I wonder if most of us really know what the scopes of practice are for the providers we may choose  for pregnancy, birth, postpartum, and for the baby.  Keep reading to see if you really know what the jobs encompass.

As you go through the list I would like you to think about the language used, descriptors, and purpose of each type of provider. When we are approaching health care decisions especially who will care for us from pregnancy through birth, postpartum and for our babies, we need to make sure we are choosing the appropriate care for our individual needs and situation.

If anything strikes you or you would like me to add any provider types, please leave me a comment!

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OBSTETRICS AND GYNECOLOGY (OB/GYN)

Obstetrics and gynecology is a discipline dedicated to the broad, integrated medical and surgical care of women’s health throughout their lifespan. The combined discipline of obstetrics and gynecology requires extensive study and understanding of reproductive physiology, including the physiologic, social, cultural, environmental and genetic factors that influence disease in women. This study and understanding of the reproductive physiology of women gives obstetricians and gynecologists a unique perspective in addressing gender-specific health care issues.

Preventive counseling and health education are essential and integral parts of the practice of obstetricians and gynecologists as they advance the individual and community-based health of women of all ages.

Obstetricians and gynecologists may choose a scope of practice ranging from primary ambulatory health care to concentration in a focused area of specialization.   – from ACOG

Certified Nurse-Midwife

Midwifery as practiced by Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs) encompasses primary care for women across the lifespan from adolescence beyond menopause, with a special emphasis on pregnancy, childbirth, and gynecologic and reproductive health. Midwives perform comprehensive physical exams, prescribe medications including contraceptive methods, order laboratory and other diagnostic tests, and provide health and wellness education and counseling. The scope of practice for CNMs and CMs also includes treatment of male partners for sexually transmitted infections, and care of the normal newborn during the first 28 days of life. -from ACNM

Certified Professional Midwife

Based on the MANA Core Competencies, the guiding principles of the practice of CPMs are to work with women to promote a healthy pregnancy, and provide education to help her make informed decisions about her own care. In partnership with their clients they carefully monitor the progress of the pregnancy, labor, birth, and postpartum period and recommend appropriate management if complications arise, collaborating with other health care providers when necessary. The key elements of this education, monitoring, and decision making process are based onEvidenced-Based Practice and Informed Consent. – from MANA

Direct Entry Midwife (including Licensed Midwife)

• Not required to be nurses.
• Multiple routes of education (apprenticeship, workshops, formal classes or programs, etc., usually a combination).
• May or may not have a college degree.
• May or may not be certified by a state or national organization.
• Legal status varies according to state.
• Licensed or regulated in 21 states.
• In most states licensed midwives are not required to have any practice agreement with a doctor.
• Educational background requirements and licensing requirements vary by state.
• By and large maintain autonomous practices outside of institutions.
• Train and practice most often in home or out-of-hospital birth center settings.
  

To learn more detail about all types of midwives go to Citizens For Midwifery

Nurse Practitioner

Nurse practitioners (NPs) are registered nurses who are prepared, through advanced education and clinical training, to provide a wide range of preventive and acute health care services to individuals of all ages. Today, NPs complete graduate-level education preparation that leads to a master’s degree. NPs take health histories and provide complete physical examinations; diagnose and treat many common acute and chronic problems; interpret laboratory results and X-rays; prescribe and manage medications and other therapies; provide health teaching and supportive counseling with an emphasis on prevention of illness and health maintenance; and refer patients to other health professionals as needed.

NPs are authorized to practice across the nation and have prescriptive privileges, of varying degrees, in 49 states. Nurse practitioners perform services as authorized by a state’s nurse practice act.  These nurse practice acts vary state-to-state, with some states having independent practice for NPs (not requiring any physician involvement), some with collaborative agreement required with a physician. -from ACNP

Family Practitioner

AAFP defines a family physician as, “a physician who is educated and trained in family medicine–a broadly encompassing medical specialty.”

Family physicians possess unique attitudes, skills, and knowledge which qualify them to provide continuing and comprehensive medical care, health maintenance and preventive services to each member of the family regardless of sex, age, or type of problem, be it biological, behavioral, or social. These specialists, because of their background and interactions with the family, are best qualified to serve as each patient’s advocate in all health-related matters, including the appropriate use of consultants, health services, and community resources. – from AAFP

Labor Doula

The labor doula assists the woman and her family before, during, and after birth by providing emotional, physical, and informational support. It is not within the labor doula’s scope of practice to offer medical advice or perform any medical or clinical procedure.

