I love the month of May. The days start to feel longer… there is the whisper of warm weather leading into the heat of summer. I get to bring out my (much cuter) summer wardrobe. Mother’s Day arrives allowing us to honor the wonderful mamas of the world. And, did you know, May has recently been declared Preeclampsia Awareness Month?!
What is preeclampsia, you ask? And why is there a whole month dedicated to being aware of it? We want to know!
Preeclampsia is pregnancy induced high blood pressure (hypertension) with protein present in the urine after the 20th week of pregnancy. The disorder can range from mild to severe. If it reaches the severe stage it can be rather dangerous for both the mother and child. It effects about 5-8% of pregnancies. If left unattended, in which it moves from pre-eclampsia to eclampsia, the condition can lead to seizures, stroke, organ failure and death.
Signs and Symptoms
-Sudden swelling of the hands, feet and face that does not vary with time of day or activity
-Sudden weight gain
-Persistent headache
-Blurred vision
-Flashing lights or auras
-High blood pressure
-General unwell feeling
-Nausea and/or vomitting
-Pain in the upper abdomen or lower back (These areas of pain may be an indication of liver dysfunction)
Even though there is quite a large list of signs and symptoms, some women do not display any noticeable symptoms in the early stage. This is one reason that your care provider checks your blood pressure and urine at every visit.
However, keep in mind that many of these symptoms resemble general pregnancy discomforts. If you have a headache, it may really just be a headache. Preeclampsia is a metabolic disorder resulting from liver malfunction and leading to contracted blood volume; it is not a set of secondary symptoms alone.(1) But if you are having several of the issues on listed, you should consult with your care provider.
Risk factors
There is still some mystery to the exact cause of preeclampsia. Although more recent research has indicated preeclampsia could start from the placenta not properly adhering to the uterine wall, there is also the belief that those with preexisiting high blood pressure and liver and kidney disorder are more prone to developing preecplamsia. Multiple pregnancies (twins), first time mothers and pregnancy in early teen years, and mothers after 40 are at a higher risk.
Resolving
Once detected, the mother will be closely monitored. Where she is in her pregnancy and the severity of the condition will determine the course of action taken. Delivery of the child resolves preeclampsia. If the mother is suffering from severe preeclampsia and is over 37 weeks, it is often decided to induce labor and deliver the baby. If the baby is not ready to be delivered, the mother may be put on bedrest or admitted to the hospital to stay under close observation. The care provider may also want to review the mpother’s diet and make any necessary changes such as making sure calories, fluid intake and protein are adequate.
Some research supports the use of alternative therapies such as acupuncture and herbs to help manage preeclampisa, lowering blood pressure and increasing circulation. If you are considering these routes, please check with your care provider first and seek professional assistance.
Postpartum Preelampsia
There is the rare exception of preeclampsia developing postpartum. This can occur within the first 48 hours or as late as 4 to 6 weeks postpartum. It is not known what prompts preeclampsia in the postpartum—it appears to affect mothers who deliver vaginally, with or without an epidural or spinal, and mothers who deliver by cesarean section. However, the mother who delivers via a cesarean loses twice as much blood as the mother who delivers vaginally. This may lower blood pressure and mask the symptoms of preeclampsia. (2) The signs and symptoms are the same as pregnancy preeclampsia. If you are demonstrating some of those issues, contact your care provider.
I hope that this new campaign of Preeclampsia Awareness Month has shed some light on a potentially serious issue. For the pregnant and postpartum moms, please be mindful your state of wellness and don’t be shy about reaching out to your care provider if you think something doesn’t feel right. Trust your mother instincts!
I remember chatting with a friend about a month before I was due with my son about my post-baby gym routine. At that time, I was an avid morning gym goer-6:30 am spin classes- things one can do before baby! I was under the great delusion that I would miss a couple of weeks and then be right back into my fitness regimen.
Reality struck me rather quickly after giving birth that it would take more time to ease back into physical shape then I had estimated. My pelvic floor needed work, I was hopelessly looking for any sign that I still had core muscles and I was downright tired and delirious from sleep deprivation. Many of the mothers I talked with experienced a similar awakening. We all had been somewhat surprised by the postpartum body compared to that of pregnancy. (Full disclosure- these women had been steady prenatal yoga students and were in very good shape during pregnancy.) The shared experience was atrophied muscles, bad posture, achy body and general fatigue. Given that was the physical state postpartum, it would take a mindful approach to returning to a fitness routine.
The first thing to take into consideration when easing back into a fitness routine is to be realistic and patient. It took around 40 weeks to form the pregnant body and it could take nearly as long to fully return to your pre-pregnancy physical self. Birth is a transforming event. I remember very clearly my midwife announcing to me, “the landscape of your pelvis will never be the same.” No matter if your labor is quick, long or surgical, the body undergoes a huge transformation to expel a baby.
Starting Back Slowly
As a general rule, I recommend that women do not return to postnatal or mommy and me yoga until their bleeding has stopped. If a woman gave birth via cesarean section, she needs to wait 6 weeks before rejoining class. If you push yourself too hard in the beginning then you can actually be setting yourself back from real recovery. That of course does not mean you need to be held hostage in your house for 6 weeks. A walk can be considered a good start to your road back!
Bleeding must stop
Once you do embark on some heavier activities, pay attention to signs from your body. Some women find that their bleeding that had tapered down starts to get heavier again, a sign that the body needs more time to heal.
How is your pelvic floor?
Also, if the pelvic floor is weak, putting intra-abdominal pressure (like crunches, pilates or general ab work) can put too much pressure on the pelvic floor and inhibit healing or even lead to a chance of organ prolapse. One of the first forms of exercise you can start to incorporate daily can be a kegel routine, restrengthening or even re-familiarizing yourself with your pelvic floor muscles.
