Stress seems to be a normal and somewhat expected part of our lives in modern America. Pregnancy, birth, and the postpartum period are typically times where the stress only tends to increase. We all know the effects of stress and anxiety in the body of a non-pregnant body. During pregnancy, many of those effects are amplified and pregnancy poses a whole unique set of risk associated with chronic stress and anxiety. Because of this, deliberate and intentional stress reduction in pregnancy is very important for the well being of the mother and the baby.
It’s important to note that the stress itself is not the problem – the amount of stress we experience is the problem. In truth, a little bit of stress is healthy. It creates a fight or flight response in our bodies that is essential to our survival. However, when that fight or flight state is the only state of being we live in, our health is at risk – physically, mentally, emotionally, and spiritually. Pregnancy, labor, and the postpartum period all are affected by stress in different ways.
The effects of stress in pregnancy are being researched all the time, so we know more now than ever about its effects. It seems the more we know, the more apparent it becomes that reducing stress and anxiety is vital to a healthy pregnancy. For instance, we now know that at its worst, stress has the ability to affect the baby’s growing brain and sometimes inhibit the development of certain parts of it, though that is known to be in only extreme cases.
Cortisol, when produced by the mother, creates inflammation in both the bodies of mom and baby. Chronic inflammation is now known to be a cornerstone for a variety of serious health conditions. In small amounts, stress in pregnancy is not harmful, but there is no known “threshold” of safety for stress levels, nor is there a way to objectively measure that. Knowing this, doing your best to have a balanced and calm pregnancy can only be beneficial.
During labor, stress inhibits oxytocin, which is an essential hormone needed for labor to progress. When a mother is tense or stressed during labor, her contractions are not as effective because the stress inhibits the effectiveness of those contractions. Doulas work hard with mothers to reduce anything that contributes to stress during labor because relaxation is required for labor to progress.
During labor, stress inhibits oxytocin, which is an essential hormone needed for labor to progress. When a mother is tense or stressed during labor, her contractions are not as effective because the stress inhibits the effectiveness of those contractions. Doulas work hard with mothers to reduce anything that contributes to stress during labor because relaxation is required for labor to progress.
After birth, mothers desperately need rest and rejuvenation. In reality, this is a time where most mother’s anxiety begins to skyrocket. Between healing from birth, learning how to breastfeed, caring for a new baby, sleep deprivation, and her continued demands within the functioning of a home, life gets overwhelming – and stressful – quickly. In many cases, the pressures of this new life mean that postpartum depression isn’t far behind. Stress also has the ability to slow a woman’s postpartum healing process. A postpartum doula can relieve a significant amount of that stress by helping mom navigate life with a newborn as well as help with the chores.
So with all these well-known effects that stress has the ability to cause, what are some effective ways to reduce your stress in pregnancy?
This is a whole topic unto itself that deserves its own blog post. But a simple, effective way to reduce cortisol levels and scale back the fight or flight effect on the body is to do deep breathing. This exercise is not only beneficial in pregnancy, it is great practice for labor and birth. Physiologically, the lower part of the lungs activates the parasympathetic nervous system, which is the state of relaxation and grounding we should live in for almost the entirety of our lives. It is the opposite of high stress and fight or flight. Deep breathing is an important and useful practice that anyone can do. Even just a few deep breaths will help to bring you back to a state of balance.
In the fast paced world we live in, you’ll never fully escape stress during your pregnancy. You should never feel guilty for feeling some stress or anxiety during your pregnancy, labor, or postpartum period. Life happens. Doing your best to give yourself a little extra TLC and trying to be deliberate about reducing your stress and anxiety during this time will go a long way for you and your baby. And hang in there – this is but a short season of life.
We are on to part 3 of our Hypnosis for Birth series! In case you missed it, check out part 1, where we detail what hypnosis really is. In part 2, we talked about the benefits associated with using hypnosis for birth. And today in part 3, we are going to talk about the crux of using hypnosis for birth: How to use hypnosis for labor and birthing.
In short, the message is that the words that you use when you speak about pregnancy and birth have a tremendous impact on your birth outcome.
We often take for granted the power of words in our modern world. Particularly with the invention of texting, communication has been reduced to rudimentary acronyms for blurbs that we wish to communicate on a whim. It’s a shame because language matters a great deal!
And in birth, language is how we communicate with our subconscious and with our bodies to accomplish the greatest and most heroic feat of all mankind: bringing forth life.
So, what kind of language is used in our culture today to discuss birth? Grab any book off the bookstore shelf for expectant mothers today, and what kinds of terms will you find?
What do these all have in common? These are medical terms. Yes, they are anatomically correct. But they are all somewhat detached from the human element and they are medical and physical in nature. For the purposes of medical study and physiological understanding, these are fine.
But from within, as a birthing woman, birth is about so much more than simply the sum of interrelated anatomical parts and their respective roles.
What effect does it have on our psyches to refer to a perfectly normal and healthy process that involves the mind, body, and spirit, using only its anatomical and functional terms?
