Newborn Procedures

There are so many things to consider and learn about when preparing for your upcoming birth. Newborn procedures may not be high on the list. If that is the case for you, here is a brief run down of what you may expect after your little bundle of joy has made his or her debut into the world!

Cord Clamping
When to cut the cord has come under great debate. Some care providers do it immediately after the baby is born with concern that the extra umbilical cord blood could lead to jaundice. Ohers allow the pulsing to stop on it’s own believing the additional blood, which is rich in iron will greatly benefit the newborn. So, which is best for you and what are the benefits to either side? The British Medical Journal recently published the largest study to date on the effects of delayed versus early cord clamping. This study concluded that waiting just 3 minutes after birth before clamping and cutting the cord has enormous benefits for the newborn. Delayed cord clamping, compared with early clamping, resulted in improved iron status and reduced prevalence of iron deficiency at 4 months of age, and reduced prevalence of neonatal anaemia, without demonstrable adverse effects. As iron deficiency in infants even without anaemia has been associated with impaired development, delayed cord clamping seems to benefit full term infants even in regions with a relatively low prevalence of iron deficiency anaemia.

Antibiotic Eye Ointment
In the US, the application of antibiotic eye ointment on newborns is mandated by law in certain states.
The purpose of this routine treatment is to prevent eye infection from certain bacteria, mainly gonorrhea or chlamydia, that may be present in the birth canal. The current medication that is being used is called, erythromycin. This has replaced silver nitrate which was known to irritate some newborn’s eyes. If your state does require this eye treatment, you may want to inquire about which medication is routinely given.

Vitamin K Shot
This is given to babies at birth in the rare instance, 1 in 10,000 babies, that they are vitamin K deficient which would prevent the blood from clotting effectively. Again, some state have made this a mandated law. An alternative option for those who wish to avoid a shot, there is an oral dosage of vitamin k. If are interested in this option,you will need to consult with your care provider about how to go about securing a liquid vitamin k.

The reason some people object to the injection is because injected vitamin K ran into a problem when researchers in 1990 noted an increased incidence of childhood cancer in children given vitamin K injections at birth. Specifically, they found that injected vitamin K doubled the incidence of leukemia in children less than ten years of age. A subsequent study in 1992 revealed the same association between injected vitamin K and cancer, but no such association with oral vitamin K. These researchers recommended exclusive use of oral vitamin K.

Weight
This is usually done after the mother has had some time to bond with her new baby. It is also a big picture moment for the new family! Most of the time it is does right in the delivery room. The baby is placed on a scale and the weight is then recorded. I have heard of some hospitals taking the baby to the nursery for weight and height check. If you do not want to be separated from your baby, you can ask to have the scale brought to your room.

Apgar
The Apgar, named after Virginia Apgar, is a culminated score of 5 categories, Appearance, Pulse, Grimace, Activity, and Respiration. This is done at the one minute mark and then again at the 5 minute. Each category is rated 0, 1 or 2. Zero being an absence of response in the 5 categories, 1 being slightly below what is expected and 2 being completely “normal”. The purpose of this quick test is to establish if the baby is adapting well to it’s new environment or if medical attention is needed. Since this test is done primarily by observation, it can be exectued with the baby on the mother’s body, so immediate skin to skin contact should not be disturbed by this procedure.

Hepatitis B Vaccination
Screening for Hepatitis B during pregnancy is mandated by law in many states, including NYS. However, even with this being a law, the use of this vaccination on newborns is still under great debate. Some people say that it is ridiculous to subject a newborn to another shot and a vaccination for a disease that primarily effects those that have exchanged bodily fluids with an infected person or those that had undergone a blood transfusion. Those that support this vaccination, including the CDC (Center for Disease Control) and WHO (World Health Organization). According to the CDC, approximately 33,000 children (10 years of age and younger) of mothers who are not infected with hepatitis B virus were infected each year before routine recommendation of childhood hepatitis B vaccination. While there is strong recommendation to give your newborn this vaccination, at this time Hep B vaccination is NOT mandated by law for your newborn. So the choice is yours if you would like your child to receive this vaccination.

There is also speculation of negative side effects from this vaccine. The Cochrane Summaries, a highly respected independent high quality research group concluded, Hepatitis B vaccination and hepatitis B immunoglobulin are considered as preventive measures for newborn infants of HBsAg positive mothers. When all the identified trials were combined, hepatitis B vaccine alone, hepatitis B immunoglobulin alone, and hepatitis B vaccine plus hepatitis B immunoglobulin reduced perinatal transmission of hepatitis B compared with placebo or no intervention. Hepatitis B vaccine plus hepatitis B immunoglobulin were superior to hepatitis B vaccination alone. Adverse events were rare and mostly non-serious.

Phenylketonuria (PKU) Test
Phenylketonuria is a rare metabolic disorder that if left untreated can cause mental retardation. The PKU test, developed in the 1960’s, was the nation’s first newborn screen test and is required in all 50 states. The test is done by pricking the heel of the newborn and gathering several drops of blood. The blood is then test for PKU along with several other metabolic disorders. Should the results come back positive for PKU, the baby will need to have a special formula. Many children with PKU who start treatment soon after birth and keep their Phe levels within the suggested range usually have normal growth and intelligence.

Bath
The first bath of your newborn baby does not need to be immediate. In fact, the vernix, a white cheesy substance that protects your baby’s sensitive skin from being encased in fluid for 40 weeks, can continue to serve as a protective moisturizer when massaged into the skin. If given the choice, it is best to delay the first bath at least an hour, as this will help your baby regulate his or her temperature.

Foot Prints
This procedure is pretty quick and usually done in conjunction with weighing the baby. The purpose of the newborn foot printing is for identification. Usually the nurse will do two set, one for the hospital ID records and medical records and one as a keepsake for the new parents.

Hearing test
The hearing test measures how the baby responds to sound. This simple, noninvasive, test is done before the baby is discharged from the hospital. It is recommended since significant hearing loss is the most common disorder at birth. Approximately 1%-2% of newborns are affected.

How long can you request to wait before the newborn procedures start?
This may vary from hospital to hospital, but you should be allowed at least one hour of undisturbed skin to skin bonding time assuming all is well medically with your newborn. (For more information about the importance of immediate skin to skin contact, please read Study Finds Benefit in Skin To Skin Contact)

The challenge with this is that once your baby is born, there is a lot paper work for the nurses to complete to “close your case” and allow you to move to the Maternity Unit. I am in no way diminishing the issue of understaffed, over crowded labor and delivery floors. However, having a baby is a huge event in one’s life, and if the mother desires this time to bond and establish initial breastfeeding, it should be honored. Most newborn procedures can be done in the presence of the parents, and even with the baby on the mother’s chest. Although, some hospitals do still take the baby out of the room for these procedures. If your hospitals works in that manner and you wish for some undisturbed time, discus this with your care provider ahead of time to see what you can negotiate.

What if you want to refuse any of these routine or mandated procedures?
Certain routine procedures like the vitamin K shot can be altered (as mentioned above, an oral dose is available), bathing, weighing and measuring can be put off, and even the Hep B is not mandated and parents can opt-out. If you choose to not have your child receive procedures that are mandated by law, be prepared to fight for your baby’s rights. New York is probably the most difficult state in the US in which to exercise your right to determine what goes into your body and your children’s bodies. Some people do claim religious exemptions to get by the red tape. New York is notorious for calling Child Protective Services in these instances!

After reviewing all these newborn procedures and deciding what is right for you and your family, have a discussion with your care provider to see what is possible. You should also be clear about your plan when you arrive a hospital and talk to the nursing staff about your wishes for these procedures. As a doula, I like to gently remind the staff of my client’s wishes as we approach the pushing stage so that these things are fresh in their mind. As in all aspects of birth, you don’t want to be caught unprepared.

Sources
1. CDC - Conjunctivitis: Newborns
2. http://www.cdc.gov/vaccines/vac-gen/whatifstop.htm#hepb
3. Hep B Fact sheet
4. Cochrane Summary for Hep B
5. PKU Fact Sheet
6. “>New York State Exception
7. Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial

Add comment January 30th, 2012at 10:35am Deb

Making a Hospital Birth More Like Home

Recently, an expectant mother asked me about changing care providers so that she could give birth in the Birth Center at St. Lukes/Roosevelt. I gave her a list of midwives and OBs that practice in the Birth Center. Unfortunately, she was already 27 weeks when she started to consider switching practices, and found that she was too far along for most care providers on the list. My next suggestion to her was to find a doula and take steps to make a birth on the Labor and Delivery (L & D) floor as close to a Birth Center or “homey” environment as possible.

As we were discussing this, several other students asked for ideas of how to accomplish this same intention. So that led to this blog. Here are some tips as to how to make a “typical L & D” room into a cozier spot.

The first thing you want to do is chose your “team” wisely. Those that you invite into your birth experience can either help or hinder the situation. You want to gather a group of people that are going to support and protect your wishes. This includes instructing those with you to dismiss a nurse or student that may be impeding on your space disrespectfully. I wrote a blog on this topic that may be helpful, How To Recruit and Prepare Labor Support.

Next, you want the L & D room to be transformed from the sterile, bleak hospital feel into a welcoming, comfortable and comforting space. Each home has a certain smell, sound and look to it that makes it unique to that particular occupant. I know when I arrive home at night I am happily greeted by the lingering smell of dinner and the dim lights in the entryway. I am immediately put at ease and feel my external guard dropping away. Tending to all the senses can help put the laboring mother more at ease, and give her a sense of comfort similar to what she may find at home.

SIGHT: You can do this by adjusting the lights. Using the natural light from outside or the bathroom light to cast a soft shadow over the room is a lot more appealing than the harshness of fluorescent lights. You can also bring pictures that you find comforting. A doula client of mine brought a picture of her older daughter and her grandmother along to her birth. I had in my birth bag a picture of my cat. Another client brought a sunflower along. The sunflower had two purposes, she thought it would light up the room, and the center of the sunflower is roughly 10 cm. She used this as a focal point for how much she needed to dilate.

SMELL: Along with the lights and other decor, you can adjust the smell of the room. You are not allowed to burn candles or incense, but you can mist the room with essential oils. I often have a squirt bottle in my doula bag and will add a few drops of oil to the bottle (whatever oil the mother prefers) and then spray the room every now and then to help create a more pleasant aroma.

SOUND: Hospitals are noisy. There are other laboring women around, staff chatting, and intercoms shouting. Bringing your own music to drown out the other sounds can help buffer you into your own world. Some women I know enjoy spending time creating a “birth play list”.

FEEL: Hospital sheets and gowns can tend to be a bit rough and scratchy. You may consider bringing your own pillow or pillow case as well as your own clothes. There are also some companies that you can find that sell more stylish hospital gowns. I would recommend a simple light weight bath robe or big, loose t-shirt. Keep in mind that the clothes will likely get messy, so don’t bring along something you are not willing to part with afterwards. And do have it loose enough and accessible for a belly band (this will hold the EFM in place)

TASTE: Many of us find comfort in taste and texture of food. While labor is not the time to sit down for a big, filling meal, it is important to still nourish yourself. Many hospitals still adhere to the antiquated idea of “only ice chips” during labor. However, your care provider can overrule that and allow you to have something more substantial, tasty and comforting! (Although, expect this privilege to be taken away once pain medication is introduced.) If you are still pain med free, then you may find solace with some juice, fruit, porridge, or toast and almond butter. Satisfying your taste buds and not feeling restricted from food or drink may allow you to feel a little less like a “sick patient” and more like a laboring woman just trying to find comfort.

FREEDOM! It is well established that once a woman is admitted to the hospital, she is going to fall into certain routine interventions that the L & D floor expects of most patients. These routine interventions can impede on the freedom of movement and general comfort level. Some of these are negotiable, but they should be discussed with your care provider ahead of time. For example, being hooked up to the External Fetal Monitor (EFM) the whole time a woman is in labor can greatly diminish her ability to move around the room or take advantage of the bath or shower that most L & D rooms have. To help keep labor “as normal” as possible, ask for intermittent monitoring.

Unless you are in a Birth Center, it is likely that you will be given a hep lock. This is a portal for which IV fluids are given. You can ask just to have the hep lock in place, but not be given the IV fluids, unless medically necessary. Being hooked up with an IV will also hamper one’s ability to move around freely.

SHOW UP LATE! Knowing that some of your freedoms are hindered upon admission to the hospital, stay at home as long are you are comfortable. (This is where is it helpful to have a doula or support person that knows what to look for in terms of when to head to the hospital). The more time you can spend in the comfort of your own home, the more relaxed you will likely be and the better the labor hormone, oxytocin, will flow.

WHY?? Some people may be asking what is the benefit of putting the effort into transforming the hospital setting? I touched on this idea a little before, if the mother is more relaxed, her hormonal system will better function. When animals give birth, they find a dark, quiet, secluded place where they feel safe. This allows the “fight or flight” response to turn off and the “birth” hormones to flow well. If an animal, or the laboring mother, is feeling tense, pressure, uncomfortable, crowded or unrespected, her “fight or flight” response will kick in and her adrenalin level will shoot up. The body will respond by not producing as much oxytocin, the hormone responsible for creating contractions, and labor will stall or even stop. This is why it is not uncommon for a woman to be laboring well at home and then arrive at the hospital and find her steady contraction pattern has petered out. If upon getting set up in the L & D room, the mother is made to feel “more at home” she is more likely to feel at ease, resulting in a better labor pattern.

I hope this blog inspired some ideas to help you to create your own “home away from home” in the hospital Labor and Delivery Floor. I always like to hear from our community, if you have any other ideas that you found useful for your birth experience in a hospital setting, I invite you to share them!

3 comments January 3rd, 2012at 11:51am Deb

Prenatal Yoga: What Poses Can I Do?

