Nausea is such a common complaint among pregnant women.  Usually the extreme nausea passes by the time a woman enters the second to mid-second trimester, however, some women experience it throughout pregnancy.

Though no solution is full proof, there are some things that can be done to aide in a calmer digestive system.  Remember that food aversions or smell aversions are normal.

• Eat regularly and frequently though smaller meals
• Use peppermint in the form of tea, essential oil, or candy such as Altoids
• Use ginger in the form of ale, tea, raw pieces, candy, or essential oil
• Have a honey stick or other quick sugar (a few jelly beans) prior to getting out of bed in the morning to abate low blood sugar from not eating for many hours
• Stay hydrated with non-caffeinated beverages
• Take prenatal vitamins with food or in the evening. Another options is to switch to a liquid or whole food vitamin which absorbs more readily and less likely to be irritating.
• Limit coffee intake
• Drink herbal tea (read labels some are not encouraged during pregnancy
• Eat yogurt and take probiotics to ensure a healthy digestive system
• Take digestive enzymes
• Wear a sea sickness acupressure band
• Seek out an acupuncturist for treatment
• Seek out an herbalist or naturopath for treatment
• If nausea or vomiting is severe or extreme, consult with your care provider as you may have a more serious form of morning sickness (hyperemesis gravidium) which requires a special course of treatment.

Here is to gestating in peace and digestive harmony.

Choosing the place of birth for your baby – It is incredibly important that you understand where you fit best prior to choosing where to birth your baby. Take hospital and/or birth center tour, call and talk to L&D floor, get facts on home birth by talking to home birth midwives, other moms who have had home births, online and in books. Being intellectually safe is not the same as being safe. Know the facts before you choose.

· Does the location offer what is most important to you (tubs, birth balls, wearing own clothing, intermittent monitoring, fetascope monitoring, etc.)?

· What are standard protocols and practices that are followed? Is individualized care a norm there or is cookie cutter style?

· Is water birth available?

· Are birthing stools or non-reclined pushing and delivery positions encouraged?

· What are the no/low intervention rates? These numbers are tracked monthly.

· What is the induction, epidural, cesarean rate? Are VBAC’s supported and encouraged?

· Are mom and baby friendly practices used? (no routine interventions, no separation of mom and baby, breastfeeding is the norm, movement in labor is utilized, doula accompaniment is accepted, labor induction rates are low, etc.)

· What if I choose to decline an intervention, medication or procedure? Will my decisions be respected? Are patient’s rights taken seriously?

Points to Ponder afterward –

· Will I be able to have the type of birth I truly desire?

· What location will I ultimately feel most comfortable in physically, emotionally and spiritually?

· What location is ultimately safest for my specific needs (I am currently a low-risk or high risk)?

· Is insurance or lack of it the reason I am choosing the location?

· Do I have realistic expectations for the location?

· Am I willing to take responsibility for my birth in the location?

· Is staff open to working with a doula or natural birth?

· Are there any compelling reasons to choose one location over another?

Women have supported women throughout the ages.  In our very busy and ever transient culture, the woman to woman education and support of yesteryear is sorely lacking.  It is very common for an expecting woman not have family nearby or to have support women who know the ways of natural, normal pregnancy, labor, delivery and immediate postpartum. The labor doula was born out of this need.  Essentially this is a woman of knowledge and skill in pregnancy, birth, and immediate postpartum (yes there are a few men in who are labor doulas as well) who comes alongside a pregnant woman (family) offering education, physical support and emotional support to both the mother and partner/husband/other support.

Below is a detailed description of what a doula is and does according to CAPPA a wonderful organization that trains a variety of doulas and other birth professionals.

What is a Labor Doula?

A doula is a person who attends the birthing family before, during, and just after the birth of the baby. The certified doula is trained to deliver emotional support from home to hospital, ease the transition into the hospital environment, and be there through changing hospital shifts and alternating provider schedules. The doula serves as an advocate, labor coach, and information source to give the mother and her partner the added comfort of additional support throughout the entire labor. There are a variety of titles used by women offering these kinds of services such as “birth assistant,” “labor support specialist” and “doula”.

