Online Childbirth Class Free Version

Intro Video:

Welcome to Voices of Eve: Birth Ministries Childbirth Course!

I am so grateful to be on this journey with you! Before you dive into the course I have a few things to help guide you through the course.

1. None of the information in this course is meant as medical advice. Do not take the advice in this course over the advice of a care provider.

2. I know that everyone learns differently so I try to have a variety of learning elements throughout the course. This means that some information is repeated but I hope that makes it easier to absorb the information for everyone.

3. I have activities throughout the course that can help reinforce what you have learned. This isn’t homework you won’t be graded but as with anything the more you put in the more you will get out of the class.

4. You have access to this course for a year so I encourage you to not go through the course to quickly. Take the time needed to learn and absorb all of the information.

5. The content of this course is meant to be unbiased. That being said it is hard to find unbiased sources and there may be times that it may come across as biased. That is not my intention and I am continually working through the content to make it as straight forward as possible and not leaning one way or another.

6. All of the content in this course was obtained from scientific and verified sources, and not the personal opinion of anyone or any source.

7. This course is not perfect or all encompassing. But it is continually growing. I consider this course to be a lifelong project and as new information comes and as I learn more I will continue to add to it. So thank you for your patience and support! When you signed up for the course the e-mail you provided was added to an e-mail list so that you will get notifications if the course changes. It is easy to unsubscribe from this list and you will automatically be unsubscribed when your subscription to the course expires.

8. Please note the 4 buttons below and take advantage of them!

– The course checklist:  can help you easily remember what topics you covered, be a place to write down questions, and serve as a map for the course.

– The enrollment agreement: is a requirement for the course. If you have not already please fill it out.

– The course evaluation: is a valuable tool for me to continue to improve on this course.

– The message Abbey: Please message me with any and all questions! I am always happy to help.

 

I hope you enjoy the course!

Download this checklist to check off as you work through the course!

Sign this enrollment agreement before you proceed through the course.

After you complete the course fill out this course evaluation to help us improve the course!

If at any point you have any issues or questions feel free to message you instructor Abbey here!

Section One: Pregnancy

In this section we will go over basic topics of pregnancy such as having a healthy pregnancy, coping with common pregnancy discomforts, recipes, and herbs.

Video 1: How to Encourage a Healthy Pregnancy, Labor and Birth:

– Take Responsibility for your health: Birth is a marathon, preparation in advance will help with good birth outcomes!

– Chose your maternity care provider and birth setting wisely: Choose a provider that will be supportive of the kind of birth you want, has low c-section rates, and is overall supportive and encouraging.

– Learn about medical options before, during, and after birth that can affect you and your baby: The more you know about your options in birth before baby comes will determine your ability to make informed choices in labor and birth.

– Brush up on your maternity benefits and rights at work: Stress is a big hinderance to labor so aim to have as many things off of your mind as possible to prepare for the big day!

– Plan for support once your baby arrives: You will need help and more likely than not many people around you will want to help. Use those support systems!

Activity: Do something healthy today

Check out my Blog on Healthy in Moderation

Source: Healthy Birth Initiative

– Eat small meals throughout the day: Plan ahead when you can and take several small snacks with you if needed. A full stomach is not good for morning sickness but neither is an empty one! Finding the balance will take practice but you’ll get there.

– Cool compresses on face and back of neck: When the sickness hits getting the nausea to subside for a few minutes so that you can get some food and fluids in you will be very helpful. 

– Fresh air: Warm stuffy air does not help with nausea. This is good news for those moms who are in their first trimester in cooler times of year. Open a door or window for a few minutes. Again this can help ease the nausea for a few minutes so you can get some food or fluids.

– Sour candies: Anything sour can help ease morning sickness. Some people even found sour foods or condiments like pickles, lemon or mustard help make food more tolerable. Experiment! 

– Peppermint essential oil mixed with a carrier oil on a diffuser necklace: Be careful doing this if you have small children around. Peppermint oil is not recommended to be used around children under the age of 6. But after you put the littles to bed or after you’ve dropped them off at school this can be a big help to make it through a work day! Get a diffuser necklace to ease in the diffusing.

– Peppermint tea, or candies: These can be great for easing morning sickness. The teas can be consumed hot or even better cold with lots of ice! 

– Ginger oil essential oil mixed with a carrier oil on your belly or diffused in a necklace: Ginger is a great help for nausea! Get a diffuser necklace to ease in the diffusing.

-Ginger tea, or candies: Again the tea can be consumed hot or cold. Adding a citrus flavoring or tea with it may make it taste a bit better. Ginger can also be used as a flavoring in food to help make meals more tolerable.

– Stay hydrated with small sips of fluid and ice: If you don’t have an ice maker at home consider buying bags of ice at the store. Ice alone can be a huge help for the nausea and well worth the purchase. And just like with meals you don’t want to be too full of fluids or have to few! Get a new water bottle to take with you, you deserve it!

Activity: Try some infused water to get extra nutrients while helping curb the nausea

 * Whenever you use essential oils please follow safety recommendations by certified aromatherapists! I recommend this facebook page that I follow myself: “Using Essential Oils Safely”.

– See a Chiropractor: This is not always an option but consider putting it in the budget at least once during your pregnancy. Information they can give you on stretches that address your specific issues is worth the price, and can be used regularly.

– Elevate you feet often: Staying moderately active during pregnancy is crucial but so is resting. Listen to your body. When you rest elevating your feet can help with the strain on your lower back. 

– Stretch Daily: These can be simple stretches targeted at your pain areas. The Mayo Clinic has these recommended stretches . Also joining a yoga class can be a way to tend to your mind and your body. Stretching should be relaxing and not a chore. Doing a few minutes every day is better than doing an hour a few times a month. And remember yoga or exercise should be cleared with your care provider.

– Be mindful of your posture: It is so easy, especially if you spend a lot of time working at a desk or standing at a counter, to fall into a bad posture. Maybe set a reminder on your phone or with a sticky note to sit or stand up straight. This can also be a good way to remind yourself to stretch for a minute or two before continuing your task..

– Sit on an exercise ball when you can: Exercise balls are usually around $20, and likely you’ll have a friend or a doula who will lend you one! And it has value beyond pregnancy for stretching and exercise. Also kids love to play with them! Sitting on the ball automatically makes your body want to sit in a better posture position. They can also be used at a desk! 

– Soothing bath: Again this is something that can help for the pregnancy aches but also gives you time to relax in peace and quiet (hopefully!). You can add some Lavender essential oil to the bathwater to make it extra soothing. Bath salts are great too! Check out this pregnancy herbal bath packets that make for a very soothing bath!

– Light Swimming: If approved by your care provider relaxing in the pool is a great way to ease those aching muscles and joints! 

– Avoid Standing for long periods of time: This can be hard to do if you work at a job where it Is required. Maybe talk with your boss about taking a few 5 minute breaks every hour or two, or having a chair nearby you can rest on when work is slow. It will increase your overall productivity. 

– Sleep on your side with a pillow between your knees: This will likely be a necessity! Go ahead and get a pregnancy pillow or a bunch of regular pillows(The don’t have to be the expensive ones, $3 Walmart pillows work great!). You can also try adding a small pillow or rolled up towel under the side of your belly and/or behind your back, this will help prevent your belly from pulling on your back muscles while you sleep.

– Wear comfortable and supportive shoes: They do not have to be expensive to be beneficial. It can be something as simple as choosing tennis shoes with some Walmart insoles, over those cute flats. Wearing comfortable shoes is also helpful for swelling. Where open or no shoes when you are able and avoid tight closed in shoes or socks.

– Have your partner give you massages often: They don’t have to be a professional. Regular massages are for your emotional and mental health not just the aching muscles. You can also use that time to have your partner talk to the baby to aid in bonding. Also try borrowing a book from your local library on massages or put massage gift certificates on your baby registry.

– Stay moderately active: Stay as close as you can to whatever activity level you were at before you were pregnant. And this is an overall goal not a daily goal. It takes a lot of work to grow a human being, be patient with yourself. Also do not actively try to work out to lose weight while you are pregnant. And any exercise you do should be cleared by your care provider. Also avoid heavy lifting when you can. 

Activity: Try a new yoga pose

* It is important to not wait until you are miserable to work on your physical health. Get those back rubs before it hurts! Most pregnant women face back aches of some kind, so being prepared is better safe than sorry.

– Avoid Ibuprofen and Aspirin: Information on pain reliever during pregnancy is often changing. Talk with your care provider about the current recommendations but also do the research for yourself to be safe.

– Deep breathing: Things like breathing are done subconsciously but deep cleansing breaths need to be conscious and often! If you decided to set a reminder to stretch or sit up straight use that same time to take a few deep cleansing breaths. An added benefit would be to have a birth affirmation like, “My baby is safe,” to say to yourself while deep breathing. Preparing for Labor is a physical challenge but also a mental and emotional one. Prepare for both!

– Relax as often as you can: Again seek quiet relaxing moments like a warm bath and resting with your feet propped up. But also find something you can do several times a day that relaxes you as you go about your tasks like deep breathing or reciting affirmations.

– Massage your head where it hurts: This can help the blood flow to the area. And it not only may help ease the headache but maybe help you identify what may be causing your headache. For instance if it’s in-between your eyes it may be a cold creeping in, maybe you can drink some orange juice and maybe pick up some tea from the store. If it’s at the base of your neck maybe your back is causing the problem and a back rub and bath may help!

– Cool compress or ice for short periods on the base of your skull on your neck, or on your temples/forehead: This is especially helpful for migraines or tension headaches. Again use them on the areas that are hurting.

– Warm moist compress where it hurts: Sometimes warmth feels better especially for sinus headaches. Warmth can also be generally relaxing.

– Take a nap: Sometimes headaches cause you to be more tense which can strengthen the headache. This can be a way for you to listen to your body and take a short nap so that your body can fully relax. Those dishes can wait for a few hours or even a day or two! and remember that a short half hour nap is usually more beneficial, unless you are sleep deprived, than a few hours. 30 minutes won’t put you too far behind on your to do list! So set a timer and relax!

– Peppermint or lavender oil essential oil diffused in a carrier oil and placed on your neck: Again use with caution around small children when using the peppermint oil. 

– Check your posture: Tension in the back or neck can cause headaches. So if you are having regular headaches it may have something to do with that. 

Activity: Find a relaxing activity that works for you!

Check out my Blog post on why relaxing can be hard to do!

 * Whenever you use essential oils please follow safety recommendations by certified aromatherapists! I recommend this facebook page that I follow myself: “Using Essential Oils Safely”.

-Drink plenty of water: Ultimately the goal should be sipping all day instead of a specific amount. And especially drinking when you are thirsty. But if having a goal in mind is helpful try drinking at least 8-16 ounces of water a day in addition to any other liquids.

– Small frequent meals: Pregnancy slows down your digestive system. There are many possibilities for why this happens, such as giving your body chances to get as many nutrients from the food as possible before it passes. Unfortunately a byproduct of this is constipation. But taking smalls meals can help.

– Talk to your provider if the constipation is severe or unrelenting: Even when you are doing everything right you may need a little extra help. But talk to your provider about over the counter options, do not take laxatives before discussing it with your provider. 

– Add fiber to your diet: Fiber is a great help! There are lots of tasty ways to include it in your diet. Some good examples are oatmeal, broccoli, sweet potato, squash, beans, lentils, pumpkin, avocado, pear, apple, orange, banana, and more! 

– Have a diet rich in fruits and vegetables: A varied diet in fruits and vegetables is the best way to stay healthy. Easiest way to do this is to make sure each plate is colorful!

Activity: Try a new healthy recipe

– Small frequent meals: One cause of heartburn is the slowing of the digestive system. There are many possibilities for why this happens, such as giving your body chances to get as many nutrients from the food as possible before it passes. Small frequent meals can help.

– Avoid eating less than two hours before laying down: If you do end up eating something less than two hours before laying down try laying down semi propped up, maybe make sure whatever is the last thing you eat is something gentle like a cup of yogurt, a few crackers, or a slice of cheese.

– Avoid very spicy or acidic foods: If you do have spicy foods eat something mild or bland along with them to help counter the spice, like rice or crackers.

– Drink plenty of water before, during, and right after you eat: This aids in digestion.

– Chew gum after eating: It’s important to make sure it’s not mint or peppermint gum, sometimes the spice of the mint or peppermint gum can aggravate the heartburn.

Activity: Add a new snack to have on hand to make eating smaller meals throughout the day easier!

– Use extra pillows while you sleep: This will be helpful, even in short naps. place a pillow behind your back, under the side of your belly, between your legs, between your arms, and between your feet. A pregnancy pillow will help with this but extra pillows will work too!

– Do some light stretching or yoga before bed: Doing these along with affirmations can be helpful. Also try a meditation app to help you relax before falling asleep.

– Diffuse a small amount of lavender: Use caution diffusing if you have pets or small children. Using a diffuser necklace won’t diffuse in the whole room and can be removed if needed.

Activity: Find a meditation track that you enjoy and listen to it before going to bed.

 * Whenever you use essential oils please follow safety recommendations by certified aromatherapists! I recommend this facebook page that I follow myself: “Using Essential Oils Safely”.

– Avoid standing for long periods of time: Again if you have to stand for long periods maybe ask your employer if you can sit for 5 minutes every hour. Keep loose knees while standing and sway or rock when you can to help with blood flow. Have the goal to be as mobile as often as you can.

– Eat high protein foods: Dark green veggies, beans, and grains are great!

– Drink fresh lemon juice in a cup of warm water: Also adding fresh lemon to your drinking water is great for swelling and managing blood pressure. Might even help with morning sickness.

– Avoid sitting with legs crossed: Sit on your birth ball instead!

– Sit with legs elevated when possible: This will also help with your lower back pain, and give you chances to rest.

– Do ankle circles as often as you can: This can be done while resting or give you moments to pause during your day. You can add them to your reminder list or use sticky notes to help you remember.

– Avoid tight socks or shoes: Another chance to wear open shoes or loose closed shoes.

– Drink plenty of water: Again sipping throughout the day is best, and always drink when you’re thirsty.

Activity: Set a reminder on your phone to move every 2 hours.

Try some of these helpful recipes or variations of them. Get creative and find what works best for you!

Morning sickness smoothie:
3/4 cup coconut water
1/4 cup ground flax seed
1 frozen banana
1 tbsp raw honey
1 tbsp almond butter
1 inch peeled ginger root
(blend and enjoy!)

this is a great base recipe! Feel free to add or adjust any of the ingredients that fit your needs and/or taste.