After last night’s class, a new student asked me about some of the poses we had practiced. She was confused that we did some twisting poses because she thought that twisting was off limits during pregnancy. She also told me how good it felt to do a fair amount of standing poses. Again, she was under the impression that during pregnancy, the class needed to be modified to an extremely gentle pace. I have put together a basic list of poses that can be safely and confidently practiced during pregnancy.

Safe Twisting
Deep twists during pregnancy are contraindications because of the possibility of straining the abdomen and uterus. However, twists that focus on movement initiating above the belly, at the upper back/rib cage area, can be a huge relief for the pregnant mom. Twisting poses can release tight back muscles and gently open the side seams of the body and chest, while also encouraging the mother to create more length in her spine. Remember when putting together the prenatal yoga cannon, the practitioner should only include “open twists”, twisting away from the leg.

Poses on all fours
Poses on all fours keep the spine and hips mobile, increasing circulation in the pelvis and legs. They also keep the baby off of the mother’s spine, creating more room in the abdominal cavity and encouraging the baby into the optimal birthing position. This is very helpful if the baby is in the posterior occiput position, meaning the baby’s head and spine is towards the mother’s front.

Standing poses
Standing poses strengthen the legs and gluteals that attach to the knees and pelvis. These joints are vulnerable during pregnancy because of the softening effect of relaxin (check out Yoga in the 1st Trimester to read more about relaxin), on the ligaments. Strong supporting muscles will help prevent injury. Most importantly, standing poses help create endurance and confidence in the mother that she can use during the marathon of labor.

Hip openers
The pelvis goes through tremendous change and compromise during pregnancy. Because of this, it is important to include poses that will help bring balance and stability to the muscles and joints. To do this, remember to include poses that work the hips in all directions, not just external rotation, which is most commonly associated with hip opening poses. The full family of hip openers access the full range of motion of the hip joint: internal rotation, external rotation, adduction and abduction, and flexion and extension.

Forward Bends/Seated Poses
These are great hip openers, but very often pregnant women collapse through the spine, and little hip opening is achieved. Sitting up on either a bolster or folded blanket will help prevent this collapse from happening and the lower back from rounding. Propping the hips up will also emphasize that the pelvis tips forward from the hip sockets and weight moves to the front of the sitting bones, out of the lower back. Also, remember to lift collar bones and heart to achieve a long, open spine.

Gentle Backbends/Chest Openers/Shoulder Openers
During pregnancy, the curves of the spine become more exaggerated, leaving the shoulders prone to rounding forward and the chest sinking in. Gentle backbends, chest and shoulder openers invite the upper body to move into a more open position. Also, since the mother tends to feel very breathless and “crowded” in the torso, this group of poses gives her temporary spaciousness in the chest and a feeling of fuller breaths.

I hope this list helps clarify all the possibilities that are still available for the pregnant mom. Enjoy and keep practicing!

4 comments December 29th, 2011at 07:08pm Deb

Change Is Not Something We Should Fear.

Today B.K.S Iyengar turns 93. For those that are unfamiliar with this remarkable man, he is the founder of the yoga style Iyengar yoga. I have been a practitioner of Iyengar yoga for about 7 years. This style, more than any so far, has influenced my teaching, taught me how to be present in my practice and has opened me to exploring the endless possibilities of moving the yoga practice beyond the mat and into practical life.

Here is one of my favorite quotes from him:

“Change is not something that we should fear. Rather, it is something that we should welcome. For without change, nothing in this world would ever grow or blossom, and no one in this world would ever move forward to become the person they’re meant to be.”

This quote has always resonated with me because change has always been something I’ve struggled with. So when pregnant and facing major changes in my life, it was comforting to be reminded that life would not grow or blossom without accepting any major shifts.

On a daily basis, I am still faced with challenges from the dramatic changes having a child brings into my life. There has not been one aspect of my life that was not touched by becoming a mother. My relationship with my husband has deepened and I can honestly say, I see him in a different light. He is an amazing father and an incredibly supportive partner. (This is not to say, at my worst moments of sleep deprivation, I didn’t want to smother him with a pillow as he soundly slept while I was up in the wee hours of the morning breastfeeding.)

My relationship to my first child, the Prenatal Yoga Center…hehehe…, has changed. This was probably my biggest fear involving change. I have been at the helm of the studio for almost 10 years and to no longer be as actively involved was and still is very frightening for me. I often talk to the students about facing fear and discomfort and finding a way to surrender to the situation. Passing along the reigns of control to my very capable staff was a hard step to take. But as B.K.S says, change moves us forward. I could not be the mother that I want to be without stepping back from my teaching and administrative obligations.

And finally my relationship to myself has changed. I have learned to surrender my past lifestyle and personal schedule and not take myself so seriously. I have to laugh when wrestling with an active 5 month old covered in his own poop. Watching my son change day after day and having the honor to be a part of his development has made me a different and more sensitive person. While I greatly feared and resisted what the change of motherhood would bring to my life, this trajectory of parenthood is allowing me to be the person I am meant to be.

As change will continue to cross my path, I hope that I can continue to face it with hopefulness, humility and a sense of humor.

I invite the PYC community to please share and support one another with your stories of facing change and what it was like for all of you.

Add comment December 15th, 2011at 11:25am Deb

Trying to Avoid A Cesarean Birth

The World Health Organization recommends that the cesarean section rate should range between 5-10% for a healthy outcome for both mother and baby. So why is the national rate hovering over 30%, and what can be done to help lower this sky rocketing epidemic?

There are a variety of ways a woman can help reduce her chances of giving birth via cesarean section:

Low Risk Women Should Go To Low Risk Care Providers.
The vast majority of women can be categorized as “low risk” pregnancy so it would make sense for these women to align themselves with a care provider that caters to this population. Those that are indeed “high risk” (i.e. twin births, those with pre-existing health conditions, gestational diabetes, etc.) should be under the care of a “high risk” doctor. What happens when the low risk woman uses a high risk doctor? Well, the high risk doctor is probably not going to change the way he or she practices medicine, and will likely be more aggressive with the usage of routine interventions. High risk care providers may also follow a stricter labor and delivery schedule. Find out the statistics of your care provider- What is the c-section rate? What kind of schedule does he/she expect you to labor around? If you are not high risk, why should you be treated as if you were?

For more ideas of figuring out if you and your care provider are a good fit, check out The 5 questions to ask your care provider BEFORE your birth

Low Risk Women Should Go To Low Risk Educated Places Of Birth
This is a similar philosophy to picking the right care provider: picking the right place to birth. If the hospital mainly cares for high risk women that are often receiving a lot of interventions, the nursing staff may be unfamiliar with techniques to support a woman that is choosing a natural birth or does not need some of the interventions a high risk woman may require. There may also be an unfamiliarity of what a natural birth looks and sounds like, as well as a lack of patience for an unmanaged labor.

To better understand the differences in birthing facilities, please read, Where You Birth DOES Matter.

Educate yourself
Because of the nonchalant attitude and public acceptance of c-sections, the seriousness of the surgery is often glossed over. I believe if more women were educated about the potential risks involved in undergoing this procedure, fewer women would agree to a c-section and take more aggressive steps to avoid the possibility of one.

For a bigger picture of the risks vs the benefits of a cesarean, check out To Cesarean or Not To Cesarean

Get Educated Support
Since most well meaning partners do not know the ins and outs of labor and delivery, it can be very helpful to have an educated labor supporter that can offer you guidance and advice during the process. A well trained labor support doula can provide support and help steer you away from interventions and procedures that may be more routine than necessary.

Here is a little more information about how incorporating the help of a doula helps lower your chances of cesarean birth.New Study: Doula Care Lowers Cesarean Rate

Stay Home As Long As Possible
Staying home (and comfortable!) as long as possible is another way to decrease your chances of having a c-section. This is also another place where having a trained set of eyes watching you labor may help determine when it is time to head into the Birth Center or hospital, and when you haven’t quite turned the corner into active labor. Many care providers have a formula as to when they would like you to come to the hospital. It is likely the 5-1-1 or 4-1-1 rule. Meaning that the laboring mother should experience contractions 5 minutes apart, lasting for 1 full minute for 1 full hour! Once the laboring mother is admitted onto the Labor and Delivery floor, she is “on the clock” and a certain level of progress is expected to occur in a timely manner. If this progress is not met, it is likely that medical interventions will take place to move labor forward.

Avoid Unnecessary Interventions
Introducing routine interventions is a slippery slope. While there is no definitive formula, there is an increased likelihood that one intervention leads to another, and to another, and so forth. This is called the ‘cascade effect of intervention’. What may seem benign, such as artificially breaking the water or continuous fetal monitoring, can soon spiral out of control eventually leading to a cesarean birth.

It has become routine practice in many hospitals that women in active labor receive continuous EFM. According to Lamaze International, routine continuous electronic fetal monitoring (EFM) provides no benefit for babies and increases the risk of cesarean for mothers. The American College of Obstetricians and Gynecologists (ACOG) recommends that for healthy, low risk women, fetal heart rate be monitored with a fetospcope or Doppler every 30 minutes in active labor and every 15 minutes during pushing. The World Health Organization (WHO) encourages intermittent manual listening and warns that EFM is often used inappropriately.

There is a fair amount of research supporting the link between labor induction and the rise in the cesarean rate. When a woman is induced, she will more likely need the support of the epidural which decreases the mother’s ability to actively move around. Movement during labor can help encourage the baby into an optimal birthing position, create more effective contractions and make labor pains more tolerable. Along with the epidural comes the need for continuous EFM, which may offer false positive readings of fetal distress.

Avoid Epidural For As Long As Possible
While there are conflicting studies about the effect of epidurals and cesarean births, it is fair to say that once the epidural is in the picture, so are a lot of other interventions that can interfere with an easeful progression of labor: lack of movement, continuous EFM, bladder catheter, oximeter, blood pressure cuff, continuous IV drip and the need for pitocin.

One way to prolong taking the epidural is to learn pain management techniques. There are a variety of methods that can be incorporated into labor like, massage, counter pressure, focusing on the breath, the use of mantras or visualizations, taking a shower or bath, moving or rocking on a birth ball, just to name a few.

For those interested in non-pharmaceutical pain management, please read, 7 Tricks Of The Trade to Help You Have a Better Labor

I hope these ideas are helpful in supporting you through a happy and healthy birth!

1 comment December 8th, 2011at 01:59pm Deb

When You Can’t Have The Birth You Want

For many women, the birth of their baby is not unlike getting married. It is an experience that may have envisioned and planned in a certain way for quite a while. What happens when that vision cannot be met? It can create disappointment, envy and an overall unsettled feeling.

Recently one of my students, Lauren, confided in me that she was having a very difficult time digesting that her birth will not be able to go as she had originally hoped. Lauren had always wanted a natural birth, ideally at home or in a Birth Center. She explained that due to a serious pre-existing medical condition, her doctors thought it best that she use an epidural to assure that her blood pressure stays more controlled for the safety of herself and her baby.

Here is what Lauren had to say about her feelings:

PYC: Would you explain why you may not be able to have a natural birth?
Lauren:My reasons for why I may not be able to have a natural birth are probably very different from other women. However I always find it helpful to hear others’ stories so I am more than happy to share mine. Here’s the short version:

I always dreamed of natural birth in a tub at home or at a birthing center. My sister is a licensed midwife and naturopath. There are the medical concerns but additionally there are the fears. I am so excited to be pregnant (it took quite awhile) and yet birthing has these fears of death attached to it now. Obviously, the aneurysm is the scariest thing I have ever and probably will ever experience. So I’m working through complicated emotions about the beauty of birth and my fears of what could happen. Our goal is to do natural birth, but in many ways it is outside of my power and hopes.

PYC: How do you feel when you read about childbirth in many of the books and website available?
Lauren: My constant dilemma in reading birth related books is that I feel a disconnect between their advice and what my options are and may become. The advice is empowering and insightful, yet it can cause me to feel anxious. Especially the parts about epidurals. When the books start talking about the possible negative outcomes of using epidurals, it can be frightening such as: epidurals can make the laboring process extended and the pushing more difficult and painful. The books often explain, even after accepting both of those negatives effects, the mother might have to have a c-section anyways. Then there are the concerns about the babies health in relation to epidurals. So much to think about….I’ve begun to skip those chapters.

My thinking is, this is out of my hands so what is the point of knowing. Ignorance is bliss and I never think that! I’m the kind of person that loves to read and learn about new things, but this is one area that I have decided doesn’t necessitate my exploration. I’m trying to accept that whatever happens will be decided based on my baby and my own health and well being.

PYC: Have you found any books/websites etc that support the use of medication?
Lauren: I have to be honest I haven’t really looked that hard for more books and websites. After a month of freaking out, I stopped reading. I’m just now starting to pick up the books again. I’m reading only the later chapters in Ina May Gaskin’s book. I decided to skip the amazing birthing stories that made me jealous. I also skipped the epidural and drugs section because it made me scared. However, I see the importance of this information for most women. They should know their options and be strong advocates for themselves.

One way to start to wrap your mind around having a birth that may differ from your original idea is to start to look at the risks versus the benefits of how you want to birth. As a Lamaze teacher, I often encourage my students to ask, “Is mother ok? Is baby ok? Can we have more time?” Well, this is not necessarily about time, per se. But it is about looking at the two most important people involved. If one or both of them are put in harms way, it is important to re-evaluate the situation. Looking at it from this angle, and understanding why you may need to deviate from your original birth plan may make it easier to come to terms with what you are facing, and perhaps make it easier to readjust the vision of what birth can look like.

