The birth marathon.

Though I would not consider myself an athlete, or a true "runner" for that matter, I did run a 5k race last spring for the very first time. It was completely and utterly exhilarated at the finish.  While a "5k" is a mere 3.14 miles (its okay, you true athletes out there can scoff a little), I did need to prepare myself for this, being that the farthest I had ever run before was about 2 miles. Ha. In the weeks leading up to the race, I tried to run daily, build my endurance, practice my breathing so I wouldn't get a side ache, and pace myself to go the distance. I ran a little farther each day so that I could be ready. When I crossed the finish line (no where close to being in first place, I might add), it felt amazing. I ran. The whole way. Without stopping. I may not have been the fastest, but I still finished. I was very proud of myself for that.  As spring has come around again, I have been thinking that I would love to experience that feeling again of pride and accomplishment, and how good my body feels after doing something like that. It makes me want to challenge myself to run a little longer race this time. Maybe train harder too.

                                                  My friend Hannah and I after the big race!

As I have been talking with some of my clients and other expectant mothers about birth lately, I cannot help being reminded that preparing for the birth process is SO much like preparing for a big race.  Can you imagine trying to run a marathon, without ever having run more than a mile or two in your life? That would be crazy. Yet, I see that a lot of women in our society aren't giving themselves the gift of preparing for birth like they could. Some women count on their doctor for all the childbirth education they need, "A Baby Story" and "What to Expect" as their go to information for birth, and the epidural for complete coping in labor and birth. How much more could they gain by truly taking the time needed to prepare for birth? Even women that have often spent a good amount of time preparing for their first baby, will see how much more valuable that can be for subsequent pregnancies. I don't want ANYONE reading this blog to find themselves in this place. I want you to feel empowered and equipped that if it is your first birth, you have dedicated yourself to preparing for your best birth possible. Then you can have no regrets.

Marathon runners have to prepare even more for their races. When I was looking around on the specifics about what they exactly "do" to train well, it is almost shocking how much it mirrors good preparation for the birth experience. One of the first things highlighted that I found was MOTIVATION. This is key to preparing for the birth process. If you want a beautiful birth, you need to be motivated to make it happen by finding the right care provider, the right birthing environment, and being prepared mentally and emotionally for this great task at hand. You also need to determine your GOALS. What is it that you want out of your birth? What is your birth plan? How do you make that happen?  NUTRITION is huge. If you are eating processed foods, lots of carbohydrates, sugar, caffeine, etc, how do you expect your body to go the distance in labor? You need to strive to feed the "machine" nourishing and vitamin rich sources of food both prenatally as well as during the labor process.  Finally, TRAINING your body physically can be huge. It is important to be in good physical shape for birth. What are you doing to prepare for that everyday? Walking? Yoga? Breathing exercises? Relaxation techniques? Just as it would be difficult to expect a body to run more than 26 miles if it wasn't prepared to do so, it is going to be difficult to handle the emotional and physical aspects of labor if you aren't prepared to do so.

I believe that every expectant mother can make these things a part of her weekly routine leading up to birth! Please give yourself that gift. Your body and your baby will thank you for it, and after the birth you may enjoy one of the most exhilarating moments you have ever had in your life.

Pack your bags!

I bring a birth bag with me to all of my births that has lots of goodies in it. What is even better at a birth is when a family comes prepared with their own bag of goodies, because it will be so much more meaningful and personal to them. I often encourage my clients to pack once the labor has started, since it is usually best to try to stay at home as long as possible, unless you have a medical reason to go into the hospital immediately upon onset of labor. Remember, always listen to your intuition and what your body is telling you about when you should leave for the hospital or wherever you will be birthing.

The following are things that you may find helpful during your birth. Feel free to tweak this and make it right for you.

A small gift of chocolate, etc to give to the nursing staff (it's always nice to come in and have them love you already!)

Several copies of your 1 page birth plan-- and tape to tape one onto your door for all who enter to read.

A sign politely requesting quiet respectful voices.

Electric Candles.
Christmas lights
Essential Oils (or other scents you like, natural ones enhance labor best)
Your own sheets, pillows, comforter (maybe even a second set for your partner's bed)
Your own clothes (something comfortable, loose, that opens at the bottom-- a cotton night dress, big T-shirt, etc.)
Sports bra and or swim suit to get into the tub or shower with, if you are wanting to be more modest
Swim wear for your partner's bed
Music. A wide variety of soft and calming, to up beat and energizing.
Comfy slippers.
Large towels (if you want, the hospital usually has thin small ones)
Things that remind you of home/ focal points (pictures, plants, memorabilia, art, etc.)
A robe to walk the halls in.
Hair tie/ head band
Small crock pot with ginger for warm compresses while pushing
Honey sticks
Snacks and foods you like that will keep your energy up (fruit, nuts, cheese, hard boiled eggs, oatmeal, yogurt, LARA bars)
Personal water bottle.
Personal Toiletries (Its always nice to have your own shampoo and soap that smells like home)
Comfy clothes and nursing bras for post birth.
Your own birth ball, rebozo, and massage tools.
Computer and phone, chargers, camera, video camera.
Quiet work for slow or restful times.
Phone and email list of your support team (Lactation, Pediatrician, Chiropractor, Cranial Sacral Therapist, Someone who you know would be encouraging if you needed it during or after birth, etc)