During pregnancy, the labor doula’s role is to assist families in preparing a birth plan, to provide information about birth options and resources, and to provide emotional support.

During labor and birth, the labor doula facilitates communication between the family and the caregivers. She supports the mother and her partner with the use of physical, emotional, and informational support.

During the postpartum period, the doula assists the mother in talking through her birth experience, answering questions about newborn care and breastfeeding within our scope of practice, and referring the family to appropriate resources as needed. – from CAPPA

Postpartum Doula

The postpartum doula provides informational and educational information to the family. Medical advice is not given; referrals to appropriate studies and published books are within the postpartum doula’s scope. The postpartum doula will determine ahead of time what duties she feels comfortable with performing for the postpartum family and she will share this information with the family prior to accepting a position with them.

CAPPA members do not perform clinical or medical care on mother or baby such as taking blood pressure or temperature, vaginal exams or postpartum clinical care. CAPPA standards and certification apply to emotional, physical and informational support only. CAPPA members who are also health care professionals may provide these services within the scope and standard of their professions but only after making it clear that they are not functioning as a labor doula, postpartum doula, or childbirth educator at the time of the care. For needs beyond the scope of the postpartum doula’s expertise, referrals are made to the appropriate resources.

CAPPA strongly recommends that members do not drive mother or baby unless there is a life-threatening emergency and an ambulance could not get to the family quick enough. – from CAPPA

Lactation Educator

Lactation educators fill an important function in educating and supporting families interested in learning about breastfeeding. This education may take place in the public, hospital, clinical or private setting. Lactation educators provide informational, emotional and practical support of breastfeeding. They may provide this service exclusively as breastfeeding educators, or may use their training to augment their support in other professions, in the cases of doulas, childbirth educators, nurses, dieticians, and postnatal or parenting educators. In addition to providing breastfeeding information, lactation educators offer encouragement, companionship, an experienced point of view, and foster confidence and a commitment to breastfeeding.

Breastfeeding education is not restricted to new families, but applies to the general public and medical staff as well. Due to the limited breastfeeding information given in standard medical and nursing training, and the rampant misinformation about breastfeeding that is so prevalent in our society, the breastfeeding educator serves as a resource for accurate, evidence-based information to the public and health care providers, as well as to childbearing families.

CAPPA does not issue Certified Lactation Consultant status, nor does the lactation educator program qualify a member to dispense medical advice, diagnose or prescribe medication. However, lactation educators provide a wealth of information about how and why to breastfeed; establishing a breastfeeding-friendly environment; basic breastfeeding anatomy and physiology; the normal process of lactation; deviations from normal; physical, emotional and sociological barriers to breastfeeding; overcoming challenges; and resources available (including medical referrals) for the breastfeeding family. They can also be a source of vital support, guidance and encouragement throughout the duration of breastfeeding. -from CAPPA

IBCLC (Lactation Consultant)

International Board Certified Lactation Consultants (IBCLCs) have demonstrated specialized knowledge and clinical expertise in breastfeeding and human lactation and are certified by the International Board of Lactation Consultant Examiners (IBLCE).

This Scope of Practice encompasses the activities for which IBCLCs are educated and in which they are authorized to engage. The aim of this Scope of Practice is to protect the public by ensuring that all IBCLCs provide safe, competent and evidence-based care. As this is an international credential, this Scope of Practice is applicable in any country or setting where IBCLCs practice.

IBCLCs have the duty to uphold the standards of the IBCLC profession by:
• working within the framework defined by the IBLCE Code of Ethics, the Clinical Competencies for IBCLC Practice, and the International Lactation Consultant Association (ILCA) Standards of Practice for IBCLCs
• integrating knowledge and evidence when providing care for breastfeeding families from the disciplines defined in the IBLCE Exam Blueprint
• working within the legal framework of the respective geopolitical regions or settings
• maintaining knowledge and skills through regular continuing education

IBCLCs have the duty to protect, promote and support breastfeeding by:
• educating women, families, health professionals and the community about breastfeeding and human lactation
• facilitating the development of policies which protect, promote and support breastfeeding
• acting as an advocate for breastfeeding as the child-feeding norm
• providing holistic, evidence-based breastfeeding support and care, from preconception to weaning, for women and their families
• using principles of adult education when teaching clients, health care providers and others in the community
• complying with the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolution -from IBCLE

Pediatrician

A pediatrician is a child’s physician who provides:

• preventive health maintenance for healthy children.
• medical care for children who are acutely or chronically ill.

