Educational Resources

Collage of images with Wednesday Wrap Up superimposed

Wednesday Wrap Up – Induction of Labor

Starting this month, I’ll be doing the Wednesday Wrap Up a little bit differently! Each month will focus on a specific topic and I’ll share articles, videos and podcast episodes that can help you learn more about the topic. If you have a topic you’d like to suggest I feature, please let me know!

Making the Decision to be Induced

Reasons for Induction

Illustration of a placenta fragmenting

“Natural” Methods of Induction

Medical Induction Methods

Other Resources

Little girl reading to a new baby

Adjusting to a new sibling

Adding a new baby to the family is tricky enough the first time around. The challenges the second time around are different, but no less tricky. One of the bigger challenges is the adjustment for an older sibling.

Here are some tips for making the transition a bit smoother:

Before the baby comes

Talk about the changes that are coming – You don’t want to alarm your child by talking about difficulties, but you also don’t want to sugarcoat it and give the child unrealistic expectations. Aim for a balance.

Have reasonable expectations – I’m talking about your expectations for your child. Your child might not be as excited about the new baby as you hope. And that’s okay. Your child might not want to be the helper once the baby is there. And that’s okay.

Acknowledge that it might be hard – Acknowledge it to yourself, to your partner, and to your older children. It might be hard, but it will be okay.

After the baby comes

Talk about feelings with your child – Allow them to express all emotions, positive or negative, without judgement. Validate their emotions, and if they need to talk through them, be willing to do that for them.

Pouting child

Adjust expectations – even if you think you had realistic expectations before the baby is born, the odds are good that things won’t go exactly as you think. Make necessary adjustments.

Prioritize the older sibling at times – your older child still needs love and attention, and taking the time to have 1:1 focused time with your older child can lessen their worries about being displaced.

Don’t try to force a relationship – It’s okay if your older child doesn’t feel love and connection to the baby immediately. Many children don’t, but that can come later. Allow their relationship to develop at their own pace. Don’t try to make it happen, and instead create an environment free of competition and with opportunities for them to connect.

Sibling adjustment isn’t a one time event, either. There are tricky times surrounding the birth of the baby, but also tricky times to navigate later. A common one is when the new baby gets mobile and starts getting into the older child’s toys. Another when the older child needs to take on chores and responsibilities the younger one is not yet expected to.

I hope these tips help you have a smoother transition in your family!

The very end of pregnancy

As I wait for this month-that-has-felt-unending to finally end, I have been thinking a lot about the last little while of pregnancy. It, too, can feel like it’s not going to end. But I promise you, it will!

First off, let’s talk about how to deal with those annoying people who keep asking you if you’ve had that baby YET!?!? I recommend when they ask, you just send them this link, without any commentary. Repeat as often as necessary.

Second, if you’re not at your due date yet, it might be helpful to be mindful of the things that are still happening and developing in your baby.

Baby shoes on a calendar with due date marked

If you are one of the many people to go past your due date, remember that “due date” is more accurately called the EDD, or Estimated Date of Delivery. It’s just a ball park guess, and you could deliver much earlier or much later. The variation can be as much as 5 weeks!

It may help to refresh your knowledge of what, exactly, it means to be “at term” as well.

It can be tempting to schedule an induction. Just to get it over with and end the suspense (and the backache, and insomnia, and heartburn…) already! Think carefully about that, and about the risks and benefits of letting labor start on it’s own.

So what can you so when you’re going crazy sitting around waiting for your baby to be ready to be born? Here are 101 ideas!

And finally, I really love the perspective on the last days of pregnancy in this article. I hope that your last days can be a time where you are able to find rest, patience and connection with your baby.

Pregnant woman on a couch, surrounded by speech bubbles of unhelpful advice

Hyperemeis Gravidarium: Not just morning sickness!

“Just drink some ginger ale!”
“Sea bands will fix you right up!”
“Just keep some saltines by your bed.”

If you have hyperemesis, you probably heard these so often it made you want to scream. While these remedies might work for your garden variety morning sickness, they are completely useless against the monster that is hyperemesis. Since today is Hyperemesis Gravidarium Awareness Day, I thought I would draw back the curtain a bit on what life is like when you have it. Because I’ve not experienced it myself, I’ll be sharing the thoughts and experiences of those who have been there.

Definition

Strictly speaking, the term Hyperemesis Gravidarium is excessive (hyper-) vomiting (-emesis) in pregnancy (gravidarium), but the medial condition with that name is more broad than that. Any nausea, with or without vomiting, that is severe enough to impact a person’s ability to get enough calories to sustain life is considered HG.

If someone around you is struggling to get enough calories, that’s “bad enough” for you to take it seriously. All the women I talked to about HG talked about how hard it was when people didn’t take it seriously or acted as though they were being overdramatic.

