"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
Benefits of Upright and Spontaneous Pushing and How to Get Support For What You Want
The female body is designed to give birth and has been doing so successfully for years. All too often, medical interventions are used unnecessarily leading to more interventions, medicine, and possibly, complications. In recent years, with increased technology and medical interventions, women have been being limited to giving birth on their backs with guided pushing by their care professionals in recent years. Evidence does not support these restrictions.
No matter which birth option you choose - medicated or unmedicated - the key takeaway is to have the right support around you to optimize your birth outcome. Throughout the course of labor, including the pushing stage, women benefit from frequent position changes and ideally, should be free to select them at will.
Lamaze’s Healthy Birth Practice #5: Avoid Giving Birth on Your Back and Follow Your Urges to Push
In order to avoid giving birth on your back, following the Healthy Birth Practices of allowing labor to begin on its own, changing positions throughout labor, having continuous support, and avoiding unnecessary interventions really come into play.
First and foremost, allowing labor to begin on its own is a key ingredient of avoiding unnecessary interventions that in turn could cause you to have to give birth on your back because it avoids the use of synthetic drugs to get your labor started. Changing positions and having continuous support throughout your labor will also help you avoid interventions like medical pain management by easing the intensity of contractions.
Throughout history, women have been pictured giving birth in positions that are much more suitable for positive birth outcomes. Squatting, sitting, and standing all use the help of gravity to move the baby down and open the pelvis so the baby has more room to descend. Being able to freely change positions is much needed during labor, not only to ease discomfort but to promote the natural descent of the baby. Freedom of movement and working with your body will allow you to determine what position is optimal for you to push.
Many care providers prefer women to birth on their backs with their legs up in stirrups simply because it's easier access to see and catch the baby. Laboring on your back generally comes with directed pushing because it's likely that you've had an epidural which caused you to have to be on your back in the first place, otherwise you’d likely need/want to move during the pushing phase. (With an epidural, you may not feel the urge to push and need guidance on when and how to push effectively.)
Directed pushing is exhausting and according to the Lamaze website, “Goer and Romano (2012) found evidence to demonstrate that directed, forceful pushing had the potential to increase pressure on the baby and the umbilical cord, and the tissues of the perineum, resulting in more tears and a weaker pelvic floor musculature which can result in urinary incontinence."
To help ensure you can birth in the position you choose, follow these tips:
Talk to your care provider and choose one who fully supports any position for labor and birth.
Hire a doula or be sure to have continuous labor support available to help you avoid unnecessary pain medications. A doula is also very helpful with positioning if you do end up needing pain medication that limits mobility.
Get educated by taking a birth preparation class. The more you know about birth and what's normal, the more confidence you will have in the birth process and the more comfort measures you will learn.
Labor at home for as long as possible. The earlier you get to the hospital, the more likely you may be to use pain relief medication. Think of it like a kid in a candy store. If the "candy" is there, you may want to sample it!
When NOT lying on your back while giving birth, you oxygenate your body so you won't be lying on your aorta. Since the evidence is not strong enough at this point to recommend one specific birthing position over another, you should receive support to birth in whatever position feels right to you. However, flexible sacrum positions—those where you don’t put your weight on your tailbone—appear to be more helpful to normal vaginal birth.*
No matter what birth option you choose, medicated or unmedicated, the key takeaway is to have the support around you who will optimize your birth outcome. Throughout labor, including the second (pushing) stage, women benefit from frequent position changes and ideally, should be free to select them at will.
This post is part 6 of a 7 part series written by our team of Lamaze Childbirth Educators. Stay tuned for our final post in this series, Keep Parent and Baby Together.