Just thinking ahead about how you want to make your environment comfy for you will probably help you think of your own ideas. The possibilities are endless! I would love to hear about the unique things some of you have brought with you to your births.

What if your baby is breech? Part TWO.

Let me begin by saying that what I am about to share is not only for mothers of breech babies, it is for any mother who wants to help her baby be in an optimal position for labor which in most cases helps to make the labor shorter and easier for mother and baby. I can hardly believe that I have not written a post about this resource before, as I feel very passionate about its content. I can usually barely refrain from telling any woman about it, let alone you all!

Gail Tully, a local midwife, has some wonderful information and evidence that suggests babies CAN and DO turn before labor and even during labor, if you work to encourage the baby to get into a good position. These techniques she uses do not work 100% of the time, but many women have had very positive experiences when they practiced these techniques daily. Gail is well known around the country and travels to various locations to teach these non-invasive methods. We are so lucky to have her right here in the heart of MN! Her website is spinningbabies.com.

Yes, there are positions that are more optimal than others. Even more than that, there are things you can do daily to encourage your baby to be in those most optimal positions (it is not too hard or time consuming-- I promise!). How can you tell what position your baby is in? Sometimes a doctor will know based on the ultrasound. You can look for clues yourself: Where does the Doctor listen to the baby's heart beat? Where do you feel your baby kick? Where do you feel little flutters (likely little fingers and hands)? Can you feel a big bulge (a butt) or are the feet closer to the front? For detailed instructions, you can visit http://www.spinningbabies.com/baby-positions/belly-mapping. This fetal compass rose shows all of the general positions your baby can be in.

(Used with permission.)

So IF your baby is breech or not in an optimal position, Gail Tully offers helpful hints about how you can try to persuade your baby into a different, more optimal position. 

For breech babies, she encourages doing the forward leaning inversion as well as the breech tilt. The forward leaning inversion positions the mother on a slope from a higher surface to the floor, such as from the seat of a chair, couch, or stairs. The mother keeps her knees and legs on the higher surface and slowly moves her head and arms into the lower position, so that her rear is sticking up into the air (http://spinningbabies.com/techniques/the-inversion). The breech tilt is also recommended in which the mother lies down on a flat surface sloping downward with her head at the bottom of the slope, and her feet at the top of the slope (see http://spinningbabies.com/techniques/activities-for-fetal-positioning/breech-tilt). 

For every mother, there are 6 things you can do everyday to help your baby be in the most optimal position for labor and birth, including resting smart, balancing your body, using the rebozo, maintaining good nutrition, balancing the pelvis, and doing at least one inversion daily (see her detailed list at  http://spinningbabies.com/more-info/for-pregnancy/what-to-do-first). 

Gail covers a multitude of information on her site, including if you could cause your baby to be in a bad position and what you can still do during labor to help your baby come into a good position. Let me end by saying that babies do come out in all ways, these techniques are simply available to you so that you can empower your birth by knowing you did all you could to help your baby the best way that you knew how. It is such a simple thing you can do for your body and your baby. As always, please check with your care provider to see if the techniques can work for you. 

What if your baby is breech? Part ONE.

(image from: http://birthwithoutfearblog.com/2010/10/29/breech-babies-is-another-variation-of-normal/)

I recently had the opportunity to attend a seminar about breech birth entitled, "A Hands Off Approach to Breech Birth." For those of us who have understood breech babies to automatically equate to cesarean birth, I have wonderful and exciting news-- it may be possibly to still achieve a natural, vaginal birth. As time has progressed, most obstetricians are no longer taught how to deliver breech babies, and therefore, if you are seeing a doctor who does not know how to deliver a breech baby, you will almost definitely will have a cesarean if your baby has not turned by the time you are "due".  In the metro area, we are very fortunate to have Dr. Dennis Hartung, who is a very unique Ob-Gyn who offers wonderful care for his patients (you can find more information about him here http://www.hudsonphysicians.com/MedicalStaff.cfm/view:112/pid:839/Dennis_R_Hartung_MD_OB-GYN/). Dr. Hartung shared all of this wonderful information (and much more) that I would like to pass along to you, so that you can make informed choices about your care. He is also the only physician I know of in the metro area who is currently overseeing the care of women who are birthing breech babies vaginally.