How people might be affected

Hyperemesis Gravidarium (HG) can look like a lot of different things. Brooke, a mom of four from Minnesota, described her HG as “Sometimes you get a milder case where it just looks like a complete inability to eat at all due to the extreme nausea and food aversions. It took me losing about 9% of my body weight and being totally unable to function in daily life for one of my friends who had had HG to suggest that maybe I had it. I had no idea. “

Sometimes it is just unmistakable. Lexia describes her hyperemesis from her three pregnancies as “Until 24 weeks I was bed-bound, peeing and puking into a bucket because I couldn’t stand up to get to the bathroom.” Needing IVs, home health care, and serious medications for nausea is common.

Laura, a mom of two from Southern California, also had ptyalism, which is excessive salivation. “It was SO embarrassing. I had to spit all the time, or it would make me throw up. I had that until about a month after birth.”

Tips for getting calories

Jennifer from Louisiana summed it up well ” Eat WHATEVER WHENEVER because you have no idea if it’ll sound good again.”

Brooke managed by “coming up with one food I could picture actually eating and then basically slowly eating one bowl of food throughout the entire day. Then I started adding more high calorie things that I could picture actually consuming. Ice cream helped a lot for me because for whatever reason the coldness and texture didn’t repulse me. And it was highly caloric.”

Lexia suggests finding anything at all that is a safe food, even if only temporary. “You get a free pass to ANYTHING you can keep down. Literally, anything. One week a ‘safe’ food might be oranges, the next week you may not be able to stomach even looking at one. One pregnancy, for a few weeks, my safe food was Arby’s roast beef sandwich and a Dr Pepper. no lie. I have NO IDEA why I could sometimes sort of eat that. Since it was my third pregnancy and I’d already done this before knowing babies come out fine whether you eat all organic non GMO food or freaking Arbys, I felt ZERO guilt. As a matter of fact, I felt SO MUCH PRIDE that I had found a high calorie ‘safe’ food that I could consume. You don’t get a choice in what your safe food is for that period of time. You just eat it (if you can).”

Tips for the logistics of life

Woman lying in bed suffering from extreme nausea

Jennifer suggests that you “Accept all help. Seal off a room to sounds and smells. My room was a sanctuary and where I spent most of my time.” She also spent a lot of time in her car with the air conditioner going when she couldn’t stand the smell of her house any more. Buying emesis bags in bulk was another of her practical tips.

For Lexia “Podcasts were a good coping mechanism for me to pass the time. Watching a screen made me sick, so I just listened to podcasts and audio books, closed my eyes and rocked back and forth on a couch. For weeks on end.”

Brooke’s mindset was “Change all your expectations. Literally expect nothing from yourself but trying to meet your goals for health. Mine was a minimum amount of calories. Your older kids can self manage a lot more than you expect. If you can, get help. I did a lot of just laying on the couch watching TV. Also try not to do too many things that expend more calories because they will just be more eating you have to do.”

Showering was a common challenge, and for many people, a day when they showered was no good for anything else because of the excessive energy it took to shower, even sitting down.

Since medication, small amounts of food and difficulty staying hydrated contributed to constipation for most of the people I talked to, most recommended magnesium absorbed through the skin, from creams, sprays or epsom salt baths if they could manage it.

Multiple women mentioned that they would sit on the toilet and puke into a bucket, or sit on towels on the floor, or wear adult diapers to deal with involuntarily peeing or pooping from the force of the vomiting. Over time, from repeated episodes and malnourishment from the disease, pelvic floor weakness is very common but rarely discussed.

Tips for mental and emotional coping

The struggles of dealing with HG are epic. Lexia said “There is literally nothing you can do, which is part of the mentally difficult part of it. You just have ZERO control, and the more control you try to have, the worse its going to be for you.”

Laura commented “The most difficult part for me was just the utter lack of help or resources. When you’re in the middle of it, if even looking at the TV, computer or your phone makes you sick, you’re completely isolated. And if your doctor doesn’t check in with you often or give you resources, you’re SOL.”

Lexia talked about her mental and emotional experience in very stark terms:
“Just think about one minute to the next. Sometimes just thinking and dreaming about abortion and talking through it would help- it was helpful to know that it was there as an option even though I know I wouldn’t go through with it. Had it not been an option I would have considered suicide.”

Amber Mossman, a mom of two from Tuscon, had to make some hard calls during her pregnancy: “it was also helpful for me to temporarily cut out relationships that were not actually helpful. It was such a fragile time for me that I needed to take a break from people who hinted that I was being dramatic or lazy, or who were telling me to try ginger and I would feel better–I really didn’t have the capacity or energy to respond to well-meaning but thoughtless “help” like I could during normal life.”

