will throw so much salt in your game about your plan to birth without medication or even vaginally, that it can be extremely overwhelming. There are a few things you can do. One is to limit who you share your plans with. Some women who find all the "poo poo'ing" too overwhelming try this. Another way is to simply ignore them. The my body, my baby, my birth so fuck off approach. Choose a way to deal with this negativity that is conducive with your personality, but also try to put yourself in situations where exposure to those negative nelly's is minimal.

Keep in mind that the negativity you take in isn't just by what people say to you in person. The web is teeming with people itching to tell you how crazy you are for deciding against epidural or birthing vaginally. Visit only natural birth friendly webpages, threads, and groups/pages in social media. Read positive books, watch NON-maintstream movies and documentaries on birth that are informative and positive. If you watch videos on Youtube, for the love of god do not read the comments! That last bit is an order :-).

 Lastly, there is a wealth of resources on the web. Finding good ones can be hard, but I will gladly list a few of them here for you:

•  Science and Sensibility - A great blog from Lamaze.org. There are articles and posts on various pregnancy, birth , and labor related topics. Well researched and well cited.  http://www.scienceandsensibility.org/

• Childbirth Connection - Another great resource with many studies and citations. Topics include helping women to understand risks and benefits many pregnancy, labor, and birth related topics. http://www.childbirthconnection.org/

• VBACFacts.com - The name speaks for itself. If you are looking to have a VBAC this is an awesome resource! www.vbacfacts.com

3.  Hire a doula: Doulas are an invaluable resource for women no matter what your birth plans are and this is especially true for those wishing to achieve a natural birth. Doulas take on a wide variety of duties from helping you write out your birth vision (plan), teaching and practicing comfort measures and relaxation techniques before birth, examining those pesky fears I talked about earlier as well as any anxiety, and helping you examine any previous life experiences that factor into either impeding or helping your birth. Doulas offer you a specialized kind of support that you can rarely find in another type of support person and their objective is to help you reach your objectives, whatever they are, and help you obtain on overall optimal and satisfying experience, no matter what arises in birth. Interview at least 2-3 doulas when you search for one, remembering to ask key questions. Here are few resources for finding doulas:

• Capital City Doulas - A great doula collective with many doulas of varying experiences serving many greater Sacramento and surrounding area cities in Northern California.  www.capitalcitydoulas.org

• Doulamatch.net - A good tool for finding doulas in your area and matching up your EDD to their availbility. www.doulamatch.net

• BabyProFinder - Another good resources for finding doulas (and other birth professionals) in your area.  www.babyprofinder.com

4. Get in touch with your spiritual side: Perhaps spiritual might not be the right word, but the goal is to tap into your inner strength, your inner self, and to quiet your mind and cleanse negativity. When I teach or when I conduct prenatals with my clients we  practice some type of relaxation technique that includes visualization. I ask that all my clients practice the technique at least once everyday until the baby is born. Find a good relaxation exercise that you can do quietly once a day. Incorporate breathing, relaxation, stretching and visualization in this exercise.

In addition to visualization, it's important to understand the influence of energy in our lives and how it relates positively or negatively to pregnancy, labor, and birth.  Allowing yourself time to reflect, calming your mind, and seeking positive energy at least once a day in your pregnancy is good practice for birth and for postpartum. It helps cleanse the unwanted energy from your life. Remember that each person in your life brings their own energy and that it may be prudent to determine whether or not you want a certain persons energy in your birth space or during your pregnancy.

Another great tool is birth affirmations. Birth affirmations help you build positives attitudes about birth. You gain mental strength and trust in your body, your baby, and the birthing process. 

In closing please remember that your goals should be your own and that when you make informed, educated choices, it leaves little room for doubt. I hope that these tips are helpful and if you find them as such I hope you'll share this with others.

Happy Pregnancy, Happy Birthing! 

How to determine what matters most in birth.

What matters most in birth? A healthy baby? The experience? A healthy mom? Vaginal or Cesarean? Medicated or Natural? If you are reading this post now to find the answers I can tell you already that you are off to a VERY bad start.