Pediatricians manage the physical, mental, and emotional well-being of their patients, in every stage of development — in good health or in illness.

Generally, pediatricians focus on babies, children, adolescents, and young adults from birth to age 21 years to:

• reduce infant and child mortality
• control infectious disease
• foster healthy lifestyles
• ease the difficulties of children and adolescents with chronic conditions

Click here for more information about the Physicians and Staff at the University of Maryland Children’s Hospital.

Pediatricians diagnose and treat:

• infections
• injuries
• genetic defects
• malignancies
• organic diseases and dysfunctions

But, pediatricians are concerned with more than physical well-being. They also are involved with the prevention, early detection, and management of other problems that affect children and adolescents, including:

• behavioral difficulties
• developmental disorders
• functional problems
• social stresses
• depression or anxiety disorders

Pediatrics is a collaborative specialty — pediatricians work with other medical specialists and healthcare professionals to provide for the health and emotional needs of children. – from UMM (I could find no concise scope of practice definition on the AAP website but here is their Scope of Practice Issues in the Delivery of Pediatric Health Care)

Doctors of Chiropractic

Since human function is neurologically integrated, Doctors of Chiropractic evaluate and facilitate biomechanical and neuro-biological function and integrity through the use of appropriate conservative, diagnostic and chiropractic care procedures.

Therefore, direct access chiropractic care is integral to everyone’s health care regimen.

A. DIAGNOSTIC

Doctors of Chiropractic, as primary contact health care providers, employ the education, knowledge, diagnostic skill, and clinical judgment necessary to determine appropriate chiropractic care and management.

Doctors of Chiropractic have access to diagnostic procedures and /or referral resources as required.

B. CASE MANAGEMENT

Doctors of Chiropractic establish a doctor/patient relationship and utilize adjustive and other clinical procedures unique to the chiropractic discipline. Doctors of Chiropractic may also use other conservative patient care procedures, and, when appropriate, collaborate with and/or refer to other health care providers.

C. HEALTH PROMOTION

Doctors of Chiropractic advise and educate patients and communities in structural and spinal hygiene and healthful living practices.

-from ACC

Cesarean is often the last thing we want to think about during pregnancy. Most of us think it will not happen to us. Having a plan, an idea of what to ask for, to know there are ways to bridge the gap between Plan A and Plan C can be very beneficial to both mother and baby.

There is no way to make a cesarean just like a healthy vaginal birth, and frankly, that ought not be the goal. It can be however a much more family centered, family bonded, more respectful and humane experience.

Speak to your provider ahead of time about needs and desires. If you know you are having a cesarean ahead of time, meeting with the Nurse Manager and the anesthesiology department can be useful in obtaining what you want. Have the conversations, create partnerships.

Below is my latest version of a family centered cesarean plan  that can be used for a planned or unplanned cesarean delivery. All requests may not be feasible in all areas, but even small changes can be helpful.

It may be copied and pasted into your own document for personalization, however I do ask that you credit the source if you are an educator, doula or related professional using it as a sample.

——————————————————————————————————————————-

Name: Jane Doe

Estimated Due Date: January 1, 20XX

Care Provider: XXXXXX

We are seeking to make a cesarean delivery as special, low stress and family centered as possible.In the event a true emergency and general anesthesia is needed, I understand that some of my requests cannot be honored.