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
Resources cited:
https://www.lamaze.org/Connecting-the-Dots/book-review-optimal-care-in-childbirth-the-case-for-a-physiologic-approach-reviewed-through-a-childbirth-educators-eyes
https://www.lamaze.org/Portals/0/HBP%20%235%20Avoid%20Giving%20Birth%20on%20Your%20Back%20and%20Follow%20Your%20Body%27s%20Urges%20to%20Push.pdf
*Excerpt from Evidence Based Birth Handout, Evidence on Birthing Positions.
https://evidencebasedbirth.com/evidence-birthing-positions/
Related articles:
5 Labor Tools for Pa
Postpartum Expectations
5 Reasons to Hire a Birth Doula
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
When Your Water Breaks: AROM Labor Management
It is best to understand your options, and always weigh risk versus benefit. No matter whether you choose to have your water broken or wish to avoid having it done, be sure you are making your choices because you understand and are comfortable with the decision at hand.
“I think we should try breaking your water to help speed things up,” said the OB. This is a very common method of attempting to hasten a stalled or slow labor, or an induction of labor. It sounds promising, but does breaking the amniotic sac - a procedure known as “amniotomy” or AROM (artificial rupture of membranes) - always accomplish this?
Are there any risks associated with this intervention? Because this procedure is quite commonplace in American hospitals, here’s the scoop on some of the science, benefits, and risks surrounding this procedure.
So what exactly is the “bag of water(s)” or the amniotic sac?
It is a very thin, strong, membrane that contains fluid that surrounds your baby in the uterus. This creates a nice cushion for your baby to soften any jolts or impacts to the belly. It also helps maintain a constant temperature and allows for easier movement and growth of your baby.
Why break it? The belief behind amniotomy in early labor, to induce labor, or to kick-start stalled labor before 6cm, is that breaking the bag of water using a small amniohook removes the fluid cushion between the baby’s head and the cervix, allowing more pressure to be placed on the cervix, resulting in faster dilatation of cervix. Often - whether artificially or on its own - the water breaking will encourage a rise in your natural oxytocin level, thus bringing on more contractions. Sounds great, right?
Maybe not. Opponents of AROM argue that the amniotic sac and fluid play an important role in protecting your baby against the stress of contractions. Imagine trying to squeeze/crack an egg inside a filled water balloon using pressure from your hands around the balloon.
Every time you squeeze, the squeeze is translated to pressure across the surface of the egg and it can move down and around as needed. Same concept with baby and their umbilical cord. That fluid can also make it easier for your baby to maneuver, should any additional maneuvering be necessary.
“Your intact amniotic sac can actually help with thinning and dilatation of the cervix.”
But what about the whole speeding up labor thing?
Although amniotomy can help shorten labor by one hour according to the American Pregnancy Association if done at the appropriate time, your intact amniotic sac can actually help with thinning and dilatation of the cervix as well, thanks to the water in front of baby’s head creating even pressure across the cervix. So leaving everything alone and letting your body do it’s job can also shorten your labor versus starting interventions that may not necessarily be needed.
What’s this about risks?
As with everything in life, there are also risks associated with artificially rupturing the membranes. These can include:
A prolapsed cord. This is when baby’s umbilical cord slips past the head into the vagina, cutting off circulation to baby significantly, resulting in an emergent c-section.
Risk of infection is also a problem. For this reason, most providers won’t let you labor too far past 24 hours after your water breaks or is broken and will suggest a c-section if your water is broken and you are not ready to push the baby out.
Another possible risk can be with the baby’s heart rate. Without the cushion of the fluid, it can be harder to un-squish an umbilical cord or placenta that is thought to be causing a drop in baby’s heart rate.
Also worth noting; a common side-effect of AROM is a significant increase in the intensity of what you are feeling, and are more inclined to ask for pain management or epidural.
That last one is not a true “risk” factor (and I myself have been a fan of the epidural) but for those who wish to avoid medicinal pain management and intervention domino-effect, it can make sticking to that choice much more difficult.
So no AROM ever, right??
WRONG. There are exceptions to almost everything in labor, and this is no different. If your baby is showing signs of extended distress and the medical staff are unable to get an accurate reading on the external monitor, it may be necessary to apply an internal monitor to the baby’s head in order to monitor baby’s heart rate without signal loss to ensure the heart rate stays stable. This is a situation where modern medicine and interventions shine and truly help protect baby and mother.
“The evidence showed no shortening of the length of first stage of labor and a possible increase in caesarean section.”