Another of our students from the PYC community had this to say about her birth experience:

“As you may remember, I had to have a C-section, much against my wishes, because my baby was breech. We also found out, during delivery, that he had the cord around his neck so its a good thing we went with the C. Not to say the baby can’t come out vaginally with the cord around your neck - I was born at home with the cord around my neck - but I think with him being breech it was the safest thing. ANYWAY, what I want to say, and I invite you to share with your classes, is this:

In class you often talk about how you don’t know what labor and delivery are going to bring. And although I had a planned C-section, so much of what I prepared for still mattered. I used breathing techniques before and during the surgery to help me stay present, calm and in my body despite the spinal. I know, for a fact, this helped me feel more like the delivery was mine. I was so afraid that the C wouldn’t feel like I really *had* the baby, but because I was able to stay present and feel him coming out of me, I was able to connect with my delivery and still feel like I had a real labor experience.”

I also advise people that cannot (or did not) have their desired birth, to mourn the experience. Personally, I had a very difficult birth and while the outcome was ultimately what I wanted, a natural birth at home, the experience was very arduous and traumatic. I was often annoyed when people dismissed my pain of the experience and said, “At least you have a happy, healthy baby.” Of course having a healthy baby is a blessing, but having to accept that the birth I had was so far from what I thought it would be is still difficult. While the outcome is vitally important, the process of birth is lasting and deep for many women and needs to be honored and supported.

I would like to thank my two students for sharing their stories with the PYC community. I hope their insight may help another mother find solace in facing a birth that differs from her original vision.

1 comment November 17th, 2011at 03:04pm Deb

Eating Chocolate During Pregnancy Can Be Beneficial!

Somewhere nestled comfortably in my nausea-free second trimester I came across a couple of articles that discussed the positive effects of dark chocolate for pregnant mothers. This was a very delightful moment since I am a self proclaimed “chocoholic” and now felt rightfully justified in my wicked indulgence.

The first article talked about a study done out of Yale University that included 2,291 women pregnant with a single baby. The study sited theobromine, a chemical found in dark chocolate, as an aid to reduce the chance of developing preeclampsia by as much as 69%. Preeclampsia is a condition in which the mother has high blood pressure and protein in her urine. Theobromine is helpful for such a condition since it stimulates the heart, relaxes smooth muscles and dilates blood vessels, and has been used to treat chest pain, high blood pressure, and hardening of the arteries. (1)

This particular study suggests multiple servings of dark chocolate a week. Women who ate five or more servings of chocolate each week in their third trimester of pregnancy were 40 percent less likely to develop preeclampsia than those who ate chocolate less than once a week.

PLEASE READ THIS CAREFULLY! A serving is one small square of chocolate, NOT the whole chocolate bar! Chocolate is high in sugar which could bulk up the mother and baby and lead to other health problems, like gestational diabetes if over-consumed. So please, do not mistake what this study is suggesting.

The other article I read suggests that women who eat chocolate during pregnancy have happier, livelier babies. This study was conducted by Katri Raikkonen at the University of Helsinki in Finland with 300 pregnant participants. (While I can not claim to be part of this study, I did enjoy in a small bite of dark chocolate on a very regular basis and have a very happy, smiley and lively little boy!) The scientists believe phenylethylamine, a mood-altering chemical in chocolate, may be responsible for the joyful little babes.

The study also explored the correlation between the stress level the women where experiencing and how much chocolate they consumed. Stressed women who ate chocolate were more likely to say their babies were less fearful in new situations. While Stressed women who didn’t eat chocolate said their babies were quite fearful in new situations.(2)

In all fairness, it must be added that the scientists said that while they could not rule out other factors, they speculated that the results could be linked to chocolate consumption. (3)

AGAIN, I WARN, DO NOT OVER INDULGE IN THE CREAMY RICHNESS OF CHOCOLATE!!! MODERATION IS KEY!!

Here is my final declaration to the wonders of chocolate: Chocolate has higher levels of magnesium than any other food except seaweed (like dulse and alaria). (4) According to Anne Frye, author of Holistic Midwifery, adequate sodium, calcium, magnesium and potassium intake will help prevent leg cramps.(5) So for those mamas that are experiencing those nasty calf cramps, a little dark chocolate (and hydration!) may bring some relief to those sore legs.

When I have mentioned the yummy benefits of chocolate in my prenatal yoga classes, it is sometimes met with concern about caffeine intake. Some women chose to completely abstain from any caffeine during their pregnancy, while others modify consumption. The March of Dimes recommends that women who are pregnant or trying to become pregnant consume no more than 200 milligrams (mg) of caffeine per day. This is the amount of caffeine in about one 12-ounce cup of coffee(6). To get a sense of fair comparison between the serving size of chocolate and the recommended limit, an average serving size (1.45 oz.) of Hershey’s Special Dark Chocolate Bar will contain 31 milligrams (mg) of caffeine. So if you are comfortable with a little caffeine in your diet, a small nip of chocolate is well within that realm.

For those that are now on board and unabashedly want to dive mouth first into Willy Wonka’s chocolate river, you can broaden your chocolate palate at the upcoming New York Chocolate Show. The Chocolate Show is returning to the Metropolitan Pavilion November 10th - 13th.

The event will feature some of the top chocolatiers and pastry chefs like Jacques Torres, Zac Young and Johnny Iuzzini from Top Chef Just Desserts, Francois Payard, and chocolate companies like Michel Cluizel, Valrhona, Guittard, Liddabit Sweets, and many more.

This event is also great for kids! There will be some very exciting events in The Kids Zone and chocolate arts and crafts. New to the Kids Zone in 2011 is a “chocolate grab” game where kids can win tickets to see the Radio City Christmas Spectacular® starring the world-famous Radio City Rockettes. The chocolate grab will take place two to three times daily. Each child will grab a handful of chocolate and the child who finds a specially wrapped piece of chocolate will win tickets. Also, American Heritage Chocolate (owned by Mars) is going to have a colonial style themed booth where the workers will be dressed in period costumes and educating consumers on the history of chocolate in the US. Definitely fun for kids!

The best part of The Chocolate Show? Children are free with a two child per adult limit, $8 per additional child (5 years to 12 years)

For more information about the Chocolate Show, visit Chocolate Show New York.

I am planning on going with my family on Thursday. Hope to see you there!

Sources
1. Chocolate May Reduce Pregnancy Complication Risks, Reuters Health
2. Chocolate ‘makes for happy babies’, BBC News
3. Chocolate ‘makes for happy babies’, BBC News
4. Nutrition Articles by Radiant Health
5. Frye, Anne. Holistic Midwifery, pg 955
6. March of Dimes

1 comment November 8th, 2011at 09:37am Deb

Episiotomy or Natural Tear?

There are so many decisions to consider when approaching birth. Where should you deliver? With whom should you put your trust to give you care? Which interventions do you feel comfortable with and which ones would you like to avoid? While sorting through all these options, it can be easy to be overwhelmed by the choices or even bypass some of the interventions you might face.

In this blog, I compare the pros and cons of an episiotomy to that of a natural tear of the perineum. My goal is to offer you enough information to either make an informed decision with what you are most comfortable with or at least open the discussion about this matter with your care provider.

What is an episiotomy?
An episiotomy is a surgical incision at the perineum (the region between the anus and the vagina). The intention of an episiotomy is to provide more space for the baby to pass through the vaginal opening. The cut of an episiotomy can be a midline cut- a cut straight down from the vaginal opening to the anus or a mediolateral cut- an incision angling from the vaginal opening to the side, cutting more into the muscle rather than tendon. Nowadays, the mediolateral cut is primarily used over the midline cut to preserve the integrity of the pelvic floor.

As of 2005, twenty five percent of women who gave birth in the US had an episiotomy. This is a decrease from the previous decade. Even though the rate of episiotomy usage is going down, according to ACOG (American College of Obstetrics and Gynecology), it is still the most commonly used procedure in obstetrics. Lamaze International states in their Care Practice Papers, the episiotomy rate can be safely lowered to 10% or even lower. I would suggest asking your care provider what his/her episiotomy rate is and under what conditions would he/she feel it necessary to perform this intervention.

What are the benefits?
There is a bit of controversy about the benefits of an episiotomy. Those supporting the use of the procedure believe that if there was an emergency and an immediate need to get the baby out, extra space at the vaginal opening would allow for an easier instrumental birth, i.e. with the use of forceps or vacuum extraction. Some providers also see the usefulness of an episiotomy for larger babies to give the baby more room to come through. I have also heard of care providers performing an episiotomy if they believe the perineum is going to tear on its own. The logic being that it is easier to repair an episiotomy compared to a natural tear. With an episiotomy, the cut should be in a straight line as a opposed to the ragged edge of a natural tear.

A news release from ACOG states, “The best available data do not support the liberal or routine use of episiotomy. Nonetheless, there is a place for episiotomy for maternal or fetal indications such as avoiding severe maternal lacerations or facilitating or expediting difficult deliveries.”

What are the risks?
Some of the risks of an episiotomy include, extension to a third- or fourth-degree tear, subsequent pelvic floor dysfunction, anal sphincter dysfunction, painful sex, infection and fecal and urinary incontinence.

What are the benefits of a natural tear?
Many care providers and medical studies are supporting the occurrence of a natural tear of the perineum over an intentional cut of an episiotomy during childbirth. Part of the reasoning for this is data suggest that women who have an episiotomy do not have significantly improved labor, delivery, and recovery compared with those who do not have one (ACOG statement). Also, by foregoing a routine episiotomy, the mother has a chance to stretch the perineum during the course of second stage (the pushing phase) and may avoid any perineul damage altogether. With an episiotomy, the connective tissue, muscles and skin are cut and therefore the strength will permanently be compromised.

What can be done to prevent the need for an episiotomy or tearing?-
There are many ways to help keep the perineum intact. First, having a regular kegels routine will help keep the perineum strong and flexible. This exercise offers the benefit of strengthening the muscle but also teaching how to relax it, too. (For more details on Kegel exercises, please reference my blog, Get To Know Your Muscles “Way Down There”, The Importance of Kegels)

Interestingly, the presence of stretch marks has also proven to be a fair predictor of tearing. They most likely are correlated with poor skin elasticity in general. A woman’s basic physiology also affects her likelihood of tearing. Women with a short perineum, when the anus is close to the vagina, are more likely to tear during delivery. (3)

The position a woman pushes in can also have an effect on the probability of tearing or not. (On a personal note- after 5 hours of pushing, I did not suffer from perineum tear. I credit this to pushing my son out in a side lying position.) Certain positions put more strain on the perineum than others. Unfortunately, the most commonly used position, the supine position, can put a lot of stress on the pelvic floor. Side lying, an all 4 position or standing and leaning forward are more optimal for perineal health.

Another method to avoid perineal damage is to avoid the use of an epidural if possible. As just discussed, the least effective way to keep the perineum intact is pushing while on the back. With the use of an epidural, the pushing options are more limited. Although, side lying pushing should still be an option for women with an epidural. In one study, women with no anesthesia had the highest rate of intact perinea (34.1%), while women with epidurals had the highest episiotomy rate (65.2%). Another study shows that women who had an epidural were more than three times as likely to suffer third- or fourth-degree tears. (4)

Perineal massage is another method that can be used to help prevent tears or an episiotomy. One study out of the Department of Obstetrics and Gynaecology, Watford General Hospital, Hertfordshire, UK came to this conclusion antenatal perineal massage appears to have some benefit [reduction of 6.1%] in reducing second or third degree tears or episiotomies and instrumental deliveries. This effect was stronger in the age group 30 years and above. Click here for direction on how to perform perineal massage.

Midwifery Today (Issue 65) focused on the perineum. There were some very helpful tips on reducing perineal damage. Here are some of their suggestions.

l. Forget those little gauze sponges and ask the nurse to bring in ten facecloths from the linen cart. Put some hot water from the tap in a beaker and applies gentle, hot compresses for the woman to push toward gently. If they are contaminated by any feces, the nurse can throw the dirty one away and stack the facecloths on the bed using them one by one as she goes through them. (They are removed later.)

2. Encourage the woman to hold and support her own tissues. Women instinctively slap any hand that is put on the crowning head. This is to be encouraged because it helps her stay in control.

3. Care providers can help by using reassuring words such as “you are stretching beautifully,” “there’s lots of room for the baby to come through,” and “I know this burning is intense but you’re doing this nice and easy”–makes such a difference. Practice saying these phrases in the mirror so they come out easily.
-Gloria Lemay, British Columbia

It’s natural for the baby to progress and regress over and over. This allows the perineum to stretch effectively. Then, massage the perineum with vernix from the baby’s head.
-Dr. John Stevenson, Australia

Apply warm compresses everywhere on the woman’s body so there is less focus on that one spot (the perineum). The woman relaxes, the midwife relaxes.
-Naoli Vinaver, Mexico

Healing from episiotomy or tear
If you do end up with either an episiotomy or tear, there are many ways to help the healing process.
The area will be sensitive for a while and you will have dissolvable stitches, so sitting for a prolonged period of time might be uncomfortable. Unfortunately, new mothers sit a lot since you will likely be feeding your baby for many hours through the day and night. You may want to consider an inflatable doughnut. These are often used for helping the discomfort of hemorrhoids (those little buggers may also be a result of pushing your baby out!)

I would also recommend either applying witch hazel pads to the perineum of sitting in a sitz bath for 10-15 minutes. My doula recommended making a strong solution of certain herbs, including rosemary, comfrey and yarrow, and adding that to the sitz bath, (For those in NYC- you can get them at Flower Power) I did a sitz bath twice a day and it was a nice time to be by myself and not be on “baby duty”.

To help dilute the acidic effect of urine, I would suggest using a peri bottle while peeing. The hospital will give you one before you leave. If you are having a home birth, it will likely be in your home birth kit.

Last but not least… kegels! Kegels will help encourage healing by bringing circulation to the perineum. Do not be surprised if the pelvic floor muscles feel very weak at first. It will take time and effort, but the strength will eventually return.

I hope you are now armed with some good information that will help you make a choice that is best for your body. Here’s to a happy and healthy pelvic floor!

