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Pregnant woman and partner getting into a car

Know When to Go

Knowing when to go to the hospital reminds me a bit of the Goldilocks story.

If you go too early, you risk being sent back home or admitted and having more interventions.

If you go too late, you risk birthing on the side or the road or at least having a really difficult drive.

So when is just right? How do you find that sweet spot for you and your situation?

The 5-1-1

A good rule of thumb for most situations is 5-1-1:

  • Contractions that are 5 minutes apart from the start of one to the start of another.
  • Contractions that last 1 minute from start to end.
  • The contraction pattern has been like that for an hour.
Graphic illustrating the 511 rule

Other Considerations

The 5-1-1 Rule of Thumb assumes a couple things that may not be true for you. You’ll need to adjust to go sooner or later if:

  • You live farther from the hospital and about 20-30 minutes. If you live a great distance from the hospital, you might consider coming closer and staying in a hotel or with a friend closer to the hospital until you’re at 5-1-1.
  • There is a big storm or event in your area that might mean it takes longer to get there.
  • Your water breaks and your care provider advises you to come in when that happens.
  • You have a condition that means you need treatment or monitoring earlier. For example, if you need antibiotics for GBS.
Couple watching a movie together on a laptop

Things to do in Early Labor

On TV and in movies, people often rush to the hospital after 1 contraction, but in real life, most people spend the majority of early labor at home. Since early labor can last a while, you might feel anxious about what to do to fill that time. Here are some ideas:

Sleep/Rest

Because spontaneous labor often starts during the night, doing what you can to get sleep in between contractions is important so that you’re not too tired later in labor. If you can’t sleep, try to get some good body rest. Relaxation exercises and water can help with that.

  • Sleep or nap if you can
  • Rest in a well supported position
  • Do relaxation exercises
  • Take a shower
  • Listen to an audiobook

Distract Yourself

Sometimes paying too much attention to your labor early in the process can cause something I like to call “Watched Pot Syndrome”. Best to stay occupied with things that divert your attention. If you can, just continue with whatever you would be doing normally. But if the contractions are mild and annoying, you can do other things, like:

  • Bake cookies
  • Make a meal
  • Watch TV or a movie
  • Go for a walk
  • Meet up with a friend
  • Spend time with your partner and/or older kids
  • Write a letter to your baby about how you feel

Be Active

On the flip side, you can spend some time being active. Don’t exhaust yourself trying to make labor happen, but if you feel like it you can:

  • Go for a walk
  • Do some prenatal yoga
  • Dance your heart out

Eat and Drink

Pregnant woman eating Nutella with a spoon

Remember that early labor can be quite long. While hospitals sometimes ask patients not to eat or drink after they’re admitted, in early labor at home you can eat and drink if you’re hungry or thirsty.

Drinking throughout labor is a good way to stay hydrated, and clear fluids like juice and electrolyte drinks can help with that and provide a few nutrients and calories for the exertion of labor. Later in labor, it’s better to sip liquids often, but in early labor you can drink normally.

Don’t force yourself to eat if you’re not hungry, unless you’d like to see it again later in labor. But if you feel hungry, go ahead and eat any of these things:

  • Whatever sounds good to you
  • Any food in your fridge that isn’t moldy or suspect
  • What you have handy in your pantry

Take Care of Business

While you don’t want to wear yourself down doing a whole lot of work in early labor, there’s no reason you can’t take care of a few things before your baby comes. Avoid driving yourself if the contractions are moderate or strong.

  • Grab a few things at the grocery store
  • Tidy up a bit
  • Call your birth team
  • Lay out your postpartum supplies
  • Call into work and fill them in

Finalize Plans

If there is anything you need to do to be ready to go to your birth place or get your home ready for your birth, now is the time. Once contractions are well established you can:

  • Arrange for care for older children and pets
  • Pack any remaining things you’ll need for your birth place
  • Set up anything you might need for a home birth
Pregnant woman looking at her watch while in labor

How to Time Contractions in Labor

The days of a “labor coach” following someone around in labor with a stopwatch are, thankfully, over. It’s really not necessary to time every single contraction when you are in labor. It’s enough to time 5-10 contractions in a row to get a good idea of what’s going on, and then put away the timing for a few hours, or until you feel like something has changed. Paying too much attention to the timing constantly can cause watched pot syndrome.

Most people will use an app for timing labor contractions, there are many free ones available for all kinds of smartphones, and I’d suggest playing around with one or two of them to make sure you know how they work.