JUST PRIOR TO/DURING DELIVERY / RECOVERY –

• I would like to meet each staff member in the OR by name who will be participating in the cesarean.
• I may ask my _________ for aromatherapy to help with nausea, surgical smells and stress.
• I ask that only essential conversation be allowed.
• I would like to play ______ music in the OR if it won’t be a distraction to those performing surgery.
• I would like my ______________ to take photos and/or video of the birth of my baby.  I respect that the surgeon and anesthesiologist may not want the entire surgery on video, however I would like a record of my baby being born to make it as special and personal as possible.
• Explain all medications that will be used to me. I prefer a bolus and oral medications versus a PCA afterward.
• Please lower the drape so I may view my baby coming out of me and hold my baby up so I can see him/her at the moment of birth.
• Request my arms not be strapped down so I may touch my baby freely.
• I would like my baby to remain connected to the placenta after manual extraction, as the cord will continue to pulsate for some time. I would like my ___________ to cut the cord after 10 minutes post delivery or the cord has stopped pulsating near the umbilicus.
• I would like my baby placed skin to skin on my chest immediately with basic assessments being done while on me. My husband (partner/family member can hold baby there with a warm blanket over my baby and help maintain the sterile field.
• I would like to breastfeed in the OR or as soon as possible in recovery.
• I would like for my ________________ and baby to stay in the OR with me while surgery is completed and remain in recovery with me.
• If the baby needs medical assistance requiring leaving the OR, I’d like for another person (doula, friend or family member) to attend me in the OR while my ___________________ goes with the baby, so my baby nor I will have to be alone.
• In the event baby needs to leave the OR, I would like the wipe down towel(s) to be placed against my chest skin and baby to be pressed on me for fluid and odor transfer.
• Asking for a delay in eye ointment and Vitamin K until after the first hour of bonding time or I am waiving all immunizations and eye ointment.
• In the event of a hysterectomy, please do not remove my ovaries or anything else that is not medically necessary

REGARDING BABY

• In the event the baby requires medical attention beyond that of a healthy baby, please inform me (husband/partner/family member) verbally what is needed or will be needed so I can actively participate in choices made for my baby’s care.
• In the event of  a need for separation of my baby from me:
  • Limit the number of persons who touch or attend my baby to only those on staff as needed and my _____________.
  • Request my baby not be bathed or fully dressed until I have the opportunity to smell, touch, cuddle, etc. with my baby and I am able to participate in the bathing.
  • I plan to breastfeed exclusively, so no pacifier, formula, sugar water should be given to my baby.
• No tests shall be performed or medications administered, etc. without my ________________ consent & prior knowledge

Thank you for honoring my requests for me and my baby.

Preparing For Birth, LLC

All Rights Reserved 2011

Transform your understanding about what breastfeeding/breastmilk really is:

• An irreplaceable relationship
• A brain developer

• An immune system
• An organ system
• A living tissue

Transform your professional skills

• Increase your doula competencies in the first hours after birth
• Hone your postpartum doula skills
• Learn unique strategies for teaching breastfeeding to families
• Explore adult learning styles
• Enhance your communication skills

Transform yourself

• Take the leap to explore new ways to work with families
• Connect with other women who love working with moms and babies
• Open your mind about new concepts surrounding breastfeeding
• Take the first step to becoming certified as a lactation
educator with CAPPA

Concepts covered over the three days include: Lactation Professionals, History
of Breastfeeding, Group Process, Learning Styles, Anatomy and Physiology of
Breastfeeding, The Importance of Breastmilk and Breastfeeding, Prenatal Support
and Breastfeeding issues, Birth’s Impact on Breastfeeding, the Hospital
Experience, Latch and the Breast Crawl, Skin To Skin, Signs of Successful
Feeding, Maternal and Infant Challenges, Medications and Breastmilk, Fathers and
Partners, and Curriculum Development.

LAST DAYS TO REGISTER!!!! Must register before 5pm, May 9th MST.

June 3-5, 2011, 8:30am-5:30pm, $425

Colorado Springs, CO at Prep for Birth

To register www.motherjourney.com

Ready to become more proficient when offering breastfeeding education? This
course is designed to improve the skill base, knowledge and perspectives on
breastfeeding and supporting both the Baby Friendly Hospital Initiative and
Mother Friendly practices.

This course satisfies the following:

*The Core Competencies in Breastfeeding Care and Services for All Health
Professionals as outlined by the United States Breastfeeding Committee (no
endorsement by the USBC is implied).

http://www.usbreastfeeding.org/Portals/0/Publications/Core-Competencies-2010-rev.pdf

*The 20 Hour World Health Organization Curriculum to support the baby Friendly
Hospital Initiative.

http://www.who.int/nutrition/topics/bfhi/en/index.html

*The CAPPA Lactation Educator certification step for workshop attendance.

http://www.cappa.net/get-certified.php?lactation-educator

Why become a certified lactation educator?