For those who skip to the end of these long posts to get the short version...Providers often suggest AROM to “speed things up” or “bring on labor.” However, a recent Cochrane review of 15 studies involving 5583 women states that “the evidence showed no shortening of the length of first stage of labor and a possible increase in caesarean section. Routine amniotomy is not recommended for normally progressing labors or in labors which have become prolonged.” The World Health Organization also reviewed the findings and supports that recommendation.
This is not to say it doesn’t ever help. It is simply best to understand your options, and always weigh risk versus benefit. No matter whether you choose to have your water broken or wish to avoid having it done, be sure you are making your choices because you understand and are comfortable with the decision at hand.
Related posts: How To Avoid Routine Medical Interventions 5 Reasons to Hire a Birth Doula 5 Labor Tools for Partners
Prenatal Exercises and Birthing Positions for Symphysis Pubis Dysfunction
Symphysis Pubis Dysfunction (SPD) can make walking or sitting difficult, and sometimes extremely painful, affecting approximately one out of four pregnant women.
A condition called Symphysis Pubis Dysfunction (SPD) occurs when the ligaments that keep your pelvis aligned during pregnancy become too relaxed (due to the hormone relaxin) and causes excessive movement of the pubis symphysis. This can make walking or sitting difficult, and sometimes extremely painful, affecting approximately 1 of 4 pregnant women.
It is recommended that women with Symphysis Pubis Dysfunction give birth in an upright position with knees slightly apart. Another option is the all-fours position, keeping the knees close together. A waterbirth may be preferable as water allows buoyancy that can support the joints. And soaking in a warm tub is divine during labor!
Pelvic Floor Squeezes, Stability Exercises, Inner Thigh Stretches, Pelvic Tilts, Back and Side Stretches
Symphysis Pubis Disorder is not harmful, but it is painful. There are exercises to relieve SPD. If any exercise seems to cause you more pain, stop immediately. If your pain lasts or seems to get worse, talk to your obstetrician. For info about rehabilitation, prevention, and reoccurrence management of SPD in subsequent pregnancies, read this article which includes stability exercises.
Watch the below video for how to give birth more comfortably with SPD. Additionally, strengthening the pelvic floor muscles will help to stabilize the spine, support the pelvic organs, and prevent incontinence.
Epidural, Please!
I've had several women tell me, “Oh, I don't need a doula. I'm planning to get an epidural.”
An epidural can be an amazing thing! There's a reason why 60% of women who give birth in the U.S. choose to get one during labor. Many women feel like their birth experience is more positive after receiving an epidural, and I have seen laboring women that I'm working with become so much more relaxed, focused, and finally able to catch their breath and rest after opting for one. For many women, just knowing that an epidural is part of the plan, when labor becomes too painful and intense, relieves some of the anxiety associated with the unknowns of being in labor and having a baby.
I've had several women tell me, “Oh, I don't need a doula. I'm planning to get an epidural.” Or they think that a doula will only support women who want a natural birth. Before I became a doula and when I first started my training, I thought the same thing! I now know that having a doula is a great resource, no matter what kind of birth you are planning to have.
Your doula sees the bigger picture, and is there for you and your partner before, during, and after labor. As a continuous and trusted presence, your doula is there to help you understand the labor process, what your labor will look like and how it will change when you get an epidural. Your doula wants you to be informed and in control of your birth and can provide information and suggest questions you can ask your health care provider.
“Having a doula is a great resource, no matter what kind of birth you are planning to have.”
Even if you are planning to get an epidural, a doula can support you while you labor at home and when you first arrive to the hospital. The transition from laboring at home to getting set up in the hospital and receiving an epidural will take some time. Knowing different methods to cope with the labor pain and any anxiety you feel will help make the transition easier. An epidural is just one form of pain management. A doula will help with other relaxation techniques before you get the epidural and can show you epidural friendly positions as you labor. You won't be able to move around as freely, but you can still change positions while in the bed, which will help you as you labor.
Your doula has a peanut ball and knows how to use it!
