birth

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.

Cartoon woman holding sign that says No Thanks, with cartoon doctor in the background

If you don’t want it, just say no!

Vaginal exams in pregnancyWarning: Rant ahead! I wrote this years ago – the original version was a little more, um…passionate. I’ve just now toned it down to where I feel comfortable posting it. Still pretty opinionated. This rant doesn’t apply in the least to moms who want exams and get them. This rant is about moms who feel bullied into an exam they don’t want.

So three times in three places in the last 24 hours I have had people ask “Can I say no to a vaginal exam?” or “I really hate vaginal exams and wish I could say no.”

Can I just say that it really disturbs me that we live in a culture where women do not even KNOW that they can control what happens to their bodies? That they even think they do not have the power to prevent someone from sticking fingers into their vagina?

When will girls be taught that they are in charge of their own bodies? So that they grow up into women who know they are in charge of their bodies? My girls definitely know that, but so many others are being taught otherwise. It makes me sad.

NO ONE, not a doctor, not a midwife, not your partner, NO ONE BUT YOU gets any say about what does – or does not – happen to your body. Anyone who thinks they can override mom’s control over her body is crossing a scary line.


Why they suggest it:

To satisfy curiosity

What it tells you:
It tells you where things are right now.

What it can tell you about the future:
Absolutely NOTHING. I’ve worked with moms who walked around 5+ cm dilated for weeks. I’ve worked with moms who were emotionally devastated because the cervix was closed, firm and posterior at a prenatal, only to have a spontaneous labor and happy baby in their arms less than 24 hours later. There is absolutely no evidence that exams in late pregnancy have any benefit or predictive value.

What you can do if you don’t want one:

Take someone else with you to your appointment, and have them come in the exam room with you. It’s easier to say no when someone has your back.

Keep your pants on. It’s harder to say no when you’ve already disrobed from the exam.

If you’d like to learn more about creating positive and collaborative communication with your care provider, you can enroll in my complete online and personal childbirth classes where I teach some helpful communication skills!

Pregnant person with suitcase

Packing for labor

I know there are LOTS of lists out there for what to pack for labor, but I wanted to post my own. If you’re planning a hospital birth or a birth center birth, this list is for you! (One nice thing about home birth is you don’t need to pack…) You won’t need EVERYTHING on this list, but this will give you some good ideas to get you started!

Header saying "Labor Items" with blurred background image of packing a suitcase.
iPhone showing music playing in a hospital bed next to a person having a baby.

Music This can be a whole post of its own – and someday I will write it. Basically, make two playlists or Spotify lists: one for relaxing music and one for energizing music. You don’t need special music, chances are you already have plenty of music you like.


Lip Balm Bring several of these, because those little suckers tend to get lost during labor. Moms in labor tend to get dry lips and hospitals either won’t have anything you can use, or they’ll give you a small tube of Vaseline and charge you $20 for it.


Tennis Balls Or, if you prefer, racquetballs. As a professional, I prefer racquetballs for their ability to be sterilized between clients, but tennis balls work just as well for personal use. These can be used for a rolling massage on the lower back or pressed firmly into mom’s lower back for counter pressure if she is experiencing back labor.


Unscented oil/lotion Laboring women are really extra sensitive to smell, so I recommend unscented. You can always bring a scented *and* an unscented if you want to give the scented a try. Just have mom take a sniff before you slather it everywhere in case it is too much.


Massage Tools I wouldn’t recommend you go out and buy any, but if you have massage tools around the house that you like, go ahead and throw them in your bag. If they are the vibrating kind, make sure you have batteries – and spares – for them.


Warm socks It’s normal for women to feel cold feet in labor. Sometimes it is the figurative kind (I’ve heard lots of moms say “I don’t think I’m ready to be a mom!” in labor.), but here I am talking about the literal cold feet. Warm socks – several pair – are good to have on hand. The kind that have tread on the bottom to make it less slippery are good if you have them. Or bring slippers.


