There is a segment in the birth documentary, The Business of Being Born, where an obstetrician is being interviewed about her opinions on midwifery care and homebirth. She says it scares her, and "can they even monitor a baby at home?"
To those of us who are familiar with midwifery care, this is hilarious... and the answer is a resounding "of course!" However, with more than 90% of women never experiencing what prenatal care with a midwife is like, it's completely reasonable for people to be unaware of a midwife's capabilities and maybe have some reservations about the level of care they can even provide. I admit, the first midwife attended birth I heard about involved a cabin and a boiled shoelace. I was horrified, as I'm sure most modern women would be.
I thought it might be fun to share with you what an appointment with my midwife, Jill, here in Salinas is like. People are usually shocked that my appointments typically run an hour, sometimes more if we get chatting. Some midwives work in offices alongside obstetricians, some work in birth centers (we don't have that option here either), some have their own offices where they conduct appointments and some come to the homes of their clients. That is what mine does, usually while my kids nap.
Jill always begins with how I'm feeling and asks lots of questions about how I'm doing both physically and emotionally, which I appreciate since I have an awful memory and I often forget everything I wanted to ask if I get rushed. We talk about what I'm eating, what supplements I'm taking, and because I have gestational diabetes, we discuss my blood sugar levels over the last couple weeks which I've recorded for her. She takes down my weight and adds notes to my chart.
Then Jill check's my blood pressure. It's usually perfect, better than usual for me actually, but if it's a bit high I lay down and we take it again... just in case.
This is my favorite part of our appointment, and what I most miss when I see an obstetrician. Jill checks the position of baby by palpating my belly. I know that an OB can give me the same information with a quick ultrasound, which is why many OB's don't know how to palpate... but it's not the same.
Baby was awake and very active this day but Jill finally cupped her hand near my ribs and said, "there... that's a little butt there," and near the left side of my pelvis, "and here's a head, baby is really having a good time in there wiggling around."
Then Jill checks my fundal height, which is the length in centimeters from the top of the pelvis to the top of the uterus, or fundus. Every centimeter equals another week. We just want to make sure I'm growing. Here I'm 33 weeks, I measured 35. Baby feels like it's average sized but she could feel lots of fluid. My babies are typically well cushioned... and whoever is unfortunate enough to be in the splash zone when my water breaks usually needs a change of clothes.
This one goes out to that OB in The Business of Being Born. Jill always brings her doppler, which allows her and anyone in the room to hear baby's heartbeat. While we have used it a few times, I usually ask her to use the fetoscope to minimize baby's exposure to ultrasound.
After feeling where baby is Jill typically finds a heartbeat right away, and today was no different. The first time I saw a fetoscope I thought it was ridiculous looking, but it's specially designed to use the practitioner's forehead to conduct sound. I can't hear baby, but it's a worthwhile trade off to minimize exposure and risk to baby. My choice, Jill and many other midwives are happy to use the doppler too.
Next I get my feet and ankles checked out for and signs of edema, or swelling, which could indicate problems related to gestational diabetes or preeclampsia. Thoroughly screening for any thing that may need medical attention is a huge part of our appointments and we always air on the side of caution.
We do a urinalysis to check for protein, sugar, blood, ketones and leucocytes (white blood cells)... which tell Jill all kinds of stuff. Late in pregnancy protein may indicate preeclampsia. Protein can also indicate a urinary tract infection or a kidney issue. Sugar could indicate that the gestational diabetes is not being controlled. Ketones show up when the body burns fat instead of carbs and could mean I need to be eating more (never an issue... I eat a lot!). Leucocytes or bacteria would mean that there is an infection.
I totally should have done my nails, that's not a weird happy face on my thumb nail, that's badly chipped polish. Jill checks my hemoglobin with a simple finger prick. Hemoglobin is a protein in the red blood cells that carry oxygen. Mine is a little low so I supplement with Floridex, a liquid iron supplement that I highly recommend to any mama with low iron.
