Conversations With Your Care Provider

It is important to spend time navigating your options for labor while pregnant. Delayed cord clamping, vitamin K, first bath, etc. These are some of the many important choices to investigate while you’re pregnant. You can decide to either accept or decline these for care options for your baby. I also encourage my Doula clients to have just as important conversations with their planned care provider, whether an OB or midwife, to gain some understanding of how they practice. Some of the topics you can start discussing with your provider include:

•How do you define “informed consent”? What does that mean to you?
•What is your cesarean and episiotomy rate?
•How often and why are you most likely to suggest an induction?
•How would we navigate a situation where my preferences or decisions conflict with yours?

In addition to their specific answers, take note of how their response made you feel. Did they brush you off? Get defensive that you’re even asking them these questions since you have already been working together for a few months? Or did you feel like they took their time with you, giving each of your questions a thoughtful response?

Now without getting too specific, think of a challenging situation that could potentially come up in labor and contemplate how you might feel working through these with your care provider. Do you feel they will listen to your voice in the matter? Do you think they will overpower you and your needs or preferences? Will they talk with you rather than at you? To find out, take a look at those times where you asked them questions during prenatal visits. These early conversations reveal much more than simply their numerical rates for interventions. Who you choose as your provider has a big influence on the way your birth goes. Make sure you feel supported and heard by the care provider you choose to hire.

Fetal Station

Fetal station refers to the location of the baby’s presenting part within the pelvis. Knowing how far the baby has descended indicates a sign of progress and can help determine beneficial labor positions to encourage further descent. When baby is too high within the pelvis, they are not “engaged,” but are essentially floating in the pelvis. Upon vaginal exam, the baby’s head would be pushed away from the fingers. On the station scale, this would be -5 to -1 station. As baby becomes engaged, whether by time or positioning, they enter the level where the ischial spines mark the midpelvis at “0.” As baby moves further down the birth canal, the numbers become positive and each increase in level of station brings them closer to being born. A +5 station would mean the baby’s head is filling the vaginal canal and ready to be birthed.
Each fetal station number indicates about a centimeter of descent into the pelvis. When your provider is evaluating your cervix for dilation, they are also noting the station of the baby in additional to cervical ripeness and effacement. Be sure to ask your provider what station the baby is at at each cervical and exam. Keep in mind that the information provided from a cervical exam is subjective. There is a degree of variation between what each provider can “see” with their fingers. Having a general idea of fetal station can help your support team suggest the best labor positions to bring baby down.

Doula’s Don’t Deliver Babies! But They Do Help You Deliver Yours

“You’re like a midwife, right?” The question I often hear when people are digging through their mental filing cabinet trying to comprehend what role a doula plays at a birth. Actually, midwives, nurses, doctors, and doulas all play very unique roles in the labor room. What makes a doula unique is that they only work for you, the client, and not for the hospital or your provider. Doulas are going to be the support person by your side through your labor, something else that none of the other health providers listed above can provide.

Because your doula works just for you, they aren’t required to spend time filing out your patient file and leaving the room to check on other patients. Doulas stay by your side as well as give space when needed. They are excellent at reading the room and knowing what is needed in the moment. They also spend time with you prenatally and get to know what your birth intentions are as well as your preferred methods of comfort.

“How about my partner? Will their role be overshadowed by a doula?” Absolutely not! A doula is a support partner’s best friend. They work with them at prenatal meetings to help them feel confident in providing hands on support during labor. Doulas also help support partners with in the moment suggestions in labor as well as encouraging breaks when needed.

