40 Weeks to Freedom – It’s Worth the Wait

2019-09-23T06:19:12+00:00September 23rd, 2019|Categories: Fertility Blog|Tags: , , , , , , |

Why does it seem like the last month of pregnancy lasts longer than the previous nine? My fellow moms – I absolutely get  why you want to end it as soon as possible. The final weeks are uncomfortable and anxiety ridden. Waiting for the baby to arrive and FINALLY starting your maternity leave, plus meeting your baby is the most exciting day! It’s no wonder we want to rush to the end by inducing labor instead of allowing labor to begin naturally. Inducing labor is defined as: you or a care provider uses a drug or an action to cause labor to start before it starts on its own. Doctors and researchers don’t really understand how or why labor begins when it does, so the drugs and interventions don’t always result in labor actually beginning and progressing to delivery. One quarter of moms that are induced end up with a cesarean birth when labor stalls or goes on too long.

Researchers now believe the fetus actually signals the beginning of the labor process, possibly when the lungs have matured enough to take the first breath of air. The fetus likely signals a hormone release that relaxes the cervix and starts uterine contractions. Because of the complexity of the labor process, it is best to allow it to begin naturally even if your due date has come and past.

A due date can be misleading, the exact date of fertilization can be nearly impossible to know for sure. Also, just like babies reach milestones at different times, it’s normal to have a range of normal gestation. Anytime between 39 and 42 weeks is considered a safe time to deliver, and waiting for labor to start naturally is another reassuring signal your baby is ready to be born.

Doctors used to deliver babies earlier in pregnancy for their convenience and at mom’s request (if she was uncomfortable – what part of pregnancy IS comfortable??) Doctors noticed the number of babies that required special care for breathing problems, breastfeeding problems and inability to regulate their body temperature increased as babies were delivered earlier. The American Academy Of Pediatrics recommends waiting until 39 weeks to consider an induction. Read the AAP position statement here The Timing of Planned Delivery:Strengthening the Case for 39 Weeks

If you are thinking about trying to induce your labor at home, there are several things women have been told to try to get labor going. Unfortunately, none of the home remedies have been shown to be effective when reviewed by researchers.

  • Hypnosis: not effective, compared with doing nothing
  • Homeopathy: not effective, compared with doing nothing
  • Sexual intercourse: not effective, compared with doing nothing
  • Sweeping/stripping membranes (office procedure done with a vaginal exam): not effective, compared with doing nothing
  • Acupuncture: not effective, compared with doing nothing
  • Breast stimulation: increases the likelihood of starting labor, but more research is needed to understand safety (there are concerns that strong contractions could reduce oxygen flow to the fetus, although the study that raised this concern was done in women with high-risk pregnancies)
  • Castor oil: effective at starting labor, but does not decrease the chance of having a C-section. Castor oil causes nausea and diarrhea in most women. More research is needed to understand safety.

If you feel the need to induce your labor or have any health concerns, talk with your doctor before trying any of these techniques. There are times when induction is the right choice for you and your baby.

 

Why hire a Doula?

2017-01-03T22:16:07+00:00January 3rd, 2017|Categories: Fertility Blog|Tags: , , , , |

In 2016 I had the opportunity to travel to many places to represent Milkies and I was lucky enough to meet some amazing people. An event in Seattle during September put me in the same room as a wonderful group named Emerald City Doulas. Doulas are the unsung heroes of the delivery room, having a doula at your side during the labor process leads to lower rates of caesarian sections, reduced pain medicine use and higher satisfaction with the birth experience.

The more I learned about doulas, the more questions I had. So I reached out the best doulas in the business, Christi Nixon and Paula Gustafson of Emerald City Doulas for an interview. I was fortunate Christi could take a few minutes away from her busy schedule to answer some questions.

The first thing I wanted to know was how Christi describes a doula, she said, “A doula provides non-judgmental support to a mother and her family. A doula provides guidance and encouragement in the delivery room and prepares a family to care for their new baby at home. For example, a doula may teach a family how to bathe their baby and may identify breastfeeding problems and refer to a lactation consultant. There are several types of doulas; the most common are post-partum doulas and labor doulas. They play very important, but very different roles for families.”

The term “doula” was coined in 1976, but women have been supporting each other in the birth process for much of recorded history. Prior to the early 20th century, women labored at home, attended by an experienced female friend or relative. After the birth, this woman would stay with the new mother during a period called “lying in”, helping her recover, initiate breastfeeding and adjust to new motherhood.

As our culture changed in the 1920s and 1930s, more women moved to hospital births and the female support person was replaced by a single, (almost always) male doctor. For high risk mothers, this was a benefit. But for most births, medical interventions are not needed and can be counterproductive to the progression of labor and the health of mother and baby.

Fast forward to the present and, in many hospitals, the birth experience can be similar to 100 years ago. Inductions, C-sections and other interventions can be lifesaving but can alter a woman’s birth experience and introduce complications that require even more interventions. Doulas have emerged as the mother’s guide to a better birth, transition to motherhood and more successful breastfeeding.

I learned from Christi the wide range of tasks a post-partum doula can take on. A post-partum doula can help families adjust to the new routine of wake and sleep, teach swaddling and soothing techniques. They can also do light housework, simple meal preparation and nursery organization.

Doulas like Christi usually has a first meeting with mothers-to-be anytime during their pregnancies – she has helped moms that recently found out they were pregnant and moms that have almost reached their due dates. Her services packages are pretty typical and include 2 prenatal visits, labor and a post-partum visit.

Christi has some great advice for choosing the right doula:

1. Meet with a few until you find a doula you feel a comfortable connection with.

2. Ask about certifications. Christi is certified through ProDoula and holds additional certifications, ProDoula CD Labor/Postpartum, ProDoula PPS, PDCBE, and CD (PALS)

3. Sign a contract outlining your expectation for the doula and her compensation. The doula should provide the contract. Be sure to ask about her compensation if your labor goes on longer than 14 hours.