Food Moms are burning LOTS of calories in labor, and if you’re hungry, EAT. Researchers are proving that food and drink in labor are just fine. Here’s a great article on what kinds of foods are good in labor.


Dim light Sometimes it is hard to get nice dim light in a hospital, especially in the bathrooms. If you’d like to labor in the tub and have dim light, bring some battery operated candles or a smallish flashlight.


Birth Ball Many hospitals have these, but it can be nice to have your own for use in early labor at home, or in case the hospital’s ball is not available. Get a standard exercise ball, sized right for you. I recommend it should be the burst resistant kind, and one that can hold 500 pounds of force at minimum. (I *know* you don’t weigh that much. We’re talking about FORCE, not weight!)

Couple carrying pillows into the hospital for their birth.


Pillow You may or may not want to bring your own. Most hospitals have plenty. But if you’re super attached to your pillow (like I am!) you will want it in labor. If you tend to bring it (or wish you could bring it) when you travel, you’ll want to pack yours. But DON’T have it in a white pillow case! It would really be sad to have it get lost in the hospital linens. Anything but white or close to white!


Fan Some moms really like a small battery operated fan.


Cheat Sheets I always tell my classes “Labor is an open book exam!” It’s OK – and GOOD – to look at your reference materials. Bring any books you read, any handouts from a childbirth class, and have mom make a list of things she wants to try. I also really like the iBirth App and the book “Deliver!” for this.


Birth Plan If you created a written document, print out several copies and bring them. Neon paper is good and helps keep it from getting lost in the shuffle. Give to your nurse, post one on the wall, etc.


Flavors for ice If you’re restricted to ice chips, having something to flavor the ice chips and add a little calories can help. This can be juices, electrolyte drinks, etc. Just no caffeine!


Ziplock Bags I use these mostly for creating ice packs (fill with ice, seal, wrap in a towel) or hot packs (Get a towel soaking wet with the hottest water from the tub or shower and seal it up so it doesn’t drip. Wrap in a towel or gown.) Occasionally I’ve used it to seal up something smelly (like a tuna sandwich with pickles one dad brought!) so mom can’t smell it any more. I bring sandwich size and gallon size and I prefer the freezer kind. They’re tougher.


Band for long hair If you have long hair, you may want to put it up to get in the shower, bath, or just because you’re hot and sweaty. Even if you never wear it up, pack something so you have the option. Most women just use a pony tail holder, but you could bring a clip or a shower cap, too.


Hand mirror I can’t emphasize enough that it needs to be an UNBREAKABLE hand mirror! Some women really benefit from seeing the results of their pushing. This is why many hospitals provide mirrors. Unfortunately, some hospitals mount the mirror to the ceiling (so it only helps if mom is on her back) or they have a small mirror on a big pole. An unbreakable hand mirror can be used in ANY position and has a lot more flexibility. They are particularly useful when mom is squatting, kneeling, or standing to push.

Header saying "Toiletries" with blurred background image of packing a suitcase.



Toothbrush/toothpaste
Because that hairy feeling in your mouth is no fun. And because moms want their partner to have fresh breath!

Assorted toiletries packed in a travel bag


Hairbrush Because it can feel nice to brush your hair out and feel good. Some moms use hair brushing as a labor comfort technique, too.


Contact lens supplies & spare glasses While most hospitals won’t make mom remove contacts for birth, even with a cesarean, if they’re bothering her she’ll want to take them out. And backup glasses so she can still see baby clearly at birth if she takes them out.


Deodorant Remember what I said above about moms being extra sensitive to smell in labor? ’nuff said.


Spare clothes for both partners Labor can go long, it’s nice to have something fresh to change into when it has been 24 hours. Plus I’ve seen moms pull their fully clothed partner right into the shower with them, and then you REALLY want something else to wear! Some partners will bring a swimsuit in case mom wants him in the tub or shower with her.

Basically pack everything you would pack for a weekend getaway, for BOTH parents!

Header saying "Don't Forget" with blurred background image of packing a suitcase.