Creating a Postpartum Nest

When preparing for your upcoming postpartum, think of creating a primary and secondary nest with the utmost comfort in mind. For example, your primary nest could be your bed and secondary could be your couch. Next, you’ll want to evaluate these locations for comfort. Add pillows and blankets, adjust the lighting if necessary, add a side table, etc. Then you’ll want to think of all the supplies you’ll want at your fingertips. Gather healthy snacks, nipple cream, pain relievers, essential oils, toiletries, baby wipes, diapers, thermometer.
Don’t forget to think of simple pleasures to add to your nest. Postpartum is the time where the focus quickly shifts to the meet the needs of the newborn. Remember you are a whole person who has needs as well, so spend time thinking about what you would enjoy to have at times of demanding emotional and physical stress. Maybe rose facial mist makes you feel refreshed when you can’t get up to take a shower, a new book or audiobook is just the thing to give you a little escape, or a journal to release and document the birth postpartum time.

Skin to Skin Is Not Always Easy

Doing skin to skin takes intention. As a doula, I see many new parents at postpartum visits who admit that they aren’t actually holding their baby in this way. It’s not often that we lay around our house without a shirt (or maybe you do) and when we have a new infant we want to bundle them up and put on those adorable baby clothes we’ve been staring at for months. Having baby held against the parent’s bare chest helps them to feel secure and regulates their body temperature, breathing, blood sugar and heart rate. This time spent uncovered also helps a baby to kickstart its natural instinct to breastfeed. Skin to skin increases the breastfeeding mother’s level of prolactin, the hormone responsible for milk production and also helps soothe a fussy baby.

Here are some easy tips that help a new parent jump into skin to skin:

• Diaper only. Resist the urge to have your newborn clothed for a majority of the day. Place the baby to your bare chest and cover them up with a cotton swaddle or a warmer baby blanket during the colder months.

• If breastfeeding, skip the nursing bra. It’s better to let your breasts air out anyway.

• Consider buying a postpartum robe. Instead of wearing a shirt, use a robe to cover up and then you have easy access to your skin!

• Place your diapered baby in a carrier or sling against your bare chest. Wear them this way around your house or head out on a walk with a big sweater covering you both.

• Bath time. This is a beautiful time to hold baby to your skin and the added element of warm water typically calms a baby as it mimics life in-utero.

• Educate your partner on the benefits of skin to skin and encourage them to spend time bonding this way.

Birth Trauma for the Laboring Person :: Part I

How does it feel to look back at the birth of your child or children? For most laboring people, they describe this time as the most difficult thing they have experienced in their life. Perhaps they’ll include some specifics about the events that occurred depending on their comfort level with the listener or audience. A select population might even describe their experience as utter bliss. Each birth story is rather unique in the string of events that lead up to the birth of a baby and the time that follows. Sharing these birth stories with one another are powerful ways to connect, discover meaning, inform, normalize and heal.

Birth is a catastrophic event in a person’s life and changes them in some form, if not many. Whether we accept this reality or not depends on the courage to be vulnerable with ourselves and others. Many withhold sharing the truth of these stories for fear of judgement, shielding ourselves from reliving the experience, or guilt about not having a difficult labor. Opening ourselves up to be vulnerable with our stories sets us on the path to emotional healing. By forging these deep human connections through the sharing of raw honesty, the collective birth experience will begin to normalize.

While a healthy baby is of course what every birthing person, partner, family, and birth team hopes for, a healthy mother is just as important. When left fragile and broken from birth, we walk through parenthood and the rest of our lives with these shattered lenses. Take a moment to reflect on your birth stories. Do you edit the content for your listeners? Do you lock away certain events that even you don’t dare look at? Is there a sense of despair or shame that shadows that day?

We will begin a journey of self-reflection through a series of posts titled, Birth Trauma for the Laboring Person. The reader can slowly begin to shine a light into the dark corners of their past birth in hopes of feeling their way through the pain and discovering a way out.

All About GBS

What is GBS?

In late pregnancy, your provider will want to test you for Group B Streptococcus, an organism that normally inhabits the intestinal tract of humans. It migrates from the intestines and colonizes the rectum, bladder and vaginal tracts of women. Swabbing of the rectum and vagina is typically performed around the 35th to 38th week of pregnancy to test for the presence of this bacteria. Testing positive doesn’t necessarily indicate an infection, rather that there is a colonization of bacteria is present. 15-30% of women will test positive for this bacteria and will require antibiotics during labor.