What matters most in birth? Only you have the answer. So here is some advice: stop looking for it externally in blogs, threads on facebook, journals, and ANY other people and search internally. Ask yourself the question and answer honestly. Determine why you came up with answer and act accordingly.

Lastly, remember this; while it may be in the general nature of us human folk to seek validation in our choices, when we make them educated, fully aware, and from our hearts, validation becomes moot point.


Happy Birthing!

Doulas and Advocacy: Are they mutally exclusive?

I hear time and time again. I'm sitting in an interview with potential clients and they tell me that one of the reasons they want to hire a doula is to have someone advocate for them in the birthing room. I'm constantly explaining to clients that while I do consider myself an advocate of choices in birth, natural birth, and natural postpartum choices; I do not advocate for you during birth, but rather help you to advocate for yourself. I also explain that if they hire me as their doula, the process of how I help them to advocate for themselves starts prenatally.

I use to always wonder where these women and couples got the idea that doulas are advocates for them during birth. That is, until I started listening to my fellow doulas. Again, I'd hear over and over about stories of doulas who would get into heated conversations with doctors and nurses about hospital policy, clients wishes, evidence-based practices and more. I'd hear doulas brag about arguments they felt they won, shouting matching, standoffs, and more. The worst to me are the stories of doulas who unhooked IV's, stopped the pit machine, and spent time interpreting fetal monitor readouts. It was quite horrifying to me. Who was serving the mother at that time? How did this truly make her feel? Did these doulas really feel they served their clients best this way?

Now I understand there is a type of doula for everyone. Some women benefit from doulas with a more no nonsense attitude, the ones that don't sugar coat things or come off more "militant".  Other women prefer a lighter touch or a more "middle of the road" doula. I respect the differences and the need for them. However, I believe there should be a separation of doula and advocate. Politics, in particular your own personal politics, have no business at the birth of your client. Once a client is in labor, any personal agendas should be checked at the door. There is a more appropriate time and venue to try and change faulty birth practices.

I think the same thing goes for the myth that we empower women through these actions at her birth. A woman's power to advocate for herself and birth in the way she wants isn't ours to give. It's her birth and it has to be her job to find the power and be empowered. We can help, we can guide, we can even lead, but we can give that to anyone. Sadly though, through our actions, just like the hospital staff, we can take it away.



So people, what do you think? Do you think there should be  separation? Perhaps there is another side I am not seeing. Maybe you are a mother who benefited from a doula doing some of the things I mentioned above or a doula who felt there was no other way. Share your thoughts with me. I'm open to them.

Attitudes about birth do AFFECT birth!

This week I am going to let this little gem I found on Cafe Press speak for itself. I found this last year and was so riled up I sat on this blog post. In fact, when I decided to revisit it I got riled up again. So let me ask you this: Would consider this a harmless joke? Should I "get a sense of humor?" Or does it evoke other emotions in you? Please share. 

I'll be back next week with my well thought out, ever so tamed blog post about this fabulous T-shirt. By the way, in case you were wondering, the letters that are barely readable only say Cafe Press and it's website where you can purchase this shirt. It was in the OB section of site with other OB and birth related clothing for professionals.

Four Reason Why Moving in Labor is Best!

I want to start off by saying that I think most women who are allowed to find their own rhythm in birth will do just that! They will find a rhythm and ritual that works best for them as long as they have freedom of movement, are educated and informed of the birth process and well supported. Having said all that, I believe that one of the best things for a women to do in active and sometimes even in late labor is MOVE! Freedom of movement in labor is essential to the process and here are four reasons why:

1. IT MAKES YOU AN ACTIVE PARTICIPANT IN LABOR AND BIRTH: Labor and birth are active processes. Your baby and your body is working together to achieve birth. Waiting around for contractions can diminish your mental resolve. Many of my clients report feeling better when they have something to doing in birth. In the late stages of  labor, it's the pushing that gives them something to do. In active labor it's movement. By walking, rocking, "dancing", swaying, or other physical activities, you are working with your body to achieve the goal of birth. It can help to distract you in late phases of  early labor and in active labor, while also having great physical benefits.


