Friday, January 31, 2014

Surviving the Last Weeks of Pregnancy

1.  Reframe the idea of a “due date.”  Your due date marks 40 weeks from your estimated last period; it doesn’t necessarily mark the end of pregnancy.

Key Points to Remember:
·       Normal gestation ranges from 37-42 weeks (and in some cases longer).
·       Average gestation for first-time mothers is 40 weeks + 5 days.
·       Babies are not considered post-term (overdue) until after 42 weeks, not at 40 weeks.
·       Due dates can be off by several weeks, even with early ultrasound estimates.
·       Women are mammals, not machines or textbooks. Variation is natural and
normal, and there is no magic timer to indicate when your bun is done cooking!

Strategies to Help You Deal:
·       Rather than a due date, think of it is your “due month.” Let people know you’re due “towards the end of April” rather than April 17.
·       Expect to be pregnant until at least 41 weeks. That way if baby comes earlier, it will be a pleasant surprise, and you won’t be phased if your due date comes and goes and you’re still pregnant.
·       Read/listen to daily affirmations that recognize your baby’s and your body’s wisdom, knowing that baby will come when the time is right.
·       Read positive birth stories of other women who had longer gestations. 
·       Come up with a list of projects to do to distract yourself during those last weeks.
·       Give yourself permission to turn off your phone and ignore emails and Facebook if you start getting the “You’re still pregnant????” messages. Or refer friends and family to
·       Schedule a date with your partner or a pampering day of massage for yourself near or even after your due date. (Babies love to interrupt that kind of thing!)

2.   Do what you can to stay comfortable. Trouble sleeping? Check. Waddling? Check. Braxton-Hicks contractions? Check. Welcome to the end of pregnancy!

Strategies to Help You Deal:

·       Fatigue:
o   If night waking is bothering you, try alternate nostril breathing, meditating, or listening to relaxing music to help you go back to sleep. Take naps in the day if possible.
o   Try not to stress about whether or not you’ll have energy for the big day. Know that your body will provide all the hormones needed to get you through it!
o   Think of this as excellent preparation for caring for a newborn. Your little one will likely wake every 2-3 hours to eat during the first weeks (or longer). You will be ready!

·       Aches and Pains:
o   Keep your body moving! This will not only help ease the discomforts of pregnancy, but will also help prepare your body for birth. Choose a couple of the following easy activities to do every day:
§   Walking. Even 15 minutes a day, twice a day, makes a difference!
§   Do hip circles while you brush your teeth. Bend your knees slightly, and place your feet hip-width apart. Move your hips around in a circle or figure 8 as slowly or quickly as you like, being mindful to go both directions.
§   Trade in your chair for a birth ball. Use it while watching TV, at the dinner table, even at your desk. You can bounce on it and do hip circles if you like, but even just sitting on it gently exercises your core muscles and promotes good posture, which helps your baby position herself for birth.
§   Spend time on your hands and knees every day. Practice the cat-cow yoga movement before bed (more throughout the day if you like!), scrub the floors, crawl after a toddler, etc.
§   Do a few squats each time you shower, and get in the habit of squatting throughout your day instead of bending over when you pick things up*.
§   If you are motivated and able, activities like prenatal yoga, swimming, and bellydance are also excellent ways to help prepare you physically for birth.

o  Consider visiting a chiropractor if you have any of the following:
§   Persistent back, leg, or pelvic pain. (Note: Lower backache is very common, and often alleviated by cat-cow).
§   You feel that when you walk, one leg moves much differently than the other (such as a limp or another awkward movement).
§   You have had a prior Cesarean due to baby’s position (breech, posterior, asynclitic) or failure to progress.
§   You have previously injured your pelvis.

·       Frequent Braxton-Hicks contractions:
o   Be sure to stay hydrated. Drinking water and lying on your left side will sometimes slow or halt these contractions.
o   Take a warm bath. This can also slow things down. If it’s the real thing, labor might speed up!
o   Use Braxton-Hicks as a way to practice your coping techniques, such as deep breathing, position changes, visualizations, etc. One simple practice is to relax your jaw by making the “haaaa” sound (like a deep sigh), visualize your cervix opening, and repeat a mantra in your mind like “open” or “welcome baby” or “relax” each time you have a contraction.
o   Erase the words “false labor” from your vocabulary—there’s nothing false about it! Know that these practice contractions are getting work done, whether by strengthening your uterus, changing the position or consistency of your cervix, or bringing baby into a better position. The more work your body can get done before labor, the better!
o   If contractions are not letting up and lasting over several days but not leading to dilation (prodromal labor), consider that baby’s position or cervical scarring might be an issue (see below).