We come to see ourselves as only a function of medicine, and we therefore think we are dependent upon it in order to birth.
And our subconscious mind comes to see medicine as necessary for healthy birthing.
While it’s absolutely true that medicine has a place in rare complications, it is not a requirement for birthing to be healthy or safe in most situations. In fact, evidence supports physiological birth as the safest option for both moms and babies.
Consider this. Every other branch of medicine has common, everyday terms for organs as well as their processes. For instance, you wouldn’t tell your friends that you had a myocardial infarction. You would say you had a heart attack. Similarly, you wouldn’t say that you had pyrosis. You would say you had heartburn.
Why is it that we do the opposite in birth? A woman is not a vagina who births a fetus. She is a whole human being whose mind, experiences and spirit are all in this birthing experience together! And the words that we use to communicate everything about the experience impact all of those parts of her.
So, how can we change our language in birth to better reflect and communicate with our minds and bodies?
Take a step back – and examine the language we’re using to communicate with our subconscious mind.
Rather than saying “I am dilating,” use the phrase “I am opening.”
Rather than saying “I am effacing,” use the phrase “I am softening.”
Rather than saying “My baby is at a zero station,” use the phrase “My baby is moving down.”
It’s a pretty big difference!
The word “contraction” is one in particular that is neither accurate nor useful. Because you see, the uterus is not actually contracting! The uterus and cervix are not, in fact, two separate organs – they are one organ doing several separate and distinct jobs! The word contraction means to tense up and to make hard. During a “contraction,” the uterus and cervix are actually doing the opposite! They are pushing, softening, opening, and moving the baby!
Furthermore, a “contraction” involves more than just the work of the uterus and cervix. A “contraction” demands the entirety of a woman including her mind, the movement of her body, and the willingness to surrender to a process that feels bigger than herself.
In hypnobirthing, the term “contraction” has been replaced by the term “surge.” So rather than saying “I’m having a contraction,” use the phrase “I feel a surge building.” The term “surge” more accurately captures what is happening within a woman – both mentally and physically.
In addition to the types of words that we use, the way they are communicated has a huge impact. For instance, imagine the way a woman would experience these two phrases from her provider:
“You’re only 6 cm.”
“You’re doing great and you’re at 6 cm!”
One plants a seed of defeat, the other of encouragement. The facts remain the same. But the language used to communicate those facts portray opposing mindsets.
Which one do you feel would be more productive for a laboring woman?
I can speak from experience as a doula, as can thousands of other doulas and midwives, that what a woman thinks about in her pregnancy is nearly almost always exactly what she gets for her birth. For instance, say a woman decides she wants to have a natural birth, but she keeps thinking she’s going to need an epidural. What ends up happening? She has an epidural.
What was she thinking about while she was preparing for her birth? The epidural.
Now hear me: This is NOT to say that epidurals are bad. It’s only to illustrate that what your mind fixates on is ultimately what leads to your experience. What you think about is what you are unintentionally telling your body to do.
So, what are you thinking about as you prepare for birth? Are you thinking about what you DON’T want? Or are you thinking about what you DO want? Are you visualizing your cervix opening, your baby moving down easily, your being in control of your surges, and holding your baby in your arms after it’s all done?
Or are you staring down your impending labor with a terrified longing?
Because what you fixate your mind on and the messages you give it will ultimately determine the way your birth plays out. The subconscious mind does not judge what we give it. It only receives and acts accordingly.
So how do you train your subconscious mind to be ready for birthing?
Practice visualization. This gives your mind the exact messages you WANT it to have as you prepare. Visualize your cervix softening and opening easily, your surrendering to the process of birth, and your surges peaking and subsiding. Visualize and practice deep belly breathing every day during the entirety of your pregnancy so that your mind and body are already practiced in the art of relaxation.
Use intentional language that creates a positive expectation for your birth. “I’m terrified to give birth” is the general feeling in our world today. “I’m confident in my body’s ability to birth” is much more productive.
In conclusion, simply being aware of the language and messages that you are taking in during your pregnancy can go a long way toward creating a healthier and more satisfying birthing experience for both you and your baby.
In all the fun and joy of preparing for birth, very few give postpartum depression anything more than an obligatory nod. Most people are inclined to skip over it when preparing for a baby, because of they, naturally, think it will never happen to them. Some may just resolve to deal with it if they face it and otherwise leave it alone.
Nobody can possibly prepare every little detail about the coming life with their baby. But a little basic understanding of postpartum depression can go a long way toward prevention and management, should the need arise. I certainly cannot provide you with all there is to know about PPD in a single blog post, but I hope you will gain some basic knowledge to help you be aware and prepare.
First, what causes postpartum depression? We still have so much to learn despite the amount of research that has been done already. Each case is unique, and the way it is experienced and manifested differs from woman to woman. Causes can be rooted in something mental, emotional, physical, or spiritual, or any combination of these.
