Posts Tagged ‘Preparing For Birth’

Throwback Thursday: Dilation Isn’t Everything

Thursday, September 14th, 2017

A look back at one of our most popular blog posts of the past few years. Originally published May 18th, 2015. And still every bit as relevant!

BESTA mother waits patiently on the small triage bed while the nurse concentrates on what her fingers are telling her about the progress of this labor. After a minute, she pulls her fingers out, and chirps brightly, “You are 5 centimeters dilated!” She flips her gloves into the trash can and turns to the computer to chart.

It’s a universal experience going into a hospital in labor. The progress of labor is reduced to a number between one and ten, and nothing else. An hour later, after being admitted to her room, the mother is told she is “still only a 5.” Once again, she isn’t a mother, she is a number. She is left alone to contemplate that, and to deal with it as she may.

Most of us tell our birth stories in terms of this number. “I was stuck at 5 forever!”

What if I told you that this number means very little when it stands alone? What if I told you that your cervix does a whole lot more than just dilate? What if I told you that there are more ways to measure progress in labor than that ubiquitous range of centimeters?

Well, it’s true.

My preceptor and mentor, Desirre Andrews says:

“There is a mystery surrounding cervical dilation and changes prior to and during labor. I like to think of it as the jobs of the cervix. The cervix does so much more than simply opening.”

So, the next time you have a baby, and you are facing a vaginal exam, make sure you ask about what else your cervix is doing!

1. Effacement
Hold up your pointer finger. Touch the second knuckle. From there to the tip of your finger is about the length of your cervix. In order for the cervix to dilate completely, your cervix has to shorten, or “efface,” completely. This is measured in percentages. If your cervix only reaches from the tip of the finger to the first knuckle, you are about 50% effaced. This process must happen before dilation can even occur. In many women, it occurs at the same time or it overlaps dilation. In first time moms, we often see effacement first, then dilation quickly follows. What if our mother was told that, while she was “still 5,” she went from 50% effaced to 90% effaced? That’s progress, people!

2. Ripening
Touch the tip of your nose. (You didn’t know this would be so interactive, did you?) That’s about the texture of a closed, uneffaced cervix. That’s no good for dilation, and it has to soften, or “ripen” in order to do its other jobs. This primarily happens before labor, but can also happen throughout labor. The texture of your cervix must work its way to the softness of your relaxed lips, and then softer still to match the texture of the inside of your cheek. We call cervixes at this stage “soft like butter.” Yet another measure of progress. If our mother were still at 5, but her cervix was much softer and more difficult to feel, that’s progress!

3. Position
To protect your baby, your cervix points towards your tailbone (posterior) during pregnancy, and sometimes even early labor. In order to open and allow the baby to move through it, your cervix must shift its position until it is pointing directly into your vagina (anterior). If our mother were told that though she were “still 5,” but that her cervix was easier to reach, this job has been done, and she has made progress!

4. Dilation
Last, but not least we have dilation. Your cervix must open up from a tightly closed position, all the way up to “10 centimeters.” Really, it’s not 10, though. At this point, nothing can be felt except baby’s head. It’s often now simply called “complete dilation.” The thing to realize about dilation is that it cannot happen unless the cervix is doing all of its other jobs already. They often happen seemingly in tandem, but sometimes a mother will be “stuck at 5” while her cervix is effacing, softening, and moving forward. Once those jobs happen, dilation is a downhill race to the finish (though it may not seem like it).

So, the next time you consent to a vaginal exam in labor, make sure you get more than a number. Ask about effacement, softness, and the position of your cervix. Your cervix is amazing and has a lot more to do than just open. Make sure it gets all the credit it deserves!

Were you informed of the various ways the cervix works before and during labor? How might this change the way you approach your future pregnancy care?

-Tiffany

Drink More Water: Creative Ways to Stay Hydrated in Pregnancy.

Monday, July 6th, 2015

Click to see more posts on healthy pregancy.

Click to see more posts on healthy pregancy.

“Drink more water.”