What Does a Doula Do?

The following is a general description of what you might expect from a CAPPA certified labor doula. Typically, doulas meet with the parents in the second or third trimester of the pregnancy to get acquainted and to learn about prior birth experiences and the history of this pregnancy. She may help you develop a birth plan, teach relaxation, visualization, and breathing skills useful for labor. Most importantly, the doula will provide comfort, support, and information about birth options.

A doula can help the woman to determine prelabor from true labor and early labor from active labor. At a point determined by the woman in labor, the doula will come to her and assist her by:

• Helping her to rest and relax
• Providing support for the woman’s partner
• Encouraging nutrition and fluids in early labor
• Assisting her in using a variety of helpful positions and comfort measures
• Constantly focus on the comfort of both the woman and her partner
• Helping the environment to be one in which the woman feels secure and confident
• Providing her with information on birth options

A doula works cooperatively with the health care team. In the event of a complication, a doula can be a great help in understanding what is happening and what options the family may have. The doula may also help with the initial breastfeeding and in preserving the privacy of the new family during the first hour after birth.

What does a doula cost? This can be a huge spectrum and is defined by where you live.  A labor doula may volunteer, work for barter, or basics like gas reimbursement, childcare coverage, snacks, etc.  I have heard of fees from $100 to $1800 (mind you this is in NYC).  On average I would say a labor doula costs $250-$600 in many areas.   Call around or visit websites in your area to get a firm idea.

What about insurance? Private doulas usually do not bill insurance though many will give a super bill to be submitted for reimbursement by insurance.  many insurance companies after some effort will pay a portion of the fee as an out of network provider.

Will a doula provide my complete childbirth education? Sometimes.  Often not.  Some doulas are educators. I provide classes separately from doula services. The labor doula will often fill in the blanks and personalize the education the client already has.  Many doulas have lending libraries or recommended reading and watching lists.

If I am going to a birth center or having a homebirth will a doula still benefit me? Yes in both cases.  When going to a birth center a doula would labor at home then arrive at the birth center at the same time as the laboring mother just as with a hospital birth.  In a homebirth scenario the doula who is not a midwife and does no medical tasks is often a welcome extra set of hands and does the same emotional and physical support as she would do in any other location.

Does evidence support that having a doula in attendance has benefits? YES. Here are some of the benefits. Lowered epidural, narcotic, induction, cesarean, and instrumental delivery rates. Increased satisfaction, breastfeeding, and bonding.  Also shorter labors!

For more information, email me at desirre@prepforbirth.com.

This is a  slight re-do from a popular blog post from early 2008. The information is vital and pertinent to the near 1.5 million women (based on previous CDC data) who will have a cesarean surgery this year.

Having a cesarean section will almost always  get you a baby.  Generally there is much more to it and anyone could bargain for or anticipate even in the best of recoveries.

Let me count the ways in no particular order:

• A scar that in no way makes a bikini look better. Sometimes described as a shelf or a pouch.
• The feeling of failure, guilt or less than deserving of motherhood.
• The struggle of living with the huge dichotomy of loving your baby and perhaps hating the birth.
• Higher probability of losing your ability to have more children either through physiologic secondary infertility, pregnancy complications, self-induced secondary infertility, hysterectomy or lack of sexual intimacy in relationship.
• Higher probability of difficulty in breastfeeding.
• Postpartum depression or PTSD, especially in an unwanted cesarean.
• The feeling of failure as a wife or partner.
• Having others discount your feelings and needs. After all you “just” had a baby. Really you just had MAJOR surgery, perhaps by coercion, a true medical indication, or completely from interventions and medications.
• Living with the idea that you failed to pass induction, you failed to push out your baby, you failed because _________ (fill in the blank).
• Obtaining your records to find what you were told and what was written are different. Could your trusted care provider have lied and cheated you?
• Simply finding out that no one told you and you didn’t think it would happen to you. That being induced, getting the epidural, allowing AROM, not getting out of bed, etc. is why you had the cesarean. Is maternal ignorance and fear enough to quell what you feel and make it okay?
• How can you trust yourself as a mother when you ignored your maternal intuition and kept saying yes, because the nurse, midwife or doctor told you to?
• The way your marriage or partnership takes a turn toward hell or in the least a divided place.
• Living with dread when a hungry hand sweeps over your scar. Being sexual can be extremely difficult physically and emotionally.
• Having great fear of becoming pregnant again.
• Having great fear of going for a VBAC and ending up in the OR at the end.
• Not being understood and having others say to your face how lucky you are that you got to take the easy way out.
• Pain.
• Difficulty moving, walking, getting up, rolling over, coughing, laughing, tending to personal cleaning…. You get the idea. It is surgery.