Most of the apps will simply ask you to tap when a contraction begins, and tap again when it ends. Which works great, if you always remember both. Some apps let you go back and edit with an estimated time if you forget. I think that’s a useful feature.

Contraction Timer Screenshot

I also think it’s helpful if an app lets you pause the timing for a few hours without thinking you’re taking a REALLY long break between contractions.

Most of the apps will calculate two important things for you:

Frequency – (Sometimes called “interval”) this is how often the contractions are coming. It’s the time from the start of one to the start of another, and it’s the first thing most midwives, doctors or nurses will ask you when you say you’re in labor. The app will calculate the average interval in a series of contractions.

Duration – this is the time from the start of a contraction to the end. Again, the apps will calculate the average in a series so you get an overall idea.

Some of the apps will also let you rate an intensity for each contraction, but I honestly think that’s a bad idea and not very helpful.

Keep in mind that the timing doesn’t have to be exact, and slight variations are very, very normal. If you think the contractions are coming in pairs, read more about coupled contractions

If you don’t want to use an app, it’s fairly simple to do the same thing yourself, just write down start and stop times and do a little math. The key is remembering that when we talk about how far apart they are (frequency) it means start to start, not the break in between.

Living room set up for a home birth

Home Birth Prep List

When you’re having a home birth, you might think there’s nothing to pack! But….there are things you can organize and buy to make for a better experience.

Many midwives will give you a list of the supplies they recommend, so I’m not going to try and cover those, but I do want to address some of the preparations you can do outside of the supplies for the birth itself.

Decide what you might want to wear in labor – big flowy nightgown? pants? a robe? Nothing?

Things to keep you occupied during early labor – Maybe a new movie or show you haven’t seen yet, baking a birthday cake for the new baby, making cookies for your birth team, knitting a baby blanket, doesn’t much matter as long as it keeps you busy and doesn’t take much mental or physical energy.

If there will be older siblings there, activities to keep them distracted can be useful as well. You might want to buy some inexpensive new things and keep them hidden away until the big day.

Similarly, make a plan for child care and pet care. You can have someone come and attend the birth with their primary role to support siblings, or you can have them go to a friend or family member’s home. Pets can also go somewhere or stay in another area as needed.

Sign on door with drawing of baby and the words Home Birth In Progress

Make a sign for your door to let people know what’s happening and that they should stay away or quietly enter, whichever you prefer.

Food – You may want to have a super simple meal ready to go. Something someone can take from the freezer and throw in the oven after the baby is born that will be done an hour or so later. Your birth team may still be there, so plan extra to share. If it doesn’t get used, leftovers are great to have, too. You can also make and freeze postpartum meals or set up a system for friends and family to bring meals in for a while.

Snacks – Have some grab and go snacks that you can use in labor as needed. Crackers, granola bars, bowl of cereal etc.

Drinks – Sometimes drinks go over easier than food when you’re laboring in earnest. Have some full sugar electrolyte drinks, juices and premade smoothies on hand.

Last Minute To Do List – Some things can’t be done that far ahead. Make a list of the last minute things, like setting up the birth tub and putting the double bedding on the bed, so that nothing gets forgotten and you can just direct your support people to the list to know what needs to be done.

That’s all I have for now, what do you have to add?

Splash of milk on black background

100% Clean Milk and other lies we judge ourselves by

I recently saw a few posts on social media that I’ve paraphrased here:

I had to have emergency gallbladder surgery this week, at 10 days postpartum. I have declined all medication even after told low doses are okay just to make sure my supply stays strong and so my baby gets 100% clean milk. Because I have done this, I am very tired and in a lot of pain, the thought of pumping sucks. I am just looking for any encouragement. I know I have made it through the hard part but it’s still rough.

My baby is 11 months old, and he’s been with me his whole life. Literally he’s always with me. He sleeps in our bed, I wear him in a carrier, and I work from home with my baby on my lap or in a small crib right next to me. The only thing I don’t do without him is shower. And that’s only sometimes! Sometimes I do shower with him on my hip. We’re pretty much joined at the hip. I have always told him I would be there for him ALWAYS. The problem is, my husband wants to leave him with his parents so we can have a date. And eventually, he wants to go on a weekend cruise! I don’t know what to do. My son needs his mommy, but my husband is pretty insistent, too. How can I just abandon him for a hike and picnic?