Camera Since I am also a birth photographer, clearly birth photos are something I value and I would hope most parents do, too. Don’t trust them to just your cell phone camera. Have a better camera on hand, along with spare batteries, a spare memory card, and a charger if it uses a special camera battery. Or just hire a birth photographer and leave it in the hands of a pro. (BONUS! When you have a pro, both parents can be in the photos!)

Close up photo of phone charger


Phone charger Or iPad charger, Kindle charger, or charger for whatever electronics you might be bringing to the birth room. You don’t want your phone to die just before you send out the “BABY IS HERE!” text!


A list of the people you want to remember to contact, so that no one gets forgotten. I would hope that families would cut new parents some slack, but I’ve seen a lot of pettiness over who gets called first, who gets a text and not a call, etc. etc.

Partner taking picture of mom and new baby

To tweet, or not to tweet? Social media during labor

Social Media Graphic

Most people would not dream of streaming their birth live on the internet or inviting strangers to be there as a piece of performance art. But just how public and immediate should your birth story be? With social media, it’s easy to have an audience of friends and family waiting for the minute by minute details. If you are thinking about posting your birth on Twitter or Facebook, here are some things to consider:


Who will see it? These days, not everyone you are “friends” with on Facebook is really someone you know. You have even less control over Twitter followers. Do you really want relative strangers knowing that you are away from your home and will be for quite some time? Do you want them knowing the current status of your cervix?


What will others do with the information? You can control what information you put out there. You cannot control what they do with it. I have seen family members show up to the birth – uninvited – after seeing on Facebook that mom was in labor. It got awkward since the parents did not want them there. While you might want to have people thinking of you and sharing your joy in real time, it also means they are waiting for a follow up. Once you put it “out there” that you are in labor, expect a large response of people calling/texting/posting wanting updates. It might make it difficult to focus on your labor.


What will you do with the responses you get back? Similarly, the responses you get may not always be supportive and positive. Some people have nothing better to do than to criticize the choices of those around them. I had one instance where mom was planning a home birth but when complications arose transferred to the hospital. Her husband had posted on Facebook hoping for support from friends and family but instead got responses like “Good! Home delivery is for pizza, not babies.” and “I told you that you’d never be able to do it naturally.” Both comments hurt the parents feeling deeply at a time when they were feeling scared and vulnerable about the change in plans. Might be a good idea to have someone else filter out the unhelpful comments you may receive back and only pass on the helpful stuff.


I urge you to think carefully about what you put out there on the internet. Sometimes staying off the radar until the big “It’s a GIRL!” or “He’s HERE!” announcement might be the wisest thing to do.

Pregnant person talking with doctor

The Culture of Risk

“It’s just not worth the risk”
“I don’t want to expose my baby to ANY risk!”
“I’m not comfortable with any risks”

I hear these comments, and others like it, all the time. Unfortunately, they’re just not realistic. Risk is all around us, and it’s an unavoidable part of life. But in this culture of fear mongering and attention grabbing headlines, it can be hard to thin calmlu and realistically about risk.

Here are some ideas for ways you can check the anxiety about risk and think clearly:

Give up on the idea of avoiding risk and shift to thinking about minimizing risk. This can be much harder said than done, but shifting away from a knee-jerk running away from something someone says is risky can be very freeing. Otherwise you’re living in fear and ping-ponging your way around life at the mercy of headline writers. Sometimes you need to decide what level and type of risk you are okay with.

In addition to the risk of doing a thing, consider the risks of NOT doing the thing. I’ll use induction as an example. While I absolutely believe that in most cases waiting for labor to begin on its own is best, there are definitely times when choosing induction is the safe route. I have seen families so afraid of the risks of induction they let complications get quite scary before they were willing to choose induction. The end result was that the baby was exposed to much more risk.