Though not every woman will experience what is on the list, many do.  For all of these – there a stories layered and interwoven for too many women.

Every thirty seconds a woman is surgically having her baby delivered. Light her a candle. Offer her a meal. Let her speak. Listen to her intently. Don’t judge her. Send her to ICAN. http://www.ican-online.org/.

I am revisiting the thought that women just aren’t the same these days and no longer able to spontaneously go into labor or birth today. There are some theories out there that the pelvis is evolving out of ability or that with all the intermingling of cultures that the option to grow a baby that plain doesn’t fit is happening as well. I don’t happen to fall in either category.  Stumbling blocks and problems are arising from the belief that women cannot so they do not.  So perhaps a dystocia of the mind and heart toward labor and delivery…..  In my opinion this doesn’t have to be the reality of many women in our society today.  There is a piece of writing I give to every doula client and class participant. I  am re-posting the story (authored by another doula Gina P.). She graciously gave me permission to use the story knowing it would be forever in cyber space . I have chosen to edit down the story a bit to retain more privacy and am abbreviating the name as requested. Please enjoy and be encouraged.

Grandma C

“… She was born in 1911, and contracted polio as a child, leaving her with a hunched back and a contracted pelvis. …Her first son was born in 1931. He was a large baby, but she welcomed that in a time when babies often died. Large meant healthy. Her second son was born in 1939, another large boy, and again healthy. In 1945, she was going through menopause and found a mass in her abdomen. She had exploratory surgery to find the mass and remove it, but when my mom was found in her uterus, she was stitched back up and pleased to carry a baby to full term. My mom was born vaginally after this surgery, a footling breech. Again, her contracted pelvis, small stature, and psychological barriers were no problem, and she had an otherwise uncomplicated birth with this baby! She lived to be 92.

When I see or hear about the inherent disbelief that babies can be born for whatever reason, I tend to think about my Grandma C. She really had the odds stacked against her in many ways throughout her life, but having babies was never a problem for her. She didn’t know any better than to just give birth. It makes me cry to see how some (most?) women feel about their uterus, pelvis, cervix, and vagina. And how this is perpetuated. Grandma C. was shamed by society to keep even the normal processes like menstruation a secret from anyone (unfortunately, even my mom), but she gave birth because it was her job as a wife and mother. And if it wasn’t a problem for her, I wonder how many of the problems that are discussed with other women nowadays are true. I wonder how much of her hard work keeping house and tending older children helped her to give birth. At the end of her life, Grandma C. was ridden with dementia, and she would tell a few stories over and over again. I listened each time as she would tell of life on the farm as a young girl and how much of a burden she had to carry. But giving birth was something she felt she did pretty well.

About the author: Gina is a birth doula and childbirth educator in Colorado who strives to help prevent primary cesareans and to support all women who want a VBAC. Viva larevolucion!

By today’s standards would this strong, capable and physically imperfect woman be “allowed” to just birth? The disturbing truth is NO she likely wouldn’t. She would almost assuredly be told she couldn’t ever birth children, that she is far too physically broken, and if she did carry a pregnancy to term that she must have a cesarean to safely deliver a healthy baby and mother.

By no one telling her she couldn’t do it, she just did it. She knew it was one of her jobs in life. A usual expectation. I would venture to guess it wasn’t easy, but nothing worthwhile is ever easy.

