Below is a compilation of common terms and acronyms that women often will come across during pregnancy, labor, and delivery.  Check back as more will be added from time to time.

• AROM – Artificial Rupture of Membranes – using a finger or tool to open the amniotic sac to to allow the fluid to release.
• PROM – Premature Rupture of Membranes – when the amniotic fluids releases before labor starts.
• SROM – Spontaneous Rupture of Membranes during labor.
• ROM – Rupture of Membranes
• Miso – Misoprostol is the pharmacological name for Cytotec a drug used for cervical ripening and induction though a controversial, off and against label used ulcer Medication
• VBAC – Vaginal Birth After Cesarean
• HBAC – Home Birth After Cesarean
• WBAC – Water Birth After Cesarean
• UBAC – Unattended Birth After Cesarean
• CBAC – Cesarean Birth After Cesarean – This is a repeat cesarean after a woman desires and tries to have a vaginal birth after cesarean.
• ERCS – Elective Repeat Cesarean
• RCS – Repeat Cesarean
• Natural Birth – Labor and vaginal delivery free from intervention except for intermittent fetal monitoring. In the hospital only a saline lock and intermittent monitoring.
• Vaginal Birth – Baby born vaginally with or without medication and intervention.
• First Stage – Early, Active, and Transition. This encompasses the effacement to 100%, dilation to 10 centimeters/complete, position movement of cervix from posterior to forward as contractions begin while staying longer, strong and closer together prior to pushing and delivery.
• Second Stage – Pushing phase after cervix is completely dilated to delivery of baby.
• Third Stage – Delivery of baby to delivery of placenta.
• Fourth Stage – First hours after placenta is delivered.
• Oxytocin – A hormone made in the brain that plays a role in childbirth and lactation by causing muscles to contract in the uterus (womb) and the mammary glands in the breast. It also plays a role in bonding with mate, child, and socially.
• Pitocin (oxytocin injection, USP) is a sterile, clear, colorless aqueous solution of synthetic oxytocin, for intravenous infusion or intramuscular injection.
• Prostaglandin – Any of a group of hormone like fatty acids found throughout the body, esp. in semen, that affect blood pressure, metabolism, body temperature, and other important body processes such as cervical ripening.
• Uterus -The muscular organ in which a fertilized egg implants and matures through pregnancy. During menstruation, the uterus sheds the inner lining.
• Cervix -The lower portion of the uterus that provides an opening between the uterus and the vagina. Also known as the neck of the uterus that softens, effaces, dilates and changes position during labor.
• Vagina – A muscular canal between the uterus and the outside of the body. Also known as the birth canal.
• Perineum – The area between the anus and the vulva (the labial opening to the vagina).
• Pelvis -The basin like cavity formed by the ring of bones of the pelvic girdle in the posterior part of the trunk in many vertebrates: in humans, it is formed by the ilium, ischium, pubis, coccyx, and sacrum, supporting the spinal column and resting upon the legs.
• Pelvic Floor Muscles -The sphincter mechanism of the lower urinary tract, the upper and lower vaginal supports, and the internal and external anal sphincters. It is a network of muscles, ligaments, and other tissues that hold up the pelvic organs.  Includes bladder, rectum, vagina and uterus.
• Fundus -  Top of the uterus. During labor contractions the fundus thickens and gets more firm as the strength of contractions increase and dilation increases.
• Placenta -The organ that develops during pregnancy that transports nutrients to the fetus and waste away from the fetus. The placenta is attached to the uterus and is connected to the fetus by the umbilical cord.
• Umbilical cord – The cord that transports blood, oxygen and nutrients to the baby from the placenta.
• Bloody Show – Mucous and blood mixed together as dilation and effacement occurs.  Starts off as blood tinged mucous and becomes heavier as labor progresses.
• Stripping membranes -  Pressing the amniotic sac away from the inside of the cervix.
• Mucous plug - The mucous that blocks off the non-dilated and non-ripened cervix for protection.
• Lochia – Post birth bleeding that though a wound site from the placenta detaching from the uterine wall, it mimics a heavy and long menstrual period.
• Cesarean – Baby born via a surgical incision made through the abdomen into the uterus.
• Obstetrician – Is the surgical specialty dealing with the care of women and their children during pregnancy, childbirth and the immediate post birth time.
• Midwife – Is a person usually a woman who is trained to assist women during pregnancy,  during childbirth, and postpartum as well as the newborn post birth.  There are many types of midwives – some work in the home, at birth centers or in the hospital.
• Doula – Is an assistant who provides various forms of non-medical and non-midwifery support (physical and emotional) in the childbirth process. Based on a particular doula’s training and background, the doula may offer support during prenatal care, during childbirth and/or during the postpartum period. A birth doula provides support during labor. A labor doula may attend a home birth or might attend the laboring at home and continue while in transport and then complete supporting the birth at a hospital or a birth center. A postpartum doula typically begins providing care in the home after the birth. Such care might include cooking for the mother, breastfeeding support, newborn care assistance, errands, light housekeeping, etc. Such care is provided from the day after the birth, providing services through the first six weeks postpartum. In some cases, doula care can last several months or even to a year postpartum – especially in cases when mothers are suffering from postpartum depression, children with special needs require longer care, or there are multiple infants.
• Birth Center – Free standing location usually run by one or more certified nurse midwife. True birth centers are almost always independently run. They are not overseen by a hospital or in a hospital. May be near a hospital. Often set-up like a home birth space and epidurals or other pain medications are not available.   Hospital “birth centers” are labor and delivery floors not birth centers in the true sense of the term.
• Intervention – Anything that does not exist in a naturally occuring labor and delivery that is done.
• Saline Lock/Buffalo Cap/ Hep Lock – Is the apparatus that the IV line hooks into.  It is silicone tubing that is lightweight with a plastic needle that stays under the skin to allow easy vein access.
• Foley – A foley catheter is used to release the bladder if a woman unable to urinate due to an epidural, post surgery, or with a swollen urethra post birth.  It can also be used for successful cervical ripening in lieu of cytotec.
• Induction – To attempt to artificially start labor usually by pitocin, artificial rupture of membranes with or without cervical ripening (Cytotec or Foley Catheter).
• Epidural - A medical method of giving pain relief during labor. A catheter is inserted through the lower back into a space near the spinal cord. Anesthesia is given through this catheter, and results in decreased sensation from the abdomen to the feet.
• Contraction – Tightening and loosening of your uterus. Productive contractions are often felt at the bottom of the uterus, start out like period cramps and progressively grow stronger, longer in length, and closer together.
• Braxton-Hicks – Practice contractions that do not dilate or efface the cervix often felt at the top of the uterus versus the bottom.
• Episiotomy – A surgical procedure to widen the outlet of the birth canal to facilitate delivery of the baby and avoid a jagged rip of the perineum. (Natural abrading or tearing is preferred and episiotomies are not evidence-based to be used except under specific circumstances).
• Ina May’s Sphincter Law -Tapping into the concept that if one sphincter is open and relaxed, the others will also open, relax and be able to handle, quite adequately, the task at hand. This also includes the aspect of birth requiring privacy, sacredness, and honor as well so a woman feels safe, unwatched and supported.
• Kegel Exercises – Named after Dr. Arnold Kegel, consists of contracting and relaxing the muscles that form part of the pelvic floor (sometimes called the “Kegel muscles”).