We finish up with a drum circle and hallucinogenic herbs... ok not true... two people can't make a circle. An appointment with a midwife is really not that much different from seeing an obstetrician, you get all of the same important medical screening, plus added attention to how you are doing as a whole and a more hands on approach to care. I don't feel like I'm being examined as much as I feel like we are working together to make sure baby and I are healthy.
I don't like the term "Natural Induction." There is nothing natural about inducing labor. I believe babies are best at choosing their birthdays, however, there are times when the risks of continuing the pregnancy outweigh the risks of attempting to induce. Seeing 40 weeks come and go, a looming holiday, or wanting your body back (trust me, you don't get it back because baby has left the building) don't qualify. If your body and baby are ready for birth, and your pregnancy needs a gentle push to the finish line, these are some possibly options.
The reason I went deep into researching induction (natural, mechanical or chemical) is because with my babies I've had gestational diabetes that tends to spiral out of control at 37 weeks. I've delivered at 41 and 38 weeks, and delivering instead of struggling with ever increasing insulin doses was a better option for us. You should always weigh the risks of encouraging labor vs the risks of continuing the pregnancy. Yes, a baby might be viable at 39 weeks, but in the process of forcing a delivery you may cause a problem that otherwise wouldn't be there (ie, injury to baby, NICU stay, infection, maternal hemorrhage).
Some people argue by doing this you wont be having a natural labor/birth. I get that, I respect that perspective, but if your options are this or a possible hospital induction with Pitocin... these are good tools to have in your toolbox just in case.
So... this is just what I have done, some things I've experienced and learned in my own pregnancies. This is not medical advice, I still suggest you talk to your doctor or midwife.
RRL - I half heartily do red raspberry leaf (RRL) tea throughout the pregnancy. It is supposed to improve uterine tone, so when you are in labor your contractions will be more effective, strong uterus's do a better job at pushing out babies. I like science and studies and statistics, so I don't really know how helpful this really is because I've never found much science behind it, but I put it in my "hey it can't hurt" category. I recently learned you can take capsules and I also heard you can get a tincture which is stronger/more effective.
EPO - At 36 weeks I start taking evening primrose oil (EPO). When I asked my OB about it during my first pregnancy he didn't seem to think it would do any good... but... after reading into it I learned that EPO is high in prostaglandins. I'm sure you've heard to have sex to induce labor, well the reason for that is because semen is also high in prostaglandins (helps sperm accomplish mission impossible). Also, once when I was researching chemical inductions (what you will encounter in a hospital) I learned that the cervix ripening cream/tampon often used, Cervidil, main ingredient that makes it work are prostaglandins - but from pig semen, which I personally find gross. EPO doesn't start labor, it softens/ripens the cervix which is an essential part of birth. Starting at 36 weeks I take 1000mg 3X a day orally and insert one up against my cervix at night. I know some women who use the oil as a lube... double prostaglandins score! (update: I've since read that EPO may increase risks of bleeding, I did not take it with my 3rd of 4th pregnancy.) (update: I've learned that EPO does not have much research supporting it, and may increase bleeding issues. I did not take it with my 3rd or 4th pregnancy)
Sex - Like I said I'm sure you've heard this, everyone loves to suggest it, but sex totally does work. Lots of reasons... because of the prostaglandins, and orgasms cause uterine contractions (gentle, nothing that will start labor but like a little uterus workout) and your body releases oxytocin, which is also released during labor. If you choose a hospital induction you will likely be giving Pitocin, which is a synthetic oxytocin (only instead of gentle contractions it'll make your uterus contract painfully hard and can distress baby). Knowing this, I never let our sex life go during pregnancy, esp the last month. Uhhh am I gonna share this? Yeah... of course I am... we even had sex during labor (my water hadn't broken) and it totally kicked things into high gear, I started transitioning a little over an hour later!
Nipple Stimulation - Nipple stimulation also releases a lot of oxytocin. I know some hospitals even suggest women use breast pumps and have them available.
