Episiotomies… Tear Here —>

Although the studies show that an episiotomy isn’t the better option than your perineum tearing, many providers are still performing the procedure. 

So, let me break it down for you…

Your perineum is designed to stretch… you can read a great blog post on instinctual perineal care during birth here.   Granted, tears sometimes do happen – and they create a beautiful setting of forcing mom to relax after birth like she should be doing anyway, but they are much less likely to happen with an instinctual birth and no cutting… or nicking… of the perineum.

Ok, so, let’s do a little activity…

Grab a plastic bag – a bag of frozen veggies is perfect… or a piece of plastic “Saran” food wrap…  You want a bag with a “Cut Here” Symbol like this:

Now, try to tear it.  What happens?  It STRETCHES.  It might tear – but often that depends on positioning and the speed in which you tried tearing the plastic.  If it did tear, it probably wasn’t until after it stretched a little and got so far beyond its stretching point that it needed to tear to go a little further.

OK, let’s do another activity…

Grab another bag with a “Tear Here” symbol… ahhh… it is starting to make sense now, huh?  This coincides with a tiny nick in the plastic like this:

 

Now, try to tear it.  What happens?  It TEARS… a lot… really fast.  It probably tears a whole lot more than what that little nick is, huh?  Yea, that’s the point.  The nick HELPS you tear the bag.  Those nice manufacturers put those handy little nicks on there to reduce your time cooking and make it easier to open that bag – no scissors necessary…

The idea behind the episiotomy is to prevent tearing and ”help” the baby through the birth canal… but, back to basics here, people.  You don’t need help – oh no!  In only a very rare instance would an episiotomy be necessary – and then you’re increasing your risks of tearing much further… as in a 3rd or 4th degree tear that can be quite difficult to heal from.  Likely, a little movement, upright/forward positioning (like hands and knees), and, of course those beautiful instincts that allow mom to hold back during the “ring of fire,” is all that mama needs to prevent unnecessary perineal damage…. but, well, that would be too hard and take too long, right?  Or, are we forgetting that “easy” in the moment isn’t always better for the long run?  Think about healing from an episiotomy… the tissue doesn’t blend as easily together as it does from a tear which can cause a more difficult healing process.

So, ladies, remember that you do not have a “cut here” tattoo on your lady parts… your perineum is a “No Scissor Zone.”

20 Reasons Not to Take a Childbirth Class

Reasons not to take an [independent] childbirth class are everywhere.  It seems like the first moment a mom even mentions learning about birth, she’s met with the following list (and likely more) of why it isn’t necessary.  It amazes me that the same people who want to tell her not to worry about learning are the same who want to tell her to worry about all the things that can go wrong.  So incredibly sad that people who love this woman would dissuade her from learning more about her body, reduce her fears, and learn about the birth industry.  But, the reality is that those who are influencing her in the non-educated birth way have likely been misinformed as well, and that’s what this post is all about. 

20 Reasons women are told not to take a childbirth class… and reasons why they’re bogus:

1. Women have done it for thousands of years.
   Absolutely!  Wow, if women only actually believed their bodies worked just as good as women thousands of years ago did, childbirth classes would not be needed.  Unfortunately, women don’t trust their body, and are being misinformed by loving friends, family, and fear-driven (and many times, money-hungry) providers.  They are told not to get educated, they have no clue how to eat well, they expect their doctor to “take care of them,” and they believe epidurals don’t cross the placenta nor affect birth.  As a result, women are being induced a month early (because even 39 weeks is a month early for many babies), they’re stuck in a bed that is not conducive to biological birth, and they’re told if they don’t have a baby in 12 hours, then their body doesn’t work and they need a cesarean (regardless of distress or not).  This, and many other reasons are why the US ranks so low in the world of maternal deaths and the cesarean rates have us believing 1 in 3 women need surgery to have their baby.  Take a perinatal education series and get back that knowledge that women had 1000 years ago – when knowledge of childbirth was gained from experiencing it first hand from women in your family and community, when business wasn’t a driving factor in the type of care women received, and when women were attending by loving providers.
2. My body will do what it is supposed to do.
   Well, not exactly.  I mean, everything happens for a reason, and essentially we do all have the birth we need – there are higher powers at work here… but, we do have the ability to influence our birth.  Your body doing what it is supposed to do really depends on where you’re birthing and who you’ve allowed into your birthing space.  You have to know how your provider practices, what routines they do and are OK foregoing.  You need to know the policy of your birth location.  Do they routinely clamp the cord early?  Do they encourage movement during labor and instinctive birth positions?  Do they limit food and water intake?  Do you know why all this matters?
3. Why do I need a class?  The nurses will tell me what to do.
   Oh, wow… ummm…  First of all, I NEVER want someone telling me what I should be doing in MY birth.  Instincts will do a wonderful job of telling me that.  If my discomfort tells me to get off my back, no one will tell me otherwise… and you shouldn’t allow them to do that either.  But, more specifically, the majority of L&D nurses have little to no training, let alone experience, in natural birth – or even positive techniques in medicated births.  Birthing in a hospital, it is very rare to see a completely natural birth.  They have something around 6 weeks of training specific to the L&D unit and they’re also taking orders from a doctor (who is likely not there).  They are focusing on paperwork (preventing litigation), getting that routine EFM strip, and checking on the numbers to see how you’re “progressing” according to their pattern, and if you “need” pitocin…etc.  And then there is the very common situation that other moms are laboring at the same time so you don’t get much of their attention.  Please, please, do not rely on an L&D nurse to guide you through birth, unfortunately, many are not equipped for the job.  You need to know how you can work with your body, and how your choices may limit your ability to do so… and how a doula can do what you likely believe an L&D nurse will do.
4. I’ll just take a hospital course.
   Quite a few of moms taking independent childbirth classes with baby #2+ are moms who either didn’t take a class, or took a hospital class with their first.  In a nutshell, hospital courses are “how to be an obedient patient” or “what to expect when you arrive at the hospital.”  They don’t provide you with all your options, and they often omit certain details that go against their policies.  And, the one-day/crash courses are simply horrible.  It is difficult to provide all the information in a 10-week series for parents to make good informed decisions… let alone a few hours!!!  Independent perinatal education provides everything from nutrition, birth, and breastfeeding to home birth, midwives, and OPTIONS.  That’s the key, you need to know your OPTIONS.  Did you even know home birth was a [safe] option?  Did you know that IV’s contribute to difficulties in breastfeeding?  Did you know those gift bags filled with formula actually damage your breastfeeding experience?  Don’t rely on “what to expect” manuals and classes.  You don’t need to know what to expect, you need to know your options and how to be involved and affect your experience.
5. I’m getting an epidural.  What’s the point?
   This is a common misconception… a perinatal class that focuses on preparing a mother for natural birth doesn’t omit all the details about medicated births.  Considering the majority of mothers are birthing in a hospital with an obstetrician, it is crucial that medicated births are discussed.  Likewise, moms planning home births may require a transfer to the hospital, and they need thoroughly prepared as well.  There is also the factor that epidurals don’t always work, and you would likely want to know some ways you can have a pleasant experience in that chance.  Not to mention understanding the risks of epidurals that many providers lie to their patients about and others may not even understand.  Even if an epidural is desired, do you know how you can work with your body to decrease fetal distress and increase labor progress?
   But equally valid, have a little faith in yourself!  Who made you think that you can’t birth without an epidural?  Most likely, they were uneducated and didn’t make choices that supported a positive birth experience.  Your body was designed to birth.  Learning a little about that may help you realize how amazing birth can be.
6. My doctor will take care of me.
   In most situations, the doctor is not going to come in until you’re pushing, and you’re going to be relying on the L&D nurses (see #3) to “take care of you” and relay the information over the phone to your doctor.  If you’re going into your birth allowing your doctor to make all the decisions for you, you might find yourself with a not-so-pleasant birth experience.  Many mothers really don’t grasp how much their birth will impact them until it is said and done.  Not to mention the impact your birth has on breastfeeding.  Don’t put your health and your baby’s health in someone else’s hands just because they wear the title of Obstetrician.  Learn and discover what YOU want for your birth and how his choices can impact your experience, your baby, your postpartum, and your future.
7. My doctor has my (and my baby’s) best interests in mind.
   Not always.  In many situations, your doctor has their business in mind and often has litigation on the brain.  Many routines that occur in maternity care today are not evidence-based but done so that a trail of paper can be used in a court room.  Some obstetricians are taught that they can’t be sued for performing a cesarean, but they can be sued for not performing a cesarean.  Learn about your options so that you can make informed decisions and not allow your doctor, or anyone else in your birth space, misinform you of procedures – especially harmful ones.
8. My doctor knows what they’re doing.
   This depends.  If you have an obstetrician, they likely know what they’re doing if you’re having a high risk birth or need a cesarean.  But, if you’re planning a normal, natural birth, as in most cases, an obstetrician is not trained in this type of birth.  In many cases, an obsterician has probably never even witnessed a normal birth, let alone has experience attending them.  A midwife, however, is trained in normal birth.  They are usually more apt to provide you with an environment that supports normal birth.  By taking a perinatal education series, you can learn more about your options for care providers and understand more of the differences in the type of care that you might receive.  Just because someone has a title doesn’t mean they’re the best fit for the job.  You have to look at how they practice and what you want.  If you hire someone to build your house, you likely don’t randomly pick it in a phone book – you get references and hire someone who builds the way you prefer. 
9. All I care about is a healthy me and a healthy baby.  I don’t need to know the details.
   You do need to know the details if you want a healthy experience.  Unfortunately, to many, “alive” is equated to “healthy.”  When many of the practices occurring in L&D units are what is causing the negative birth experiences, you need to know how to avoid this from happening to you.  Don’t get the perception that just because someone has a cesarean that their doctor “saved their lives.”  Although some moms believe “if it weren’t for the doctor, I would have died,” in reality, many of those cases are actually ”if it weren’t for the doctor, I could have had a normal birth.”  The cascade of interventions starts by small changes like continuous monitoring, induction, back-lying positions…etc.   Many of the birth practices are what contributes to postpartum depression and breastfeeding difficulties.  The World Health Organization recommends no country should have over a 15% cesarean rate and the US MORE THAN DOUBLES this rate.  This equates to quite a bit of unnecessary cesareans which means unnecessary major abdominal surgery, and all that goes with it… which also equates to unnecessary maternal/fetal morbidity and mortality.  You need to learn how you can be healthy in pregnancy to avoid complicated births.  You need to know how birth affects postpartum and your future.  You need to know way more than you get from a 15 minute appointment every few weeks, more than an ultrasound will show you, and more than your friends and family are likely sharing.  Don’t be blinded by the poor state of maternity in the US – please, take a small portion of your time and learn some enlightening information.
10. Don’t worry about a class - you don’t need to be a  super hero.  There are far more important things than a natural childbirth.
    First of all, it doesn’t take a super hero to have a natural birth.  I’ve had two at home and they were amazing.  They make me LOVE birth.  I love to be in labor and that power I feel.  It has nothing to do with being a super hero – I was scared once (before I was educated).  There are many things that may be more important than a natural childbirth, but if you have the ability to do so, to affect your health and your baby’s health, then take it!  Your birth will impact you more than any other event in your life – your body was designed for this.  Just because another mom may have needed an epidural or induction or cesarean absolutely doesn’t mean you will.  Just because a b and c happened to so and so doesn’t mean it will happen to you.  And, remember that they likely didn’t take an independent childbirth class either.  You’re talking two different ball games with the educated vs. uneducated births.
11. I’ve had a baby before, I think I know what I’m doing.
    Many moms taking childbirth classes are mothers with previous children, and often previous births.  Likely, along their way, they met someone who didn’t have such a horrible birth experience, and they asked “how?”  They were probably told about childbirth education, a doula, or a home birth (or all three).  Every birth is different, and every birth is a learning experience.  Don’t believe that all births are the same or that you’re unable to learn anything just because you’ve been there before.  Equally, maybe you didn’t have a positive experience…. and I’m here to tell you that they do exist, but they require knowledge about the industry and making choices that support a positive experience.  Learn about those options!
12. I can’t have a vaginal birth, so what’s the point?
    (See #5)  Equally, perinatal education isn’t just about “the birth.”  You are going to learn about nutrition and exercise in pregnancy.  You will learn about emotional well-being and how this affects you and your baby’s development.  You’ll learn about prenatal changes as well as routines and procedures (that you have the right to refuse and that also carry risks).  You’ll learn about postpartum and breastfeeding, doulas and how they can help – especially in this type of birth.  I can’t say this enough – PERINATAL education… it is NOT just childbirth!
13. I took the one day course at the hospital.
    Please don’t believe that you can receive all the information about your perinatal health and options in a one-day course.  Not only do you lose focus after a few hours, but there is just too much information.  These are even worse for “what to expect” when you arrive at the hospital than the series that most hospitals provide.  If you’re looking for a crash course, there are independent options out there, including very inexpensive options at EB Online; however, we really recommend a full series. 
14. My OB gave me a prenatal packet when I first got pregnant, and it had a lot of great information in it, and a book!
    Unfortunately, these bags are often filled with formula handouts and pacifiers.  They often have little to no quality information on breastfeeding, and likely full of medical pamphlets.  This is not your ideal spot for anything of value.  The real problem (as far as birth and education are concerned) is that dreaded book, “What to Expect When You’re Expecting.”  To put it simply, avoid expectation guides and stick to informed decision-making about options.  If you want a good book to read, check out Ina May’s Guide to Childbirth.  Now, I do understand that many turn to this “expectation” book to understand that their breast changes, new dreams, and other similar things are normal – but there are countless places on the internet that will tell you the same thing.  By grabbing this book, you’re only learning what to expect, and not how to change (and some of the information is just incorrect).  Most perinatal classes will talk about these conditions and how you can make them better or not exist.  Many of these conditions are diet related – something which you can learn about in a perinatal class.  Many of these “expectations” are actually choices that you can refuse.  Take a class, trust me, you’ll learn way more than from hearsay and expectation guides.
15. My provider said it isn’t necessary.
    RUN… no, drive (at a safe speed) away from this care provider and find someone who encourages learning all you can about your changes and your options.  If your provider offers their own childbirth class, then see #4 – it is the same situation.  If your provider just doesn’t think it is necessary, I would bet they’re trying to hide something.  I would bet they have some control issues and don’t want you thinking for yourself.  They are likely telling you #6, #7, and #8.  A provider who wants you to believe vaginal exams are necessary, the Group B Strep test is required (and there are no risks to the treatments), and the test for Gestational Diabetes is required is a provider who wants you to have no choices.  A provider who doesn’t want you to know about positive birthing positions and moving with your instincts, just might have a lot of moms birthing on their backs.  You’ll learn about all this stuff and more in a perinatal series… might as well sign up.
16. Not right now, it’s too early.
    I totally understand this one… you’re not that far along, you might not even look pregnant yet.  You want to be sure you get all that information so you remember it close to birth.  However, planning for early education means you have time to make changes.  Lots of moms take a perinatal series and then realize “WOW, look at all these options” and then they don’t have time to change.  Many times this happens with moms who discover home birth exists and it is wonderful.  Unfortunately, when you get too far along, it can be difficult to find a care provider available, and some have limits of when they take new mothers (because being with you during your pregnancy means they learn a lot about you).  Of course, always ask, but the sooner you ask the smoother things go.  Additionally, and probably most importantly, if you wait until your third trimester to learn about good nutrition, it might be a little late.  Of course a change in diet at any time is always a wonderful thing, but preventing third trimester complications can happen the earlier you learn.  (Just a note, if you’re worried about forgetting everything you learned – all you have to do is follow your instincts, your good choices will take care of the rest.  But, even then, Esali Birth offers online classes that you can use until you birth your baby for review whenever you want).  So, no need to wait until you’re freaked out about everything from misinformation all around, get educated!
17. I don’t have time/I’m due in just a few weeks.
    Again, see #16.  And, also know that there are a LOT of “condensed” options.  Esali Birth has condensed options that cost $10 and will only take 1 hour of your time.  That is more information than you’d get from a hospital crash course.  Ina May’s Guide to Childbirth is a great read as is Creating Your Birth Plan by Marsden Wagner.  The Birth Partner by Penny Simkin is also an option.  If you have just a few hours a day, you can take the complete online course with Esali Birth, or you can pick and choose between seminars (even a breastfeeding course to prepare you for postpartum).  If you have time to spend reading this article, then you have time to take at least an online class.
18. My birth partner doesn’t want to take a class.
    If your birth partner, someone you’re expecting to support you and protect you, doesn’t want to get informed – take this as a hint that they shouldn’t be your birth partner.  This doesn’t mean they shouldn’t be involved, but this means they probably don’t know how to support you.  And, if they don’t want to take a class, they likely aren’t interested in learning.  This can be the most loving father or best friend, but all of that really doesn’t matter if they don’t have the knowledge or desire to properly support a birthing woman.  Find someone who is interested in learning about your birth philosophy and take them to a class.  It does not have to be the dad.  Many dads are just not made to support birth.  Their presence can be so valuable, but if they don’t have the knowledge or compassion to support you during this intense time, then don’t count on them.  Hire a doula, and recruit a friend to be your class companion.  You need to learn about options to develop your birth philosophy so that your birth partner (and doula) knows how to help you and so that your choices provide you with the best support. 
19. So and so said their birth classes “didn’t work.”
    This perspective is a big pet peeve of mine (and the issue with childbirth “methods”).  First of all, don’t take a class because you believe their method is going to take all your problems (and pain) away.  Take a class because of the informational value.  Then, YOU are still required to make choices that support your birth.  Just because you know the information doesn’t mean you have the miraculous ability to avoid the unnecessary interventions.  You have to apply the knowledge.  If you want a natural birth, most times, an obstetrician just won’t deliver.  If you want freedom of movement, eating and drinking, many times, a hospital won’t deliver.  If you don’t want routines happening to you and your baby, don’t try to change their policies, just make selections that support your wishes.  Your method doesn’t make your choices – YOU make your choices.  Now, a birth class that promises pain-free birth, I wouldn’t recommend.  A birth class that focuses more on birth pain rather than information about your options and biological birth, I wouldn’t recommend.  A birth class that focuses on “expectations” are just ridiculous (see #14).  I recommend a class that empowers you for biological birth, and provides you with the information for birth variations.  I recommend a class that provides you with information about nutritional necessities so that you can have more options by being healthy.  Take a class for the information that affects your options, because only you can make those options.
20. I can’t afford it.
    Let’s put aside the fact that most educators are more than willing to work with budgets with payment plans, discounts, sliding scales, bartering, trades…etc.  This is often the biggest reason mothers aren’t taking independent classes – because they are often priced higher than the hospital course and usually not covered by insurance.  However, you really shouldn’t let money get in the way of good health and a good birth.  You don’t realize how this birth will affect you.  I understand, it can be a little awkward to ask someone for a cut in price… I get that.  So, let’s move on to the real reason money shouldn’t matter.  This is your BABY.  This precious thing you’ve grown inside you is relying on you to make good decisions.  If I had a grown child and told them “I spent $200 on clothes and toys for you but didn’t have $200 that could have actually changed your health, changed your future, prevented complications, and affected the way I parent” they might think that is a little selfish.  Perinatal education can do that.  I know, you’re looking at this thinking “wow, what a &!%$#” but it is true.  Learning about your body and about birth allows you to understand how your choices affect your ability to birth biologically.  Paying a small amount for independent perinatal education can prevent paying a large amount for interventions and assisted births.  If you learn how to stay healthy, if you make choices that support birth in a positive way, if you change your provider because you learn that they really don’t have your best interests in mind, you can increase your health, your baby’s health, increase your ability to bond through a positive birth experience, increase you chances of breastfeeding success, and change the way you view parenting.  You can learn to stand up to people who are just throwing misinformation around.  You learn about the business of birth.  As a matter of fact, check out Rikki Lake’s Business of Being Born and you might be enlightened as to why all these choices affect you more than you think.  Don’t worry about the money.  This is more important than toys and cute blankets.  Babies really don’t need those things (your body does a wonderful job of regulating their temperature).  Babies need you to be their voice, and without knowledge, you have no voice.

What are some reasons you’ve heard (or thought) for not taking a childbirth class?

A Doula’s Role in Birth

A doula is a “woman who serves” and a popular role in the birth industry these days.  What does a doula do?  This topic is covered in a variety of ways all over the web, but I want to cover a very important topic that seems to get lost in the mix of attended births, especially hospital births.   Although there are a few male doulas here and there, a doula typically is a woman and “serves” other women during the perinatal stages, commonly, birth. 

There are a variety of areas a doula can specialize in including antenatal doulas (who serve during pregnancy), labor doulas (rather self-explanatory), and postpartum doulas (who support during postpartum and many also provide placenta encapsulation services).  Their role, first and foremost, is SUPPORT for the mother.  We’re going to discuss that specifically in this post.

Because a mother may often require emotional and physical encouragement and/or assistance, the labor doula’s top priority is providing this type of support. 

Doulas (as adapted from DONA.org):

• Reduce fear and anxiety
• Reduce requests for pain relief
• Increase chance of spontaneous vaginal delivery
• Shorten labors
• Reduce complications
• Reduce pitocin usage
• Reduce need for interventions and cesarean delivery
• Increase use of a birth plan
• Increase positive feelings about childbirth experience
• Enable couples to feel more secure & cared for
• Increase success in adapting to new family dynamics
• Increase breastfeeding success
• Decrease risk of postpartum depression
• Increase bonding and sensitivity
• Create more self-confidence in parenting

Contrary to what many believe, advocacy is not her primary role.  And, although she may provide this type of support in some sense, she cannot change policy.  This is why parents need to understand why hiring a doula for the right reasons is so essential to a positive experience.  Let’s get a few things straight, first:

1. Get Educated
2. Make choices that SUPPORT YOUR birth philosophy and understand how those choices affect your ability to birth biologically.
3. AFTER you’ve made those choices THEN hire a doula for support and maybe advocacy if you don’t have the option of a birth philosophy-supported experience.

You really should not make birth choices that require you to use a birth guide or doula to have your wishes met.  In most locations, finding a provider to support your birth philosophy is very possible.  In many cases, yes, you likely need to be open to a home birth, but, I haven’t quite understood how parents feel safe fighting for a birth guide in a hospital rather than being thoroughly supported by a home birth anyway.  In a hospital, chances are, your L&D nurse is the one caring for you and conveying details to your provider.  A home birth midwife is typically far more experienced than an L&D nurse (especially in regards to natural birth).  Not to mention, they are right there with you and can do things to help you or transfer if needed, whereas most births in the hospital require waiting for the care provider to show up to determine risks and emergencies….hmm… something to think about.

The birth team works best when everyone supports each other and negativity is thrown out of the mix.  Negativity increases stress, which increases pain, which decreases oxygen, which triggers maternal and/or fetal distress…  See where I’m going here?  You should not choose a birth environment or care provider believing you (or dad, or your doula) can change the way they practice.  Do you have rights?  Of course.  But, so do they (and you also have to consider all those consent forms you may have signed).  And, they also have a bit more power than you might like to believe.  Better to reduce the tension and just have a great birth, don’t ya think?

Along those same lines, don’t hire your doula and forego the perinatal education because you believe your doula can educate you along the way.  Many doulas do offer childbirth education, often even private classes, BUT this is PRIOR to the birth.  A doula can absolutely provide you with on the spot pros/cons/education…etc., when necessary (which shouldn’t be needed in the average birth situation that was created through choices supporting your birth philosophy) but this should NOT be relied upon!  When you’re in the moment of birth, you don’t want to switch on that logical part of your brain to get some last-minute education.  You need to stay in that primal-brain birth mode to work with your contractions, listen to your instincts, and progress your labor.  Additionally, if you haven’t been educated, you have likely not developed a birth philosophy and therefore don’t really know what all your options are or what you want (and may not be selecting choices catering to what you would have wanted had you been educated…etc…etc.)  All of this tends to end up in a “had I known…” scenario or “wish I would have…” situation.  Doesn’t cater to the positive birth experience that could occur.