The peanut ball is most commonly used when a laboring mother needs to stay in bed. Studies show that epidurals lengthen the amount of time women spend in labor. Lengthy labors and ineffective pushing increase your chances of needing a c-section. Your doula will help you use a peanut ball to promote dilation and descent, change positions while you're in bed, and stay relaxed, which can help shorten your labor and make it less likely that you will need a c-section! Getting an epidural won't necessarily take away your anxiety about giving birth. Having someone with you, however, who is familiar with the labor process and can be reassuring and help you feel more confident and relaxed.
Your doula will also be a great resource to your birth partner! Sometimes our birth partners are so focused on their loved one, they forget to take care of themselves! A doula is there to provide an extra pair of hands and remind both of you to rest and stay nourished. As Cynthya describes in one of her posts about the role of a doula,
"A doula can preserve the intimacy of the birthing room and be a consistent care provider for you and your partner. Doulas maintain the ambiance of a labor room, keep good energy flowing, and help limit distractions, which allows the couple to relax and know they are cared for. Your doula wants to make sure that you both enjoy the birth of your child and has only your interest in mind. After all, birth is her passion and you've hired her for this special event - use her to your full advantage."
Your doula is on your team and trusts that you are a strong and capable woman who can listen to your body and decide what kind of birth you want to have and wants to help you embrace whatever forms of pain management you decide to use. She will be there supporting you along the way.
Review your options for building your support team by reading the profiles of our team.
Along For The Ride: Embracing The Roller Coaster of Motherhood
PART 1 OF 3, THE HOLISTIC APPROACH TO CHILDBIRTH AND POSTPARTUM
Part 1 of 3, The Holistic Approach to Childbirth and Postpartum
by Stephanie Finn, Certified Pediatric Nurse Practitioner and Registered Nurse
In this series of posts I would like to share with you some things to consider when searching for pediatric healthcare setting. First, I will share a little background about myself and few personal insights from my experience with having a doula and snippets from my postpartum journey.
I entered the scenario of prenatal care and obstetric services as a pediatric nurse practitioner. In addition to managing my own unique health concerns and wanting the best for our baby, I had several years of education and experience as a nurse working with children under my belt. I have witnessed first-hand the concerns of parents fraught with so many important decisions to make in a short amount of time, albeit a precious emotional time. This spans everything from breastfeeding issues, formula selection, vaccination concerns, treatment side effects, potential surgeries, food allergies, mental health concerns, you name it. I knew that I needed to provide my body with the most healthful foods and supplementation, exercise, meditate, pray, and stay centered and at ease throughout the turbulence that can surround pregnancy and early motherhood. Pregnancy is a joyous time, and although we are designed to carry and birth children well, it can be particularly demanding for mothers juggling work, caring for other children, or managing health concerns. With all of this in mind, I began my search for a doula.
First, I must say, I am so thankful to have a loving and supportive husband, who took great joy in helping me with decisions surrounding our birthing day. This was huge! For those in a relationship, having a doula can bring a lot of relief and support to both you and your significant other. Not every mother will have this support—and as I see it, doula care is even more valuable in these situations.
Although I have a handful of very close friends and family who have walked beside me in the best of times and the worst of times (incredibly thankful for them), and very kind extended family members, there was one key piece missing for me during my pregnancy, and more so postpartum: Nearby family-the ones I grew up with so close to me.
“We all share the desire to connect with those close to us and to fulfill our needs and matters of the heart.”
My mother and the close-knit family I grew up with do not live in the same state as my husband and me. This was disheartening for me as I longed to share more special moments as a new mom with them. Even though they are not extremely far away, I missed the communal aspect of being near them. Growing up with a large family full of women and children, I was blessed with the joys of engaging in frequent chats around my grandmother’s kitchen table, having tea on the back porch, time to vent frustrations with family and share our joys, laugh together, and most importantly, do this with those who knew me well as a person. I realized this interaction was so much a part of my norm and integral to my being. While it did not dampen my joy and gratitude surrounding the blessing of a baby, this need became so apparent during my pregnancy and journey postpartum! I’ve heard many mothers relate to this need in varying ways. Whether one’s family is large or small, the key is that the support network must be one that is relatable and unique to the mother. It’s her village, her sustenance. Though the circumstances are unique to everyone, we all share the desire to connect with those close to us and to fulfill our needs and matters of the heart.