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.

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.

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.

Normal, natural birth is spoken of all the time in the birth world.  It is discussed on many levels from the evidence of being overwhelmingly the safest and healthiest way to birth, to the emotional aspects of privacy, safety and support,  to following the money trail of interventive birth versus natural birth and so much more in between.

I ponder and sometimes struggle with what to share with expecting families and  how to share it.  Why the struggle?  This normal, natural birth viewpoint is counter-cultural.  I, along with many peers believe in the inherent design of women and babies to work as intended.  There is lack of belief in routine intervention, non-evidence based protocols or practice style that is created around pregnancy and birth being a tragedy in waiting.

Even in trepidation, the truths must be shared and not hidden simply because most of what is seen and heard in our culture is the opposite (think as an example of the media and the dramatic voice over person on those birthing shows).  The longer I am in this field and calling of work, I believe that protecting women from the truth for whatever reason is harmful.  I participated in a Henci Goer session several years ago at a conference that set this ideal permanently within me.  She asked many questions for the participants to answer.  One question was regarding telling options to expecting families even if they are not available locally – should you or shouldn’t you?  I stood for quite a time in front of the large paper on the wall while holding the marker in my hand.  There were many NO’s on the paper in front of me and it took some courage for me to write a commanding YES! next to their responses. I had bucked the trend.  Not easy, not a bit. When all the sheets were gathered and Henci peered at them to discuss all of the responses, she overwhelmingly said we have an ethical obligation to tell it all.  Phew I was not wrong in my group of peers, but sadly most of them said no probably out of the same fear as I had in answering the questions.  That moment gave me great strength and clarity not because Henci said so, rather because I stood in my conviction and faced the fear of being apart from others in the truth.