Repairing Diastisis
It is very common that women experience a separation of the abdominal muscles, specifically the rectus abdominals- aka the 6-pack muscles. Your care provider can check this for you when you return for your 6 week check up. If it is severe enough, you may need to work with a physical therapist to help draw the muscles back together. So when easing back to an abdominal workout be mindful not to overdo it. In postnatal and mommy and me yoga, we focus more on plank pose and variations of plank instead of old fashion crunches. It is also advised not to do extremely deep twisting poses which can also inhibit the muscles from repair.
Wiggly, Wobbly Joints
Relaxin, the hormone that is responsible for softening the ligaments and joints during pregnancy and childbirth can stay in the body for up to 6 months postpartum. This can lead to wobbly, unstable joints and a loose pelvis. Again, just be mindful that the activity your choose is not too jerky in movement.
Find All Sorts of Exercise!
You do not need to attend a scheduled class to start to return to a general fitness routine. As I mentioned earlier, walking is a great place to start: don’t discount walking as a gentle cardiovascular exercise! At one point, I was told to avoid higher impact cardio since I was healing from some pretty severe pelvic floor issues and was instructed to try swimming. Fortunately, I have been an avid swimmer for years, so it felt like a nice welcome back to exercise and rediscovering my body. The nice thing about swimming is that it is gentle on the joints and pelvic floor and is great for strengthening the core and back muscles.
Hydrate
Once you do start to ease back into your routine, please remember to hydrate well, especially if you are breastfeeding. If you are out for a stroll with your baby, put your water bottle in the cup holder as a reminder to drink often.
Rest
At the end of every postnatal or mommy and me yoga class we incorporate a few restorative yoga poses and then savasana (corpse pose). Even though many new moms hear the old saying, sleep when your baby sleeps, very few (I believe) adhere to these wise words. So including a few moments to simply relax post-workout can really help replenish you. If you are feeling rested and restored, you will have so much more to offer to those that need you.
I hope that these ideas of how to ease back into a fitness routine post-baby have been helpful. Enjoy your baby and your new life!
For months I have been referring to my son in several of my blogs. So I thought it was time to share a few shots from my scrapbook. Thanks for viewing!
The other day while breezing through some blogs, I came across an entry on the Lamaze Science & Sensibility blog about Vitamin D. The article explained the average person, especially breastfed babies, need additional vitamin D supplements. This concerned me, since my 9 month old has never been given supplements to his diet of breastmilk and solids. So I reached out to my pediatrician- whom I love!- and was a bit surprised that she does recommend this for the winter months since they are not getting as much outside time.
At first I was a bit angry that she did not tell us that we should be giving Shay a supplement. But then I realized that I cannot count on our care provider to hold my hand on every subject. She has always been extremely prompt in answering my questions and reminded me that my son is healthy, so not to worry that he was not getting extra vitamin D.
I have now accepted I need to be pro-active and take responsibility for my family’s health. I cannot assume my doctor is going to give me all the answers. I need to be a smart consumer and know the questions to ask my provider.
Throughout the years, I have talked to many pregnant women about their ideas for their upcoming birth. When the discussion of options available and routine interventions one may want to forgo has come up, many were surprised there was a choice in the matter. Several expressed they assumed there was no choice since their care provider didn’t tell them about different choices in birth. Again, it’s essential that we become smart consumers and researchers so we know what types of questions to ask our care providers.
If it is up to the individual to educate themselves about pregnancy, birth and child raring, where does one look? There are several venues to find this type of information. There are many reliable websites, (I am partial to the two Lamaze websites: Science & Sensibilty, Giving Birth With Confidence, as well as articles and books by Ina May Gaskin and Penny Simkin.) For those just finding their way through the different choices in childbirth, here is a blog that you may find helpful as a jumping off point: Educate Yourself, Know Your Birth Options. I have also put together an in depth list of books I often refer to and devoured on my path into the childbirth education world. Please check out My Book List.
Some other ways to educate yourself is to take advantage of groups and classes in your area. Pregnant women and new moms love to talk! From my own personal experience, I learned a lot about sleep schedules, solid foods and sippy cups from the moms in the New Moms Support Group I attended. I am still in touch with several of these women, and it has become a great community to talk through issues that arise with our kids.
My hope for this blog is simply to remind pregnant women and new moms that we can not always wait for others to educate us about our bodies, our babies and our births. If you don’t know your options, you don’t have any.
Why are some labors long and others quick? One main factor can be the position of the baby at the onset of labor. The ideal position would be with the baby’s back facing the mother’s abdomen, occiput anterior (OA), with the chin tucked in towards its chest. There are, of course, variations of this position. The baby could have its back slightly to the right -ROA (right occiput anterior) or slightly to the left -LOA (left occiput anterior).
Other fetal position variations are:
OT- Occiput Transverse- the baby’s back is to the mother’s side
OP-Occiput Posterior, the baby’s back is towards the mother’s back
ROP- Right Occiput Posterior- the baby’s back is towards the right side of the mother’s back
LOP- Left occiput posterior - the baby’s back is towards the left side of the mother’s back
Any of the OA positions are considered the easiest of fetal positions to facilitate labor progress because when the baby is in an OA position, the smallest part of the baby’s head, the fontanel, is pressing against the mother’s cervix. This pressing causes the cervix to dilate. Since it is the smallest part and molds easily, it is a better fit to push the cervix open. Think about when you put on a turtle neck sweater (the cervix being the turtle neck); if you tuck your chin, the sweater slides over your head easily. If you are looking up towards the opening of the sweater, it is more challenging to slide over your face. The same logic applies to your cervix!
When the baby is in the OP or OT positions, the fontanel is not the presenting part. Instead, it is likely that part of the baby’s un-moldable forehead is pressing up against the cervix. Sometimes the baby’s back is in the anterior position, but the baby’s head is slightly ascyclitic, meaning it is slightly kinked to the side. This is also going to create a bit of problem in pushing the cervix open in a timely manner.
How Do I Know My Baby’s Position?