Physically, as a woman recovers from birth, her hormones take a while to readjust to a new normal. During this time, it is likely that she is not getting adequate nutrition to support this process if she doesn’t have enough help at home. If she is breastfeeding, prolactin is at work as well, trying to perform its essential function. In addition, she is also likely sleep deprived of caring for a new baby.
Emotionally, a woman can understandably feel overwhelmed by the demanding job of caring for her new baby. If and when her partner returns to work this stress can be amplified especially if there is no additional help at home.
The symptoms of postpartum depression are easy to observe. It is classified as a condition that can be self-diagnosed. Postpartum depression is not to be confused with baby blues, which generally only last a few days after birth. Conversely, postpartum depression tends to be more extreme and rather relentless.
Many women feel ashamed about the possibility of having postpartum depression because motherhood is “supposed” to be the happiest time of your life. In theory. The reality is often much grimmer than we presupposed, as this season of life involves so much life adjustment, difficult navigation, and physical strain involved in baby care. Women are afraid to admit that they are depressed during this time for fear of being shunned.
Some general signs to watch for:
Women are more likely to experience PPD if they have:
The standard postpartum follow up visit with a care provider after birth is a full 6 weeks. That means a woman is sent home from the hospital on her own, and they do not see a professional who can help them for 6 whole weeks. This is a huge gap in maternity care in the US. After birth, a lot can happen in a couple of days, let alone 6 weeks.
The exception to this rule is the home birth midwife. Home birth midwives usually see their clients several times between birth and 6 weeks, but only 3% of births in the US are attended by home birth midwives. The majority of other providers do not do visits before 6 weeks.
This is significant because one of the most well-known causes of postpartum depression is the lack of support.
Both birth and postpartum doulas are in a unique position with a mother. Doulas can come and visit a mother to provide support, but they can also be a perceptive eye in this sensitive time. A doula sees the mother in her own home, in her element. Even though birth doulas generally do not to postpartum doula work, most birth doulas tend to stay in touch with their clients long after the birth. They can be a source of emotional support, and they can provide resources for professionalhelp and support should it become needed.
In theory, a postpartum doula can help prevent postpartum depression. We know that postpartum depression can be caused by stress, breastfeeding problems, emotional demands, or lack of support. We also know that the postpartum doula helps support all of these issues. When she hires a postpartum doula, a new mother does not need to juggle the demands of the household, worry about meals, or handle the housework. She can get adequate rest too since the doula helps the mother make sure she is getting some sleep. A postpartum doula can help reduce stress in an indescribable way.
If you think you may be experiencing Postpartum Depression, it’s so important to talk to someone. It can be managed in a number of ways that range from additional support to herbal supplements to medication. You must know that you are no less of a mother because you are struggling with postpartum depression – there are 3 million known sufferers in the US alone. You do not need to suffer in isolation.
For more information, check out these resources:
Preferred Counseling / Support Groups
Alexia Johnstone, LMHC
Mental Health Counselor
Expressive Arts Therapist
Mara Acel Green LICSW
Massachusetts Postpartum Depression Treatment
Boston – Massachusetts General Hospital’s Center for Women’s Mental Health
Boston – Brigham and Women’s Hospital Women’s Mental Health Program
Boston – Judith Robinson MD, Tufts Medical Center
Boston- Vivian Halfin MD, Tufts Medical Center
Cambridge – Laurie Ganberg LICSW
Cambridge – Suzan Wolpow LMHC
Lexington – Ellen Hilsinger MD, 781-863-5225
Roslindale – The Leggett Group
Somerville – Vicky Reichert LMHC
Wakefield – Janice Goodman
Waltham – Jewish Family & Children’s Services PPD Support
Waltham – Jessica Foley MA
Watertown – Mara Acel Green LICSW
Wellesley Hills – Deborah Issokson PsyD
Westborough – Carolyn Chapman MSW
Worcester – Univ. of Mass. Medical School Women’s Mental Health Program
Worcester – Birchtree Psychology, Rachel Smook PsyD
For more PPD specialists in Massachusetts, visit the North Shore PPD Task Force’s provider list
If you are seeking therapy offering a sliding scale fee based on income, or free counseling services, you might try: La Alianza (Boston, Roxbury)
How Can Hypnosis Help You In Labor?Of the most popular birthing approaches today, hypnosis is gaining ground as an effective tool to use during labor. While anyone can use general hypnosis, the method that teaches how to use it in labor is called Hypnobirthing. I am not a hypnobirthing instructor, but as a doula I have worked with women who have used it in labor and found it helpful.
In my last post on hypnosis for birth, I described the foundational psychology behind hypnosis. Before reading on, I encourage you to take a look at it! You can read it here.
So, how can we utilize this tool in labor?Well, to start with, consider this: a woman is already experiencing a type of hypnosis in active labor anyways – without even trying to be!
You see, when a woman starts active labor, her thinking brain shuts off and the primal brain takes over. It’s one of the ways that birth professionals can identify that a woman is in labor: can she answer a basic question? If the answer is no, or if it takes considerable effort for her to do so, she’s likely in active labor.