2. IT HELPS MOVE YOUR BABY INTO MORE OPTIMAL BIRTHING POSITIONS: While I've come to believe that most positions your baby is in during labor are variations of normal, there are more optimal positions for labor and birth. Most will agree that one of the more optimal positions is LOA (Left Occicput Anterior). There are many things you can do to encourage your baby to rotate into that position and lying down on your back is not one of them. Movement, in particular, pelvic tilts, rocking in the hands and knees positions, squats, and lunges are helpful.

3. IT CAN HELP SPEED UP LABOR: The process of labor and birth is greatly benefited by walking and the use of gravity. Gravity can help move the baby down in the birth canal, thus allowing the baby to press down the cervix more as it descends. This in turn helps to dilate the cervix with the pressure from the fetal head that also promotes more oxytocin to be released. Oxytocin is the hormone produced in the female body that causes contractions. The more efficient the contractions a woman has are, the better there are at effectively dilating the cervix. This is how  labor can be sped up by walking, standing, and squatting!  All movements that utilize the help of gravity!

 4. MOVEMENT CAN BE A COMFORT MEASURE FOR BIRTH: Movement, such as walking, rocking, swaying, bouncing on birthing ball, and squatting can all help to decrease the perception of pain, thus making it a comfort measure and labor coping technique. As a woman labors, any tension both during a contraction and after, increases her pain perception level. Effective relaxation techniques help greatly, but so does the use of movement. Through movement, a woman is effectively managing her pain, thus decreasing her stress and tension levels naturally and in turn her pain perception is lessened.



In the end, the goal of birth is always a healthy baby and healthy mom! The journey of birth should be distinct to every woman's ideals and birth vision. Your Journey belongs to you and your baby! Freedom of movement is one way to help you reach your optimal goal of a healthy baby and mom, while also giving you many options to use on that journey.  Happy Birthing to all!

Maternal positions and mobility during first stage labour. Cochrane database of systematic reviews (Online) (2) PMID: 19370591

Simkin, P., & Ancheta, R. (2005). The labor progress handbook (2nd ed.). Malden, MA: Blackwell Science.

Simkin, P., Whalley, J., & Keppler, A. (2001) Pregnancy, Childbirth and the Newborn (Expanded & Updated Edition). New York, NY: Simon & Schuster.

Three Postpartum Things No One Tells You While You're Pregnant!

Pregnant women always seem to bring out the inner expert in people. Everyone from your mother-in-law to the grocery store clerk has advice to give or a story to tell about pregnancy, childbirth, and beyond. However, rarely do we hear about certain things postpartum that could be useful to us if we had advice about it or even a heads up. I'd like to take some time to go over the top three things that occur postpartum I hear from clients, see on parenting/pregnancy boards, and have personal experience with, yet seemingly pregnant women rarely know anything about. I hope this list helps some of you ladies out there navigate through your first weeks postpartum with more knowledge and confidence that what you going through is normal and common.

#1 - HAIR LOSS

You read that right. Lots of women experience hair loss postpartum. It can be very daunting watching clumps of your once luxurious pregnancy-induced Pantene locks falling out suddenly, but fear not! It's perfectly normal and probably not premature female balding! Telogen Effluvium is the excessive shedding of hair that can occur anywhere from 1-6 months postpartum and you can blame those pesky hormones for it! Normally, about 90% of your hair is an active state and 10% is dormant. During pregnancy, the increase in hormone levels can keep your hair from entering the dormant phase, so hair you would shed normally stays put. When pregnancy ends and hormone levels return to normal, your hair that ceased to shed during pregnancy, then begins to fall out postpartum. It seems like you are losing more than normal, but in fact are losing hair you essentially should have lost before.