It’s not just the pregnant person who struggles emotionally. Amber’s husband also felt the HG took a toll on him. He described feeling powerless to help, and the financial burdens that came from suddenly and unexpectedly being the sole provider at a time they had anticipated saving up. He recommends “Make sure you have someone to help you and your needs, too. If you have family near, eat with them and try to visit them so you can be more energized when you go back home to take care of her for so much time.”

Several people mentioned just taking it minute by minute, and that joining a support group was critical to their mental health. Most also mentioned letting go of any expectations or guilt in favor of simple survival. All mentioned accepting help and using medications.

Tips for partners, family and friends

Don’t wait to be asked. Step up and help. Jennifer shares how hard it was to feel alone and unhelped in her fourth pregnancy: “When I did (share my condition) with those who I thought were close and they weren’t there, it was hard… They saw the IV’s, the pump… they knew (her husband) worked out of town… still people didn’t offer to help or just come sit.”

Clint Mossman, who experienced HG with his wife Amber, recommends that you “Move the bed as close as you can to the bathroom. Be sure to help with her self-care, like taking showers, cleaning up, making food (if she eats), washing clothes, getting dressed, stuff like that.” He also recommends that you accept and go with changes to the whole family’s diet and invest in things that can help keep her busy and distracted during the worst times.

Another theme was that many of them did not talk about the depth of their struggles with others, and felt difficulty in asking for help. Brooke shared a story of a particularly difficult moment when she was alone caring for older kids and a noxious crisis happened. She was struggling to not throw up cleaning it up alone, and she says “In my right mind now I realize I should have just called a friend to help. But it just felt like something I couldn’t ask for help for.”

Tips for Recovery After Birth

Brooke advises “People with HG should expect to spend their first year post baby rebuilding their bodies. I was so exhausted for the first month because I just had no reserves to pull from in those early days of nursing and what not. It did not go away immediately for me after birth. It was at least 50% better right away. But it took about 3 months for it to leave to the point that I was not nauseous at some point most days of the week.”

It’s not uncommon for people who endure hyperemesis to have long lasting implications from it. Trauma, flashbacks and even PTSD are common, and even talking about their pregnancies was difficult for some of the women I interviewed. Dental problems from stomach acids hitting the teeth frequently can also happen, and was mentioned as a significant expense and stressor after the baby was born.

Many people who go through HG never want to have another baby again. Others take a while, and eventually get to a point where they are willing to go through it again for another child. Both are normal and totally okay.

In conclusion

Hyperemesis is so much worse than morning sickness. Lora, a midwife from the east coast who has experience helping women through it, described it as “So much depletion and trauma and fighting for survival at what’s supposed to be a joyous and seemingly lovely time for everyone else.” The massive divide between the idealization of pregnancy and the trauma of HG is heartbreaking. Please, if you or someone you know is experiencing HG, believe them. Be proactive to step up and help them. Choose to respond with compassion and caring instead of minimizing and dismissal. And know that it does not end when the baby is born.”

Resources

HelpHer – The Hyperemesis Education and Research Foundation has information for people going through it, their friends and family, and the public. Their Q&A forums can be good for connection, and they recently released an app.

So you are expecting twins!

Image credit: Jeremy Miles on Flikr
http://www.flickr.com/photos/jeremymiles/
Twin pregnancies are very interesting, and I have loved working with the twin moms who have hired me. I’ve compiled some resources for learning more about twin pregnancies and births.

The best explanation of the different types of twin pregnancies that I have seen.

Nutrition Requirements in twin pregnancies.

A new Canadian study shows that with twins the risks of vaginal birth and the risks of cesarean birth are about equal. In the words of the study author: “If you can get an equally safe result without doing surgery, why would you choose surgery?”

An excellent list of questions for discussion with your care provider.

An inspirational story of a natural hospital birth of twins.

Things you can try to help your twins get in a good position for a vaginal birth.

A classic – and finally updated – book on Twin pregnancies by Elizabeth Noble.

This is a fantastic book that gets rave reviews from the twin moms I have been working with.

Great book about Mothering Multiples.

5 Things I Learned Breastfeeding Twins Great article from a mom who breastfed her own twins. She shares her personal story of breastfeeding preemie twins after a cesarean here.

A nice collection of resources for parenting and breastfeeding multiples.

Babywearing with Twins!

And finally two great videos showing that moms CAN carry twins to term, and even birth them naturally!



Birth Photography

Do you use Pinterest?

If so, I have several birth-related boards you might enjoy. You can see all my boards here or pick the individual boards below. Feel free to follow me, and please share your favorite birthy Pinterest boards in the comments!

My Birthy Stuff board is where I pin articles, products, books, and links to resources that I think will be helpful to pregnant women and families as they prepare for an upcoming birth. I also pin articles that might be useful to other doulas, or to parents who want to understand what professional doulas do. You can click on the image below to see that board.