Here’s some more recipes to give you some ideas

Pregnancy Tea:
spearmint
red raspberry leaf
strawberry leaf
nettles
rose hips
fennel
lemon grass
lemon verbena
alfalfa

(Steep and enjoy!)

Again this is a great base recipe! Feel free to add or adjust any of the ingredients that fir your needs and/or taste. Clear any herbs with a certified herbalist and/or your care provider to make sure they are safe for pregnancy.

Be aware that some herbs and herbal teas are not safe during pregnancy. Here is a list of teas that are safe. 

All herbs should be cleared by a certified herbalist or your care provider before consuming. Also advice from a certified herbalist on how is best to consume or use each herb is necessary.

  • All purchased herbs should have the common and scientific name on them.

  • Can be used in a tea, a soak, or a tincture.

  • Can be used for nutrition or as a remedy.

  • Can sometimes be alternatives to pharmaceutical drugs.

  • Should be used only with the approval of your care provider and preferably under the guidance of a certified herbalist.

  • Should not be used to mimic modern medicine but to aid it.

Here are some common herbs for the following uses.

Morning Sickness

Ginger Root: grated into a cup and boiling water added to make a tea. Leave to infuse for 5 to 10 minutes and add honey if required. This can be taken 3 or 4 times a day.

Red Raspberry leaf tea: Loose leaf is better but tea bags from the store is good in a pinch.

Anxiety:

Lemon Balm (Melissa) or Chamomile can be very effective at helping with anxiety. Both make soothing teas, or they can be mixed with ginger root as well.

Lavender is also very good for easing anxiety.

Heart Burn and Indigestion:

Slippery Elm: coats the lining of the oesophagus and stomach and so helps to protect these areas from acid attack. Going more to the root of the problem,

Meadowsweet can help prevent the overproduction of stomach aced, and there is also the gentle

Chamomile: calms and soothes the stomach.

Labor:

Fenugreek: stimulates the muscles of the uterus and can help to bring on labor. Do not use during pregnancy without express permission from a medical professional.

Black Cohosh: known for increase and normalizing uterine contractions, as well as relieving any nervousness experienced before or during labour. It can also be used when the cervix fails to dilate as well as to prevent postpartum hemorrhage.

Raspberry Leaf Tea: can also be effective as a uterine stimulant to encourage the onset of labor, as well as helping to prevent postpartum hemorrhage. If there is a history of miscarriage, do not take during pregnancy at all.

After Birth and Breastfeeding:

Vervain: has many excellent properties to help the new mother. It encourages the secretion and flow of milk and so helps the establishment of breast feeding. If you’re tired after a long labor, it has excellent restorative powers, as well as enhancing mood and combating depression. Vervain also helps you to absorb the nutrients from good better and stimulates the digestive processes.

Comfrey: This anti-inflammatory is loaded with healing allantoin, making it an herbal brew that’s worthy of any postpartum sitz bath, padsicle, or peri bottle.  promotes strong, flexible, healthy, and functional vaginal tissues. 

Great Sitz bath herbs: calendula, lavender, witch hazel, goldenseal, and plantain.

Yarrow: an antispasmodic with an affinity for the female reproductive system. It has been used to treat the heavy bleeding and intense pains of dysmenorrhea and endometriosis. A uterine stimulant, yarrow is also used to provoke menstruation, increase circulation to the uterus, and to promote its overall health and function.

Again, always seek professional advice before using any herbs or essential oils especially while pregnant.

Here is some helpful information on risks and benefits of some common herbs. But please before choosing any herbs check with your care provider and a certified herbalist. 

Source: Birth Arts International

As you may have noticed there were several elements in this first section that helped with many of the discomforts. Which is great news because sticking to those few elements can accomplish helping more than one issue. 

Eat plenty of fruits and vegetables. 

Drink plenty of water.

Relax and rest.

Maintain a steady level of activity.

 If  you begin by working on these 4 things you will be well on your way to a healthy pregnancy, labor, and birth!

Section Two: Emotional and Mental Aspects of Labor and Birth

In this section we will discuss the aspects of your past and state of mind that can effect your pregnancy, labor, and birth and how to hopefully address those issues before birth.

Video 2: Emotional and mental aspects of Labor and birth: 

In this section we will discuss how your state of mind can effect you during labor and how you can address those issues before birth.

Emotional Changes: 

It’s different for every mom and every pregnancy. The important thing is to not ignore the changes but address them head on! Emotional struggles can be amplified during labor and birth, so it is important to address them early.

Here are some possible ways to help you work through how you are feeling.

– Talk about your feelings with your partner and/or a trusted person.

– Join or start a pregnancy support group.

– Take time to pamper yourself.

– Exercise.

– Ask for help with tasks to help keep you from getting behind and overwhelmed.

Mild emotional ups and downs during pregnancy are normal. But extreme shifts in your normal way of thinking or feeling are not. If you think that this is the case for you please seek out professional help. There are low cost counseling options available in some areas and even online.

Weight Gain:

I included this item in the emotional and mental aspects of birth because it sometimes has a big impact on your state of mind going into your labor. How much weight you gain is different for everyone but the general rule is:

25-35 lbs if you were healthy before pregnancy.

15-25 lbs if you were overweight and.

28-40 lbs if you were underweight.

 The important thing is to not focus too much on the numbers. 

– Discuss with your doctor if you have any sudden increases or decreases in weight. 

– Avoid providers who might try to use shaming you as a method of communicating with you. 

– If you are taking all the healthy steps necessary/you can, and you don’t have any additional condition causing the weight issues then it should be something that is out of sight and out of mind. 

– Women who are over and under weight have healthy perfect babies every day! Focus more on a healthy lifestyle and never try to lose or gain weight while you are pregnant.

The rigors of labor are a physical marathon yes, but also a mental and emotional marathon. Every labor is different. So you cannot prepare for what your labor will be like, at least not exactly. 

 But you can begin preparing for your labor by beginning to understand where you are at emotionally and mentally before the labor begins. To do that take some time to address any fears you have approaching labor. The quiz below can help you with that. So take some time now to write down your answers to these questions. Feel free to write paragraph responses the more you analyze your feelings the better!

1. What are my three biggest fears about my future labor?

2. What would I consider to be one of my best qualities?

3. What are my experiences in hospitals or medical situations? (positive, negative, or both)

3. What doubts do I have about my ability to birth my child? or about my ability to labor or birth “well”?

4. What doubts do I have about my ability to be a parent?

5. What traumas do I have from my past? (does not have to be birth related)

These 5 questions can help you identify things that may become mental or emotional blocks in labor. And as we clearly know, how we feel or think about things can greatly effect how our body functions. Stress has huge impacts on our health or our ability to function at our highest capacity. So how much more would that stress effect your ability to function in a situation like labor?

Based on your answers to the quiz write a list of words and phrases that empower you and combat your negative thoughts or feelings. 

For instance if one of your greatest fears is a complication in your labor you could choose an affirmation like “I believe in my body’s ability to birth my baby”. 

Anchoring:

Anchoring is a very useful psychological tool that you can do yourself! To make anchoring even more effective think of a fear, trauma, or concern you have and try and feel out where in your body do you tense up when you think of that thing? Try these steps below to get started!

1. Determine how you want to feel. For example “I want to feel stronger” “I want to feel braver”.

2. Remember a time when you felt the emotion you want to feel. For our example a memory where you felt really strong or brave. It can be any memory when you were feeling those things, under any circumstances. 

3. Choose an anchor device that involves touch, such as touching your thumb and forefinger together or making a fist. It might be better to choose something that you don’t do often. Whatever your physical anchor is will not likely effect the results of the anchoring. But if you find that this exercise isn’t working maybe try a different physical anchor or a different memory. I do recommend choosing an anchor action that is in an area you hold tension when feeling the opposite of your goal.

4. Remember what you saw, heard and felt in your memory That encouraged you to feel the desired emotion. You must put yourself inside the memory as if reliving it. Don’t view the memory from a distance. You’ve got to “be there” again. Relive the memory until you begin to feel the desired emotion, for instance strength or courage coming over you in the same way you felt it at the time. As you feel those feelings coming on, activate your anchoring device from step #3.

For instance if you were using the thumb and forefinger anchor Touch your thumb and forefinger together as the brave feeling increases. Release your thumb and forefinger when the feeling begins to subside. If you’ve done this well and there’s no underlying reason you shouldn’t feel more brave or strong, this anchor set!

5. Test the anchor by touching your thumb and forefinger together in exactly the same way again and find out if you naturally access that confident state. Don’t be skeptical and resist the anchor. Allow it to happen.

These steps require time but also remember the benefit may very well outweigh the time. And it can be done laying in bed before you fall asleep, in down time at work, or while resting during the day. Especially if you have some trauma in your past I highly recommend some method of healing before labor begins. Your heart and mind deserve some ease.

Tips to make your affirmations more effective:

– Make sure you speak your affirmations out loud! preferably several times a day.

– Anchor your affirmation in areas you hold tension. 

– Involve your partner or a friend/family member in your affirmation process so they can encourage you as well.

 

You can take some of these affirmations and turn them into affirmation cards you can use before or during labor. 

Preparing for the physical rigors of labor is important, preparing for the emotional aspects of labor is equally as important.

Some other examples of birth affirmations: “I am strong”, “I can do this”, “My body can birth my baby”, “I am calm”, “I open and release,” “I can do all things through Christ who strengthens me”. 

Activity: Identify elements of labor and birth that might be causing you anxiety and choose an affirmation that speaks directly to that

Having some kind of block is completely normal! But that doesn’t mean you are stuck with them. Here is a list of very common ones but do not rule out anything that you might be struggling with. Talking with a care provider or counselor can sometime be helpful in identifying these blocks.

Common blocks:

  • Not being able to birth “well”
  • Tearing or an episiotomy
  • Loss of sexual enjoyment
  • Pooping on the table
  • C-sections
  • Interventions
  • Cord around baby’s neck
  • Premature birth
  • Labor pain
  • Not knowing what to do if something goes wrong
  • Not making it to the hospital on time
  • Delivery will be gross or embarrassing
  • Being a bad parent
  • That your body will never be the same
  • Assault from a care provider

There is no reason to fear labor or birth. But you also don’t need to diminish any fear or concern you have as irrelevant or small. Most of these common blocks could be solved simply by being informed, allowing labor to begin naturally, and maintaining your health during your pregnancy.

I encourage you to research any concerns you may have because more likely than not it’s something that you shouldn’t be worrying about.

And the others are likely inevitable no matter what you do. You will survive them, and being afraid of them will not keep you safe. Being informed is your best protection. Your baby will come,  birthing “well” is a common myth. 

Your history can make a huge impact on your labor and birth. I will talk about two of the main ways.

History of Assault: Firstly is any history of assault, especially sexual can effect your ability to feel safe in a birthing environment, and can even effect your ability to relax your pelvic floor.

You are a survivor, and you may be to the point of healing where you don’t think of your assault and may believe that it doesn’t effect you anymore. And it may not! 

There are some cases where women who have gone through assault have experienced longer than average labors. There is no definitive way to know if this is because of their history or not. But it is generally thought that the feeling of not being in control causes stress on their bodies. There is also the possibility that muscle memory, if the sexual assault was penetrating, could make it very difficult to relax the pelvic floor. As the baby moves in the birth canal, or as the care provider checks for dilation, this can cause labors to stall or drag out.

There is no need to fear any this happening to you, but that does not mean that you shouldn’t prepare for it in advance. Using affirmations to address any of the fears, concerns, or traumas surrounding your body or your assault can be helpful. Also discussing this with your doula, birthing team, and preferably also with your care provider as well. 

If you are a survivor I highly recommend reading “When Survivor’s Give Birth” By; Penny Simkin

Bad experiences surrounding medical situations: This can be any circumstance where you lost a loved one, almost lost a loved one, or was mistreated in a medical situation, maybe even your own near death experience. Seeing familiar things you associate with that loss or trauma like hospital rooms, needles, etc. can be triggering. Again using birth affirmations can help preempt these fears. 

Your history does not have to determine what your birth will be like. Stay informed, be proactive, and choose to focus on what will empower you in your labor and birth. Your history does not have to define your future. And even if when the labor comes and you have a prolonged labor you will overcome that too. Because you are a survivor and that’s what survivors do!

Section 3: Birth Plan

In this section we will be discussing everything you need to know to create a birth plan that is best for you, your family, and your baby.

Video 3: Creating Your Birth Plan

In this video we will cover what a birth plan is and what you need to know to make your birth plan the best for you

Every labor and birth is different. There is no way to predict every aspect of it. Creating a birth plan is like creating a plan for what would be ideal, knowing that sometimes things change. 

A birth plan helps lay out simply for your care provider and staff to know exactly what your needs are. Hopefully you will have a care provider who has built a relationship with you and hopefully they will remember and have in your chart all the desires for your birth. But having a physical birth plan with you will account for any possibilities especially the likelihood of a care provider or staff you have not met.

It can also help to have your goals in writing so that you can feel more sure and confident.

It is also helpful for your doula if you choose to have one!

1. Let baby choose their birthday. Avoid inductions as it causes unnatural labor, and increases likelihood of complications and interventions. Baby’s lungs actually release the hormones that start labor! If Induction becomes necessary learn about your options in advance so that you can make an informed decision.

2. Choose the provider and birthing place that best fits your desires for your birth: Ask any potential provider lots of questions! If you don’t feel confident they fully support your plan choose another provider and/or birthing place. For instance if you are choosing a VBAC make sure that your provider has low C-section rates and is fully supportive of your plan!

3. Practice whole body relaxation: Meditation apps are great for this, also yoga, and breathing exercises! These relaxation techniques can often be translated into the labor space and incorporated into your birth plan. And practicing them during pregnancy will help them flow easier during labor.

4. Get birth educated: The more informed you are the better your birth plan will be. It is also the best way to know exactly what you want in your birth plan and why.

5. Practice whole body relaxation: Try meditation apps and/or pregnancy yoga! These relaxation techniques can be then used in labor too!

Keeping all of these steps in mind when creating your birth plan will be a big help in creating a birth plan that serve your physical, mental, and emotional well being.

Activity: Start making your birth plan (remember that your plan can develop and change over time, nothing is finalized until baby is in your arms).

Begin by asking your self these questions:

– What kind of safe birth do I want? (medicated, unmedicated, hospital, birthing center, etc.)

– What kind of safe birthing environment do I want? (quiet, low lighting, specific music, etc.)

– What are my medical needs in birth? ( I am choosing a Vaginal Birth After C-section (VBAC), I am a surrogate, I am allergic to latex gloves, etc.)

– What are your needs postpartum? (I have a history of heavy bleeding after birth, I want to delay cord clamping, etc.)