Sources
1. http://www.acog.org/from_home/publications/press_releases/nr03-31-06-2.cfm ACOG News Release :ACOG Recommends Restricted Use of Episiotomies
2. Excerpt from “Care Practice Papers” from the Lamaze Institute for Normal Birth.
3. Elizabeth Bruce, excerpted from “Everything You Need to Know to Prevent Perineal Tearing,
4. Elizabeth Bruce, excerpted from “Everything You Need to Know to Prevent Perineal Tearing,

3 comments October 28th, 2011at 11:20am Deb

Find Your Advocate

There is a reason for the old saying, “It takes a village!” And in the days of my grandmother and mother, there was actually a village present to help with child rearing and birth. In the case of my mother, it wasn’t the “old country” my grandmother came from, but the yentas of Brighton Beach, still very much a village in itself.

Nowadays, with families spread out and births happening in a more medicalized environment, the village one builds may look a little different, but this “village” or community is still vital in helping to provide support for the new mother during this transition.

Deer Caught in Headlights
The other day in class, one of my second time mothers was talking about her first labor. She was explaining, prior to her first birth, that she put a lot of thought and effort into establishing her “labor tools” (the coping mechanisms she would use). However, when she was actually in labor, she drew a complete blank and panicked. I asked her if she shared these ideas with her partner. She explained that she talked it over a bit, but didn’t go to into depth about how she may need help. She knew this time around she would approach things differently.

As a doula, one of the things my clients and I talk about are the different pain management techniques they may like to use. We may use every single one discussed during her labor, or none at all, depending on how they work for the mother. I also suggest that my clients and students, especially those that are not hiring a doula, do a little “test run” of using these tools ahead of time to acquaint their support person with the different options. In prenatal yoga class we practice something called the mock contraction. This is a 60 second wall squat that is rather intense on the quadriceps and takes both mental and physical stamina. The idea is for the woman to take the pain management tools out of the theoretical state and put them to practical use.

At home the pregnant mom can either do the mock contraction or the Lamaze One Minute Ice Cube Test. This is when the mother submerges her hands in bowl of ice cubes or ice water for 1 minute and the partner uses some of the relaxation techniques previously discussed to help the mother through that 1 minute period. This gives the couple a chance to hash out what was helpful and what was not.

During labor, the mother is definitely the one calling the shots as to what works and what doesn’t, but she may need some help in identifying and remembering what those specific pain management techniques are. The laboring woman has enough going on and should not be responsible for coming up with her “tool kit”, which is why it is so important to begin building a “village” early. (See How to Recruit and Prepare Labor Support!)

Fighting the Bully
I was meeting with a group of new moms the other day. And as new moms do, we started talking about our birth experiences. One of the mothers asked me about my birth. She knew that it was a lengthy process and that the second stage (the pushing stage) was a 5 hour marathon. She curiously asked about the different positions I tried. “What position didn’t I try!” I replied. After discussing with her my myriad of pushing positions, she explained that she wanted to try alternate positions other than the traditional supine position, but was bullied into staying flat on her back by the nurse who was attending her birth.

The mother was talking me through her birth story, and was still trying to resolve what happened at the pushing stage. She was unmedicated and was under the impression that she would have the freedom to choose what position was most beneficial and comfortable to push in. She asked the nurse several times if she could get off the bed and try pushing while stand up. The nurse was far from supportive and gave her a snarky answer saying, “If gravity helped with pushing, women would just stand up and the baby would just fall out.” So one would conclude from an answer like that, that the mother remained in the bed unable to have her desires fulfilled.

In a situation like this, the mother may not have the strength to advocate for herself and needs to have the support from her birth partner, care provider or doula. Birth preferences should be discussed ahead of time and if a mother finds herself in a position that is not right for her, she needs to look for her “village of supporters” for help. Also keep in mind, if one member of your birth team is not working for you, you can ask them to leave. In reference to this story, should the mother find herself in a similar situation again, she can have one of her birth partners ask for a replacement of the nurse.

Fighting the System
This advocacy story is a personal one, it is mine. My story is not one about labor or even the postpartum experience. But about getting the support I needed to PAY for the birth I had. My husband and I chose to have a homebirth. When we signed on with our midwife, Stacey, we knew she was out-of network. I had to get permission from my insurance company to cover her services. Luckily, I received a letter stating that my midwife would receive in-network level of benefits. I was greatly relieved and continued to receive excellent care from our midwife.

After the birth, I was informed that the insurance company was only willing to pay a fraction of the cost of the birth and all the prenatal and postnatal visits. This seemed ridiculous to me, especially considering how inexpensive a homebirth is in comparison to a hospital birth. All this started to unravel about 3 weeks after the birth of my son.

Not only was I exhausted and trying to figure out how to sleep, breastfeed and be a mother, I now had to deal with the insurance company! Fortunately, the NYC midwives work with an woman, Haya Brant, who knows how to handle tricky insurance situations. She informed me that New York State laws require insurance companies to cover home birth. She was going to bat for me with the insurance company and also helped me get in touch with the Attorney General to file a complaint. Haya became my advocate for me and my midwife at a time I just could not speak up and fight for myself.

My story ends with Haya passing along the joyful message, she was able to talk to someone at the insurance company, and repeal the claim and finally get the midwife the money she deserves.

Pregnancy, labor and delivery and motherhood can transform a woman. This new woman is strong, supple, fragile and fierce all at the same time. While she is passing through this life changing transformation, she may need some help along the way. Sometimes she can ask for it right out, other times, she may need her “village of supporters” to clear the way for her.

Add comment October 21st, 2011at 12:55pm Deb

Postpartum Depression

Not long ago, I was speaking with a friend about her experience right after her babies were born. She confided in me that she suffered from postpartum depression and started to tell me her story. I asked her if she would be willing to share what she endured so that other women can learn from her struggle.

Here is my brave friend Nicole’s story.

Please describe you postpartum experience
The postpartum experience for me was shocking. It really had no idea what was wrong with me and it didn’t occur to me for several weeks that it could actually be postpartum depression. I was walking around for weeks in a perpetual fog and funk. I was of course tired and overwhelmed after giving birth to twins, but what stood out was that I couldn’t seem to shake the “gloomies” and had a very hard time bonding with my babies. To say I was not myself was an understatement. People would describe me as a girl who was always “up” and looked at things “glass half full.” I could barely pull myself out of bed in the morning and I dreaded the rigors that would lie ahead for me each day. I took absolutely no joy in being a new mother. I was so convinced that I had made a huge mistake in having children that if my doctor had come to me and assured me that I was a good person, that he knew I meant well but clearly I was not cut out to be a mother, I think I would have let him take my kids away. It is very hard for me to look back on those first couple of months, I feel guilty and ashamed about how I felt. The person that I was at the time was a complete stranger to me. As bad as I felt, I am thankful for the fact that never once did I think about harming myself or harming the children, I just wanted to run away.

When/how did you recognize that you were experiencing postpartum depression?
I felt the “doom and glooms” from day one. I had experienced HELLP syndrome when delivering the babies which caused my blood pressure to skyrocket and kept me in intensive care for a few days. I had to see my OB a few days after coming home from the hospital and mentioned that I was feeling bad - feeling like I wasn’t myself and I couldn’t “hold it together” but he wrote it off as be overwhelmed and the stress of the HELLP and the delivery. But help arrived on the day I took the girls for their 8 week check up at the pediatrician’s office. We saw the physicians assistant, Dr. Gardiner for the check-up. I immediately liked her, she had such a calm and reassuring way about her. She took one look at me and asked me very gently how I was feeling. When I told her how sad and lost I felt (my husband was with me at the time and was obviously so worried about me), she immediately recognized the symptoms and was at least able to give me a reason and a name for what I was feeling. While it didn’t help my depression it at least allowed me to realize that what was happening wasn’t my fault and I wasn’t going crazy!

What measures did you take to help relieve the situation?
Dr. Gardiner discussed medication with me and was very reassuring that it would help and I wouldn’t have to take it forever. I have always had a phobia about taking medication (I don’t even like to take Advil!) so I was reluctant. I kept thinking the next day would be better, that I would “pull myself out of the fog” and get back to being my old upbeat self. Somehow just knowing that it was a chemical issue and not me losing my mind really helped. I knew that my darkest times were when I was alone so I began to reach out to every friend, family member, neighbor and acquaintance to keep me occupied and the upside was they could help me with the babies. I didn’t wind up taking any medication but it’s a decision that quite honestly I regret. There was no reason I had to suffer the way I did when medication could have helped. I look back on it now and realize it was such a shame that I wasted precious months with the girls crying and feeling worthless and like a terrible mother/person when if I had at least tried the medication I could have enjoyed being on maternity leave and loving and appreciating my new family.

What measures best worked for you?
The only thing that really worked was time and honestly going back to work. It seems strange that going back to work helped cure me because the thought of returning to my job while I was home made me unbearably depressed each day. I felt so awful and knew that each day was slipping away - I became obsessed with the fact that each day I felt sad was one less happy day I was going to have with the kids. It became like this doomsday countdown in my mind knowing that each day my maternity leave was closer to being over. But somehow when I was forced to get up in the morning, take a shower, put on makeup and nice clothes and get back to the reality I knew prior to the babies, I felt rejuvenatetd. Having a little time to myself made me whole again and it allowed me to appreciate every waking moment I had with the girls when I was home. I became so much more patient and loving, I finally felt like a new mother was supposed to feel. Luckily I only had to go back to work three days a week so I really felt like I was having my cake and eating it too!

Did you feel like you could discus what you were feeling with other people ie- partner, friends etc?
I felt like I could talk about it with my husband and my best friend and sisters but no one could understand what I was going through. They would try everything from sympathizing to “tough love” but no one really got it. I was so relieved when Dr. Gardiner was able to recognize my symptoms - for the first time I felt like I wasn’t going crazy and someone really knew (at least from a clinical point of view) what I was going through. A couple of years later when I read Brooke Shield’s book, “Down Came the Rain”, I cried (with sadness and relief) through every chapter. It brought back all the raw and painful emotions I felt each day and it made me so happy that someone with fame and noteriety was able to share such a personal story that was bound to help thousands of women. My only wish is that it had come out before I had my kids, not after. Since she had taken the medication, I think it would have given me the courage to do the same. I am tempted to go and see Brooke Shields in The Adamms Family and wait outside the stage door after the play in the hopes of telling her how much that book meant to me.

Do you have any advice for other mothers that may be experiencing postpartum depression?
My advice would be to try and recognize your symptoms early and to talk about it with your doctor. My biggest mistake was thinking that I could will the sadness away, that mind over matter would help me to persevere - instead the hormones won and I wasted 4 months feeling like there was a rain cloud above my head that followed me everywhere. It’s also important to take time for yourself. Don’t be afraid to take people up on their offers to help (another of my many mistakes) and get out and do something slightly indulgent like meet a friend for lunch or get your nails done. Don’t waste precious free time doing mindless errands like food shopping and Duane Reade runs, try and let others help you with it. Most of all I would say that you have to remember you are powerless against this force of nature - it is not your fault and you just can’t help it. It was such a waste of energy for me to carry the shame and the sadness that I did. Be very vocal with your doctor, let them help you whether it’s taking medication or connecting you with a support group - just putting a name to the issue will help the healing process.

Facts
* Up to 1 in 7 women experience PPD (approximately 13% of postpartum women)
* For half of women diagnosed with PPD, this is their first episode of depression
* About half of women who are later diagnosed with PPD may have begun experiencing symptoms during pregnancy—so it’s important to seek help early!
* Postpartum depression can occur at any time after birth, but it most commonly starts 1–3 weeks after delivery.

Reasons
It is impossible to pinpoint what may be the cause of one’s Postpartum Depression (PPD) There are several reasons that can contribute to PPD, but not one single reason often leads to postpartum depression.

* Infant temperament and maternal anxiety and depressed mood in the early postpartum period. (1)
* Isolation
* Expectations of what motherhood would be like, what the baby would be like
* Lack of support
* Overcoming a difficult birth (If you experienced a challenging birth, you may be interested in the article, Birth Trauma)
* Ambiguous feeling about the pregnancy - may have been an unplanned pregnancy
* Loss of freedom and personal identity
* Body image issue- loss of pre-pregnancy body
* More prone to experiencing PPD if there is a history of depression or mental illness pre-pregnancy or family history of depression or mental illness.
* Stress from marital problems or financial problems

What are the Signs of Postpartum Depression?
* Feeling restless or moody
* Feeling sad, hopeless, and overwhelmed
* Crying a lot
* Having no energy or motivation
* Eating too little or too much
* Sleeping too little or too much
* Having trouble focusing or making decisions
* Having memory problems
* Feeling worthless and guilty
* Losing interest or pleasure in activities you used to enjoy
* Withdrawing from friends and family
* Having headaches, aches and pains, or stomach problems that don’t go away

It is normal to see a change in mood and desires postpartum, especially considering the huge hormonal shift your body experiences after birth and sleep deprivation. However, if you are experiencing any of the symptoms of depression listed above (2) for more then two weeks, it is best to consult with your care provider. Your doctor can figure out if your symptoms are caused by depression or something else.

Getting Help
Even the idea of reaching out for help may seem overwhelming. If you need, start small, maybe your partner can make a phone call or two to get the ball rolling for additional support.
* Seek professional help
* LifeNet Call Center - Listening Service for people in crisis, including substance abuse. 800-543-3638
* Get support from partner, family and friends
* Sleep! Sleep deprivation can really wear on the mind and body!!
* Find a New Mother’s Support Group in your area. (PYC often offers two groups per season)
* Try to get some time away from your baby, even if that is just going outside and walk around the block a couple times.
* Placental Arts. (Check out the article in NY Mag on this) It is believed that ingesting the placenta postpartum helps balance the estrogen which drops significantly after birth. This can be done by having a professional first dehydrate the placenta and encapsulate it. I had this done with my placenta and took the capsules for about 2 months postpartum. This also helps with low iron levels, which is not uncommon postpartum.
* Supplements: Fish Oil Promising Against Postpartum Depression in Small Trial

Society’s Expectations and Stigma
From my own experience, I believe a new mother may feel a certain amount of pressure to “get it right.” Many people said to me, “You seem to be doing great!” While it was nice to have the encouraging support and feedback, there was a part of me that felt, if the outsider thinks I am doing a great job, why don’t I? Was there even room for me not to be doing so great when everyone believed (and maybe expected) I was?!

