MotherNurture – Part 2

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Hello! A while ago we left you in the middle of an interview with the delightful ladies of MotherNurture and this is the second half of that interview! If you have not yet read part 1 of this interview, I invite you to check it out before reading this part. There’s a fair amount of back story about the company and a great deal of information about what services postpartum doulas can provide for new mothers.

We left off last time with our topic of postpartum doulas and when mothers might need or want to hire a postpartum doula.

Interview – Part 2

Me – Do you usually get more clients who contact you prenatally or postpartum?

Teresa – Some women know they will want a postpartum doula and they know ahead of time, but others don’t and maybe somebody else identifies the need and refers them to us.

Margi – One woman from France, and living in Aiken, searched for a doula online after her baby was born. She found MotherNurture and said, “Not many doulas around here. There are more in France.” Her baby was about a week old and we actually called Teresa in on that one. That’s what Teresa does, and does well. Teresa is an IBCLC (International Board Certified Lactation Consultant) and I’m a CLC (Certified Lactation Counselor). We kick it up a notch when there’s something I am not comfortable with. In that instance, since Teresa speaks French and the French woman spoke only broken English, this made a difference in the depth of support she got.

To further address the question:  It kind of varies from person to person when they’ll know they want or need a doula. Additionally, some women are gifted with a Postpartum Doula!

Teresa – Breastfeeding has been my life! My 18 year old son is the webmaster for the CSRA Breastfeeding Coalition and he talks about breastfeeding all the time. He helped with a breastfeeding flash mob for World Breastfeeding Week last year at Holy Trinity. (Teresa and Margi participated as did Margi’s granddaughter)

It’s fun that teens and kids who grew up with breastfeeding are involved.

Me (nodding) – My mother-in-law nursed my husband for 3.5 years. He remembers breastfeeding and he’s always been extremely supportive of me nursing our children for as long as they want to nurse.

Margi – I remember the first time I saw a woman with a child who was 4 years or more breastfeeding. They supported breastfeeding in our church. We had an annual event on Jekyll Island and this woman was there with a pillow on her lap and her kid was taking up almost 2 chairs. I’m watching her while breastfeeding my daughter. Her son fell asleep and she managed to get her breast out of his mouth and she carried this tall boy out of the Mother’s room on the pillow. I was sitting there with my munchkin thinking that it was ridiculous. But then, you know, when you’re breastfeeding your own you cry when they don’t want it any more. And you are willing to continue as long as they are willing.

Teresa – I remember going to a La Leche League meeting when I was pregnant and seeing an 18 month old nursing and thinking that I just don’t think I could do that – breastfeeding is great and all – but almost all my children were well over three when they weaned.

Margi – I weaned my last two ONLY because my husband made a comment that he thought weaning might be a good thing because the child was manipulating me in public. In the home, the breastfeeding was very minimal, but out in public it would get to be more… insisting with pulling up my clothing, etc. I believe both would have continued well beyond two years.  Then, we had another child that, at 9 months, decided that she was going to be like her older siblings and wanted a cup, saying “NO” to the breast and – “cuppy, cuppy, cuppy.” So they’re all different, that’s for sure.

Leslie – We don’t push breastfeeding on our clients. If the mother isn’t interested, that’s it.

Teresa – We meet the needs of the family.

Margi – If they are bottle feeding, we support them in that, and we never call Teresa in to push breastfeeding.

Teresa – If you’re talking about any aspect of care, we don’t push it despite our personal beliefs. With education, there may be a change as some of these people don’t know the pros and cons, but if they continue to want to do it their way, we let them. We are there to support.

Margi – We give information, but we’re not going to push them any way.
MotherNurture is a collaboration – not a partnership. Basically, for the present, when the calls come in, Leslie is the one who does most of the work or we share the work, calling Teresa in when needed.

With Elizabeth (artist) we share her information and at our MotherNurture events, she displays her belly casting.

As far as Tavish (Licensed Midwife, Certified Professional Midwife), I do referrals and she has her own connections throughout the state. I also serve as her Birth Attendant at local births.

Our collaboration is a loose one, and the reason I keep it that way is because we each have lives, and/or jobs. We can’t really be rigid because we each have to be flexible. And remember, with postpartum work, there can be more flexibility. In that regard, it is quite different from labor doula work.  If I get a call and I’m working a 12-hour shift, then I have to coordinate it with Leslie. That’s where it also helps that there are three of us.

At this point Margi realized that we hadn’t talked much about Leslie’s role in MotherNurture so we asked her to talk a bit about what she does.

Leslie – Basically, I do clinical massage. I graduated 14 years ago and I started working in doctor’s offices. I never really did the spa massage, that’s why this works so well now because of my experience in the clinical side. I love my work – any given day I might see an elderly person or an athlete, my clients are varied. I work on a lot of elderly women as well. I do pregnancy massage – some of the military wives. I have a few who are at different stages in their pregnancies which is where I’ve been able to draw on Margi and Teresa’s knowledge and to talk to Tavish, as well, about pregnancy issues. I’m constantly learning – even after 14 years.

Me – How many pregnancy clients do you usually see?

Leslie – Only about 10% of my clients are for pregnancy massage.

Margi – If we get a call from someone wanting something that we don’t offer, we’re happy to make referrals. But, Leslie has been in the past a tri-athlete and she works on sports figures and several clients are local athletes. She’s had a very interesting career. She’s clinically-based and can also take referrals from physicians – she worked for 3.5 years for an osteopath warming up patients and doing post-manipulation massage.

Leslie – I am able to nurture the new mother and I love making peppermint tea and making sitz baths – creating a spa next to the bed. I have one daughter, she’s now 17 and I was very thankful to my mom (Margi) because I had my daughter at home and she was there to be a buffer for the curiosity seekers.

Margi – Leslie is also really good with kids – in her college days she was a nanny, “Super Sitter” – she traveled with families and did a lot of work with the horse families in Aiken. Paying attention to siblings is a big part of our postpartum work.

Leslie is very modest and very sweet – I could definitely see her creating a lovely mini spa right next to newly postpartum mothers. After the interview we went in to look at her massage space, which MotherNurture also uses as a teaching room for classes. When I walked into the room I immediately felt a sense of peace and calm – it’s a very welcoming room.

We asked Teresa if she could talk a bit about herself next, since she also hadn’t been there right at the beginning of the interview when Margi gave her background.

Teresa – I have 5 children and I’ve been, in terms of lactation, I’ve been helping families for about 34 years in breastfeeding. The career of lactation is not new any more, but there was not such a thing as an Lactation Consultant when I first started. I’ve been a Certified Lactation Counselor for about 27 years. I used to have a lactation business in the community before I started working at the hospital (MCG/GHS). I’ve been at the hospital for 19 years – first as a contractor because they didn’t think breastfeeding was that important in the beginning, but then they made a job for me. That first La Leche League meeting was my first exposure to breastfeeding.

I remember my mother’s stories of birth. She was in labor and they put her in an elevator and she’d had scope (scopolamine – twilight sleep) and she thought she was going up to heaven. When I started having children, breastfeeding and home birth, I found this very interesting. I’ve had three c-sections, but I had all home labors and one home birth.

I grew up in a military family and so did my husband. I wasn’t around my family and I didn’t want people telling me anything so I didn’t access any of the sort of help that we offer now. That’s why I want people to know about this because it’s nice to know you can have the support and it can make your journey so much easier. A lot of people don’t have the community support so this is something where people can plug into and access that sort of support.

Me – How long do women usually need or want postpartum care from a doula?

Margi – First of all, we are not a long term commitment for anyone. We’ve had some women start off wanting 3-4 months, but nobody has ever needed that much. Actually, six weeks is pretty long.  We address this on our initial visit and I do have a contract..

Leslie – We have a true statement, “We work ourselves out of a job.”

All three women nodded and smiled in agreement.

Teresa – If they need extra lactation support then that would be outside of the doula scope.

Margi – For a postpartum doula there’s a four hour minimum shift for about $25/hour and people can add on a la carte items (massage, infant massage instruction, babywearing – Moby wrap with instruction, LC, infant CPR class) for a little extra fee. We work from 8-5pm normally but  try to keep hours flexible to accommodate their needs.