Her mind is already in a sort of hypnosis – it’s deeply relaxed and the subconscious is at the forefront.
How do I mean?
Hypnosis is essentially just a mental state of being. In hypnosis, your mind is deeply relaxed, and your subconscious mind is especially vulnerable to suggestion. This is exactly what is happening in labor as many women can attest!
Women who have experienced natural labor report that labor feels very mentally hazy – like a fog of sorts. They have no concept of time, they cannot hold a conversation, and they don’t know what they want. As soon as they start pushing, the fog lifts a little bit and they can converse and engage a little better. Then, as soon as the baby is born, it’s all over and instantly they are back to being themselves.
A woman’s subconscious mind is highly receptive during labor. In a very real way, intentional language and messages can go a long way toward sustaining a labor. The body responds to the mind – and the messages that we give it truly matter. The impact that these messages have is heightened when in hypnosis and deep focus.
A woman can give her mind specific messages about labor that help her with the entire process. We call these affirmations.For example:
And these messages can carry a mother through her labor.
The big question most mothers have is: Will it help with the pain of labor?
Well, it certainly can. I’ve seen it be a great tool for this use. However, it’s important to note that a mother should never feel that she has somehow “failed” if she prepares to have a pain free birth through hypnosis and ends up feeling the intensity of her contractions.
That said, does hypnosis help a great number of women with pain management?
Hypnosis for labor is most effective if a mother has been practicing its use as long as possible during her pregnancy. She can intentionally give her mind the message that birth is safe, normal, and attainable. As she practices saying affirmations,listening to relaxation scripts, learning to intentionally read her body for areas of tension, and visualizing her birth, she prepares her mind and body to relax in the same way during labor.
Furthermore, it’s entirely risk-free. Hypnosis in birth is simply strengthening, taking advantage of, and honing in on a natural process that is already in place during labor: deep focused relaxation. There are no risks associated with that!
In order for hypnosis to be truly effective in labor, the choice of one’s words matters quite a bit. We will cover that in our next installment on hypnosis for birth.
Hypnosis For Birth: What IS It?
In recent years, a number of birthing “methods” have come into vogue. Clients ask me all the time about my thoughts on the Bradley method, Lamaze, and hypnobirthing all the time.
The last of that list usually strikes a chord of curiosity with most people. Hypnobirthing = hypnosis and birth? It certainly sounds intriguing and trendy, doesn’t it? But what is it really – and does it even work?
Furthermore, what does it mean to say that a birthing method “works?”
First, let me preface by saying that I do not believe there is any “one method” of birth that is best for every mother. No single method will work for all women.
But all methods will work for some women.
And herein, education is critical. You see, I believe birthing women should learn as much as they can before and duringpregnancy in order to prepare for birth. This is because you do not know what is going to work best for you until you are in the middle of labor! And that’s decidedly NOT the time to try and educate oneself!
So with that in mind, education is my primary intent with this series.
I am not a hypnobirthing instructor, and I’m not affiliated with the Hypnobirthing organization at all. Still, I have worked with mothers who chose hypnosis for birth as their preferred method of birthing, and it has several wonderful benefits, and for that reason, I think all pregnant women should learn about its benefits as a part of their childbirth education.
So with that in mind, let’s start with some background: What IS hypnosis?
Or rather, what is hypnosis NOT? It’s not surrendering of one’s will, it’s not manipulation, and it does not involve losing control over oneself.
Rather, in the most basic of terms, hypnosis is simply a normal state of being. It’s intense focus. It’s tapping in to our mind’s ability to direct thoughts to influence our body and subconscious mind. Really, that’s what it comes down to.
You see, your mind is an unspeakably powerful thing. In particular, the subconscious mind is the driving force behind all that we do. We may think our thinking mind is in charge, but in reality, it’s our subconscious mind that shapes our reality. And yet, our thinking mind is what gives our subconscious mind all the tools and information it needs to do just that.
The subconscious mind is incredible because it does not discriminate. It simply receives messages and drives our actions (and bodies) accordingly. And it affects what happens to us WAY more than we even realize.
In addition, the subconscious mind does NOT work in negatives. It only receives the messages it sees and / or hears. Let’s use a non-birth example to illustrate this. If you tell your mind NOT to think of a pink elephant, what image comes to mind?
That’s right: the pink elephant! Now try this: Picture an orca. Did the pink elephant disappear? Yes it did. So it is with the messages that we send our brains.
If you are preparing for your labor, and you intentionally think about NOT having pitocin during your labor, what is going to happen? Conversely, if you picture having a normally progressing labor and a healthy contraction pattern, there is no room for pitocin!
In hypnosis, as well as any other childbirth preparation method, intentional focus on the desired outcome is encouraged rather than fixation on fears. Because when you’re fixating on the fear – let’s say it’s the pink elephant – that is the only message that your mind is being given about your birth!