Social support has been reported to be a buffer to postpartum depression. What social support means is individual. While one mom may need a few weeks to bond with her new baby with one or two significant others around, another may prefer a more extended network of visitors around. Many new moms may need to make arrangements to visit family, and some may need to warm up to visitors or childcare situations. A new life has shifted from the inside of her body, to the outside world; she has evolved, and there is a beautiful yet major shift taking place during this time. This precious time is not without some degree of vulnerability.
“Ensure the new mother is comfortable and has the conditions she needs to heal physically, rest, and bond with her baby.”
The common thread which is important to keep in mind postpartum is to ensure the new mother is comfortable and has the conditions she needs to heal physically, rest, and bond with her baby. Baby needs mom to be supported! I vividly remember our doula encouraging us to make choices that would be conducive to mother-baby well-being and our health as a growing family, regardless of outside pressures.
The experience of missing family postpartum, being extremely exhausted from breastfeeding and the accompanying sleep deprivation (along with expected hormone shifts) certainly granted me moments of feeling anxious. It’s quite the adjustment. To date, my sweet little one has spent more time in my womb than outside of my womb. The motherhood rollercoaster is just beginning!
My heart is full. I am happy to say that with a supportive husband, an encouraging doula, awesome healthcare provider, a supportive employer and a handful of close friends and family as advocates, I truly ended up with the support I needed. Despite the longing for back home, I was able to stay afloat and keep from spiraling into postpartum depression. Support showed up in unexpected places.
The good health and smile on my child’s face was more than enough to keep me going on days when sleep was out of reach. I had to be proactive to create time and space for what I needed to take care of our baby and myself. Also, I reminded myself that there are gracious and understanding people who have been there. Moms, do not lose sight of this! Thankfully, from the beginning I had the most joyous bond with our baby girl. My heart has stretched with welcoming our greatest treasure into the world, and also for new moms out there who are in the throes of postpartum hormone swings or depression.
“I had to be proactive to create time and space for what I needed to take care of our baby and myself.”
We can all help pregnant women and new mom’s seek out the support they need. Be proactive. Ask, and do not assume what they may need or what they should be doing. As the old saying goes, “Mother knows best.”
As you navigate the world of pregnancy and postpartum, be true to yourself and trust your inner guidance. Reach out for the care that YOU need to be healthy, and fully embrace it. Trusting that you are doing what’s best for you and letting go of the rest will become easier with practice. Pray about it, meditate on it. Find your advocate(s), and extend this custom care to your child and family.
In my next post, I will share a few things to look for in a healthcare setting for the bundle of joy that is entering your world! Soon to follow I will be sharing more details about my birthing day!
Stephanie Finn is a Certified Pediatric Nurse Practitioner and Registered Nurse at CentreSpring MD.
Read Part 2 of 3: Holistic Care For Your Child After Using A Doula
Related articles:
How To Avoid a C-section Without Changing Hospitals
Consider Hiring a Labor Doula
Childbirth Classes Have A Measurable Impact On Birth
How Does a Braxton-Hicks Contraction Feel?
What does a Braxton-Hicks contraction feel like?
How to Make Healthy and Safe Decisions During Pregnancy and Parenting
This new resource is great for expecting parents and their partners to help them keep track of important events, questions to ask, and even has a contraction timer.
Lamaze launched its first-ever mobile application for parents, Pregnancy to Parenting. This unique app is complete with evidence-based weekly development updates, daily tips and helpful tools developed by Lamaze Certified Childbirth Educators. This new resource is great for expecting parents and their partners to help them keep track of important events, questions to ask, and even has a contraction timer. The best part is that it is free to download - try it today.