Margi mentioned a meal scheduling and delivery service called Take Them a Meal.

Margi – Another option is for the postpartum doula to participate in the creation of a meal service schedule from the listing of family/friends who have volunteered.  Then, when  people bring a meal over, we can make sure it’s heated up or put ingredients together – light cooking – and serve it up. Some larger postpartum doula practices, like ABC Doula in Oregon, even offer menus for clients to choose from.  We are not there… yet!

Teresa – Meals are wonderful after a birth.

“Amen!” I thought.

Margi – This (the Central Savannah River Area) really is a community of many different towns and we serve them all.  As a nurse, I basically doula at work – at the hospital – that’s what a postpartum nurse does! Reassurance, teaching, and nurturing are all part of the job.  Also, it’s a blessing to be able to teach over there at that institution.

Teresa – We have no specific prescription or overseers for what we teach so we have a real opportunity to help mothers explore their options for birth and beyond.

Conclusion

Postpartum doulas are rare in our area, but their job is so very important, especially in a city with a military base where new parents may be without a familial support system and may not even have many friends in the area yet. The women at MotherNurture meet their clients where they are and help them find the options that will work best for them and for their families while gently educating them and helping them to better care for themselves, their families, and their babies.

I am so thankful to have had the opportunity to meet with these amazing women for two hours and talk about birth, babies, and new mothers! It was an absolute joy to spend time with them and I can confidently recommend them to any pregnant moms in our community who might need some extra help and nurturing after their baby is born and to any new mom who is struggling with a lack of support in the early postpartum days, weeks, or months.

Thank you, Margi, Teresa, and Leslie for being willing to spend time talking to me and for letting us share with the community more about who you are and what you do!

~B.

October Meeting – Letting Your Baby Choose His/Her Birthday!

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This month our wonderful co-leader and local birth doula at CSRA Birth Services, Laura Selvidio, presented the topic: Letting Your Baby Choose His/Her Birthday – Why and How to Avoid an Induction. 

First of all, the why’s:

You could be earlier in your pregnancy than you think you are and an induction could result in a premature baby. Most women don’t know when they ovulated and sperm can live for several days after intercourse. If a woman ovulates later in her cycle than she usually does then her baby could be a week younger than everyone thinks he/she is.

With a premature baby there can be issues with breathing, regulating temperature, and feeding. Even if you’re in the “due zone” of 37-42 weeks, the baby may not be ready quite yet. The lungs could be immature still. In a study on mice, they found that sufficient levels of surfactant – necessary for proper lung function – could be the signal that starts labor.  Some babies take longer to become mature enough to really thrive outside the womb.

Inductions also carry with them an increased risk of cesarean section, low heart rate, infection (especially if your water is broken on purpose during the induction – artificial rupture of membranes = AROM), and cord prolapse (if the baby isn’t engaged in the pelvis when the water breaks).

Other potential risks include uterine rupture, bleeding after delivery due to having pitocin during delivery instead of your body’s natural oxytocin, overstimulation, placental abruption, NICU stay (with a premature baby). You could experience contractions that are much stronger and more painful for you and the baby than natural contractions are, without the natural endorphins that your body would produce in a naturally starting labor. Your uterus can become hyperstimulated, which can lead to fetal distress as the baby’s oxygen supply is cut off during longer than normal contractions, placental abruption, and uterine rupture.

An induction also increases the chances of having a malpositioned baby. Usually the body works before labor begins to get the baby into an optimal position. If you put your body into labor before it is ready, then the baby might not be in a good position yet. Once your water is broken, commonly done during an induction, the chances of your baby getting into a better position are very slim, which ties into the increased risk of having a cesarean section.

Even inductions at 40 or 41 weeks can be unsuccessful, but since postmaturity syndrome is real, it can be beneficial to at least do kick counts starting at 37-38 weeks or even get a Biophysical Profile after 41 weeks just to check on baby even if you aren’t being pressured to induce.

And how does one avoid an induction?

If your doctor is really pushing for an induction, what can you do?

If your doctor is concerned about how the baby is doing, then you can request a non-stress test or a biophysical profile to check on the baby. Be informed about your decisions and share your reasons for not wanting an induction with the doctor if he or she is open to hearing them.

Keep in mind that you can also just not show up for your induction. You are the consumer, you hired the doctor, and you can make the final decision about what happens to you and to your baby. Find out what your specific numbers are – such as with amniotic fluid levels, just as you do with other tests like the Glucose Tolerance Test. Keep in mind that low amniotic fluid levels alone are not an indication for an induction. A heavy baby alone is also not an indication for an induction and ultrasounds can be off by 2 pounds either way in estimating fetal weight.

What if it’s medically necessary?

Sometimes an induction is absolutely medically indicated and necessary. If you’re dealing with intrauterine growth restriction, pre-eclampsia, or something else serious that outweighs the risks of induction then there are some simple ways to make an induction more positive for yourself and for your baby!

First of all, know your Bishop Score. If you can wait a little longer before being induced and your Bishop Score is unfavorable – then wait! A good Bishop Score will greatly increase your chances of having a successful induction.

Try to avoid Cytotec because this drug, used off-label to induce labor, increases the risk that you will experience a uterine rupture. Ask your doctor to start you off on the lowest level of pitocin possible and then gradually increase. Some people are more sensitive to medication than others are and if you start off with too high of a dose, this can lead to uterine hyperstimulation, decreased oxygen to the baby, then more medication to slow down the contractions, and an epidural because with hyperstimulation you aren’t getting the breaks that you would normally be getting during labor.

Ask your doctor not to rupture your membranes until you’re fairly far along and the baby is well engaged in your pelvis. If your induction is not for an immediate emergency then you can always leave and go home and wait a day or two if your induction fails as long as your water is not broken. Once your water is broken, that baby is coming out in about 24 hours – one way or another!

You can also still ask for all the after-birth care preferences you would have otherwise asked for. Skin-to-skin contact with baby (if baby is stable), delayed cord clamping, quiet room, dimmed lights, etc. You will need to be on the monitors during the actual labor because of the increased risks to yourself and the baby, but if you bring a birth ball you can experiment with many different positions on or right next to the hospital bed if you’re still planning to avoid an epidural. Moving around will help the baby descend more easily with an epidural, just like it does with a natural labor.

Finally

Being educated, having a good care provider whom you can trust, having confidence in your body (you can birth a big baby!), and hiring a doula are some of the best things you can do when trying to avoid an induction or when planning a positive medically-indicated induction.

Announcements:

Our November Meeting will be at a NEW LOCATION!!! 

The Doula Tea this month will still be at Earth Fare on the third Monday of the month at 7pm and our Healing Circle will be at the home of a local doula on the second Monday of the month at 7pm.

For more information about our group and about events in the area, please check out our website and e-mail any questions you have to the co-leaders at Admin@CSRABirthingConnections.org – we hope to hear from you or see you soon!

Freedom for Birth Movie Showing

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A couple of weeks ago we hosted a premier showing of the movie Freedom for Birth and it was awesome!!! We had a nice turn-out and it was a very powerful movie with a powerful message. Afterwards we had a panel of midwives speak about what it’s like to attend home births in both legal and illegal states.

The movie began by talking about fear. Fear about childbirth is pervasive in our society and has been for quite some time. The media perpetuates and plays on our fears through “reality” shows like A Baby Story and I Didn’t Know I Was Pregnant as well as through sitcoms and movies. Our fears about childbirth also have a basis in history. As doctors and hospitals became more plentiful, home and midwife-attended births were portrayed as less safe for *all* women than hospital or physician-attended births were. Midwives were portrayed as ignorant women and there were often negative racial undertones to those portrayals as immigrant and black “granny” midwives were common in those days.

Nowadays, generations removed from seeing our mothers, sisters, and nieces give birth before having our own babies, women in general don’t tend to be very informed about birth and about how their bodies can usually give birth without any problems. Most modern American women don’t ever get to see any other women have babies unless they are lucky enough to be asked to come to a friend or family member’s birth as a support person.

