Margot’s Birth Story

The first time I gave birth, I was induced one week past my due date. I was 0cm dilated, my cervix wasn’t softening, I hadn’t felt one single contraction, and it was a miserably hot end of July—I was DONE being pregnant. We spent 49 hours in the hospital before our baby was born and it took Cervidil, a foley bulb, Pitocin, an epidural, sleeping pills, 3.5 hours of pushing, a 3rd degree tear, and a vacuum to get her out. We were thankful to go home from the hospital with a healthy baby, but for weeks I would lay in bed, when I should have been sleeping, replaying the whole scenario over and over (and over) again. I knew that I wanted the next birth to be different.

Our first daughter was 13 months old when we found out I was pregnant again. I went to Target and bought both a pregnancy test and a big sister t-shirt. We had always dreamed of having two babies close together, and it was early enough that I didn’t even feel sick yet—just excited. Right from the beginning of my pregnancy, I was committed to doing whatever it took to avoid being induced again. Do you know how many articles are on the internet about inducing labor naturally? I have read every single one. I walked our one-year old to the park nearly every day of my pregnancy; I went to workout classes at the YMCA weekly. I spent basically all of my third trimester sitting on an exercise ball, I drank red raspberry leaf tea before bed, I begged my OB to tell me what I could do to avoid being induced at every single appointment. She promised me that even if I had to be induced again, it would be easier than the first time. I still went home and googled “ways to induce labor” for the thousandth time anyway. We contacted Rachael, our doula, at the end of the first trimester (after convincing my husband that, yes, it would be worth the money). I still joked to everyone that the baby’s due date was April 28th…or you know, the middle of May!

I am pretty convinced that there is some magic that makes the end of pregnancy last an eternity: If you have ever been overdue, you know that it’s true—somehow the days get even longer. I told everyone throughout my whole pregnancy that I was going to wait the full 42 weeks that my doctor would allow, even though every single person I know thought that was totally crazy. I had an appointment at 39 weeks where they did an ultrasound to check on the baby, and she was looking healthy and happy—she was not planning on coming out anytime soon. I was trying to come to terms with the idea that  I was going to have to be induced again (apparently I have the gestation period of a giraffe) while also trying to delicately balance believing that my body was capable of going into labor naturally.

Since I was committed to trying everything to naturally induce labor, as my due date came and went, I asked Rachael for some recommendations. I called an acupuncturist, and she told me that every pregnant client of hers (except one) went into labor within 5 days. I immediately made an appointment. Five days later: I was still very pregnant (although, for what it’s worth, I would 100% do the acupuncture again, even though it didn’t put me into labor. It was the most relaxed and in tune with my body I have ever felt).

Next, I made an appointment with a chiropractor, and made her promise at least 12 times that it was safe for both me and the baby before she did any adjustments. Then I made another appointment. And another. I tried EVERYTHING. Acupuncture. Chiropractor. More pineapple than any one person should eat. Spicy food, teas, essential oils. Walking and walking some more. Relaxing, exercising. Sex. Packing a hospital bag and unpacking a hospital bag. Pedicure. Making plans that I didn’t want to cancel because surely the baby would come then! Two membrane sweeps. Every night I would go to bed thinking, “Maybe tonight is the night!”. Then I would wake up in the middle of the night and think, “Maybe my water will break on the way to the bathroom!” But every morning I would wake up just as pregnant. And disappointed.

We scheduled an induction for two weeks after my due date. I was bummed. My mom came into town to stay with our one-year old. My husband and I went out for one last dinner and went to bed early to try to get some sleep. We woke up early the morning of May 11th, the day of my scheduled induction, to call and see if there were any labor rooms available. They told us to come in at 8:30am, so we went to Starbucks to get a “light breakfast” and made our way to the hospital—each minute felt like it was the equivalent of at least ten. It is such a unique feeling to know your life is about to change…but just wait 20 more minutes. We arrived at the hospital, calmly carried in our bags, and made our way to our room.

After getting an IV and filling out some paperwork, they immediately started with pitocin. I was 2cm dilated, and had been for the past couple weeks; so while I was thankful to jump right in with the pitocin, I was gearing up for a long day. We turned on Moana and I paced around our little hospital room. After 3 hours, my doctor checked my progress— I was a measly 3 centimeters. One centimeter in three whole hours!! She suggested breaking my water, and at that point, I was willing to do anything to get the process moving. I knew that during my first birth, once the doctor broke my water, the pain intensified quite a bit. but I was prepared for many, many more hours. After all, at this point I was still casually texting friends about House Hunters, not getting ready to push out a baby.

Once my water fully broke, about 30 minutes after my doctor left the room, the contractions became quite painful. My husband thought we should have Rachael join us, but I was so worried that we would have her come too early. I texted her, and she arrived at the hospital about an hour later, around 2pm. By the time Rachael got there, the contractions were much more painful. I was holding on to my husband, still trying to stand and walk around, but during the peak of contractions I was unable to walk or talk. I didn’t take any classes during either of my pregnancies that talked much about pain management, so Rachael offered suggestions for more comfortable positions. She was calming, knowledgeable, and exactly what I needed.