Here are some of the wonderful tidbits I learned:
-50% of babies who are breech, turn in labor.
-Only 3-4% of babies are breech during labor.
-A fair amount of evidence suggests that a trial of labor is safe for breech babies.
-Induction is not recommended for breech.
-Typically, breech births are rapid.
-A mobile mother during the first and second stage of labor is key during breech birth.
-Once there is a bulging perineum, Dr. Hartung has the mother assume a knees and elbows position on the bed.
-He specifically uses the technique of no touching of the baby until the very end.

Dr. Hartung uses as special technique developed by Dr. Frank Louwen, which uses a knees and elbows position for the mother to birth in, and involves a "hands off technique" which allows the mother and baby to do the work, and the doctor to guide only when necessary. Interestingly, Dr. Hartung shared that he really does not need to intervene, even in the unique setting of breech birth, that the babys  STILL know how to be born. He does avoid having mothers with complicated situations (such as gestational diabetes, or high blood pressure) give birth vaginally to breech babies.

In my next blog, I will talk about some ideas for helping your baby to turn before birth, so that you can have your baby in an optimal position.

For more information about vaginal breech birth, you can read this article: http://spinningbabies.com/baby-positions/breech-bottoms-up/339-vaginal-breech-birth?showall=1

Simple Math: The Bishop Score and Optimal Induction

While it is largely used in determining the effectiveness of induction, knowing your Bishop Score can help you determine how ready your body is to have your baby. This can be beneficial information when you are presented with the option to induce your labor.

No matter the method of induction that is being suggested, knowing your Bishop Score can help you gather the information you need to make an informed decision about how helpful induction methods will be. It is also important to note, that while some induction methods may not be intended to start labor, they may help your body to prepare the cervix in another way so that the Bishop Score would in turn be increased. Determining your bishops score is fairly easy. You can speak with your care provider to find out the information they are already gathering about your body. Then you can ask what your Bishop Score is, or better yet, you can find out the individual values and add them up for yourself.  You can see the bishop score table at the bottom of this post.

The Bishop Score is a table of values based on (I have added some pictures to demonstrate the general idea of what providers are talking about when they use these terms, but these numbers SHOULD be determined by a care provider, and not by yourself):

*Consistency of your cervix (firm, moderately firm, or soft).
Firm may feel like the tip of your nose....

(Image from:www.artisticrealism.com)

Soft may feel like a piece of chewed gum....

(Image from: http://www.soimmature.com/sub_pages/all_thumb_subs/page_gum.html

*Position (towards your back-- typical in early pregnancy, in mid position or towards your front-- typical in late pregnancy or early labor) of your cervix.

**Believe it or not, this is the BEST picture that I could find on the Internet, which obviously does not clearly show the anterior or forward facing cervix, but you get a general idea.
(Image from: http://www.glowm.com/resources/glowm/graphics/figures/v1/0390/012f.gif)


*Dilation (closed, or open up to 5 or more centimeters).

Image from (https://www.birthinternational.com/magento/media/catalog/product/cache/1/small_image/135x135/5e06319eda06f020e43594a9c230972d/b/e/be021-large.jpg)

*Effacement (the amount the cervix has thinned to).

(Image from:http://blogs.families.com/media/effacement.jpg)

*Station of your baby's head in your pelvis.

(Image from:http://www.healthsquare.com/fgwh/wh1c2603.jpg)

Phew... Just wanted to give you a better idea of the kinds of things they are talking about when they use those terms. 

NOW you can add your Bishop Score. 

As inductions today are on the rise, it is important to know how likely it will be that your induction will end in a safe, vaginal birth. According to the midwifery model of care, it is preferred that a woman would have a score of 9 or higher for a sucessful induction. A score of 7 or more is recommended for women under obstetrical care. 

(Image from: http://holisticdoulanycblog.com/wp-content/uploads/2010/02/Picture-51.png)

For this information and more, please refer to:

http://www.mybirthbydesign.com/Bishop's%20Score.pdf

Just eat it.

Let me begin this post by saying, I am not a nutritionist and I am not offering these resources as an absolutel definitive guide to what you need to eat while pregnant or even (ideally) in the year before you try to conceive. Please speak with your own doctor, midwife, nutritionist, chiropractor, or naturopath about what is right for you.

I would like to offer the following resources as a guide for you to understanding the importance of preparing our bodies to carry and grow healthy, strong babies. Traditionally, many cultures have emphasized the importance of eating nutrient dense foods in the year prior to bearing children, and throughout the pregnancy. Our culture has lost much of this importance, and has simply reduced pre-natal nutrition to consist of pre-natal vitamins. But only adding a vitamin supplement to our diets and not really considering what the rest of our diet looks like could be potentially a huge problem. In a world of highly sugared, highly processed foods, many of us fall victim to eating calories that can't help us because they have no real nutritional value.