Make sure you’re looking at absolute risk, not relative risk. In an effort to draw attention to their work, study authors and people writing articles about studies have a tendency to report the results in the most dramatic way possible. Headlines that scream things like “DOUBLES THE RISK!” etc can be very misleading. For example, people commonly hear that waiting for labor to begin past 41 weeks has (cue scary music) double the risk of stillbirth than when babies are born earlier in pregnancy. The rate of stillbirth is very low in either case, going from .004% to .006%. So *technically* it does go up, but the absolute risk isn’t changed much.

Make sure that you’re not comparing apples and oranges. Let’s take another look at the example above. If you are 41 weeks and trying to decide about induction, the risk of stillbirth at 40 weeks is totally irrelevant. Delivering at 40 weeks is no longer an option. When you’re evaluating the risks to make a decision, what you need to consider is not the risk of delivering at 40 weeks vs 41 weeks. What’s relevant is the risk of induction now compared to the risk of waiting for spontaneous labor. The only risks that matter are the comparative risks of the options available to you.

It can feel very overwhelming trying to figure out what’s safest for you and your baby. I hope these tips are helpful as you try to navigate the information out there. A trusted care provider who has a practice style similar to your birth plan can also help you navigate it.

Don’t plan your wedding!!!

Don't Plan BirthI’ve really gotten tired of it. Pregnant women who are planning for a specific kind of birth are told things like:

“You know what is so cute? You – when you’re pregnant and think you actually control how things go in the delivery room.” -ScaryMommy

“I encourage my clients to create “birth preferences” rather than a “birth plan.” In this case, semantics are important. By writing your preferences instead of a plan, you maintain the understanding that circumstances beyond your control may change and you’ll need to adapt your preferences accordingly.” -Fit Pregnancy

“Since you can’t plan how your labor and birth will unfold, I prefer to talk about your birth wishes or birth preferences than your birth plan.” -Motherscircle.net

“If my births and every single birth story I’ve ever heard is any indication, birth follows anything but a plan.” AnHonestMom.wordpress.com

“The word “plan” in reference to normal, unmedicated birth is pretty silly, actually.” – Facebook post

Why is it that when it comes to birth, women are shamed and told they should not expect to have any control? Birth is life. Life is unpredictable, in any given day you may have “circumstances beyond your control may change and you’ll need to adapt” – but no one says that we should not take time to plan out our day to make things run smoothly and we don’t miss anything we need to do! When I am teaching about birth plans in my classes, I ask for a show of hands who in the class had some plan for their day when they woke up this morning. Nearly everyone raises their hand. I ask how many had their day go exactly as planned – and most (if not all) of the hands go down. And yet somehow, in pretty much every class, someone talks about how the plan helped them adapt and/or prioritize when things went wrong.

Think about another significant event in the growth of a family: A Wedding.

Would it ever be OK to tell a prospective bride something like:

“The word ‘plan’ in reference to a wedding is pretty silly actually. After all, things go wrong at weddings all the time!”

“If my wedding horror story, or the ones I’ve read online are any indication, weddings follow anything but a plan!”

“Since you can’t control the weather or the behavior of your guests, I think it’s better to think of it as ‘wedding wishes’ or ‘wedding preferences’ rather than a plan for your wedding.”

“As a wedding planner, I encourage brides to create ‘wedding preferences’ rather than a ‘wedding plan.’ In this case, semantics are important. By writing your preferences instead of a plan, you maintain the understanding that circumstances beyond your control may change how your wedding day will go and you’ll need to adapt your preferences accordingly”

“You know what is so cute? You – when you’re engaged and think you actually control how things go on your wedding day.”

PinterestWeddingI sincerely doubt anyone would dare tell a bride any of that. And yet, things go wrong at weddings all the time!

Instead brides are advised things like this:

Unexpected Wedding Disasters and How to Handle Them

Wedding Planner Disaster Stories – and How to Avoid Them

Top Wedding Disasters and How to Plan for Them

Not a single story I read on weddings mentioned avoiding planning as a way to make the day run smoothly. Huh.