When the bacteria is found to be present from a positive test result, there is an increased risk of infection to the baby. However, to most babies it is not harmful and they’ll acquire the bacteria and a plethora of other organisms as they are exposed to the mother’s vaginal flora in labor.

GBS was found the be the leading cause of many serious infections in newborns such as pneumonia, sepsis and meningitis. Exposure to the bacteria occurs as the baby is passing through the birth canal and can also cross membranes so cesarean birth carries some risk as well. Approximately half of all babies born to GBS positive mothers will be colonized by the bacteria and according to the Center for Disease Control, 1-2% of babies will develop a life threatening GBS infection. Antibiotic prophylaxis administered to the laboring person is used to prevent early-onset infection. Rebecca Dekker, PhD of Evidence Based Birth, cited from a large study of 148,000 infants born between 2000 and 2008, that nearly all of the 94 infants who developed early GBS infection were diagnosed within an hour after birth – suggesting that early onset GBS infection probably begins even before birth.

Risk factors for GBS infection in newborn include prolonged rupture of membranes (>18-24 hours), early onset ruptured membranes, elevated body temperature during labor, birth prior to 37 weeks, African-American descent, chorioamnionitis (infection of the membranous sac surrounding the baby), and intrauterine monitoring during labor.

Testing for GBS by a bacterial culture is considered highly reliable, however it is important to note that the numbers of organisms in an individual may fluctuate. Waiting to test during week 35 to 37 yields more accurate results than testing during early pregnancy due to these fluctuations. There is a 5 week window of reliability, meaning if you test positive during pregnancy, you’re likely to be positive for the next 5 weeks.

A healthy microbiome of the gut and vaginal flora can reduce the risk of GBS colonization and decrease risk of infection for baby. Incorporating a probiotic supplement during pregnancy can inhibit the growth of harmful bacteria. Look for probiotics that contain Lactobacillus reuteri and Lactobacillus rhamnosis species in particular, as they work to support normal vaginal flora. Consider eliminating sugar and most fruits which will help balance vaginal pH. Incorporating lacto-fermented foods such as sauerkraut and yogurt will help support a healthy flora. Stress greatly impairs immunity, gut health and the microbiome. Find ways to manage stressors through meditation, journaling, massage and other relaxing activities.

Doula? But I’m having a Cesarean!

Preparing for labor often looks like a birthing person reading a slew of childbirth books, enrolling in childbirth education classes and hiring a doula. But what if the labor you had hoped for decidedly changed and now required a cesarean to bring your baby into the world? Would a doula be necessary? The answer is absolutely!

Having a planned cesarean doesn’t mean all your options go out the window. It also doesn’t have to rob you of an inclusive birth experience. A doula can help prepare families for cesarean surgeries and educate them about their options. This allows families to work together with their birth team and care providers to create a gentle experience.

Breathing and relaxation techniques come in handy for cesareans as well! A doula will provide a calming presence at the birth and prepare families so they feel confident and focused. These tools can also be helpful for emotional and physical recovery postpartum.

Approximately 45% of babies will require some time in the NICU (neonatal intensive care unit) after delivery. Having extra support allows someone to stay with the birthing person post-op while their partner remains with baby. This is greatly helpful for someone coming out of surgery while also processing any possible complications with baby.

A doula can assist the birthing parent in lactation support after surgery. When they feel ready, a doula can guide the parent to establish a positive feeding experience. They can identify feeding cues, assist with latching, pumping, and hand expression. Having this support helps the parent feel confident and relaxed in order to establish a positive feeding relationship.

After delivery, the birthing parent may have a lot to process emotionally about the event while healing physically. Challenges may be present that require the assistance from professionals such as counselors, pelvic floor therapists, lactation counselors, group support, postpartum doulas and more. Working closely with a birth doula can help recognize if additional support is needed and provide local resources.

Whether a baby is born vaginally or through the sunroof, a doula can assist the family so they are prepared, educated, have a healthy bonding experience and a supported recovery.