For some women it can be difficult to feel what is happening internally. In addition to not understanding the movements inside, some mothers are at a further disadvantage by having an anterior placenta (the placenta being adhered to the front of her uterus) making it even harder to feel the baby’s movements. Start to pay attention to where you are feeling kicks and the shapes of your belly. Ideally, if the baby is in an OA position, you will feel kicks on one side of your belly. If your baby is in a posterior position, the kicks will be more towards the front of your belly. Visualize your baby inside your body, if the baby’s back is towards your back, then the feet will be more towards your front.
You can also start to palpate your abdomen. First picture your baby’s body. If the head is vertex, then the landmarks you are looking for are a smooth round back, a hard butt and feet. Ideally, you will feel this along either the left or right side of your belly. If you baby is facing back, then you may not feel this. Your belly will also look a bit different. Picture your baby’s back towards your back. This will leave your belly having a bump at the top- where the legs are tucked in -a small depression around your belly button, and then another bump where the arms are hugging inward.
If you suspect your baby is in a posterior position, there are things prenatally you can do to encourage your baby into a different position. Even if your baby is in an anterior position doing these things will only encourage your baby to stay put.
Be mindful of your posture and the way you position yourself in your daily life. If we know that heaviest part of the baby is the back of the head and their back, put your body into positions where that is encouraged into an anterior position, letting gravity help you and your baby. So instead of coming home and throwing your feet up and sinking into the couch, which will draw your baby towards the hammock shape our your back, lay on your side or rock on a birth ball. Or if you are comfortable, hang out in child’s pose.
Prenatal yoga and swimming are also great activities to help your baby into an optimal fetal position. For one reason, swimming and many of the prenatal yoga poses are belly down, encouraging the baby’s back towards the mama’s belly. Another reason for malposition could be tight, twisted pelvic ligaments and muscles. If the psoas and pelvic ligaments are tight this can restrict the baby from manipulating itself into a good position. In prenatal yoga, we address this issue and incorporate many hip opening poses into class.
What Are The Signs of A Malpositioned Baby?
*One of the biggest indicators of back labor is a tremendous amount of pain in the back, mainly the sacrum area. This is not to be confused with the ordinary amount of back pain a laboring women may experience. Lingering pain on the sacrum area is often secondary to the pain of the contraction itself. This pain is due to the baby’s head pressing up against the boney structure of the pelvis.
*Mothers may also notice a nonlinear labor pattern. In a functional labor, the contractions generally start out about 10 minutes apart lasting 30-60 seconds. As labor progresses, the contractions become closer together, forming a predictable pattern and being consistently 60 seconds long. In a dysfunctional labor, the mother may be having contractions 3 minutes apart with short painful contractions and then dropping back to 10 minutes apart.
*In a “normal” labor, if a mother was having contractions close together, say 3 or 4 minutes apart, it would expected that she was in active labor and her cervix was between 4-7 cm dilated. In a back labor situation, the mother may be experiencing strong, frequent contractions with little progress and slow dilation
*Another telltale sign of a malpostioned baby is the frequent need to urinate during/after contraction. This is because the baby’s forehead is pressing against the mother’s bladder.
*If the cervix is open enough the care provider can feel for the suture lines to determine the position of the baby’s head.
Ways To Help Rotate A Malpositioned Baby During Labor
Once you have identified that the baby is malpositioned, there are ways to help rotate the baby. This often takes patience, time and effort. BUT it can work, so don’t give up hope!
If the baby’s head is not deeply engaged in the pelvis, sometimes it can be as simple as spending time on all 4’s in positions like cat/cow or doing body circles or “shaking the apples”- this is done by placing the mother on all 4’s and jiggling her legs, this will loosen the pelvis. Counterpressure and the “double hip squeeze” can also be useful tools.
If the baby is a bit more stubborn to move, you will likely want to work on positions that open the pelvis allowing for more space to rotate the baby- like lunges. With the hips facing squarely forward, place a stool to the side of the mother and ask her to externally rotate her leg and bring one foot up on the stool. Then have her lean into the lifted leg and then rock away. Keep repeating this action for at least 5 contractions. This will create an asymmetric opening of the pelvis and can help rotate the baby. Walking up and downs stairs will also have the same effect, as well as walking while doing leg lifts with the lifted knee going towards the mother’s arm pit.
If the baby is still not rotating, the baby may be rather engaged in the pelvis and actually need to be disengaged to help it properly rotate. To do this, ask the mother to come into a position where her butt is higher then her shoulders. For example, “butt up child’s pose” or a wide leg forward bend. These poses need to be held for about 45 minutes. Truth be told- it will not be a comfortable position to hold. With the butt up, the is a fair amount of pulling on the round ligaments that hurt during the contractions, but this is an effective way to float the baby’s head out of the pelvis and allow it to reposition itself.
Also keep in mind that a malpositioned baby tends to lead to a longer labor, so offer the laboring mother a resting pose between the hard work of these “butt up” poses. Lay her on her side in a semi-prone position with her bottom leg extended and her top leg elevated on pillows or a bolster. Roll her towards her belly so her top hip is leaning forward. Take into consideration which side the baby’s head is facing. If the baby is ROP (right occiput posterior) then she should be laying on her left side. This will encourage her baby’s back towards her belly.
If the baby is still malpositioned, DO NOT opt for an amniotomy (breaking the water). While it may sound enticing and hopeful that this intervention could possibly move labor along, the water still intact will give some cushioning and more ease in trying to rotate the baby. With the bag broken, head may go further down in the WRONG position.
Sometimes, an epidural can also assist in helping a baby to rotate. If the woman is exhausted and her pelvic muscles are tight and constricted, putting them into a relaxed state can allow the baby to move more easily.
Knowing that malpositioned babies take the longer to dilate, be prepared to push against preconceived ideas of labor progress. Seventy percent of cesareans are due to “failure to progress” which could be from poorly positioned babies. Ask “If mother is ok and baby is ok, can you have more time?” These questions can possibly afford you more time to let your baby maneuver itself into a good position.