3. Address any emotional or physical barriers to birth. While there are many natural “induction” methods, these often do not lead to labor unless baby is ready to be born. But occasionally, a baby that is ready to be born might be held up by emotional or physical barriers that you can address.

Strategies to Help You Deal:
·       Scan your emotional/psychological state. Do you have any nagging fears or concerns? These may not even be directly related to the birth, but might be about your financial situation or worries about motherhood, for instance. Stress hormones hinder the process of labor, as your primal brain needs to feel safe and secure to do its job. To address this:
o   Do a fear release exercise, alone or with your partner.
o   Air out any submerged relationship issues with your partner that are sources of insecurity or doubt.  
o   If there are issues with other family members (such your sister feeling uncomfortable with your birth choices, for example), you will have to decide whether or not it will be productive and healing to talk with them, or if it will cause you more stress and be unlikely to change anything anyway. In that instance, writing a letter can be cathartic (whether or not you send it). Doulas are also great listeners – talk to us!
o   Crying and laughter are both great emotional and cleansing releases – give yourself the chance to do both.
o   Surround yourself with women who support and share your desires for your birth (whether physically, virtually, or through the pages of a book).
o   Do whatever works for you to keep you feeling calm and confident, whether listening to affirmations, meditating, practicing yoga, praying, or talking to a trusted friend.
o   Talk to your baby daily out loud or in your mind, letting her know that she is loved, welcome, and that you are ready for her. If this feels awkward at first, it will likely become easier with practice.

·       Address any position-related issues that might prevent labor from starting on its own. Sometimes even a subtle misalignment prevents baby’s head from putting adequate pressure on the cervix to get labor going. Medical inductions that begin with a misaligned baby many times end in Cesarean. To promote proper positioning:
o   Choose sitting and resting positions that bring your belly forward – sleeping on your side (preferably left) while tilting your belly slightly down towards the mattress (with lots of pillows for support); sitting on a birth ball; avoiding slouching or leaning back (in the car, couch, armchair, etc).
o   Get on your hands and knees as often as you feel comfortable (adding cat-cow if you like), especially when you feel baby active.
o   Walk up and down stairs (two at a time if it feels good and you can do it safely). Alternatively, walk down the street with one foot on the curb, and one on the street (be sure to go both ways!). Creating asymmetry in the pelvis makes more space for baby to negotiate and find the best position.
o   Do hip circles.
o   Go swimming, using belly-down strokes (breaststroke, freestyle, side-stroke).
o   Consider visiting a chiropractor trained in the Webster technique.
o   Ask your doula to do some rebozo sifting or the side-lying release.**

·    Consider whether cervical scarring might be an issue. If you’ve ever had a LEEP, D&C, or other cervical procedure, scar tissue can sometimes form and prevent dilation. (Signs would be prodromal labor with little to no dilation despite significant cervical thinning/effacement). The good news is that your provider may be able to "rub out" the scar tissue in early labor.

·    Encourage the production of oxytocin (the love hormone, and the one responsible for starting contractions) through any of the following: cuddling (with your partner, children, even a pet!), hugging, holding hands, laughing, massage, sex, orgasm (with or without sex), watching a funny or emotionally compelling movie, spending time with friends and family, and singing, dancing, or exercising with others.

4.   And most of all…. be patient! Easier said than done, no doubt about it. But truly, baby will be in your arms before you know it. And patience is something that all parents need in astronomical quantities—might as well get a head start on practicing it now!
Good luck. =)

*Note: Only practice deep squats after 36 weeks if you are sure that your baby is properly positioned – head down, facing your back (anterior). Avoid squats if baby is suspected to be posterior, if you’ve had a prior Cesarean related to baby’s position or failure to progress, or if you have unusual pains in your pelvis, back, or legs that might indicate a pelvic misalignment.
**See for more information about these techniques.

Thursday, October 24, 2013

What is a Doula? Doula FAQs Part 1

  1. What is a doula?
  2. What are the advantages of hiring a doula?
  3. What does a doula actually DO during a birth?
  4. Will having a doula take away from my partner’s role in the birth?
  5. Is a doula the same as a midwife?
  6. My doctor wants me to do x, but I want to do y. What do YOU think I should do?