It seems to be the pregnancy panacea. Having a lot of Braxton-Hicks? Drink more water.

Feeling tired? Drink more water.

Having headaches? Drink more water.

Constipated? Drink more water.

How many of us feel like we are paying our care provider to tell us to stay hydrated? In Colorado it’s doubly tough, because of the arid climate and extreme temperature changes. It feels like we have to drink twice as much as those in other areas of the country to maintain any decent level of hydration, even when we are not pregnant.

Of course, the best way to stay hydrated is to drink water. So, since we should drink more water, we don’t want to drink water. We begin to crave soda, sweet tea, and chocolate milk instead. This is because we are drawn to that which we should not have, by our very nature. Silly humans!

Still, we do get bored drinking plain water. Especially when we think our choices are between crushed or cubed iced. Hydration doesn’t have to be boring though! There are myriad ways to stay hydrated, and here are just a few–some with recipes linked–to get you started:

  • Herbal teas, hot or iced. Most do not contain black or green tea, and are naturally caffeine-free, if that is a concern for you. They also come in a plethora of flavors. The fruit flavors are especially delicious iced in the summertime.
  • Infused water. This is the “in” thing right now. At least it’s in for a reason–it’s delicious! Explore Pinterest for infused-water recipe overload! Like these unique combinations, or these that have an interesting twist.
  • Flavored sparkling water. This works better if you make your own. That way, you can avoid sugars, artificial sweeteners, and artificial dyes. Just mix up some sparkling water with a little bit of your favorite fruit or vegetable juice. Add ice, and enjoy!
  • Eating high-water fruits and vegetables. Think watermelon, cucumber, celery, and others. Of course, you can’t measure those in ounces, but every little bit helps!

“That’s great,” you might say. “But how am I supposed to get that enormous quantity of liquid into me in one day? The simplest way is to treat yourself like a toddler. Rewards. Positive consequences. Bribes. Whatever you want to call it. The simplest form of this is to make it your goal to get your water in by dinner time. Then, if you reach your goal, treat yourself. A square of chocolate, a scoop of ice cream, that movie you’ve been dying to watch, or any other treat that will help you stay on track.

Hydration is important in pregnancy, for so many reasons, but that’s another post for another day.

What are your favorite ways to stay hydrated in pregnancy? What are your least favorite?

Warmly,
Tiffany & Desirre.

Dilation Isn’t Everything: The many jobs of your cervix.

Monday, May 18th, 2015

BESTA mother waits patiently on the small triage bed while the nurse concentrates on what her fingers are telling her about the progress of this labor. After a minute, she pulls her fingers out, and chirps brightly, “You are 5 centimeters dilated!” She flips her gloves into the trash can and turns to the computer to chart.

It’s a universal experience going into a hospital in labor. The progress of labor is reduced to a number between one and ten, and nothing else. An hour later, after being admitted to her room, the mother is told she is “still only a 5.” Once again, she isn’t a mother, she is a number. She is left alone to contemplate that, and to deal with it as she may.

Most of us tell our birth stories in terms of this number. “I was stuck at 5 forever!”

What if I told you that this number means very little when it stands alone? What if I told you that your cervix does a whole lot more than just dilate? What if I told you that there are more ways to measure progress in labor than that ubiquitous range of centimeters?

Well, it’s true.

My preceptor and mentor, Desirre Andrews says:

“There is a mystery surrounding cervical dilation and changes prior to and during labor. I like to think of it as the jobs of the cervix. The cervix does so much more than simply opening.”

So, the next time you have a baby, and you are facing a vaginal exam, make sure you ask about what else your cervix is doing!

1. Effacement
Hold up your pointer finger. Touch the second knuckle. From there to the tip of your finger is about the length of your cervix. In order for the cervix to dilate completely, your cervix has to shorten, or “efface,” completely. This is measured in percentages. If your cervix only reaches from the tip of the finger to the first knuckle, you are about 50% effaced. This process must happen before dilation can even occur. In many women, it occurs at the same time or it overlaps dilation. In first time moms, we often see effacement first, then dilation quickly follows. What if our mother was told that, while she was “still 5,” she went from 50% effaced to 90% effaced? That’s progress, people!