I will echo Gina and question, how much of what women are led to believe today is not based in truth? How many women are led down the path of fear to induction, medication, instrumental delivery or cesarean because they are being told over and over they cannot or should not labor and birth normally? Too small, too skinny, too fat, too young, too old, too scarred, too imperfect, too overdue…..This is not true. We need to stop believing that we inherently cannot.

Plain and simple fear instilling care, induction, augmentation, continuous monitoring, epidurals, cesareans and everything that goes with them – places low risk women and babies into a category of high risk, lessening the ability to JUST DO IT. Even truly high risk moms and babies are being hindered, but that is a note for another day.

Labor can be tough, it can be blissful, painful, orgasmic, you name it. It is anything and everything. My hope is that women will stop believing these lies and again start believing that it is something women are meant for, a normal expectation.

Be encouraged by Grandma C and all those like her. My heartfelt thank you to Gina for allowing me to inspire others with her writing.

Whenever I am asked why I am a doula, I need to stop and think for a moment.  My response every time is that as a doula I am filling the gap (along with others)  that is missing in today’s transient and autonomous society. When I respond, I am thinking of the days when girls and young women learned the ways of pregnancy to all things postpartum at the feet of their grandmothers, aunts, sisters, cousins, and other women in their community.  What a beautiful and age old scene that is.

Then that scene brings me to my own journey in becoming a doula.  Here is my “why” story.

Living without my own mother since I was 10 years old, I yearned for the mentoring and teaching that I am called to act upon in my life’s work.   Even without my mother, I was blessed to grow up around some other women who modeled breastfeeding, cloth diapering, and natural birth for me.

I also think of the journey that brought me to being a doula for real.

I had an epiphany one day almost 25 years ago when a close friend and I were waiting for the bus to get home from work.  She described her birth – left by her partner during pregnancy, her mother refused to come since she was unwed, and she was at an overtaxed county hospital where the staff was barely in the room to support her.  She was utterly alone and scared.  My heart broke for her and her daughter. No woman should ever be alone to fend for herself under those circumstances.  EVER.  In looking back, I can say at that moment my doula heart seed was planted though it would be years before the seed came to full bloom.

Fast forward a couple of years and I had a knack for mamas and babies.  I could help a baby latch and mom grow confidence in breastfeeding.  I knew how to calm a mama when she was tired and at her wit’s end. I understood the pregnant mama and could easily encourage.  I was invited to attend a birth of a family member I was very close to.  She delivered in a freestanding birth center.  It was an amazing natural birth with very little requirement of her except to labor and birth.  An atmosphere of encouragement, freedom, and calm. I will say it was one of the most comfortable places I have ever been in my skin supporting her.  I didn’t understand the job I had done with her, but it was good.  I think I was on a birth high for weeks.  The doula seed was beginning to ferment.

I attended birth along the way for friends and other family, assisted in breastfeeding and talking through general pregnancy issues. Mind you I hadn’t had my own children, was educated and worked in fields that had nothing to do with birth.  I loved the mamas and families that I knew.  When I started having my own family, it seems the mojo went into high gear.  I was asked questions all the time about many things pregnancy, birth and breastfeeding related, no matter where the place or situation.  Even my husband began fielding calls when I wasn’t home from friends who needed baby help.  The doula seed was slowly sprouting.

When my dear youngest boy weaned himself, I began wondering OKAY now what am I going to do while maintaining being a SAHM? My sister-friend “J” found the CAPPA website and told me I needed to take the trainings and then I could really support the families in my community as an extension of what I was already doing.  Get the education she said.  I went to the site, spoke to my husband at length and took the leap.   Three trainings in 5 months.  Then I began to to seek out clients, put together curriculum, and found a local doula group to join.  The doula seed exploded into a blossom of great fragrance about me.

I ill not say the work is easy. Anything worth any value is not.  From the prenatal meeting, to the birth while looking into a mother’s eyes encouraging her down the path so many have walked before, to the early postpartum time in assisting with breastfeeding, attachment and family health, I am honored and blessed doubly.  Participating in the most intimate time possible, witnessing the transformation that so often occurs in a woman (and her huband/partner/family), and hearing that first sound of life when her baby “speaks” is beyond description.  A miracle takes place each and every time.

The doula blossom has deep roots now.  On occasion it needs some pruning, soil treatment, and large doses of sunshine as all beautiful plants need to maintain health and well-being.  Still it is very good.

I am often asked what someone needs to take to the hospital or birth center.   I am going for items that may not be normally thought of along with some tried and true items. Wherever a mother is going to have her baby – it is her space, her labor cave as it were.  Now for a hospital or birth center birth painters tape could be a good idea for some items on the list as not to mark up the walls.

Appealing to the senses: Items that speak to sight, touch, sound, smell, and taste.  Try and figure out where the items fit!

• Pillow case that smells like you or your partner, really like your normal normal environment.  I eschew the thought of taking an actual pillow outside your home simply for the germs that are anywhere else you may deliver.
• Your own clothing:
  • For her: robe, a sports bra, bikini top, tank top – something that can get wet and not be ruined.  Two piece outfit, a Binsi or bathing suit cover skirt.  Sandals, slippers, socks or flip flops.
  • For him/labor partner: sweats, shorts, pajamas, hoodie, pullover, socks, underwear – items other than just a pair of jeans.  Swim trunks in case she wants you in the shower or labor tub with her. Nakedness outside of a homebirth is generally reserved for the laboring woman. Flip flops or other waterproof foot covers.
• A favorite blanket
• Essential oils or scented lotion.
• Pictures of other children, pets, favorite vacation, anything that is her happy place in thought, spirit and mind.
• Flashlight and/or night lights to give subtle low light illumination.
• Posters or phrases to put on the wall.
• Music – soft, slow, upbeat, fast – whatever is relaxing for the individual.
• Lip balm
• Mints and lollipops
• Toothbrushes and toothpaste
• Colored items that soothe and encourage.
• Affirmation cards or cd’s
• Scripture or encouraging religious texts
• Fresh herbs.
• A cooler with easy to digest foods  for her- smoothies, yogurt, ices, peanut butter sandiwches, protein bars…..
• A cooler with his favorite foods and drinks (again remember the toothbrush)
• Special symbolic or religious pieces
• Phone numbers of those who can encourage, pray, etc.
• Something to cover the clock with.
• your labor doula

Finally some of the inangibles that are not items:

• Quiet
• Peacefulness
• Courage
• Strength
• Patience
• Trust
• Faith
• Calm
• Connectedness
• Love
• Joy
• Excitement
• Patience (not a typo)
• Openness
• Willingness

Be blessed and to all those who are pregnant – I hope for you to gestate peacefully.

ACOG recently updated guidelines for fetal monitoring in labor.  They call it a refinement.  Very interesting.

Directly from the press release “Since 1980, the use of EFM has grown dramatically, from being used on 45% of pregnant women in labor to 85% in 2002,” says George A. Macones, MD, who headed the development of the ACOG document. “Although EFM is the most common obstetric procedure today, unfortunately it hasn’t reduced perinatal mortality or the risk of cerebral palsy. In fact, the rate of cerebral palsy has essentially remained the same since World War II despite fetal monitoring and all of our advancements in treatments and interventions.” That is an increase in use by 89% with what benefit to mothers and babies? More cesarean?  More interventions and managed labors? Perinatal mortality hasn’t decreased.  Shocking really.   So for the needs and most likely benefit of the truly high-risk moms and babies all women have been subjected to more and more electronic monitoring in labor resulting in more morbidity for mothers and babies.

Apparently a big issue is that there are huge discrepancies in interpretation when assessing the FHT strips by physicians. There was a group of 4 physicians who initially assessed 50 FHT tracings and only agreed 22% of the time. Then two months later the same 4 physicians were asked to re-assess the same 50 tracings and their own evaluations varied nearly 1 in 5.   I have heard this over and over anecdotally from labor and delivery nurses through the years.  That no one can agree.  That the variance is so great.  Better to treat just in case whether by interventions or a cesarean.  I have been told that even a 40 hour course on FHT assessment leaves one without any clear advancement of skill or knowledge. The training actually left one individual less inclined to trust assessment.  So how does this comfort the expecting woman? Knowing that the machine that rules so much of labor and delivery in combination with the human element is so fallible.  Now that is non-reassuring in real life application.

So what can be done?  Unless there is a real high-risk situation that needs to be addressed, ask for intermittent auscultation with a handheld doppler or even better with a fetascope.  When a nurse, midwife or doctor actually listens personally to a baby with a fetascope there is no machine interpreting sound. It is with their own ear and skill assessing your baby.

The other thing to remember is keeping away from routine use of  induction, narcotic use, and epidural use in labor can greatly improve the opportunity to remain low-risk and healthy.  Thus not requiring continuous fetal monitoring.

I only touched on a few aspects of the new guidelines.  For a more complete breakdown of the refined guidelines, the NY Times did a nice piece.

ACOG released a press release today regarding a new practice bulletin revising labor induction guidelines.  Though the practice bulletin is not available on the ACOG site, a detailed review is available by Medpage today.  I hope to soon have the full copy to share.

Some high points I found in the explanation and review of the revision:

• Misoprostol (Cytotec) should not be used to induce any woman with a previous uterine surgery or cesarean due to the increased risk of uterine rupture.
• The Foley catheter is a reasonable and effective alternative for cervical ripening and inducing labor (as stated in my blog earlier this week).
• The recommendation for fetal demise is for induction rather than cesarean unless unusual circumstances present as it is associated with maternal morbidity without fetal benefit.
• ACOG also states that the assessment of “gestational age and consideration of any potential risks to the mother or fetus are of paramount importance for appropriate evaluation and counseling before initiating cervical ripening or labor induction.”
• Admitting to this fact – At the same time, there have been a number of reports linking the induction of labor with increased risk of adverse events including uterine rupture and meconium-stained amniotic fluid.
• “A physician capable of performing a cesarean should be readily available any time induction is used in the event that the induction isn’t successful in producing a vaginal delivery,” notes Dr. Ramin. Although rare, there are potential complications with some methods of labor induction. (perhaps less inductions that are for lack of medical reason will be done if a physician must induction sit?)
• Post cervical ripening whether by medication or mechanical once the cervix is dilated, labor can be induced with oxytocin, membrane stripping, rupture of the amniotic membrane, or nipple stimulation. (using an alternative like nipple stim interesting)

Some low points I found in the explanation and review in the revision:

• The new guidelines include seven recommendations based on “good and consistent scientific evidence” — considered the highest evidence level — including one that sanctions 25 mcg of misoprostol as “the initial dose for cervical ripening and labor induction.” The recommended frequency is “not more than every 3-6 hours.” (I want to see these studies)
• ACOG said that the data on the safety of high-dose misoprostol (50 mcg every six hours) were “limited or inconsistent,” making its recommendation on high-dose misoprostol an evidence level “B” recommendation. (again studies please)
• The practice of inducing labor has become more common. More than 22% of pregnant women undergo labor induction, ACOG says, and the overall rate doubled from 1999 to 2006. (once again – only 22% – this one I need to research)
• Rapid delivery or lack of access to good care at home as a potential reason to induce labor in rural areas.

More possible low points:

• Some examples in which labor induction is indicated include (but are not limited to) gestational or chronic hypertension, preeclampsia, eclampsia, diabetes, premature rupture of membranes, severe fetal growth restriction, and postterm pregnancy.(need more information on how these are defined)
• Low- or high-dose oxytocin regimens are appropriate for women in whom induction of labor is indicated. (Pit to distress with high doses?)

So even ACOG says that induction needs to be taken seriously as there are risks and consequences associated.  Definitely I am in agreement with that. It IS a very big deal and the risks to not having your baby immediately must outweigh the benefits of baby staying put a little longer.