I can understand this type of fear coming from the unknown because – even having been to quite a few births myself – every single time it seems miraculous to me that those big beautiful babies can come out of a woman’s vagina – and it is miraculous! Birth is a miracle every single time and it’s incredibly important for women to understand that our bodies were made to give birth. Barring unforeseen complications, women can birth babies.

Back to the movie – we learn that Agnes Gereb is a midwife in Hungary who was jailed and is now under house arrest for attending home births when they were illegal in Hungary (they have recently been legalized although Hungary is still not actually licensing home birth midwives, from what I can find). Agnes has reportedly attended over 9,000 births in 32 years and about 3,000 of those were home births.

In her interview, Agnes states that she believes in helping, caring for, and instilling confidence in her clients. She wants to give her clients a choice without compromising their safety and she understands that not all women should birth at home. Agnes started off as an OB/GYN and was shunned by the other doctors when she started encouraging midwives to work independently.

When she was arrested, it was not even for a planned home birth. The mother had a precipitous labor during a childbirth education class and Agnes, very wisely, called for medical assistance. With the medical assistance, however, came the police, as well, who placed her under arrest.

During the trial Agnes was not allowed to present her defense, it was very one-sided in the media as well, and throughout her years of attending home births she had tried to become licensed, but the country would not allow it. A representative from the media told one man who was interviewed for the movie that they painted Agnes as a villain because they could not fathom painting her as a heroine.

Agnes poses a very good question at one point – Babies die in hospitals too so why aren’t those attending doctors not jailed? Indeed! Why not? Why the double standard?

Currently laws all over the world are suppressing midwives’ ability to provide quality care as well as women’s choices about their own bodies and about how they give birth. Women are often coerced into making decisions by threats of child services and court orders. Women are also being given incorrect information and therefore are not being allowed to make informed choices.

Now, some women do not mind the way things are. Some women are perfectly happy to have their babies in a modern medical way, and that’s fine, but many other women do mind and can be traumatized by the way their birth actually ends up being compared to how they had hoped it would be. For the women who want choices, those choices need to be made available.

Licensure of home birth midwives alone doesn’t solve all the problems with modern maternity care either. Licensure doesn’t always ensure that women have choices and often can even limit women’s choices and the types of care that midwives can provide their clients: suturing, attending VBACs, and administering vitamin K are just a few of the things midwives can be denied the ability to do legally even though they are licensed by their state.

Midwives are still being prosecuted in both legal and illegal states and countries. Mothers, American citizens, are still sometimes being threatened with CPS or police action in states where home birth midwives are legal and licensed.

In the Netherlands it’s not illegal to have twins vaginally or at home, but at least one woman who chose to do that has been accused of child abuse, even though her babies are fine and so is she. In Florida, which licenses home birth midwives and has no law against VBACs, the authorities took custody of a baby in utero and forced the mother into a repeat c-section while denying her a chance to even try for a vaginal birth after a cesarean.

There is a pervasive and erroneous idea in our society today that women who make choices in opposition to their care provider are a danger to their babies. Nobody loves babies more than their mothers do. Usually women have very good reasons for making the choices they make regarding childbirth.

I have yet to meet someone who chose an unconventional birth believing that their baby would’ve been safer in the hospital with medical management. Most home birth mothers do the research and make informed decisions that they believe are in the best interest of both themselves and their babies.

No mother wants to lose her baby, so why is that idea so common?

Ternovsky vs. Hungary

Thankfully for us, Anna Ternovsky got involved in this issue. Anna was a client of Agnes’ who thinks very highly of Agnes and she took a stand and brought a case against Hungary for denying her the right to choose to have a home birth.

This case went all the way up to the European Court of Human Rights and they agreed that Anna has the right to give birth wherever she would like to. The European Court of Human Rights agreed that birthing women are the decision makers in childbirth and legally upholds women’s rights to choose the circumstances in which they give birth in all of the European Union.

This case does not set a binding precedent in the United States, however, it can help set the tone in the US. Hopefully someday soon we will recognize the full set of human rights here and perhaps someday soon American women will take the question of their right to choose where and with whom to give birth all the way up to the Supreme Court.

One woman can make a difference!

Ina May mentions that countries without strong midwifery professions have worse birth outcomes. We certainly see that on the CIA list (2010) where the United States is tied with Iran and Hungary for spot 45 from the bottom (the list goes from worse to better from the top). That’s extremely concerning for a developed country – especially one that spends as much on health care as we do.

Well, there we have it. Our maternity care system is in a sorry state and our society as a whole does not recognize birth as a human rights issue that needs to be talked about and reformed. During the Rally for Change most of the people who passed by thought that we were protesting abortion or that we were pro-abortion. Many people seemed to think that we had to have been there about abortion although they admittedly couldn’t tell which side we might be on. Most people we talked to did not realize that many women are dissatisfied with the available birth choices or why anyone would be!

What Can We Do?

So, what to do? Midwives can only fight so much before their money runs out and so consumers NEED to let their care providers know that they’d like them to support women’s right to choose to birth where and with whom they choose. Consumers need to contact their representatives and work towards raising awareness of these issues!

Often women don’t even know they have these choices or a right to informed consent and a right to decline – even a lifesaving surgery, like a cesarean. Women may not know that they also have the right to know about the benefits and risks of any proposed treatments and that they can almost always fire their care provider or work with their care provider to come to a compromise in a situation where the care provider is getting nervous.

Knowing your reasons for wanting your compromise or for making non-mainstream choices can make a huge difference in how you are treated by care providers and even by child services. If you can tell your care provider or the authorities something like, “I’m making this decision because of this, that, and the other study which had these results.” they will be more likely to take you seriously and less likely to give you a hard time about your choices.

Consumers can also be careful when interviewing care providers by asking questions like, “How many of your clients have intact perineums?” or “How many of your clients deliver their babies in a position other than on their backs?”

Asking questions like those not only helps to weed out care providers who would be unwilling to compromise, but also lets more care providers know that their clients want choices and that potential clients are willing to ask difficult questions and even switch to a different care provider if this care provider is unwilling to try something new.

As clients express their preferences for unconventional births more often, care providers should be more willing to try allowing unconventional methods and will then, as a result, become more familiar with them, which will hopefully start a positive cycle of allowing women more choices in childbirth, which will increase the care providers’ comfort levels with those choices, etc. Maybe someday women will even be encouraged to have more choices in childbirth!

Every woman should be the decision maker in her own childbirth. Women should have the right to give birth wherever and with whomever they choose. Women should be given complete information about their choices so that they can make an informed decision that is in the best interest of themselves and their babies.

Every woman should have legal access to a well-trained attendant in the birthplace of their informed choice and no woman should be left to bleed to death after her birth.

In Our Community

Please join CSRA Birthing Connections at our free monthly meetings for more information about childbirth choices in the Central Savannah River Area!

~B.

MotherNurture – Part 1

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A couple of weeks ago, I had the distinct pleasure of speaking with Margi Deneau-Saxton (RN, CCE, CLC, CIMI®, CPD), Teresa McCullen (BS, IBCLC, RLC, LCCE, CIMI®), and Leslie Saxton (LMT, CIMI®) about their business, MotherNurture. MotherNurture is a wonderful resource for local pregnant and newly postpartum mothers and is, by far, the most unique provider member we have – so unique, in fact, that we had to invent a new category for them because the categories we already had could not adequately convey what their business has to offer to our community!

So, you might be wondering, “What is a Collaborative Childbirth Service?” or “What is MotherNurture?” and we hope that this interview helps to answer those questions for you!

All three main women of MotherNurture – Margi, Teresa, and Leslie – are certified infant massage instructors. Margi is also a perinatal nurse, lactation counselor, childbirth educator, and postpartum doula. Leslie is also a massage therapist who offers prenatal as well as postpartum massage and is a doula. Teresa is also an International Board Certified Lactation Consultant (IBCLC) and a childbirth educator. These three women work together to provide a service that, aptly named, nurtures mothers so their clients can better nurture their babies and families.