I didn’t want to get an epidural yet because I was afraid of doing anything that might slow down labor, but by 3pm the pain was too much to bear. My husband asked me for the epidural code word that we had picked weeks prior,  but in the moment, I couldn’t remember. I’m pretty sure yelling “EPIDURAL NOW” made it pretty clear that I wasn’t joking. The nurse told us that the anesthesiologist had just gone in for a C-section and couldn’t be there for 45 minutes. After spending a couple minutes in our room, she went to find another anesthesiologist from another floor.

By this point I was laying on the bed: I could no longer stand because my legs were too shaky and I was worried I might fall. I felt like I had to go to the bathroom, but I couldn’t walk there. Really I was barely able to communicate anything at all because I was in so much pain. The contractions felt continuous and my entire body was overcome with pain. I felt tense and out of control and the idea of relaxing anything to let the baby come out felt completely impossible to me. I was desperately asking everyone to fix it. I started to feel the baby descend and I was involuntarily pushing, but I couldn’t communicate to everyone in the room what was happening. I was moaning “the baby, the baby,” to which my husband kept sweetly responding, “The baby is totally safe, you are doing a great job.” I couldn’t communicate more than more moaning, but internally I was yelling “The baby is coming out NOW!!!”

The nurse came back in and realized what was going on. She checked me and I was fully dilated—I hadn’t been checked at all since I was 3cm— and the baby was right there. They called my doctor, brought in some other nurses in case the doctor couldn’t be there in time, and I yelled/screamed/very loudly declared that someone else had to push the baby out—I couldn’t do it. My doctor ran in the room, told me to stop yelling, to focus, and that I most definitely would be the one to push out the baby. Six minutes later at 3:56pm, our precious 9lb baby was born, looking around calmly as if to say “What just happened?!” I laughed, started apologizing for all the screaming, and drank the most delicious apple juice of my entire life.

I always hoped and dreamed I would give birth without an epidural, but I rarely said it out loud because I didn’t believe that it was possible for me while also getting induced. I still hope that one day I’ll go into labor without pitocin, but for right now, all I know is that May 11th was one of the most wonderful, magical, and redeeming days of my life.

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Exercise and Pregnancy

Audra Wilson is a local mom and group fitness instructor at the Stephen’s Family YMCA. She has two kids; 5, 2 ½ and is in her third trimester with her third child. She has always been pretty active throughout her life. She was a gymnast for 10 years and became a cheerleader and pole vaulter in High School. Audra competed in college as a pole vaulter. After her kids were born she had a hard time finding a fitness routine that worked with her busy schedule, like most new moms. Then she found the YMCA, the group fitness classes with childcare and  the motivation she needed to get back into it. She fell in love with Bodyflow and decided to pursue getting certified to teach. She was also introduced to BARRE and decided get certified in teaching that as well. She currently teaches Bodyflow, Barre, and a Mommy and Me Yoga class. Audra is excited to share how she modifies the work outs for her during her pregnancy!

When it comes to pregnancy and fitness, many people have a lot of questions on what is recommended and safe, and what isn’t.  Knowing that I am not a healthcare professional, I don’t claim to have all the answers. With my fitness background, and research along the way, I feel I have gotten a better idea on what to expect when it comes to working out through pregnancy.

Talk to your healthcare provider about your plans for exercise during pregnancy. If you have been regularly working out pre-pregnancy it is safe to continue a similar routine. Continue to check in with your body and don’t be afraid to make modifications as necessary depending on how you are feeling. Things will continue to change throughout pregnancy so continue to be aware of how you’re feeling throughout a workout.

If you have not been in a routine of working out, pregnancy can be a great time to start up a fitness routine. Low-impact to moderate exercise is recommended. Exercise in pregnancy can help better prepare your body for labor and delivery and decreases your chances of complications that might come with it. Exercise can also prevent abdominal wall separation, (a condition that causes lower back pain and pelvic floor dysfunction), help regulate your babies birth weight, and have an overall positive impact on you and baby.

Here are some modifications you can make throughout specific group fitness classes.

Bodyflow/Yoga modifications

    Stand hip width apart instead of together in forward fold and standing strength (intense pose for example)

hip width intense pose

    Instead of crocodile and up dog you can do a cat/cow pose. On hand and knees, curve your spine and tuck your chin into your chest. Then arch your back and lift your chin up.

Cow pose

cat pose   

     Wiggle/move through stagnant holding positions. This will help prevent changes in blood pressure

    Avoid cross body twisting. Do an open twist during the twisting tracks of the workout.

open twist

    During core work, prop your body up using your elbows or arms behind you so that your heart is lifted and avoid laying flat on your back.  This helps maintain blood flow to your heart. You can lift and lower pushing off your arms or lift and lower your legs if you are on your elbows

core option b&w

    During back tracks, come to a horse stance on hands and knees and lift the opposite arm and leg for back stability and strength

Horse Stance with opposite arm_leg

    Be careful in stretching portions of class not to over stretch your muscles because the hormone released in pregnancy can loosen your joints. A good rule of thumb is to not stretch beyond what you were doing pre-pregnancy. Now is not the time to learn a yoga scorpion move! Sorry friends.