2 More Reasons You Don’t Need an Induction
No two pregnancies are the same (even within the same body), no two labors are the same; there are so many factors that play into a pregnancy and her subsequent labor and birth.
by Lauren King, Registered Nurse, Certified Lamaze Educator, and DONA Labor Doula
What is the average size of a baby born in America? Would you guess 7 pounds? Maybe 7 and a half? Eight pounds. Eight pounds is the average size of babies born in America. That means some (lots!) of babies are bigger than that – and many babies are smaller than that. Genetics and mom’s lifestyle, among other things, play a huge role in how big you grow your babies. I’ve seen babies born vaginally that weighed over 10 pounds! I’ve heard stories of babies just as large born vaginally with no pain medication! It’s certainly not impossible. (Maybe not necessarily the most pleasant thought… but not impossible!) Do you know how much amniotic fluid is adding to your weight? Well, not much honestly, but if you’re around 34 weeks, you have now reached the peak amount of amniotic fluid at about 800 mL. From 34 weeks on, amniotic fluid levels will gradually decline. Read on to learn why this matters.
Some doctors suggest an induction for “big baby” because they believe it decreases the chance of a shoulder dystocia (difficulty delivering the shoulders) or the need for a cesarean due to the baby being too large to fit through the pelvis. However, research shows this is simply not true. The risk of shoulder dystocia is relatively small – and it’s impossible to predict who will have a shoulder dystocia. Furthermore, for a doctor to suggest a woman to induce for this reason, the doctor must assume the ultrasound is accurately assessing the size of the baby. Next time a late-pregnancy ultrasound is recommended to you to assess fetal size during your pregnancy, ask your doctor or the sonographer how accurate it is. If they tell you the baby “might” weigh about 8 pounds, please know they can be off by as much as 2 pounds either direction. There is a HUGE difference between a 6 pound baby, an 8 pound baby, and a 10 pound baby. I have seen elective c-sections performed on first-time mothers due to “possible macrosomia” (big baby), only to discover the baby weighed LESS than 8 pounds.
I often tell people that things in labor and delivery can be very dynamic. The more I think about it, the more I realize how true that statement is in so many ways. No two pregnancies are the same (even within the same body), no two labors are the same; there are so many factors that play into a pregnancy and her subsequent labor and birth. Another dynamic aspect of pregnancy? Amniotic fluid. As I mentioned above, the amount of amniotic fluid peaks at about 34 weeks, reaching around 800 mL, and gradually declines to around 600 mL by 40 weeks. However, there are many factors that can play into these numbers. The baby, the mother, and the sonographer measuring the amniotic fluid can all affect the actual or perceived level of fluid.
The baby constantly circulates the fluid by inhaling it, swallowing it, and then releasing it through the urinary tract. Near term, the baby swallows more and urinates less often, thereby holding more fluid at any given time. Other baby-driven factors include: post-term (past 42-weeks), birth defect, or problems with the kidneys or urinary tract.
If you are dehydrated, such as in the coming summer months especially, if your water is broken, or if the placenta is no longer functioning properly, you may be diagnosed with low amniotic fluid. Some things you may try to increase amniotic fluid levels include drinking more water (at least 2-3 liters a day) and laying on your left side during an ultrasound when measuring fluid levels. Other factors that can play into an inaccurate reading include too much pressure on the ultrasound transducer, floating particles in the fluid, and an obese mother. Yes, “low amniotic fluid” could be a sign of a health issue and can be a medical reason for induction, but ask your doctor what their specific concern is before agreeing to induction simply for “low amniotic fluid.” Furthermore, you may wish to have a reevaluation in a couple days. Drink lots and lots of water, and when you return for another ultrasound (hopefully by the same sonographer!), if the fluid level is still low, or has decreased further, then you may wish to discuss the next step with your provider. If it has increased, then you might have saved yourself from an unnecessary induction! For a brand new diagnosis of “low fluid” without any other known cause, you may be better off to wait.
"What I have heard, and what I suspect it ultimately boils down to, is for one thing, doctors are human." - tweet this!
