Don’t Lie Down: Birthing On your Back and the Worst Case Scenario

I speak from experience that moms are often checked in, set up in the bed and hooked up to monitors. Many uniformed moms end up staying there throughout the rest of their labor. Granted some maybe walked the halls once or twice, or gotten up to go to the bathroom, but then end up back in the bed, hooked up to monitors.

As a doula, my job requires me to tell the truth, to give you pros and cons, so here it is. While there are times to lie down and rest, the worst position is to be horizontal. Why is that? You are working against gravity.

“Well, that is where the nurse put me to monitor the baby”. For future reference, this monitors can be put on you, while you are in different positions. You could be on your side, on a ball on the floor, or even in water. They often have portable monitors that can go where you go.

Most hospital policies only require 20 minutes of fetal monitoring every hour. When my clients are being monitored, we watch the time and immediately unhook when the 20 minutes are up. I usually give the nurse a heads up that we will do so. Then we are up, moving around again. If you have a midwife, there are often fewer, non-invasive monitoring going on. Usially they just monitor thru a contraction, to see how baby is during and after the contraction.

So why is laying on your back such a problem? First of all, your pelvis is compacted down to the smallest space, the “hot dog space”, I call it. Lying on your back decreases your pelvis by 30%.  If you turn to one side, you are opening up a bit more to an egg-shaped pelvis, as you are widening the side closest to the bed. Oftentimes, by having a doula put pelvic/hip pressure on the other hip, you are widening it to a circular shape. If in any other position, you are causing less cramming of your pelvis, allowing baby to move freer.

Other reasons are that is restricts blood-flow and can also lead to harder births, because you are pushing uphill and against gravity, causing your efforts to not work efficiently. These moms often have longer labors and require more interventions.

When moms are less comofortable, it increases intensity of each contraction. Her hips becomes sore, her tailbone numb, and she will begin to sense more activity, because she isn’t moving with the pain. Moving while contracting, especially before pushing, can help destract mom from some discomfort and pain. As she builds a rythm, she can often manage her hips and pelvis into an ideal position. With techniques, such as the double-hip squeeze, mom’s pelvis can open to a more rounded optimal position.

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(Me doing double-hip sqeeze on laboring mom. She is leaning over a counter).

Ideally, squatting is a wonderful position, or even semi-sitting or side-lying, while bringing legs up to the body. During the pushing stage, if you can get your legs toward you chin, the better the outcome. Even getting one leg up, can make all the difference. If you must do some side-lying, I recommend putting  a few pillows under your head, to create some incline, as well as putting a few pillows or a small peanut ball between your legs. Anything to open the pelvis is most beneficial.

A common question may be “What if I get an epidural”? There is still hope in a shorter birth, if you practice having an incline of your head, sitting upright or side-lying. Believe it or not, you can still maneuver to a squatting position with an epidural.

Here are a couple suggestions that can be used with or without an epidural. Have the staff help you into a sitting position, dropping the bed bottom down (for hospital births). Have them put up the birth bar. You can use that for leaverage. Even using a sheet or rebozo to pull up on can help get you into a squat. Another favorite is having the staff help you turn around on your bed, raising the head up really high, and leaning up over the bed. These optimal pushing positions will encourage gravity to work in your favor.

Overall, the worst-case senario is feeling trapped in your bed or even worse yet, not moving throughout your labor. These labors are far more dangerous and may lead to interventions and possibly a cesarean, as the numbers go up with moms not being aware of positioning for baby in the pelvis. Why do I say dangerous? I always go back to the Fear-Tension-Pain Cycle.

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The more fear a mom has, because things might not be progressing well, the more pain and tension she holds. The more tension on her causes muscles to tense up, narrowing the pelvic floor outlet for baby.   To avoid these disruptions in labor, move frequently, get into upright, gravity-loving positions. I assure you, labor will go smoother than sitting in a bed.

For more information, please research to make an informed decision to not birth on your back. Hire a doula, as she is great at recommending the right position at the right time.

Written by Tina Black @ Doula💜

 

10 Reasons To Not Give Birth On Your Back

 

Don’t Do It For Convenience

BF00F903-C476-46D3-BCA2-1262855E59BBThe sad reality is that we are always looking for the convenience, for the easy route. As Americans, we often look for those hacks that will make life more simple. Yes, it is a very “American” idea. Sometimes convenience with newborn care can detract from your bonding experience and healthy living,  and middle-of-the-night feedings are one of those.

I recently came upon a few posts that claim “how I got my 2 week, 4 week, and/or 10 week baby to sleep thru the night”. This may be more of a personal opininon, but I feel that we were built to wake every few hours, especially in the first year-two years of life. There are various studies to proove that yes, infact, it is healthy and normal for babies to continue to wake in the night. It is the tired, sleep-deprived parent who desired to break this routine.