Both of these illustrate a trend that I’ve noticed and find concerning. The idea that babies need perfection and parental contact 100% of the time. And it’s not true.

Sometimes it’s better to take care of yourself and your relationships first!

The word SuperMom with the second half crossed out and changed to Exhausted

It’s absolutely OK as a parent to take care of your own medical needs – in my opinion, taking care of your own medical needs will make you a BETTER parent than suffering in order to have “100% clean milk” (whatever that means).

And I’ve been there, I’ve had to make that call.
When I had emergency surgery when I was a few months postpartum, it was rough. But the pain meds helped me rest and recover more quickly, which was crucial because my husband was not able to take any time off work – he’d used all his leave when baby was born. His boss was kind and gave him 2 *unpaid* days off, but after that I was on my own. Pain meds helped me get baby back to the breast (instead of the pump) sooner. If I had not used those couple days to take the meds and rest, no way would I have been in any kind of shape to care for the baby – and my older kids – when he had to go back.

The second example is focused more on relationships between parents and trusting that your baby will be okay apart from you. The bond with your baby is intense. As it should be…at first. That intensity in the first weeks builds a strong attachment that is a foundation for your baby being able to explore the world. A “home base” of sorts. It’s normal and developmentally appropriate for babies to spend time away from their parent. Once that home base has been established in the first few weeks, babies will want to start exploring their world. And they can start experiencing other caregivers. I promise they won’t feel abandoned. And nurturing your relationship with your partner is important too. Start small. Leave your baby with your partner for a trip to the store. Do that a time or two and then leave your baby with someone you trust for a date with your partner.

I encourage you to think critically about the absolutes and the pressures you are buying into. You don’t have to be perfect or do it all as a parent!

Expectant parents discussing with midwife

Various viewpoints on consent

Some people think of informed consent as a two step process. The care provider tells you the information and you consent. That’s the quick and easy way of doing it and it’s the way some care providers prefer it.

But TRUE informed consent isn’t quick and easy. It involves a conversation, not just a recitation of the form. It involves taking time to ensure all questions are answered and other options are explored. Including the option to refuse what’s being suggested. You cannot freely consent if consent is your only option!

Additionally, some people think of consent on different scales from other people. There are two ends of the scale of consent:

Pregnant person talking with a doctor

“Package Consent”

People who think of consent as a package deal tend to think that when someone has consented to a cesarean, that consent automatically includes consent for: IV fluids, blood pressure monitoring, urinary catheter, antacid medication, antibiotics, and pitocin to guard against excessive bleeding.

In this way of thinking, ideally all those other things that are part and parcel of a cesarean birth are discussed. Unfortunately that does not always happen as staff can assume that “everyone knows you get a catheter with a cesarean” when that isn’t really true.

“Piecemeal consent”

The piecemeal approach is one that I find more patients expect. I often see something like “I plan to stay involved in decision making, please discuss everything with me before using any interventions.” included in people’s birth plans.

Those who follow this viewpoint feel that even when someone has consented to the cesarean, they also need to consent to the IV fluids, blood pressure monitoring, urinary catheter, antacid medication, antibiotics, and pitocin to guard against excessive bleeding.

Where do you draw the line on what is included or not included? And does your care provider see it the same way? A mismatch in your approaches to informed consent can lead to conflict and frustration in labor.

High school students being shown a scary birth video

Did high school make birth and parenting hard for you?

I’ve noticed the ghost of high school health class reverbating into adulthood in a couple different ways. And not in good ways!

Scary birth videos

I honestly LOATHE the idea of high schools using birth videos as birth control. Maybe it is because I get those same women 10 years later and have to work them through all their fears that come from being shown childbirth as a horrific thing when they are in high school. You’d be AMAZED at how often those high school experiences come up as fears in my classes and with my clients.

So when my oldest daughter’s high school biology teacher found out what I did for a living and asked me what was the most “graphic and terrifying” birth video she could buy to show to her class, she got an earful from me on the topic. Turns out she herself took HypnoBirthing and delivered unmedicated. And had never thought about long term effects at all.

I do want high school students to see birth. I want them to know how powerful birth can be. But I don’t want it portrayed as horrific or used as a fear based birth control tactic.

Teen boy holding fake newborn

Newborn Simulators

Whether it is an egg, a bag of flour, or an expensive robobaby, many high schools make students do an assignment where they “simulate” parenthood for a day or two, or even a week. In theory, this experience teaches students how hard it is to care for a newborn and discourages them from becoming pregnant as a teen. The reality, though, is that it artificially makes things HARDER than real parenting!

Most of the time, the assignment only allows for one person to care for the baby, while the reality is that partners, family, and friends can all help care for a real baby. When using the fancy robotic babies, students have a time limit and are expected to get the baby to stop crying within just a few minutes. The reality is that in real life, babies may cry for much longer, even when parents do everything right! The assignments are also being graded, and it’s possible to pass – or fail – because of things beyond your control. With unrealistic ideas that you have to do everything yourself without help, pressure from time limits, and being graded on your performance as your “simulation of real parenting” is it any wonder that new parents struggle to ask for help and feel pressure?

Plus, the research on these simulations actually might do the opposite of what they intend! Check out the references below or listen to this podcast on the simulations.

If any high school health or child development teachers are reading this, I strongly encourage you to rethink how you teach about birth and parenting. Focus your teaching on a healthy understanding of the birth process, the options available to them, and on parenting as a relationship rather than a graded performance. Preventing teen pregnancy should not be the primary goal while teaching these topics. Save that for *real* sex ed and include contraception in that part of the curriculum!

(And if you’re in the Salt Lake City area, I’d be happy to come be a guest speaker. I enjoy teens!)

References

https://www.bmj.com/content/354/bmj.i4666.full
https://www.statnews.com/2016/08/25/infant-simulators-teen-pregnancy/

Hands holding a tablet with the words The Quest for the Best

Looking for the ONE best?

We ALL want the best for our babies! That’s a good desire that can serve you well – or become a hard burden.

Trophy with the words ISO the Best

Wanting the best for your babies means I get a lot of questions like these:

  • What’s the BEST bottle?
  • Who is the BEST doctor?
  • Where is the BEST place to birth?
  • When is the BEST time to introduce solids?

The truth is that none of these questions have a single answer. I know that I frustrate people when I answer all these questions with “Well, it depends….” so often. But it is the reality! The best bottle for someone who is breastfeeding and wants to occasionally feed with a bottle may be different than the bottle that is best for someone formula feeding.

The doctor who helped one of my clients through several high risk pregnancies, and supported her in a VBAC, probably isn’t the best doctor for someone low risk who lives the next county over. Birth centers are great, but not the best fit for someone who wants to use an epidural for their birth.

And since every baby grows and develops at different rates, there is no one best time for all babies to start learning to eat solid foods.

Sometimes I see new parents become seriously overwhelmed and frustrated trying to research to death what the best is, because they are operating on the assumption that there is one best option and they just need to figure it out.

If you find yourself in this situation, you may find it helpful to revise the questions some:

  • What bottle will work for us?
  • Which doctor is a good match for our parenting style and personalities?
  • Where do I feel safe birthing?
  • What signs can I watch for to know when my baby is ready to introduce solids?

Do you see the differences there? When looking at your options and trying to figure out how to do the best for you and your family, the second set of questions take a different approach. Evaluating your situation, personalities and needs as part of your research gives you valuable perspectives on what is best *for you*. It can lead you to feel comfortable making a choice that is different from family and friends. It can help you cut through all the reviews and recommendations that conflict with each other.

The other thing that differs here is being open to flexibility. Instead of asking when to introduce solids, you can learn the signs of readiness and be open to starting them earlier or later, based on your baby’s individual progress. That openness to flexibility, trusting yourself to understand your baby’s behavior and apply what you have learned about readiness cues can build your confidence in your parenting.

If you find yourself on an exhausting, confusing quest to figure out which breast pump is the absolute best, or paralyzed trying to choose a car seat to buy, remember to take a step back, breathe, and think about this in terms of finding a good fit for you and your family.

jars of herbs in a row on a shelf

There’s no such thing as a “natural induction”

It’s tempting to just “get this show on the road” and have the baby already! Especially if you’re suffering from S.T.O.P. Syndrome (Sick and Tired Of Pregnancy). Or maybe your care provider is threatening an induction or repeat cesarean if you don’t have the baby by a certain date.

So you might think that a “natural induction” is the way to go.

Let me make something very clear: An induction is an induction is an induction. So called “natural” methods are STILL an intervention to bring the baby before the baby is fully done.

In my doula career, I’ve actually seen a lot more complications and downsides from “natural” induction methods than I have from medical inductions.