So, knowing all of this, why do doctors recommend things that are not backed by research or ACOG? My honest answer is: I don’t know. What I have heard, and what I suspect it ultimately boils down to, is that for one thing, doctors are human. Meaning: doctors want convenience and easy and predictable and good ratings. What? Good ratings? Exactly. Doctors and hospitals have a business to run. They have to keep their patients happy to keep them coming back for subsequent care! And businesses are consumer-driven. How many times have you heard that you can’t treat a viral infection with antibiotics? And yet, when a patient goes into a doctor’s office, demanding something to be done about their illness, they just might walk out with an antibiotic prescription in hand. Same thing with inductions. When a patient begs, pleads, whines, and complains about all the aches and pains, and difficulties of pregnancy, their doctor wants to appease them. No, not all doctors act this way, but the ones that do are the ones contributing to the problem and making it “okay” for other doctors to do the same. Although, I have to say – it’s not ALL the doctors’ faults. We, as women, as mothers, as consumers are just as much to blame. If I walk into my doctor’s office, demanding an induction – all the while, knowing all the risks of doing such – my doctor doesn’t want to lose me as a customer, so he agrees.
You Have More Power Than You Know
On the flip side, if more women – more consumers – are asking their doctors to allow their bodies to go into labor naturally, they will stop suggesting and allowing for non-medical inductions. If more women are getting educated on their options and on the pros and cons of such procedures, and refusing inductions for the sake of convenience, doctors will follow suit. Ultimately, they want to make their customers happy.
For more information on inductions, please visit MedLine Plus, American Pregnancy Association, and the Adventures of a Labor Nurse.
"Amniotic fluid peaks at 34 weeks, reaching around 800 mL, and gradually declines to around 600 mL by 40 weeks." - tweet this!
Related articles:
Knowing Your Options Is Vital To Your Labor And Birth
How To Avoid a C-section Without Changing Hospitals
6 Comfort Tips For NOT Breastfeeding
So You Need An Induction, Eh?
So You Need An Induction, eh?
I believe women (actually any person) should be able to whole-heartedly trust their doctors. We want to believe our doctor is doing what is in our best interest – and they should be.
by Lauren King, Registered Nurse, Certified Lamaze Educator, and DONA Labor Doula
Photo By BirthYearBook
I feel the need to provide a disclaimer before I delve into this topic. I am not saying all doctors, midwives, or other medical staff are bad. There are definitely a lot of really great medical personnel out there. But just like anything in life, there are always a few bad apples.
I believe everyone should be able to whole-heartedly trust their doctors. We want to believe our doctor is doing what is in our best interest – and they should be. But I don’t think it’s a secret that there are doctors that sometimes do things in their own best interest. The question is: how do you know? As a non-medical person, how does one know their doctor is top-notch, and not suggesting every intervention, hoping for another nickel in their pocket, or hoping to be out on the golf course in an hour?
Of course, the obvious response here is: talk about your options with your doula from The Happiest Doulas, and we will do everything we can to help you achieve the beautiful birth you want and deserve. But equally as important is to be educated. You don’t need a nursing degree or a medical license to make important medical decisions, but you do need at least a pretty basic understanding of some of the top decision areas. And for everything else, ask lots of questions. Specifically, discuss the B-A-R with your provider: benefits, alternatives, and risks. When discussing pros and cons about procedures (especially induction) a great question for your provider is, “What research do you have about that topic?” or, “Where can we get more research-based information about that to help us make a decision?”
I’ve written before about inductions, but this is a topic that comes up a LOT in my classes. Plus, it’s the topic that really gets me started, gets me up on my high horse, my soap box… and it is hhhaarrrddd for me to get off it! “My doctor wants me to have another ultrasound next week because the baby is measuring big,” – and as a bonus to that one, “And if I don’t deliver by my due date, the doctor wants to induce me.” “My doctor said my amniotic fluid level is low.” “My doctor told me I need an induction because I conceived through IVF.” Ok, well, I don’t actually know what the literature says specifically about IVF, but just in my personal OPINION, it doesn’t make sense to me.
"I whole-heartedly believe in inductions for medical reasons for mom or baby’s health." - tweet this!