Herbal Tinctures - During my pregnancy with Ash my midwife suggested a "mother's blend" tincture, which you can get from someone trained in Traditional Chinese Medicine. I wasn't a big believer but I figured, 20 bucks, I'll try it. SO impressed! My Braxton-Hix contractions really would kick up, not in frequency but just in strength. While this was annoying, like labor I knew it was doing something important. The day I finished my bottle, 37w5d, I saw my midwife, asked her to strip my membranes (sliding a finger into the cervix to slightly separate the bag of waters from the uterus, which releases hormones). I went into labor the next morning, it was awesome. This just strengthens your uterus, the tincture I used contained black cohosh, partridge berry, and black haw. Did I mention I walked into the hospital 9cm dilated and ready to push and I had experienced almost no pain? While I partially credit preparing for a natural birth/being informed/relaxation, I think everything I did to strengthen my uterus and soften my cervix made labor a lot easier... if such a thing exists.
Walking - Walk and stay active right to the end. Use gravity, the swaying motion of walking helps baby settle into your pelvis and his or her head will put more pressure on your cervix. I do lots of squatting, like just when I'm playing with the kids and stuff, because that helps baby settle down more also. I also watch tv on one of those yoga balls and bounce. Anything to help to get baby low and ready to go :)
Membrane Sweep - This is the most invasive and some women complain that it causes uncomfortable cramping. During a pelvic exam your care provider inserts a finger into the cervix and separates the bag of waters from the uterine wall just a bit, which causes prostaglandins to be released. If this is your first baby, don't get your hopes to high on the sweep working, it's more effective in women who have already had a baby... but if you feel comfortable with the idea of trying it then it's a great option.
What else have I tried? Everything. But the above are what make the most sense from a scientific and logical stand point in my opinion. I've also drank castor oil (there's a video, I'll post it at the end, castor oil sucks), spicy food, ate a whole pineapple in one sitting (the internet told me to), balsamic oil vinaigrette, date fruits, bananas and acupressure but in acupressure's defense, I think I did it wrong at the time.
Something to remember is that if this is the first time your body has ever birthed, it might not respond, just as it will be less likely to respond to an induction in a hospital. On average, first time moms will go into labor at 41w1d... I know... no one likes hearing that... that's just average and not a death sentence. Ideally you can just enjoy the last weeks of your pregnancy, but I hope you find the above suggestions helpful should you need them.
Last year I ran my first half marathon (13.1 miles). I had never run more than 6 miles, but 8 weeks after Ash was born and 12 weeks before the race, I signed up. I googled "half marathon training," picked out a schedule at random, bought some shoes, and hit the roads. A few weeks into training I was experiencing a lot of hip pain, but running hurts right? I pressed on. I lost 3 toe nails, nursed blisters, battled numb toes and endured persistent ankle, knee and hip pain. Race day came and 6 miles in I had shaved a full minute off each of my mile times, 7 miles in I realized I had made the novice mistake of not pacing myself properly. I was too low on energy to effectively take on the hill the stretched from 6.5-8 miles and had to walk.
My goal had been to run the whole thing and to finish in under 3 hours. I finished the race in 2 hours and 48 minutes. I should have just been happy with the end result, but I was unsatisfied with the experience and felt ill aftwards so I wasn't able to really celebrate with the other runners. No one told me it was essential you don't drink just water during the race and I was nauseated and dizzy. There were so many things I could have done to improve the experience and perhaps even the outcome if I had sought professional guidance before hand.
If I were a gazelle, this would have been no problem. Animals that are meant to run go from womb to ground ready to get their legs under them. A coach doesn't circle around giving tips, they just know. Just as soon as little ducklings crack through their eggs and dry they are ready to hit the water, mom is not lining anyone up for swimming lessons.