2. Ripening
Touch the tip of your nose. (You didn’t know this would be so interactive, did you?) That’s about the texture of a closed, uneffaced cervix. That’s no good for dilation, and it has to soften, or “ripen” in order to do its other jobs. This primarily happens before labor, but can also happen throughout labor. The texture of your cervix must work its way to the softness of your relaxed lips, and then softer still to match the texture of the inside of your cheek. We call cervixes at this stage “soft like butter.” Yet another measure of progress. If our mother were still at 5, but her cervix was much softer and more difficult to feel, that’s progress!

3. Position
To protect your baby, your cervix points towards your tailbone (posterior) during pregnancy, and sometimes even early labor. In order to open and allow the baby to move through it, your cervix must shift its position until it is pointing directly into your vagina (anterior). If our mother were told that though she were “still 5,” but that her cervix was easier to reach, this job has been done, and she has made progress!

4. Dilation
Last, but not least we have dilation. Your cervix must open up from a tightly closed position, all the way up to “10 centimeters.” Really, it’s not 10, though. At this point, nothing can be felt except baby’s head. It’s often now simply called “complete dilation.” The thing to realize about dilation is that it cannot happen unless the cervix is doing all of its other jobs already. They often happen seemingly in tandem, but sometimes a mother will be “stuck at 5” while her cervix is effacing, softening, and moving forward. Once those jobs happen, dilation is a downhill race to the finish (though it may not seem like it).

So, the next time you consent to a vaginal exam in labor, make sure you get more than a number. Ask about effacement, softness, and the position of your cervix. Your cervix is amazing and has a lot more to do than just open. Make sure it gets all the credit it deserves!

Were you informed of the various ways the cervix works before and during labor? How might this change the way you approach your future pregnancy care?

-Tiffany

Homebirth: The Basics.

Monday, March 2nd, 2015

General Information

The Safety of Homebirth

Other

My Favorite Colorado Springs Midwives

Preparing For Birth Has Moved!

Monday, May 12th, 2014

We are still at the same address, but we have moved upstairs into a new, more spacious office suite. We are now in Suite 201, just at the top of the stairs. The very first door. We now have three midwives working out of this office, and five doulas, all of whom are a joy to work with. Classroom space is bigger, too, which excites me to no end!

As I grow in my business, I am learning so much, and I am grateful to be a part of Preparing For Birth as it grows to better serve our community with more options for women during the perinatal period. From Early Pregnancy classes, to Essentials for Childbirth, to Life With Baby, Pregnancy Fitness, and Breastfeeding classes, we really are covering a wider range of needs at an affordable price.

Stay tuned for more information!

Grace & Peace,
Tiffany

Preparing For Birth Game Night!

Wednesday, April 9th, 2014
Click here to visit the Preparing for Birth site.

Click here to visit the Preparing for Birth site.

Preparing for Birth is opening our doors for a night of postpartum themed games, food, and fun! All are welcome.

-Henna: Like face painting for grown-ups!
-Babywearing: Try various carriers, and get tips!
-Cake: Who doesn’t love cake?
-Food and drinks.
-Postpartum-Themed games and activities: Yay activities!

We can’t wait to see you and your family.

Warmly,
Preparing for Birth

To RSVP on our Facebook event, click HERE, or just show up!

Nuts & Bolts: What exactly am I paying my doula for?

Monday, October 14th, 2013

Image credit: shipulski.com

Next to finding a good personality fit in a doula, financial concerns are probably the biggest factor in choosing which doula to hire, and many potential clients ask me exactly what the fee covers. In some ways, that’s an easy question to answer: “My fee covers x number of prenatals,  labor, birth, and immediate postpartum, and x number of postpartum visits, as well as unlimited phone/text/email support.”