On a personal note, I would have been one of the 70% to have a c-section for failure to progress. Luckily, my midwife gave me the time (about 42 hours!) and tools to turn my baby so I could birth him vaginally.
A friend of mine recently told me about her experience and dilemma with finding the right OB/GYN. She and her husband are trying to get pregnant and when she discussed this with her current doctor, she was surprised, saddened and slightly frustrated to hear that her doctor is only a gynecologist, not an obstetrician. She now needs to start from scratch and try to figure out what she is looking for in an obstetrician.
I urged her to take some time and really think about what kind of care she is looking for. I cannot stress enough that finding the right care provider, one that shares a similar philosophy of birth, is instrumental in shaping your pregnancy and birth experience.
Here are some guidelines for those in the same boat.
Do you have a preference for a male or female care provider?
Are you a high risk or low risk pregnant woman?
If you are considered a low risk pregnancy, it’s best to find a provider that works mainly with low risk women. They are more likely to have an open mind regarding the use of unnecessary routine interventions.
Group Practice versus the Solo Practitioner Group Practice
While it seems logical that all the doctors in a group practice share similar birth practices and philosophies, this is not always the case. When interviewing doctors, ask if all the doctors are on the same page and will honor your requests should you need to see another doctor in the practice.
Since it is unlikely that you will get to meet all the doctors in the practice before signing on as a patient, see if you can make appointments with as many as possible early in your pregnancy. Once you choose a care provider, you will generally be seeing that particular person for your visits and only start to rotate through other doctors towards the end of your pregnancy. However, I have worked with many women who have expressed a dislike for one provider, and desiring to have one doctor over another on call during her birth. As mentioned above, I cannot stress enough that the attitude and support you receive from your care provider greatly impacts your birth experience.
Understanding that you are not guaranteed to have “your doctor” at your birth, are you ok with this set up? If not, then a group practice may not be the place for you and you may want to consider a solo practitioner.
The Solo Practitioner
If you have decided to go with a solo practitioner, you will have all your appointments with this care provider, and you will not be surprised by who will be attending your birth.
However, there are a few things to consider when signing on with this type of practice. You may find that your appointments can be canceled more often than with a group practice. With a group practice, your doctor will only have certain office days and the other days, he/she is on call in the hospital. You will not be booking your appointments on the days that your provider may need to attend the birth of another patient, since you know those dates in advance. A solo practitioner’s schedule is less structured, as there are not designated days that this person will be on call for hospital duties.
Even with a solo practitioner, emergencies and vacations arise, and they generally have another doctor or midwife as a backup. You may want to find out who the back up is, and possibly meet them before your due date.
If you are admitted to the hospital during a week day, your doctor is likely to be seeing patients in the office at that time. So, when does the doctor arrive at the hospital? He/she is not likely to cancel the days appointments if you arrive and are in early labor.
Get To Know The Doctor
You have now decided if you want a male or female doctor, if you are high risk or low risk and if you prefer a group or solo practice. The next step is to determine if your philosophies and desired statistics match up. Awhile back, I wrote a blog call “5 Questions to Ask BEFORE Your Birth” . In this blog, I reviewed some basic points that can help establish what kind of care you can expect from your provider.
The Cliff Notes version of the blog are the following 5 questions:
What is your birth philosophy?
How aggressively do you manage patient care?
What kind of schedule will you be on?
What are the statistics or rates of the practice?
When does your care provider arrive at the hospital or birth center? How involved is he or she in the labor process?
Once you determine how you feel about these questions, you can then interview a care provider to see if your answers match.
Considering you will be relying on this person for guidance through out your pregnancy, do you like his/her bedside manner? Is this person patient with you and willing to spend some time answering your questions and offering you resources to help answer your questions? Or is he/she in and out of the room so quickly you didn’t get a chance to ask anything? Is this person easily reachable? If you do have a question or problem, does the doctor get back to you in a timely manner? Since you will usually have to deal with a “middle man”, aka the office staff, are they helpful and organized?
Which Hospital Is The Doctor Associated With?
Just as your care provider will effect your birthing experience, so will the place you choose to have your baby. (Read, Where You Birth DOES Matter).
Again, the abridged version of this blog-
Are you ok with a teaching hospital?
Do they primarily handle high risk or low risk women?
What kind of NICU (Neonatal Intensive Care Units) is at this hospital?
What are their policies?> For example, do they allow intermittent fetal monitoring or is it mandatory to have full time fetal monitoring?
What are the statistics of this hospital? Meaning- what is the cesarean section rate? What is the induction rate?
Also keep in mind the proximity to your home when choosing a hospital and your doctor. You will be going to prenatal appointments often, especially the last 4 weeks of your pregnancy when you go every week. As for the hospital, you may want to factor in your comfort level with traveling while in labor.
I hope that this list provides a helpful framework for those starting their quest to find a care provider. Best of luck and hope you enjoy the journey!
Yesterday before postnatal yoga class, several of the students and I were talking about the amazing way a baby maneuvers itself to exit the pelvis. If the head, shoulders or torso are not aligned well it can disrupt the process leading to a longer labor. This video beautifully demonstrates the delicate system of development of the baby and twists and turns it must take to be birthed. I hope you enjoy this!
Last Monday night, I was on the panel to speak at an event following the screening of More Business Of Being Born. The event was organized by Urbanity Baby. What I appreciate most about this film is the honesty and bluntness about the hardships of labor, and the disappointments that evolved. Alanis Morissette was among my favorite as she described her labor. She was honest and straightforward in explaining that labor is PAINFUL. I often joke with my students that you must experience some degree of pain in order to get a human out of your body. But behind the laughter, there is truth in that statement. For years I was reluctant to say outright that labor is painful for many women. I didn’t want to scare a room full of moms-to-be, many of whom were first time mothers.