For Peter Fleming, professor of infant health      and developmental psychology at the University of Bristol, the idea that babies should sleep through the night is a 20th-century idea. It’s more natural for them to wake up, often.

“Human infants are not designed to sleep for long periods, it’s not good for them, and there is absolutely no evidence whatsoever that there is any benefit to anybody from having a child that sleeps longer and consistently,” he tells BuzzFeed.

“That’s not perhaps what most parents would like to hear.”

Why do I claim this is Americinized? Culturally speaking, many other nations’ families live with more members to help aid in raising children. Grandparents, aunts and cousins often living in the same houshold share responsibility of caring for baby. The term “it takes a village” is true, but our culture says otherwise, as we seek to live independently of our relatives. Our burden becomes our alone.

Co-sleeping is very old-school in our country, but not so in other countries. On a personal note, my children slept better when I brought them into my bed vs. their own crib. But again, our independence has separated the notion that we should be individual and should be in our own beds, have caused our culture to decline the co-sleeping efforts that our ancestors did.

Another great reason to embrace babies waking in the middle of the night is brain development. Our babies are hitting milestones and their brainwaves are becoming more active. Their sleep schedule includes shorter sleep patterns and their activity level is becoming more ripe. This also plays a role, early on, when babies night and day schedule is being fine-tuned. Their bodies didn’t know the difference while being in the womb.

One of my biggest reason for posting this, is the fact that babies, as young as 4, 6, 10, 20 weeks still need adequate night-time feedings, for nutrition and bonding! Your baby can’t wake up and walk to the kitchen for a night-time snack to ward off a growling stomach. They burn through calories and need replinsihment. Yes, they may have eaten right before bed, but remember, they are growing and need more calories and fat intake. Babies burn through calories quickly.

Bonding, bonding, bonding! Even though you may feel you are bonding plenty during the day, your baby has learned to associate eating with bonding. Through the years, your baby will wake, because they are hungry, uncomfortable, having reflux, etc. Their intuition is to seek attention to address their feelings. Just as any human, they don’t have the perfect sleep pattern each night. They want to be comforted; they want their comforter to help them go back to sleep.

 

 

For more info on sleeping through the night: https://kellymom.com/parenting/nighttime/sleep/

Why babies wake at night

https://seattlemamadoc.seattlechildrens.org/why-do-babies-wake-up-at-night/

https://www.buzzfeed.com/patricksmith/its-evolution-baby

Why humans wake in the middle of the night:

How To Stop Waking up in the Middle of the Night

 

Why Not Home?

C14396DF-45F9-43DF-8E7F-C1A87FD580BFDo you know that many main-stream physicians are giving birth at home or a birth center? That’s right, they are choosing  to birth outside of the traditional hospital route. Why do you think that is? Is it safe?

Hint: Interventions are far less likely, if birthing at home. (94% of homebirths have zero interventions; whereas it is 50% in a hospital).

 

Helpful Websites:
Midwives Alliance of North America-https://mana.org/

Childbirth Connection: http://www.childbirthconnection.org/

https://www.homebirthsummit.org The Home Birth Consensus Summit

Evidence Based Birth: https://evidencebasedbirth.com/

 
Article:

https://www.pdxmonthly.com/articles/2014/7/15/the-big-push-towards-safe-home-birth-july-2014

 

 

 

 

 

 

 

VISITORS, BABY, BREASTFEEDING, HOUSEWORK…OH MY!

Ways to manage the first few post-partum weeks.

So many moms feel very overwhelmed the first few weeks home. I often help prepare my clients for home-management skills, for the first week, to help them prioritize their needs and wants. Here are some helpful tips.

1) Schedule food deliveries or meal-prep before giving birth.

If you have loved-ones who wish to bless you with meals, have a sign up list. Either something you create or have a friend put it together. I have often had people use: https://takethemameal.com/.

A great way to avoid the munchies after baby comes, is to freeze extra servings. In your second and third trimesters, try to make extra servings of your meals and snacks (ones that freeze well) and save. This way, you’ll have enough for the two of you, and possibly for guests that you are expecting, or not expecting.

Another task, is to buy extra snack items that don’t need refrigeration, such as nuts, dried fruit, jerky, etc. Stash these items away, specifically for your early post-partum days and keep them handy for one-handed snacking when you are nursing later; it is a great way to keep your energy levels up. Eat & drink when baby eats.

2) Limit Visitors and have them earn their visit.

Many families have visitor after visitor come by. Although you want everyone to meet your precious new one, it can take away from mom’s bonding, breastfeeding, nap, and other pressing tasks.  It is not unheard of to give your visitors tasks, so that they are being just as helpful for mom. Below, you will find some of my favorite printouts.

Remember, the most important thing about having visitors early on, is your baby’s immune system. Be sure to notify guests that they should not visit if they, or someone living with them, has been sick. These germs can be passed on to baby by the slightest touch. When they arrive, gently send them to wash their hands or have a bottle of hand sanitizer nearby.

https://pin.it/tx4jedpcfjnr76

Help them help you- new baby sign with ways for visitors to help

3) Hire a popstpartum doula.

While supermoms feel they can do it all on their own, most moms could use the extra help, even just a couple hours per week. A postpartum doula can offer check-ins with you and come to your aid, whether it is meal prep, watching baby while mom takes a shower or a nap, helping with little ones while mom gets some much needed work done in the house, or doing light chores for mom. These doulas often have a list of things they will and will not do, some do heavier chores and cooking, while others do light tasks. They will often pre-schedule times with you and set up an agreement ahead of time.

Post-partum doulas often have knowledge of breastfeeding and can often help with that as well as discussing recovery. Moms can often feel anxiety when dad returns to work, so having someone stop by, can ease fears.

4) Meet with a breastfeeding counselor/lactation consultant.

Even though breastfeeding may seem to be going well, some small red flags can begin to be a part of something bigger and cause more issues down the road. If you notice sore breasts, red/hot feelings or burning, cracked nipples, or pain during feedings, or fussy baby at the breast, these can all be the start of bigger issues, if not resolved immediately. Hire a counselor to meet with you in your home. She will do an evaluation to determine the best course to help you along. Many moms give up on breastfeeding, because they don’t have the help or answers they need. Often times, a pediatrician or ObGyn will not have the same advice as a breastfeeding expert. It doesn’t hurt to have a counselor stop by, even if you are not experiencing the issues yet.

4) Have open coversations with your partner.

Be sure to include your partner on these conversations, especially if he has returned to work. Dads often feel lonely or left out when they return to work. Be sure to include him on happenings and fill him in on baby’s milestones. A sweet text or photo may be just what he needs for his tough day at work.

Include him on routines and make a plan of action. Prenattaly, I often discuss with my doula clients, how they forsee home tasks to play out once baby has arrived. Will dad be part of caring for baby when he gets home? If so, to what extent? How can he be of most help? Throw in a load of laundry, finish dishes, change and bathe baby? These are all great discussions before, so you can stay on the same page after.

 

For more specific information about what to expect post-partum, visit:

Things They Don’t Tell You After Delivery

Things They Don’t Tell You About Breastfeeding

Doula Love of Facebook –Great resources posted weekly!
https://facebook.com/doulalovetina

 

 

 

 

Labor At Home First

My last post was about Considering Giving Birth at Home (https://mydoulalove.com/blog/).  This week, I want to address those who will be birthing at the hospital.

I have assisted homebirths, birth center births, and hospital births. The best hospital outcomes have come from laboring with mom at home first. As a doula, I tend to meet moms at home, where they have already begun active labor. I come when mom has a difficult time talking and walking during contractions, when she needs the support of hands-on care.

Why do we encourage laboring at home? Interventions. More interventions are preformed, the longer the mother labors in the hospital. The hospital has policies and procedures that may not be in your birth plan; it can often become theirs, especially if you don’t have a doula to support your choices and help you make informed decisions.

I often encourage moms to labor at home, just as transition is happening.  This does depend, however, if mom is high-risk, or they are quite a distance from their hospital.

Here is a great post I found. It follows my suggestions for laboring at home.

https://www.motherrisingbirth.com/2016/10/labor-at-home.html

 

Considering Giving Birth at Home?

Galbreath 2018 005 - Copy.jpgWhen expecting to give birth, moms often feel nervous about not only controlling pain during labor, but nervous about the ultimate outcome. Will they feel comfortable with the doctor or staff?  Will they feel their needs were met and their birth plan followed?  These are legitimate concerns and well worth the discussion about the location you will birth in.

Recently, I met a mom who had two prior births in the hospital, only this time, she was birthing at home.  She had okay deliveries at the hospital, but she felt uncomfortable, she couldn’t relax, she didn’t feel her needs were met, by her standards.  This time, she had decided to birth in the comforts of her home.  She wouldn’t have constant monitoring, beeping of machines, outside noises from others, and staff she was unfamiliar with.  She hired a midwife team to come in and help create a relaxing atmosphere, quiet and serene. She said that this experience has made all the difference.  She is less apprehensive about her care team and feels the natural approach has made a tremendous impact already.

When having a home birth, the atmosphere is your own.  Often, your doula and midwife has been to your home to become familiar with your space.  We ask about how we can set up, where supplies are, how you want your room, including sounds, visuals, and smells.  Your senses are on high alert, so these are very important.  If it is at home, I enjoy setting up candles for the evening, to set the mood.  I recommend families have a song playlist ready, also the use of essential oils can help relieve stress in the atmosphere.

Your home is often quiet and the midwife will check on mom occasionally, with fetal monitoring and assessment.  You can feel free to move about your home, leaning over counters, sitting on a ball, sitting on your toilet (yes, it is comfortable), or even taking a shower.  While some of these can be accomplished in the hospital, you often need to wear uncomfortable hospital gowns, and don’t necessarily feel comfortable laboring in the hall with other mothers, so moms often retreat to their room and limit good movement.

Having access to your things also helps alleviate stress.  Many families forget items at home and can feel on edge about the surroundings.  When you are at home, having access to food during labor greatly assists mom, because she is able to keep energy longer, whereas hospitals discourage food in labor, often leaving mom weak and can cause her pain to increase.

The presence of a birth tub also helps sooth mom.  More hospitals are offering this feature, but not all are tub ready.  Birthing at home requires you to buy a birth kit.  A birth tub is optional, but recommended.  Otherwise, it is challenging for moms to give birth in a bathtub, because it is usually a cramped space for midwife, dad, doula, and any other birth assistants.

The cost of having baby at home is very comparable to hospital costs.  Many insurances do cover midwifery care, so you just might have a deductible.  They usually have a flat fee that includes prenatal and postpartum care.  Hospital births can range between $6000-15,000 or more, depending on medications, complications, surgeries, etc. In southwest Washington state, midwives charge around $5000-7000.

Unfortunately, if you have a high-risk pregnancy, a midwife will have to refer you to an OB at the hospital, to oversee your care.  Some midwifes can still assist with the delivery, depending on their connections to the hospital.  For any other procedures or surgeries, she will step back and have the OB take on the rest, but can help with postpartum care after delivery.

If you are still considering and weighing your options, think about what makes you comfortable.  If having baby in a hospital, near doctors and in case of emergency, that is completely understandable.  I recommend a doula, either way, so that she can help you manage stressors and help advocate for your needs and wants.  For homebirths, make sure you ask your midwife what her procedures are if the birth doesn’t go as planned.  What hospital does she transfer to?  Will she be able to continue care there?  Always ask the “what if” questions, so that you feel comfortable with your decisions.  Be informed and consider your goals and make sure you have others to surround you on your special day.  Having the best care team will make the biggest difference.

 

 

 

 

Episi-What?

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You’re going to cut my wife where? Let’s take the episiotomy one step at a time,
in a simple, less perplexing way. No pictures…I Promise!
We all know that a baby has to wiggle out of a small space during birth. This space grows
larger with each dilation of the cervix. Dilation is measured by finger-span. One centimeter dilation allows the doctor to measure with one fingertip. Two centimeters, the doctor can measure with two fingers, etc. At ten centimeters, the cervix is about the size of a grapefruit. Wow- crazy, I know. This process of dilation takes time, by once mom is at 10 centimeters,
she is complete and is ready to push.
So, what happens if 10 centimeters isn’t enough? There are gradual ways to help stretch the tissue just a bit larger. It can be done by your care provider. They can use mineral oil or even the application of a warm compress around the area and along with a gentle massage/stretch. If these methods don’t work, there may be risk for tearing of the tissue around the perineum, maybe even leading down toward the rectum. Tears often heal rather well; however, if it is a large tear, there can be severe damage.
What’s a doc to do? Well, that is up to mom. Mom may choose to try the methods above, but she could be open for a little assistance. Doctors can control a tear by cutting. This is called an episiotomy. Unlike a tear, this is a more directed cut that helps to alleviate or prevent a severe tear. You can ask your doctor to cut a little at a time, as needed. The healing of a tear can be easier than an episiotomy; however, both tears and cuts will need to be cared for and given time to mend. Please note that it is possible to get an episiotomy, but continue to tear.
Types of tears:
· Superficial-tears at the outermost layer of the vaginal tissue (no stitches required).
· 2nd Degree-deeper tears into the muscles (stitches required).
· 3rd Degree-vaginal tissue tears, perennial skin and perennial muscle tear
· 4th Degree- tears around anal area and sometimes through the anal area
How do you help your wife try to prevent tearing or the need for episiotomies? Remind
her remember to do her “Kegal” exercises. Kegal exercises decreases risk of developing hemorrhoids and leaking urine in late pregnancy. It also prepares the pelvic floor for childbirth, improves healing of the perineum from episiotomy, and can increase sexual pleasure for you and her. How does she do this? First, identify your pelvic floor muscle. One way to do this for women and men is to contract the muscle that stops the flow of urine. (Avoid doing Kegels while urinating; this can actually weaken the muscle. Only do Kegel exercises with an empty bladder). Contract the muscle and hold for 2-5 seconds, then release it, being careful not to contract the muscles in your abdomen, thighs, or buttocks). She should repeat this 10 times in a row, three times a day.
Please talk to your care provider about your wishes, before the time comes. No one wants to tear or be cut, but discussing alternative options and choices can help tremendously.