That’s not to say you shouldn’t talk through your apprehensions or concerns – it just means that you should also be intentional about the messages that you are giving your mind! Because the mind controls the body – and there is no greater place that this is proven true than in birth!
For instance, I know a doula who told me a story about a client of hers. The doula noticed that this particular client was rather self defeating with her speech about her upcoming birth. Though the doula tried to encourage her, the client would consistently say things like:
And every single one of those things came true. Every one of them, down to the last detail.
Conversely, we’ve seen scores of mothers who have had intentionally positive self talk experience birth exactly the way they envisioned with tremendous outcomes!
The body is only responding to the messages it’s been given. And there is no place quite like birth where the unity of the mind and body are so apparent to observers.
Now, please understand that hypnosis is far more than self talk. But it’s most effective as a birthing method if it’s started long before the birth even arrives. Mental preparation for birth is over half the battle, and nothing can quite prepare the mind for birth as much as intentionally visualizing what you want from your birth, and giving your mind and body the exact messages you want it to have.
Also, please understand that sometimes things don’t go the way we intend, and that is okay too! But you’re sure setting yourself up for success by going in as prepared as possible.
Hypnosis is preparation, but it’s deep relaxation and focus as well, and we will touch on that in Part 2 of our series on hypnobirthing: How Can Hypnosis Work During Birth?
Of all the thing on your to do list after having a baby, resuming sex with your partner can understandably fall pretty low on the priority list. Between your fluctuating hormones, your healing vagina, your needy baby, your fatigue, and your lack of personal lubrication, sex can feel more like a chore than the pleasurable experience it was once upon a time. So here are a few short thoughts on resuming sex after baby.
Take it easy.
Your first few sexual encounters after having a baby should not be an all out party. Vaginal stitching (if you have it) can take several weeks to heal, and your partner should be very gentle on you until you feel you can handle a more rigorous encounter. Cesarean scars can take a couple months to heal, so be creative about positioning so that you can be safe.
Things may feel different.
Your hormones change the way that you experience everything, including physical sensations. If you are breastfeeding, your breasts may feel particularly tender. This may be a good thing or a bad thing – either way is normal! During birth, the pelvic floor gets stretched and slightly weakened, so penetration may feel slightly different. Differently is ok – and it can even be exciting!
Kegels can help.
As soon as you start to feel ready, start practicing Kegels. With the pelvic floor slightly weakened from pregnancy and birth, Kegels can add tone that can make sex more comfortable and pleasurable.
Tell your partner if something is not working for you or if it is causing you pain. What worked well for you only a few weeks ago may now be uncomfortable. Make sure you are communicating a lot during the postpartum phase as your body adjusts to a new normal.
Don't be afraid to lubricate.
In the postpartum period, hormones suppress a woman’s ability to self-lubricate, particularly if you are breastfeeding. That does not need to slow you down – just use what tools are available to you and make the best of it!
If you had stitches – either vaginally or from a cesarean, they can take several weeks to heal. Sex can still be resumed during the healing time provided you are able to be comfortable. Trying different positions during this time can be helpful.
There is no "expected time."
There is no “expected time” that a couple should resume sex. If you are comfortable a couple weeks after birth, go at it! If you are still 8 weeks (or more) after birth and still not feeling ready to resume sex, that doesn’t mean that something is wrong with you. The first several months with a new baby are incredibly challenging and if intimacy is slow to start, that is ok.
Make the best of it!
Sex after baby can sometimes be new and confusing – sometimes even comical. Laugh through the adjustments as you and your partner figure things out!
Some women experience pain during intercourse in the postpartum period. Some of this is normal, particularly as stitches are healing, but pain should not last for several months. If you are experiencing pain during intercourse after baby, the best person to visit a woman’s physical therapist. A woman’s physical therapist is an expert at the female pelvis, its ligaments, muscles, and complications with it. A woman’s PT has the best tools to find what it is that is causing your pain and help you correct the problem.
Do what works best for you and your partner. During the postpartum and newborn phase, be flexible and patient with yourself. In time, your sex routine will reach a balance with the rest of your new life with baby.
Consider this: child birth is the one and only time in your life when you will be admitted to the hospital – completely healthy. Birth is normal, and labor is not an illness, so you are not sick or diseased. You’re just having a baby. Yet, from the time you walk through the door at triage, you may be subjected to an avalanche of procedures, tests, monitoring, and interventions. In the age of information, it’s no surprise to anyone that many interventions in childbirth are overused, many times to the detriment of mothers and babies.
Before I continue, please don’t misunderstand me – I’m not saying that interventions are bad. They are designed to be used when necessary, and they certainly can save lives. Medical interventions are tools – nothing more.
However, evidence shows that the use of interventions during childbirth increases the risks of complications. In fact, as soon as a woman is given an intervention or drug of any kind in labor, she is automatically considered high risk.
If you are not sick, but risks are real, and your body is doing something completely normal doesn’t it make sense to have fully informed consent prior to accepting a procedure that will interfere with a normal, healthy process?