There is, of course, the exception to every rule. One of my closest friends had a seemingly pain-free birth (pain-free being relative to my own experience!). In fact, promptly after her first natural childbirth, she declared the experience “wasn’t all that bad and she would do it again.” Which she did, two more times. Now all that said, there are many pain management techniques available to deal with the pain. If a laboring mother is prepared mentally and physically, it can make the endeavor easier. (Read these blogs for pain management tips…7 Tricks of the Trade To Help You Have A Better Labor, Comfort Measures For Mom, Paging Dr. Feel Good)
I believe it was Cindy Crawford that discussed the idea that the pain of labor is different than any other pain one will experience. Labor pain is pain for a purpose, created by the body. It is not an injury or malfunction of the body. Labor pain is also rhythmic and offers the mother moments of relief between contractions. Sometimes being reminded that labor is only for a finite amount of time and is purposeful can help create a new perspective of the road ahead.
I also appreciated hearing about the birthing scenarios that did not unravel perfectly. The stories were not negative or scary, but they simply did not go as planned. One of the mothers explained that she needed to be induced and another woman gave birth via an unplanned cesarean section. I think it is important to hear of the “not perfect, but not scary stories” to realize there are so many variations of birth. I often recommend the books Ina May’s Guide to Childbirth or Spiritual Midwifery to my students. Both of these books are wonderfully inspirational and filled with a tremendous amount of wisdom and education. My only gripe is that the birth stories are not very realistic for the average women birthing off of The Farm (the midwifery center in Tennessee that Ina May and several other midwives pioneered). Few women find themselves embedded in a community of knowledgeable and nurturing midwives and friends who are willing and wanting to support you through your hours of labor. Some of my students have expressed to me that as beautiful as these stories of undisturbed birth are, they cannot relate to them and ended up feeling badly knowing their birth will not look like those in the book.
This brings me back to my new crush on More Business of Being Born. Alyson Hannigan (aka -Willow for you Buffy fans) was hilarious in recounting her experience of shock, disappointment and dismay when her midwife told her after several hours of laboring she was only 1.5 cm dilated. This is such a common and realistic story. I also loved when Alanis Morisette asked her midwife if the labor would get any easier and her midwife answered, “No, it will get harder.”
Thank you, ladies, for speaking the truth. Labor is hard work, which is why it is called labor! And from my experience, it is like no other pain you will encounter or challenge you will endure. BUT the stories of labor amnesia are true. My own labor lasted 42 hours- including 5 hours of pushing. Eight months later, I have a very hazy memory of the days it took to birth my son and only snap shots in my mind of the most painful moments.
…And keep in mind, the amount of pain one endures in labor is somewhat controllable. Some women will choose to take the journey of labor without medications, while others will include it in their experience. No judgment should be cast either way, as we all have our own threshold of what we are willing and open to endure.
I am thrilled to offer our PYC community a guest blog from Dr. Zoe Veritas, a well respected Manhattan dermatologist, about the many skin and hair issues that arise during and after pregnancy. Enjoy!
I often tell my patients to expect to see many changes in her skin during her pregnancy. These are called physiologic changes, meaning they are normal and expected, and there is nothing to do to avoid them. Many of these changes disappear some time after delivery, and that is usually welcome news. Here are some things a pregnant woman may expect:
~For some women acne develops for the first time during pregnancy. For others, acne which has been present for years will suddenly disappear!
~ Most women will see darkening of the skin including areolae, nipples, genital skin and inner thighs and the development of a linea nigra (a dark line from the navel to pubis). Many women develop melasma, or dark patches of skin on the face.
~Vascular changes result from the natural pregnancy state of blood vessel stretching, instability and new vessel formation. This can be seen in pregnant woman as redness to the palms, varicose veins, redness and easy bleeding of gums, hemorrhoids and specific growths on the skin. Most do not need treatment as they will resolve postpartum, although anything that is painful and actively bleeding should be evaluated and treated.
~A pregnant woman’s hair will grow strong and often look luxurious during pregnancy. This is because the scalp goes into a phase of hair retention, or hanging onto new hairs, during pregnancy. During the postpartum phase all women experience something called telogen effluvium in which they see abrupt shedding of many hairs. Hairs will be seen to fall out from the root. This typically begins 3 to 5 months after delivery. This generally resolves spontaneously within a few months, but may last up to 15 months postpartum. (Interestingly, your baby may develop his or her own postnatal telogen effluvium between birth and 4 months of age! Usually regrowth occurs by 6 months of age.)
~And finally we get to stretch marks. Stretch marks, or striae gravidarum will develop in up to three-quarters of pregnant woman on the abdomen and sometimes on the breasts and thighs. This seems to be due to both hormonal factors as well as the physical stretching of the skin. They occur more commonly in women who gain significantly more weight in pregnancy and carry bigger babies. They are more common in younger first-time moms than in older pregnant woman. A woman is much more likely to develop stretch marks during her pregnancy if she has a previous history of stretch marks. There also appears to be a strong familial tendency, so a good predictor of stretch marks would be whether a pregnant woman’s mother developed stretch marks during her pregnancies.
Of note, studies have shown that coco butter does not help to prevent stretch marks and along those lines, I tell my pregnant patients not to waste their money on expensive creams and lotions that claim to diminish stretch marks. Nothing has been convincingly proven to prevent stretch marks, and I have seen allergic reactions in my patients to these creams. One small study showed that abdominal message with oil can help prevent stretch marks, although a more recent study disproved this. In this recent study pregnant women in their second trimester messaged twice a day with olive oil and this did nothing to prevent stretch marks. I recommend keeping the skin well-moisturized in general, including the pregnant abdomen, for good overall skin health and decreased itching.