I clearly remember one difficult Wednesday afternoon when Shay was about 2 1/2 weeks old. All the family had left and our postpartum doula was not in that day. At this time, our pediatrician wanted Shay to eat every two hours. I had been up with him since 6am and managed to get him down for a few rounds of feeding. But the the successful cycle of eat, change him and put him down for a nap stopped abruptly. He had gone straight through three feeding and no nap. He was tired and irritable and I was exhausted. I tried every position and trick I had learned in my few weeks of motherhood. We bounced on the birth ball, I swaddled him, rocked him, sang to him, Sh’d him. Around 3 pm that afternoon, I called my husband asking him when is he going to come home. He said soon. I hung up the phone and just started crying. Fifteen minutes later, my husband entered the apartment to find me sitting in our bedroom, rocking on the ball with the baby in my arms and tears streaming down my face. He gave me a kiss and took the child. After a few minutes, he said, “Thank you for calling me. Now please go to sleep.” I had never been so grateful for the opportunity to rest and for help to arrive.

As Nicole explained in her story, it may be challenging and disappointing to face that one can not “pull themselves” out of the funk they are feeling by themselves. Some people may even be a level of embarrassment or shame that goes along with experiencing PPD and needing a medication. Even though pharmaceutical drugs are very prevalent in our society, some may still feel stigmatized for taking SSRIs (Selective Serotonin Reuptake Inhibitors). A close friend of mine talked to me about how she was finally able to accept taking medication. She said she could acknowledge that if she had diabetes and needed insulin, there would be no doubt that she would take the medication. So she was able to rationalize, taking a medication for her mental health was no different then taking a medication for her physical health.

No matter what level of depression or anxiety one feels, there is always a way to find support and feel better.

Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/21391161
(2) http://womenshealth.gov/publications/our-publications/fact-sheet/depression-pregnancy.cfm
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004481/
American Psychological Association
http://www.acog.org/publications/patient_education/bp091.cfm
http://www.womenshealth.gov/faq/depression-pregnancy.cfm

2 comments October 7th, 2011at 01:57pm Deb

The Pelvic Floor, Prolapse and Pregnancy

It is quite ironic that I started this blog prior to the labor and delivery of my son, and now I am in the midst of dealing (and healing!) with pelvic floor problems postpartum. I was originally drawn to this subject matter because so many students discretely approached me about pelvic floor issues. Many had bladder prolapse, and several were still suffering from incontinence months after the delivery of their child.

It was surprising for me to learn that so many women were quietly suffering from pelvic floor dysfunction. My own midwife explained about 20-25% of her clients have some sort of pelvic floor weakness postpartum. So while it is a common issue- it is rarely talked about. I believe this is mainly due to women being embarrassed to talk about the pelvic area. One of our teacher trainees kept referring to this area as “the bathroom muscles.” It is unfortunate that there is such shame, isolation and embarrassment when addressing the powerful area of the body that carried and birthed our babies.

One of the woman I spoke with asked if there was anything she could have done prenatally to avoid the bladder prolapse and incontinence she suffered from. One proactive idea: next time you are at your prenatal or 6 week postpartum visit, ask your care provider to assess your pelvic floor strength and check for pelvic organ prolapse. If your care provider recognizes a problem, it is best to find a physical therapist who specializes in pelvic floor issues and start a rehabilitation regimen. Even if all is well with your pelvic floor it is still important to establish a regular Kegel routine.

Why Should I address this Issue?
The strength and flexibility of the pelvic floor is especially important to address during and after pregnancy mainly because of the effect of the hormones relaxin and progesterone, combined with the weight of the growing fetus, weakens the pelvic floor. If a woman does not maintain a strong, flexible and healthy pelvic floor, she can suffer prolapsed bladder (Cystocele), prolapsed uterus, prolapsed anus (Rectocele), urinary incontinence, back pain and pelvic pain. Even if a woman gives birth by Cesarean section, she will still have carried the weight of her baby for an average of 40 weeks, and the pelvic floor will have experienced some weakening.

My midwife explained to me that during the postpartum stage, the estrogen level drops dramatically- on par with what is experienced during menopause. This drop of estrogen effects the muscle tone and leaves the muscles in a more relaxed state. Decreased estrogen levels can account for some of the hypotonia (low muscle tone) which can diminish the sphincters from fully closing leading to incontinence and a lack of support for the pelvic organs. If the mother is breastfeeding, this low level of estrogen is prolonged until solid foods are introduced to the baby. Once the baby has started on solids, the mother is often breastfeeding less and her estrogen levels start to increase.

Brief Explanation of the Pelvic Floor Muscles.

The pelvic floor is made of two layers of muscles, the superficial layer and the deep layer. The muscles that we focus on when practicing Kegels are part of the superficial layer of the pelvic floor. To help visualize these muscles, you can think of a figure 8 shape. Simplifying this greatly, the bulbospongious muscle is the front loop of the figure eight, which runs from the clitoris to the central tendon (the perineum), and the anal sphincter is the back loop of the figure eight.

The deep layer of pelvic floor muscles are made up of the Levator Ani and Coccyeus muscles and create a bowl shape. These two muscles are the sides of the bowl, or the walls of the lesser pelvis, and support the pelvic organs in their proper alignment.

What is Prolapse of the Organs?
When the normal anatomical position of the pelvic organs slips out of place either into the vagina or presses against the vaginal walls due to a weakened pelvic support of muscles and ligaments, one experiences prolapse of the organs. The extent of severity is measured as 1st, 2nd and 3rd degrees of prolapse.

What Can Be Done During Pregnancy and After Pregnancy to Prevent Prolapse?
There are several ways to help prevent prolapse during and after pregnancy. As I already mentioned, continue to regularly practice Kegels, also maintain a healthy weight and diet (this will lessen the pressure and weight on the pelvic floor muscles), avoid smoking, exercise regularly, and refrain from straining during a bowel movement.

Besides kegel exercises, you can maintain strength and stability in the pelvic floor by also working what I call the periphery muscles to the pelvic floor- the adductors, abductors (inner and outer thigh muscles) and transverse abdominal muscles.

In prenatal and postnatal yoga class, we often include poses to target these muscles groups. Poses such as:
-squeezing a block between the thighs for downward facing dog, utkatasana (chair pose), tadasana (mountain pose) and uttanasana (standing forward bend)
-opposite limb extension
-strapping thighs and pushing outward into the strap
-prenatal and postnatal abdominal -specifically transverse abdominal exercises

The transverse abdominus is the inner most muscle. It arises from the lower 6 costal cartilages, the lumbar fascia and the iliac crest. The fibers of the transverse muscles run inward towards the midline. You can think of this group of muscles as a natural corset, helping to stabilize the torso and maintain internal abdominal pressure. Unlike the other three abdominal muscles, the transverse abdominus does not move your spine. You flex this muscle to pull in your belly.

Transverse abdominus muscles can be toned using an exercise involving deep slow exhalations of the breath. The pregnant mom comes on to her hands and knees. While trying to maintain a flat back, she inhales and releases the muscle tone of the belly and then exhales contracting the transverse and rectus abdominus. Many women want to “cat/cow”� in the exercise, and it is more effective to avoid undulating the spine. Another way to think about this exercise is to imagine that with each exhalation you are tightening a corset around your middle, and drawing their baby closer to your spine.

Symptoms of Prolapse Organs (1)
* A feeling of heaviness or pressure in the pelvis
* Pain in the pelvis, abdomen or lower back
* Pain during intercourse
* A protrusion of tissue from the opening of the vagina
* Recurrent bladder infections
* Unusual or excessive discharge from the vagina
* Constipation
* Difficulty with urination, including involuntary loss of urine (incontinence), or urinary frequency or urgency

What Can Be Done After Pregnancy to Repair the Situation -
There are several options for repair depending on the severity of the pelvic floor issue.

* Pelvic floor exercises or electrical implants - These may help to strengthen your pelvic floor muscles if your prolapse is minor.
* Vaginal pessary - This is a plastic ring put inside your vagina to prevent any loose vaginal skin from coming down. It can be an effective and comfortable alternative to surgery, but does not work for everyone. With regular checking it may work for many years.
* Laparoscopic surgery - This is an operation using keyhole instruments. The pelvic floor is repaired through a number of small cuts in your abdomen rather than through your vagina.
* Burch colposuspension - This is an abdominal operation to lift the bladder. If your bladder has prolapsed, especially when you also have problems with leaking urine, this may be the best treatment.

All of these alternative treatments may be improved by hormone replacement therapy (HRT) or by using hormone creams, called oestrogens. These help by increasing the blood supply to your pelvic organs.

Commonality of the Problem
It is estimated that at least half the women who have had more than one child have some degree of genital prolapse (although only 10-20% complain of symptoms)

From the women I have talked to, there is little discussion postpartum about pelvic floor prolapse with their OB/GYNs or Midwives. Interestingly, an article came out last year in the New York Times, highlighting that in France “all new mothers are entitled to 10 free sessions of pelvic floor rehabilitation, followed by abdominal workouts. The sessions, which are paid for by the French government, include electric stimulation devices and computer games that aid in post-birth recovery.” (2) So if your care provider does not bring this subject up, it may be up to you, the new mother, to inquire about the state of your pelvic floor.

This is a message from one of my students. “Stress incontinence after complete recovery from vaginal birth (e.g. several months) is not something you should have to accept as part of the effects of birth on your body. Get evaluated and if your stress incontinence cannot be address with physical therapy (as was my situation) review your surgical options. I “put up with” the condition for two long years thinking that I could kegal my way back to normalcy. I wish I had been more aggressive about treatment options earlier on.

Where to find Treatment
Pelvic floor rehabilitation may not be the specialty of all physical therapist. I would recommend researching specifically for a PT that has a strong background in that area.

In the NYC area, I would recommend:
* Pamela Morrison at Pamela Morrison Physical Therapy P.C (This is the PT I have been working with. She is on the UWS and is fabulous! A real no-nonsense woman!)
* Isa Herrera at Renew Physical Therapy
* Amy Stein at Beyond Basics Physical Therapy

Sources
(1) http://my.clevelandclinic.org/disorders/uterine_prolapse/hic_uterine_prolapse.aspx
(2) http://www.nytimes.com/slideshow/2010/10/12/world/europe/20101012-france-5.html
(3) http://www.uterine-prolapse.net/a_complete_overview_of_uterine_prolapse.html
(4) http://www.womhealth.org.au/factsheets/genital_prolapse.htm
(5) http://www.gulfmd.com/pregnency/Prolapse.asp?id=15

2 comments September 27th, 2011at 11:01am Deb

My (42 hour labor) Birth Story

I am a very good example that prenatal yoga will not necessarily guarantee you a shorter labor, but can offer you tools to get through whatever your labor turns out to be. I could not have gotten through my labor without the support of all I have learned about myself through my years of practicing yoga.

I grew up hearing from my mother about the fast, easy labors she had with my brother and me. Naively, I was expecting to follow in her footsteps since our body structures are so similar. I never would have predicted that my labor would be about 42 hours long with 5 hours of pushing.

The story starts, July 9th- my due date!- early in the morning. My husband and I were trying some “natural methods” to get labor started. About an hour and a half later, dressed and ready to head out to the gym, I noticed that I was starting to experience strong cramping feelings- like intense menstrual cramps. I decided to hold off on my gym excursion and see where things would lead. After a bit of time, I realized that these cramps were not going away and were becoming a regular pattern of every 5 minutes. The sensation was still quite manageable, but I called my labor support doula and my midwife just to give them the heads up that something was brewing. My husband had a prep class that morning for his Social Work licensing exam, and since I was certain that I was still at the beginning of the process, I insisted he go to the class. I also felt like I needed some time alone to wrap my head around what was to come. I took a bath and spent some time to relax and breathe through the rise and fall of the contractions.

Terry, our doula, arrived around 3pm that afternoon. I knew I had not “turned the corner” into active labor, but did believe I was on the brink of it. Things slowly progressed through the day. I alternated between laboring in the birth tub- which brought my contractions on to every 3 minutes- (this as painful as it was, made me hopeful that things were progressing) and moving around the house and resting. Terry had been in contact with our (AMAZING!) midwife, Stacey Rees, through out the day and was informing her of my progress. By late Saturday night, I was aware that things were moving along very slowly and was concerned about a disfunctional labor. At this moment, being a professional in the birthing community proved to be a double edge sword. I knew enough to realize that something was not quite right in the progression of my labor, and suspected it was the baby’s position. After a night of moving between resting - I did actually fall asleep between contractions- and trying different exercises to adjust the baby’s position- I was reinvigorated by the rising of the sun.

Joey, Terry and I went to the roof of our building to get some fresh air and change of scenery… and, continue with lunges and stair climbing to encourage the baby to rotate forward. Our midwife arrived a little after 9am and did an internal exam to see how far along I was. I was terrified she would say that I was only 1-2cm along. It is typical that with a malpositioned baby, the mother could experience quite strong contractions but have made little progress in dilation. To my great delight- and surprise to all involved- I was 80% effaced and 5 cm dilated! This news gave me renewed hope and a second wind to keep truckin’ forward. Stacey checked my vitals signs, continued to listen to the baby’s heart rate every 15 minutes and declared that my labor was “methodically” progressing. She then put me to work to try to disengage the baby from my pelvic in hopes to re-rotate him into a more optimal birthing position. For almost an hour I did “butt up” child’s pose. The “big guns” came out when Stacey said she wanted to do a method Guatemalan midwives use with a rebozo sling. This technique involved the help of my husband, Terry and Stacey. I laid on my back and Stacey placed the rebozo sling (a big piece of fabric) under my hips. Joey lifted my feet while my head and shoulders remained on the floor, and Terry took one end of the rebozo and Stacey held the other end. They then rocked my hips from side to side trying to use gravity and the swinging motion to disengage the baby’s head from my pelvis and help him re-engage in a better manner.