MotherNurture also works closely with other birth professionals in the community such as South Carolina home birth midwife Tavish Brinton LM, CPM and artist Elizabeth Barnes who does belly casting.

The Interview – Part 1

Margi met with me at her daughter Leslie’s lovely massage space on a warm, bright Friday morning. Margi and I talked first about how MotherNurture began and then what a postpartum doula does when Teresa and Leslie joined us a little bit later.

Me – How did Mother Nurture begin?

Margi – I began my nursing career in 1967, worked in Women’s Health, then, married a military officer and chose to be a “stay-at-home mom”.  I birthed all of our six children while living several states away from my family. I think I soon realized that my local friends had the support of their mothers and therefore, had uniquely different perinatal experiences. Some of my children were a year old before my mother even got to see them. In 1996, I returned to work when our youngest was ten, and after my husband had a heart attack. I worked as a perinatal nurse case manager in Jefferson County, GA with the Rural Health Outreach Program of the MCG School of Nursing. Our Director had a real commitment to making a difference in the lives of the women we served.  My clients lived in matriarchal systems but they didn’t really have the support of their families or mothers. So, I studied infant massage and began teaching these women how to massage their babies and we saw their home environments begin to change. They learned how to communicate with and respect their children.

Margi’s training in infant massage, her community work, and her experiences raising her children away from her family all contributed to the beginning of MotherNurture.

After some thoughtful consideration, in 2004, Margi came up with the name “MotherNurture” and she and Leslie began teaching infant massage at several locations, including Lula Bloom Maternity Boutique in Aiken and then in North Augusta. There’s a doula group in New York City with the name “Mother Nurture” so Margi asked them if it would be fine to use the name before starting this group.

Their business is not only about infant massage though. Not by a long shot!

Margi – We had a client for the infant massage class and when she arrived, I thought she’d left the baby at home, but the baby was actually in a Moby under her winter coat so we got involved with and became a local distributor of Moby Wraps.

MotherNurture also provides Postpartum Doula services – a service that is uncommon in the CSRA.

Me – What do Postpartum Doulas do?

Margi – Basically, it is all about flexibility. Postpartum doula care is a continuation of the mother’s care from the birth. The doula “nurtures the mother.” Our focus is not on the baby but focuses on the mother being nourished, rested, and having time for self-care. This means a postpartum doula might take care of the baby so the mom can take a shower or bath without worrying about the baby.

Another key component of the doula’s function is education – not in a didactic way – but by modeling or making suggestions. The postpartum doula comes alongside the parent(s) and together they decide what support the family needs. Some clients have informational needs, like how to take care of a baby and the mother herself, and others have practical needs like running errands or helping with other children or fixing meals. Most doulas will step up to the plate and do what needs to be done.  This might include assistance with breastfeeding and comfort measures, helping family members learn how to mother the mother, teaching and modeling newborn care (baths, circumcision/non-circumcision care), and providing instruction in swaddling, holding and babywearing.

Postpartum doulas help calm nervous new mothers and are also there to meet the needs of older children – reading stories, overseeing games/play periods and/or bringing in new activities for them to do. This provides for a more peaceful environment!  Leslie is very good at finding activities for children. By the way, Dollar Tree is a great place to find those items!

A postpartum doula can also run interference and help modulate visitors or phone calls and keep curious onlookers to a manageable number.

Margi – Sometimes our hospital patients have rooms that are full of family and friends. One situation was like a viewing in a funeral home – extra chairs all around the room, Mom sitting in the bed and nobody actually talking to her. People were sitting around and were talking to each other…about the mom, the birth, the baby etc.

Teresa – That can sometimes cause a meltdown because the mother feels like she needs to be “together” all the time.

Margi – We do encourage mothers to wait a while before having visitors in their home.  It is so easy to slide into the entertaining mode.  We can do light cleaning for them, cook some meals, and help with baby laundry or organize nursery items. We can help create spots around the house to change the baby and we may get groceries or run errand, as needed. We give foot massages, back massages, or Leslie may come in, upon request, to do a full body massage. Infant massage techniques are taught to help with gassiness and we can instruct in infant CPR.  We might support babywearing if the mom has bought a baby carrier, and needs help with learning how to use it.

Every postpartum doula creates a referral or community resources information sheet.

It’s also important to be able to recognize when a woman isn’t doing so well emotionally and to be able to recognize if she might be going into postpartum depression.

Postpartum doulas can also help the mother address family questions – like if the mother-in-law keeps asking if the baby’s getting enough milk.

Postpartum doulas do not provide medical advice. Some postpartum doulas work nights, but MotherNurture postpartum doulas work only during the day.

Margi – We don’t perform health assessments on the mother or the infant, but as health care professionals we will certainly recommend follow-up with the pediatrician or obstetrician.

A postpartum doula does not replace the father or the family, but works alongside – she doesn’t tell the mother what she should do. Sometimes they’ll ask, “What would you do?” and the doula might say, “Many mothers do this or that” or…we might turn the question back around to, “What is your gut feeling about this?”  It is so important for mothers to learn to listen to their instincts.

A postpartum doula does not act as a maid and is not a nanny even though she may assist in those areas. She also does not do baby care, but instead assists the mother with caring for the baby. MotherNurture is about nurturing the mother, not about nurturing the baby directly, because that’s the mother’s job and if the mother is nurtured then the nurturing “trickles down” to the baby as well.

Margi – A postpartum doula’s main job is to nurture the mother – mother the mother.

Me – When is the most critical time after birth that a woman needs to have a postpartum doula?

Margi – At first, they have more support from family members and friends and then, a week or so out, the mother is sitting there in an empty space saying, “Where are those people?” and “They’re too busy” and “Oh, I’ll manage. I won’t bother them.” Basically, I would think, after 3 days maybe, or late in the first week. However, for some mothers that may be different because, especially in our community, we have military families who might need help immediately. Remember… husbands don’t always help because they don’t always realize how to help.

Teresa – I think, for some women, the doula should come the day after the birth or even the day they come home, but for other women who have that “busy bee network that disappears after a week or so,” that might be another crucial period when a doula is needed.

Margi – That’s a major reason why we do a prenatal home visit and consultation to assess the couple’s lifestyle and learn their particular needs. We seek to build a service-based relationship with mutually shared expectations and a mutually agreed upon set of guidelines.  

Intermission

Assessing a family’s and/or client’s individual needs and meeting women where they are is something that the women at MotherNurture are clearly experienced with!

As mentioned earlier in this part of the interview, MotherNurture offers babywearing help and classes with the purchase of a Moby Wrap. Babywearing is wonderful – especially for mothers who have a newborn as well as a toddler to chase around. Wrap Your Baby has some excellent video and photo series tutorials about how to tie a baby wrap.

This interview ended up being fairly long for just one post, so part 2 will be posted in a few days and we’ll get to hear more about how Teresa and Leslie became involved in MotherNurture, as well as covering topics like breastfeeding and both prenatal and postpartum massage!

In the meantime, please check out MotherNurture’s website for more information and like their Facebook page 🙂

~B.

Labor Day Meeting!

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Introduction:

After our exciting morning at the Improving Birth – National Rally for Change rally in downtown Augusta, we had a few hours to rest before welcoming most of the rally attendees, as well as some brand new faces, to our evening meeting about Choosing a Care Provider. We had wonderful attendance, considering the fact that it was a holiday, and it was a lovely meeting altogether.

When we showed up at Earth Fare to set up for the meeting, we were surprised to see that they were closing one hour early for the holiday.  Thankfully we are all birth workers and can be very flexible with last-minute changes and our second half of the meeting, mostly mingling and visiting, can just as easily be done outside as inside and the weather was particularly beautiful that night. It all worked out perfectly.

Our speaker on Monday was Ashley – a local birth activist and soon-to-be postpartum doula/Childbirth Educator – who has personally experienced care by three different types of care providers. She planned a home birth and had prenatal care throughout her pregnancy with a Certified Professional Midwife (CPM) who attends home births. She also had backup care from a Certified Nurse-Midwife (CNM) at a local hospital, just in case, and saw an Obstetrician (OB) a couple of times as well. During her labor she had a very necessary transport from home and experienced care during labor from the CPM, the CNM, and from an OB.