Certified Lactation Educators (CLEs) provide evidence based information to the
community, families and professionals to encourage an increase in breastfeeding
initiation, duration and support. CLEs are found teaching community and hospital
based breastfeeding classes, as peer breastfeeding counselors in hospital and
public health setting, facilitation support groups, running pump rental stations
and providing phone support.

The CAPPA CLE does not prescribe, treat, nor diagnose breastfeeding related
conditions and is trained to refer clients facing circumstances that require
this degree of intervention to a qualified professional. The CAPPA 20 Hour CLE
course is not an IBCLC exam prep course, nor does the CAPPA CLE training prepare
a student to become an IBCLC.

Your faculty:

Laurel Wilson, BS, IBCLC, CCCE, CLE, CLD, CPPFE, CPPI owns and manages
MotherJourney in Centennial, Colorado. She has her degree in Maternal and Child
Health-Lactation Consulting. With over sixteen years experience working with
women in the childbearing year, Laurel takes a creative approach to working with
the pregnant family. So is co-author of forthcoming book, The Greatest
Pregnancy Ever: The Keys to the MotherBaby Connection. Using journaling, birth
art, visualization and experiential exercises, women connect with their inner
resources to discover their true beliefs about themselves, their relationships,
and their abilities to birth and parent their children.

Laurel is certified as a lactation consultant/counselor and educator, childbirth
educator, labor doula, Prenatal Parenting Instructor, and Pre and Postpartum
fitness educator and prenatal yoga teacher. She serves as the CAPPA Executive
Director of Lactation Programs and trains Childbirth Educators and Lactation
Educators for CAPPA certification. Offering education and movement classes to
families in private and hospital settings, Laurel has created teaching
strategies that facilitate better understanding of the change processes during
the childbearing year. Laurel has been joyfully married to her husband for
almost 20 years and has two beautiful teenagers, whose difficult births led her
on a path towards helping emerging families create positive experiences. She
believes that the journey towards and into motherhood is a life changing rite of
passage that should be deeply honored and celebrated.

In light,
Laurel Wilson, BS, IBCLC, CLE, CCCE, CLD
Co-Author of forthcoming book, The Greatest Pregnancy Ever: The Keys to The
Mother-Baby Bond
MotherJourney Childbirth Services
CAPPA Executive Director and Faculty for Lactation Programs
Customer Advocate for InJoy Birth and Parenting
linfinitee@aol.com, www.motherjourney.com
720-291-9115

Connect with CAPPA:

Our website

On Facebook

Knowing your Bishop’s score prior to agreeing to an induction when not medically necessary or setting the stage for a medically necessary induction can make a great difference in expectations, additional interventions and understanding for the process as a whole.  Knowing your score can help you determine the type of induction or whether or not to be induced at all.
Your score is based on a vaginal exam that takes into consideration the areas listed in the chart below.

Dilation, Effacement, Consistency and Position all have to do with your cervix. Station is telling where the presenting part of baby is in relation to the ischial spines. (sitz bones).

Additional links and information on induction can be found in this previous post http://prepforbirth.com/2009/08/12/preparing-for-labor-induction/.

A birth plan is designed to facilitate communication between you and your provider, especially necessary if you are  birthing outside the home environment.  Secondly, it is to offer information on the individualized care you as the mother would like during labor, birth and immediately postpartum for you and your baby.

It should be brief (no more than one page) and only have the bullet point information that is specific to individualized care and desires not usually within your care provider’s standing orders or usual protocols of the birth location.

It is important to take a written birth plan to a prenatal visit at least a month prior to your given estimated due date in order to have a clear understanding of expectation and agreement. If it becomes apparent that you and your provider are not on the same page, this gives can give time to seek out another provider that fits you and you fit with. Remember it is not a legal document that your location of delivery or care provider must adhere to.

 =======================================================

Birth Needs and Desires for: _______________________. 

Care Provider:_________________.

Estimated Due Date: _________________.

Labor

I am planning on a no to low-intervention natural birth.  I plan on being mobile, lightly snacking, drinking orally, and having ___________ present.   I understand that intermittent monitoring of me and my baby will be necessary.  I want to be fully consented for any procedure that may come up and fully participate in the medical care for myself and my baby.  I understand that there is pain management available to me, I will ask for it if I so desire.