At this point, our midwife headed home for a few hours and I was then instructed to alternate between resting and being active to try to turn the baby. This went on for a while, which brings us to late Sunday afternoon when Stacey returned to check in on me. To my great delight I had progressed to 8 cm and almost 100% effaced. This progress helped me regain confidence and hope that labor was nearing an end. I continued to follow the same routine I was doing before, resting and moving. About 3 hours later- convinced I had to be close to full dilation, considering the intensity of the contractions, I was still at 8 cm.

In my mind, I started to fall into despair. I was tired and had been at this game of labor for about 34 hours. The contractions were definitely challenging and took over my whole body. I often counted my breathes, knowing that at a certain number, I was hitting my halfway point in the contraction, and soon the pain would subside. I also allowed my body to move however it needed to move. And, I talked myself through the wave of intense sensation with mantras like “the breath is the path through the contraction.” I had to dig deep to keep going and started to question if I should transfer to the hospital to get an epidural so I could rest. I felt that I had the capability to deal with the pain, but I was so tired, I just wanted to sleep.

I started to doubt myself and my choices and mentioned the idea of transferring. Everyone agreed we could do that if I really wanted to, but they all believed I still had the strength to complete my labor at home. Stacey suggested that I try to push and see if she could stretch me open the last couple of centimeters. She also wanted to see what kind of room I had in my pelvis and if the baby would easily descend. After a “practice” push, she believed I could push the baby out. So for about an hour, I pushed as she had her hand in me trying to stretch my cervix open. I made some progress and pushed the baby down a bit. My water spontaneously broke at this point and Stacey wanted to see if this new development of ruptured membranes would bring on strong enough contractions to push me through transition (moving from 8 cm to fully dilated at 10cm) and help rotate the baby into an anterior position.

Intense does not even begin to describe the sensation of the contractions at this point. I was curled on my side in bed actually sleeping between the 3 minute apart contractions. As the contractions started, I moved onto an all 4 position, rocked, moaned, counted, breathed to get through them. An hour and a half later, I begged to start pushing. I was still only 8 cm. UGH!! But, I was not going to stop until my baby was born. As I pushed, Stacey again, stretched my cervix open and finally I was 10 cm and the baby stayed down. After an hour, he rotated into the anterior position- a position that allowed him to continue to descend and fit through the pelvis easier. We tried a myriad of pushing positions; supported squat, pushing on the toilet, “tug of war” pushing and finally side lying (the easiest position on the perineum).

Second stage of labor - the pushing stage- held it’s own challenges. I liked that I was more actively involved instead of just tolerating the experience. But the act of pushing was exhausting. I wanted to give up and be done with the whole thing. Luckily, my baby tolerated this lengthy labor with ease. Stacey checked his heart rate with every contraction and he was never showed any sign of distress. The midwife and doula even joked that his heart rate was so strong, the baby didn’t even seem to know he was in the birth canal. But I certainly knew he was!!! I will be honest- the pain near the end of pushing was a pain that I did not know could exist. I mustered strength- both mental and physical- in a way I didn’t know I was capable of. I would start the contraction and say to myself- “Just finish this off and get the baby out” and then proceed to push with everything I had. Once the baby was crowning- which lasted an eternal 45 minutes- I had to shift into an even more serious mode. (There is a reason this stage of pushing is called “The Ring of Fire”) I wanted to give up, I just wanted this all to end. I looked down at my big belly and wondered, “How is this baby ever going to get out?!” I knew with each push I would have to deal with excruciating pain of my pelvic floor muscles stretching as his head continue to emerge, but I also knew that if I didn’t meet the pain and go through it, labor would continue to drag on. So I faced the obstacle and just plowed forward until he was finally out.

Relief, joy, exhilaration, exhaustion, disbelief all came flooding over me at once as my baby was placed on my chest. He was so alert as he looked around taking in this new, dry world. My hard work paid off, and my beautiful baby boy was finally in my arms. The placenta came out soon enough and much to my incredible surprise, I only had a minor tear on the side of my vagina, my perineum stayed intact. After Stacey skillfully repaired the small tear, Joey and I stayed in bed and took in the wonder of our new son. Terry was busy cleaning up the birth tub, reorganizing the living room and she cooking us breakfast - it was about 4am on Monday morning at this point! Stacey was conducting her newborn procedures and assessment. Her final task was weighing our boy and measuring him. 8 pounds and 20 inches long! WOW! That was a surprise!

After telling my story to some friends and family, I am often asked if I regret doing a home birth where pain medication was not available. No, I don’t regret that choice at all. I will admit that towards the end, an epidural sounded like a fantastic idea. However, I can see with the labor that I had- slow and methodical - as my midwife called it, I would have likely experienced a very medicalized birth in a hospital setting. Having a career in the birth community, I have a good sense of the time table that births need to run on in a typical hospital. I likely would have had pitocin to help move my slow labor along and an epidural. This would have made the chances of my son rotating from posterior to anterior even slimmer. Since I never progressed past 8 cm on my own (remember, Stacey helped stretch me to full dilation) I likely would have been declared “a failure to progress.” If I did dilate to 10 cm on my own, the 5 hours it took to push him out would have been too long for the protocols of most hospitals and I would have been told my baby was too big for my pelvis and ended up delivering via cesarean section. So, yes, it was painful, but for me and my little family, it was the right choice.

As for how my yoga practice helped me. There is a term in the study of yoga, svadhyaya, which means “self study.” Through my years of yoga, I have encountered asanas (poses) that were challenging and took years for me to uncover how to fit them into my body. From the poses that did not come easily to me, I learned how to deal with discomfort, find patience and surrender my ego. Those tools were invaluable to me during my long, arduous labor.

Shay Henry was born in our bed, in the warmth of our small apartment on July 11th. We could not be happier, prouder, (tired!) parents.

Shay, Mom and Dad just moments after the birth

18 comments August 5th, 2011at 12:34pm Deb

Breastfeeding: Getting the Support You Need

After teaching a postnatal class two weeks ago, a few of the mothers and I began talking about breastfeeding, and the support one may need during that period. One mother, Dina, who was bottle feeding, shared her story about why she was no longer breastfeeding.

“About half my friends did not breastfeed so when I had problem after problem, even though I really wanted to breastfeed, I thought it was pretty average to stop breastfeeding. My mom, mother-in-law and sister-in-law didn’t breastfeed, so I just didn’t have much support on the homefront. They didn’t understand why I was “putting myself through this.” Now that I’m out in the mommy world, I see that most people do breastfeed. I really feel that if I had known that, and if I had known that what I was going through was completely normal, and similar to what everyone else is going through, I would have been more inspired to continue to push myself through the rough part.

Also, the problems that we encountered were firstly due to a severe lack of help from the nurses at Lenox Hill Hospital to get me started on the right foot, so I came home from the hospital already with sores on my nipples. Sloan would only latch if she was hungry but not starving. If she was starving, it was really hard to get her to latch. She was extremely gassy, so I had to cut out a lot of food from my diet. Then she developed acid reflux and an allergy to milk and soy and I had to cut them both from my diet. I was trying to pump and hardly anything was coming out, so I felt that my supply was low. In retrospect, I don’t think it was, since Sloan was gaining weight.

And on a personal level, it was just hard for me to feel like I didn’t have any break. It was constant, every 1-2 hours and it would take her at least 45 minutes to eat, so I felt like it was just unending. Of course, I’ve now learned that the babies get more efficient and it takes them less time to eat as they get older. My mom said that if I didn’t bottlefeed, she’d never sleep through the night, but of course I know tons of breastfed babies who sleep through the night and did sleep through the night earlier than Sloan did. ”

Stories like Dina’s are not uncommon. One of my close friends, Valerie, also experienced difficulties breastfeeding. Her daughter, Mia, had a hard time latching on. Valerie was pretty discouraged by this turn of events, but luckily was able to find a supportive network that encouraged her to continue pumping in order to exclusively feed Mia breast milk. For 12 months, Valerie and her breastpump were intimate friends. Recently, Valerie shared that had she not had the support and common bond with another mother going through the exact same experience at the same time, she does not know if she would have been able to sustain such a challenging pumping and feeding regimen.

Common Problems That May Arise

It may be reassuring to realize that many mothers experience a slew of common problems when first initiating breastfeeding. Many of these issues are solvable once addressed with the proper guidance. Here are just a few difficulties you may encounter.

* The mother many not feel enough support from family, friends or hospital. When researching doctors and hospitals, look for a “Baby-Friendly” hospital status.
*Sore nipples
*Cracked nipples
*Inverted nipples
*Low milk supply
*Going back to work and managing pumping
*Breast problems and pain including thrush and mastitis
*Challenge with baby latching
*Fussy feeder
*Colicky baby

From just listening to the breastfeeding stories of these two amazing mothers, Dina and Valerie, I learned how important it is to seek out help, should trouble arise. Recognizing that the problems you may have are actually normal can be comforting and encouraging. Additionally, please know that if you are having problems breastfeeding, it is in no way a reflection on you as a mother, you have not failed your child in any way. There are several venues to find support for breastfeeding mothers that can help should you encounter breastfeeding obstacles.

Where to Find Support
La Leche League
Dr. Mona Gabbay - for those in the NYC area
International Lactation Consultant Association
National Breastfeeding Helpline Call 800-994-9662 for support!
Support groups- At the Prenatal Yoga Center we offer a drop in Breastfeeding Support Group twice a month. You may be able to find a similar offering in your neighborhood.

Interesting Statistics and Data about Breastfeeding Practice in the US

How many infants born in the United States are breastfed?

The CDC National Immunization Survey is a nationally representative sample of the U.S. population, among infants born in 2006:

* 73.9% were ever breastfed
* 43.4% were still breastfeeding at 6 months of age
* 22.7% were breastfeeding at 1 year of age
* 33.1% were exclusively breastfed through 3 months of age
* 13.6% were exclusively breastfed through 6 months of age

How long should a mother breastfeed?

The American Academy of Pediatrics (AAP) recommends that breastfeeding continue for at least 12 months, and thereafter for as long as mother and baby desire. The World Health Organization recommends continued breastfeeding up to 2 years of age or beyond.

Whereas 59% of women initiated breastfeeding in 1984, roughly three-quarters of women now start breastfeeding, according to the Centers for Disease Control and Prevention’s National Immunization Survey.

Despite recent progress, gaps still persist between current breastfeeding practices and national breast-feeding objectives. Rates of exclusive and sustained breastfeeding remain low. Less than one-third of infants are exclusively breastfeeding at 3 months of age, and almost 80% of infants in the United States stop breastfeeding before the recommended minimum of one year. Furthermore, unacceptable racial/ethnic and socioeconomic disparities in breastfeeding persist. Compared with white children, breastfeeding rates are about 50% lower among black children at birth, 6 months of age, and 12 months of age, regardless of the family’s income or education status. Compared with middle- and upper-income families, children in low-income families are less likely to be breastfed.

Sources
Surgeon General’s Perspectives: The Status of Breastfeeding Today (PDF, 1.22 MB)
By Rear Admiral Steven K. Galson, Acting US Surgeon General
Centers for Disease Control and Prevention
La Lech League

3 comments July 8th, 2011at 02:48pm Deb

Preparing for Postpartum

Recently I stumbled across an interesting article from The Journal of Perinatal Education titled “New Study Finds First-time Mothers Could Benefit from Postpartum Preparation” The article explains, first-time mothers want more information about how a newborn will impact their lives. Thirty-five percent did not feel prepared for the physical experience following birth and 20% did not feel prepared for the emotional experience. With that in mind, I put together some ideas of ways to prepare for the transition into motherhood.

Ask for help!
Asking for help is one of the best ways of taking care of yourself. This could be from a postpartum doula, schedule of friends that will come by and help, parents or in-laws.

Be clear with your requests. If people are there, they want to help. Do you need more water, light housekeeping, someone to watch the baby so you can step out of the house just to walk around the block?

Set boundaries
Discuss with your partner about handling traffic control of visitors and unwanted (yet often well meaning) advice.

Talk with your partner about life with baby
Have an open, honest discussion with your partner about what life will look like with baby.

Some topics to think about are:
-Looking for postpartum depression
-Understanding that both parents will be sleep deprived and that can lead to edginess and irritability. -Ask partner to be understanding of the huge hormonal shift occurring postpartum
-Your sex life will be different postpartum. Talk about what the expectations are and how you can support one another in this different phase of your physical relationship
-Talk about what your fears are surrounding the arrival of your new baby.

Pack your freezer!
Tell your friends not to bring flowers, but to bring food! A well stocked freezer of healthy, easy to heat up nourishment is going to be far more appreciated in the moment then a bouquet of slowly wilting flowers that you do not have the energy or desire to throw out.

Take some time to either cook some of your favorite freezer-friendly meals or stock up on some from your local grocer. Some areas also have meal services that cater to the nutritional needs of the new mother. In the NYC area, you can check out Mothers and Menus

Create a “nursing corner”
Most likely there will be one or two spots in your home that are designated as your nursing station. Get this area ready with your Boppy pillow or My Breast Friend, a place for water, books, a spot for your cell phone, and what ever else you may think you need. The first several weeks after your baby arrives, you will be nursing your baby about every two hours, so there will be a lot of time stationed in one spot.

Wash some baby clothes
Once you arrive home from the hospital or birthing center, or stumble back to your bedroom after a home birth, it will be nice to know that your new arrival already has some fresh clean clothes awaiting. The last thing you want to do is a load of laundry!

