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Dear Family and Friends of Expectant Mom,

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     We know that you are anxious to hear news about your loved one going into labor and giving birth. And we know that you really do care.     

     If you really want what is best for this woman-in-waiting, you might consider leaving her alone for now. We promise, someone will let you know when anything important occurs.       

     We also know that you have a wealth of knowledge and experience. But sharing that right now is not going to make the baby come any sooner. And it just may cause your loved one some fear and stress. Now, we all know, those two emotions are not good for momma or baby.     

     We know that you are acting out of love and concern. It is for that reason we ask that you give her the most important gifts…faith, trust, love, patience, and plenty of space.       

     We know she is dealing with her own thoughts, discomforts, impatience. Please do not give her yours, too.      

     Thank you so much for understanding and not having hurt feelings. Do not worry, your new, wee baby will be here exactly when the time is right.      

Respectfully,  

Triad Birth Doula, 

Doula of a 40+ week momma-in-waiting

 

When a woman is first administered an epidural…she needs her doula.

indexWhen a woman is first administered an epidural…she needs her doula. In fact, she and her partner need, and want, their doula* very, very, much!

 
In most cases when a doula is present, this woman has just given up her dream to have a natural birth. This is difficult for her. And that is not even mentioning the pain she is dealing with at the time. She hurts; she is upset; she is scared. She may even feel that imaagesshe has just been forced down a path she did not want. She knows that this is a turning point in her labor and takes her closer to the possibility to major surgery. And all of this has a huge impact on her partner.

 
It is obvious…they both need the woman they have come to know and trust over the past several months. They jwant the woman they have handpicked to be with them throughout this journey of childbirth. They want that one consistent and ever present woman. They want their doula.

 
And why shouldn’t their doula remain with them? Around these parts, the anesthesiologist do not mind. There is plenty of space in the room. And the doula knows to stay out of the way. She is beneficial because imageksshe knows how to calm the woman so that she is not moving about during this precise procedure. She knows how to keep a watchful eye on the partner. She offers a sense of peace and calm for this couple with whom she has spent so many hours, as no one else in the room can offer.

 
imagesThen there are those first delicate moments immediately following the administration of the drugs. The woman’s blood pressure may drop; the baby may not react well; etc. Again…this is the time to have the soothing presence of the doula. This is the very important time for both mother and partner to be assured by this woman they trust so much.

 


The doula knows that the medical team must do what they need to do at such an intense time and is prepared to remind this couple of what is occurring, as she has already reviewed the possibilities weeks ago. She is also prepared to remind the mother of her options, her choices, with all the pros and cons. She is able to explain to the couple what might be occurring, even while the mother and baby are being cared for by the medical team.

 
kWhen an epidural is administered, which is a turning point in a woman’s labor, the woman and her partner need and want their doula.

 
It is very simple…the doula gives them what no one else can.

 

*For the purpose of this article, when I refer to a doula I am referring to a certified doula, or one in the process of certification, who abides by a set Code of Ethics and Standard of Practice.

The Squat Bar

The squat bar can be an awesome tool to use when you are pushing your baby into this world. But it can be very confusing as to how to use it…and feel strange. I will try to give you a feel for it with the pictures and comments below. Unfortunately, it is rare to have an opportunity to actually practice with a bar.

3cbd034e9e27cd1efe410ff6801cc37b.wix_mp_1024 This is how the bar and the bed are positioned. You sit right on edge of raised portion until a contraction comes. Then with a contraction, you squat so your bottom is not touching bed, and you push.

khkhjymjjkujPushing like this at first can feel a little insecure because all of your weight is on that lowered portion of the bed. It will help you to know that your support person is right there with you.
It may also help to have entire bed lower to the ground so you do not feel like you might fall off a cliff.

hNote how the bar is tilted towards the foot of the bed and all of your weight is on lowered portion.

 

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Between contractions, you can try to rest the weight of your body back onto the higher portion of the bed.