"Human beings are the only animals I could think of who drown when dropped in deep water; all other animals I know or could remember from my youth know how to swim, and do so immediately and perfectly when immersed.... Does that mean that we should curse our Creator because He apparently shortchanged us and "forgot" to give us this knowledge?" - Dr. Robert Bradley in Husband-Coached Childbirth
Animals are blessed with instincts to guide them and humans are expected to learn. I'm sure most of you picked up early in this post that my decision to train for my race myself was not going to go well. Well, then how is it that so many women walk into labor and delivery untrained for the event they are expected to complete? Is there any surprise that not long in they've slowed to a walk, experiencing challenges that a trained woman might have avoided, or are unable to reach the finish line on their own two feet and are having their baby pulled out with forceps or is being wheeled into the OR for a cesarean?
"God gave us a magnificent brain capable of abstract thinking, a high level of communicative ability, learning, retention, reasoning, and so forth.... a woman who doesn't know how to swim is given nine months' notice that she will be thrown in deep water. Let's assume that during that nine-month period she does not avail herself of classes where swimming is taught. This is as unreasonable as one who knows she is pregnant, does not know how to act in labor, and then during her nine months does not bother to attend classes in the conduct of labor. The results in both cases would be horrible to behold, particularly by someone who loves the participant." - Dr. Robert Bradley in Husband-Coached Childbirth
For my second half marathon I signed up for a 12 week training program. Under the guidance of skilled coaches I experienced fewer injuries, improved my performance, and I gained a toolbox full of solutions for common running challenges. I completed my second half marathon 13 weeks pregnant, improved my time by 20 minutes and felt GOOD afterwards. Honestly, it's amazing I finished my first race at all considering how uninformed I was! I can make a similar comparison with my first and second birth!
It's scary that something as important as giving birth is our responsibilty to learn, but we are well prepared for the task. Before birth moved to hospitals, women taught women to birth. Daughters grew up comfortable with the normal processes of labor, perhaps even attended the births of her siblings.
The fear of the unknown, of what happens behind those sterile doors, did not exist. She saw skilled women bring babies into the world safely and women working hard, perhaps experiencing pain, but she saw that women's bodies were capable (yes women died in childbirth, but not necessarily because they were at home or attended to by women).
"There is nothing more pleasurable to observe than an expert human swimmer frolicking in deep water. Similarly there is nothing more marvelous to behold than an expert, educated, trained human mother giving birth. - Dr. Robert Bradley in Husband-Coached Childbirth
I talk a lot about birth's design, and women educating women is apart of it! Imagine if we had all the confidence and understanding of a girl who grew up comfortable with birth only now we have antibiotics and clean water. We'd be unstoppable right?
Congrats to Glimmer & Gilroy Van Frost on the birth of Evergreen Sparkle, our first Birth Boot Camp birth in the North Pole!
I totally want to paint my birth ball to look like an ornament now... and I'm kinda digging the name Evergreen.
I don't know about you, but when I'm pregnant I could live off of ice cream. While half a cup of full fat natural ice cream is a fine nightly treat, it's not the best idea for breakfast, lunch, and dinner (if only!). My way around that? Smoothies! This is my favorite protein packed smoothie that I enjoy during... and between... my pregnancies!
Green Protein Smoothie
Green smoothies are packed with nutrients, and if you include Greek yogurt, with protein too. The recipes are very forgiving and you can add all kinds of stuff to change up the flavors. Protein: 15g.
1/2 cup Greek yogurt, plain, look for 23g protein per serving!
2 Tbs milled flax seed (you can leave it out if you don't like the texture)
Spinach, a big handful
Stawberries, a handful
Handful of ice
Put in blender... and blend.
Tip: I freeze my bananas and strawberries in premeasured baggies.
Natural Birth Series
Sept 28 – Nov 15
Infant Sleep for Expecting & New Parents
6:30pm - 9:00pm
Gentle Cesarean: Planning & Recovery
Toro Park, 3-6:30pm
Natural Birth Refresher
Salinas, 1– 4pm
Preconception & Early Pregnancy Class
Salinas, 1– 4pm
Sibling Prep for Parents & Kids
November 4th & 5th
Toro Park, 2:-4pm
Fall Home & Birth Center Birth Series
Nov 7 – Dec 12
Natural Birth Series
Nov 29th – Jan 17th