Once a pregnant woman has developed stretch marks she often wonders what she can do to treat them. Studies have shown the addition of a retinoid cream can help the appearance of the stretch marks if started early, although retinoids are not prescribed for breastfeeding woman. Glycolic acid may also improve the look of stretch marks and this is a safe option in a woman who is breastfeeding. More recent studies have shown that some of the newer lasers can improve the appearance of stretch marks. The appearance of stretch marks tend to improve spontaneously over time, thus it is hard to determine through studies which treatments are helpful versus nature just taking its course.
Dr. Zoe Veritas is a Dermatologist in private practice in downtown Manhattan. She practices general and cosmetic Dermatology, and enjoys seeing pregnant patients.
Pregnancy is ladened with aches and pains. Many of them we can address during our prenatal yoga classes and offer poses that may help and some that may not! Here are three of some of the more common issues and a few suggestions as to how to deal with them.
Respiratory Issues
Dyspnea (shortness of breath) can sometimes be one of the first signs of pregnancy. During the first two trimesters the increase in progesterone increases the brain’s sensitivity to carbon dioxide and raises the breathing rate.
Other causes of respiratory issues can be skeletal. As the pregnancy continues and the baby is growing larger, the body compensates by deepening the S curves in the spine. The lumbar (lower back) sways more and the thorasic (middle upper back) rounds more. This causes the shoulders to round forward and the chest to collapse in leading to tightening of the chest muscle as well as decreases the space for the lungs to fully expand and the diaphragm to drop. Also as the uterus grows and pushed upward, the lungs and diaphragm are compromised since they can not expand fully.
Asanas to do Gentle backbends like: ustrasana (camel pose), supported supta virasana, supta matsyasana, shoulder openers like gomukasana arms (cow face) . Also maintaining an elongated spine in forward bends. Stregthening the back muscles that will help keep the chest open and collar bone broad: downward facing dog, ardha uttanasana (“flat back”) and standing poses
Asanas to avoid Any pose that exaggerates a collapse in the chest.
Alternative rememdies Massage may be helpful if the chest and shoulders are tight which is causing the shoulders to round in and collapse.
Quadratus lumborum (Lower Back Pain)
The quardratus lumborum is a well known muscle that is a primary cause of lower back pain. As the belly continues to grow, it pulls the top of the pelvis forward causing lordosis (sway back) in the spine. This position of the pelvis causes the lower back muscle to contract which can lead to lower back pain.
Asanas to do Body circles, side stretches gentle forward bending combining with a twist like janusirasana (head to knee pose), poses that focus on elongating the lower back like downward facing dog.
Asanas to avoid Backbends and poses that emphasize the pelvis overly tipping anteriorly (forward) creating a sway back situation. This will only contract these lower back muscles further.
Alternative remedies Massage, acupuncture, heating pad or hot water bottle.
Carpal Tunnel Syndrome
This can be due to increased blood volume and fluid retention that can cause an impingement of the nerves and range of motion in and around the shoulder joint and wrist, as well as increased repetitive hand and wrist motion.
Asanas to do Shoulder and chest opening poses and wrists stretch. Many poses that require the palms to be flat on the mat can be done on the forearms or knuckles. Also, rolling the mat up or putting a wedge under the heel of the hand can lessen sharp wrist flexion.
Asanas to avoid Lots of sharp wrist flexion
Alternative remedies acupuncture, splints, hot/cold bath, and massage to release tight shoulders and chest muscles
Hope these ideas and tips may be helpful to some of you ladies out there!
Last Friday’s class was a bit challenging in juggling the myriad of issues present in class. Amongst the typical aches and pains, there were a few cases that needed a bit extra attention: two students were suffering with acid reflux, a hand full had sacroiliac issues, and two mothers had placenta previa. It was absolutely necessary to offer adjustments and modifications to the students with more specialized issues. After class, one of the students that has placenta previa approached me and expressed her relief in understanding what she needed to modify in her practice. She had been taking “normal” yoga classes and the teacher, understandably, did not know of this condition. So that leads me to this blog, explaining placenta previa and how it relates to the mama-to-be’s yoga practice.
What is placenta previa?
Placenta previa is a condition in which the placenta is covering the cervical opening, either fully, partially or marginally.
Fully The placenta is fully covering the cervical opening Partially The placenta is covering part of the cervical opening Marginally The placenta is next to the cervical opening.
This condition occurs in 1 out of 200 women. It is usually detected in the mid second trimester via ultrasound. For most women that have partial or marginal cervical coverage, the previa is usually cleared up as pregnancy progresses. The placenta is adhered to the uterus, so as the uterus grows, the placenta is lifted away from the cervical opening. This may not happen to those with full previa. If a woman is presenting with previa near her due date, she will need to give birth via cesarean. (For those that will need to have a c-section, you may want to read Keep A Cesarean Birth As Intimate As Possible)
A pregnant woman is more likely to have previa if she has had it in previous pregnancies, had a previous c-section, uterine scars, carrying twins, a smoker or over the age of 35. But don’t worry- if you fall into one of those categories and your provider has not mentioned previa to you, you are likely fine. Once the placenta implants itself on the uterine wall away from the cervix, it does not move downward.
What yoga poses should you avoid?
Some women with previa, usually full previa or those that have had vaginal bleeding, may be put on bed rest or pelvic rest. Others may be asked just to reduce their activity. To accommodate those with placenta previa during yoga we need to eliminate or modify poses that add extra pelvic pressure or compress the abdomen.
Poses that create deep pelvic openings should be removed or modified during the practice, such as deep unsupported squats. Instead, a woman can squat on two or three blocks, supporting the pelvic floor. Additionally, she should do poses like virabhadrasana II (warrior II) either with a shorter stance or sitting on a chair. The same modification should be made for utthita parsvakonasana (extended side angle).
Some seated poses like baddha konasana (bound angle pose also known as tailor’s pose) need to be adjusted. The mother should be seated on either a bolster or one or two blankets with her feet further forward, more like tarasana (star pose) with blocks propping her knees up. This will lessen the opening of the pelvic outlet.