 

index (2)Then, with a contraction go into a deep squat, supporting yourself with the bar.

squatting bar on hospital bedRemember, your support people are right there for you and will help steady you. And having the entire bed lower to the floor will also help you to feel more secure in this position. Everyone else will accommodate your position.

a4128bd43637fbfa63d5aa40946a1e19.wix_mp_1024This is an awesome way to use the squat bar and “tug-of-war” position. Please note how she is not on her bottom; how she is really in a squat but on her side. Very useful with an epidural. “Tug-of-war” position is usually used for pushing; not labor.

maxresdefaultI’m not sure about this kind of position because while it simulates a squat, it leaves her sitting on her butt. It does, however, allow for that “tug-of-war” position.

fThis position allows you to be asymmetrical while being able to take some weight off of the lower body by leaning on the bar. If possible, spread your legs as wide as you can.

 

Most of these positions can also be good for labor. It is considered best to use the bar for a deep squat during a contraction. Sit back and rest in between. You want to be sure that when you are in that deep squat, you are NOT PUSHING until your cervix is ready.

If your hospital does not have squat bars…start asking for them. This is how change can occur!

What Impact Can IV Fluids Have on Mother, Baby and Breastfeeding?

 A Quick Look.

images (4)Written by guest author, Jacqueline Levine

Having IV fluids is a medical procedure. It’s meant to restore normal body fluid balance when there’s blood loss or dehydration, but the Listening to Mother’s Survey1 reports that 83% of women have IV in labor. Having a routine IV , as so many do, isn’t risk-free.2 An excess of IV fluid can dilute red blood cells and other components of the blood like clotting factors, so that less oxygen gets to the uterus and less to the fetus, increasing the possibility of post partum anemia or hemorrhage3,4.
Too much fluid can overcome normal pressure in blood vessels, and fluid goes where it shouldn’t. The mother’s and/or baby’s lungs can become “wet”5. Large amounts of fluid given quickly (a bolus) can interfere with the activity of the uterus.6 The type of IV fluids given can have unhappy effects as well, such as hyponatremia which can cause seizures, and symptomatic hypoglycemia in the baby7,8,9. Plastic IV lines may “off-gas” phthalates and other chemicals that are harmful. This list is brief. There are lots of studies that show harms from routine use of IV. Even the safety of “normal saline” has come under scrutiny.10 And the effect of IV administration lasts well into the days after the mother is disconnected from her hanging bag of fluids.
Fluid has weight, of course; haven’t you heard that helpful little reminder, “a pint’s a pound the world around”? If a laboring mother gets bag after bag of IV fluids, odds are that her baby will be born with an inflated birth weight. Breastfeeding success is often measured by how quickly the baby regains its birth weight after the normal weight loss in the first week or so. What exactly might that baby’s normal birth weight have been? What does it mean to the motherbaby pair when of them both are full of extra fluids? Water moves everywhere in the mother’s body and aside from ankles and wrists and fingers and toes that can be swollen like sausages, breasts and nipples hold water as well. A swollen breast with taut skin makes latching difficult. This scenario is often the beginning of early nursing troubles10: the transition from colostrum to mature milk may be delayed in a water-swollen breast, and a newborn may not able to achieve a deep latch so he can’t get sufficient food and cannot stimulate the breast well. Supplementation comes next. We know it and the studies show it. There are remedies to those situations…good support for mother and baby… but best-evidence, optimal maternity care is the answer.
Supplementation frequently comes next. We know it and the studies show it. There surely are remedies to the problem of swollen breasts, like Reverse Pressure Softening, and methods to build up milk supply, and ways to support better positioning for a baby who is having latch difficulties..
But the overarching answer is for mothers to be aware of best-evidence, optimal maternity care, and to understand their rights as patients to refuse routine interventions. By avoiding IV fluids except for compelling medical reasons, mothers will be able to avoid the negative consequences of fluid overload to their babies and themselves, and give themselves a chance at better breastfeeding beginnings.