– What have you decided about your child’s first few days? (vaccinations, first bath, etc.)

Using these questions you can have a starting point for what the main purpose or purposes in your birth plan are. You can flesh it out and expand it based on what you find in your research and what needs arise during your pregnancy.

Use this Birth Plan format to help you lay out your birth choices in a clearand thorough manner.

Use this Birth Plan Questionnaire to help make sure you cover most if not all of your options in birth. Research each option and discuss each option with your care provider.

Video 4: What is a doula?

In this video we will cover what a doula is, what their role is in pregnancy, labor and birth, and how they can benefit you in your birth.

A doula Supports families emotionally, physically, emotionally, and by advocating for them.

There are many kinds of doulas for many kinds of situations. Some examples of doulas are Birth Doula, Postpartum Doula, Bereavement Doula, and Sibling Doula. Doulas also have many different styles for example VBAC focused doula, Hippy style doula, Plus size mom doula, and so much more!

I encourage you to explore the doula options that best fit your family needs and then interview potential doulas and find a doula who’s style best fits your needs.

Here is some information on Birth Doula Support:

A Birth Doula Does: Support Mothers and families through physical support, emotional support, informational support, and advocacy.

A Birth Doula Does not: Support clinically, medically, give medical advice, or take over for the role of, partner or family member, or care provider.

They are an added tool to help you succeed in the elements of your birth plan!

Evidence of Birth Doula support:

– 25-39% decrease in risk of C-sections.

– 8-15% increase in likelihood of spontaneous vaginal birth.

– 10% decrease in use of medications for pain relief.

– Shorter labors by an average of 41 minutes.

– 38% decrease in the baby’s risk of low 5 minute Apgar score.

– 31% decrease in the risk of being dissatisfied with the birth experience.

What should you ask a potential Doula?

It is important to decide if you want a professional doula or a friend or family member advocating for you. Having a professional doula is helpful in a variety of ways. Doulas have general medical knowledge to help translate between you and your care provider, They have experience of labors and births so they know how best to apply counter pressure and massages, they also have a general knowledge of positions and activities to perform during labor to help it progress or help ease pain and tension. Below are some questions you could ask when interviewing a doula.

1. What training and experience do you have?

2. What is your philosophy about birth and maternal care?

3. What do you feel is your scope as a doula?

4. What do your services include?

5. What types of birth places do you work with.

6. Do you have a back up?

7. Do you offer payment plans?

8. How would you describe your doula style?

9. Why did you become a doula?

10. At what point should we contact you during labor? When do you typically join your clients?

11. How do you work with husband, partners, families, etc?

12. How would you describe your style when working with hospital/birthing center staff?

13. Do you have any additional services?

14. Is it possible to read any reviews or testimonials?

Check out this video on how to safely hire a doula that will be best for your needs!
 
 
Activity: If you are wanting to have a doula find a doula in your area who can help you decide if a doula is right for you and start interviewing

Video 5: Making Informed Decisions

Informed Consent: “Is fundamental in both ethics and law. Patients have the right to receive information and ask questions about recommended treatments so that they can make well-considered decisions about care. Successful communication in the patient-physician relationship fosters trust and supports shared decision making.” – American Medical Association

Remember, It is not your job to ask your care provider’s permission, it is your care provider’s job to ask your permission. And if their recommendation is truly what is best for your care then it should be easy for them to provide risks and benefits for making the choice.

With any choice use the Informed Consent Steps B.R.A.I.N to make sure you have all the information to make the best decision for your care! Feel free to use the below graphic to help! Also save it to your phone or print it out to keep with your birth plan!

It is always best when working through informed consent with your care provider to be respectful of them and their position. It doesn’t mean that you have to do what they say but your best chance for better care is to be kind and respectful while being sure of your rights and wishes.

Activity: Go over the B.R.A.I.N steps with your care provider at your next prenatal visit. It can be a good way to test if your care provider is on board with you making informed decisions!

Video 6: Your Rights As a Parent And As a Patient

In this section we will cover your legal rights that cannot be taken away from you under any circumstances
These are you patient and parental rights. If you feel these have been violated at any point contact the care provider’s HR person, the head of the hospital, the head of the nursing staff, any and all of these people must know if your rights have been violated.

1. You have a right to healthcare during pregnancy and after birth.

2. You have the right to healthcare that is consistent with current scientific evidence.

3. You have the right to choose a midwife or a physician.

4. You have the right to choose your birth setting

5. You have the right to leave a caregiver if they do not meet with your needs or likes.

6. You have the right to information about your care providers views on interventions and methods in labor and birth. As well as their C-section statistics.

7. You have the right to privacy.

8. You have the right to receive maternity care that addresses all of your physical and social needs.

9. You have the right to be fully informed in every decision by being made fully aware of all benefits, risks, and cost of all care related elements of your birth.

10. You always have the right to accept or refuse anything offered by your care provider.

11. You have the right to be made aware if your provider wants to include information about you or any of your family members in a research study.

12. You have the right to care that is appropriate for your culture and/or religious preferences.

13. You have the right to have anyone in the room with you that you desire.

14. You have the right to receive full in advance information of risks and benefits.

15. . You have the right to freedom of movement in labor.

16 . You have the right to uninterrupted contact with your newborn.

17. You have the right to complete information about and benefits of breastfeeding.

18.  You have the right to make decisions collaboratively with your caregivers.

19. You have the right to continuous emotional, physical, and social support.

20. You have the right to unrestricted access to all of your records at any time.

Source Childbirth Connection   

Video 8: Interventions

In this video we will discuss risks and benefits of interventions as well as what qualifies as an intervention.
Things that can interfere with normal labor progression are not just medical. Normal labor progression is discussed in a later section. Research shows that movement and hydration are often all that’s needed to get a slow labor moving and that membranes shouldn’t be ruptured routinely.
 
Here are a few examples of things that can potentially interfere with normal labor progression:
 
  • Medications to induce or speed up labor.
  • An environment that is not private or comfortable.
  • Time limits on the progression of labor.
  • Restrictions on food and drink.
  • Pain medications, epidurals, or anesthesia.
  • Episiotomy.
  • C-Section, Vacuum extraction, or forcep delivery.
  • Early cutting of the umbilical cord (before it stops pulsating).
  • Separation of mother and baby after birth.
  • Any situation where you feel threatened or unsupported.

Some of these things are helpful tools when needed. But when used unnecessarily they can interfere with the natural birthing process. This will be discussed in more detail in Section 5.

 

Medical Intervention is anything that is administered during labor. some examples are:

  • IV fluids
  • Induction medication
  • Pain medication
  • Fetal monitoring

Sometimes interventions are necessary, helpful, and even life changing! Other times they can interfere with what your body was designed to do and lead to even more interventions. One example of a possible domino situation is if a pregnant woman receives Pitocin to induce labor. The contractions are very strong (stronger than biologically normal) and so she chooses to have an epidural. Pitocin is hard on the baby because he/she gets squeezed tighter during contractions than what is biologically normal. The baby’s heart rate begins to go down under the stress. A C-section becomes necessary. This is just one possible scenario. The same set of circumstances can happen and go completely differently and perhaps even perfectly the next time around. 

Overall being informed about all of your options and the risks and benefits of each intervention is the best way to get a good birth outcome.

Activity: Check out Evidence Based Birth and familiarize yourself with its format so that you can use it as a tool to research interventions later.

When choosing wether or not to have IV fluids during labor you must weigh a variety of things. If there is another medical indication to need an IV such as an induction Group Be Strep, or epidural it will be required. But if labor is progressing normally and you are able to consume enough fluids then having a saline lock or hep-lock will aid in your ability to move and position yourself comfortably in labor.

– When the laboring person is free to drink the need for IV fluids can be guided by the person’s unique situation.

– People who received IV fluids at 125 mL/hr versus 250 mL/hr had longer labors by about one hour and a 30% higher risk of Cesarean.

– People who are not allowed to drink, or not managing to consume enough liquids, may benefit from higher rates of IV fluids.

– High amounts of IV fluids during labor can lead to an artificial drop in the newborn’s weight and possible painful breast swelling, both of which can harm breastfeeding.

Medical reasons for IV fluids: Nausea, vomiting, maternal exhaustion, Group B Strep, or prolonged labor are some examples.

Source: Evidence Based Birth

Inductions

Again inductions are an amazing tool when needed! But when used unnecessarily they place you at risk for entering into a domino of interventions. Here are some of the risks and benefits of  some induction methods. 

  • Going into labor spontaneously reduces your risk of C-Section and Interventions.
  • Once you are induced you will likely be put on a clear liquid diet for the remainder of your labor.
  • Once induced you will likely be required to be on continuous fetal monitoring.
  • Induction labor is unnatural labor and harder to manage without pain management. (And pain management comes with it’s own risks that could effect you or your baby)
  • Induction medications place stress on the mother’s body and the baby.

1. Pitocin

Risks: 

– 6 times more likely to have a C-section

– 78% get an epidural (compared to 60% of mother’s who went into labor spontaneously)

– Longer labors

– Postpartum hemorrhage

– 77% of uterine abruption patients received Pitocin

– Fetal distress

– Low APGAR scores

– Babies are 3 times more likely to have oxygen deprivation (which can lead to cerebral palsy or brain damage)

– Lessens oxygen to baby .

– 25% of the time Pitocin isn’t successful and a C-section is necessary.

– When Pitocin is used unnecessarily, it can trigger a “cascade of interventions” that actually can lead mothers to c-section.

Benefits:

-When Pitocin is used well, it can help moms avoid cesarean section.

– Can help with Postpartum hemorrhage

2. Artificial Rupture of Membranes: 

An intact amniotic sac (“bag of waters”) protects your baby’s head and your vagina during labor. Contractions will generally be stronger after water breaks. 

Risks:

– Greater chance of a C-section

– 44% more likely to have an epidural.

– Increases risk of infection

Benefits:

– Slightly reduces instances of shoulder dystocia when performed after 3 cms

– Can help speed labor if movement and hydration did not get a slow labor moving. 

3. Foley Catheter: 

Considered safe and effective. No strong increase in risks or benefits.

4. Membrane Sweeping: 

Considered safe and effective. No strong increase in risks or benefits.

5. Prostaglandin:

I have found limited information on this particular induction method, I will add to this section when I find more information.

Risks: 

– Associated with low heart rate in babies

– lessens the flow of oxygen to baby.

Benefits:

– Can be effective in ripening cervix.

Source: Evidence Based Birth:Due Dates , Science Direct, Medical Journals , Evidence Based Birth: Pitocin

Monitoring is a valuable tool when needed, but there is evidence that points to the fact that it is overused. And when used unnecessarily it can aid in a domino of interventions.

Intermittent Monitoring or Hands on Monitoring:

This method of monitoring is when a hand held doppler device is used periodically to check baby’s heart rate.

Benefits:

  • Comfortable for the mother.
  • Can be used in many different laboring positions.
  • Can be used in and under water.
  • Allows for more personal space.
  • Does not require wearing uncomfortable belts and is easier to move.
  • May calculate and display fetal heart rate values.
  • Lower rates of stillbirth.
  • Encourages more contact with care providers and staff.
  • Encourages better laboring and birth positions.
Risks:
  • Not available in all birth settings, staff may not be trained in its use.

Continuous Fetal monitoring:

This method of monitoring is when devices are placed on the pregnant belly to register baby’s heart beat and contractions. There are some remote options but most hospitals still only have the ones that have long cords attached. And even the remote devices tend to only work in certain positions, which limits the mother’s ability to move in labor.

Benefits:

  • The risk of a newborn seizure was 0.15% ( 50% lower than intermittent monitoring)
  • Is helpful in high risk situations.

Risks:

  • 63% more likely to have a C-section.
  • 15% more likely to need forceps or vacuum extraction
  • Limits movement in birth.

“The bottom line is that hands-on listening [Not continuous monitoring] is an evidence-based option for mothers and babies.” – Evidence Based Birth

Source: Evidence Based birth  

“In many hospitals, patients are told not to eat or drink during labor. The medical term for this is “NPO,” which comes from the Latin nil per os, meaning nothing by mouth.

In a recent survey of mothers who gave birth in U.S. hospitals, 60% of them reported not drinking during labor, and 80% said that they did not eat (Declercq et al. 2014). When people are free to eat and drink as desired during labor, as is typical in U.S. freestanding birth centers, most of them (95%) choose to eat or drink (Rooks et al. 1989).” – Evidence Based Birth

Problems with women being instructed not to eat during labor.

– Fear of aspiration is obsolete ( since the 1940’s)

– In the case of aspiration severe reactions are rare. (1 in every 14 million births)

– Does not increase risk to mother or baby for low risk mothers/babies in the event of an emergency c-section.

– Women naturally limit their intake as labor gets stronger anyway.

– Not being allowed to eat can increase a mother’s stress levels during labor, also causing the pain to be more intense (in 78% of cases).

– You have the human right to choose if you want to eat or drink during labor or not.

If you choose a path of interventions for your birth the necessity for not eating is stronger. Because pretty much any intervention you choose comes with an increased risk of C-section. But if you choose a natural labor I encourage you to discuss with your provider on why or why not you will be allowed to eat and drink during labor. 

Source: Evidence Based Birth   

A very common reason care providers choose inductions for their patients is because their water has broken. I encourage you to go over your options with your care provider in the event that this happens. Discussing risks and benefits of your choices.

Premature rupture of membranes (PROM): 

-Rupture (breaking open) of the membranes (amniotic sac) before labor begins. 

– PROM occurs in about 8 to 10 percent of all pregnancies.

– When water breaks sometime after 37 weeks gestation or later on it’s own with no contractions.

– Does not seem to increase the risk of C-section or maternal/infant death.

– 95% go into labor on their own within 24 hours.

– You will need to avoid vaginal exams to avoid infection. 

Source: Evidence Based Birth, New York Times

Video 7: Natural Induction Methods

Any home induction technique you try should only be attempted when you are well rested, well hydrated, and after a good meal! Also preferably after you have treated yourself to a relaxing activity. All of them should also only be attempted after you have passed the 38 week mark (preferably after you have passed the 40 week mark) and after your care provider gives you the go ahead. Also do not attempt them daily. Try for a day or two then give your body some time to rest for a day or two. Remember birth is a marathon don’t go into it exhausted. Make plans to relax in the week leading up to your due date. Like taking a nice herbal bath soak. Here are some methods you can try along with some of the risks and benefits. 
 

Sex: Most studies show that there is a slight increase in chance of inducing labor but a few studies have shown the opposite.

– Mild Exercise: Highly recommended. May not produce active labor but likely to help you be healthy for a natural labor.

Nipple Stimulation: Use only under the guidance of you provider. It is very effective at releasing oxytocin and causing contractions. Could help in causing active labor but can also wear the mother and baby out if used too excessively.

Acupuncture or acupressure: Lack of evidence on its effectiveness. can be expensive, but could help if you are able.

Membrane Sweeping: Seen to be very effective but can also cause vaginal bleeding, premature rupture of membranes, and cramping.

Red Raspberry Leaf Tea: Helps keep the uterus healthy not a method of induction.

– Spicy foods: Rarely results in true labor and can cause intestinal discomfort.

Castor oil (laxative): Risky side effects. Not proven to be effective.

– Herbs: Some herbs that have been encouraged to use in labor have been shown to be dangerous to the baby. Only take advice on herbs from a certified herbalist.

Essential Oils: Jasmine and Clary Sage essential oils have not be proven to start labor but can potentially start labor. Testimonials say that they have noticed shorter labors with use of these oils. This roller ball is helpful!

Blue or Black Cohosh: Limited research but the evidence we have says there are major safety concerns for using either black or blue cohosh.

Eating Dates: Limited research. Some research shows that the rates of Pitocin use is lower with those that eat dates regularly leading up to labor.

Also check out this article by Evidence Based Birth.
 
Before using essential oils consult a certified aromatherapist’s advice. Here is a page that is very helpful!

Section 4: Warning Signs and Complications in Pregnancy and Labor

In this section we will be covering the different signs that something is going wrong either in pregnancy, labor, or birth. 

Video 8: Warning Signs

In this video we will discuss what some of the warning signs that something could be going wrong in your pregnancy (not medical advice)

 

Contact your provider if you experience any of the following during your pregnancy. They could be signs of a bigger problem, call quickly if you experience a combination of more than one of them.

1. Severe pain

2. Fever

3. Vaginal bleeding

4. Continuous vomiting

5. Headache that won’t go away

6. Change in urination

7. Edema (Excessive swelling)

8. Gush of fluid

9. Visual changes

10. Baby moving less than you are used to or not moving at all. 

Activity: Download a kick counter app to use every so often to track baby’s movements. (but ultimately lean into your instincts, you know your body, you know your baby).

I developed this criteria below with a midwife for when to call 911. It can help you assess if it is an emergency situation. When in doubt call your care provider or 911, follow your gut. Also included in the criteria is a criteria for when to call your care provider.

  • What it is: High blood sugar that develops during pregnancy.
  • Risk factors: Being plus sized( BMI of 25 or higher), increasing maternal age, history of GDM, history of large babies, diabetes in a close relative, being in certain ethnic groups.
  • Lower risk: Being under 25 years of age, “normal” weight, no close relatives with diabetes, no history of glucose intolerance, no history of poor birth outcomes.
  • Possible health problems that can result: Pre-eclampsia, fetal high blood sugar, first time C-section, premature birth, bigger babies, shoulder dystocia or birth injury, newborn intensive care, newborn jaundice, newborn low blood sugar, mother developing diabetes and/or heart disease later in life, baby developing excess body weight or diabetes later in life.

Ultimately a diagnosis of Gestational Diabetes does not mean you will have bad outcomes. It is a good reason to be proactive in your health and develop a thorough birth plan. Tips for managing your gestational diabetes (under the approval and direction of a care provider)

1. Healthy Diet

2. Exercise

“High blood sugar can cause problems, but it can be treated with diet, exercise, and sometimes medication.” Evidence Based Birth

Source: Evidence Based Birth

Group B Strep:

  • How common: 10-30% of pregnant women carry the GBS (most do not have symptoms)
  • Risks: sepsis, pneumonia, and meningitis in newborns (1-2% risk when not treated, 0.2% if treated).

Treatment Options:

– Taking probiotics can lessen your chance of being colonized with GBS. (43% were GBS negative by the time they gave birth).

– Washing vagina with Chlorhexadine during labor (not proven to be effective).

– IV antibiotics every 4 hours during labor is shown to be effective.

Source: Evidence Based Birth

 

Section 5: What’s Happening During Labor and Birth?

In this section you will find information on natural elements of labor and birth, C-sections, big babies, and failure to progress.

Video 9: Normal Labor Progression

in this video we will cover normal labor progression including, dilation, cervical change, station, and more.

Video 10: Stages of Labor

in this video we will talk about the 4 stages of labor. How to identify them and what happens during the individual stages.

– In stage one of labor, which lasts from the onset of labor until the cervix is fully dilated. It is the longest stage of labor.

– Anywhere from 3-6 cms in dilation.

– Contractions consistent, patterned, and causing cervical change.

1. First stage of labor:

         – Thinning (effacement) and opening (dilation) of the cervix.

         – Contractions that help your cervix thin and begin to open.

         – Active labor.

2. Second stage of labor:

        – Baby moves through the birth canal and is born

        – The pushing stage.

3. Third stage of labor: Placenta is delivered.

4. Fourth stage of labor: Recovery.

Activity: Check out this Video on Epidurals and Second stage of labor

– Final phase of the first stage of labor, following early and active labor.

– When the cervix changes from from 7 to 10 cms.

– Often lasts less than an hour but can be longer.

– The word transition means that her body is making the shift from opening the cervix to the beginning of the baby’s descent.

Video 11: C-sections

C-section:

– 37% of women have had a C-Section. (WHO states that only around 10-15% of C-Sections are medically necessary).

– A C-Section can be life saving when medically necessary.

Risks to mother: Infection, injury to blood vessels and organs, excessive bleeding, chronic pelvic pain, Hysterectomy, increased likelihood of stillbirths and miscarriages in subsequent pregnancies.

Risks to baby: Breathing difficulties, needing to be in the NICU, higher risk childhood diseases. 

Subsequent pregnancies will be considered high risk by most care providers.

If a C-section becomes necessary for you there are many ways to manage. And it can still be an empowering and beautiful birth. The way to make it an empowering beautiful is for you to be fully informed and fully confident that the decision is what is best for you and your baby. 

Many elements that you may have on your birth plan can possibly still remain the same. Here are some helpful links.

Skin to Skin and C-section

Delayed Cord Cutting and C-section

Source: Evidence Based Birth   

C-sections are a life saving measure! They come with a very long and hard recovery and if they can be avoided they should. Choosing a provider with a low C-section rate is possibly the most important step to avoiding a C-section.

– Choose a provider and birth setting with low C-Section rates.

– Stay active and healthy to prepare for labor.

– Arrange to have continuous labor support. (Look into a doula!)

– Get extra rest, especially towards the end of pregnancy to prepare for labor.

– Avoid induction unless medically necessary.

– Wait to be admitted to the hospital until in active labor (usually after 6 cm dilation or Purple line is around half way up the chart, we will talk about the purple line in a later section).

– While in labor stay upright as much as possible.

– Be an informed patient, know your rights and know your options.

 

A common reason for a C-section is because of a breech baby. Unfortunately there are few care providers that are trained to delivery a breech baby, but are many ways to turn a breech baby.
 

Activity: Check out Spinning Babies and have their resources on hand if needed.

Big Baby Myth

“The main problem with big babies is that it’s hard to predict if you’re going to have one or not! Hindsight is 20-20, but we don’t know ahead of time which babies are going to be big, and which big babies are going to have problems. You may want to ask your care provider what their usual treatment is for suspected big babies, to get an idea of their routine practice. It’s also a good idea to find out if your care provider trains regularly on how to manage shoulder dystocia, as this situation can happen with a baby of any size, and training has been shown to decrease the chances of a baby experiencing permanent injury due to shoulder dystocia.” – Evidence Based Birth

Important things to remember:

1. Movement during birth is more important than baby’s size.

2. A woman’s pelvis and body are made to stretch and adjust.

3. A baby’s skull bones are not set in place.

4. Accurately predicting the size of a baby before birth is not possible.

5. Medication in labor can stop your body from laboring naturally and can effect your baby’s descent, more than if they are a bigger baby.

6. Being put under the wrong mental state can stall or lengthen your labor, such as being told your baby is too big to birth, which as mentioned above is impossible to know.

7. What would happen to the human race if baby’s were too big to be born? How does humanity survive in rural areas in third world countries in the world today?

8. It is nearly impossible to accurately predict a baby’s size and these “guesses” have a 15% margin of error. 

Your choice for a C-section should be made with all of the information and never out of fear but out of the confidence that you did what was best because you had science and knowledge behind you.

Source: Evidence Based birth , Childbirth Professionals International    

 

Failure to Progress:

– “As long as the laboring person and baby are healthy and as long as the length labor does not meet the criteria for ‘labor arrest,’ laboring people should be treated as if they are progressing normally.”

– Labor arrest: Can be diagnosed in the second stage (Pushing) if there has been no improvement in the baby’s rotation or descent after:

• ≥ 4 hours in first-time mothers with an epidural
• ≥ 3 hours in first-time mothers without an epidural
• ≥ 3 hours in experienced mothers with an epidural
• ≥ 2 hours in experienced mothers without an epidural

– “Cesarean delivery for active-phase arrest in first stage of labor should be reserved for women ≥ 6 cm of dilation with ruptured membranes who fail to progress despite 4 hours of adequate uterine activity, or at least 6 hours of oxytocin administration with inadequate uterine activity and no cervical change.” In other words, the appropriate term is now “labor arrest,” and people should be at least 6 cm dilated and have no cervical change for 4 to 6 hours before being given this diagnosis.

Activity: Check out this article by Evidence Based birth

 

Section 6: Pain management 

In this section you will learn what contractions feel like, medical pain management, natural pain management, and positions.

Video 12: Pain Management

in this video we will discuss labor pain and different options you have in managing that pain

Contractions: Pain Vs. Suffering

“..there is a difference between pain and suffering. Penny Simkin is a famous doula and author who has written a lot of about the topics of pain versus suffering. She teaches people that you can have pain without suffering. You can also have suffering without pain. They don’t necessarily have to go hand in hand.” – Evidence Based Birth

There are generally two perspectives on pain management. It is important to decide on your own what your perspective is and it will help you create a plan that will best serve your needs and desires.

Pain relief Perspective:
“Many doctors and labor and delivery nurses believe strongly in the pain relief perspective. They many believe that pain during labor is unnecessary in today’s society and that we should eliminate pain, and that the benefits of pain medications always outweigh the risks. Some of them may not understand why someone would want to go without pain medication during labor, and that’s because a lot of nurses and doctors were trained in medical school and nursing school that it’s very important to assess people’s pain and eliminate it as much as possible.” – Evidence Based Birth

Coping with Pain Perspective:
“On the other hand, a lot of people believe in the coping with pain or working with pain philosophy. In this perspective, people believe that pain is a normal part of labor and that it’s necessary to entice you to move around and try different positions that will help the baby come down and out. In the right environment, an environment that feels supportive and private and lets you feel not anxious, people can better cope with labor pain in an environment like that because they feel safe and supported. Also, it helps them release natural pain-relieving hormones called endorphins.” – Evidence Based Birth

Other things to keep in mind.

– Everyone’s experience of pain is different. Everyone, and every labor is different.

– Early contractions may feel quite painless or mild, or they may feel very strong and intense.

– The intensity you feel can also differ from one pregnancy to the next.

– Typically, active labor contractions feel like a tightness that starts in the back and moves to the front of your lower abdomen with each contraction (unlike the ebb and flow of Braxton Hicks)

– True active labor contractions feel steadily more intense over time.

– During true labor contractions your belly will tighten and feel very hard. They usually start in the back and wrap around the belly.

– Some moms liken these contractions to menstrual cramps just more intense, more rhythmic, and covering a wider area.

An epidural is a valuable tool. And there are times when it is needed. Consult with your provider the benefits and risks of choosing an epidural for your specific circumstance before you are in labor and then again when/if the choice is presented to you in labor if necessary.

Risks:

– Associated with shorter breastfeeding time.

– May effect baby for weeks after birth.

– Associated with breastfeeding difficulties.

– Associated with poor sucking co-ordination in infants.

– Increases risk of a C-section.

– Increases risk of vaginal tearing.

– Increases risk of vacuum or forces aid in delivery.

– Associated with difficulty in pushing.

Lower Risks:

– Longer recovery time after birth.

– Low blood pressure

– Loss of bladder control

– Itchy skin

– Feeling sick

– Inadequate pain relief

– Headache

– Slow breathing

– Temporary nerve damage

– Infection

– Permanent nerve damage

– Death

Benefits:

– Can give an exhausted mother rest to relax and encourage dilation.

– Can help a mother who is struggling to relax do so.

– Can help ease the intensity of unnatural contractions of inductions or particularly un-patterned and difficult labor.

Morphine:

“of people who were given opioids through their IV – these are morphine-like drugs – only 24% said that those were “very helpful”.- Evidence Based Birth

Source: Evidence Based Birth  , Science Direct

Nitrous Oxide or Laughing Gas:

Is growing again in popularity to use during labor. Like anything else you should discuss the risks and benefits with your care provider. 

Benefits:

  • Safe for the mother, fetus, and neonate.
  • Simple to administer.
  • Does not interfere with the release and function of endogenous oxytocin.
  • No adverse effects on the normal physiology and progress of labor” (Rooks, 2011)
  • Does not affect infant alertness during the early bonding period between a mother and her newborn.
  • Does not affect breastfeeding.
  • Does not increase the risk for neonatal resuscitation.
  • Many women find it helps them relax and decreases their perception of labor pain.
  • The mother can decide how much to use and went to stop.
  • Easily discontinued, and its effects disappear within five minutes after cessation.

Risks:

  • Mother may still have an awareness of labor pain.
  • Currently only a few hospitals have Nitrous Oxide as an option.

Discuss with your provider in advance if this is an option you want. You may have to switch providers to be able to have it as an option.

 

Natural Pain Management:

Aromatherapy: We don’t really know exactly how or why aromatherapy is effective at pain management. Essential oils should be used very carefully and as directed by certified aromatherapists. This does not mean following the advice of an Essential oil sales representative. And oils should be used with strong caution around children. “More than 50% of mothers rated the use of aromatherapy as helpful during labor and 13% said that it was unhelpful” – Evidence Based Birth.

Positions: Upright positions are known to decrease pain and help baby descend. There are a variety of positions to experiment with and it is helpful to have a basic knowledge of them so that you can explore what works best for you. Upright and active positions during the first stage of labor are linked with much shorter labors and less need for epidurals.

Breathing: There are several theories on how and why conscious breathing is effective in easing labor pain.

  1. Focused breathing might work by interrupting the transmission of pain signals to your brain by giving you something positive to focus on.
  2. It may also work by stimulating the release of endorphins, which are natural pain relieving hormones,  and by helping you reframe your thinking about labor so that you view it as positive, productive and manageable.
We will talk more about breathing later in the course.
 

Hypnosis: Researchers think that hypnotherapy works by changing how you perceive pain. It can effectively alter the higher centers of your central nervous system. Hypnosis is most effective if you work at it. It’s not something you can decide spur of the moment to do in labor, it takes practice.

There are many established methods available such as HypnoBirthing and Hypnobabies. Using their teaching and tools has been shown to be effective for some. But again what you get out of it depends on how much you pour into it.

Pain Perception: “In the Netherlands, only about 22% of mothers give birth with an epidural compared with 61% in the United States.” – Evidence Based Birth

I hope to add more to this section soon! 

Water: The healing and soothing effects of water on the human body are well known outside of pregnancy and labor. Few use water in labor 8-18%, but “49% of people who used a warm bath during labor described it as “very helpful” for pain relief, and 32% of people who used a shower during labor described that as “very helpful’ “. – Evidence Based Birth

“Although hydrotherapy was reported as being more helpful to mothers than opioids, only 6% of mothers in that study used water immersion in a tub or pool, while 30% had opioids given to them.” – Evidence Based Birth

Studies show that those who choose submersion in water at some point during their labor are less likely to choose pain medication to cope with pain.

Doula: Using a doula has many benefits all of which have emotional, mental, and physical ramifications.

– 25-39% decrease in C-sections

– 8-15% increase in spontaneous vaginal birth

– 31% increase in feeling satisfied with the birth experience

– 10% decrease in use of medical pain management

– An average of 41 minutes shorter labor times

– 38% decrease in low APGAR scores in newborns

 Cochrane Review Study:

“…found that, on average, the mothers who had doula support experienced less anxiety during labor and less pain. The authors concluded that the doula’s presence has a clinically meaningful impact on both pain and anxiety during labor.” – Evidence Based Birth

There are many different kinds of doulas and sometimes you can find low income doulas or doulas In training if money is an issue.

Sterile Water Injections:

“It seems that sterile water injections do offer benefits for helping relieve pain, although the procedure itself may be uncomfortable; however, there are evidence-based ways to lower the discomfort of the procedure. In some countries around the world, sterile water injections are a commonly accepted way of helping someone manage their pain, while in other parts of the world it’s not used as often. The bottom line seems to be that evidence does support the use of sterile water injections for helping manage pain during labor, especially back labor.” – Evidence Based Birth

This particular procedure is not commonly used so if you are interested in learning more discuss it with your care provider to see if it is an option for your birthing place and the risks and benefits.

Education: Knowing about your options in managing labor and managing pain in labor is important no matter what your birth plan is.

TENS Unit: It is believed that the TENS Unit helps change a person’s perception of pain during labor. There is a couple of different methods of using a TENS Unit.

Low intensity: Using a TENS Unit on low intensity may serve to limit the amount of stimuli to the brain. This is the “Gate Theory” which says that the brain can only receive so much information. So with the electric signals from the TENS unit it can somewhat replace or drown out the signals of pain from the labor.

High Intensity: Using a TENS unit on a high level it is possible that you are signaling your body to release extra natural endorphins to relieve the pain.

A possible third option is that using the TENS Unit gives the laboring mother a sense of control over the labor and that can possible help ease the anxiety of labor.

“in the second stage of labor, during the pushing phase, only 20% of the people in the TENS group reported their pain as severe compared to about 83% – 87% of people” who didn’t use the TENS Unit. – Evidence Based Birth

Music: It is believed that listening to music, especially music specific to you or specifically relaxing, helps adjust your perception of pain. Just as it has similar effects to our mood in times of our life outside of labor and birth.

There is a lot of variety of the kinds of music that can be chosen. Spiritual and emotional connection with the music itself likely plays a role. 

I look forward to adding more to this section soon!

Massage: Massage has multiple benefits.

– Helps the mother feel like she’s not alone in the journey.

– Soothes sore muscles.

– When the massage is given by a loved one there is the added benefit of the familiar touch helping your body release more oxytocin, which is itself a pain reliever.

Rebozo: Use of a Rebozo or a scarf during labor is relitively new in western culture, so therefore there is little research or studies on the effectiveness of them.

But “The World Health Organization has stated that the lack of studies on traditional practices should not become an obstacle in their application or development. ” – Evidence Based Birth

anecdotal evidence points to the fact that it is effective in easing labor pains and under professional guidance in turning babies in utero.

Relaxation: There are many different ways to achieve intentional relaxation. Relaxation in labor is not the same as taking a nap or getting a massage. Relaxation for labor should be practiced and maintained to use in labor.

  • Psychoprophylaxis: Combining relaxation methods with breathing techniques.
  • Visualization: The person recalls or imagines a pleasant, enjoyable and relaxing experience. This kind of imagery can be guided or unguided.
  • Guided imagery, you may listen to an audio file or a script of someone reading to you, to help bring you to that pleasant place where you can relax and enjoy the visualization.
  • Unguided imagery: May involve doing something like scanning your body for sensations of pain and replacing those sensations in your mind with feelings of comfort, heat or cold. (MRI studies have found that guided imagery changes the way that the brain perceives pain.)
  • Progressive muscle relaxation: People are guided to successively tense and then release different muscles in their body, often starting from the toes and working their way up to the head to achieve a sense of relaxation. 
We go more in depth in relaxation later in the course!


Video 13: Labor Positions

In this video we will cover different positions you can labor in as well as the benefits of the individual positions

Video 14 Birthing Tools:

In this video we will discuss different tools you can use during labor and birth and the benefits of each one.

 There are many amazing tools to use for pregnancy, labor, and birth! And all of them can be experimented with beforehand. It is very likely that things you find comforting during pregnancy will also be comforting during labor.

– Birthing Ball: Great for helping dilate, ease discomfort, rest, and help move baby down. 

– Tub: Great for helping you relax, helps soften perineum, eases sore muscles, and can be very helpful for making delivery more comfortable.

– Stress balls/ reflexology tools: Especially helpful during pregnancy to help encourage relaxation and ease stress.

– Soft scarf  or Rebozo: This can be used fo belly lifting to ease back pain before or during labor, to block out light during labor, and can be sweet to wrap baby in afterwards.

– Rice sock: These can be warmed or cooled to help ease sore muscles. They are better than a heating pad because they are more of a moist heat. Dry heat can dry out your muscles and aid in soreness.

– Hair brush: This can be a good stroking tool to help remind you to release tension in certain muscles during pregnancy or labor.

– Focal points/ affirmation cards: These are most helpful when chosen and practiced before labor, they can help you stay positive and calm. Focal points help remind you to keep your eyes open which helps make pain less intense.

– Lip balm: Chapped lips are common in labor, and can remind you to sip some water, but can be distracting. Make sure you choose a mildly flavored chapstick in case you are feeling nauseous.

– Breath mints: Especially peppermint or mint can help ease nausea (Don’t use too much peppermint because it can reduce breastmilk quantity).

– Music: Choose music that is encouraging, relaxing, or empowering for you. It can help distract or help you focus, whatever you need.

– Battery operated tea or twinkle lights: These help create a soft light in the room. Remember hospital florescent lightbulbs provide a harsh clinical light, something softer might help you feel more relaxed and calm.

– Massage tools: These are great for before, during, or after labor. They can help ease tension and sore muscles.

– Hand fan: Can help keep you cool, and can be a way for your partner to help.

– Lotion/ massage oils: These help make massaging during pregnancy or labor much easier on your skin and the smell can be comforting. Again remember to choose a mild smell in case you are nauseous.

Using upright positions is statistically proven to help birth outcomes. It puts your pelvis in more optimal positions for baby to move down the birth canal, uses gravity to help, and eases contraction pain. Upright positions are also much easier to cope with the intensities of labor.

Here are some statistics on upright positions.

25% less likely to use a vacuum or forceps

25% less likely to have an episiotomy

54% less likely to have abnormal heart rate patterns

75% experienced less pain

Ultimately no specific position is statistically proven to be “safest”. The important aspect is to be flexible and to not place a lot of unneeded pressure on your sacrum. Upright positions are the best for that. 

Source: Evidence Based Birth  

  • Standing or walking: This is a great upright position to help gravity aid you in labor. It can also help distract you if you are able to walk around the halls of your hospital floor or outside. Remember to lean into your partner, a chair, or a wall to stabilize during contractions. 
  • Rocking and Swaying: Any combination of motions back and forth or side to side. Mobility is key here and feeling where your pelvis feels tight. Lean into those tense muscles to help loosen them.
  • Squatting: This can be done in a variety of ways, hanging from your partner, leaning on a chair, etc.
  • Sitting: While sitting it is good to keep your pelvis open and knees spread apart. an easy way to do that is to spread your knees apart. Additionally making sure that you sit pushing your belly forward slightly (straight back)
  • Leaning over or kneeling: Make sure you have something comfortable to press into like pillows, a comfy chair, birthing ball, or your partner’s arms. When kneeling being able to reach up can help elongate your spine to help your pelvis.
  • Hands and knees: Put pillows or a yoga mat under your knees so they don’t get sore. This position is great for rocking your pelvis to encourage movement.
  • Side-lying: When you do rest it is best to do it on your side. Starting on your left and alternating. And to help you still make progress in your labor try a peanut ball to help keep your pelvis open.

Help you rest during early labor. 

Make sure you keep your pelvic floor open as much as possible using pillows or a peanut ball.

Helps explore hip movement by rocking back and forth or side to side.

Especially good for active labor to help baby’s decent.

Helps create movement in the hips.

 

The pelvis goes through major changes during pregnancy and labor.

squatting helps improve mobility.

Make sure that you squat with support to avoid straining your knees.

Activity: Try different positions with your partner for practice

Things that can interfere with normal labor progression are not just medical. Normal labor progression is discussed in a later section. Here are a few examples of things that can potentially interfere with normal labor progression:
 
  • Medications to induce or speed up labor.
  • An environment that is not private or comfortable.
  • Time limits on the progression of labor.
  • Restrictions on food and drink.
  • Pain medications, epidurals, or anesthesia.
  • Episiotomy.
  • C-Section, Vacuum extraction, or forcep delivery.
  • Early cutting of the umbilical cord (before it stops pulsating).
  • Separation of mother and baby after birth.
  • Any situation where you feel threatened or unsupported.

Some of these things are helpful tools when needed. But when used unnecessarily they can interfere with the natural birthing process. This will be discussed in more detail in Section 5.

 

Medical Intervention is anything that is administered during labor. some examples are:

  • IV fluids
  • Induction medication
  • Pain medication
  • Fetal monitoring

Sometimes interventions are necessary, helpful, and even life changing! Other times they can interfere with what your body was designed to do and lead to even more interventions. One example of a possible domino situation is if a pregnant woman receives Pitocin to induce labor. The contractions are very strong (stronger than biologically normal) and so she chooses to have an epidural. Pitocin is hard on the baby because he/she gets squeezed tighter during contractions than what is biologically normal. The baby’s heart rate begins to go down under the stress. A C-section becomes necessary. This is just one possible scenario. The same set of circumstances can happen and go completely differently and perhaps even perfectly the next time around. 

Overall being informed about all of your options and the risks and benefits of each intervention is the best way to get a good birth outcome.

Activity: Check out Evidence Based Birth and familiarize yourself with its format so that you can use it as a tool to research interventions later.

When choosing wether or not to have IV fluids during labor you must weigh a variety of things. If there is another medical indication to need an IV such as an induction Group Be Strep, or epidural it will be required. But if labor is progressing normally and you are able to consume enough fluids then having a saline lock or hep-lock will aid in your ability to move and position yourself comfortably in labor.

– When the laboring person is free to drink the need for IV fluids can be guided by the person’s unique situation.

– People who received IV fluids at 125 mL/hr versus 250 mL/hr had longer labors by about one hour and a 30% higher risk of Cesarean.

– People who are not allowed to drink, or not managing to consume enough liquids, may benefit from higher rates of IV fluids.

– High amounts of IV fluids during labor can lead to an artificial drop in the newborn’s weight and possible painful breast swelling, both of which can harm breastfeeding.

Medical reasons for IV fluids: Nausea, vomiting, maternal exhaustion, Group B Strep, or prolonged labor are some examples.

Source: Evidence Based Birth

Again inductions are an amazing tool when needed! But when used unnecessarily they place you at risk for entering into a domino of interventions. Here are some of the risks and benefits of  some induction methods.

  • Going into labor spontaneously reduces your risk of C-Section and Interventions.
  • Once you are induced you will likely be put on a clear liquid diet for the remainder of your labor.
  • Once induced you will likely be required to be on continuous fetal monitoring.
  • Induction labor is unnatural labor and harder to manage without pain management. (And pain management comes with it’s own risks that could effect you or your baby)
  • Induction medications place stress on the mother’s body and the baby.
  1. Pitocin:

Risks: 

– 6 times more likely to have a C-section

– 78% get an epidural (compared to 60% of mother’s who went into labor spontaneously)

– Longer labors

– Postpartum hemorrhage

– 77% of uterine abruption patients received Pitocin

– Fetal distress

– Low APGAR scores

– Babies are 3 times more likely to have oxygen deprivation (which can lead to cerebral palsy or brain damage)

– Lessens oxygen to baby .

– 25% of the time Pitocin isn’t successful and a C-section is necessary.

-When Pitocin is used well, it can help moms avoid cesarean section.

– When Pitocin is used unnecessarily, it can trigger a “cascade of interventions” that actually can lead mothers to c-section.

Artificial Rupture of Membranes: 

– Slightly reduces instances of shoulder dystocia when performed after 3 cms, greater chance of a C-section, 44% more likely to have an epidural.

Foley Catheter: 

Considered safe and effective. No strong increase in risks or benefits.

Membrane Sweeping: 

Considered safe and effective. No strong increase in risks or benefits.

Prostaglandin: 

Associated with low heart rate in babies, lessens the flow of oxygen to baby.

Source: Evidence Based Birth:Due Dates , Science Direct, Medical Journals , Evidence Based Birth: Pitocin 

Monitoring is a valuable tool when needed, but there is evidence that points to the fact that it is overused. And when used unnecessarily it can aid in a domino of interventions.

Intermittent Monitoring or Hands on Monitoring:

This method of monitoring is when a hand held doppler device is used periodically to check baby’s heart rate.

  • Comfortable for the mother.
  • Can be used in many different laboring positions.
  • Can be used in and under water.
  • Allows for more personal space.
  • Does not require wearing uncomfortable belts and is easier to move.
  • May calculate and display fetal heart rate values.
  • Lower rates of stillbirth.
  • Encourages more contact with care providers and staff.
  • Encourages better laboring and birth positions.
  • Not available in all birth settings, staff may not be trained in its use.

Continuous Fetal monitoring:

This method of monitoring is when devices are placed on the pregnant belly to register baby’s heart beat and contractions. There are some remote options but most hospitals still only have the ones that have long cords attached. And even the remote devices tend to only work in certain positions, which limits the mother’s ability to move in labor.

  • 63% more likely to have a C-section.
  • 15% more likely to need forceps or vacuum extraction
  • The risk of a newborn seizure was 0.15% ( 50% lower than intermittent monitoring)
  • Limits movement in birth.
  • Is helpful in some high risk situations.

“The bottom line is that hands-on listening [Not continuous monitoring] is an evidence-based option for mothers and babies.” – Evidence Based Birth

Source: Evidence Based birth  

“In many hospitals, patients are told not to eat or drink during labor. The medical term for this is “NPO,” which comes from the Latin nil per os, meaning nothing by mouth.

In a recent survey of mothers who gave birth in U.S. hospitals, 60% of them reported not drinking during labor, and 80% said that they did not eat (Declercq et al. 2014). When people are free to eat and drink as desired during labor, as is typical in U.S. freestanding birth centers, most of them (95%) choose to eat or drink (Rooks et al. 1989).” – Evidence Based Birth

Problems with women being instructed not to eat during labor.

– Fear of aspiration is obsolete ( since the 1940’s)

– In the case of aspiration severe reactions are rare. (1 in every 14 million births)

– Does not increase risk to mother or baby for low risk mothers/babies in the event of an emergency c-section.

– Women naturally limit their intake as labor gets stronger anyway.

– Not being allowed to eat can increase a mother’s stress levels during labor, also causing the pain to be more intense(78% of cases).

– You have the human right to choose if you want to eat or drink during labor or not.

If you choose a path of interventions for your birth the necessity for not eating is stronger. Because pretty much any intervention you choose comes with an increased risk of C-section. But if you choose a natural labor I encourage you to discuss with your provider on why or why not you will be allowed to eat and drink during labor. 

Source: Evidence Based Birth  

A very common reason care providers choose inductions for their patients is because their water has broken. Go over your options with your care provider.

Premature rupture of membranes (PROM): is a rupture (breaking open) of the membranes (amniotic sac) before labor begins. If PROM occurs before 37 weeks of pregnancy, it is called preterm premature rupture of membranes (PPROM). PROM occurs in about 8 to 10 percent of all pregnancies.

– When water breaks sometime after 37 weeks gestation or later on it’s own with no contractions.

– Does not seem to increase the risk of C-section or maternal/infant death.

– 95% go into labor on their own within 24 hours.

– You will need to avoid vaginal exams to avoid infection.

Source: Evidence Based Birth, New York Times

 

 

Section 7: Preparing for Labor

In this section we will discuss ways to prepare for your upcoming labor and birth!

Video 15: Relaxation Practice

In this video we will go over different ways you can relax during pregnancy that can help you cope through labor more effectively.

Relaxation is very important during pregnancy and labor. It can help keep you healthy, positive, and focused. It can have huge physical impacts as well as emotional and mental aspects. Here are a few helpful ways to encourage relaxation throughout your pregnancy.

Another resource I have is this blog post on the question of “Why is Relaxation So Stressful?”

Yoga

Yoga is such a valuable tool during pregnancy because it is not only beneficial for keeping you flexible and loose but also for helping you relax. 

Fortunately there are many ways to work yoga into your routine. But even if classes or couches aren’t affordable there are also great prenatal yoga videos online

You don’t have to create a full-blown routine or follow strict yoga plans for it to be beneficial. Even if it is only used for a moment or two at the beginning or end of the day to help get you on the right foot. 

A good place to start might be to find a few poses you like that address areas where you are carrying tension and build from there. Don’t feel pressured to make it this super amazing experience every single time. And if you have little kids under foot sometimes they like to play yoga too!

*Make sure you have the go ahead from your care provider before doing any rigorous yoga!

Muscle Relaxation

Check out this resource for Progressive muscle relaxation. You can use this in almost any environment. It is most helpful laying down relaxing. You can even use it alongside one of the relaxation tracks below!

The basic technique of progressive muscle relaxation is to begin with your hands by tensing and releasing individual sets of muscles along each side of your body. After your hands, work up your arms, into your shoulders and jaw, and then down the length of your body.

Again this is something that is most effective with the ideal environment but can be at least some help no matter what. If you work and have a moment to do at least your shoulders, neck, and face you can hopefully ease some of the physical stress you may be experiencing.

Get a Massage

Here are some great prenatal massages. Getting a massage from a professional that Is certified to work with pregnant clients is ideal, any massage can be beneficial. Even if it’s not working everything out it will be at least a relaxing thing that you and your partner can do together. And can be a bonding time where dad can talk to the baby while mom relaxing. The baby will associate that awesome oxytocin produced by the intimacy and massage with daddy’s voice.

remember that if you choose to go to a professional Massage a full-blown body massage isn’t recommended early on in a pregnancy. So during your first trimester opt for a relaxing head, shoulder, arm, leg, hand or foot massage (Which is also nice during later pregnancy too).

*Get approval from your care provider before going to a massage therapist.

Deep Breathing

Deep breathing offers a number of overall health benefits: 

– Increased relaxation.

– Helps lower your heart rate

– Helps you fall sleep more quickly.

– Can help you monitor your emotions. 

Deep breathing can feel clumsy and awkward at first. But once you have done it a few times it will become more and more fluid and more and more beneficial. 

This is probably my favorite relaxation technique because it can be done anywhere at anytime. It is also the most beneficial thing you might do during pregnancy that can positively impact your labor and birth. After all you aren’t likely going to be wanting to do “tree pose” while you are in labor but deep breathing is a big yes!

It is probably best early on in your learning to do deep breathing that you spend at least one 10 minute session a day for a few days to get in a good rhythm. And again you can use this alongside one of the relaxation tracks below!

Start by getting in a comfortable position and taking a deep breath, hold the breath and then release it slowly.  While doing deep breathing you can be using other relaxation techniques like yoga and Progressive Muscle Relaxation.

Guided Imagery

There are plenty of apps and even playlists available for free to help take you through a guided imagery practice, but it’s also possible to do on your own.

Visualization is helpful in pregnancy but also in labor. Getting yourself as out of the moment as you can, distracted even can help coping through intensity of labor easier. But how effective it is in labor is almost directly correlated with how much time and work you put into it during pregnancy. So if that is something you want to actively use during your labor do the leg work now. 

I have a practice track below that helps you create that safe space.

Meditation

There are a number of meditation practices that combine deep breathing with guided imagery. If you want some help, check out some free apps online or listen to some of these guided meditations

Meditation works to combine deep breathing and, in some practices, guided imagery. The focus of meditation is to bring about a sense of calm while you work to clear your mind.

Meditation takes time and practice. It is not second nature. This relaxation technique would be very hard to do on your own. Having professional guidance is key to make it optimal. With the help of a professional they can teach you to do it on your own.

Exercise

Exercise helps your body release endorphins, which make you feel happy and relaxed.

It doesn’t have to be intense exercise. In fact any exercise should be cleared by a professional. A general rule is to not do something more intense than you would have done before being pregnant and anything that you do at all do cautiously and be aware and listen to your body. 

Rest

This one sounds like a no brainer, but when I say rest I don’t mean sleep for at least 8 hours at night (although do that too!). Be intentional with your resting, make it a plan. And yes we all have things we need to do even while we are pregnant but set goals and reward yourself with rest. Do the dishes and tidy the kitchen then lay down and set a timer for a half hour nap. 30 minutes will not wreck your day! 

Go Outside

Any time in fresh air and sunshine is beneficial! And it doesn’t have to be for long. 

Communicate

Being able to talk freely about things you are going through physically, mentally, and emotional can go a long way to helping you. Being able to be open and honest with your partner is ideal but in addition having the support and wisdom from other moms is amazingly helpful. Especially moms who have been in similiar circumstances,

Take a Bath

At the end of a long day, nothing works better to relax your body and mind than a nice warm bath. Just avoid scalding temperatures and talk to your doctor before using any aromatherapy to make sure it’s safe for the baby.

Conclusion

Relaxation is key to a healthy pregnancy, labor and birth. Find ways to slip relaxation in your schedule, not because you deserve it, even though you do, but because you and your baby need you at your best!

Safe Place Relaxation Track

Emotional Awareness Relaxation Track

Video 16: Preparing for Labor

In this section you will get practical tips on how to be best prepared for when labor begins

It can be hard to know when labor actually starts. After all most of the time you have been experiencing Braxton Hicks Contractions for days to weeks leading up to birth (sometimes for months). Those tend to fade into real labor. But no matter when you start to wonder “is this real labor!?” The action plan remains the same!

  • Ignore labor signs as long as possible: Continue with whatever you would normally be doing. If it’s the morning fix a nutritious breakfast. If it’s night time go to bed and get some rest.
  • First thing when you are pretty sure you are in labor: REST!! The contractions will do their thing best when you are rested. Don’t waste a bunch of energy trying to get them stronger. REST. 
  • Practice Focused breathing: When contractions are easier to manage it is a good time to practice focused breathing. That way it will be a habit as the intensity increases.
  • Practice letting go of tension on exhaled breaths: As the contraction builds notice any areas you are tensing up. The most common ones are the shoulders and face. Consciously relax these muscles. Again hopefully this action will become habit as the intensity builds.
  • Practice creating a resting space for between contractions: Find a position that is comfortable so that you can close your eyes in between contractions. It is not so much about sleep so much as it’s about being calm and relaxing.

Early Signs of Labor:

-Backache: Vague, low, and nagging, restlessness.

-Menstrual like cramps (May be accompanied with pain in thighs).

-Soft Bowel Movements (May be accompanied with intentional cramping).

– Nesting urges: Unusual burst of energy

* These are not always present but if you experience any of them in latent pregnancy its a good idea to listen to these signs and make sure you are well rested and hydrated.

Primary Signs of Early Labor:

Bloody Show: Passage of blood tinged mucous, pink or red

Leaking amniotic fluid: Could be a slow leak or a sudden gush.

Contractions: Often are not progressing but they are regular and patterned. They may come and go if labor is stalling.

Early Labor:

Early labor can last a long time. pace yourself through it, relax as much as you can. exhausting yourself during early labor can make labors drag on longer and make your need for an epidural more likely. Don’t rush it! Baby is coming and he/she needs you rested.

Tips for Partners In Early Labor

  If labor begins at night, suggest she drink a big glass of water and take a warm, relaxing bath, then help her go back to sleep with a massage.

  If labor begins during the day, take her to a place you both love where you can get used to labor together. Alternate walking or other activity and napping throughout the day.

  You both should sleep every chance you get – there may not be another opportunity to sleep for a long time. Play music that helps her relax or massage her scalp, shoulders or back

  Help her to remember to drink plenty of water or juice and to eat as long as possible; prepare (or buy) her favorite foods.

  • Wear something she likes, and keep in close, relaxed physical contact with her.
  • Take responsibility for making arrangements (pet or child care, phone calls, etc.) so she has nothing to think about except being in labor.

  Play cards or watch a movie or TV with her.

  • Run her a bath or shower. Light some candles.
  • Pour water over her back or belly.

Sure Active Labor Signs:

– Progressive contractions: becoming longer, stronger, and closer together. Felt in the back, abdomen, or both.

-Gush of amniotic fluid: Often followed by pushing contractions.

– Wether she has been laboring for a long or short time as labor intensifies it becomes harder to follow the relaxation techniques or to breath as she practiced.

Tips for Partners in Active and Latent Labor

– Remind her to relax and focus.

– Make her tea or broth to drink and remind her to eat small meals or snacks, especially before leaving for the hospital.

– As labor progresses, help her relax by encouraging her to let her body “go limp,” and stroke her gently to reassure her.

  • Synchronize your breathing with hers if she starts to panic.
  • Don’t be embarrassed to use common endearments with your doula, caregiver or nursing staff around; she needs to hear them from you!

– In transition, speak tenderly to her between contractions, and maintain eye contact during contractions.

– Once she is pushing, get your body close to her somehow so she feels your support and reinforcement. Support her head while she pushes by putting your hand or arm under her pillow.

– Let her know when you can see the baby’s head, and help her if she wants to reach down and touch it.

– Tell her you love her, especially after the baby is born.

It is best to practice all of these breathing techniques before labor begins! Added benefit would be practicing them while resting or listening to a meditation track.

Focused Relaxation Breathing: Slowly inhale through your nose and pause before slowly exhaling. Each time you exhale focus on relaxing a different part of your body.

Contraction Breathing: Deep breath as a contraction builds, this signals your birthing partners that a contraction is coming, reminds you to carry out focused breathing through each contraction. Then do the same thing at the end of a contraction. It can be a way to blow away last of the contraction.

J-Breathing: Begin each contraction with two deep breaths- Exhale slowly during bearing down or breathing down. Picture your breath moving down your body in a j-shape. 

Breathing Baby Down: Inhale deeply through the nose and exhale slowly through pursed lips. Relax your bottom and push down. Keep your abdominal muscles tight around your baby as you take another breath. You may find yourself making throaty sounds. Repeat these steps as long as the contraction lasts

Good breathing brings extra oxygen to you and your baby. Avoid holding your breath at any point during labor but especially while pushing. Discuss any desires you have for breathing during pushing with your provider. Breath holding pushing is still a common practice in hospitals and sometimes necessary if you have an epidural

Helpful Acronym: H.E.L.P.

Hydration: Offer juice, water, ice, popsicles, after each contraction. Explore any and all elements of hydration, sometimes alternating methods, something like watermelon, or cucumbers, grapes etc., can help break monotony.

Endearment: Tell her you love her, are proud of her, that she’s amazing, and beautiful. A woman In labor is very susceptible. If told she is doing badly or not told she is doing well she will take it to heart. Even playful teasing that is foundational in your relationship outside of labor can be a roadblock in labor. Talk with her beforehand and make a plan for how you might interact during labor. Use the affirmations she and/or you both created during pregnancy to help keep her spirits up!

Lighting: Find all the lights soon after arriving at the hospital. Feel free to ask the nurse for help. Keep lights dimmed whenever possible. Anything harsh or bright in the environment can be grating to a woman in labor. But be mindful of the entire environment as well; such as pillows, visitors, adjusting her gown when needed, or even something like her underwear lying on the floor. Try to think like a mom 😉

Protect: Advocate for your partner. Don’t expect her to make all the decisions or listen to everything that your care provider is saying. Help her understand and help her process what you both want to do. Use the B.R.A.I.N steps with her when making decisions. 