They all mentioned planning well, carefully evaluating the people who you hire, having backup plans, and thoroughly evaluating your options.

Sounds like a Birth Plan of Action to me….

Go ahead and plan for your birth. Yes, PLAN. Not “Wishes” or “Preferences” but actually plan for and put your plan into action. No, it’s not a script or a guarantee, but it does significantly increase the chances of having the birth you want.

Wednesday Wrap Up January 20

WednesdayWrapUpAThis is so true, and something I have tried to convey to the women I work with. If you don’t like the care, and it’s not a good fit for what you want, move on. Take your health care dollars elsewhere!

Maybe I loved this so much because I can relate, but I really appreciated how this letter to the bloggers and writers who want to feature birth photography addressed the issues we face as birth photographers. I’ve been there, and it’s not fun.

There is some irony in the fact that this article is published….on the internet. But it’s a good one anyway: 4 Things You Can’t Learn About Birth On The Internet

I have explained this to so many parents, it’s a ridiculous conundrum. Why Most Private Practice IBCLCs Don’t Take Insurance (Hint: Probably better phrased as “How Most Insurance Companies Get Out of Paying for Mandated Breastfeeding Services”)

Great overview of why cesarean rates are high, and how they can be lowered. I found it really interesting to see what step had the biggest impact in this pilot program in Southern California.

Newborn looking at mom after birth

My favorite moment at births

There are many things I love about births. I love seeing women be strong and powerful. I love seeing the relationships between partners and the way partners step up and provide just what is needed, or say just the right thing at just the right moment. I love the humorous moments – and a time or two the parents and I have had an inside joke by the end of the birth.

But there’s one thing that I see almost every time, and it gets to me every single time. Not unusual for me to have the tears start welling up at that moment. It’s that moment when a parent makes eye contact with their baby for the very first time.

Newborn looking at mom after birth

Often that sweet moment comes soon after birth, when mom is snuggling that baby skin to skin and baby lifts their head up to look at mom eye-to-eye. Often there will be sweet words for the baby “Oh how I love you already!” or “Hi, I’m your mommy and I love you fiercely!” are two from recent memory.

Generally a little while later comes the moment when the other parent gets a chance to hold baby close and stare into their eyes. This sweet little girl even reached up to touch her mama’s cheek!

Newborn touching mama's cheek

I’ve loved and appreciated these moments throughout my entire doula career, but it’s only in the last few years when I’ve been doing birth photography that I’ve been able to capture them and share them with the families I serve. I hope you enjoy this collection.

Venn diagram of the three kinds of birth doulas

There’s more than 1 kind of birth doula?

Venn diagram of the three kinds of birth doulasIt’s been at least a decade since I first heard of the concept of birth doulas with different ways of looking at the job, and it has been an interesting concept to consider as I’ve come to know other doulas and mentor new doulas just starting it. I feel it can be a useful concept for parents considering which doula can best help them meet their goals as well.

At some point in the first 2-3 years of being a birth doula, I took a little quiz that categorized doulas into three types:

Birth focused – These doulas were focused on helping moms have the kind of birth that they felt was the best. They are the ones who are advocating for all low risk women to birth at home, for midwifery to be the standard of care unless higher level care is needed, and who have in mind an ideal birth they’d like to help their clients achieve. They tend to be huge fans of birth plans and often align themselves with specific methods of childbirth. Some doulas who have this philosophy will work only with out of hospital birth, and many go on to become home birth midwives.

Baby focused – These are the doulas who view everything about birth through the lens of the impact on the baby. They tend to be attracted to the work of APPPAH, to encourage mothers to talk to their babies and to be huge proponents of skin to skin bonding and breastfeeding. Many doulas who philosophically fall in this area tend to be very much against circumcision, routine newborn procedures, and formula. They can be passionate and valuable advocates and supporters of moms who have similar philosophies.