If you are considering an induction, I encourage you to drop any ideas about there being a difference between “natural” and “medical” and look carefully at ALL available induction methods. Some factors to consider:

Effectiveness – In an induction is truly necessary for medical reasons, you want something with a higher effectiveness, which I would define as higher rate of vaginal birth and lower rate of cesarean. Many of the “natural” methods have much lower effectiveness. Consider what the next step might be in the event that attempts at a “natural” induction don’t work well.

Benefits The induction method needs to match the need. You can use an induction method to cause contractions, but if the cervix is still hard and closed those contractions are not likely to make much difference. If the cervix is already soft, using a cervical ripener will not make much difference. This is where consulting with your care provider can help.

Risks Nothing is without risks. I’ve seen clients have allergic reactions to cohosh, get horribly dehydrated from diarrhea after taking castor oil, and end up with vaginal infections from inserting EPO vaginally!

Cost – certainly would be great if health care cost wasn’t a factor. Unfortunately, money IS an object and it is something to consider.

Inductions are not inherently bad. They can be a useful and necessary tool for a healthy and safe birth at times. But they should be used with careful thought, consultation with a familiar care provider, and the most appropriate method – whether natural or medical – should be used.

Chromosomes of Turner Syndrome

Missing Chromosome disorders

Most disorders of missing chromosomes involve only partially missing chromosomes, with one exception:

Turner syndrome happens when the baby girl has a single X chromosome instead of a pair of X chromosomes. People with Turner syndrome tend to be short, have normal intelligence, and may need hormone therapy to induce puberty. Many need fertility help to get pregnant.

Diagram showing missing arm of a chomosome

Prader-willi Syndrome is caused by a partial absence of the 15th chromosome. Most of the symptoms are behavioral, including constant hunger, which can result in obesity and an increased risk of type 2 diabetes.

Cri-du-chat (French for “cry of a cat”) syndrome babies have a partially missing 5th chromosome. It can be fairly severe or fairly mild. It’s name comes from the characteristic way that newborns with this syndrome sound like a cat when they cry.

Most of these happen randomly and are not inherited.

Couple interviewing a potential doula

How to Hire Your Dream Doula in Five Easy Steps

Step 1 Define what you want

Think about what services you want. Are you looking for someone to help you with your birth? Or for someone to do postpartum support? Or both? Would you want the same person to do both services, or would you be open to both?

Also think about your general philosophy. Do you lean towards a scientific approach or do you want someone who is open to alternative treatments? Ideally you want someone with a philosophy similar to your own.

Step 2 Collect names of doulas who meet your requirements

Do a google search. Check at listing sites like DoulaMatch and local or national professional groups. Visit the web sites and social media of doulas you are considering. Look at online reviews.

Check to see what they say about experience and training if that is something that is important to you.

Step 3 Do preliminary screening

Reach out to the doulas you’ve found who appeal to you. This could be by text, phone or email. Whatever you are comfortable with. Ask about pricing, availability, and what’s included in the service. Pay attention to how responsive the doula is and how you feel about the conversation.

Step 4: Interview a few

Schedule longer interviews with a few doulas who seem like they might be a good fit. I recommend an in person interview when possible, as that’s the best way to get a good feel for whether you are compatible.

Be ready with questions about what is important to you. Think back to what you decided in step one and consider how you might discuss those things with a doula.

You might consider questions like:

  • What is your experience with (my doctor or midwife, families who bottle feed, twins, etc. Whatever is related and important to you.)?
  • What is included in your services?
  • Why did you become a doula?
  • Have you chosen certification? Why or why not?
  • Do you have backup? Can I meet them?
  • Tell me about a time you experienced conflict in your doula work. How did you resolve it?
  • What do you bring to doula work that sets you apart from others?

Step 5: Seal the deal!

You don’t have to make a decision during the interview, though if you are sure you’ve found the one, go for it!

Most doulas will have a contract or client agreement for you to sign. Read it, and make sure you understand it before you sign. Most doulas also have you pay a deposit, retainer or even the balance at this point. If more money is due after the contract signing, make sure you clear on when that is due.

Find out what happens next. Birth doulas will probably schedule prenatal visits with you, and will have information on how to schedule those and how to reach them in labor. Postpartum doulas will have a process for letting them know when your baby is born and how to schedule their shifts at that point.

Downloadable worksheet

I’ve created a free downloadable worksheet you can use to help you through the process, click the button below to grab it for yourself!