Use all the above modifications throughout any class in addition to these:

Bodyattack, Bodystep (recommended only if you previously have been taking these classes)

    Take lower impact options. Keep firm footing and lower your step risers for lower impact and prevent falling.

Bodypump/Lifting classes

    Raise/incline one side of your step for shoulder and chest tracks so you aren’t laying flat on your back.

If your belly is beginning to get in the way when you clean and press, substitute an upright row,  knee push ups, or come to a wall do wall pushups

Sha’bam/Bodyjam/Zumba/Dance classes

    Avoid cross body twisting. Listen to your body and take breaks when necessary.

RPM/Cycling classes

    Maintain similar routine, taking less resistance, breaks when needed, and avoiding standing positions when uncomfortable.

The following Les Mills classes are not recommended in pregnancy according to their website:

Bodycombat/Kickboxing

    Due to the joint instability it may cause

GRIT/Plyometrics Classes

    The intensity level is too intense

CXWorx

    Not recommended in the 3rd trimester because of the intense core focus that is difficult to avoid in this class

Along with that, drink plenty of water and wear loose clothing to avoid over-heating your body because your baby is unable to self regulate heat. Take breaks when you need to. Stay active and have fun!  Remember, pregnancy is a time for maintenance of the body…not a time to strive for big fitness goals! But, just because you are pregnant doesn’t mean you have to stop all working out. It is actually the best time to workout for your health and the baby’s! And don’t be shy. Ask your instructor on appropriate options and suggestions. They are there to help you! Don’t be afraid to try something new or continue the classes you had been attending. With these modifications you can get through any fitness class!

 

Photo Credit: Alyssa Brooke Photography

Exciting Changes Coming!

GT Pentwater 2017

Sand, waves, beautiful sunset, RegCake…ahhhh…doula retreat! We (Shannon, Rachael and Jill) have been enjoying a quiet weekend away to refresh, re-fuel, and plan for our upcoming year. We have some exciting changes coming down the pike that we can’t wait to tell you about!

Starting in January (for NEW clients–nothing will be changing for existing clients), doula clients who sign on with the Gentle Transitions team will be getting the awesome experience of working with not one, but three skilled doulas throughout your pregnancy! We have decided to combine our individual businesses to be the Gentle Transitions Doulas. So, what will that look like?

  • Throughout the year, we will have 6 group prenatal meetings where we will discuss an overview of things to consider and research throughout your pregnancy, basic childbirth education, and comfort measures during labor and delivery. After the class, you will have time to chat with other expectant parents, and ask us any questions that you may have at that time. Clients can attend as many of these meetings as they like!
  • On the “off” months, when we do not have prenatal meetings, we will be continuing to host our Pregnancy Resource Meetings, going more in-depth on certain topics, or bringing in guest speakers from the community to share with us. These will be open to both clients and the general public.
  • Between 7-9 months gestation, clients will have a personal, one-on-one prenatal meeting with one of us to talk about your birth plan and any other questions you might have.
  • Throughout your pregnancy, you’ll get to text/email/call us and have all three of us consulting with you, answering questions, and recommending resources as needed.
  • Two of us will be on call at all time for births. When you go into labor, the primary doula on call will most likely be the one to attend your birth. If she is with another client, the backup doula on call will be there for you!
  • If you want to request a specific doula be at your labor and delivery, you can do so for an additional fee.

We are so excited about these changes! Not only are clients going to benefit from more support and meetings during pregnancy, but we will have better continuity of care between us, and be able to prevent “doula burnout” by having a structured on-call schedule. If you have any questions, please don’t hesitate to let us know! We look forward to continuing to serve expecting families in the CU community 🙂

 

 

Family-Centered Cesareans

by Shannon Morber

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Disclaimer: Before venturing into the arena of Family-Centered Cesareans, I feel the need to address something first…

It’s no secret that just about any subject related to mothering can be a “hot button” topic, which includes cesarean births. This is an unfortunate reality to the parenting realm in the 21st century. The upside of hot button topics is that it creates a forum and space to dialogue about different viewpoints and share information. It can provide opportunities for each of us to consider new perspectives, potentially triggering expanded ways of thinking and self-growth. The downside? These topics can be an avenue for division, judgment, the shame & blame game and hurt feelings.

We here at Gentle Transitions would like to be unequivocal in communicating our feelings about birth…there is NO one “right” way to birth. There is no greater or lesser way; there is no “failing”. There is only birth. According to Merriam-Webster, birth is “the act or process of bringing forth young from the womb”. So, no matter how your young emerged from your body, it is a birth. It is YOUR birth, for better or worse. Talk about your experience with pride or if needed, seek out the help & resources you need to heal from it. If you did have a cesarean and you have trauma concerning that birth, connect with other mothers who have been there too. And don’t hesitate to reach out to us for any support you might need! We are here to walk alongside you on your path, witness your journey and encourage you every step of the way.