Contrary to our cultures present fear of fat, many cultures traditionally ate many foods rich in fats and vitamins that would naturally help them to get the most nutrients out of all of the fruits and vegetables they were also consuming. Many cultures would eat organ meats (from animals that were grass fed, and untreated with any medications or hormones), eggs, raw milk, fermented vegetables (such as saurkraut), and seafood (wildcaught, without any mercury), cod liver oil, lots of dark leafy greens, beans and lentils, and chicken or beef stock, among other whole foods. Many of these foods not only made for robust children, but also gave great strength to the birthing mother.  (http://editor.nourishedmagazine.com.au/articles/pregnancy-nutrition-for-making-strong-healthy-babies)

If you can find organic, locally sourced meat and produce, they are an excellent choice, and often have more vitamins, minerals, and nutrients than their genetically modified and chemically altered counterparts. Many local products can be bought at reasonable prices either at your local farmers market or your local co-op, or online at http://www.localdirt.com/. Personally, I feel that it is very important to purchase organic raw milk, organic eggs, meats and dairy. Preparing these whole foods as our ancestors did can often be very time consuming, but the meals are markedly more nutritious and have far more health benefits than eating processed foods or fast food options. We should honor our ancestors, and take a closer look at how they ate and birthed well.

For more information about nutrition, as well as prevention pre-eclampsia, please visit http://www.blueribbonbaby.org/ifyouarepregnant/4/     http://minnesotabirth.com/pregnancy-and-birth/252-prevent-hypertension-in-pregnancy.

All about Oxytocin

In honor of Valentines Day approaching, I would like to talk about oxytocin-- the hormone of love. You may know that oxytocin is released when you sit down to eat that box of valentine chocolates, snuggle up to your honey after a romantic date, or while making love. You may not know that this hormone plays a vital role in the onset and continuation of labor. Oxytocin may be more free flowing at home, where a woman is comfortable and feels safe. Sometimes, when a woman gets to the hospital, the flow of oxytocin can be inhibited and labor may slow or even stop. Often times when a woman's labor is not progressing as a medical provider would like it to, they may implement the usage of pitocin, the synthetic form of oxytocin. If you understand the essential role of oxytocin in labor, you can help enhance the flow of it and may even prevent your labor from slowing or stopping.

In order to understand the relevance of oxytocin to labor, it is important to liken its relevance during orgasm. A surge of oxytocin creating height of orgasm is only released under the right conditions. Scientific research has found that during orgasm, the parts of the brain that help us to think logically and control our behavior actually shut down. For women, another part of our brains is actually stimulated during orgasm. This part of the brain controls our "fight or flight" response-- meaning that women must feel safe in order to let go and allow orgasm to take place. (http://health.howstuffworks.com/sexual-health/sexuality/brain-during-orgasm2.htm) As a side note, you may also be interested to know that some scientists have found that orgasm causes the cervix to contract and draw semen up into the uterus, potentially enhancing fertility (http://www.beautifulcervix.com/cervix-photo-galleries/photos-of-cervix/pre-and-post-coitus/).

You can imagine that it would be difficult to have an incredible orgasm with lots of unfamiliar people milling about the room where you were making love, bright lights shining on you, or if there were machines loudly beeping, doors slamming and medical personel probing you with questions. If we want to promote oxytocin release during labor, we need to create the right environment! We can do this by dimming the lights, having soft or silent voices, setting the mood with (electric) candles and essential oils, lots of touch and massage, encouraging and endearing words. Skin to skin contact and nipple stimulation can also enhance the release of oxytocin which is often accompanied by endorphins-- the body's natural pain killers (http://oxytocinaccelerator.com/what-is-oxytocin). Ina May Gaskin, a world-renowned midwife, promotes kissing and sexual caressing during labor. Mental preparation for labor is also essential-- preparing your mind with positive messages about birth, as well as believing that you can and will birth your baby. Additionally, having a doula at your side who is trusted and familiar can enhance your feeling of safety in your own birth environment.

After you birth your baby, oxytocin will continue to be released as you breastfeed your baby. This will enhance bonding with your baby, as well as contract your uterus to whip it back into shape and control bleeding. Oxytocin also plays a role in your milk letting down during breastfeeding. Some women find it helpful to nurse privately as this may help them to have a let down if they are having difficulty.

Oxytocin is an incredible hormone that plays such a huge role in female sexuality and reproduction. For more information about oxytocin related to birth, I would highly recommend watching Orgasmic Birth which talks more in depth about the connection between birth and orgasm. http://www.youtube.com/watch?v=siLbqthiTWo