Woman focused – These are doulas who are most concerned with mothers feeling supported in their decisions and having the power and right to make decisions for themselves. They have an easier time supporting moms who make decisions that they may not have made for themselves. They tend to work in homes, hospitals and birth centers somewhat equally, and can support women planning everything from a planned cesarean birth to an induction with epidural to a home waterbirth or lotus birth.

Now these three types of philosophies are not at all mutually exclusive, nor are they unchanging and constant. As doulas learn, grow, and see more births, their thinking often changes. I would say that when I started out, I was definitely more birth focused, but over time I have become more woman focused, though I still do have quite a bit of overlap between the two with some baby focus thrown in there for balance. I feel pretty passionately that there is not any ONE way of giving birth that is “correct” for everyone, and I firmly believe parents have the right – and should be trusted – to choose what is best for their family.

Want to take the quiz for yourself? You can find it here: What Kind of Advocate Are You?

I don’t think that any one focus of a doula is necessarily any better than any other, but I do think it is important for parents to consider if the doula they are interviewing has a focus that is a good match for them. Most doulas will (like me) have quite a bit of overlap, but often there is one area that is more passionate for them, and it sure comes out when doulas talk about what drives their work and motivates them to do this job. You’ll hear it in their tone of voice, in the fire in their eyes, and in the power of their words.

One thing to watch out for is the doula that ProDoula founder Randy Patterson calls the “Birth Avenger” style of doula work. I’ve seen many times that new doulas come to this job because they had a horrible birth experience and they want to “save others from what happened to them” – this can create a really difficult situation when the doula has not processed and resolved her difficult birth experience. I’ve heard from a doula that she had to leave in the middle of a client’s birth because “she was going down the same road I did and I could not stick around for the train wreck” that she believed was coming. It was her last birth as a doula, she dropped all her remaining clients and left the field. I’m sure the client felt abandoned at a vulnerable time as well.

I’ve counseled doulas who were retraumatized by attending births at the hospital where they delivered – even if all went well.

Let me be clear here: Having experienced birth trauma does not mean a woman can never be a doula. It does mean she should do whatever it takes to process and heal from her birth trauma before attending other women’s birth. It may mean she sets boundaries such as not working with a specific place of birth or provider, too.

Being aware of what drives a doula philosophically is an important thing when practicing as a doula or when choosing which doula to hire. Not all doulas are alike, and find a good match in style, philosophy and personality is crucial for a good working relationship with your doula.

Wednesday Wrap Up Sept 24

WednesdayWrapUpCSymphysis Pubis dysfunction is a painful (and surprisingly common) complication of pregnancy and can progress to a full on separation. One woman’s experience and some tips for working through that kind of pelvic instability are here. I would recommend a women’s health physical therapist as well as a chiropractor.

Fear of labor can be just a normal thing in pregnancy, but it also can escalate to a phobic level, and this article talks about why and how we can help.

ACOG, the American Institute of Ultrasound in Medicine, and the
Society for Maternal-Fetal Medicine have issued new guidelines on estimating a due date in pregnancy. I’ve seen some crazy, crazy things happen when providers move around due dates as late as during labor. I love that they still call it “estimating” and that they discourage making small changes in the second & third trimester.

An interesting way to preserve and remember your breastfeeding experience. Would you do it?

14 ways to use the birth ball. Practice all of these and adjust/adapt to your own body and birth!

Here’s a great video on how to find and paint your baby’s position on your belly.

Wednesday Wrap Up August 13

WednesdayWrapUpNNo one, NO ONE, has the right to decide for a woman if her birth was traumatic or not. My Traumatic Birth, According to Me

One of the frustrations about living in Utah. People are so afraid of seeing women’s bodies they do things like call the police over a breastfeeding booth at the Farmer’s Market.
Thankfully the chief of police is well versed in Utah’s laws and handled it well.

And to get my blood pressure down again, I could use of these apps to learn relaxation and meditation in pregnancy.

A new Pinterest board you might want to check out “What Childbirth Educators Want You to Know About Birth”

I’ve already shared a bunch of funny pregnancy announcement videos, but I found a new one that is a fun one: