"Cynthya was our doula for the birth of our third child in April 2016. As this was my third birth, and I had been attended to by a doula at the first two, I knew that finding the right doula was crucial to a successful and satisfying birth." - Winter Wheeler-Young
Essential Items for Baby and Which to Ditch
Check out our list of must-have essential items to get your nursery stocked and ready for your little bundle(s) of joy!
Having a baby is such an exciting time but we know it can also be overwhelming with so many choices to make during pregnancy. When considering which items to add to your gift registry, the baby aisles may seem enormous and have you wondering which items are really necessary to get. Check out our list of must-have essential items to get your nursery stocked and ready for your little bundle(s) of joy! For a more detailed list of "less major" items, check out our BabyList Registry.
4 Things You Can Do Without
Wipes warmer. Having your baby get used to warm wipes at home won’t do much good when you're out and about and all you have are cold wipes.
Bottle sterilizer. Hot soap and water or running the bottles through the dishwasher kills the germs just as well.
Portable swing. Unless you travel a lot and want an easy swing to take along, this really isn’t necessary.
Stuffed animal with womb sounds. These are much too quiet for baby.
12 Must-Have Baby Items
Pack n Play / Crib / Bassinet or rent or buy a SNOO (they have cribs too)
Swaddle blankets or Swaddle Me wraps; Halo and Sleepea are good choices too. Get a variety of brands/kinds to try out.
Conair white noise sound machine; read why here
Tommee Tippee bottles or try biomimetic bottles (and pump adapters) from Emulait
MAM pacifiers or ones from Emulait
We recommend creating only ONE online gift registry to include all the items you wish to receive. Add our Gift Card link to be gifted any dollar amount toward the purchase of doula services and childbirth classes. How cool is that?!
You can review our listing of suggested items that may aid your postpartum recovery.
When Childbirth Moved Into Hospitals Labor Support Was Left Behind
The 2013 Cochrane Review concluded that all women should have continuous support during labor, and further state that the services of a person, such as a doula, with some training, who is experienced in providing labor support, is the most beneficial.
Part 4 of 7, written by Christina Thomson, Certified Birth Doula and Lamaze Childbirth Educator
Healthy Birth Practice #3: Bring a loved one, friend, or Doula for continuous support.
As humans, we do better when we’re surrounded by those we love and trust, with people who are positive and encouraging. Historically, women were helping other women as they labored and gave birth. Since most births were happening in the home with a local midwife delivering the baby, the laboring mother took comfort and support from her female relatives or close friends.
As we moved away from home births and into hospitals, this tradition wasn't as common. Your support person became your doctor or nurse. In modern hospitals, however, it is difficult for staff to offer the continuous support that you need during labor and delivery. According to the Journal of Obstetric, Gynecologic, and Neonatal Nursing, women expect their labor nurses to provide information, comfort, and support, but research shows less than 5 percent of a nurse's time is spent doing that.
Credit Lamaze International
What does good labor support look like?
According to The Official Lamaze Guide, it's “making sure you are not disturbed, respecting the time that labor takes, and reminding you that you know how to birth your baby.” Your support person “should spin a cocoon around you while you're in labor – create a space where you feel safe and secure and do the hard work of labor without worry.” Good labor support might include: helping you change positions or move around, offering words of encouragement, reminding you to eat or drink, and offering you cold cloths if you are hot. “Good labor support tries to respond to all your physical and emotional needs throughout labor.”
The 2013 Cochrane Review finds that women who received continuous labor support had the following positive outcomes: more spontaneous vaginal births, fewer cesarean surgeries or instrumental vaginal births, less use of epidurals and other pain medications, slightly shorter labors, and greater satisfaction with their birth experiences. Babies of these mothers were less likely to have low Apgar scores at birth. They conclude that all women should have continuous support during labor, and further state that the services of a person, such as a doula, with some training, who is experienced in providing labor support, is the most beneficial.
“The doula’s presence allows your birth partner to participate in the birth in a way that is meaningful to them.”
In Penny Simkin's book, The Birth Partner, a birth doula “guides and supports women and their partners continuously through labor and birth.” According to Lamaze International, a doula is “trained to provide continuous physical, emotional, and informational support to a mother before, during, and just after she gives birth.” A doula isn't going to replace your birth partner.
In fact, the doula’s presence allows your birth partner to participate in the birth in a way that is meaningful to them. If your partner wants to be more active in supporting you, your doula can gently remind them about techniques they learned in your childbirth class, assist them in physically supporting you, and model ways to provide emotional support. If partners prefer to let the doula be the primary support person, the doula can take the lead and help partners to participate in the birth to their level of comfort, while ensuring that the mother’s needs are met. The doula may even give the partner a break to go to the bathroom or to get something to eat.
The true value of having a doula is that a doula knows birth. She brings a quiet confidence in the process of birth, which allows you and your support team to relax and find strength as you do the hard work of meeting your baby. Research has shown doulas to be so effective that neonatologist and researcher John Kennell says, “If a doula were a drug, it would be unethical not to use it.”
Continuous labor support is an essential component of safe, healthy care during labor and birth. All women should be allowed and encouraged to bring a loved one, friend, or doula to their birth.
In both Atlanta and Tampa, we teach an "intensive" preparation for childbirth - the 3 Hour Labor Lesson. You can schedule a private prenatal lesson here. Registration includes weekly follow-up emails to further learning, and access to our online Learning Center where you may watch videos, review current evidence, and download sample birth plans. This is an excellent opportunity for you and your birth partner to gain knowledge on healthy birth practices to help you have the safest birth for you and your baby.
This post is part 4 of a 7 part series written by our team of Lamaze Childbirth Educators. Stay tuned for upcoming posts in our series, How To Alleviate Fears and Manage Labor Pain.
Read part 2, Hormones and the Waiting Game
Read part 3, Make Labor Productive
Read part 4, When Childbirth Moved Into Hospitals
Read part 5, Avoid Routine Medical Interventions
Read part 6, Benefits of Upright and Spontaneous Pushing
Read part 7, Keep Parent and Baby Together
Related posts:
How Taking a Childbirth Class May Prevent Birth Trauma
5 Reasons to Hire a Birth Doula
6 Points For Birth Partners to Consider When Hiring a Labor Doula
5 Reasons Your Labor Nurse Cannot Be Your Doula
2023 Update: Episiotomy and C-section Rates at Atlanta and St Pete Hospitals
The following hospitals in metro Atlanta have reported their c-section and episiotomy numbers to the Leap Frog Group.
by Cynthya Dzialo, Birth Doula-Photographer, Lactation Counselor, and Owner of The Happiest Doulas
Experts agree that Cesarean Sections or c-sections, particularly among low-risk, first-time mothers, may not be necessary and can actually be risky for mother and baby. C-sections are linked to an increased risk of infections and blood clots, and many women who aren’t at higher risk for delivery complications get unnecessary c-sections.*
Various evidence-based strategies aimed at hospitals and healthcare providers can help reduce c-sections in low-risk women. Evidence shows that doula support improves birth outcomes, including a vaginal delivery with lowered risk of episiotomy and other interventions. Benefits described in randomized trials include shortened labor, decreased need for analgesia, fewer operative deliveries, and increased satisfaction with the experience of labor. Read ACOG’s approach to preventing the primary c-section here.
According to the Healthy People 2030 initiative by the U.S. Department of Health and Human Services, and Leapfrog Group’s Maternity Care Expert Panel, a hospital’s rate of first-time pregnancy (nulliparous/NTSV) c- c-section delivery should be measured against a national target of 23.6%. The World Health Organization states the international healthcare community has considered the ideal rate for c-sections to be between 10-15%.
Experts agree that episiotomies - an incision made in the perineum during childbirth - should not be done routinely and can result in worse perineal tears, loss of bladder or bowel control, and pelvic floor defects. According to Leapfrog Group, the national episiotomy rate should be 1% for all hospitals. Hospitals report on their episiotomy rate in vaginal deliveries.
To decrease perineal trauma during the second stage of labor, studies show it may be beneficial for nulliparous people to perform perineal massage in the weeks before labor begins; however, evidence is limited on the benefits and there’s no consensus on frequency or duration. Some studies showed that more frequent massage had less benefit than less frequent massage. As an alternative, there may be a benefit to applying warm compresses to the perineum during the crowning phase. More on that here.
For Leapfrog Group’s Hospital Survey, hospitals report on their rate of c-sections for first-time mothers giving birth to a single baby, at full-term, in the head-down position as well as their overall rate of episiotomy.
Reporting Period: Summer 2023
The following hospitals in metro Atlanta have reported their numbers to the Leapfrog Group. Northside Hospital in Atlanta DID NOT DISCLOSE their numbers.
Emory Decatur averages 56 babies delivered per week, with an annual c-section rate of 31.5% and an episiotomy rate of 2.4%.
Emory Midtown: annual 30.1% c-section, episiotomy 1.9%, averaged 106 weekly births
Piedmont: annual 26.5% c-section, episiotomy 3.4%, averaged 56 weekly births
North Fulton: 23.6% c-section, episiotomy 1.2%, averaged 25 weekly births
The following hospitals in St Pete / Tampa Bay region have reported their numbers to the Leapfrog Group. HCA Florida St. Petersburg Hospital has DECLINED TO RESPOND
Bayfront Health “Baby Place” averages 63 live births per week, an annual 28.8% c-section rate, and an episiotomy rate of 1.7%.
Morton Plant: annual 26.5% c-section, episiotomy 4.8%, averaged 45 weekly births.
Tampa General Hospital: annual 26.6% c-section, episiotomy 1.5%, averaged 131 weekly births.
Manatee Memorial Hospital: annual 36.7% c-section, episiotomy 4.5%, averaged 35 weekly births.
If your doctor or midwife can tell you their personal rates or the collective rate of their group, that’s great! It likely means they care about improving their patient outcomes by measuring their practice. Ask your provider.
Resources referenced:
*Text excerpts from Leap Frog Group: https://ratings.leapfroggroup.org/sites/default/files/inline-files/2021%20Maternity%20Care%20Fact%20Sheet_2.pdf
https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth/reduce-cesarean-births-among-low-risk-women-no-prior-births-mich-06
https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/
https://icea.org/wp-content/uploads/2020/01/ICEA-Position-Paper-Episiotomy-PP.pdf
Related posts:
Postpartum Expectations and Must-have Items
Avoid Routine Medical Interventions
Episiotomy, Tears, and Perineal Support
How Taking a Childbirth Class May Help Prevent Birth Trauma
You go to one baby shower and inevitably, you start to hear the worst of the worst birth stories. “Did you hear about Kim’s birth? She pushed for FOUR hours and the baby was 11 pounds. Imagine. that. tear.” Everyone squirms.
by Megan Ciampa, Birth Boot Camp Childbirth Instructor
You go to one baby shower and inevitably, you start to hear the worst of the worst birth stories. “Did you hear about Kim’s birth? She pushed for FOUR hours and the baby was 11 pounds. Imagine. that. tear.” Everyone squirms.
“Andrea had to have an emergency c-section. She was induced and the baby’s heartbeat decelerated and they needed to deliver the baby immediately. Andrea’s blood pressure dropped and it was really scary. They said she almost died.”
Or, still, even worse:
“She asked for no episiotomy but the doctor insisted and cut her right before the baby was born. She had a 4th degree tear. Healing from that was the worst. She’s afraid to have another.”
While some of these stories may sound like just another unfortunate birth story, some of them are legitimate birth trauma. There is a term, called “obstetric violence,” that, on its surface, seems implausible. Obstetricians are all about bringing new life into this world; how could one be violent?