Here are few things you can do to help during this time:

*Eat a diet high in fruits and vegetables, which contain flavonoids and antioxidants.

*Avoid hair styles that place stress on your hair such as ponytails, braids, and weaves.

*Use shampoos and conditioners containing biotin and silica

If for some reason you still feel your hair loss is exceptionally excessive, consult with your physician.


#2 - NIGHT SWEATS

I know some of you pregnant women out there are probably thinking big deal! I sweat already. To that I would say, not like this. Postpartum night sweats are a completely different beast. I've had clients who reported waking up with sheets soaked so bad they felt they'd been doused with a bucket of water. Although it may seem like a very strange post-pregnancy symptom, it's actually quite understandable considering all the extra fluid retention a pregnant woman takes on. After birth your hormones (yes, hormones again) adjust and signal to the body that it’s time to eliminate the extra fluid. Like many postpartum symptoms, this too shall pass. Usually in about 2-4 weeks. In the meantime, here are a few things you can do to make yourself more comfortable:

*Drink plenty of fluids. It may seem counter-intuitive, but drinking extra fluids will keep you hydrated (all that sweating can dehydrate you afterall) and help your body reestablish a normal water balance more quickly.

*Put a soft towel or a pad over your pillow and under your sheets to absorb some of the moisture.

*Wear loose, lightweight clothing and sleepwear made of cotton, or even sleep in the nude.

As always, if you have other accompanying symptoms with the night sweats such as fever or dizziness consultant with a physician.


#3 - DISCOMFORT AND UNCERTAINTY WITH BREASTFEEDING

Many pregnant women read up on the benefits of breastfeeding, hear about the magical bonding of mother and child, and may even witness a mother, sitting on a park bench, breastfeeding her baby with ease and grace. A real pro. Then you birth your wonderful baby, settle in to breastfeed the little angel and realize not only do you not know what the heck you are doing, but it hurts as well. Yes, it's a perfectly natural thing, breastfeeding, but it doesn't come without it's challenges, i.e., pain and discomfort. Especially those first few days postpartum. Now I completely understand words like pain and discomfort are subjective. One woman's mild discomfort is another woman's severe pain. Keep in mind though, that my point here isn't about those cases of bleeding cracked nipples, mastitis or severe engorgement, but the run-of-the mill discomfort caused by a hungry baby vigorously sucking (and at times tugging and pulling) on your virgin nipples.

You may have heard or even read before that old saying If you are doing it right it shouldn't hurt. Let me interject my first (and only) swear word in this post by saying that is utter bullshit. Well meaning women say this without realizing how condescending and hurtful those nine words can be. It's also wrong. Breast-feeding is a learned skill, and you'll need time, along with practice, and patience to make it a comfortable, successful experience. While many issues that come about during breastfeeding can be attributed to malpositioning of the baby and a poor latch, there is still that initial discomfort you can feel without experiencing those aforementioned issues. You may also feel unsure you baby is getting enough milk that exacerbates you concerns. These feelings are all within the range of normal and there are measures you can take to help you along with breastfeeding:

*Nurse on demand. During the first 12-24 hours after your milk comes in, by letting the baby nurse almost continuously, you may be able to avoid the initial engorgement (and accompanying pain) that normally occurs when the milk comes in.

*Even though fear of pain and discomfort may make you shy away from it; always begin feeding the baby on the sorest breast or the one that seems to be the fullest.

*Expose your nipples to air whenever possible to help toughen them up and to prevent continuous contact with moisture, which can cause nipple irritation, soreness, and damage.

*Lastly, you want to make sure you latch is correct. If you need further help you can contact breastfeeding consultants at Le Leche League International . Also consult a physician if you have severe bleeding cracked nipples and/or fever accompanying swollen painful breast.

As a passionate advocate of breastfeeding I urge any mothers going through this to allow for yourself and your baby the time patience to hang in there if you experience this rough patch! There are many reasons that make it worth it and a few weeks postpartum you'll mostly like be that mother looking that old breastfeeding pro in the park.