Choosing a Health Care Provider in Pregnancy

The first step in choosing a care provider is to know what kinds of providers are available in your area.

  • Obstetricians (OB) are trained surgeons who attend to pregnant women through their pregnancies and births.
  • Family Practice Doctors can also attend women through pregnancies and births and are not trained surgeons so they would need to call in an OB if a c-section was needed at any point.
  • Certified Nurse-Midwives (CNM) are trained nurses with additional studies in midwifery. Most CNMs deliver in hospitals and are affiliated with an OB.
  • Certified Professional Midwives (CPM) undergo rigorous competency testing by the North American Registry of Midwives in order to be certified. CPMs are independent practitioners who mostly catch babies at their clients’ homes and at birthing centers.
  • Direct Entry Midwives (DEM) are independent practitioners who are trained through midwifery studies, apprenticeships, and possibly a midwifery school or a college that is not part of a nursing program.
  • Licensed Midwives (LM) are licensed to practice in a particular area, normally a state. They can be CPMs or DEMs depending on the laws of the state in question.
  • Doulas are non-medical birth assistants who provide informational, physical, and emotional support. A doula can help you know when it’s time to call your midwife or leave to go in to the hospital. Doulas can also help with comfort measures during labor and birth. Doulas do not provide any clinical care and are hired in addition to one of the primary care providers listed above.
  • Pediatricians are physicians who specialize in the care of infants, children, and adolescents. Most primary care providers for pregnant women like their patients/clients to choose a pediatrician for the new baby before the baby is born.

When considering an Obstetrician (OB) – 

Typical questions that are good to ask:

  • What is your c-section rate?
  • What is your episiotomy rate/How many women under your care give birth with intact perineums?
  • What is your epidural percentage?
  • Are you board certified?
  • How much time do you allow for prenatal visits?
  • How many women under your care give birth in a position other than on their backs?
  • How many doctors are in your practice?
  • Are you on rotating call or do you see your own patients?
  • Can I meet the other doctors in your practice before I go into labor?
  • Have you ever seen a natural birth/What do you consider to be a “natural birth?”

Some red flags to watch out for when interviewing an OB are –

  • Using the word “try,” “attempt,” or “we’ll see.”
  • Saying, “I have to be able to get to the baby.” when alternate pushing positions are brought up.
  • Bringing up potential lawsuits or hospital policies/option to deny your wishes.
  • Time limits or restraints on what you can do.

Keep in mind that your OB might only come in at the very end of your labor to catch your baby. Planning to ask for a natural-friendly nurse when you go in and having a birth plan that your OB approved and signed ahead of time can help a great deal during your labor before your OB arrives.

When considering a Certified Nurse-Midwife (CNM) – 

Be sure to ask about:

  • Restrictions by the CNM’s attending OB or hospital – time limits, IV’s, etc.
  • Same questions you would ask an OB about rates and percentages.
  • Insurance coverage.
  • Can they attend the birth themselves? What happens if you need a c-section?
  • Have they ever seen a home or natural birth?

When considering an Out of Hospital Midwife (CPM, LM, DEM) – 

Ask about:

  • Number of births attended.
  • Rate of transfer and typical reasons for transfers.
  • Will she come with you to the hospital in case of transfer?
  • What types of medical issues will risk you out of having a home birth?
  • Has she delivered breech babies or twins?
  • Is she trained in Neonatal resuscitation (NRP)?
  • What emergency equipment does she bring to births?
  • What are her guidelines for a healthy pregnancy?
  • Does she have any references from previous clients?

When considering a Doula – 

  • Make sure your personalities mesh well.
  • Find out what services she provides, how often you meet prenatally, and if she has any backups available if she cannot get to your birth.
  • Is she willing to help facilitate the involvement of the father in the birth?
  • Does she offer postpartum assistance or does she have any suggestions for postpartum doula services?
  • Does she have any references from previous clients?

When considering a Pediatrician – 

  • What are their feelings on circumcision?
  • Do they understand how to care for an intact (not circumcised) boy?
  • How do they feel about vaccinations – are they open to having patients with selective vaccines or no vaccines?
  • How do they feel about breastfeeding and do they recommend an age of weaning or of introducing solids?

*With a pediatrician, just like with any other care provider, it’s most important that their views are consistent with your own so that they can support your choices and work well with you and your family.*

Special Situations: Military – 

We had some very informative side conversations about how things work with doctors in the military. For military mamas be sure to ask your doctor if he/she will come in to catch the baby, otherwise whoever happens to be on call will come in.

Military spouses have a great deal of freedom in choosing their care providers – more than many spouses think they have. If they aren’t happy with the military doctors then they can switch from Tricare Prime to Tricare Standard and then they’re covered to see civilian doctors.

If you are a military spouse, you do not have to agree to or show up for an induction. Just like any other civilian, you can request to have Non-Stress Tests done weekly on the baby from 41 weeks instead of scheduling an induction. If you’re doing well and the baby’s doing well, there’s no reason that you have to be induced.

That wraps up the meeting topic for this month!

Announcements: 

In other news: we have a new location for our first-Monday Birthing Connections meetings starting on the first Monday in November. Family Bible Church – located across from the Martinez Post Office – has graciously agreed to let us meet in their space. We are very excited about this new location because our current location has gotten rather crowded recently! Our Doula Teas will continue to be at Earth Fare on the third Mondays of the month for the time being. We are not affiliated with Family Bible Church or any other religious group.

Our Healing Circle meeting this month will be at the new location and this will be a sort of trial run with a smaller group of people before our big meetings move there.

We are also looking forward to our very first movie screening on September 20th! We will be screening the film Freedom for Birth at Augusta’s First SDA Church and we hope that you will be able to join us! The movie screening is free, but we do ask that you consider making a small donation or becoming a BirthNetwork National member to support our group so that we can continue holding community events like the Rally and the Movie Screening.

Thank you so much for your continued support!

~B.

For more photos from this month’s meeting, please see our Facebook Album.

Improving Birth – National Rally for Change

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Today we were honored to participate in the Augusta, GA Improving Birth – National Rally for Change!

There was a really nice turnout of about 15 adults, 6 little babies, and a toddler! The weather was gorgeous, if a little bit warm, but we hung in there and had some very nice reactions from the community! We stood on the corner of Walton Way and 15th Street right by Georgia Health Sciences/MCG Hospital and near University Hospital and there was quite a lot of traffic considering that it’s Labor Day!

We did get some confused looks from a few of the people in cars, but overall, everyone was so nice and friendly! A police officer stopped by to say hello and to ask more about what our goal was. He knew about the rising c-section rate and was very supportive.

A couple of nurses – one of them an OB nurse – stopped by and thanked us for what we were doing and expressed their support. One of the nurses parked and came to talk to us for a little while. His wife had a natural birth and he was very supportive and interested in what we were doing.

Several women rolled down their windows and asked questions about c-sections and inductions. We had more than a few people – men and women – honk and wave and give us a thumbs-up as they drove past.

This was a wonderful experience and we are planning to be a part of any future birth rallies in Augusta! Thank you to everyone who came and to Improving Birth for organizing this National Rally for Change and giving us the opportunity to be a part of their nationwide effort to improve maternity care in America!!!

Tonight is our Birthing Connections meeting and we hope to see many of you there! The topic is “Choosing Your Care Provider” and we have a woman speaking who has experienced care with a Home Birth Midwife, a Certified Nurse-Midwife in a hospital, and an Obstetrician, so she is uniquely qualified to talk about this topic. We’re excited to hear what she has to say!

~B.

What Our Group Is

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On our Facebook page, beneath our statement of not being affiliated with any other groups or pages on FB, one of our supporters has asked, “How are the groups different? The names sure are confusingly similar.” with reference to the “Augusta Birth Network of CSRA” group.

We have tried very hard to focus on our group, the future, and moving forward after we were no longer associated with Augusta Birth Network; but in the interest of differentiating clearly, here is a summary of why the names are similar and how our groups are different:

Similar Names?

Several of our co-leaders used to be involved with the “Augusta Birth Network” group. There was a difference of opinion and the founder of ABN told us to start our own group and then publicly stated that ABN and all groups associated with ABN would be disbanded. The other co-leaders had not agreed to disband ABN so we decided to continue the group. The founder then changed her mind (which she had every right to do) and decided not to disband ABN so we went forward with our plans except with a new group – this group, then known as BirthNetwork of Augusta because we were under the impression that “BirthNetwork” had to be in our group’s name if we wanted to be a chapter of BirthNetwork National.

BirthNetwork National has been extremely accommodating with our situation here and suggested that we choose a new name to differentiate ourselves from the other group so we held a community vote on our blog to choose our new name in order to ensure that the names would not be so similar. Our community overwhelmingly chose “CSRA Birthing Connections.” Soon after our community chose this name, the founder of ABN decided to add “of CSRA” to the end of “Augusta Birth Network” which has caused some further confusion.

How We Are Different

Our group is different because we have seven co-leaders instead of just one. Every one of our co-leaders is a birth professional in some capacity. We have a midwife, some student midwives, several doulas, a couple of childbirth educators in training, and between us we have had hospital births, home births, c-sections, VBAC’s (Vaginal Births After a Cesarean), unassisted births, and HBAC’s (Home Births After a Cesarean).

Part of our goal is to build connections between natural birth proponents, doctors, midwives, chiropractors, allopathic doctors, nurses, home birth moms, and hospital birth moms. We want to support all birthing women in making informed decisions, regardless of their planned birthplace, and we want to meet every woman who attends our meetings where she is – not to suggest that she can only have a good birth at home or that having a c-section is a horrible tragedy. We are all natural and home birth proponents, but we do not want to limit ourselves to only helping like-minded families. In this way we are different from most natural-birth groups in the country, not only ABNoC.

We currently host three meetings every month on the first, second, and third Monday evenings at 7pm. We have a general informational meeting at which anyone wishing to learn more about making informed choices in birth is welcome to attend. You can learn about how to have a more pleasant hospital experience and also about midwives, doulas, birth centers, and home births if you want to learn about them. We have a Healing Circle for any women who have experienced a pregnancy or birth loss or traumatic experience associated with pregnancy or birth. We have a Doula Tea meeting where you can learn about what a doula is and does as well as meet several local doulas at a time and hopefully find one whom you would love to have support you during your birth!

Our group is also under the umbrella of BirthNetwork National. We wanted to have some oversight for our community’s money so that you don’t just have to trust that we’re being good stewards. We also wanted to be able to offer a tax-deduction for community members who join or donate to our group. During our time as co-leaders with ABN (once ABN was no longer a BirthNetwork National chapter) not one of the co-leaders, other than the founder, nor any professional members ever saw a bank statement or knew exactly where the membership dollars were going. We believe that we owe it to you, our community, to be transparent with your funds.

Every year we will have at least one public statement available so that you in our community can see how your money is being spent. Your membership money is not only going to help a national organization do good work all over the United States, but is also being reinvested here in ways that will greatly benefit the birthing community in Augusta and the surrounding Counties.

In Conclusion

This is all not to denigrate ABNoC. The founder of ABNoC has done some wonderful things for our community. She’s a Trust Birth facilitator and, if anyone is interested in learning more about unasissted birth, she’s the person to talk to. That topic is beyond our scope as a BirthNetwork National chapter.

It pains all of us, here at Birthing Connections, that this is how our group started. However, the response from our community about our new group – particularly from those who understand the differences between our groups and have been attending our meetings – has been overwhelmingly positive. We would not have even addressed this issue in the first place had concerned community members not come to us and explained how confusing the two groups has been an issue for them and others in the community.

One final note, for clarity’s sake: We would have done things very differently when the group started had we known at the time that ABNoC would still be continuing. Many of the name confusions and initial misunderstandings were a direct result of us operating under incorrect information, while doing our best to salvage a group that we felt was bigger than just one person and that should not be disbanded without any prior notice.

Please see this blog post for more information about the benefits of our membership with BirthNetwork National (BNN). Some of the benefits were specifically sought after because of our experiences with ABNoC, such as the fact that, under BNN, no co-leader can decide to disband the group unilaterally and we have to give advance notice before leaving as co-leaders. We do not want our community to ever again be in a situation where people are panicking about losing their birthing support and source of information because of a hastily written public Facebook message.

We hope that this helps to clear up some of the confusion about the groups. We serve very different purposes in the community and it is unfortunate that the similar names continue to be such a big issue.

We appreciate the huge outpouring of love and support that we have received since starting this group and we plan to continue to serve our amazing birthing community for a long time to come ❤

~B.

August Doula Tea!

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This past Monday we had a surprisingly large turn out for our monthly Doula Tea! It was a great group of seven local doulas, a couple of seasoned mamas wanting to support the group, two people seeking more information about doulas and the role of doulas, and two expectant couples wanting more information about hiring a doula. We even had two extremely well-behaved children and three adorable little babies 🙂

Now, some of you might be wondering, “What is a doula tea?” Well, Doula Teas are held nationwide – maybe even worldwide – in areas where there are enough doulas to run a regular meeting like this. We certainly didn’t invent the idea. Not all Doula Teas are held on a monthly basis, but since pregnancy is so short, relatively speaking, we believe that it is important to hold Doula Teas regularly so that women who are just hearing about doulas towards the end of their pregnancy will still have an opportunity to meet some doulas and decide whether they would be interested in having one at their birth.

For any readers who are not local, a Google search should pull up Doula Teas or “Meet the Doula” events nearby. If there isn’t one in your town, maybe some of your local doulas would be interested in starting one!

At our meeting we started off by inviting all of our attendees to have a cup of tea. We offer a variety of pregnancy teas as well as raspberry leaf and chamomile tea.

After everyone was situated, we welcomed our guests and began a DONA International film about the role of doulas during childbirth. The film answers the question, “What is a doula?” and has several birth scenes showing how doulas support mothers during birth.

Doulas, as the movie we watched explains, give emotional, informational, physical, and spiritual support to women during labor and birth. Doulas change the way that women are cared for, lower c-section rates, reduce interventions used, and reduce the incidence of postpartum depression.

One of the things stressed by the movie is the importance of talking to more than one doula before choosing one. It’s important to make sure that you agree with your doula about birth-related matters. It’s also just as important, maybe more important, to have a connection with your doula – for her to be someone you would like to have present during your birth.

Birth is a very personal and intimate event and you do not want to have someone present at your birth who isn’t in tune with your needs.

After we finished the movie we went around the room and everyone introduced themselves. One of the most exciting things to me is how many different types of doulas we have in our area. We have doulas who have had home births and doulas who have had cesareans as well as doulas who’ve had subsequent VBACs. We’re a very diverse group of doulas ranging all the way from the hippy dippy to the more medical or informationally-minded. There’s a doula for everyone!

After introductions we had a question and discussion time. We talked about how doulas do not perform any clinical tasks, do not take over the dad’s role during the birth, and doulas do not talk to the care providers about your care other than possibly to ask questions to clarify a situation or to make polite chit-chat with the staff.

Then we talked about what does fall within the role of a doula. Doulas help dad be more comfortable with supporting mom; offer meaningful encouragement, coming from experience, to both parents throughout the labor and birth; help parents know when it’s time to go to the hospital so they can stay home as long as possible but still be at the hospital for the birth; support the mother in her choices; help by explaining pros and cons of interventions; and remind parents that they can discuss their options alone, if desired.

Doulas talk at length with the mother during prenatals about what she wants during the birth and how the doula can best serve her. Some doulas can also provide a fair amount of supplementary or primary childbirth education during the prenatal visits.

When asked why she wanted a doula, one woman present said that she would like a doula because she wants what’s best for her baby. She’ll be able to make decisions more easily because she’ll be supported and there will be someone there to remind her about pros and cons and of her goals during labor. She’ll have someone there to help with pain relief so she can hopefully avoid using medications for as long as possible or have a completely natural birth.

One of the most important things about the Doulas Teas, in my opinion, is that women get to meet several doulas at one time and they get to meet the doulas in person!

When faced with printed or online listings it can be difficult to decide who to call first. By meeting several doulas at one time, women can choose a few doulas to call for a more in-depth free consult, and they can be fairly certain that the doulas they call for consults will be a good fit for them in their unique situation.

We had a lovely meeting – thank you to everyone who was able to attend!

~Betsy
CBC Secretary

August Meeting: The first hour after birth!

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Hello friends,

We had a lovely meeting this past Monday! Thank you so much to everyone who was able to attend. Your participation added a great deal to the meeting and we appreciate it. For everyone who was unable to attend this month, we hope that this post will allow you to attend our meeting virtually and maybe we’ll see you in person next month!

Our speaker this month was Brooke Connor, a newer doula in our community. Brooke has seven children, six were VBACs, and she has a wonderful passion for mothers, babies, and birth that shines through whenever I’ve worked with her at a birth or talked with her about birth. Her passion certainly shone through during this past meeting, despite having been awake almost all the previous night at a birth.

We had a full room of attendees ranging from mothers with older babies, pregnant women, nurses, doulas, a high school senior, and local business owners. The six older babies played happily on the floor as we met and there was a precious little newborn to snuggle as well. Everyone present seemed eager to learn and participate in the discussion.

Our topic this month was: The First Hour After Birth

The first hour after birth is so important that it has been called the “Golden Hour.” This hour is the perfect time to bond with your baby because your hormones, as well as the baby’s, are primed and ready to form one of the strongest bonds possible – the bond between a mother and child. The first hour is also the perfect time to initiate breastfeeding while your baby is alert and ready.

Certain medical interventions can interfere with this precious time. It’s very important to understand how they can affect your first hour and to be prepared to decline any interventions that are not medically necessary. If the interventions are necessary then the benefits outweigh the risks and you can always do things later on to increase bonding and get some of the benefits of the first hour even if you have to miss it for any reason. Your health and your baby’s health need to come first.

Now, let’s talk about the first hour after your baby’s birth!

Believe it or not, newborns aren’t always beautiful just after birth. Sometimes they enter the world looking a little bluish or bruised, or with a little bit of a conehead from the passage through the birth canal. Sometimes babies are covered with vernix – a white creamy substance that is actually quite good for their skin if you rub it into their skin instead of washing it off. Sometimes babies will have small white bumps on their faces, their reproductive organs may be swollen, and girls may have a little bit of bloody discharge – all aftereffects of their mother’s hormones.

This is all normal and within just a few days (sometimes even hours), the marks of childbirth will have faded or disappeared completely.

Newborns are almost always very alert just after their birth. Their eyes are wide open and they are ready and eager to meet their parents! They can’t see well at all distances, but if they’re in your arms, they can see your face, and will focus intently on it. Eye ointment is an intervention that can interfere with bonding by making the baby’s vision blurry. You can ask them to give it later, and they are usually fine with that.

Your baby has just come from a very warm place, and will want to be immediately snuggled up in your chest, skin-to-skin. If you put your finger in the baby’s palm, baby will automatically hold and squeeze it.

Sometime during the first hour after birth, your baby will be ready for his first breastfeeding session. Don’t rush it – just snuggle and enjoy him, and let him hear your voice and study your face.

When your baby is ready to eat, he will begin to wiggle, fuss, and suck or chew on his hands. During the first hour after birth, most babies will be ready to begin nursing, and will even initiate nursing themselves if you do not! Don’t worry if he doesn’t latch on immediately. Babies usually like to smell and lick the nipple before taking it in their mouths. Give him time to get comfortable with you, and feel free to ask for help from your nurse, midwife or doula if you want or need to.

Colostrum is the first milk a mother produces – it is thick and rich and perfect for a newborn’s tiny tummy. It contains large amounts of leukocytes that defend against viruses, and antibodies that protect the baby’s vulnerable mucous membranes. It also has a laxative effect, which is protective against jaundice. Newborn babies’ stomachs only hold about 1 teaspoon and colostrum is all that your baby needs before your milk has come in.

This article explains the Nine Instinctive Stages of Development and they are summarized below:

“The first hour after birth is a developmentally distinct time for a baby, and there are… nine observable newborn stages happening in a specific order that are innate and instinctive for the baby.”

1. The Birth Cry – Very distinctive first cry.
2. Relaxation – Skin to skin with mother.
3. Awakening – About 3 minutes after birth.
4. Activity – Rooting and mouthing movements begin about 8 minutes after birth.
5. Rest – Periods of rest may happen between periods of activity throughout the first hour.
6. Crawling – Breast crawl – there are a great many excellent videos on youtube showing how the Breast crawl works!
7. Familiarization – Getting familiar with the nipple.
8. Suckling – This usually happens about an hour after birth.
9. Sleep – Babies usually fall asleep about 1½ to 2 hours after birth.

Now that we know about the 9 Instinctive Stages, what might we want to do differently in order to give time and space for our newborns to go through these stages at their own paces, rather than being pushed through them, however gently?

Being calm and relaxed about nursing and not rushing into it or feeling like you need to be in a big hurry can help a lot. Sometimes if we rush into nursing before the baby is ready yet we can cause or exacerbate latch issues and cause unneeded frustration for both mom and baby.

Just like the eye ointment, cord clamping, vaccines, and baby’s first bath can interfere with bonding if they are done too soon. Cord clamping can be delayed for at least 3-5 minutes, allowing the baby to receive most of his blood from the placenta. Vaccines can easily be delayed at least until the first pediatrician appointment or longer.

It is normal for babies to lose up to 10% of their birth weight in the first few days after birth. They should be back up to their birth weight by 2 weeks after birth.

After the baby comes out, you still have to birth the placenta! The placenta usually is birthed on its own within about half an hour. Your care provider may need to apply gentle traction with the umbilical cord to help it come out.

In the hospital Pitocin is usually given via the IV or a shot, usually in the thigh, within about ten minutes of the baby being born. Pitocin, an artificial form of Oxytocin, triggers contractions, which encourage the placenta to detach from the uterine wall. The Pitocin is also administered to help the uterus return to its normal size after your delivery. Your nurse will show you how to massage your uterus to help it return to size as well.

You can ask the doctor to skip the Pitocin if you intend to breastfeed. Afterbirth contractions are triggered by oxytocin, which is released during breastfeeding. If you choose to skip the Pitocin, your doctor will stress the importance of fundal massage.

At a homebirth the placenta is usually expelled spontaneously within 20 or 30 minutes. Breastfeeding and fundal massage are all that are necessary in most cases to prevent excessive bleeding. Most midwives carry Pitocin that can be used if needed.

In the hospital, your doctor will usually check for tears and do necessary repairs immediately after the placenta is delivered. You can always ask for them to wait a little while. As long as you are not bleeding excessively, they can wait until you’ve had a chance to enjoy your baby for a little while.

At a homebirth they usually check for tears a little later in the process unless there is excessive bleeding from a tear. They have 6 hours to suture. After 6 hours there’s really no point in suturing at all because the tissues have healed up too much by then.

During this first hour, your hormones are primed to bond and fall in love with your baby. You will experience one of the highest levels of Oxytocin that you’ll experience in your lifetime. Oxytocin is the falling in love hormone. It does not work in isolation, but is part of a “complex hormonal cocktail” that includes prolactin, which is known as the “motherhood hormone” and these hormones induce a strong love of your baby.

You can make a list of things to discuss with your care provider, to help make sure that you can take advantage of this critical time in your baby’s life. Birth plans are very helpful in doing this as well. Generally, with birth plans, it is best to choose just 5 things that are your “hills to die on” regarding your birth and 5 more things regarding the baby after the birth.

If there are complications during your labor or birth, then you need the interventions that are being done, and you can still have skin to skin bonding time after the first hour. Try not to feel badly if you miss that first hour because of a medical complication. But if there is no complication, enjoy that first hour, it will never come again!

There are even ways to make a c-section a more “natural” experience for you and your baby. In this video on youtube (which contains footage of a cesarean birth), you can see that the mother gets to hold her baby immediately after birth and they are able to do everything they need to do – stimulate the baby and even suction the baby – while the mom is holding her baby.

In this longer video, you can hear how the procedures surrounding a c-section can be altered and then watch a cesarean birth where the mom and baby are able to get a more natural experience – more like what they would experience with a vaginal birth.

For more information about implementing skin-to-skin care after a cesarean as well as the benefits of and recent studies about skin-to-skin care after a cesarean birth, please check out this article from Evidence Based Birth.

For more general information about the first hour after birth, you can check out this website as well: www.womenshealth.gov/pregnancy/childbirth-beyond/baby-first-hours.cfm

Thank you for taking the time to join us at our meeting and/or to read this recap ❤ I hope you all have a lovely week and please let us know if there are any topics you'd particularly like for us to cover in future meetings!

~Betsy Alger
CBC Co-leader and Secretary

July 2012 Meeting: Common Interventions

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Last night we had a lovely meeting! In addition to having an almost full room of adults, we had six delightful babies, and a sweet little girl.

We were able to meet the owner and founder of the new cloth diaper service in the CSRA – Busy Bee Diaper Service! We are so very excited to have a cloth diaper service in the area 🙂 From what I understand, there used to be one quite some time ago, but there hasn’t been one since I moved to the area over 3.5 years ago. This is definitely a niche that needed to be filled! If you already have a stash of cloth diapers, they will even clean your own diapers each week for a small fee.

After our introductions, Christine Wieberdink, a local Certified Professional Midwife and Licensed Midwife, talked about several common interventions during childbirth. All of these interventions have a time and a place when the benefits outweigh the risks. However, none of these interventions have been proven to be beneficial when done to all laboring women regardless of their health history and situation.

We learned about Continuous Fetal Monitoring (CFM) and about how it can be beneficial for women who have a high risk situation, as well as being necessary for women who have gotten an epidural or are getting pitocin to speed things up. Babies can more easily and more quickly go into distress after an epidural is placed or after pitocin is started. The continuous monitoring is advantageous to the hospital staff because they get a continuous strip of your baby’s heart rate and they don’t have to send a nurse in periodically to listen by hand.

The downsides of CFM are that the belt is rather uncomfortable and tight, you cannot move around as easily, CFM hasn’t actually been shown to make a statistically significant difference in fetal outcome, and studies have shown that CFM increases your risk of having a c-section. When you move around, the belt can slip and the monitor can sometimes lose the baby’s heartbeat. This can lead to some panicking if the heartbeat cannot easily be found again.

If you are healthy and your baby is healthy, you can always request intermittent fetal monitoring. Sometimes the hospital staff can use a hand-held doppler device or hold the monitor to your belly for a couple of minutes instead of strapping on the belt. They can also simply unplug the belt monitor from the machine to let you have 20 minutes off the monitor and 10 minutes on the monitor, if you agree to that.

Here is the American Congress of Obstetricians and Gynecologists (ACOG) most recent revised position statement about Continuous Fetal Monitoring. There was also a New York Times article about the changes in 2009.

We also learned about cord clamping and about the routine intervention of immediate cord clamping. At the time of a fully-term, healthy baby’s birth, about 1/3 of the baby’s blood is contained in the placenta and cord at any given time. Cutting off 1/3 of a baby’s blood supply is probably not the best way to welcome them into the world, no matter how you look at it.

The American Academy of Pediatrics has, on their website, an abstract of a study that shows some of the benefits of delaying that cord clamping, such as increased iron stores in newborns and the lack of any evidence to show that delayed cord clamping is harmful.

There’s also an excellent talk from the Academic OBGYN about Delayed Cord Clamping. If you have a spare 50 minutes, I strongly recommend that you listen to what he has to say. He has handy graphs and discusses quite a few studies about cord clamping.

This is definitely an issue to be informed about before you go in to talk to your doctor about your preferences because it often takes a while for practiced medicine to catch up to the newer evidence and this issue is not an exception. Doctors are busy people and they only know what they’ve learned on their own or were taught in school and continuing education programs.

Most Doctors are open to learning if you are willing to bring in the evidence from legitimate studies and professional organizations. Your work in bringing this information to your doctor could have a ripple effect on your doctor’s future clients who might be encouraged to look into this issue by the doctor him or herself!

Breaking your water, or Artificial Rupture of Membranes (AROM), is another intervention that we talked about . AROM is necessary if you need to have an internal fetal monitor and is generally preferable to having a c-section due to external fetal monitoring not finding the heartbeat. Studies have also shown that, if done early in labor, AROM can reduce the length of labor by about an hour.

However, in the grand scheme of things, one hour is really not very long, and that benefit really needs to be weighed against the sobering potential risks that AROM introduces into your labor. AROM drastically increases your risk of infection because the protective amniotic sac around the baby is no longer intact to protect your baby from outside germs. If you are still at home after a Spontaneous Rupture of Membranes (SROM), you need to be scrupulous about hygiene and put NOTHING in your vagina.

Once your water has broken you are on a clock and most doctors like to see the baby born within about 18 hours of the water breaking. Most midwives like to see women in good, strong active labor by 24 hours after their water breaks. Not only is the baby’s protection against infection gone, but the cushion  around the baby is gone once the water is broken as well. If the baby’s head is in a less than optimal position, it could get stuck there. If the baby’s head is not down in the pelvis then the cord could slip between the head and the pelvis, cutting off the baby’s oxygen supply; or prolapse, which necessitates a c-section in most cases.

The next intervention we talked about seems less like an intervention to most people because it doesn’t seem like something that’s done to a laboring woman – it’s something that she’s not allowed to do. However, not allowing a woman to eat and drink during labor is most definitely an intervention.

There is really only one benefit to not allowing food or drink to a woman in labor. If a woman had to have an emergency c-section and be put under general anesthesia she could vomit and aspirate her stomach contents and she could get pneumonia or asphyxiate, IF she is not intubated properly. Now, the situation where a woman would need general anesthesia for a c-section is extremely rare to begin with. It is even more rare for a woman to be intubated improperly and not everyone who aspirates their stomach contents gets sick in the first place, but it is a small risk of eating and drinking during labor.

The downsides of not eating and drinking during labor are that women are working extremely hard during labor and birth – many people liken labor and birth to a marathon or climbing a mountain – and their bodies need fuel. When a woman’s body is exhausted and no longer has any reserves of fuel, her uterus doesn’t work as effectively and she starts having ketones in her urine. The baby can become acidic and can go into distress.

The answer to not eating during labor, for most women in the hospital, is to be hooked up to an IV, which is the last intervention we discussed. The benefits of an IV are very clear, if you’re not being allowed to eat or drink during labor. IV’s prevent dehydration and can help preserve electrolyte balance. They can also keep a woman’s blood sugar levels up so that she has energy. For women who are nauseous and cannot keep any food or drink down during their labors, IV’s can be lifesaving.

The downsides and risks of getting an IV range from the minor annoyance of having a painful port in your arm or hand, which can make it difficult to move around or hold your baby after the birth, all the way to the more serious risk of the baby’s blood sugar levels getting too high and then crashing after he or she is born. You can also get too many fluids and swell up, which is rather uncomfortable and can cause issues with breastfeeding. If the baby gets swollen with fluids then he or she can end up losing more weight than the doctor or hospital is comfortable with and you might end up being encouraged to supplement or being told that you aren’t producing enough colostrum or milk.

There are benefits and risks to every intervention. It is up to every individual family to weigh those benefits and risks, with the help of their care provider, before deciding what to do routinely during their labor and birth. As long as the baby’s doing well and the mom’s doing well, you can decide to refuse any of these interventions. Sometimes the benefits of complying with a more minor intervention can include the goodwill of the hospital staff, but be very careful about making decisions during your pregnancy, labor, and birth solely for the benefit of the people who are working for you, and think things through carefully before making that decision.

If you missed this month’s 1st Monday meeting we hope to see you at next month’s! We will be talking about the first hour after a baby’s birth. It is a very special time for both mother and baby and if you join us for our meeting you will find out why 🙂