It is also important to stay away from poses that compress the abdomen. Deep twists are contraindicated during pregnancy, so that is easy to avoid. When twisting the pregnant mother should focus isolating her twist to the upper back, “above the bra strap line” is how I like to describe it. It would also be best to avoid abdominal toning. In our prenatal yoga classes, we focus on tranversus abdominal exercises. During this segment of class, I invite mothers with previa to either take a restorative pose, rest in child’s pose or do extra kegels.
Other than those exceptions, a woman with placenta previa can still enjoy most of what the prenatal yoga class has to offer. I hope that these explanations are helpful to those practitioners with placenta previa, and to yoga teachers working with pregnant women. Enjoy your practice!!
When I was pregnant, I fantasized about life after baby and how it would all work out. Here is the picture I had envisioned: I would have some leisure time with our new baby- taking walks in the park and meeting other new moms. I would easily maintain my teaching schedule and presence at the yoga studio, including writing my blogs, heading up teacher training and keeping up with my general responsibilities as the studio’s owner and director. To support this fantasy, we would find a part time nanny who’s hours could match my class times. I would find a wonderful woman who works 28 hours, segmenting her time to fit my specific schedule. I thought- great, this is all going to work out, I can easily manage motherhood and work. On paper, everything was perfect!
Fast forward - the baby is is no longer a fantasy, but a real baby! My maternity leave is long over and the work I thought I could neatly fit neatly into those several shifts a day does not fit! I did not take into account things like going to a yoga class or to the gym, showering, eating, breastfeeding or pumping. It’s been months since I saw the dentist. I am forever trying to find the balance between feeling like I am giving my son enough attention, yet still fulfilling my role at work. While I may be judged for saying this, I am surprised how much I truly love spending my time with my little guy. He makes me laugh and light up inside. I thought it would be easier to separate work from home life. When I am at work, I am missing my son and longing for that time with him. When I am at home, I feel I should be putting more effort into my work.
I recently met up with a few other working moms for an afternoon drink. I must say, I was never a big daytime drinker, but these mom meet ups tend to bring out my inner beer lover. WHICH, is good for breastmilk supply (Ok, I digress!). These working mothers either have full time help or day care. When I ask them if their work life has changed, they answer with a simple “yes.” While their careers are still important to them, they explained there is less desire to stay late or put in extra effort. At the end of their work day, they want to get home to see their child. They also feel that their “time for themselves” happens while they were away from their child at work, leaving little time for other needs to be met. One mom confessed that she feels guilty about getting a babysitter during the weekend since most of her week is already spent away from her child.
So here lies the eternal question- how do you balance work, life and motherhood?! One of my closest friends, who is in a similar work situation as me (she works for herself), explained that there is a certain level of acceptance to being out of balance at times. In the past she would strive to give 100% to her work and home life, and now 80% at work will just have to be enough. The house may not always clean, more meals are being ordered, and there is true beauty in ordering groceries online. My friend manages her time the best she can by not taking on more then she can handle, and knowing that each day’s balance will be different. Some days are more work oriented, and other days are all about her child and family.
So while striking that perfect balance between work and motherhood remains a great fantasy I long to achieve, I must settle for doing the best that I can. I am learning the great skill of multi-tasking and prioritizing. As I sit here and type, I am giving myself an at-home facial made from the left over avocado and banana from Shay’s dinner!
I would love to hear the stories of the other mothers out there that face these same challenges. Please share your wisdom!
I found that a great deal of attention and information was given to me while pregnant about receiving proper nutrition. However, upon entering the postpartum phase, all I heard was “make sure you get enough water to compensate for the fluids lost while breastfeeding.” But besides the reminder to hydrate well, very little was discussed about what other nutrients were needed for supporting my milk producing body.
Since I was exclusively breastfeeding, I did experience the “breastfeeding weight loss” and noticed a drop in dress size pretty quickly. I also noticed that between breastfeeding and getting my little one down for a nap or even out the door for a walk, I had little time left to focus on my own food intake. I was joking with friends that the reason new moms lose weight is because we don’t have time (or a free hand) to feed ourselves! But laughing aside, I did start to notice that I was neglecting my own diet. I was grabbing whatever was in the fridge, specifically those things that could be eaten with one hand. I even started substituting Larabars for meals every now and then.
My diet started to concern me. Was I getting the right nutrition to support myself and my breastmilk?
I knew that breastfeeding mothers need on average 300-500 extra calories a day. The La Leche League cautions new mothers to approach this increased caloric intake with healthy dietary guidelines in mind. For example, the extra calories should from nutrient-dense foods such as fruits, veggies, complex carbs and protein, not empty calories from sugary treats. As for protein, the basic rule is to eat 1 gram of protein each day for every pound you weigh.
Even though research suggests that I don’t have to worry about the quantity of my milk supply, it is still important to replenish the nutrients lost while breastfeeding. For those who like to follow guidelines to help establish a healthy diet, the US Department of Agriculture released a suggested food pyramid for breastfeeding mothers. My Pyramid Plan for Moms maps out a clear selection of healthy foods that support breastfeeding mothers. You can even get a plan designed just for you and your lifestyle. Go to www mypyramid.gov/mypyramidmoms The suggestion My Pyramid Plan offers seem quite reasonable to follow. For example, they focus on 5 different food groups; fruits, vegetables, whole grains, meats and beans and dairy with realistic intake from each group, like 2 cups of fruit a day or 3 cups of veggies. To get an idea of what that would look like in a daily diet, 1 medium grapefruit equals 1 cup or 1 large sweet potato equals 1 cup.
From the food pyramid, you will notice two things. One- there is not a category for nutritional supplements. Assuming you are getting all your nutrition from food, you may not need additional vitamins. (Although many women do continue to take their prenatal vitamins postpartum.) Lana Levy, founder of Just For Today Nutrition states, “Dietary supplements can improve milk quality and quantity in women that are malnourished; however, a balanced diet without excessive supplementation is the best way to ensure good milk. Vitamins that are taken in excess are excreted in the urine anyway, so don’t waste your money!”