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Okay, off we go now! 🙂 When mothers have a cesarean birth, they have two options for future births: planning a Family-Centered Cesarean (or sometimes referred to as a “gentle cesarean”) or planning a Vaginal Birth After a Cesarean (VBAC). In this post, I will be focusing solely on the former option for the time being.

In 2004, I had a cesarean birth with my oldest son. It was a positive experience in that I got to meet the little man who first made me a mom. However, it was a negative experience in that I felt ignored, disrespected and bullied by my healthcare provider and hospital staff throughout my labor process, which ultimate led to an unnecessary cesarean (in my opinion). While I did go on to have a VBAC in 2006, should a repeat cesarean ever be in my future, I would absolutely utilize options to make it more family-centered than my first!

You may be asking: What the heck is a Family-Centered, or gentle, cesarean? To familiarize yourself, view this brief video about how one hospital defines it and is making changes for expectant families. NPR also did a great piece on the topic, highlighting the benefits of it and one mother’s personal experience. And lastly, another Huffington Post author shares the top 5 most positive aspects in her family-centered cesarean birth.

What choices does a mother have to help make a cesarean more family-centered?

Now that you know what a Family-Centered Cesarean is, or what it might look like, let’s discuss the related options. The graphic below covers the vast array of choices you have to tailor your cesarean birth, according to your desires. From surgery preparation all the way through postpartum, you have a voice and can use it to help achieve the birth you’d like to have.15994864_1176555299108395_4406328689558233219_o

What steps can a parent take to implement a Family-Centered Cesarean?

1) Know your options.
Familiarize yourself with how other families have opted to have a family-centered cesarean. Ask questions & read books. Talk to other women in your community or online who have had one. If this is your first cesarean, have an idea of what to expect before, during and after the surgery. Check out the fabulous resources at ICAN (International Cesarean Awareness Network) and learn tips on recovering from a cesarean birth.
2) Stay in positive & continuous dialogue with your healthcare provider.
Inquire about your healthcare provider’s personal experience with a Family-Centered Cesarean and get a feel for their comfort level. If your provider seems uncomfortable or indicates he/she would rather not deviate too far from the standard cesarean norm, find another one who will actively work with you to achieve your birth goals. Some items in a Family-Centered Cesarean may require extra time and planning ahead (e.g. obtaining a clear surgical drape, extra nurse staffing assigned to be with the baby in the OR, etc.), so be mindful of earlier preparation and
3) Outline your preferences & choices into a formal birth plan.
Once you have educated yourself on your options and made your choices, it is always a good idea to let your healthcare providers and birth team know your preferences. That way, there is no room for confusion or miscommunication. You will feel more comfortable and confident heading into your birth experience with the peace of knowing those around you are all on the same page. Not sure what to include or wording to use? Check out this sample from Birth Without Fear.

Finally, remember that this lovely day is when you get to meet your sweet babe face-to-face. Drink in your baby’s features, smell their little heads to your heart’s content, sit in awe at the wonder of human reproduction and its results. Keep yourself as comfortable as you can. (Pain medication is necessary when recovering from major surgery; your body will thank you.) Go slowly in the days and weeks ahead. Ask for and accept help whenever it comes. Despite having a surgical birth that probably involves a longer recovery, it is still possible to have a gentle transition into your family life. May your birthing day truly be a day you look on with joy and love.

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Surviving Summer with a Bun in the Oven

It’s summer. You are hot. And in the last few weeks of your pregnancy. We have compiled a list of a few things around town and at home to help you survive the last few weeks of pregnancy and prepare for your new bundle of joy!

  1. Go to Sholem on one of the hottest days of the summer… the kind where you don’t want to leave the house at all. But trust me- go to the pool. Float down the lazy river and it will be a super relaxing and cooling way to get comfortable on a hot day at the end of pregnancy! You won’t be the only pregnant person there- I guarantee it! Don’t forget to bring your water with you though!
  2. Get a massage! Schedule an appointment with Abby Meyers of Abby Meyers massage to do a prenatal massage. Work out those knots and relax as she works her magic.
  3. Get a pedicure! It’s an awesome way to relax and pamper yourself- plus you will have pretty toes when you are done!
  4. Go on a date. You may not be able to do that for a while after the newest addition arrives, and it is a great way to connect with your partner before baby comes.
  5. Take a nap. You probably won’t be able to get solid sleep after baby gets here.  So, sleep as much as you can now- if you are tired, listen to your body and take a nap!
  6. Go get coffee or ice cream with friends. Or do both. Both is better. Again, your life is about to change. And it is awesome to get out and do the things you really enjoy… it really helps pass the time until baby gets here.
  7. Go get adjusted. A chiropractic adjustment from Emily McCabe at McCabe Chiropractic is a great way to get comfortable and can help get your body ready for the marathon of labor!
  8. Go do a session of acupuncture! I’ve never been more relaxed than I have when I’ve gotten an acupuncture treatment with Bensky Family Acupuncture. Plus it’s getting your body ready for labor
  9. Pack your bag. Some great suggestions here and here.
  10. Make your Postpartum Plan. A lot of times we prepare so much for baby’s arrival and forget all about how much help we will need once we are home.
  • Has anyone offered to set up a meal train for your family? Meals can be so helpful in this transition so be sure to take people up on that offer.
  • Make your Postpartum Care basket. After baby comes- you won’t want to walk all over the house to find the things you need those first few weeks- having a basket on each floor in your common areas of your house can make sure you have everything you need in one place. These are a few ideas of what to have in your basket: Birth Without Fear: Postpartum Basket
  • Schedule Belly Binding with Shannon Morber. There are a great deal of benefits listed here.
  • Order the ultimate Postpartum Celebration snack… a cake from RegCakes!