A doula is a crucial part of your support team before during and after labor. She works with your medical team and family to help you move through your pregnancy, labor and into new motherhood and breastfeeding. Find out more about the doula services in your area and how a labor and post-partum doula can help you and your family, reduce stress and increase the happy memories of your birth process.

Thanks to Christi and Paula at Emerald City Doulas for being a source for this article.
Find them at http://www.emeraldcitydoulas.com/

More is better with skin-to-skin

2015-12-11T18:57:58+00:00December 11th, 2015|Categories: Fertility Blog|Tags: , , , , , |

The first hour after birth is known as the Magic Hour. This is an exciting occasion as the family meets the new addition, and babies get their first experience of the world outside the womb.

Research shows the best way to spend the first hour with your baby is against your bare chest; she should be wearing only a diaper. This is called skin-to-skin contact, because your baby’s bare skin is against your bare skin. When researchers measured the stress level of newborn babies, they found the lowest level of stress in babies that spent the most time skin-to-skin with mom (or even dad!). The highest stress levels were measured in babies that were separated from their moms in the nursery.

Most mammals, like humans, are in close contact with their young immediately after birth. Having your baby against your skin lets you share body heat to keep your baby warm. Your baby can hear your heart beat, your voice and other familiar sounds that have comforted her as she grew into your beautiful baby.

The positive effect of skin-to-skin contact on breastfeeding is strong. Newborn babies on mom’s bare chest will often begin breastfeeding without any help. Check out this video of a newborn finding the nipple and latching unassisted. http://www.breastcrawl.org/video.shtml

Research shows the longer a baby stays skin-to-skin immediately after birth, the longer breastfeeding lasts. When your baby has easy access to breastfeeding, he will do it frequently, helping establish a strong milk supply and more successful breastfeeding.

If you want to have your baby skin-to-skin after he is born, let your birth partner and hospital staff know your wishes. Give instructions to wipe off your baby, put on a diaper on her and place her on your bare chest. If you have a caesarian (C-section) you can still hold your baby skin-to-skin after birth, in the operating room – so be sure to ask for it!

Below is a short list of the benefits of skin-to-skin contact after birth-

• Warmth, as you share your body heat.
• Stability of heartbeat and breathing as your baby is more relaxed, feeling safe and comfortable.
• Increased time spent in the deep sleep, the restorative sleep that prepares her body and mind to learn and grow.
• Increased time spent in the quiet alert phase, this is the observation time when your baby uses her senses to learn about the world.
• Less crying as your baby feels safe, warm and her needs are met
• Increased weight gain, your baby is breastfeeding as needed.

If your hospital doesn’t offer skin-to-skin, ask for it – for the health of you and your baby.

Article sources

American Academy of Pediatrics. (2015). About Skin to Skin Care. https://healthychildren.org/English/ages-stages/baby/preemie/Pages/About-Skin-to-Skin-Care.aspx
Leslie Bramson, Jerry W. Lee, Elizabeth Moore, Susanne Montgomery, Christine Neish, Khaled Bahjri, and Carolyn Lopez Melcher. (2010). Effect of Early Skin-to-Skin Mother—Infant Contact During the First 3 Hours vol. 26, 2: pp. 130-137., first published on January 28, 2010

Labor, delivery and breastfeeding – know before you go

2015-03-05T21:53:28+00:00March 5th, 2015|Categories: Fertility Blog|Tags: , , , , , , |

Getting ready to welcome your new baby into the world is a time of excitement and anticipation. Unless you have been through giving birth 19 times and counting, it’s unfamiliar territory for us. If you plan to breastfeed, and almost all of us do, it is important to know how your birth plan affects you and your baby’s readiness to breastfeed.

Remember you are in the driver’s seat of your birth experience and your body is your navigator. Listen to your body and be ready to speak up if things are not going in the right direction. If you have a birth plan, share it with your partner and health care team. Watch this fun and informative video comparing 2 birth experiences – https://www.youtube.com/watch?v=N9KptD3t110

A birth plan that supports breastfeeding will have limited interventions (an intervention is any act that attempts to modify an outcome.) Many interventions can have unintended consequences and we need additional interventions to manage the unwanted side – effects. This phenomenon is common enough to have a name, the Cascade of Interventions.

An example of a common intervention is an epidural (pain medicine injected into the tough membrane around the spine).Laboring can be painful and last for extended periods, so pain control is a common priority of mothers and their support team. However, there are a few undesirable epidural side effects on breastfeeding. Hospital protocol often requires a mother with an epidural to have IV fluids; this is because the epidural can cause a precipitous drop in mom’s blood pressure. The IV fluids moms receives during labor can stay in mom’s tissues (think of your swollen ankles except this time in your breasts) making it difficult for baby to latch on after birth. The extra fluid can transfer to her baby as well, artificially increasing the baby’s weight and causing alarm at the upcoming well-baby check-up when the scale shows a big weight loss (although it is the extra fluid baby received during birth). The pediatrician may direct mom to supplement with formula due to the weight loss, mom feels her milk supply is inadequate and formula becomes the primary food source for baby.

There are many other interventions we accept as part of our hospital birth which can affect our ability to breastfeed. This epidural example illustrates the importance of educating ourselves about birth interventions so we can make the right choice for ourselves and our babies.

Resources: http://www.cochrane.org/CD000331/PREG_epidurals-for-pain-relief-in-labour
https://www.birthinternational.com/articles/birth/15-epidurals-real-risks-for-mother-and-baby-
http://www.childbirthconnection.org/article.asp?ck=10182