In other ways, not so much. Doulas have to strike a balance between affordability for clients, and maintaining a sustainable practice. This can be tricky sometimes, and often takes a lot of time (and mistakes) for a doula to figure out how to structure her individual fee. Finding that happy medium is essential: 1) to prevent burnout from being constantly on-call, and 2) to reach the widest economic base they can.

Basically, a doula is going to base her fee on a combination of a few factors. Her experience, how many births she can take on in a month, and her business expenses are all part of the equation.

Now, no doula enters this profession thinking, “I’m going to make it rich doing this!” No, indeed! Doulas are all heart, and do this work because they can’t not do it. Beyond their hearts, though, a doula does have to consider the financial part of the equation, because it would be unwise not to. After all, just because she had a light month, as far as births go, doesn’t mean her rent won’t come due.

That said, I would like to explain, as simply as possible, what a doula’s fee covers–both for the client, and for the doula herself.

Nuts and Bolts–What the fee covers for the Client:

  • 2-3 prenatal visits.
  • Labor, birth, and 2-4 hrs. postpartum.
  • 2-3 postpartum visits.
  • The tools in her birth bag.
  • Unlimited phone/text/email access. A doula’s time spent just communicating with her clients can quickly add up to several hours a week in order to make sure the client has all the emotional and informational support she needs.
  • Usually four full weeks of on-call availabilty, during which she cannot leave the area, must take her own car everywhere, and cannot make any firm commitments.
  • Objective help writing a custom-tailored birth plan.
  • Continuity of care throughout pregnancy, labor, birth, & postpartum period.
  • A walking birth encyclopedia.
  • Someone dedicated to keeping the environment peaceful.
  • A skilled communicator that helps create positive dialog among members of the birth team.
  • Specific to the doulas here at Preparing for Birth: Guaranteed back-up doulas, and continuous access for the doula to an experienced mentor when things get “interesting.”
  • A professional person with an emotional investment in each client’s care, who answers only to the client–not to hospital staff, doctors, or other family members.
  • If you’ve had a doula in the past, what might you add to this list that your doula did for you?

Balanced with the above are the doula’s financial needs. In order to do such demanding work, doulas need to charge enough that they can take enough births to meet those needs, but not so many that they burn out. Let’s face it: Living on-call nearly 24/7 most of the year can get exhausting for anyone–no matter their profession. Below is a basic explanation of where the doula will put her fee to good use.

Nuts & Bolts–What the Doula needs the fee to cover so she can keep working:

  • Childcare, if she has children too young to stay home alone. Most doulas pay their childcare person by the hour, and if a birth is long enough, that can add up to a significant portion of her fee. It’s probably the single biggest cost factor in this work.
  • Her time. Probably the second-biggest cost factor when setting a fee.
  • A back-up doula, on the off-chance she can’t make the birth.
  • Phone & internet bill, including website fees.
  • Gas money & mileage on a personal car.
  • Office space, even if it’s in her home.
  • Basic business supplies (paper, printer ink, files, etc…)
  • Business checking account
  • Certification Fees
  • Taxes and state business fees
  • Birth bag tools, some of which are costly, and all of which need to be replaced periodically.
  • Promotional materials and marketing.
  • Continuing education.
  • Professional memberships.

Most doulas spend a minimum of four to eight hours with their clients prenatally, as well as another two to four during the postpartum period–not including phone calls, emails, or texts. When the time spent with a client during her labor and birth is factored in, many doulas will need their fee to cover anywhere from 16 up to 36 hours or more of time, in total. If that were the only factor to consider, let’s take a look at what a Colorado Springs doula “brings home.”

Doulas in Colorado Springs charge anywhere from about $300 up to $650, which is actually somewhat less than other cities in the U.S. of similar population size. Doula’s fees range from $500 up to $850 or more (some go higher than $1,000) in other comparable cities (based on an informal poll I took in a birth professionals group).

So, if hours were the only factor, a Colorado Springs doula grosses about $19.00 to $40.00 per hour, for each client, at the minimum amount of hours she might work. This is before any of the other listed factors come into play. When those are factored in, what’s left for her time is often less than minimum wage.