Even if it doesn’t seem like it, you WILL survive these last few weeks! Put some of these ideas on your calendar, and the time will fly by while you stay cool and calm.

Do you have a late summer or fall baby? What ideas could you add to our list? We’d love to hear from you!

 

 

 

A Smashing Success!

We are long overdue for a post about our big event of the year–the inaugural Growing Families Expo! On June 3rd, B. Lime and Gentle Transitions worked together to put on the Growing Families Expo at Presence Covenant Medical Center. It was an awesome event targeting young and expectant families, and we hosted 30 awesome vendors in our community. Businesses and Non-Profit organizations came together to share their products and services with families in the area. We had tons of amazing raffle giveaways, mini photo shoots with Echolight Photography, storytimes from the public libraries and Usborne Books, coffee and treats provided by Espresso Royale, Uncrustables from Smuckers, gift bags full of coupons and freebies from Meatheads, LuLaRoe, Teeccino, Preggie Pops and many more (see complete listing below!). We are so thankful to all of our vendors for partnering with us and hanging in there as we worked out the kinks of our first year. We are looking forward to being in a larger space next year, and offering more tables and larger spaces to the waiting list of vendors who have contacted us already!

We want to thank all of our amazing participants and guests–we couldn’t have done it without you!

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We had such an incredible group of vendors to work with this year. Businesses and not for profit groups from all over CU came to share their services and products. Here is the complete list of 2017 Vendors!

vendors

Our gift bags were stuffed!! Along with what is pictured below, we had information/coupons/freebies from Preggie Pops, Nurtured Beginnings, Dragonfly Meadows Therapy, Espresso Royale, Postpartum Support Group, and the Illinois Microbiome Study.

gift bags

We had *so many AMAZING* raffle prizes to give away! Thank you so much to all of the community partners and businesses who contributed so many products and services to our raffle giveaways!

raffle prizes

If you haven’t already, please “like” our Growing Families Facebook page in order to find out about next year’s expo! Preliminary planning is already in the works, and we can’t wait to bring you an even bigger and better expo in 2018. Thanks again to all of our participants this year!

Getting Breastfeeding Off to a Good Start

by Theresa Hardy

breastfeeding pic for blog

At my monthly breastfeeding class, I always open with a discussion of concerns that expectant moms might have about breastfeeding. The top two concerns are avoiding nipple pain and establishing a good milk supply. I always reassure the moms that they have made an excellent first step towards breastfeeding success, and that’s coming to a breastfeeding class. Knowledge is power! By the end of our two hour class, we have gone over what to expect in the early days and weeks, how to improve baby’s latch, how to tell baby is getting enough milk, using good physical supports to reduce your fatigue, waking a sleeping baby, managing return to work and breastfeeding, as well as pumping and milk storage.

Your journey to successful breastfeeding begins with lovely, uninterrupted skin to skin contact with your newborn, which is simultaneously soothing and stimulating to baby. Skin to skin contact reduces crying, regulates their temperature, and brings them “right up to the dinner table” for a nursing. Newborns are often wide-eyed and alert immediately following their birth. Cuddled against your breast, baby may just latch on her own, or she can be assisted to latch. Take advantage of this alert time, because after an hour or two, baby gets really tired, and often needs to be coaxed to feed for the next several feedings.

There will come a time when your little one will need almost no assistance or supports to latch effectively, but newborns can’t reach or hold. They (and you) definitely benefit from physical support such as nursing pillows, rolled blankets to lift baby’s head and shoulders, and a nursing stool. You will be spending many hours a day nursing your little one, and those physical supports will reduce your fatigue as well as promote the best latch possible.

Since breastfeeding is new to you and your baby, you will be wondering how to know if baby has a good latch, and if he is drinking enough. Though your nipples will be tender in the early weeks, if baby has a good latch, you should feel a gentle tugging, and not pain. When baby is latched well, your nipple floats freely in baby’s soft palate. A shallow latch feels “pinchy” or painful. Baby makes a characteristic “kuh” sound when he is drinking. We like to see 10-15 minutes of active drinking each breast each feeding. You will hear more drinking as the early days go by. When your full volume of milk is coming in, you will hear gulping! Baby should be very content after a nursing sessions. We also expect to see more wet diapers and stools each day until about day five, then at least 4-5 stools a day.