Birthy Stuff Pinterest Board

My birth photography is where I pin some of my own work and the work of other professional birth photographers who inspire me. If you love seeing births of all kinds and the joy that a new baby brings, this might be the board for you!

Birth Photography

And finally, this last board is where I pin the web sites of local midwives, doulas, childbirth educators and lactation consultants that I enjoy working with and refer to as needed. If you live in Utah, you might find it a useful resource.

Utah Birth Professionals

Birth by the Numbers

You’ve probably heard lots of different statistics bandied about when people talk about birth. It can be really, really hard to sort throug it all and understand what it really means for birthing women. I’ve had the chance to hear Gene Declercq speak in person, and I really appreciated his ability to make complicated statistics accessible. He’s helped put together a fantastic web site for those who are interested in understanding maternal-child health on a large scale. The video below is fairly long, but well worth the time. So grab a snack, put your feet up, and spend the next 25 minutes learning!

Parents holding hands during labor - doula supported birth

Online Pregnancy Resources I Love!

There are so many sites out there for pregnancy, but not all of them are mother-friendly and natural birth friendly. Here are some of my favorite places for pregnancy information that respects a mother’s intelligence and right to make decisions for herself and her baby:

Information

  • Science and Sensibility A great blog to learn more about birth research, if I do say so myself. I am a regular contributor there.
  • Giving Birth With Confidence A great blog to learn more about birth from childbirth educators, doulas, and other moms.
  • Push for Your Baby A great site for expectant moms all about pregnancy and birth, and what you can do to improve your baby’s health.
  • Spinning Babies Great site with information about how moms can help their babies be better positioned for birth.
  • Kim James The web site of a doula I’ve only met once – she has fabulous information on epidurals.

 

Parents holding hands during labor

Birth Stories

  • Birth Diaries Beautiful site with many birth stories shown in pictures or video. All are rated on a “graphic” scale, so you will know ahead of time if there is anything in the stories you might find objectional.

 

Organizations

  • DONA International Official web site of the doula organization that certifies me. Great information on what doulas are and do, details on how to become a doula, and doula boutique where you can buy doula-related merchandise.
  • Lamaze International The childbirth education organization that certifies me. A great resource for parents, and also the organization I would recommend to anyone considering becoming a childbirth educator.
  • ICEA Web site of the International Childbirth Education Association, which is the group I received my first certification through.
  • La Leche League Web site of the best-known organization supporting breastfeeding. You can access articles on various breastfeeding topics, find a meeting in your area, or join in on online group. To find a group meeting in the Salt Lake Area, you can call (801) 264-LOVE.
  • DoulaNetwork.com I’m listed at DoulaNetwork.com – you can check out my profile there.

 

Newborn footprints - Utah doula and childbirth educator

Recommended Reading

I highly recommend that you read at least two or more books on pregnancy and delivery. This way, you will start to see that
what some authors portray as fact is truly opinion. Also, as you read contrasting points of view, you can begin to form your
own opinions and make decisions about what is important to you. Here are some of my favorites:

Pregnancy Books
  • Conception, Pregnancy and Birth, by Miriam Stoppard
  • A Child is Born, by Lennart Nilsson
  • Pregnancy, Childbirth and the Newborn, by Simkin, Whalley, & Keppler
  • The Pregnancy Book, by Willam and Martha Sears
  • Complete Book of Pregnancy and Childbirth, by Sheila Kitzinger
Childbirth Books
  • Natural Hospital Birth: The Best of Both Worlds by Cynthia Gabriel
  • Giving Birth With Confidence: The Official Lamaze Guide by Judith Lothian and Charlotte DeVries
  • Creating Your Birth Plan by Marsden Wagner
  • The Birth Book, by William and Martha Sears
  • Gentle Birth Choices, by Barbara Harper
  • The Birth Partner, by Penny Simkin
  • Thinking Woman’s Guide to a Better Birth, by Henci Goer
  • The Doula Advantage, by Rachel Gurevich
  • The Doula Book, by Klaus, Kennel & Klaus

Newborn at Birth

Postpartum & Breastfeeding
  • Infant Massage, by Vimala Schneider McClure
  • The Baby Book, by William and Martha Sears
  • Nursing Mother’s Companion, by Kathleen Huggins
  • Your Amazing Newborn, by Marshall Klaus and Phyllis Klaus
  • The Womanly Art of Breastfeeding, by La Leche League
  • The Year After Childbirth, by Sheila Kitzinger
Special Needs
  • No More Morning Sickness, by Miriam Erick
  • This Just Isn’t What I Expected, by Kleimann (postpartum depression)
  • The VBAC Companion, by Diana Korte (for those with a previous cesarean birth)