• I plan on wearing my own clothing. I will ask for a gown if I change my mind.
• I would like a saline lock in lieu of a running IV.
• Limited vaginal exams after initial assessment.
• In the event an induction and/or augmentation is medically necessitated-
  • Ripening – Foley Catheter instead of Cytotec (misoprostol), Cervadil or Prepadil
  • Pitocin – A very gentle and slowly administered dosage increase.
  • AROM – will only consent to if an internal fetal monitor is a must.
• Spontaneous pushing and delivery in any position I am most comfortable with.
• No cord traction or aggressive placental detachment, including deep uterine massage.
• Delayed cord clamping for at least 10 minutes or until my placenta spontaneously detaches (baby can receive oxygen or other assistance while still attached to me).

Postpartum and Baby Care

• Request that my baby is on my belly or chest for assessments and warmth (even oxygen can be given on me)
• Delayed bathing
• Delaying vaccinations including eye ointment and vitamin k.
• Exclusive breastfeeding, no pacifiers, sugar water, or formula. I will hand express if necessary.
• No separation from me unless absolutely medically necessary not just protocol.

Cesarean: In the event a cesarean becomes necessary and is not a true emergency requiring general anesthesia.  I would like to keep the spirit of my plan A to plan C so the delivery can be as family centered and intimate as possible.

• Only essential conversation related to the surgery and delivery
• Lower sterile drape or have a mirror present so I may see my baby emerge
• Only one arm strapped down so I may touch my baby
• Pictures
• Aromatherapy as I desire for comfort, abate nausea and to mask surgical odors
• Baby to stay with me continuously in OR and recovery
• If baby must leave OR for treatment, my partner/spouse goes with baby and I would like my ____________ to stay with me so I am never alone.
• Breastfeed in OR and/or recovery
• Delayed immunizations
• Delayed washing and dressing of baby
• No separation from me except what is absolutely medically necessary

This “plan” may be copied, pasted and edited  for use by others.

It has occurred to me through my time with doula clients and students,  that many care providers serving hospital birthing mothers do not ask any questions of their pregnant patients during the 7-10 minute prenatal visits that lead to a substantive working relationship.

I have also learned that too often the pregnant “patient” does not know to tell her provider anything about what is going on in her life or pregnancy since she is not queried first.

Thinking there must be a way to better bridge this very real separation to solid patient-provider relationship building, I am drawing from my work as a midwife assistant in the making of this tip list.

Pregnant mothers your provider needs to know so much more about you and your pregnancy than blood pressure, weight, fundal height and fetal heart tones. I encourage you to freely offer the below information at every appointment to grow personalized care, advisement and support.

1) Appetite/Diet/Supplements – tell your provider if your appetite has increased or decreased between visits. Do you have food aversions? Are you taking any supplements or want to take supplements?

2) Sleep habits – tell your provider how you are or are not sleeping.  For example, are you having trouble falling asleep, falling back to sleep or staying asleep.

3) Nausea – Do you continue to have nausea? When? How often? Does it correlate with anything in particular?

4) Hemorrhoids – if you have them or not. What you are doing for them.

5) Varicose veins -  Are there veins sticking out or causing issue anywhere in your body?

6) Bowel habits – Are you experiencing normal or abnormal bowel habits?

7) Exercise – What have you been doing? Do changes need to be made?

Stress – Is there anything in your life that is really stressing you? Stress can impact pregnancy health. Important to discuss.

9) Related Providers – Are you going to any pregnancy related providers (such as chiropractor, acupuncturist, yoga, etc.)?

10) General  – Are you feeling well or not. Do you need more information or referrals?

There is so much more to you than a pregnant uterus. You are a holistic person who needs to be treated as such. I would venture that something much more individualized can come out of your care with simple sharing!

Here’s to whole care!

The below post is written by a mother of 3 wee ones. She graciously accepted my request to share her journey to placental encapsulation. I have personally witnessed a significant in Kailah’s postpartum between baby 2 and three overall along with her milk supply increase. I am truly amazed by the differences.

_______________________________________________________________________________

My Experience With Placenta Encapsulation by Kailah Brost

Not all crunchy people are born that way. In fact, the more blogs I read the more I realize that that becoming “crunchy” is a process for most people.

Since my first birth I have considered myself to be “semi-crunchy”, but I think that my last birth experience officially graduated me into full fledged crunchiness. I mean, not only did I have a homebirth, but I (gasp!) had my placenta encapsulated so I could ingest it!