Sounds: Help eliminate any annoying or loud noises. Maybe ask if you can adjust the heartbeat monitor to louder or softer depending on what you need. Ask in advance what music she would like and help keep it playing at a comfortable volume. Remind visitors and/or staff to be quiet if needed.

One way you can do all of these things is by talking with your spouse about hiring a doula. A doula can help make all of these steps much easier to help you focus on the Endearment step to the fullest.

 

First become aware of how to properly perform a Kegel, it’s very likely you’ve been told how to do them wrong!

How to perform a proper Kegel:

Method 1: Wash your hands and then place two fingers inside your vagina and tighten the muscles around the fingers. This may take a few tries but it can be very effective in helping you identify your pelvic floor muscles.

Method 2: (This one is way more fun!) Practice Kegels while engaging in penetrating sex with your partner. Again this method can take a few times to get it right but with practice can be very effective! It also will aid in your orgasm and will likely increase the pleasure for your husband as well!

Once you find the muscles and practice flexing them doing Kegels anywhere you are becomes a breeze! How often you do them greatly depends on you and your needs. Truthfully if you do at least one you are better off than doing none. The more you can do them the better it will be for your health (within reason)

Ideally get into a system that fits for you doing them once or twice a day for 5 minutes at a time sessions. Within each session tighten and hold your pelvic floor muscles for 3-5 seconds at a time 5-10 times a session.

Biggest thing is to not feel intimidated but to jump in! Even if you only do them while your having sex it’s still a huge benefit!

Now that you’ve learned how to properly do a Kegel you can properly practice reverse Kegels. Sometimes we subconsciously hold tension in our pelvic floor. Especially after giving birth when the possibility of peeing yourself seems to always be lurking. 

Next time you are sitting comfortably or on a toilet may be even better consciously release your pelvic muscles. Sometimes this is easier if you do a Kegel and then release it. A helpful image is often a blooming flower. Imagine the heart of the bud at the heart of your vagina where your cervix is. (Exploring your vagina and feeling for your cervix can be helpful). Then picture that bud opening and unfurling completely. 

Doing this in active labor can help relax your pelvic floor muscles. It is NOT PUSHING. It is relaxing your body and giving it permission to bring your baby down.

Patient or partner administered perineal massage during the last 4 or 5 weeks of pregnancy reduces the number of episiotomies by about 15% (Cochrane Library).

-The benefit is strongest for women delivering vaginally for the first time, although the number of women with prior vaginal deliveries was small in comparison and, thus, may have been statistically underpowered to demonstrate a benefit.

Source: Cochrane Library , Evidence Based Birth

When you go to your birthing place is completely up to you! Your plan for when you want to leave for your birthing place should be discussed with your provider. The below recommendations are a minimum, you can labor past this criteria. And of course leave if at any point you become concerned that something is wrong. The average length of labor is 18-24 hours.

1. When Contractions are consistently 4 minutes apart, lasting more than 1 minute, for 1 hour or more. (The 4-1-1 Rule)

2. If the contractions are too strong for you to speak through.

3. If you don’t feel the baby moving during a contraction.

4. Check your purple line for dilation rate. The best time to be heading to the place of birth is usually around 6 cms when your purple line is about half way. ( More on the purple line below)

These are the favorites among laboring mother’s. 

Exactly where you press will vary slightly so let the support person explore. 

Most often for counter pressure you press right above the tailbone, at the rhombus of Michaelis point.

With Hip squeezes you find the meaty portion of the butt and press inward, again this will vary slightly person to person.

Activity: Practice hip squeezes and counter pressure

Video 17: Body Language of Labor/Water and Birth

In this video we will talk about different ways that the laboring mother’s body communicates during labor and birth and the benefits of water elements in labor and birth

 

Section 8: Options in Birth

Some hospitals/birthing centers will have some of these tools but definitely not all! So make your list and ask your provider what will be available or not so you can plan accordingly.

– Birthing Ball

– Tub

– Stress balls/ reflexology tools

– Soft scarf

– Rice sock

– Hair brush

– Focal points/ affirmation cards

– Lip balm

– Breath mints

– Music

– Battery operated tea lights

– Massage tools

– Hand fan

– Lotion/ massage oils

Upright positions:

25% less likely to use a vacuum or forceps

25% less likely to have an episiotomy

54% less likely to have abnormal heart rate patterns

75% experienced less pain

Ultimately no specific position is statistically proven to be safest. The important aspect is to be flexible and to not place a lot of unneeded pressure on your sacrum.

  • Showering: Can bring relief to sore muscles, give a feeling of refreshment, can distract from the intensity of the contractions, encourages you to be upright, oils or herbs can be diffused in the water, lessens anxiety, aids relaxation, increases oxytocin.
  • Soaking in a tub: Can help soften perennial area as well as sooth the area, bring relief to sore muscles, give a feeling of refreshment, can distract from the intensity of the contractions, encourages you to be upright, oils or herbs can be diffused in the water, lessens anxiety, helps aid in relaxation, increases oxytocin.
  • Soaking feet: Can bring relief to sore feet, encourages you to be upright, oils or herbs can be diffused in the water, lessens anxiety, aids relaxation, increases oxytocin.
  • Warm or cool compresses: Help warm or cool mother, aids in relaxation, can be placed over eyes to keep bright lights out, can ease headaches.

Source: Evidence Based Birth  

Video 18: Cervical Checks

“Studies also show that vaginal exams are not really accurate. When checking for exact dilation, studies show the accuracy to be around 48-56% . When allowing a margin of  1 cm (which is a large margin of error when this information is used to time interventions or labor “cut-offs”) the accuracy is around 89-91%.” – Birth Without Fear

Cervical checks while pregnant likely have little to no value. They increase your risk of infection and premature labor. And if you are dilated it can give you false hope or worse, discouragement. And even if the exam shows that you are dilated it doesn’t really mean anything when you are not in labor. A woman can be at 2-6 cms for days or even weeks before labor begins.

Cervical checks during labor are also a double edged sword in labor. If you are checked and you have progressed it can give you encouragement to know that you are making progress. But if you haven’t progressed as far as you thought or hoped then you can get discouraged. And when a mother is discouraged in labor she is more likely to have a slow progression in labor and more likely to choose interventions.

When it comes to cervical checks discuss risks and benefits with your provider, partner, and your doula if you have one. 

Source: Evidence Based Birth , Birth Without Fear , National Center for Biotechnology Information 

There are two amazing alternative options to cervical checks! They are more accurate and reduce the risks of discouragement and infections. Check out the video below for more details!
  • Purple Line:

-A study showed that the purple line appeared in 75.3% of women during the active phase of labor and appearance of the purple line in the prediction of labor progress had 90.2% sensitivity

  • Rhombus of Michaelis:

– Appears at the beginning of the 2nd stage of labor (fully dilated and ready to push)

– Mother’s head will role back, and reach hands upward.

– Always appears and is a natural sign of the final stages of labor

Source: Evidence Based Birth , Birth Without Fear , National Center for Biotechnology Information , Human Birth Project , Birthworks International 

Talk through these possible scenarios with your partner about what you might consider doing in those circumstances. This is not a test, there are no right or wrong answers, it’s just good practice and can help bring you and your partner to the same page.

Birth Options Practice Scenarios

– You’ve Decided to have an Epidural. 5 Hours after the administration it stops working, even after the anesthesiologist adjusts the catheter and also increases the dosage.

– You are having twins. One twin is head down. You are told you must have an epidural and be prepared for a C-section

– You labor is going faster than you anticipated. You arrive at the hospital at 8 cm. They tell you it’s too late to have an epidural but you planned to have one.

– Your doctor tells you  at a prenatal visit “Things like birth plans keep me from doing my job.”

– You’ve been experiencing a tremendous backache in labor. The nurse tells you that the baby is posterior (sunny side up)

– You’ve been practicing for week on the breathing, relaxation and Comfort Techniques. You didn’t plan to use any medication. You’re in labor, 4 cm, in a lot of pain it’s harder than you thought it was going to be.

– You really desire to have a natural birth. The hospital you are giving birth at has a 75% c-section rate.

– You are at 6 cm and coping well, even though it is hard. The doctor suggests pitocin to speed up the labor.

– At 33 weeks your doctor informs you that your baby measures big and will likely be close to 8.5 lbs. The doctor advises you to schedule a c-section to ensure a safe birth.

 – You have been in labor for ten hours, you are at 5 cms and you feel good about how you are handling the contractions. You are asked if you would like your water broken to speed up labor.

– Your labor is going slower than you expected, you are very tired and at 3-4 cms.

– you are 1 day past your due date, your doctor says because baby is measuring big he “will not let you go more than a week past your due date” and that we need to schedule a c-section.

– Your doctor performs a vaginal exam at a routine appointment at 39 weeks. Over the next hour you notice bleeding and cramping. You call to inform your doctor and he says that he stripped your membranes and that your symptoms are normal.

 

Activity: Go over these scenarios with your birthing team

Video 19: Directed Vs. Spontaneous Pushing: 

  • Directed Pushing (Purple Pushing): Doctor, Midwife, or Nurse will direct you through pushing, usually this means holding your breath as you bear down for the count of ten repeatedly until the contraction subsides and you rest.
  • Spontaneous Pushing: Self guided and is in response to the body’s natural urge to push (fetal ejection response), does not necessarily correspond to a held breath, but is often on the breath, or short holds on the breath or with sound. Usually comes not long after 10 cms is reached.
  • Directed Pushing: Can reduce pushing time (10-15 minutes), causes you to push sooner in the contraction than you would naturally. increases the likelihood of tearing, could lead to bladder problems, can have smaller bladder capacity postpartum, pelvic floor problems, can cause baby to become more tired and could lead to distress, reduces oxygen to the mother and baby.
  • Spontaneous Pushing: Less stressful on your baby, lessens the likelihood of tearing, less likely to develop pelvic floor issues, is harder to do if you have an epidural because you may not feel the urge to push.

All of these are not likely to be long term problems so the mother should do what feels more comfortable to her and best for her situation.

Source: WHO, AIMS, Medical Journals, Evidence Based Birth , Cochrane Library    

 

Section 9: Postpartum

In this section we will talk about the options you will have from the fourth stage of labor (delivery of the placenta) through the first few days of your baby’s life. We will also cover some elements of the fourth trimester (your first 3-4 months after baby is born). 

Video 20: Postpartum Options

This video covers options you will have for your healthcare immediately after birth through the first few days of baby’s life. 

Postpartum Pitcoin is administered to prevent or stop postpartum hemorrhaging. It is considered standard of care in some hospital births, some have it as an optional preventative measure, still others use it only if there is specific indication for its use. For instance if you have a history of postpartum hemorrhage or if you are hemorrhaging in the moment. You always have the right to choose active management of the fourth stage of labor or physiological delivery of the placenta without Pitocin. 

– Around 3-5% of all births in the United States experience Postpartum hemorrhage.

– Early postpartum hemorrhage is at least 1,000 mL total blood loss or loss of blood coinciding with signs and symptoms of hypovolemia within 24 hours after delivery of the fetus (The American College of Obstetricians and Gynecologists)

– Hemorrhage can occur even with no risk factors.

– Potential complications of Postpartum hemorrhage: Anemia, Anterior pituitary ischemia with delay or failure of lactation (i.e., Sheehan syndrome or postpartum pituitary necrosis), Blood transfusion, Death, Dilutional coagulopathy, Fatigue, Myocardial ischemia, Orthostatic hypotension, Postpartum depression.

– There is not enough data yet to determine if having routine postpartum chemical oxytocin for every mother is worthwhile, but there is some evidence that it does protect mothers against hemorrhage.

– Keep in mind that Pitocin also carries risks as mentioned above. Weighing the risks and benefits of your specific circumstances with your care provider is a good course of action. 

Source: Evidence Based Birth, Medical Journals   

Delaying cord clamping is not standard of care in most hospitals yet. But the evidence of the benefits is well established.

Benefits to Baby:

-Waiting at least two minutes allows precious red and white blood cells to be transferred to the infant from the placenta (Hutton, Journal of the American Medical Association)

– Can also protect against anemia and irregular breathing for weeks and months after delivery.

– Increases iron stores and the number of red blood cells

– Increases white blood cells, which contributes to immunity.

Risks:

– Baby’s who have had delayed cord clamping have a slightly higher risk of jaundice. But there is some debate on if this is actually a good thing or a symptom of a good thing that may protect baby’s later in life. (Breastfed baby’s also have higher instances of jaundice). Jaundice is also easy to treat and overall common anyway.

 

Here is a series of helpful videos

Source: Evidence Based Birth     

Procedure:

Baby is placed on his back in a holding device with his arms and legs restrained, Skin around the penis is cleaned and pain medication is applied locally as a cream or injection, the prepuce is pulled out past the glans penis, a surgical tool is used to “sweep” around the prepuce and his glans to separate the shared membrane, the provider then either uses one of two clamps to remove the prepuce or instal a ring device to cut off circulation to the prepuce (which will eventually fall off days to a week later with the prepuce), the procedure takes about 15-30 minutes.

Risks and Benefits:

Sexual Difficulties: no statistical significant impact on premature ejaculation or difficulty in orgasming.

Complications: Less than 0.2-1.3% of cases. Pain, bleeding, swelling(1% of cases), and cosmetic concerns about the amount of removed skin, re-operation, UTI’s (7.3% in circumcised 0.3% in intact infants)

Serious Complications: 1-2% of cases. Severe infection requiring antibiotics or excess scar tissue.

Penile Cancer: Circumcision offers some protection against penile cancer.

Meatal Stenosis: (when the opening of the urethra becomes abnormally narrow) 7-20% in circumcised males.

Herpes Simplex Virus (HSV): Circumcision could lower risk by 30%.

Human Papilloma Virus (HPV): No significant difference.

Human Immunodeficiency Virus (HIV): 54% less likely to contract if circumcised.

Research: Limited and sometimes biased. A lot of the research is done in poorer countries which may not have as good healthcare or effective hygiene practices.

Summary: Ultimately the evidence is pretty even on both sides for risks and benefits and this is a personal decision.

Source: Evidence Based Birth , WHONIH   

Benefits of Erythromycin Eye Ointment:

– Has been shown to help protect against newborn pink eye from gonorrhea

– May offer some protection against less serious types of newborn pink eye from chlamydia and other bacteria picked up in the hospital and home environment, like staph.