The second observation is, 1/5 of the pyramid is taken up by animal protein, and for those that are vegan, 2/5 of the pyramid would be excluded. Nutritionists urge vegetarian and vegan mothers to make sure they are getting enough b12, calcium and zinc which are generally found in dairy products, meat, fish and eggs. To get adequate b12, try fortified soy milk and fortified yeast or b12 supplement. Calcium is abundant in dark leafy greens, almonds, calcium-enriched tofu, and blackstrap molasses. Zinc can be found in spinach, pumpkin seeds, yeast, wheat germ, peanuts, beans, and bran cereals.
I hope this has clarified supportive nutritional needs for those that choose to breastfeed. As for my own time management/eating schedule, I try to have a bowl of almonds handy, along with yogurt packs and instant steel cut oatmeal to hold me over until my son is calmly playing or napping. Then, I can have a proper meal. I figure, as long as I am making healthy choices in my “quick bites” my body and my baby will be just fine.
The average pregnant woman is very capable of a doing a challenging asana practice that can build confidence and stamina. However, it is important to strike a balance by also practicing gentler, more restful poses that teach her how to soften and surrender when she needs to relax. Perhaps one of the greatest benefits of quieter, restorative poses is that they offer the mother time to be with her baby, listen to her baby and to her own body and, if anything, the opportunity to gain a greater understanding of her inner thoughts and feelings.
Some of the other wonderful benefits of restorative poses include:
• Helps reduce stress
• Slows the heart rate
• Lowers blood pressure
• Slows the breathing rate
• Increases blood flow to major muscles
• Reduces muscle tension
• Reduces hypertension
• Renews energy
• Helps concentration
• Quiet time with baby!
Here are some yummy restorative poses the can be adjusted for all three trimesters.
Supta baddhakonasa (Reclined Goddess Pose)
We usually start with this restful pose at the beginning of the class. Place two blocks on the mat, the first on the medium facet and the second on one the highest. Place the bolster over the blocks forming a comfortable back rest which should be about a 45 degree angle. Also, have several blankets available, one or two for knee support and two additional ones for forearm support. Bring the soles of the feet together and then either place one blanket under each knee, or make a longer roll and wrap it around the ankles and under the shins. It is also nice to place a trifolded blanket under the forearms to add a little extra support.
Keep in mind with these reclining poses, it is important to have the lower back well supported. You do not want an excessive lumbar arch when reclining. So when reclining back, make sure the lower back is snug up against the bolster.
Legs Up the Wall
This pose is particularly good if the mother is experiencing any edema in the legs or feet, suffers from varicose veins or her legs are just feeling tired.
If the mother is still comfortable with legs up the wall, place a bolster under the hips so that she is not lying flat for a prolonged period of time. The bolster should be placed so that the sitting bones are just hanging off the bolster. This also creates a nice gentle chest opening pose.
Legs Up the Wall
Half Legs Up the Wall aka- Single Leg Drain
This pose is an option for those that can no longer lay on the back, but still offers the wonderful benefits of having the legs elevated. It is done with one leg up the wall while in a somewhat side lying pose and the bottom leg gently bent in the torso.
“V” legs Up the Wall
If neither of the two previous “legs up” options work for the mother, the “V” leg up the wall pose may be a solution. Take the same bolster/block set up as supta badhakonasana and place the bolster about 1 ½ to 2 feet away from the wall. The distance will need to be adjusted depending on the height of the woman. Then in a reclined position, bring the legs up the wall. This forms a “V” like shape in the body offering elevated legs and chest. (This is a good option if the mother wants to elevate her legs, but she is experiencing acid reflux and can’t have her head below her heart.)
Supported Child’s pose
Some mothers prefer to rest in a long child’s pose if she feels a lot of pressure or discomfort in her lower back or suspects her baby is in the posterior position. To do this pose, simply take a wide knee child’s pose and place a bolster under the head or even further down, under the under chest and head.
Tarasana with Block Under Head
It can be very restful to allow the forehead to rest on something. This takes pressure and strain off the neck while aiding in quieting the mind. In this pose, the feet are further away from the groin, decreasing the bend in the knees and one or two blocks are placed in front of the feet. An individual’s flexibility and the size of the belly will determine how to use and place the blocks. Most women in their third trimester are not bending forward too easily, so two blocks may be needed. Or another option is to place a bolster on top of two blocks and create a little “altar” to rest on. *Remember moms with sacroiliac issues, place a block or rolled blanket under the knees in this pose.
Eye pillow or Head Wrap
Incorporating the use of an eye pillow or a head wrap can help relieve tension and promotes the withdrawal of the outer senses and stillness in the mind. In yoga we refer to this as pratyahara. By utilizing an actual object to help withdraw the senses, the eyes, which are often expressive and focused outward, are now encouraged to focus inward. If you choose to use a headwrap, do not wrap too tightly and draw skin of forehead down, not up.
Hopefully, these restorative poses can allow the mother-to-be a little quiet time to rest, renew and restore her energy.
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.
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.
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.
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!
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!
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.
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?
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.
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.
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 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:
In 2007 I ruptured a brain aneurysm in yoga class (doing triangle pose!). Before that point I had no idea I had an aneurysm. I was rushed to the ER and had surgery to coil it. Although my brain is monitored every year and I live life with very few restrictions (no scuba diving or sky diving, oh well) I am considered high risk. I am monitored every 2-3 weeks throughout my pregnancy to check my blood pressure and the development of my baby. My baby and I are both healthy and doing wonderfully. The concern for me is that natural birth may pose a risk for my brain. My doctor does not want my blood pressure to elevate too high. The ramifications of high blood pressure could be causing another brain bleed. Although this seems like a common concern (about high blood pressure, not the brain bleed ;))the emotions that are connected to it are quite complicated.
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.