Most would give a resounding yes to that question.
So what is informed consent?
Wikipedia (not that I am stating Wikipedia is in any way a reputable resource…) defines informed consent as such: Informed consent is a process for getting permission before conducting a healthcare intervention on a person. A health care provider may ask a patient to consent to receive therapy before providing it.
The “process for getting permission” portion of the definition should always – always – include a discussion about the benefits, risks, and alternatives available. You can’t have informed consent without all of the information – the good and the bad, the alternatives, and a discussion about what would happen if you do proceed by doing nothing.
This is what informed consent would look like for Pitocin: “I’d like to start some Pitocin on you. I believe it is important because your water has been broken for 18 hours. At this point, your risk of contracting an infection starts to climb and I would like to do my best to make sure you have a vaginal delivery without any infections. If you were to develop a uterine infection before the birth is imminent, we will need to perform a cesarean because an infection can be very dangerous for you and especially for the baby.”
“Pitocin is a drug that mimics your body’s own oxytocin, though not perfectly. It will likely make your contractions stronger (and/or closer together) to encourage the birth to come a bit sooner. Because it isn’t exactly like oxytocin, your body’s own coping hormones won’t be as high, and you may experience more pain with your contractions.”
“The risks associated with pitocin are: we don’t know how your body will respond to it, and it could hyperstimulate the uterus. If this were to happen we would just shut it off. Because pitocin makes contractions stronger, it can cause the baby to go into distress. Babies who have been subjected to pitocin often times have lower APGAR scores, a higher risk of heart abnormalities, central nervous system damage due to lack of oxygen, and a higher risk of developing jaundice. In rare cases, death can occur, as with any drug.”
“For alternatives, you can try nipple stimulation, walking, and other natural augmentation methods that are available. What would you like to do?”
NOT informed consent: “I’d think we need to start you on some Pitocin. Your water has been broken for 18 hours and your risk of infection is higher now. I’ll have the nurse get it started so you can have your baby in arms!” And if you say nothing, silence implies consent.
Informed consent is NOT “I inform you, and you consent.” Furthermore, any discussion about informed consent also needs to include a discussion about informed refusal. Informed refusal simply states: “What are the risks associated with my choosing not to accept this procedure?” There is a flip side to every coin and consent also includes the right to refuse.
To simplify informed consent, refer to the BRAINED acronym:
Benefits – What are the benefits to having this procedure done?
Risks – What are the known risks?
Alternatives – What else can we do to manage this situation?
Intuition – What does your intuition say?
Nothing – What happens if we choose to do nothing?
Evidence – What does the evidence say?
Decision – Remember that your decision is your own and nobody but your lives with the consequences – good or bad. Own it.
So how does a mother get as much information as possible so that she can be fully informed going into her birth? How can she be sure she is truly informed?
Can the doctor do it? Statistically, OB appointments between doctor and pregnant patient are only an average of 5-7 minutes long. If a woman sees her doctor a dozen times prior to her birth, that is only about an hour of time they have spent together. Can an OB possibly explain everything a birthing woman needs to know in an hour over the course of many months? I think the answer is obvious.
Midwives spend considerably more time with their clients (30 minutes – 1 hour) at each appointment. However, these appointments are dedicated health monitoring prenatal visits and birth planning, not childbirth education.
As for birth doulas, we do 2-3 prenatal visits that are an hour or so long. Certainly we can’t give you all of our training’s worth of information in 3 hours!
Doulas and childbirth educators go through many hours of training and instruction on birth prior to certification. There is a lot to know about the birthing process and available options for women today. A dedicated independent childbirth education course will provide you with the most information you need to be fully informed. Independent educators can teach about scopes of practice, alternative protocols that are oftentimes used for various procedures, models of care, and many more crucial topics. Childbirth educators could easily make their childbirth classes a semester’s worth of daily instruction, and still feel like they didn’t give you all the information you could use.
Hospital based childbirth education classes are really good at explaining what is available in their facility and what to expect during certain procedures. They cannot explain or offer alternatives to the facility’s available interventions and procedures because hospitals do not offer those things. Furthermore, the majority of childbirth education classes at hospitals are not taught by certified childbirth educators – they are taught by OB nurses. OB nurses are WONDERFUL at what they do. They do not, however, have training in alternative protocols, models of care, alternatives to hospital protocols, or natural methods, so they cannot teach you those. This does not make hospitals bad at all – they just can’t teach about what they do not offer or do. They are a medical facility – they practice medicine – and we are grateful that they do.
To make sure you have as much balanced information as possible, an independent childbirth education class is going to be your best bet. As a birth doula, I have access to local resources for independent childbirth education that I’m glad to pass along to you.
Informed consent means choosing to be informed. Do everything you can to be fully informed prior to the onset of labor, so that you will understand risks, benefits, and alternatives before you even arrive at your birthing facility. That helps to make your labor easier, and your provider will appreciate knowing that you know exactly what you are choosing. Ultimately, the decisions you make are yours and nobody else. Make sure they are the right ones for you.