Why is it of the utmost importance to share all?  Because no one else goes home or remains home with that baby.  The care provider, staff, doula, educator….they all go home to their own lives.  Each expecting family must be able to live with the decisions made during pregnancy, labor, and birth.  Natural birth has many benefits but it isn’t consequence or risk free, so that too must be spoken of.  Each woman must decide what she needs and can best live with as a mother, wife, partner, even as a woman in her community who will go out and share her experiences with others.

I will often tell expecting families who contact me about childbirth education classes that they will receive much more than the anatomy, physiology, comfort measures, etc. from my course.  That very likely it will challenge to the core their beliefs and value systems surrounding what they know in their own birth culture of family, friends and personal history.

I love this work.  I hope someday to be replaced by the community based education women ought get back to. If not, I along with many others will be here to keep the conversation and education moving forward.

Today pregnant women need to be consumers and self-advocates. Many childbirth classes are teaching strategies to better these skills. This is not by chance, but rather by the often one-size-fits all packaging and management from pregnancy onset to labor through immediate postpartum in the care provider offices and hospitals of today.

Many routine tests are done prenatally. Though prenatal care and these tests can help further healthy outcomes for moms and babies, too often women can be funnelled into a cycle of unnecessary fear, stress and choice limitation while in reality still healthy and maintaining normal pregnancy.

Below is a listing of common prenatal tests and practices for you to question (what is it for, what does it improve upon, what can it lead to in other tests or interventions, is it for low-risk moms and babies, what will I do with the information), research and decide on are:

• pregnancy test by urine dip or blood work
• ultrasound to date the pregnancy
• blood pressure reading each visit
• weight measure each visit
• urine test – check for protein in the urine
• fundal height measurement as pregnancy furthers
• gestational diabetes testing
• triple screen testing (AFP)
• just because ultrasounds
• ultrasound for fetal size
• routine ultrasound for fluid level as “due date” approaches
• biophysical profile(s) as “due date” approaches or passes
• membrane sweeping

It is vitally important that you are equipped and aware of your care provider’s philosophy and usual practices.

What are you willing to do? What are you willing to bypass? How responsible for your pregnancy and birth are you willing to assume? At the end of the day you are ultimately the one who has to live with the choices you or your provider make.

Be a driver – you are more likely to arrive at the destination you desire.

Visit http://www.birthingtouch.com/ for upcoming childbirth classes serving the Colorado Springs area and for CAPPA childbirth educator trainings in Colorado, Missouri, and Utah.

• Proper support is important for childbirth – builds confidence in mom, builds safety in mom, lowers complications, interventions, medications and cesareans.
• Induction is only for medical reasons – big baby, past “due date”, tired of being pregnant, care provider preference, upcoming holidays… all put mom and baby at risk for complications, interventions and cesarean.
• Cesarean only for medical reasons – cord prolapse, placenta previa, pre-eclampsia or HELLP syndrome where induction fails, true fetal distress, some breech positions, placental abruption, uterine rupture (there are other less common reasons as well – notice previous cesarean, non-medical reason, large baby, gestational diabetes, obesity, convenience are not on the list)
• Unrestricted movement in labor –
• Pushing in gravity prone positions – only use reclined or lithotomy of mom desires it.
• No separation of mom and baby unless there is a complication.
• Drinking and eating in labor – the uterus is a muscle it needs to be watered and fed.
• Intermittent monitoring of mom and baby – only high risk moms and babies need continuous monitoring.
• No routine medications or interventions – pain management should not be pushed on a mother, episiotomies should not be routine, augmentation of labor should only be done AFTER non-medical methods are tried and patience is used, naturally occurring rupture of membranes, etc.
• Unrestricted breastfeeding access.
• Informed consent and refusal need to be utilized.

Check out http://www.cappa.net/, http://www.independentchildbirth.com/, http://www.lamaze.org/ for resources outside of Colorado Springs, CO (classes, doulas, other related professionals).