Babies learn to breastfeed by breastfeeding. When your friends tell you how much easier breastfeeding is than bottle feeding, they’re not talking about the first few weeks. Over time, baby gets more and more efficient, and feedings get spaced out a bit. Feedings are shorter and more effective, and you will get lots of milky smiles. Perhaps the most important thing you can do is to get good help if breastfeeding isn’t going well. Most hospitals have lactation consultants on staff. I am a lactation consultant/pediatric nurse practitioner in private practice, and can do both home and hospital visits. At a consult, latch will be fine-tuned and adjusted, drinking will be assessed, and you will be shown how to position the baby so both of you are comfortable. Together, we will come up with a plan for breastfeeding success!

 

A Day in the Life of a Doula

Some days as doulas are totally normal… Other days we are hyper vigilant because a client could go into labor at anytime. Or maybe you weren’t expecting a client to go into labor and you have to quickly figure out and change the days plans to accommodate your client’s needs.We aren’t ever far from our phones and the phrase “I’d love to come, as long as I am not at a birth!” comes out of our mouths often. This is from a day last year when I had plans but knew a client was in the early stages of labor.

My morning started by gathering all of our booth supplies. Gentle Transitions was a vendor at our local Cloth Diaper Expo. My daughter loves to come with me and help set up and meet people, so we ran through Starbucks and went to set up for our show. Thankfully I have wonderful team members and I was able to leave early for a family event while they finished the expo.

A client had texted me the night before that she was having some contractions so I wasn’t surprised to hear from her at my cousin’s bridal shower that day. We talked through what she was feeling and some other positions to try and get relief/comfort.

I checked in with her once I got home- she was still doing good at home! But she could tell things were progressing and getting harder to handle.

We had dinner and my husband prepared to go out for a night with friends. He had planned to carpool with someone but had to let them know they might have to come back early if I had to leave.

He left and called me about 2 hours afterwards from a number I didn’t recognize. He was worried wondering if I had tried to call. His phone didn’t have good service where he was and he was concerned that I called or would need to and he wouldn’t get it. So he called me from a friends phone so I had an alternative number. You never know when you will need to go- these babies run the show! 😉 I am also thankful for a husband who cares about my job and all the little things that go along with it.

Around 2am my client decided to head to the hospital and continued to check in with me throughout the night… Until about 4am when they decided they were ready for me to come. I gathered my things and left for the hospital. When I got there she was on her hands and knees over the bed. She let me know most of her pain was in her back and she wanted to rest but the back pain became much worse while laying down. We worked on a few other positions that were restful but more upright. She continued laboring while her husband and I took turns applying pressure or massaging her lower back and fanning her while changing out cool washcloths for her neck and forehead. She was doing great and the hospital staff was so helpful. Not long afterwards she felt the urge to push slightly with her contractions. We followed her lead as she pushed and breathed as her body led her through each contraction. Soon, we could see much more of the baby’s head and before we knew it our nurse was making phone calls and asking to get the delivery set up finished quickly. Just minutes passed until that sweet girl was born. The new parents were so thrilled!

We got mom and baby skin to skin and baby started nursing pretty easily with just a few tips.

I got home in time for lunch and to hang out with some friends before heading off to meet another couple for our prenatal meeting. It was a great weekend full of babies, clients, friends and family! And I slept really well that night!

Pit: Labor and Postpartum

This is the 4th and final blog post on our series about pitocin. Check out our introductory post about pitocin here, our post about the differences between pitocin and oxytocin here, and pitocin in inductions here

We’ve talked about the role of pitocin during inductions, how pitocin differs from oxytocin, and how pitocin works in the body  biologically. Pitocin is not only used during inductons, but also to augment, or speed up, the labor process.

The most common use for pitocin during labor is what many providers deem “failure to progress.” What FTP means depends on the care provider. Often times providers base labor progress on something called the Friedman’s Curve. The Friedman’s curve was created in 1955 (over 60 years ago!!) that plotted the average woman’s dilation time, which came out to approximately 1cm dilation per hour of labor. For a GREAT detailed evaluation about the Friedman’s curve, please check out this post over at Evidence Based Birth. The most important thing to realize about the Friedman’s curve is that it cannot apply to every woman (that’s the nature of a bell curve!), and that so much has changed in the labor and delivery process since it was created so long ago. Thankfully, here in Champaign-Urbana, there are very few, if any, providers who still expect all of their patients to progress at the rate of the Friedman’s Curve. However, that does not mean that FTP no longer exists. It is still often diagnosed when mom is not dilating as quickly as their care provider would like (for a myriad of reasons).

No two labors are the same, and labor can speed up or slow down based on so many factors. Some of these include:

  • Malposition of baby
  • Epidural use
  • Mom feeling stressed/scared/anxious about her labor/location/people around her

There are obviously many factors at play, but in my personal doula experience, these are the most common reasons that labor seems to slow down, or “fail to progress.”

Labor slowing down, or stalling, does NOT mean that a mom needs pitocin to help it progress. Let’s look at some ideas that mom can try in order to get things moving again.