I had heard about placenta encapsulation some here and there, but hadn’t thought about it as something I would do. The first time I gave it consideration was when I lost my milk supply with my second baby at 5 months – just like it had happened with my first baby. I worked with a Lactation Consultant with both, and tried just about everything, but we couldn’t get it back up and had no idea why it had gone in the first place.

So when I found out I was pregnant with baby number 3, I knew I was going to give placenta encapsulation a chance. Couldn’t hurt right? And as fate would have it, the new leader of our local ICAN chapter was a Placenta Encapsulation Specialist. One of our meetings I was the only one who showed up, so I got to pick her brain. She also sent me to www.PlacentaBenefits.info and gave me a study on the placenta and hormones and I was amazed at the what the research had to say.

We all know that with the birth of a baby our hormones come crashing down around us. Well, all those hormones we lose – thyroid, progesterone, prolactin, etc – are in the placenta and ingesting it gives us doses of those hormones that help keep us from crashing so hard. Thus Postpartum Mood Disorders are much less likely, milk supply is boosted and can come in faster, and energy is increased. After looking at that, I was sold. Who wouldn’t want all that while introducing a baby into the family, especially with 2 other very small children?

Right after my son was born, one of my first calls was to the Placenta Encapsulation Specialist. The baby was born at 5pm, so she came up the next morning and started on the 2 day process. Day one was preparing, cutting it up and putting it on a dehydrator. Day 2 was grinding it up and putting into capsules for me. I had an average sized placenta and ended up with 117 capsules.

We had decided I would take enough for just a couple weeks so I could save some for the time when my supply traditionally decreased. I took 2 3x/day for 2 days, 2x/day for a week, and 1x per day for a week. I could not believe how I felt! I wasn’t sleeping continually, I didn’t mind getting up in the night with the baby, and I felt so calm and at peace with the world. The night I started taking them, almost 3 days post partum, my milk supply came in with a BANG! I was actually on facebook chatting with my doula for help I was so engorged. It rapidly resolved itself, however, and an awesome breastfeeding relationship was established. Three weeks postpartum my mother-in-law came to visit, and she stressed me out so badly that half way through her visit I started taking them once a day again. Amazingly, it worked! She was still driving me nuts, but suddenly I was calmer about it and able to focus and make it through the week.

The best thing for me was how it affected my breastfeeding. My supply was much stronger than it had been with my other two. I LOVED watching my baby get so beautifully chunky! However, a couple of weeks ago at 4 ½ months postpartum, my supply again dipped. I immediately took out my reserved placenta capsules and while we work on figuring out why my body does this, I am using them to keep my supply at a good level.

It’s fun for me to see the journey to crunchy I’ve taken. I was sick in November and saw the PA in my Dr.’s office. While going over my history I noted I’d done placenta encapsulation and he was really fascinated. The Dr.’s wife is a nurse in the office and a friend of mine. She told me later that the PA came to her and asked if she’d ever heard of ingesting the placenta. “Oh,” she replied, “you must have met Kailah.”

Bio:

Kailah is wife to an amazing man, and babywearing, cloth diapering, co-sleeping, breastfeeding, stay at home mountain mama to 3 kids under 3 whose births turned her into a crunchy birth geek, and VBAC and homebirth advocate.

Email – zarikailah@yahoo.com

twitter – @klabrost

facebook – http://www.facebook.com/klabrost

A clean slate. A fresh start. Hope and dreams reactivated. Passions toward change are stirred. All of this by the calendar rolling over from one year to the next. It is not just  anew year though, it is a new DECADE to set precedent in. To make a mark. Oh the possibilities and opportunities that are ours to reach for and accomplish.

In the spirit of all of this, I decided to make an #in2011 wish list on New Year’s Eve 2010 and with some help from a few friends here is what flowed out.

#in2011 breasts will be viewed as nurturing, comforting, and beautiful.

#in2011 the majority of women will be served under the midwife model of care for the majority are low-risk and will remain so.

#in2011 Childbearing women will be greeted with open arms by providers with their questions, needs and knowledge.

#in2011 pioneering social media women will gain even more ground in their work liberating childbearing women.

#in2011 delayed cord clamping and physiologic third stage will become the norm.

#in2011 doulas will be respected as educated, knowledgeable birth professionals by staff and care providers.

#in2011 childbearing women will be given opportunity not limited

#in2011 Those striving to improve the maternity system at the ground floor as educators will be mutually respectful and supportive.