But when abuses bring with them “loss of autonomy and the ability to decide freely about their bodies and sexuality,” there is a price women pay at the hands of their care providers [Law on the Right of Women to a Life Free of Violence, supra note 13, art. 15(13)].
We know this does not characterize all or most OBs. But in the United States, in 2018, there are still too many women who experience birth trauma and feel more like a vessel of a person delivering a baby, and not like a human themselves.
“When you do not expect to have a problem with birth and then it happens, there can be long lasting psychological scars.”
Experiences such as these can have unfortunate consequences. Of course there’s the physical pain and recovery one must heal from. There’s also psychological and emotional recovery one hopes to experience as well.
In an article for The Atlantic, Ilana Strauss recounted stories of women who experienced post-traumatic stress disorder (PTSD) after giving birth. Not to be confused with postpartum depression, postpartum PTSD can be characterized by “hyper-vigilance, intrusive memories, flashbacks, severe emotional distress, irritability, trouble sleeping, and nightmares,” as is explained by Anastasia Pollock, a therapist who specializes in treating trauma.
Strauss also explained that the theory behind women who develop postpartum PTSD is complicated, but it often has to do with expectations. When you do not expect to have a problem with birth and then it happens, there can be long lasting psychological scars.
So… what does one do? How do you appropriately create your expectations?
Aside from talking to a wide range of women who have given birth before you and hearing their experiences, another very practical thing you can do is actually quite simple: take a childbirth class!
Not all childbirth classes are created equally, so do your research on with whom you study. What all is covered? Policies and procedures of the hospital? What meds you’ll be given? It’s important to discuss who your care provider is, and what his/her track record is for vaginal vs. cesarean deliveries. It’s also important to know your hospital or birth center’s policies and statistics. Even Consumer Reports is reporting on this. Read CR's article here.
To see Florida's c-section rates from 2016 and 2015, take a look at this spreadsheet from Florida Health Finder (source linked below). Check your state’s c-section rate here.
What else would you cover in a childbirth class?
In our Birth Boot Camp series, Training for an Amazing Hospital Birth, we discuss EFM or electronic fetal monitoring, the use of IVs, frequent vaginal exams and your care provider and/or hospital’s VBAC (vaginal birth after caesarean) policies.
We look back on the history of birth in this country and how it continues to impact the birth experience today. We discuss the physical and emotional happenings of labor and arm both mom and her partner to navigate it successfully. We share the stages of labor, including pushing and what positions are helpful and how the birth partner can help.
We educate on ways to avoid a cesarean, and how to feel at peace with one if needed. And perhaps most importantly, we arm you with the tools and knowledge you need to ask informed questions as you plan your birth and postpartum.
Taking a birth class does more than just show you how a baby is born. It shows you how amazing your body is, and how it’s your body, and how you can have a say over what happens to it. It encourages you to find and work with care providers who honor you and that process and respect your baby and you.
Sources:
https://scholarship.law.duke.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=3924&context=dlj
http://www.floridahealthfinder.gov/researchers/QuickStat/cesarean-buffer.aspx
Related articles:
Positivity, Positions and Personal Support
5 Labor Tools for Partners
Postpartum Expectations and Must-have Items
Maternity Care in America: Midwifery Model of Care
Although not everyone needs the skills of a surgeon at their births; every woman can benefit from the presence of a midwife. Read more thoughts by Nuria Nelkin, certified nurse-midwife at North Fulton Regional Hospital in Roswell, GA.
How does society view pregnancy and birth? How do YOU view pregnancy? How do YOU view birth? Is it automatically an illness/problem? Are pregnant women ill, weak? Is it a natural state of the body? Can things go wrong? When are interventions appropriate?
The belief and attitude towards pregnancy and birth as a normal part of life versus an illness waiting to happen is the basis between the medical versus midwifery models of obstetric care. The short answer is, NO. Most pregnancies are not a medical problem. Because there is always a possibility of complication during the amazing transformation of a woman growing a person, it is sensible to monitor pregnancies closely to be able to recognize potential or actual problems, and refer to appropriate providers (that can manage a higher risk/problem) as needed.