Relaxing
The baby’s room (or corner) does not have to be complete and not everything off your registry has to be purchased before the arrival of your little one. Spend some of your last days of pregnancy relaxing. Relaxing before the onset of labor will actually benefit you during your labor and delivery and can make the transition into postpartum easier.

Nursing Preparations
If you are choosing to breastfeed, have some nursing bras and all that goes with it- breast pads, creams for sore or cracked nipples and a breast pump ready. There are several stores in the NYC area that can assist with getting started. On the UES, I recommend Yummy Mummy. (I have already visited there and picked up a few nursing bras. You don’t have to make an appointment and the owner, Amanda, is super helpful! On the UWS, there is The Upper Breast Side, also a very helpful, resource center for new mothers.

If you are going to bottle feed, you will want to get a few different types of bottles since you don’t know which one your baby will like the best. Also- some babies have food allergies, so you may also want to have a few different types of formula on hand.

Be prepared for some physical discomforts after baby comes
It is not uncommon to have either tearing at the perineum or hemorrhoids after delivery. There are a few products to have on hand that could help ease the discomfort. Get some of the overnight maxi pads, put some witch hazel on them, and then stick them in the freezer. These home-made “ice packs” will help promote healing of the pelvic floor and also feel very soothing. You can also use a sitz bath for hemorrhoids and peri bottle while urinating to help with dilute the urine which can cause some stinging.

Taking an Infant CPR class
My husband and I took this class last weekend and while I hope I never have to use these skills, I do feel more prepared with Infant and Toddler CPR and choking skills. The class at PYC also covered SIDs prevention.

Contact list
Have all the numbers you need for contacts on hand. While many of us have these numbers stored in our cell phone, have a master list clearly posted or kept in your apartment so that anyone could find them, and so you have easy access to them.

This list should include:
-your pediatrician
-lactation consultant
-poison control
-cell numbers for both parents
-cell numbers for close friends
-food delivery places
-(this one may sound odd) if you have a pet- have your vet’s number on hand in case someone else has to help the family pet.

Support Groups
Find out ahead of time if there are local support groups in your area such as New Mother’s support groups or breastfeeding support groups. At Prenatal Yoga Center, we offer both. The La Leche League is also a very popular and supportive breastfeeding resource available in many places.

I hope that these suggestions can help ease you into motherhood! For those seasoned moms out there, if I am missing anything you think was helpful for you, please leave a comment and let the community benefit from your experience!

Add comment July 1st, 2011at 08:04am Deb

Surrendering to Pregnancy, Labor and Motherhood

Stretch marks: much to my dismay and efforts, they have invaded my belly region. For months I have been slathering on creams and lotions that promised to help prevent stretch marks and then one morning - last Thursday to be exact - I woke up with my belly feeling rather itchy, looked in the mirror and there they were, little red lines around my belly button. After a few minutes of whining about this to my husband and trying to put some more cream on the jagged lines, I finally had to surrender to the fact that this is life, and just one of the many opportunities to learn to surrender to pregnancy, labor and motherhood.

During Pregnancy
For many women, the onset of pregnancy invites a host of new issues to adapt and surrender to overwhelming fatigue, nausea, vomiting, sore breasts and mood swings. This can be a challenging time, since many women do not announce their pregnancy right away, and suffer through these discomforts without being able to share them with friends, family and colleagues. Huge changes are happening in a pregnant woman’s body and life.

As pregnancy progresses and the mother-to-be continues to grow into this new role and body, new opportunities (i.e. and aches and pains) arise and offer the mother a chance to explore how she can learn not to fight these changes.

Personally, I had to accept that I could not do everything at the same intensity and speed I did pre-pregnancy. At first, I tried to keep up with my busy schedule, but my body (and midwife) soon reminded me that I had to honor that I was in a different place in my life and the body. The life I knew before has changed. With that change, my priorities had to shift. I admit, it was hard at first to surrender to this new pace. But once I did, I felt more at ease.

I have also learned to surrender to my own personal fears about the unknown of labor. I have been hearing for months that “You will do great! You know so much about labor and seen so many women give birth.” While it is true that I have witnessed and been part of many, many births, it does not diminish my fear of what labor and delivery will be like for me. As I enter my 38th week of pregnancy the inevitability of labor starting hangs in the air, I have accepted and surrendered to the fact that I am scared. I think acknowledging this and accepting it instead of denying the emotion is helping me be less apprehensive about the unknown factors of the upcoming event.

During Labor
During the first birth I attended as a labor support doula in-training, the midwife said to my client, “Don’t fight the contraction, surrender and drop into the bed. Let it support you.” I have carried these words of wisdom with me through nearly a hundred births. I have watched many laboring women find their own manner of “dropping or surrendering” to the contraction instead of fighting against them. Most peoples’ first response to pain, whether it be physical or emotional, is to avoid it or lift away from it, usually tightening up their body or mind. This actually leads to more discomfort since it restricts blood flow and oxygen to the muscles. But learning to move with the contraction or discomfort and finding tools to surrender to the sensation or situation usually brings some relief and makes the experience more tolerable. My own midwife reminded me that it is important to surrender to the experience of labor, and there is little I will need to do… just let my body lead the way.

There is also the aspect of surrendering to the unraveling events of a birth. I warn my doula clients and students not to hold onto their birth plan with an iron clad grip. This can lead to disappointment and an unwillingness to see the full picture and options of birth. I know it sounds a bit corny, but I believe there really needs to be a “go with the flow” attitude to labor and delivery. I have had clients that had told me that they definitely want pain medications, but as they sank deeper and deeper into their labor, they found coping methods that took them the whole way through and gave birth in a different manner then they anticipated. On the flip side, I have been with mothers that expressed they whole heartedly wanted a natural, unmedicated birth. But as their labor unfolded, it proved necessary to incorporate some interventions. I was with one client that after about 30 hours of labor she was barely able to support herself and I recommended she get an epidural so that she could rest and have the energy needed to push her baby out and be awake enough to enjoy the first few moments with her baby. Even though this was not her original intention for her birth, she surrendered to the change of plan and ultimately was able to rest, regain her strength, and was prepared to deliver her baby and embrace the joy of her birth.

Motherhood
For years I have heard the story of the the first 6 weeks of my brothers life. He was a colicky baby who wouldn’t stop crying unless he was in a car being driven around. My mom often explains that she had preconceived ideas of strolling around with a cute, cooing baby and was not in the least bit prepared for the crying fits of a colicky, unhappy child. Eventually she surrendered to the fact that, this was the baby she had and she could either fight and resent the situation that was less then ideal for a new mother, or find a way to embrace the needs of my brother.

Motherhood seems to be a road full of opportunities to learn to surrender to the circumstances that are presented in front of us. Our best efforts may not go over as well as planned and rarely do we really ever have true control over anyone other then ourselves. We cannot control the situation presented to us, but we can choose how we react to it.

I have asked some of my “mom friends” to share some of their experiences with surrendering to motherhood.

“Sitting on the floor next to the potty waiting for my daughter to actually relax enough to let the pee or poop come out… How many times did I read the same potty book, acting excited about all the different steps. But you just have to have patience. Even if you had plans to meet friends… you have to sit next to your kid and let the potty training process evolve. It just takes so long each time in the beginning. But then it becomes routine and I miss those days of sitting next to the potty.” ~ Valerie Gerstein

“As a type A personality I had to surrender to many things in my life not going or being perfect. In terms of the housekeeping, gift giving. In terms of work. Everything has been at about 80% which has been difficult when I am used to doing things at 100%. But I have learned that, that is ok. You just have to breath and accept it. And remind yourself, this is what I am capable of right now.” ~ Jen D’Onofrio

In yoga class, we purposely incorporate poses that safely challenge the student both mentally and physically. Learning to surrender to poses or sensations on the yoga mat can allow for the student to start to learn her personal methods of letting go. For some it is relaxing into the breath (maybe with a releasing sigh), and for others it could be a mantra or gentle reminder- “This shall pass. I can do anything for a short period of time. Or simply repeating “Let go”. If we can learn to surrender to the smaller obstacles in life, like a yoga pose, I believe it will be easier to then digest the bigger challenges in life.

Add comment June 24th, 2011at 01:22pm Deb

Interviewing Pediatricians

This afternoon my husband and I are going to visit and interview a potential pediatrician. At first, I was a confused and overwhelmed about what kind of questions to ask. After a little thought and some help from my “Mom-friends”, I complied a pretty thorough list. So for those out there that are also at this stage of baby-planning- I hope this is useful for you!

1. What is your philosophy on child rearing? Just as you likely aligned yourself with a care provider that shared a similar birth philosophy for your labor and delivery, you may want to do the same with your pediatrician.

Here are some questions that may help you decide if you and your pediatrician are on the same page.

*Does the pediatrician support and help facilitate breastfeeding?
*How do you feel about co-sleeping?
*Does the pediatrician want you to stay on a strict feeding and sleeping schedule?
*What is their advice on how to handle a crying baby?
*If you are a family that incorporates alternative healing modalities (like acupuncture, chiropractor or holistic medicine) is that supported?
*What is the pediatrician’s opinion on circumcision?
*What is the pediatrician’s opinion on antibiotics?
*What is the pediatrician’s opinion on immunizations? Do you allow parents to space out vaccinations if they want to do that?

2. What hospital are you affiliated with? If I am giving birth at a different hospital, Birth Center or home birth, do you come there or do we wait until I leave to have our first visit with you?

3. What happens if my baby gets sick during the weekend or after office hours? Do you have weekend hours? Or do I go to the emergency room?

4. Are you a solo practitioner? If so, who is your back up? If you are part of a group, do we rotate through the group or primarily see you?

5. Do you take insurance? Are there procedures that you perform that are generally outside of the realm of insurance? Do you charge for phone or email questions?

6. How long have you been practicing? What drew you to pediatrics?

7. If I have a question, do I call the office or email? Who is likely to respond, the desk staff, the nurse or the doctor? How long should I expect to wait for a non-emergency question to be answered?

8. How do you handle first time parents that can be a bit nervous and have many questions?

9.. What is your “well child” visit schedule?

10. How easy is it to get a same day appointment for a sick child?

11. Are there separate waiting rooms for sick and healthy children?

12. On a “normal” running day, is there usually a long wait or does the schedule run smoothly? How long should I schedule for a visit?

13. How do you feel about obtaining a second opinion?

14. Is the pediatrician part of a large network of specialists should your child need something beyond their realm of expertise, ie- allergies, childhood obesity, hearing problems?

A few other things you may want to keep an eye out for during the interview process:

*Does the desk staff seem organized and friendly?
*Does the waiting room appear clean?
*Are there toys in the waiting room? A pediatrician friend of mine said she does not leave toys in the waiting room since most kids put these in their mouths and it is impossible to clean them after each and every use.
*Does the office/examination room appear clean and organized?
*Did you get a good feel from the doctor?
*Was he/she attentive and answered your questions to their fullest or was he/she distracted by the on-goings of the office?

Remember these are just a few questions to help you feel out who you want to entrust your child’s healthcare to. If you do chose a certain practitioner and it turns out not to be the right relationship, you are not stuck with this person. There are plenty of fish in the sea!

Add comment June 10th, 2011at 10:13am Deb

Childbirth Education Classes Why? When? Where?

I am probably a bit biased about the importance of taking a childbirth education class given I am a certified Lamaze teacher. Given that, I am always surprised when a student asks me if this is something she and her partner really need to invest time and money in to. I try to be diplomatic with my answer and explain that it is a choice if one wants this information. My belief is that you cannot make informed and empowered choices if you don’t know what your choices are.

Most childbirth education classes are going to cover the essentials: the stages of labor, what to expect within those stages, the emotional signposts of labor, pain management techniques, how to involve your partner, interventions and complications, and a video showing of at least one vaginal birth. For many people, this could be their first introduction to interventions and complications, and they may be presented with choices they had never thought about. Once they have this information, the couple can start to determine what is important to them and then discus these points with their care provider before the birth process begins. (See 5 questions….)

If a woman has an idea of what to expect, it takes some of the fear out of this unknown experience (even if she and her partner simply learn the basics). For many women, their only encounter with birth is what they see on TV or in the movies, and these scenarios are often depicted as a scary emergency situation or a comical event. When fear is lessened, a woman may feel more confident in herself and her body’s ability to birth. A less stressed state will allow the natural hormonal system to work better, which may lead to less chance for intervention.

A few students have told me that their care providers said such classes are unnecessary since they - the doctor or midwife- will tell them what they need to know during the labor. From my experience as a labor support doula, I haven’t seen a doctor show up at the woman’s home and offer her pain management techniques or take the time to explain the pros and cons of labor induction, or show her comfortable laboring positions. My opinion- if given this advice from your provider, you may want to think of switching providers UNLESS you are 100% comfortable with your care provider taking the drivers seat.

When to take these classes?
I recommend taking the childbirth education class sometime during the 3rd trimester. Most care providers like to have “the big talk” about your birth choices around week 36. If you have taken your class and have had time to discuss and further investigate your options, you will be able to go into the meeting with your provider with a clear idea of your birth choices. (I try to stay away from the term birth plan, because most of life does not go as planned, but “choices” allows for more flexibility.) Also- keep in mind that full term is considered anytime after 37 weeks, so you may not want to wait that long.

If you are shooting to take your CBE class between 32 to 34 weeks, you need to sign up well in advance. I am speaking from my experience at the Prenatal Yoga Center, and from knowledge of many NYC birthing classes. Most of our CBE classes fill up about 2 months in advance, and we receive many panicked calls from people needing a class right away. Plan ahead of time!

Where to go for your class?
This really depends on the teacher. I have run into some situations where hospitals have had the same teacher teaching the CBE classes for many, many years and have not changed their approach or information. One student told me her teacher is still teaching the Lamaze rhythmic breathing. The Lamaze Organization stopped teaching that style of breath work quite a while ago.