1.     What is a doula?

A doula is a trained birth professional who provides continuous support to a woman throughout her labor and birth.

Photo credit: Peggy Loftis of Cherished Motherhood
Your doula gets to know you and your family prenatally to understand your birth preferences, and provide you with information as needed. After the birth, she makes several postpartum visits as needed to assist with breastfeeding and baby care basics. Mothers report that this continuum of care helps them feel so supported during this important life transition!

2.     What are the advantages of hiring a doula?

Numerous studies have reported the many benefits of having a doula, including:

  •     Reduced rates of all sorts of interventions, including Pitocin use (a drug used for labor induction/augmentation), epidural use, and Cesarean section
  •     Shorter labors and fewer complications
  •     Healthier babies and mothers
  •    Increased breastfeeding success
  •     Increased sense of satisfaction about the birth

My goal as a doula is for all mothers to begin motherhood feeling confident in themselves and satisfied that they made the best choices possible during their labor and birth. This is possible whether a woman has a natural homebirth, a planned Cesarean, or anything in between. 

Major factors in a woman’s feelings include how respected she felt during the birth, and the extent to which she felt she was involved in the decision-making—taking an active role rather than having things “done” to her. A doula can definitely help with this!

3.     What does a doula actually DO during a birth?

Doulas provide three basic types of support to the laboring mother (and her partner/family): physical, emotional, and informational. What that support actually looks like will be different for each mother and at each birth! But here are a few ways that a doula might support you:

    Physical Support

  • Creating a calm environment with lighting, music, and aromatherapy
  • Giving awesome foot massages during early labor to encourage relaxation
  • Using specialized massage and counter-pressure techniques to ease the sensations of active labor
  • Showing your partner how to support you using touch and massage
  • Suggesting position changes to speed labor, alleviate pain, and help baby find the position for birth
  • Drawing a bath that is just the right temperature
  • Refilling mom’s water cup; bringing dad a sandwich…and so much more!

    Emotional Support

  • Prenatally, helping you talk through your feelings to determine if your childbirth goals and actions are aligned
  • Offering you and your partner calm encouragement, reassurance and support
  • Reminding you that you CAN do it (and you ARE doing it!)
  • Providing compassionate and nonjudgmental support if your birth plan changes or unexpected situations arise
  • Assuring your partner (or mother or best friend) that “yes,” this is normal!

    Informational Support

  • Offering you the latest research about evidence-based practices when you are asked to make a decision
  • Helping you communicate with your care provider and nurses
  • Reminding you that it’s okay to ask questions about the benefits, risks, and alternatives before making a decision about a procedure

Is a doula still useful if a mother chooses an epidural, births by Cesarean, or is planning a homebirth? Absolutely! More on that below.

4.     Will having a doula take away from my partner’s role in the birth?

On the contrary! Part of the doula’s role is to enhance the bond between you and your partner and support both of you during this amazing and intense time. That can mean helping your partner learn some of the massage and counter-pressure techniques, showing him or her how to physically hold and support you in different positions, making recommendations about supportive language to use with a laboring mother, and more. It may even mean stepping out of the room to give you some private time together!

Studies show that women who hire a doula report greater satisfaction with their partners in the postpartum period, and partners report feeling more confident about their abilities to help during the birth. Birth is often a long and sometimes scary process for the partner, and it can be really nice to have a calm and reassuring presence with you!

5.     Is a doula the same as a midwife?

Nope! A midwife is a health care professional who provides medical care to women from conception through birth. She is qualified to deliver babies and do basically everything a doctor would, with the exception of deliver a baby by Cesarean.

Doulas do not provide medical care, give medical advice, or perform medical procedures. We provide physical, emotional, and informational support to a laboring woman and her family (see above).

6.      My doctor or midwife wants me to do x, but I want to do y. What do  
          YOU think I should do?

Good question—but unfortunately one that your doula can’t answer! Doulas do not provide medical advice or recommend medical courses of action. What your doula CAN do is:

  • Research a particular condition or procedure, and provide you with the latest information about it. However, it is up to you and your care provider to determine what is best for you in your unique situation.
  • Talk with you to help you uncover your own feelings, fears, and intuitions about a given situation to help you gain clarity.
  • Help you articulate your childbirth goals and evaluate whether your not your actions align with those goals. If they do not, your doula can help you come up with more realistic goals, or suggest that you consider different actions. For this particular question, an action might be to interview other care providers to see if their philosophy is more in line with yours.