Malposition of Baby

If baby is positioned “perfectly” in the pelvis, and mom’s pelvis is properly aligned, generally labor and delivery will go very quickly. If the baby’s head is not aligned in the pelvis properly, her head will not be engaged properly on the cervix to increase dilation. Then, if mom does get to 10 cm, the baby can get lodged into the birth canal at a less-than-ideal angle, causing problems during pushing and delivery. So what can we do to help make sure baby is aligned properly? The biggest one that we doulas recommend is chiropractic care during pregnancy, and even labor. Seeing a Webster-Certified chiropractor during pregnancy can help keep everything aligned (and also relieve a lot of typical pregnancy discomforts!). Even in labor, a chiropractor can gently manipulate the pelvis to help create the right space for baby’s head to be engaged in the pelvis. (Check out our Community Partners page for some great chiropractors in C-U).

Additionally, we also recommend all of our clients check out Spinning Babies. Spinning babies is a series of exercises and body positioning to help encourage the baby to be in the best position for labor and delivery. If a mom is in labor and her care provider or doula thinks the baby is not in a great position, there are different positions that a mom can try to encourage the baby to turn even in labor. Check out the spinning babies “In Labor” page for more details on those!

If a baby truly is malpositioned in the pelvis, pitocin is only going to make things worse by intensifying contractions on the baby and for the mom, and potentially wedging baby into the pelvis even more tightly, rather than letting labor slow down to give the baby an opportunity to turn and get into a better position for birth.

Epidural Use

Epidural use in labor can also slow down labor, because the laboring woman is confined to the bed and not up and moving. Think about gravity–if a mom is up and moving, gravity is going to help the baby engage the cervix and move down. The opposite is also true–laying in bed, not upright, does not work with gravity, and can make the labor longer and slower. Additionally, mom’s reduced movement doesn’t allow ample opportunity for the baby to turn into the best position for birth. If a mom does choose to have an epidural during labor, it does not mean that she is doomed to have pitocin, too! In fact, one of the more recent labor tools that we have been using has been shown to drastically help reduce the length of labor and the risk of c-section: a peanut ball! Peanut balls come in different sizes to fit different women, and are used especially if the mom has an epidural. The peanut ball allows care providers and doulas to help get mom into different positions that will open her hips and pelvis, and allow more room for baby to move through the pelvis and into the birth canal in a good position. I remember after one particularly challenging labor, we tried using the peanut ball as a last ditch attempt to get mom to rest and open her hips. Less than an hour later she pushed out her baby, and the nurse exclaimed to me (in the hallway), “the peanut ball saved that birth!!” She was shocked and surprised, and to be honest, so was I! We couldn’t believe how quickly things started moving after 30 minutes of hip opening positions while mom was resting with the epidural in place. If your hospital doesn’t have peanut balls, consider getting one to bring with you in labor–you won’t regret it!

 

Emotional Blocks

Emotional blocks in labor are one of the more difficult things to discuss, purely because we can’t know exactly how a mom is thinking and feeling. Only SHE can know that! She may try to explain it to us, but when a woman is in the throes of labor, explaining how she feels emotionally in a given moment is difficult, to say the least! However, as doulas, we can help watch and observe our clients, and if we notice that mom is starting to appear nervous, or suddenly stressed, or uncharacteristically anxious, we can broach the subject and try to help. Sometimes it can be because mom had to move from a location where she felt comfortable to a less comfortable place (like moving from home to the hospital). This can disrupt the labor flow, and make the mom feel unsafe. When a woman feels unsafe, and her cortisol (stress hormone) levels rise unrelated to labor, her labor will slow or stall–it’s biology’s way of trying to give us the greatest odds for our baby’s survival. Talking through (ahead of time) what it will be like to get out of the house, into the car, and into the hospital can help alleviate some of those concerns ahead of time. In the moment, it’s important to do sort of a reality check. Am I really unsafe? What is scaring me? What can make me feel safer right now? These are all questions to ask yourself (if you can), or that a doula will ask you to help facilitate a smooth emotional transfer, and get labor back up and running again.

I heard someplace, sometime (super specific, I know) that for every additional person in the labor room, the length of labor increases by an hour. I have no idea if this is statistically true, but on paper it makes sense! If a woman is being watched during one of the most vulnerable experiences in her life, she’s bound to feel a little bit uncomfortable, or even unsafe depending on who the person is. It is ALWAYS okay to ask people to leave your labor space, be it at home or the hospital. If you don’t feel comfortable with that, your doula can help you get people out! Decide ahead of time who you’d be most comfortable with in labor, and either stick to your guns or remove people from that list! Once you start to feel safe and less “watched,” chances are good that your contractions will kick back in and start making progress.

If labor is slowing or stalling, running through these three categories can absolutely help get things moving again. There are lots of things to try before pitocin becomes the only option.

 

Postpartum

Immediately after birth, it is very common and sometimes protocol for women to have an injection of pitocin. It’s given so that it can help the (presumably tired) uterus to start clamping back down and healing the wound that is in there from the placenta, which slows blood flow and helps to prevent hemorrhage. Many women are less opposed to pitocin postpartum because it is not going to affect their labor or delivery (and is safe for nursing). Speaking of nursing, that’s the best way that you can prevent needing pitocin postpartum. When a mom nurses, the bond she is creating is created because of the release of oxytocin. That oxytocin helps the uterus contract, to encourage it to heal it’s own wound. Yet another reason to start breastfeeding right away after birth!