Another concern I have with taking a hospital course is that the course may just cover their protocols, and not introduce you to the many options that are available. For example, if that hospital has a standing rule that everyone on the Labor and Delivery floor is required to have full time external fetal monitoring, the class may not discuss the option of intermittent monitoring, or the data and studies that suggest that it is better for low risk women. If the hospital holds strictly to “no eating or drinking once admitted to Labor and Delivery” the teacher may not share that ACOG (American College of Obstetricians and Gynecologists) has relaxed their stance on fluid intake other then ice chips. However, some teachers of hospital courses may not feel obligated to stay within the parameters of the hospital’s protocols and may offer more general information.

Overall I think that you get more diversity in taking an out of hospital class, and perhaps hear more options of birthing styles and ideas that could inform your birth choices. My husband and I recently took a class with 8 other couples. Out of those 8, many different hospitals were represented, a few couples planned to birth at the Birth Center, and one couple was planning for a home birth. Some of the couples that are birthing in a more traditional hospital seemed to enjoy hearing the options of a Birth Center. One mother even said it inspired her to talk to her doctor about trying to make the hospital experience more like a birth center approach.

Aside from thinking about our birth choices, it seems that there are a million other things to think and learn about! For example, my husband and I spent days talking about, researching and reading reviews for the kind of stroller and crib we want to get. It made us wonder if people are spending more time researching strollers than researching birth choices. Be even more diligent about educating yourself on the birthing process and deciding what is right for you. Your birth experience will stay with you a lot longer than any of the items off your registry.

Add comment June 3rd, 2011at 09:55am Deb

Over Exhaustion During Pregnancy: What to do?

I feel very fortunate that I have a fair amount of control over my work schedule (just one of the perks of owning my own business!). I have decided that at 37 weeks pregnant I will slow my schedule down and stop teaching my regularly scheduled prenatal and postnatal classes. This has been a very hard decision since I enjoy my work, and also feel the pressure and responsibility to stay involved. I consider myself one of the lucky ones to even have a say in this matter. For many women, choosing their work schedule is not an option, and the majority of students that come through the PYC work right up until they give birth. This common occurrence in our work-driven culture often leaves women fatigued and stressed right before the grand act of giving birth.

Why is this a problem?
If the body is in a state of stress and sustained fatigue, adrenaline levels will be high, therefore not allowing for the natural, uninhibited flow of oxytocin- the hormone responsible for creating uterine contractions. This can result in inadequate contractions leading to a longer labor.

Starting labor feeling stressed and fatigued also puts the mother at a disadvantage since laboring and delivering a baby takes a lot of energy and hard work. For those moms that are just finishing a tough day and hoping for a good night sleep (and let’s face it- at the end of the 3rd trimester, is there really such a thing as a good night’s sleep?), you may be slightly unhappy to learn that the most common time for labor to start is in the middle of the night. This is when the mother is most relaxed, in a place where she feels safe and comfortable, and oxytocin levels are at their peak.

What to do if you don’t have a choice with work schedule?
If your schedule is not flexible towards the end of your pregnancy and does not allow for time off, here are a few ideas that will only take a short amount of time, but can still offer you the benefit of rest, relaxation and rejuvenation.

-Take a prenatal yoga class, which promotes relaxation. Prenatal yoga classes typically include an active section as well as restorative poses that can help you relax. If prenatal yoga classes are not available in your area, online videos or dvds can be a good option. (The PYC site has 3 free videos you can watch!)

-Schedule down time. Even if that means just a 20 min bath or getting a relaxing massage or pedicure.

-Try meditating or deep breathing relaxation. Meditation is different then just “relaxing” in that it focuses more specifically on training the mind into stillness through contemplation, concentration and mindfulness. This “stilling” of the mind can help the meditator step away from the nagging thoughts and “to-do” lists that accumulate in our minds.

Deep-belly breathing promotes the function of the parasympathetic nervous system. The autonomic nervous system (ANS) is divided into two parts: the sympathetic nervous system (the fight-or-flight response), and the parasympathetic nervous system (the rest-and-relax response). The body responds to the parasympathetic nervous system by slowing the heart rate, decreasing blood pressure while increasing the release of endorphins, which cultivates relaxation and strength.

-Plan about 10-20 minutes a day to reconnect with your partner. During this time you can work on relaxation techniques or visualizations that you may want to use in labor. Or, simply spend this time just cuddling or lying down together. It’s unlikely that you’ll have this kind of time after the baby is born.

-Step away from the computer and phone at night so you are well rested.

-Enjoy activities that release oxytocin. Oxytocin eases stress and anxiety. The oxytocin response can also prime the brain to react more calmly to future stress just by thinking of those we love, scientists say. According to researcher Phil Shaver of the University of California-Davis, the chemical release in the brain that this simple action causes acts as a stress buffer before it even occurs.

So make plans to hang out with friends or your partner. Don’t forget, oxytocin is also know as the “love hormone” since it is at a very high level during orgasm.

Hopefully this list of ideas for how to bring some relaxation into your days leading up to the birth of your child has at least one option that is doable. My personal theory is, I better get some rest before the baby comes, because it is unlikely that I will get much rest afterwards

Sources
Encyclopedia of Stress Volume 3 by Academic Press
Varney’s Midwifery 4th Edition by Helen Varney, Jan M Kriebs, Carolyn L Gegor
http://oxytocincentral.com/2011/03/oxytocin-eases-stress-and-anxiety/#more-913″

1 comment May 26th, 2011at 12:14pm Deb

Is Pregnancy Public Domain?

Over the past few weeks, it seems that my pregnancy has become public domain for all to comment on, and even reach out and touch! It is probably a combination of hitting the 3rd trimester growth spurt and no longer donning a heavier jacket, revealing my blossoming belly. I have heard students complaining of this issue for years, but now I am a victim myself.

Here are my three favorite examples of inappropriate comments:

Place: Reebok Sports Club.
Scenario: I was walking around the gym when a man stopped me and said,“You look fabulous! May I touch your belly? I just love life!” I responded by telling him I would prefer that he not touch me. But, I thanked him for the compliment. If the tables were turned, would it have been appropriate for me to say to him, “You have a great butt! May I touch it? I just love a firm ass!”???

Place: The women’s changing room at the Iyengar Institute
Scenario: I was changing into my yoga clothes and a fellow practitioner asked when I was due. I told her, two months from today! (Putting me at 32 weeks along). She then asked, “Is your partner a large person.” “No”, I replied. “He is tall but rather thin. Why?” She then answered, “Well, aren’t you really big for still having two months to go?” I said, “No. Actually, I am measuring right on target and have not gained an excessive amount of weight.” After that, I left the room.

Place: The practice room at the Iyengar Institute
Scenario: “Hey, Deb, are we going to have a baby today in class?” My response, “Not unless it is pretty premature. I still have about 8 weeks to go.” The other student’s response, “Oh really?! I haven’t seen you in a coupe of weeks. You have gotten so much bigger since then.”

These are just a few examples of what I have encountered. I know I am not alone in receiving such comments. When I talk to other pregnant women, we all have similar responses to such up-front, personal comments. We are shocked and possibly offended about what has been said, and often too caught off guard to respond.

It seems that when a woman is pregnant, the public feels it is an open invitation to comment on her physical appearance or to share unsolicited advice. Why is this the case? Pregnancy seems to be one of the only times when a friend, an acquaintance or even a complete stranger feels that it is appropriate to comment on someone else’s physique without taking into account that such comments can be hurtful, or even harmful. From my own personal experience, it has been challenging to watch my former figure slowly disappear. Body image issues and eating disorders are unfortunately affecting approximately seven million American women each year . There has even been a new disorder recognized called “Pregorexia”- anorexia in pregnant women and women in early motherhood. Such negative comments about one’s weight and appearance can just add fuel to the fire for those already suffering from these issues.

My theory is that social media is to blame for why most people are surprised by the actual size of a full term or near term belly. Pregnant characters in movies and TV shows are rarely portrayed with bellies accurate to size. A 40 week belly should measure 40 cm from pubis to the fundus (top of uterus). Take a tape measure out and see how big that really is. There is also the celebrity influence of what it is believed one should look like during and after pregnancy. It’s rumored that some celebrity moms have asked to deliver their babies via C-section a month before their due dates to get a head-start on slimming down, says Wang, co-director of the newborn nursery at Massachusetts General Hospital.

I was talking to a fellow prenatal yoga teacher and LSW, Anna Hindell, who was witness to one of the scenarios listed above. Her take on why people feel it is acceptable to make such outright comments is that there is a disconnection in realizing that when someone is talking about “the belly,” they are still talking about the person carrying the belly. It’s as though “the belly” and the woman are two different identities. So, the person commenting on the size of my baby bump may not see how I would take that comment personally. I get what Anna is saying here. It is possible that people see the pregnant belly as a separate entity from the mother-to-be. In a society that compartmentalizes so much, this theory could be true.

Another reason why I think people share unwanted stories and comments may be that they are just processing their own experience. The comments being said likely have little to do with the pregnant women, and more to do with the person saying them. Perhaps the woman that said my belly looked really big had a tough pregnancy, and either gained a lot of weight (or too little), and was self conscious about how she looked while pregnant. Regardless, such feedback can be hurtful and mean. My husband believes I should be armed with some witty comebacks for these loose lipped people. But, I know I would be too dumbfounded by what I just heard to get the words out. So for the time being, I will just smile and move on.

If anyone has encountered such experiences, I would love to hear about them and how you responded. Maybe this will give the rest of us some ideas of how to stop this unnecessary harassment. Pregnant women unite!!

5 comments May 19th, 2011at 08:12am Deb

The Lost Art of Touch

About three and a half years ago, I traveled Summertown, Tennessee to study at the renowned midwifery center, The Farm. The Farm Midwifery Center offers an in depth Midwifery Assistant course to those interested in deepening their knowledge of childbirth education and midwifery practice, and I couldn’t pass up the opportunity to go. This amazing place is home to Ina May Gaskin, plus other brilliant midwives, who carry on the tradition of superb midwifery care to expectant and new mothers.

The course taught us how to measure blood pressure, check heart rate, check dilation, and deepened my understanding of newborn procedures. Additionally, we were taught a hands on method called Leopold’s Maneuvers (which consists of 4 different hand positions used to measure and palpate the belly) to determine the position of the baby. While, I am NOT claiming to be an expert in these skills, they were very interesting and actually not that hard to learn. Aside from the experiential and practical portion of the course, we also had the opportunity to observe a few prenatal appointments. Although I had been a doula for five years already, and had observed how many medical professionals handle pregnant and laboring women, I was surprised by how hands on the midwifery examination is for the pregnant mother. The amount of touch utilized in these appointments was astounding as compared to the hospital examinations. Instead of palpating the belly to determine baby position and estimated fetal weight, the ultrasound machine was rolled into the room. I do not recall seeing a set of hands touch a pregnant belly.

This experience got me thinking about why the hands-on technique of determining fetal position and estimation of fetal weight were no longer being instrumented. Were these techniques put out to pasture when the ultrasound machine became so accessible? Was the art of human touch not being taught to the younger generation of care providers? (SIDE NOTE- my midwife does palpate my belly at every visit and using Leopold’s maneuver regularly and is passing this skill on to her apprentice.) I asked two OB/GYNs their thoughts on this technique.

From Dr. Gae Rodke at St. Lukes/Roosevelt in NYC

“Yes, palpation of the pregnant abdomen, like so many physical examination techniques, seems to be a dying art. When I was a resident, ultrasound techniques for evaluating fetal well-being and size were just being developed… As ultrasound proficiency became a greater part of residency training, it was seen as more “objective”/ scientific, and gained increasing favor. Never mind that a sonographic estimate of weight can be 10-15% off, depending on baby’s position, angle, and whether it is shorter or longer-legged, proportionally. (So a 4000 gram estimate–8 lb 12oz baby, could really be a 3400 gram baby–7 lb 8oz, or 4600 grams–10 lb 2oz–a huge difference.)

Like all techniques- they are only as good as the person doing it. If these skills are not taught and practiced, then the accuracy and proficiency will be less.”

From Dr. Harry Lee at St. Lukes/Roosevelt

“Leopolds aren’t so much taught as they are self taught. As a resident I would palpate a belly of a laboring patient and take a guess and then correlate that with the birth weight. The more you do this the better you get.

As to positioning, that’s what the Leopolds was originally for. To determine fetal position. It is imperfect for that however. I’ve seen patients come up from the Birthing Center with an undiagnosed breech in labor. That’s why the policy on L&D (Labor and Delivery) at Roosevelt is to confirm cephalic presentation by ultrasound on everyone. That is clearly superior.”

The conclusion I have drawn after talking to OB/GYNs and reading multiple studies on this subject is that while there is definitely value in the ultrasound, the hands-on, less invasive method (if performed by an experienced practitioner), can be equally as accurate.

Skills like Leopold’s Maneuver and touching the pregnant and laboring belly are unfortunately not being passed on or practiced very much by the up and coming obstetrics practitioners. The removal of human touch is just a symptom of a bigger problem that is arising in the obstetrics community, and perhaps in our culture. Human contact, trust of instincts, personalization and consistency of care are slowly slipping away from the very human, primal experience of birth, leaving us with a very sterile, medicalized view of childbirth.

For those wishing to read more of the studies conducted questioning this very idea of the value and accuracy of the human touch compared to that of a machine, please refer to the links below.

Accuracy of Leopold maneuvers in screening for malpresentation: a prospective study.

Is it time for routine ultrasound in late pregnancy at Bhumibol Adulyadej Hospital?

A comparison of Leopold’s maneuver, McDonald’s measurement and ultrasonic estimation of fetal weight

1 comment May 12th, 2011at 11:39am Deb