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Home Birth vs Hospital Birth
Please note: This post is not meant to sway clients one way or the other in terms of their childbirth choices. As a doula, I support women no matter what they choose. I simply wish to shine some light on some observations I’ve noted about the various options that women have for their births.
Each woman is different, and each birth is different. Most of the births I have attended have been in hospitals. I’ve worked with some incredible hospital births. Most go swimmingly, and I’ve seen women have wonderfully empowering experiences there.
On the other hand, I’ve been a firsthand witness to the effects of interventions. Most of the time, medical birth interventions, despite their legitimate risks, are overall safe and usually well managed.
However, I’ve seen the effects of invisible passive interventions as well. The clock is a perfect example of a passive intervention, and its effects are very real.
“Textbook birth” happens in one place, and one place only: the textbook. The range of “normal” in everything related to birth is vast, yet most hospitals tend to confine “normal” down to a rather narrow window. Women tend to be “allowed” to labor for “X” number of hours, they can push for another “X” number of hours, and the placenta must come within another “X” amount of time.
I see something very different in home births.
Homebirth midwives respect the birth process too much to restrict it down to a fixed series of allowable proceedings. They understand that the body can start and stop labor, that some phases can go unusually quickly and others can take longer. Midwives do not define labor by a set “allowable” time since their practice is not governed by a hospital’s rigid status. As long as the mom and baby are both doing well, labor is respected and permitted to take its course. When a stage of labor takes longer than normal, midwives carefully watch, listen, monitor medical safety, and let the birth proceed as usual.
Which begs the question: how does the hospital differ? What do they do when labor doesn’t always go according to the allowable textbook timeframe? In my experience, most normal, healthy women are given a myriad of interventions to force the process along, and many ends up in the OR with a cesarean. They often refer to the Friedman’s Curve as a guideline to call an “arrest in labor” and a need for a cesarean. I do see differences between hospital to the hospital due to policy and provider to provider due to their experiences, but for the most part, cesarean for Failure to Progress according to the textbook definition of the Friedman’s curve is really happening and many times unnecessary.
Birth interventions are known to increase the risk of cesarean so this is not surprising. However, it can be devastating to women who truly wanted to experience birth, or who were frightened of having a cesarean.
I talk to a lot of women that want to hire a doula so that they can avoid the operating room – they want to avoid having a cesarean. Doulas absolutely do reduce the incidence of cesarean for many reasons. However, my encouragement for women that truly desire to impede the risk of cesarean is to carefully consider your provider. Hospitals are wonderful places for the most part. But one cannot accurately predict exactly what their birth is going to look like beforehand. If your desire is to avoid the OR, perhaps it’s time to consider other options.
The hospital is not your only option. It can certainly be a good option, but it is not your only one. A new study on home birth safety concluded childbirth at home with midwives in the US to be a safe option for low-risk pregnancies. I encourage you to consider exploring all of the available options during your pregnancy. You can always switch your provider – up until the moment you go into labor! Read Care Providers in Pregnancy to learn more about the difference in providers. If you are considering home birth, contact me for some great referrals and care in Massachusetts!
I support you no matter what you choose – just make sure that the choice you make is for sure the right one for you.
Teething is an exciting time when your baby starts growing up and forming his or her mouth. However, it can be an uncomfortable situation that affects the baby’s sleep and yours. Here’s how:
It Causes Pain
Dentists say the most prevalent of the signs of teething is the pain. It hurts for a tooth to erupt through the gums. Just talking about it can feel painful. Teething hurts for adults too, so your baby is likely to fuss and have trouble sleeping because of the soreness. Teething rings can help with the pain. The cold feeling that they get when they chew on the teething rings is quite soothing. You can also purchase some numbing agents that you can rub on the baby’s teeth, as well.
The Baby’s Temperature May Rise
Researchers explain that the teething process may also slightly raise the baby’s temperature, which will also make him or her uncomfortable. Your little one may have trouble sleeping because of that, as well. However, teething will only elevate the baby’s temperature a little bit. If you notice a massive increase in your child’s temperature, he or she may be sick. The illness probably has nothing to do with the teething if the temperature is above 101.
It May Cause Irritability
Irritability is another sign of teething that may affect your little one’s sleep. The baby may cry a lot during this time because of the pain and discomfort. According to children’s medical experts, your child may also be angry and seem generally fussy during the entire time. Teething has a variety of symptoms that will affect a child’s sleeping patterns. Irritability is just another one of them. You can try to use love and comfort to combat the problems with irritability. For example, you can embrace him or her for a little while or sing a warm song to help calm the child down.
Your baby may be generally restless during the teething process without any accompanying symptoms. He or she may just have difficulty falling asleep. The teething period is just a trying time. Parenting experts explain, trying to distract the child or giving them something cold can help them relax enough to fall asleep. Patience is a necessary skill while a child is teething because most of the time there isn’t anything that you or your child can do but wait it out. It will pass, it will end, it just takes a bit of time, so hold out until then. That being said, playing some soothing music in conjunction with a cold treatment may help the baby to fall asleep faster.