– Helps protect the baby if the mother has a sexually transmitted infection.

Erythromycin is 80% effective at preventing newborn pink eye from gonorrhea.

 

Risks of Erythromycin Eye Ointment:

– Eye irritation, called chemical pink eye, can occur.

– Blurred vision could interfere with bonding by disrupting early eye gazing between the baby and parents

– While Erythromycin is 80% effective at preventing newborn pink eye from gonorrhea but is probably less effective now due to growing bacterial resistance

– Group B Strep bacteria are becoming resistant to erythromycin, and there are also signs of resistance among staph bacteria

– The pregnant person can be screened for chlamydia and gonorrhea and treated for a positive test result with antibiotics, along with the sexual partner(s)

 

Alternatives:

– Eye drops of the mother’s first milk have been shown to reduce newborn pink eye from staph bacteria.

– The mother could follow a wait-and-see approach, in which antibiotics are used only when necessary to treat an infection. Parents who decline eye ointment should seek immediate treatment for pus-producing pink eye.

Source: Evidence Based Birth   

Pros of the Vitamin K shot:

– Highly effective at preventing classical and late VKDB

– Vitamin K is slowly released over time from the injection site, which provides enough Vitamin K1 until the baby’s Vitamin K levels reach adult levels naturally.

 

Cons of the Vitamin K shot:

– Causes pain

– Can cause bleeding or bruising at the injection site.

– If the baby has undetected gallbladder or liver disease, the shot still may not protect them from VKDB. Being aware of symptoms to be mindful of can help keep baby safe.

– The baby’s natural stores of vitamin K boost around the 8th day after birth.

Pros of oral Vitamin K:

– Easy to give and not invasive (pain-free)

– The 3-dose regimen of 2 mg Vitamin K1 lowers the risk of classical and late VKDB to under 1 per 100,000, but is probably still not as effective as the injection, which has incidence rates even closer to zero.

– The weekly regimen seems to protect infants with undiagnosed gallbladder problems just as well as the shot does. The 3-dose regimen of 2 mg Vitamin K1 has not been tested yet in this high-risk group.

Cons of oral Vitamin K: 

– Some babies may not be able to absorb it (e.g., diarrheal illness may reduce absorption), or they may spit it up

– If the baby has undetected gallbladder or liver disease, a 3-dose regimen of oral Vitamin K may not protect them as well as the shot

– The 3-dose regimen of 1 mg oral Vitamin K1 is less effective than the shot at preventing late VKDB; data from some countries suggest the 3-dose regimen of 2 mg oral Vitamin K1 is also less effective than the shot, although it’s possible that there is not a significant difference between these two options in their ability to prevent late VKDB (Mihatsch et al. 2016).

– Requires that parents commit to giving at least three doses or weekly doses

Source: Evidence Based Birth   

Acute hepatitis B virus infection:

– A short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis B virus.

Symptoms:

– Fever, fatigue, loss of appetite, nausea, and/or vomiting

– Jaundice (yellow skin or eyes, dark urine, clay-colored bowel movements)

– Pain in muscles, joints, and stomach.

Hepatits Injection:

– Given directly after birth, at 1-2 months, and at 6-18 months.

– According to the CDC, everyone needs it.

   No significant difference in the proportion of HBV neonates dying of unexpected causes. (31% vacinated and 35% unvaccinated).

– There were no significant differences between vaccinated and unvaccinated newborns in the proportion of infants who received care for fever. (0.8% vaccinated and 1.1% unvaccinated)

Risks of the injection:

– Soreness, fever, and/or allergic reaction.

– Associated with only mild reactions.

Benefits:

– 75-95% effective at preventing the passage of the disease from mother to baby.

– Drops infection by the disease later in life to 0.7% and 1.1%.

Alternatives:

– This vaccine, like all vaccines, can be delayed.

Source: Science based Medicine    

 Why should you delay the first bath?

– Vernix caseosa, the waxy coating on newborns’ skin, is a natural moisturizer and cleanser, and protects against infection.

– Babies are not good at regulating their temperature, their vernix coating help this.

– Babies are not born dirty.

– Improves breastfeeding rates.

When should be bathe our baby?

– At least 24 hours after birth (WHO reccomends), others suggest the minimum should be 48 hours.

– Some suggest after the umbilical cord is healed.

– As long as a few days or even a few weeks after birth.

– Try only wiping your baby’s face, hands, hair, and private areas with a warm cloth for the first few days or weeks. (Anything that comes in contact with strangers or potential germ sources.

Source: WHO    

A new baby will always be an adjustment. Take each day as it comes, but here are a few things you can do to help make the transition a little easier.

– Involve your child in the discussion early on.

– Visit friends with a new baby.

 – Make sure your child knows about the pregnancy before others, and later on the gender as well. 

– Make any adjusted sleeping arrangements in advance.

– Check with your hospital about tours you can take them on.

– Invite your child to prenatal visits to meet your birth attendant.

– Give them a realistic idea of what to expect of life with a baby.

– Read books about pregnancy, birth, newborns, home birth, etc.

– Give them a chance to ask questions, voice concerns, and vent.

– Look at pictures/video of your older child’s birth and babyhood.

– Have your child practice holding and caring for a doll. Even changing diapers and rocking to sleep.

 

If you would like to have any older siblings attend the birth:

– keep in mind that it will be different for different kids and different ages. 

– Set realistic expectations for how much or how little they can be involved. 

– Give them an age appropriate task so that they can feel connected with the process.

– Birth is not as weighty to young children as it is to adults. They usually won’t understand elements like intense pain, fears or concerns. They will only know what they can see and feel from you.

– Find age appropriate birth videos to watch with your child to help prepare them.

– Keep the plan flexible. If the child is not handling being in the labor space well, or is adding stress to you, have a back up sitter come take them and bring them back later.

Check out this video I did for a family who had their 9 year old daughter at their birth.

Overall be conscious of your body and your health. Ultimately no matter how you feel after birth you should not feel like you are completely miserable or suffering and you should feel a measurable amount better every day. 

– Passage of blood larger than a lemon.

– Heavy bleeding that soaks a maxi pad in an hour.

– Fever of 100.4 or higher.

– Problems with urination: Burning, blood in urine, inability to urinate.

– Very foul or fish-like oder or vaginal discharge.

– Increased pain at site of episiotomy or tear.

– Swollen, red, hot, painful area on the leg especially the calf.

– Sore, reddened, hot, painful are on breast, along with flu like symptoms.

Video 21: Postpartum Depression

In this video we will cover postpartum depression from risk factors, warning signs, prevention, to getting help if it develops.

Postpartum Depression can look different for each person. But if you have any one of the following it is best to contact your care provider. Early diagnosis can help prevent you from prolonged effects.

Postpartum Depression Symptoms:

– Depressed mood or severe mood swings                            

– Difficulty bonding with your baby                                                 

– Withdrawing from family and friends

– Excessive crying

– Loss of appetite or eating much more than usual

– Inability to sleep

– sleeping too much

– Overwhelming fatigue

– Reduced interest and pleasure in activities

– Intense irritability/anger

– Fear that you’re not a good mother

– Hopelessness

– Feelings of worthlessness, shame, guilt or inadequacy

-Restlessness

– Diminished ability to concentrate or make decisions

– Severe anxiety/panic attacks

– Thoughts of harming yourself or your baby

– Thoughts of death/ suicide

Symptoms of Postpartum Psychosis:

– Delusions or strange beliefs
– Hallucinations (seeing or hearing things that aren’t there)
– Feeling very irritated
– Hyperactivity
– Decreased need for or inability to sleep
– Paranoia and suspiciousness
– Rapid mood swings
– Difficulty communicating at times

*It is important that you and your family is aware of all of these symptoms for both PPD and PPS so that they can be watching you as well. 

When to see a doctor:

– If feelings don’t fade after a couple of weeks

– Are getting worse, making it hard to care for baby

– Make it hard to complete everyday tasks

– Include thoughts of harming yourself or your baby.

Suicide Prevention Hotline: 1-800-273-8255 (TALK)

Source: Mayo Clinic    

Your risk factors increase your chances of having postpartum depression but nothing will make it happen for sure. The best thing you can do is to care for your health and be mindful of your state of mind. Caring for you physically, emotionally, spiritually, and mentally is caring for your baby too.

– Exercise when you can.

– Maintain a healthy diet.

– Make time to rest.

– Add fish oils to your diet. The vitamins are a great option if you don’t like to eat fish.

– Resist isolation. Join a support group or find a place to make mom friends that you can share experiences with.

– Create time for yourself. Even if it’s just a few moments each day.

– Communicate with your care provider in advance to create a plan.

– Complete the postpartum depression questionnaire and keep in mind the questions on it occasionally (you will likely be given it by your care provider)

– Be aware of yourself and your needs.

– Get help from families and friends before, during, and after birth so that you can be more at peace.

– Choose a natural healthy childbirth to avoid birth trauma.

– Hire a birth or postpartum doula.

 – Breastfeed.

– Find a care provider and birth setting that are supportive of your desires for your birth.

You will likely receive a similar quiz at the hospital when you deliver and perhaps later as well. But having these questions on hand to help you continually evaluate your emotions can be a benefit.

1. Have you been able to laugh and see the funny side of things as you usually do?

2. Have you been able to enjoy things as much as you used to?3. Have you been blaming yourself unnecessarily when things go wrong?

4. Have you been anxious or worried for no good reason?

5. Have you felt scared or panicked for no good reason?

6. Have you been feeling overwhelmed?

7. Have you had difficulty sleeping even when the baby is asleep and the house is quiet?

8. Have you felt sad or miserable?

9. Have you been so unhappy that you’ve been crying?

10. Have you thought of harming yourself or your baby?

Section 10: Breastfeeding

In this section we will cover initiating breastfeeding, helpful tips, benefits of breastfeeding to mother and baby, common breastfeeding ailments, and helpful breastfeeding remedies.

Video 22: Breastfeeding

In this video we will cover initiating, latching, baby’s reflexes and instincts, positioning, getting the support and resources you need, common struggles, and how long to breastfeed.

Breastfeeding Protects  Baby against:

– Food allergies

– Postpartum depression

– Ear infections

– Diarrhea/vomiting

– Respiratory problems

– SIDS

– Speech issues

– Crohn’s Disease

– Ulcerative colitis

– Both tips of diabetes

– Heart Disease

– Obesity

– Osteoporosis

– colds, viruses, staph infections, strep

– E-coli infections

– Some Cancers.

Source: La Leche League International   

Breastfeeding Helps Protects Mother Against

– Postpartum hemorrhage

– Osteoporosis

– Iron deficiency anemia

– Rheumatoid arthritis

– Anxiety

– Postpartum depression

– Delays menstruation

– Helps naturally space out pregnancies.

Breastfeeding also:

– Exclusive breastfeeding turns off the stress response,

– Breastfeeding resets the mother’s metabolism to pre-pregnancy levels.

– Exclusive breastfeeding increases both the quality and quantity of mother’s sleep.

– Breastmilk is specifically designed for each baby and adjusts to baby’s needs as baby’s needs change or gets sick.

– Can provide pain relief to baby

*Breastfeeding is more likely to be successful when it is a village effort. Don’t be afraid to ask for help. Partners can still bond with baby through playtime, bath time, naps, baby massage, and more! 

Source: La Leche League International    

Breastfeeding is awesome but can be a struggle sometimes! Always reach out to a lactation consultant or La Leche League leader for help! 

Sore nipples: Correct your positioning, check latch, break suction before removing baby from breast, offer least sore nipple first, don’t use soap on nipples, put breastmilk on nipple, use nipple balm, Salt water rinse, change nursing pads frequently, cool moist compress.

Sore breasts: Continue breastfeeding, moist heat, increase fluids, gently massage sore areas. (Consult a physician if a fever or other flue like symptoms occur).

Clogged ducts: Moist heat, hot shower or bath, soak breasts in warm epsom salts, change breastfeeding positions, breastfeed on all fours so gravity can help, massage the clog gently starting above clog and working down towards nipple, do not pinch or pop the clog, wear loose fitting clothing and bras.

Baby won’t latch: Spend as much time as you can doing skin to skin. Talking to a lactation consultant is very important early on to identify any problems you may have with positioning or latch. Until then this video can help you work on it on your own.

Baby keeps falling asleep while breastfeeding: This is very common and not all bad. Baby feels comfy and cozy! If you suspect that your baby is falling asleep before completely full try uncovering baby to let some room temp air get on their skin, tickle baby’s feet periodically, stroke baby under their chin to help keep them away, and/or compress your breast occasionally to give baby a good mouth full.

Latching Hurts: It is likely to be tender or sore the first few days as your body adjusts to the new activity. But it should not be extremely painful and should be getting better every day. Check your latch and positioning.

*I am going to be adding more to this section of the course soon! I am also going to be creating an online Breastfeeding course soon!

 

Activity: Find a local or online breastfeeding support group or La Leche League International Group to join.

No matter what your breastfeeding issue is these tips will always help alongside other necessary steps.

1. Skin to Skin: This helps release oxytocin in both you and your baby’s bodies. Oxytocin promotes healing, pain relief, and lactation.

2. Keep breastfeeding: The best thing to help encourage your baby to breastfeed, help cure any ailment you or baby might have during breastfeeding, or to help with low supply continuing to breastfeed will be helpful along with other healing techniques.

3. Quiting breastfeeding does not make you a bad mom no matter when it happens! Everybody weans!

4. If you are committed to breastfeeding then nothing is an end to your breastfeeding journey but a challenge to overcome. I highly recommend this book!

Section 11: Summary

In this section we will summarize important things that we learned!

Video 23: Summary

– Overall good health and fitness of both mother and baby.

– Feeling confident in your birth knowledge before and after your delivery.

– Knowing your rights so you can advocate for yourself both during and after your delivery.

– Have providers and care settings that support your decisions.

 

Source: Childbirth Connection   

– Stay healthy

– B.R.A.I.N: Benefits, Risks, Alternatives, Intuition, and Nothing

– Don’t make decisions out of fear

– Ignore signs of labor as long as possible.

– When you walk through the doors of your place of birth you don’t magically stop being human or a parent. You are not ill, you are not incompetent. You are a parent, not a patient.

– Suffering is not a normal condition of labor, birth, postpartum, or breastfeeding.

– You should feel better every day after delivery not the same or worse.

Thank you so much for taking this course, I am so honored that you would bring me on your journey!

Keep an eye out on my page and this course because I will be continuing to improve and add more helpful information! You will receive updates to the e-mail you signed up for the course under when I add or remove content from the course. You can unsubscribe anytime!

Please fill out the course evaluation below so I can continue to improve!

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