 

Conclusion

While I hope that you have learned a little bit (a lot!) about pitocin through this series, I hope that you take away the most important message, which is to be educated and not be afraid to talk with your own doula and care provider about your feelings on pitocin.  If interventions/options exist  for labor, delivery, and postpatum, but are not discussed ahead of time, very people know they are options and can be implemented. Make sure to keep the lines of communication with your care provider open, and discuss your wishes for labor and delivery at one of  your prenatals. Don’t be afraid to speak up if pitocin is being offered to you and you don’t understand why. Most importantly, feel empowered to enjoy your birth!

 

Pit: Inductions

This is #3 in a series of posts about pitocin. Check out #1 here and #2 here.

Inductions are a hot topic in the “birth world.” Are the necessary? Sometimes, absolutely. Are their unnecessary ones? Sometimes, absolutely. This post isn’t going to be about whether or not your induction is/was necessary, instead, I would encourage you to check out ACOG’s stance on inductions, as well as head over to Evidence Based Birth and check out her posts about inductions (they are awesome, and so thorough). What this post IS going to be about is pitocin during inductions, and other induction options that you might have. I say “might” because every situation is different, every care provider is different, and every hospital is different. As always, we are not care providers, so please discuss anything that you read here with your provider regarding your specific situation.

Inductions happen for many, many reasons. All induction methods are not equal, but one thing that IS something every woman who is facing induction should consider is her Bishop Score. The Bishop Score is a scoring system that providers can use to determine how likely an induction is to succeed, and also the liklihood of spontaneous pre-term labor. The Bishop Score is determined by scoring from 0-3 each of the following: cervical dilation (0-10 cm), cervical effacement (0-100%), cervical consistency (firm to soft), cervical position (anterior to posterior), and fetal station (how high the baby is in the pelvis).¹ For a great chart with this scoring system on it, check out Wikipedia. The higher a woman’s score, the greater chance of a successful induction (successful meaning ending in a vaginal delivery). A score of 8 or higher is generally considered to be favorable for induction. If a woman’s score is not “favorable,” it does not mean that she will be unable to have a successful induction, it just means it’s less likely. If you have a lower Bishop score, and are facing an induction, have a chat with your care provider to see what options you might have to make your chances of an successful induction better (waiting, for example, or possibly going home if induction doesn’t start labor).

If you and your provider agree that an induction is the best course of action for you, make a plan for how you would like your induction to proceed. You have options about how to start the induction process. These include a cervix ripening suppository, if necessary, which often takes more than one day to make an effect on the cervix. Cervidil and Cytotec are both used to help soften the cervix, but we strongly encourage you to look into the medical indications for using cytotec. If you choose a cervical ripening suppository, you will be checked into the hospital and stay (usually overnight) while the suppository is in place. Sometimes these cervical ripeners also start contractions, in which case you may need nothing else to get labor going! After doing the cervical suppository, often pitocin is the next option. Pitocin is usually started off slowly, and increased as labor goes on. Sometimes if a woman’s body appears to take over all by herself, pitocin is turned off. If your cervix appears favorable for induction, but you want to avoid pitocin, another option  is AROM (artificial rupture of membranes). This is sometimes done in addition to pitocin is the pitocin doesn’t seem to be doing the job on its own, but could also be done without pitocin. This basically means that your care provider will break your water, which hopefully signals to your body to start contractions. Another option for starting an induction is a Foley bulb catheter. This is a catheter that is inserted into the opening of the cervix. The catheter is slowly filled with water to dilate the cervix. Once the cervix is dilated to 3 centimeters, the catheter falls out or is taken out, and hopefully will have encouraged a woman’s body to start contractions and continue the dilation process.

Inductions do not always have to be an all-or-nothing process. We have all had clients and know others personally who have gone in to attempt an induction, have it not work, and leave to come back and try another day. Pitocin can be turned off and the induction can be halted, as long as a woman’s water is not broken. Once a woman’s water is broken however, the induction needs to proceed forward due to the risk of infection for the longer the induction process goes on. Have the discussion about what you would like to do if the induction does not work ahead of the induction, so that you and your care provider are on the same page.

There are also more “natural” methods for potentially inducing labor. We are not endorsing any of these, and none have been scientifically proven to work, however they are options that you can talk to your care provider about, should you be interested in them. The first, and most often recommended method of starting labor is by having sex. The prostaglandins from semen can help ripen the cervix, and an orgasm causes contractions of the uterus, which can also start labor. This will only work if a woman’s body is ready to go into labor, however. Having sex at the end of pregnancy is not going to put you into labor if your body is not ready for it! Other options are nipple stimulation (manual or breast pump) and taking castor oil. There are also plenty of opinions about which foods can also induce labor– we have never seen any of these necessarily work, but many of them are worth a shot (spicy foods, pineapple…you name it 🙂 ) Natural methods of labor induction can be used in addition to medical options for induction, as long as you have the discussion with your care provider ahead of time.

Next up in our blog series about pitocin, we’ll be discussing pitocin during labor for augmentation, as well as pitocin used postpartum. Stay tuned!

 

¹https://en.wikipedia.org/wiki/Bishop_score