Those are some of the ways that you can tell that your baby is teething. Be patient and loving, and this difficult stage will pass. Your baby will come out of it with the most gorgeous teeth ever.
If you’re looking for more information on infants and other small children, make sure to check out our blog!
Positively PregnantYou just haven’t felt yourself lately. Your breasts are tender, you feel tired, bloated and your heart seems to be working over time. You may even be feeling that you are coming down with something.
Wait. ...When was my last period??
You grab a pregnancy test at the nearest pharmacy and head home in anticipation. Is this it? You wait anxiously for the 2 minutes to creep slowly by as you watch the test window like a hawk preparing an attack on it’s prey…
You rub your eyes in shock and take a closer look…
…Well, now what?
It’s hard to know where to start! Here are some clear cut first steps to take as you prepare for your journey into pregnancy.
1. Call your Primary Care Physician.
Check in with your primary care physician to confirm your pregnancy with a blood test. When you talk to them, make sure to check about your current medications to see if you should still be taking them.
2. To Share or Not to Share? That is the question.
And there is no right or wrong answer. It can be incredibly hard not to tell your friends and family as soon as you find out you are pregnant, but I recommend trying not to post it to social media just yet – at least not publicly. Allow yourself some time to mentally adjust to the pregnancy, the upcoming birth, and the life changes that are soon to follow.
Some decide to keep their newly developing baby a secret for fear of a miscarriage. Or, they will decide to tell only a select few close family members or friends until the first trimester is over. The pregnancy is most vulnerable during the first 12 weeks, and after the first trimester, the chance of a miscarriage drops dramatically (down to 10% of all known pregnancies). If you decide to wait for this reason, that is just fine.
And if you decide to announce your excitement to the world, that is fine too! Just make sure you do what you really feel is best for you.
3. Call the Midwife!
Or OB/GYN. Ask friends and family for recommendations for local recommendations if you do not have a prenatal or women’s care provider. You will want to know which OBGYNs and Midwives worked best with their patients and provided satisfactory experiences to women. Google their names and see what you can find out. We can also help to match you up with a care provider that may be suited to you best.
Choosing a primary care provider is likely one of the most important decisions of your entire pregnancy and you don’t need to determine who you’d prefer to work with right this very minute. Keep in mind that you are hiring your provider to provide you a service, so at the end of the day, you are in charge.
Like an apple a day, daily supplements can help give your baby the best start.
Ask your provider or general care doctor for a prescription for a prenatal multivitamin, preferably with DHA Omega -3s. Many medical insurance companies will cover prenatal vitamins in full, although fewer will cover a prenatal with DHA – the building block for the development of the brain, eyes and heart. Don’t waste your money on over the counter vitamins if you don’t have to. Check with your insurance company to see what they will cover.
Folate is a supplement essential in DNA production, repair, and function. Studies show it can help prevent neural tube defects of the spinal cord and brain – such as spina bifida or anencephaly when taken before pregnancy through the first trimester. Some research suggests that folate may help lower your baby’s risk of other defects as well, such as cleft lip, cleft palate, and certain types of heart defects.
Research supporting Vitamin D’s role in immune function, healthy cell division and bone health has been released(1). Vitamin D is necessary for the absorption and metabolism of calcium and phosphorus. Many studies are finding a connection between low serum vitamin D levels and an increased risk of certain types of cancers, autoimmune disease, neurological disease, insulin resistance, and cardiovascular disease.
There is so much to know! DON’T WAIT until you are at the end of your pregnancy to research your pregnancy and birth options, and I encourage you to read evidence-based information.
Evidence based information:
Websites: Childbirth Connection, Evidence Based Birth, Birth Without Fear, Spinning Babies, and Mama Natural.
Books: Ina May’s Guide to Childbirth, Spiritual Midwifery, The Birth Partner, The Thinking Woman’s Guide to a Better Birth
Documentaries: The Business of Being Born I & II
Steer Clear of:
Websites: theBump, WebMD, BabyCenter, Parents.com, What To Expect and of course, Facebook.
Books: What to Expect When You are Expecting, Your Pregnancy Week by Week, Becoming Baby Wise
TV: A Baby Story
Many women experience lethargy during the first weeks of pregnancy. It’s hard growing a baby; Your genetic map is being encoded and using the building blocks to create a little human and it’s nurturing placenta. So don’t apologize for allowing yourself to get some rest – you need it.
7. Seek a Doula
It’s never too early. A doula is not a medical professional but can help you navigate choices in the confusing medical world. She can share evidence-based education to help you prepare for your birth. Many times as doulas, we hear “I wish I had you to talk to from the day I found out I was pregnant! Why did I wait so long?!”
Take a look at Improving Birth’s Fact Sheet on Doulas.
Congratulations on your pregnancy!
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