Do you know what? It’s worth it for doulas! It’s enough for many just to be there, in that sacred birth space, participating with a family the way they do. Quietly going about their doula business caring for and nurturing a new family in the moment of its expansion, melting into the background, and holding space for the mother-baby unit to hold their focus. There is nothing like that moment when a woman looks up at her partner, that wet baby held tight to her chest, with tears in her eyes, saying “I did it!”

Doulas love what they do, and they share that love and passion with each family they serve.

Taking all this into consideration, hiring a doula is probably one of the most valuable things a mother can do for herself. Forget the fancy nursery decorations, stroller, and extra stuff. Instead, a mother can invest in customized, top-of-the-line, evidence-based care by hiring a doula–and get the best deal of her life for one of the most important times in her life!

Wondering how to afford a doula? Keep an eye out for my next post, with tips on how to get creative with finances to do just that!

I had a lot of help in putting this post together, and I just want to give a shout-out to my fellow doulas at Preparing for Birth: Sarah York, Christin Yorty, Rachel Madrigal, and Jamie Nyseth. Each of these women serve as wonderful peers and fresh perspectives, and I am privileged to work with them. Click HERE to visit each of their profiles.

Grace & Peace,
Tiffany

Dad Matters – A doula’s perspective

Sunday, September 29th, 2013

Many men in our culture are fairly apprehensive about birth. Most have never seen a real birth, or talked about it outside of sex ed. They are often nervous about birth itself, seeing their partner in pain, the what-ifs, and all that may come after. They doubt their ability to support their partner in her journey, and wonder if they’ll be strong enough.

In fact, they often doubt and fear and wonder just as much as their partners do, but are often not allowed to express it, because they’re not the ones giving birth, so they feel that they don’t really matter. They may feel like they don’t have much voice in the process, and are just expected to go along for the ride, smiling and nodding whenever the experts speak.

Yet, at the same time, they are expected to know everything about birth, protect their partner, communicate her wishes, and support her physically and emotionally without pausing for breath.

Many worry that they just can’t live up to all of that. It really is an awful lot to ask of one human being, after all. Especially since history shows us that there have always been many support people surrounding a mother during birth.

Still, many men don’t realize just how much they are capable of. They don’t realize that they matter, too, and that they can enter their partner’s birthing space with confidence, ability, and strength to meet the challenges of supporting a labor and birth.

 

So, how do we help fathers to step into the birthing space with confidence?

 

We free them to be who they are, that’s how. We let go of our expectations, and help them to form their own expectations and desires for supporting the birth of their child. We help them to see that they alone can define their role in the drama and sacredness of birth.

I would suggest two important things that may help a father gain confidence and acquire tools to help him fulfill the role he wants to play during birth: 1) Independent childbirth education classes, and 2) Hiring a doula.

The more a man knows, the less he will fear birth, and taking Childbirth Classes is one of the best ways to lower anyone’s fear level in anticipation of birth. Many men appreciate information given in practical, interactive ways, and independent childbirth classes are often right up his alley. He can join with like-minded dads, ask questions, and have his concerns addressed more readily.

Information is a great, big factor in helping couples manage their stresses and fears regarding birth—as much for the father as it is for the mother. As an educator, at the beginning of a series, I usually see high levels of apprehension, which quickly fade from week to week, to be replaced by realistic expectations and informed confidence in both parents.

This is just as powerful for the father as it is for the mother. When Dad has confidence in Mom’s ability, she believes in herself all the more, and Dad begins to see that he has power to influence her for the better! Dad is able to acclimate himself more readily to the realities of birth, and begins to realize that he is an important part of her support team. Perhaps the most important part.

He feels a little more ready to step into his support role, and probably has clarified what he wants that role to look like. He will feel more confident about what he can do, and more realistic about what he might not be able to do.

 

In which case, he may begin to consider…

 

Hiring a Doula to help him fill in the gap in the support team he might not be able to fill himself. If he participates in choosing and hiring a doula, he is much more likely to have his own expectations met, as well as those of his partner. When Mom and Dad are both fully supported, Dad is far freer to just be and do what his partner needs him to be and do.