Jacqueline (Jackie) Levine, LCCE, FACCE, CD(DONA), CLC is committed to providing a continuum of care for underserved women at PlannedJackie-Levine Parenthood, on Long Island, NY, where she has provided free Lamaze education, birth and breastfeeding support to all the women in her classes for the last 9 years. She is a guest lecturer on Childbirth in the US at CW Post, has worked for CIMS, contributed to the Lamaze e-newsletter Building Confidence Week-by-Week , all after her 30-year career as a designer in the garment center. Jackie is a recipient of the Lamaze Community Outreach Award, mother of three and Grandmother of five.” Science & Sensibility

 
References:
1-DeClerq E, Sakala C, Corry MP, et al. Listening to Mothers ll: Report of the Second National US Survey of Women’s Childbearing Experiences. New York: Childbirth Connection
2-Wasserfstrum N. Issues in fluid management during labor; general considerations. Clin Obstet Gynecol 1992;35(3):505-13
3-Carvalho JC, Mathias RS, Intravenous Hydration in obstetrics. Intl Anesthesiol Clin 1994:32(2):103-15
4- Carvalho JC, Mathias RS,Senra WG et al. Hemoglobin concentration variation and blood volume expansion during epidural anesthesia for cesarean section. Reg Anesth1991;16(1S):73
5-Gonik B., Cotton DB.,Peripartum colloid osmotic changes; influence of intravenous hydration. American Journal Obstet Gynecol1984;150(1):99-100
6-Cheek, T.G., Samuels, P.,Miller, F., Tobin, M., Gutshe, B.B. Iv load decreases uterine activity in active labor. Journal of Anaesthesia 1996;77:632-635
7-Stratton JF, Stronge J, Boylan PC. Hyponatremia and non-electrolyte solutions in laboring primigravida. Eur J Obstet Gynecol Reprod Biol 1995;59(2):149-151
8-west CR, Harding JE. Maternal water intoxication as a cause of neonatal seizures. J Pediatr Child Health 2004;40(12):709-10
9-Nordstrom L, Arulkumaran S, et al. Continuous maternal glucose infusion during labor; effects on maternal and fetal glucose and lactate levels. Am J Perina. Am J Perinatol;1995;12(5);357-62
10-http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Normal-saline-is-not-normal-may-be-harmful/ArticleNewsFeed/Article/detail/776186?ref=25
11-Chantry CJ, Nommsen-Rivers LA, Peerson JM et al. Excess Weight Loss in First-Born Breastfed Newborns Relates to Maternal Intrapartum Fluid Balance. Pediatrics 2010

No…thank you!

No Thank you

The Use of Lubricant During Childbirth

 

     When a woman is pushing her baby into this world, the care provider will more than likely use a lubricant to help make the crowning process, and then birth, easier and hopefully result in less tearing. * And no, our bodies usually will not create enough natural lubrication at this point in birth.BirthBowl.2jpg

     At the hospital where I most often attend births, this lubricant is soapy. I use to laugh and say the baby was getting his/her first shampoo.

     The other day, a nurse told me as she was watching this process that she noticed the newborn squinting, blinking, having a difficult time keeping his/her eyes open. And then it struck her, there was soap in his/her eyes! For all these years and births, they have been putting soap in the infant’s eyes. And we all know how that feels.

     The solution appears easy enough…do not use a lubricant that is soapy. Okay…but then what should be used? It must be something that is sterile and water-soluble so as not to harm mother or baby…right?

     I thought perhaps mineral oil. Someone else suggested vitamin E oil. Why not baby shampoo? If it is safe for a baby, with “no more tears”, would it be safe for a newborn?

     Whatever suggestions you may come up with, please, please, discuss with the experts before using. I am not an expert. I am just a doula who wonders about that soap in the newborn’s eyes.

*No lubricant is used in a waterbirth.

To Epidural or Not…

Are you planning on having an epidural? iStock_000008463436XSmallIf so, that is certainly your choice…but have you considered all of the effects, and not just for yourself, but for your baby, too? I mean really considered???

If you tell me yes to these questions, then I say go for it!