“Although not everyone needs the skills of a surgeon at their births; every woman can benefit from the presence of a midwife.”
Approximately 90% of births in the U.S. are attended by physicians (National Vital Statistics Reports, 2014). All women do not need a surgeon to directly manage their pregnancy, labor, and birth. Physicians/surgeons are taught how to analyze situations by identifying a medical problem and solving it. Labor and birth don’t always need that type of analysis or intervention. The midwifery model approaches pregnancy and birth as a normal process until proven otherwise.
Midwives are taught to educate women about the process of labor, birth, and motherhood and help a woman manage labor and birth, while also having the skills to identify complications. They are taught to handle small complications and identify which ones they need to send on to a physician. Sometimes that means using their amazing, life-saving surgical skills; sometimes it does not. Although not everyone needs the skills of a surgeon at their births; every woman can benefit from the presence of a midwife.
Midwives and obstetricians working as a team is the perfect answer. Having hands-on care treating pregnancy as normal unless it presents otherwise, and involving the obstetrician/physician in the care if concern arises, gives women high-touch, low-intervention care unless otherwise necessary.
About the author Nuria Nelkin, CNM:
After working as a nurse for several years and experiencing the pregnancy and birth of her second child, she knew that to pursue a career in midwifery was her calling and dream, and completed her MSN in Nurse-Midwifery at Frontier Nursing University. Nuria is also a wife and mother of two young, active boys. She enjoys spending time with her family and friends, reading, and exercising.
References:
Liljestrand, Jerker. Midwives are Essential to Global Health. Time Magazine. May 5, 2016.
National Vital Statistics Reports, Volume, 64, Number 12. Births: Final Data for 2014. December 23, 2015. Obstetric Care Consensus. Levels of Maternity Care. Number 2. February 2015.
Related articles:
5 Labor Tools for Partners
The Most Common Complications of Childbirth
AROM: To Break or Not To Break
Labor Comfort Measures
An Easy Fix For Back Pain During Pregnancy
As the fetus grows, the body stretches, shortens, and compresses organs, muscles, and ligaments so it's no wonder why a pregnant body can become uncomfortable.
As the fetus grows, the body stretches, shortens, and compresses organs, muscles, and ligaments to accommodate the baby. Since pregnancy brings on a lot of changes in the body, it can get a little uncomfortable at times.
Photo Courtesy of Pregnancy Massage Center
If you develop pain in your back or neck, it could be due to a number of reasons. During pregnancy your breasts grow, which in turn can pull forward the muscles of the neck, shoulders, and back. As the weight of the uterus increases, it can tilt the pelvis which can also pull on muscles of the back, hips, and glutes.
Always check with your primary care provider first to make sure there isn’t a medical reason as to why your back or neck hurt. Next, see if your doctor has any recommendations for you. If there isn’t a medical reason for the pain, you should not have to take any medications to ease it. A few easy solutions is to increase your water intake, establish a new exercise routine (preferably modified for pregnancy), take a nap or rest for a short time during the day to take the pressure off the area that hurts, and get regular massages.
“More and more care providers are suggesting prenatal massage to help soothe some of the aches and pains their patients experience during pregnancy.”
It is recommended to find a massage therapist that is certified in pregnancy. Most massage programs provide therapists with training for licensure only and may not include education on pregnancy related issues and how to deal with such. If you're located in the metro area of Atlanta, GA, please visit me or any of the certified prenatal massage therapists at the Pregnancy Massage Center and be sure to place a 4 pack of pregnancy massages on your gift registry. After all, you deserve pampering too.
Related articles:
Waterbirth: How To Have An Easy and Relaxed Labor
Childbirth Classes Have a Measurable Impact on Birth
The Most Common Complications of Childbirth
10 Benefits of Exercising During Pregnancy