#in2011 Doulas from all backgrounds and organizational affiliation will be open to one another, supportive, sharing.

#in2011 a woman with needs and opinions with not be marked for a cesarean because of it.

#in2011 Homebirth transports will be treated with dignity and respect.

#in2011 Stigma of mental illness and motherhood will be adsressed by every childbirth care provider. RT @WalkerKarra

#in2011 Childbearing women will not have to live in fear of their providers.

#in2011 We CAN change the world together for childbearing women. Put your words intro action.

#in2011 More birthing women will have low-intervention births that lead to healthier outcomes.

#in2011 Childbearing women will be seen, heard, respected and offered a variety of care options.

#in2011 there will be less imbalance of power between maternity patient and provider.

#in2011 childbearing women will rightfully claim their health records as their own -RT @midwifeamy

#in2011 we will wake up to and address the shameful disparities in access to and outcomes of maternity care RT @midwifeamy

#in2011 Less pointing fingers among insurance companies, providers & orgs that continues to feed this ever medicalized maternity system.

#in2011 I would like to see an equal playing field with accessibility to all to maternity research, guidelines, statistics…

#in2011 I would like see accountability for providers and institutions in their maternity care practices.

#in2011 I would like to see hospitals treat only the patients they serve the very best – high-risk or in-need mothers and babies.

#in2011 I would hope more women stop blindly trusting and do their own research for pregnancy, birth and postpartum.

#in2011 I would like to see arrogance leave the treatment room. It is not a personal affront for a patient to have an opinion and needs.

#in2011 I hope women are treated as holistic beings especially in pregnancy.

#in2011 I hope for care providers to be transformed into partners with their patients instead of authorities.

#in2011, I want to see care providers and family members taking postpartum mood disorders seriously. RT@smola04

#in2011 I hope women stop being treated with hostility and looked down upon for wanting something more in pregnancy, birth and postpartum.

#in2011 I would like to see more women receiving comprehensive postpartum care from their OBs and hospital based midwives.

#in2011 I hope that women will openly mentor those coming up after them to better understanding and expectations in birth.

#in2011 I hope social media efforts have even more impact on unveiling the hidden and progressing healthy birth practices.

#in2011 I hope less mamas are unnecessarily cut open in pursuit of delivering a baby.

#in2011 I hope to see midwives working together no matter the track they came up on. Being respectful and open.

#in2011 I hope to see women who have experienced amazing births be loud and proud sharing the good news without fear.

#in2011 I hope that midwives of all types will be fearless in their pursuit of their model of care for women.

#in2011I hope that hospitals and providers realize they need to offer individualized care to women and babies for the health of it.

#in2011 I would like to see women openly breastfeeding their children without shame or discrimination.

#in2011 A drop in the cesarean rate would be progress toward healthier practices.

#in2011 I want to see women in droves having their eyes opened and being fierce about the care they receive. About their maternity options.

#in2011 I would like to see less care providers offering up defensive and fear based medicine to their maternity patients.

#in2011 I hope for more accessibility to home and birth center births for women and babies.

#in2011 I would like care providers to view women as a sum of all parts, not a uterus growing a baby more valuable than she is.

#in2011 I would like to see more women taking charge of their care, taking personal responsibility and being powerful pregnant women.

#in2011 I desire more respect and autonomy for maternity patients.

#in2011 For women who want a VBAC to easily find an accommodating provider.

Is all this attainable in one year? Perhaps not, but pushing toward the positive and never taking the eye of the reason for all of this, the childbearing women and families, I do believe we can change the world and make the maternity care system as a whole a safer, healthier  and more respectful place.

What is on your 2011 wish list? If you would like to have it added here, leave a comment.

Reader Additions:

Kay Miller:

I hope that we (doulas/educators) can stop alienating the providers, instead partnering with them to provide the best care possible for the mamas and babies that we work with.
I hope that doulas/educators and providers can have mutual respect for one another, and realize the value of the care and support that each provides.
I hope that while we work to change the negatives of health care for pregnancy, birth, and postpartum, that we can remember to openly recognize and affirm the positives.
I hope that families will make decisions based on education and research, not on fear.
I hope that both “sides” stop using fear tactics to persuade families to make certain choices. A decision to home birth due to fear of hospital birth is still a decision based on fear.