A doula is best used when physically and emotionally supporting the mother.  This can come in the form of physical touch, pressure, supporting positions, suggesting bathroom breaks, creating privacy, calming breathing, making noises, and what have you.  Telling mom “you’re doing great,” “one contraction at a time,” and remembering specifics like relaxation triggers, positive words (wave, sensation…etc. vs. contraction, pain…etc.).  She is with the woman throughout her labor rather than doing paperwork and tending to another birth.  She is also suggesting supportive techniques to the birth partner, giving the birth partner breaks, and allowing the birth partner to participate as much as they can (and prefer) to be involved.  If she has to spend her time fighting over policies and routines, telling someone she doesn’t want to labor on her back, and preventing a provider from doing things like episiotomy and early cord clamping, then her skills are not being efficiently utilized, and the mother is not being fully supported…nor using her instincts.

This is no different in a home birth.  You should not select a provider in any location where a doula needs to be your advocate.  And, because this perspective of a doula is so prominent, many midwives get offened that doulas are hired for home births.  Likewise, many mothers are not hiring doulas because they really don’t “get” how valuable they can be at home.  For the most part, a midwife offers continuous support.  However, they are often doing more clinical things that a doula doesn’t provide…. and if they’re doing clinical things, then the mother may be lacking some support that she needs.  If the mother feels like she doesn’t want to birth alone (i.e. unassisted) then she needs to select the team that best supports her.  If the midwife needs to document part of the birth, check heart tones, check blood pressure (or one of those crazy vaginal exams)…etc., the mother may want that doula-support that she isn’t getting during those times.  Not to mention the births that may require a little more clinical care than others, difficult labors, or births that need transferred.  If there is an emergency, the midwife will be focusing on health of the mother and baby.  Even when there isn’t an emergency, the midwife is watching over the mother and focusing on the health – a perspective that isn’t the same as just supporting.

Bottom line, select a birth environment that SUPPORTS you.

Birth is…

Beautiful
Instinctual
Rhythmic
Trusting
Healing

Biological
Intrinsic
Respectful
Touching
Historic

Blissful
Intimate
Raw
Tantalizing
Heavenly

Basic
Influential
Remarkable
Testing
Hopeful

Breathtaking
Incredible
Riveting
Thrilling
High

Blossoming
Individual
Remembering
Therapeutic
Heroic

Bilingual
Intertwined
Rudimentary
Telling
Home

 

Birth is… what you make it.

Acknowledging Fears

When I first found out I was pregnant this 2nd time, I briefly considered an unassisted birth – and then some fears surfaced – many from my husband, but some from myself as well.   

Going into my first birth experience, my biggest fear was the risks from an epidural and the temptation and pressure of getting one anyway – so I chose a home birth.  It had nothing to do with an empowering spiritual event – it was a choice to avoid the unecessaries and have the best chance at a natural birth.  Aside from that, I was scared of the pain, but the fear of unecessary interventions far exceeded the short amount of pain I would experience.  When I hit transition (not knowing I was there at the time – just thinking it was active labor), I got a little worried thinking “Oh my gosh – this is just going to keep getting worse” and it never did.  I had a beautiful birth – the one I planned for – but for this birth, I am looking for even more… for a biological birth experience.

Going into this birth, my biggest fear is unecessary intervention – once again.  Only this time, it isn’t the typical “intervention” you think about.  Not the heplock, the EFM, the vaginal exams, or the time limits… no, not that.  But the watching, the kind suggestions for positions, and the attendant’s need to “do something” when there is nothing to be done but labor and birth a baby.  These fears have mostly been taken care of… I’ve selected a birth team who fits with my birth philosophy.  A team I’ve communicated with so that they know my wishes – and they also understand my wishes (not simply just complying – but believing in them).  A birth team who is perfectly capable of sitting in a corner watching me moan, move, sweat, and biologically birth.  And a birth team who is also perfectly capable of telling my husband ways he can help, letting him take care of Bell, reminding  me to stay hydrated, reminding me to urinate, putting cold wash cloths on my head, and providing emotional and physical support whenever I need it should this birth doesn’t go as perfectly planned.

• Best Choice for Birth Environment – Check
• Best Choice for Birth Team – Check

So, it would seem as if all my fears are taken care of, right?  Wrong.  I still have fears that simply require positive thinking and faith.  It is very important to acknowledge all of your fears so that you may deal with them, get help for them, move past them, or accept them. 

My biggest fear is something going wrong and having a birth experience completely opposite of what I’m planning.  I expect changes, bumps, and turns.  I know things happen – I know nothing is perfect – I know birth is safe, but that doesn’t mean nothing ever goes wrong.  I respect birth for the normal bodily event that it is and do not feal I need medical attention to get through the normal process.  Just like with any normal bodily process, rare things sometimes occur that require assistance – and I respect that as well.  But, because I have so little fear of pain and birth – so little fear of the actual process - and because I talk about all the normal biological processes that occur… I fear some crazy rendition of kharma.  I fear a lesson from God, essentially…  I’ve had a lot of those over the years and have learned much from them.  Nonesense?  A little bit – but a fear nonetheless.  But it is this reason that I chose the birth team that I have in line.  I want a birth team who loves to support biological birth experiences, and who is also more than capable of watching over me – who knows when transport is necessary, and who can still continue that high quality of support should an emergency happen. 

Some fears, for many women, will just not disappear.  There is no trickery, no education, no mantra, no book, no method that can take all the fears away for some women – and that is OK.  It is OK to have fear.  Fear is a normal process in life, and has a very valid purpose.  Sometimes we make better choices because of fear.  Sometimes we are more cautious and preserve our bodies better because of fear.  As non-fearing humans, we would make many decisions that would otherwise harm ourselves or others.  Fear is in the background of morals, values, beliefs, and everyday choices.  What you choose to do with those fears is the real issue.

You can choose to only dwell on those fears – increasing the feeling to an unecessary state.  You can choose to avoid or hide those fears, causing them to resurface at inopportune moments (like during birth).  Or, you can choose to acknowledge those fears and work through them as much as possible and make choices that best accommodate those fears.

If you fear interventions, what would cause those interventions to go away?  If you fear pain, what techniques can you use to minimize and/or eliminate your pain?  If you fear a cesarean, who can help you avoid that situation?  If you fear a posterior baby, what positions can you utilize that will help with moving your baby to a more LOA position?  If you fear negative environments, how can you create a positive situation?  Only you can answer this for yourself, because every woman and birth is different.

Pass on the Paci

Pacifiers are everywhere, and mom’s breasts are nowhere to be seen.  In a culture where most moms bottle feed, it is no wonder why we see pacifier use in almost every household throughout the toddler years.  When most babies would still be breastfed if allowed to nurse as long as they desired, a toddler drinking from a bottle would have the same sucking desires as their breastfed peers.  The issue, however, lies in the detrimental impact on breastfeeding and of course on oral and facial development. 

Learning your baby’s cues is an ever changing task.  Our babies communicate with us in a variety of ways, much like we have multiple ways of communicating our thoughts and desires.  We may walk to the kitchen for a drink.  We may ask a loved one to get us a glass of water.  We may point to a cup.  And we may even use different words during our requests.  Our ability to communicate is vast and this isn’t any different just because of age.  In the newborn days, a baby almost always wants to nurse and will root almost every instant that they’re not put to the breast while they’re awake.  Even when they’re hot, gassy, or need a diaper change –they are almost always comforted by simply being put to the breast often and unlimited.  This ensures the meconium and bilirubin is passed, their digestive system is coated with colostrum, and mom’s milk supply is established.  When many babies have a difficult time latching, this helps them to get milk even when their latch isn’t perfect.  A baby that is put to the breast without limits can have a poor latch and still thrive (although mom’s nipples may become damaged if latch isn’t adjusted). 

Their cues may not always be the same, and change as they learn to communicate to an adult’s perspective more efficiently.  They will start smacking their lips, making noises, and sucking on anything that nears their mouth.  When mom doesn’t respond, they start making whining noises, and eventually cry – and many babies skip the whimpers and go straight to screaming.  When mom responds to specific cues repeatedly, they learn that they get a response from certain cues and will continue that cue more.  If crying is what gets responded to, they will cry more – and when early cues of lip smacking…etc. get responded to, they will likely cry less.  This is the beginning of good communication.  They often learn that any cue they make elicits some type of response from mom, and as they grow and develop, their need for the breast for total comfort starts to fade, and they begin to want interaction, holding, and general play along with comfort and nourishment nursing.

What seems to cause some confusion is a baby’s love of sucking causing parents to believe that is the only way they can be comforted.  Some babies will nurse until they’re full, and then get frustrated when they want to comfort nurse and they’re still getting milk, and this is when many parents start introducing a pacifier.  In those early days, moms fill up with a lot of milk, and babies are learning to latch – a forceful letdown and a large milk supply may make breastfeeding difficult for some babies.  But as the milk supply establishes, it often levels off to a manageable amount, and baby’s stomach grows meaning a baby who may not have been happy comfort nursing, will love to do so at a later time.

Additionally, we need to understand that artificial nipples almost always cause some type of issue with breastfeeding, particularly if artificial nipple use is prolonged and not used on a limited basis.  Before breastfeeding is well established, artificial nipples use can cause a lot of difficulties learning to latch and establishing milk supply.  It also causes nipple discomfort for mom because the baby (even when they seem to do OK between artificial nipple and mom’s breast) often has a slight change in nursing that causes a difference in the sensation for mom (and is a contributor to mom ending the breastfeeding relationship early).   Therefore, it is best not to introduce artificial nipples until breastfeeding, and supply, has been well established – somewhere around 6 weeks or more postpartum and then only use it on a limited basis when other means of comforting aren’t working.  This need is likely not to happen very often in most babies who have unlimited access to the breast and are parented with an attachment-style approach.  However, no matter when you begin using a pacifier, do so on a limited basis and only after other methods of comfort have been tried, especially as baby gets older.  Remember, babies are often comforted by nursing even when they need a diaper change, they’re hot, their scared, their bellies hurt, their sick…etc – and trying other methods than nursing can be a great way of determining what they need.  When an artificial nipple is used, especially in the early weeks, it can be difficult to determine if you’re replacing a feeding – because 8-12 feedings per day is a minimum.  If your baby doesn’t have a good latch, they may not be getting an efficient amount of milk, and breastfeeding and health could be damaged.

If your baby has taken a full feeding, you know their latch is well, and they are having difficulty comfort nursing, there are many other things you can try to keep your baby happy before using a pacifier.  Even if a pacifier has been something you’ve used before, it doesn’t mean it is something that needs to continue for months or years.  With my daughter, I initially didn’t want to use a pacifier, and then introduced one at about 2-3 weeks postpartum on a limited basis, and then stopped altogether at 6 weeks when I discovered new ways of comforting her.  With my son, we haven’t used pacifiers at all.  I believe not having a pacifier in the house is less of a temptation – similar to why us lactivists recommend refusing or donating formula samples from providers and hospitals.

Your baby wants to be close to you at all times.  In western cultures, many moms nurse the baby, and then put the baby down (if they’re even nursing at all) and babies really don’t get much skin contact and mommy time.  Sometimes, especially in an older baby, they will suck on their hands (because they now have the control to get them to their mouths) even when they’re not hungry.  In many instances, I would say this is a hunger cue, but for a baby that has just taken a full feeding and seems to be spitting up quite a bit or has a history of comfort nursing to the point of spitting up what seems to be all of their stomach contents and you know it isn’t vomiting) then this act of sucking can be a good indicator that they simply want comforted or interacted with in a different way.  They may simply feel like they want held and talked to, or even taken to a quiet space and rocked.  Often, your baby wants that rhythmic motion and sound they had when they were in the womb, while being close to your heart.

• Holding your baby while singing nursery rhymes can be very comforting.  Humming or even just mimicking the sounds of a heartbeat can be very soothing (especially if you’re not to keen on your singing skills).
• Rocking your baby, or walking while bouncing is quite soothing and mimics the womb quite well.  Most parents can find walking and holding a baby quite tiring, however.
• A birth ball is a great item to have on hand to soothe baby, and even get them to fall asleep.  Just hold he baby and gently bounce.  There were many times where I bounced my daughter to sleep – and sometimes it took 30 minutes or more, and taking turns with my husband and my mom when we got tired.  Sometimes nursing, then bouncing, then nursing, then bouncing… and sometimes even nursing while bouncing.
• Babywearing is an excellent way of allowing baby that comfort while giving you some hands free moments, and not causing tired arms and a sore back.  There were countless days where my daughter wouldn’t fall asleep at all unless she was in the wrap, being walked, as I gently kind o hopped up and down, while also patting her back and butt.  My son loves this as well, and it makes falling asleep while shopping or talking with friends quite easy.  Nursing while babywearing is also a great way of comforting.   
• A swing or a bouncy chair can give you a break from holding your baby in any way while still avoiding a pacifier.  Sometimes a white noise machine or any type of noise or background rhythm can be soothing along with other comfort techniques.

Many times it is a combination of rhythms that soothes them and trying 3-4 different things can be beneficial before choosing a pacifier.  Just remember that pacifiers can be beneficial for some instances, and I am by no means saying they should not exist.  But just try a few things before choosing them as a first option, especially when your baby (and milk supply) is new to breastfeeding, and as your baby gets older and is interacting more.  It is easy to get into a habit and then forget about trying something you tried previously that didn’t work.

What is your favorite way to soothe your baby?

MOV Birth Statistics

The following is a list of birth & c-section rates in the Mid Ohio Valley.*

Marlene Waechter, CPM
500+ Total Births
3% C-Section Rate
97% Vaginal
90% – VBAC
8% – Hospital Transfer
0.2% – Perinatal Mortality
0% – Maternal Mortality
1.8% – Premature Births
99.7% – Breastfeeding Initiation (99.5% continue for 4+ mnths)

Marietta Memorial – Marietta, OH
614 Total Births – 2005
24% C-Section Rate
461 Vaginal – 75%
6 VBAC – 1%
69 Primary C-section – 11%
78 Repeat C-section – 13%

St. Joeseph’s – Parkersburg, WV
344 Total Births – 2005
22% C-Section Rate
262 Vaginal – 76%
6 VBAC – 2%
50 Primary C-section – 14.5%
26 Repeat C-section – 7.5%

Camden Clark – Parkersburg, WV
1266 Total Births – 2005
28% C-Section Rate
897 Vaginal – 71%
5 VBAC – 0.3%
186 Primary C-section – 15%
178 Repeat C-section – 14%

Obleness – Athens, OH
633 Total Births – 2008
36% C-Section Rate (+6% from 2005)
406 Vaginal – 64%
0 VBAC (2005 report shows no VBAC’s attempted, no info on 2008)
126 Primary C-section – 20% (+1% from 2005)
101 Repeat C-section – 16% (+5% from 2005)

WomenCare Birth Center – Hurricane, WV
Total Births -
C-Section Rate
Vaginal -
Primary C-section -
Repeat C-section -

CAMC W&C – Charleston, WV
3098 Total Births – 2005
42% C-Section Rate
1789 Vaginal – 58%
11 VBAC – .3%
855 Primary C-section – 28%
443 Repeat C-section – 14%

http://www.wvdhhr.org/bph/oehp/hsc/pubs/vital05/vs_22.htm

*Our c-section rate is very high in this area (as is in the rest of the country). Please note, simply because the percentage is lower, doesn’t necessarily mean the hospital is more “birth friendly.” You must take into consideration the amount of births that occur in that hospital all together. You must also consider these are only statistics, and your experience will be based on your education, care provider, nurses on staff, and any other labor assistance that may be available to you. Do your own research, get input from people in the area, and create a birth plan that will be placed in your file. Take a hospital tour of any hospitals that you’re interested in, and research the pros and cons. Your location choice will have just as much impact on your birth as your care provider. This is updated as often as possible and reflects the most recent data I’ve been able to obtain; the year of data collection is noted in the total births section for each hospital.

Interviewing a Home Birth Midwife

When choosing to have an attended birth (i.e., not unassisted), finding a provider is very important.  You want to find the location that supports your birth situation in the best way, and in many situations this is at home.  Though evidence-based studies may indicate safety in one direction or another, you still need to look within yourself and determine what your priorities are and what your comfort level is, and how your choices affect your ability to birth biologically.  Having a provider that matches your birth philosophy will be a very important decision.

People tend to throw around titles like they actually mean something, and I really want to stress that birth is a natural event – there are rare situations that need medical assistance when birth is able to continue as nature designed.  So, what is important when finding a care provider for your birth?  Experience, of course.  A certified nurse midwife who hasn’t been practicing home births very long will likely not have nearly the experience of a lay midwife who’s been practicing 30+ years.  Likewise, a midwife who has been in practice for a long time doesn’t simply mean she is a good attendant.  You have to ask questions. Period.  Without asking questions, you can’t know how she is going to attend your birth.  You also need to talk to other mothers that have used that attendant, and get their feedback on the whole experience, making sure you ask if there is anything they would do differently next time. 

Many questions will come from your own thought process and concerns depending on previous birth experience, or not, but here is a basic list that I recommend parents ask when interviewing a home birth midwife.  And, yes, emphasis on the “patrentS” – as in the mother and her birth partner need to go together.  Too many times moms talk with a midwife, and daddy is at home or work and doesn’t get all his fears taken care of and questions answered… mom goes home ecstatic about her home birth, and dad still says “eh, I don’t know.”  Such a common scenario that can easily be worked out with a little bit of rescheduling. 

• Why are you a midwife?  What do you feel your role is during pregnancy, labor, birth, and postpartum?
• Do you come to my house for prenatals and other appointments, or will I visit you?
• Do you have an OB backup?  Would I transfer to them during labor if complications arose?
• Do you recommend moms hire a doula?  (Which ones?)  How do you feel your role differs from a doula? 
• How many births have you attended?  How many have been home births?
• What prenatal testing do you require?
• Do you use a fetoscope or Doppler?  Would any situation cause you to use something different than your routine option?
• What are your procedures for things like Group B Strep & Gestational Diabetes?
• At what point during my pregnancy would I be required to see an obstetrician? 
• At what point during labor would you suggest transferring to the hospital?
• What is your transfer rate?  Cesarean rate?  Episiotomy rate?  Breastfeeding rate at birth?  Are you aware of your breastfeeding rate at 6 months?
• How would you handle a hemorrhage during labor/birth?  How would you handle a hemorrhage after the placenta has been birthed?
• How close do you feel a mother should be to a hospital in case of an emergency?
• How would you handle newborn resuscitation? (Are you capable of providing resuscitation with room air?)
• Do you routinely provide natural cord clamping?  In what instances would you require clamping the cord before it has stopped pulsing?
• When would you come to me in labor, and how should I contact you?
• Do you offer water birth? (Do you have a tub available, if not, how could I obtain one?)
• For what reasons do you perform vaginal exams?  Are you comfortable with no vaginal exams before or during labor?
• Do you recommend your mothers take herbs to “prepare” her for birth, or do you believe a good diet and exercise will allow her body to work efficiently?
• Do you allow your moms to instinctively labor and birth?  At what point do you start suggesting positions and pushing?
• Do you perform perineal massage?  Why?
• Do you stitch?  If not, and I require stitches, how is this handled?
• If transfer during labor is required at any point, how is this handled?  Will you stay with me?  At what point would you leave?
• IfI transfer during labor, do you still see me for postpartum visits?
• What do you do to ensure mom has uninterrupted bonding with her baby?
• How do you help moms with breastfeeding immediately after birth and during postpartum?
• When will you visit after the birth?

Then, finally, talk about fees.  Discuss any contracts the midwife would require, ask about payment plans, and don’t be afraid to ask about bartering/trade if necessary.  Be sure to ask how fees are handled if you should transfer during pregnancy and/or labor, birth, or immediately afterwards.

 

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The Jolly Mama

What makes a jolly mama?  Love, support, sleep, and knowledge.  I’ll expand on that at some other time… but, right now, this is simply for all you stressed out mamas out there…

While vacationing with my husband (kidless at the time), we discovered one of our new favorite drinks.  Granted, we typically prefer beer & liquor… but this particular drink had just enough tang and the right amount of sugar to make it worth our while…

The Jolly Rancher… otherwise known to the Mamaology crowd (who is known to so carefully split being a mother and not thinking that motherhood stops all “fun” ) as the ”Jolly Mama.”  According to those girls, “Danielle, this drink is dangerous.”  You’ve been warned.

1 Shot Watermelon Vodka
1 Part 7-Up
3 Parts Cranberry Juice

Mix over ice & serve!

Notes:
Substitute Watermelon for any other JR flavor.  And, no, you can’t substitute with other types of liquor or cranberry mixes… yes, substitutions will make another fruity alternative… but I promise you, it is just not the same.

Drink responsibly… especially while nursing!

Babywearing

Babywearing provides an easy way to integrate baby into your life by offering options to keep the little one close to your heart where they’re comfortable, skin-to-skin to regulate temperature, easy nursing access, and flexibility so you can be hands free for cooking, cleaning, shopping, eating, and many other tasks new mothers may find difficult while adjusting to life with a new baby.

Babywearing is a beneficial type of kangaroo care that keeps babies close, stimulates physical, emotional, and mental development and helps babies, particularly preemies, where studies show they gain weight and are healthier than those who are not worn.

Many moms are getting into the trend of high quality carriers to ensure their child’s safety, but aren’t quite sure which one to buy.  There are a variety of carriers to choose from; finding your style only takes a little bit of research.  It is best if you can try a few before buying them, but here is a breakdown of the basic styles:

Wrap

A wrap is super soft and flexible with a lot of versatility.  There are adjustable types as well as pre-wrapped styles offering something for everyone.  These wraps distribute the weight very well, and have no points that compress the body creating extreme comfort at almost every stage of wearing.

The adjustable types consist of a very long piece of fabric that allows multiple wrapping methods and easily grow with the baby from birth (even preemies).  The pre-wrapped are easier to get the hang of, and have much less fabric, but only fit the baby well at one stage, and may not go between care givers easily because of body shape differences. 

Wraps are often the best for the newborn stages, but are not recommended for back-carrying because of safety. 

Sling

A sling style carrier seems less intimidating than a wrap and is worn over one shoulder and across the body.  These may be a pouch-type of just fabric, or may have a clasp, like a ring, to adjust and tighten to fid the child.  They often require some support of the care giver with an extra hand, but are super fast to get on and off.  Be cautious of low-grade slings that don’t allow the baby’s head and neck to extend or their back to be fully supported.  These may not be great for extended wear because the weight isn’t distributed, but make short shopping trips much easier, and safer, than carrying the baby in the car seat. 

Soft Structured Carrier

These carriers are typically the easiest and support the baby well – especially as the baby gets older and into toddlerhood.  These carriers are often preferred by the dads.  They usually have a large panel of fabric, some adorned with pouches and hoods, and are tied or buckled to stay secure.  These adjustable carriers are excellent for extended wear like hiking, and many are useable from newborn through about 45lbs (though many need a newborn insert for those smaller stages).  Be sure to avoid the “crotch-dangling” carriers that support the baby by the groin rather than separating the legs as they would naturally go when holding your child.  This is especially important for a newborn as it is easy to dislocate the legs/hips and prevent proper physical development.

Once you’ve found the style (or often styles) you prefer, there are just a few basic safety guidelines (which may seem a little too logical, but they need to be pointed out) you’ll want to think about when you wear your baby:

• Use your carrier according to the manufacturer’s instructions including baby’s height and weight and inspect for defects before wearing.
• Practice with a doll to get comfortable with your carrier.
• Be sure baby can breathe – their chin should not fold against their chest & fabric should not cover their face.
• Be careful of your activity using the same activity precautions as you would while pregnant.
• Do not wear your baby while driving or riding in a vehicle or sleeping.
• Be sure baby’s exposed areas are protected from outside elements.
• Be cautious of what baby can reach, and what can touch your baby especially while cooking or if baby is worn on your back.
• Be sure anyone carrying your baby can assess risk, knows how to use your carrier, and understands babywearing safety.
• Position your baby close enough to kiss & in a way that mimics how you would naturally hold them with just your arms.  Baby’s back should be straight & the head and neck well supp­­orted.

So, those are the basics.  My personal favorites are the Moby or Boba Wrap and the Boba Soft Structure Carrier, and if I were going to pick just one, I would pick a wrap like the Moby or Boba Wrap (formerly known as the SleepWrap).  I recommend parents attend a babywearing workshop, or get together with a group of babywearing moms and try on a few styles.