While he will likely remember a lot of what he has read and learned about, that information may become secondary to him during the birth, and take a backseat to more immediate concerns in his mind.

He may become simply focused on loving this woman who is birthing his child. And why shouldn’t he? Why should he have to remember every counter pressure technique? Every massage technique, position change, or even the water jug and bendy straw? Why shouldn’t he be the face close to hers, his eyes beaming his love, concern for, and confidence in her?

A doula allows Dad to be front and center in the support role he always wanted to fill for Mom, in whatever way makes the most sense for their individual relationship in this particular moment. If he wants to be the Expert – he ought to be equipped to do that. If he doesn’t, then he needs the space and freedom for that, too. Or anything in between.

When he is free, all his anxieties and apprehensions tend to fall away, and he finds that birth is a challenging, beautiful, amazing space to be in with his partner. He finds that he is strong to meet the challenge, just like she is. Together, they grow in strength and confidence, becoming truly ready to meet this tiny new person they have made.

Doulas help open wide the door, making the birthing space more navigable, understandable, and pleasant for fathers. This, in turn, can only benefit the mother as she is able to rest in the support of her birth team. She no longer feels concern for her partner, because he shows no reason for her to be concerned. She is able to just birth.

Then, we can just step back and watch, as he exceeds all the expectations we have laid on him, and as he steps into Fatherhood in the way that makes the most sense to him and his new family.

Tiffany Miller, CLD, CCCE

This Is Hard.

Friday, May 31st, 2013

I can no longer describe myself as a stay-at-home-mom. Of course, I am still home the majority of the time, but I am definitely working more now.

Slowly, my business is building and increasing. I have at least one client a month through July, and a few births a month with Desirre as her assistant. Also, I am still teaching as the only educator at Preparing for Birth. That work will have some relief soon, as one of our other doulas is pursuing her childbirth education certification too. She’s student teaching under me right now.

Needless to say, I’m officially a Really Busy Mom. Adding work hours has been tough. Tougher than we thought it would be as a family, but we’re working out the logistics pretty well. I am so grateful that my husband is not just grudgingly supportive, but encouragingly so. He has really stepped up to help on the days I have to go in to work, or get called to a birth.

In addition, with my mom living here for now, we have had some welcome relief. She cannot help but pitch in and do things that need doing around here. She is a beautiful gift. She would make a great postpartum doula.

I know that I am called to this work. When doubts creep in, someone always comes along to remind me of the truth of my calling in birth work. They usually don’t know that’s what they’re doing, but it is.

God is faithful, and is holding me up in this journey.

This is hard, but I am glad I am here.

What has been worth it in your life, in spite of difficulty? Why?

Grace & Peace,
Tiffany

Scavenger Hunt Contest

Monday, December 3rd, 2012

Preparing for Birth is having an online scavenger hunt to ring in December.

 

You could win this cute pocket diaper.

 

Here is the scavenger hunt:

Answer:

1)      How many births has Desirre Andrews attended?

2)      Name a doula that is working through Preparing For Birth?

3)      How many on average gel capped pills can be made from a placenta?

4)      What breast pump brand does Preparing for Birth have for sale?

 

Answer these and provide a link to the source:  

5)      What is the most common risk of induction?

6)      What is an evidence based reason for induction?

7)      What is the Bishop Score used for?

8)      What are Daniel Berwick’s three principals of patient centered care?

 

Find:

9)      A picture of a child nursing in a funny position.

10)   A picture of artwork that’s at least 100 years old depicting a woman in labor.

 

Bonus Questions:

1)      What is your favorite pregnancy or childbirth related blog?

2)      What is your favorite pregnancy or childbirth related book?

Send your entry to nichole@prepforbirth.com by 9pm Wednesday December 5th.

The winner will be announced Thursday, December 6, 2012, and must be able to pick up the prize in person. Everyone who enters will get a coupon for a free birth or postpartum plan session with one of the doulas from Preparing For Birth.