Let’s talk about the reasons for induction, though. There are actual medical reasons for induction, and I whole-heartedly believe in inductions for medical reasons for mom or baby’s health. What I don’t believe in is disguising a convenient induction in medical terminology. Here are some medical reasons for induction, according to ACOG: pregnancy that continues 1-2 weeks past the estimated due date, high blood pressure, uncontrolled gestational diabetes, an infection in the uterus, or a baby who is not growing properly (IUGR). This list is not completely exhaustive, but “big baby” and even “low amniotic fluid” (by itself) are not included in the list of medical reasons for induction.
I’ll discuss those two things in a later post, but for now, let’s discuss induction for postdates (going past your due date). Do you know what “EDC” or “EDD” stands for? Both start with E for estimated. (EDC stands for “estimated date of confinement”, in case you didn’t know.) A point I made in one of my classes recently was this: do you always have a 28-day cycle? Do you know, for a fact, that you ovulated on day 14 when you got pregnant? Do you know, for a fact, the exact date you conceived? (Ok, so some can truthfully say ‘yes’ here.) So, I went on to say: Did you all walk at 12 months? Did you all crawl at 7 months? Did you all roll over at 3 months? My point is that just as we all grow and develop at different rates Earth-side, so too do our babies grow and develop at different rates in the womb.
Due dates are calculated based on an archaic formula, called Naegele’s Rule, which assumes every woman has a 28-day cycle. Even then, the man behind Naegele’s Rule, Frederich Naegele, was not the original “inventor” of “how to estimate the length of human gestation.” It was an 18th-century professor of botany and medicine, Hermann Boerhaave, who developed the formula. Am I the only person who thinks this whole business of calculating a due date deserves a little more visitation by the research and medical community?!
Many Are Mislabeled as "Post-Term"
I do a lot of reading to keep up with the newest information. One of my favorite places to get information is from Evidence Based Birth. Rebecca Dekker, the author, just published a very extensive article on the evidence for inducing for going past your due date. She touches on Naegele’s Rule as well, but one thing she wrote really struck me. She wrote, “using the LMP [last menstrual period] to estimate your due date makes it more likely that you will be mislabeled as “post-term” and experience an unnecessary induction.” The reason for this is just as I stated above: not everyone’s cycles are cookie-cutter perfect! Even if a woman does ovulate on day 14, if she conceives that month, the embryo may not implant for several days! I was so thrilled for this article to come out, I wish everyone could take the time to read it word-for-word; however, I realize it is lengthy. I encourage you to skim it, and if nothing else, read the section “What’s the bottom line?” found at the end of the article.
"If a woman ovulates on day 14, and conceives that month, the embryo may not implant for several days." - tweet this!
So that you have more time to read that very important article, I’ll go ahead and end now. I hope this has given you some valuable information and resources. Next up, I’ll discuss why doctors induce for “big baby” and low amniotic fluid, so come back soon!
Labor Tips for Birth Partners
If you've skipped taking a childbirth class during pregnancy, your partner may feel unprepared and need additional tools to support you during labor. Read Cynthya's 7 points to her clients.
As your due date approaches, it's completely natural for your partner to feel some anxiety regarding how they can best support you during the labor process. To help ease their uncertainty, I’ve compiled a helpful list of suggestions to guide them through it!
For instance, in early labor, taking a long, warm bath can be incredibly soothing, as it can relieve tension and ease anxiety. This suggestion is primarily meant for the laboring patient; however, if your tub is spacious enough, it can become a wonderful, relaxing experience for both of you to share.
The latent phase of labor is typically the longest stage of the process and can often wax and wane over time. It’s a great idea to take it easy during this time. Try to rest as much as possible between contractions and allow labor to progress at its own pace. Every minute of sleep that you manage to get will help to ward off future fatigue during the more intense active and pushing stages ahead.
It might be best to save the use of a shower for when you are at the hospital, as it may provide effective pain relief and help facilitate the progress of labor. For an optimal birth experience, explore additional tips here on how birth partners can provide effective and compassionate labor support.