But what are you going to do until the anesthesiologist administers it? How are you going to handle your labor until that point? An epidural is usually not given until you are well into active labor, about 5 centimeters. Heck, these days you are often not even admitted to the hospital until you are about 5 centimeters.

And what if, as happens so often, you have “break through” pain? Do you know what you will do then?

And don’t forget about the 2nd stage…pushing.

My point…….an epidural does not take away the need for education, coping tools, and the need for a birth doula!

 

Bed Rest Survival Tips

Have you been placed on bed rest for a medical reason?

How are you spending your time?bedrest-300x200

We all know those reality TV shows about pregnancy/birth/babies are a waste of time. Friends and family are not always available to entertain you. Just how many times can you write your birth wishes???

Grace has been on bed rest for the past nine, yes, that’s NINE, weeks with a couple more to go!!!

She wrote to me the other day about how she has been able to maintain her sanity and we both thought it might be helpful to other pregnant women who are on bed rest, for whatever reason.

Hi Kenny!

Hope you had a wonderful weekend!

 Just want to let you know things that helped me during the whole bed rest season! (I am doing my 9th week!!)

 Journaling, putting your thoughts, hopes and feelings in words definitely helps expressing them in pen and paper

 Books on Bed Rest survival:

*Amy Sprenger- Baby bumps (This is a true story and written in a very comical way of her bed rest journey)

*Kelly Whitehead- High Risk Pregnancy- Why me (I enjoyed this book because there are so many amazing success real life stories, tips on what to do while on bed rest, and statistic on some condition on why pregnancy becomes high risk, and the best part is natural birth is possible with High Risk- the arthur herself had a natural birth after being on Bed Rest since 20 weeks)

 *Wanda Hale- Pregnancy Bedrest – A journey of Love ( I really love this book covers the emotional health and it is really about a journey of love, it encourages positive visualization, relaxation technique, practical breathing exercises, and practical physical exercises on bed rest, very spiritual, and covers post partum following bed rest with a newborn too)

 Of course, Josh mentioned the amazing forums online! I am on Bed Rest club in www.BabyCenter.com and there are groups on Facebook too, and the ladies( and some men) are amazing cheering you on, and knowing you are not alone in what feels like a lonely journey definitely is a boost!

 It’s all about keeping up with the positive!

 We don’t really have much physical help since I’ve been on bed rest, so we’ve learned to set our expectation low, since life doesn’t stop for everyone when you are put on bed rest. We learn to do without, and live simply to the fullest.

 Good Luck and I am cheering on for her!

 

If you would like to chat with Grace about this adventure of hers, her email joshxgrace@gmail.com

If you wish to share some of your tips, please send to KennyShulman@aol.com

Thank you, Grace!!!

I’M NOT SAYING IT IS EASY…..

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BUT I AM SAYING IT IS WORTH IT!!!

                                                             WATERBIRTH!!!!!

YOUR BABY’S FIRST TWO HOURS

How do you envision your baby’s first two hours of life?

 

Will it be peaceful and soothing? Maybe soft lighting, soft sounds, soft touches, and familiar smells that remind baby of where he has been? Will your baby lie safely and peacefully on your chest, staying warm with your body heat, regulating his heart beat with yours, gazing into your eyes, searching for his nourishment? Will it be a gentle welcome after such hard work to be born and then quickly adjust to this world of gravity and air?

 

Or will it be bright with fluorescent lights, loud voices with lots of people talking to vitamin K shotyou, to your baby, to each other, and too many people wanting to lay their hands on your baby, or even rub your baby down with a rough terry cloth towel.

Can you imagine after having been floating in warm water for all of your existence to only suddenly being roughly rubbed with stiff terry cloth??? Do you think that might feel like sandpaper?

And what of the ointment that goes into the newly used eyes that only caught a glimpse of the world? Need I even mention the prick of a needle?

How do you envision your baby’s first two hours of life? Consider this all important time. Then consider writing down what you envision so that after you describe it to your nurse and care provider, they have your vision and wishes in words to remind them.

How do you envision your baby’s first two hours of life?