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My friends are a huge part of my life, but none of them have kids. I’m starting to feel really isolated. What should I do?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

Let me paint you a picture. Lady gets pregnant with Baby. Lady’s friends are super excited for her and want to support her. They throw a baby shower. They do most of the same things they’ve always done, only Lady’s wine is replaced by mocktails. Everyone is confident their friendship will seamlessly flow into Lady’s life with Baby, but no one talks about what that will look like. And then Lady has Baby. The friends show up to ooh and aah, then everyone leaves. Friends want to invite Lady to this and that, but they don’t want to pressure her or make her feel bummed she’s missing out, so the invites dry up. Friends want to call, but they don’t want to bother Lady. “Maybe she’s trying to nurse? Or sleep? I should probably just let her call me when she’s ready.” Lady is elbow-deep in diapers and exhaustion and at first doesn’t notice the radio silence. But then the fog of the fourth trimester begins to fade, and she notices. She notices that she feels isolated. She wants to call Friends, but doesn’t. She thinks she’ll just bore them with mom-talk.

This is a classic case of Postpartum Friendship Dissolution. As you probably noticed, much of it is birthed from lack of communication.

While your relationships with your buddies will definitely change, they don’t have to end. Your life circumstances have been shaken up and turned upside down, but you’re still you — the you that loves your friends, and vice versa. There has to be a way to save those friendships. But how? How do you side-step Postpartum Friendship Dissolution and walk the path of Postpartum Friendship Evolution?

What to do

Talk to your friends, one at a time, about how you’re feeling. (If you’re reading this while pregnant, talk to them before you have the baby, so you can all prepare for the changes.) These conversations aren’t meant to cause guilt for either party — they’re opportunities for you to be vulnerable and to co-create a plan for how the relationship will look moving forward. After you let them know you value their friendship and need more of them in your life, the two of you can brainstorm ways you can connect. For example . . .

  • Maybe your friend loves talking on the phone, and you can schedule calls for times you’ll be on a walk with baby.
  • Or maybe this friend lives nearby and is often free to join you for those walks.
  • Maybe this is the friend you used to see live music with or take dance classes with. While it will likely be hard to meet up for your activity of choice as often as you used to, you could commit to doing it once a month — or whatever works best for your schedules.

After you’ve created the plan, forewarn your friend that you won’t be as reliable as you were before baby. Motherhood is predictably unpredictable, potentially causing you to cancel plans at the last minute because of a sick child, or an AWOL babysitter. Being forthright with this information will hopefully prevent your friend from being annoyed that you’re not able to show up for the friendship in the same way you used to.

In addition, ask them to reach out if they haven’t heard from you in awhile. As a foggy-brained new parent, it can feel near impossible to remember how many days you’ve been wearing those pajama bottoms, much less when you last contacted your friends. Remind them that radio silence doesn’t mean you don’t care, it just means you’re overwhelmed.

Here are some additional considerations when navigating friendships as a new mom:

Be thoughtful of conversation topics. While your non-mom friends probably won’t mind hearing a bit about motherhood, they won’t be able to relate to it and will likely tire of the topic if it’s not kept to a minimum. Ensure your time with friends is filled with connection by asking each one about their life, and bringing up topics you used to love gabbing about. If you’re worried you’re incapable of thinking of anything but mom-topics, keep a running list of conversation starters you think would be interesting to your friend. For example, if the two of you love celebrity gossip, write down juicy tidbits you can bring up. If you’re politics fanatics, list hot topics you want to get their opinion on. You won’t always have to put this much effort into talking points, but while you’re trying to find your footing on the balance beam of parenthood and friendship, this forethought will pay off.

Note: If your friend is not child-free by choice, it might be best to steer clear of all talk of baby, unless they ask. Hearing about you living the life they desperately want could be devastating, and it could drive a wedge in the friendship. For more on this, see question 7.

Know that you might need to let go of some friends. Not all friendships will stand the test of motherhood. While it might be painful to let those friends drift away, you can honor them by sitting with the idea that they were meant to be in your life for a certain period of time, and now it’s time to part. This parting will likely be made easier by the fact that your time is now seriously limited, and you have to be selective about who you spend time with.

After I had Hudson, only three of my prebaby friends were still standing. These were the friends who weren’t offended if I forgot to call or text back, or didn’t reach out for months at a time. These were the friends who would try to make a meetup happen if I randomly had a free hour and reached out to them last minute. These were the friends who would come to Hudson’s birthday parties, even when they were the only ones without kids. They understood the constraints of my new circumstances and didn’t fault me for them. They were free of drama (at least the not-fun kind) and always there when I needed them.

Find new friends. One of the most natural parts of parenthood is making new friends. The playgroups, time at the park or library, and other baby-centered gatherings all create organic opportunities for fostering fresh friendships. And many of these connections will feel refreshing as you can gab about the trials and triumphs of parenthood without feeling self-conscious.

While these new relationships will likely be easier to maintain and should absolutely be nurtured and enjoyed, you should still use the suggestions above to hold on to at least a few of your pre-parenthood friends. Those are the folks you probably feel most comfortable being your unfiltered self around, which is a dynamic that can feel like gold as you navigate the unsure footing of early motherhood.

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What if part of my placenta doesn’t come out of my uterus? What will my care provider do?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

If part of your placenta doesn’t vacate your uterus within around thirty minutes after baby is born (something called a retained placenta), it will be evicted. As a full or partial retained placenta could cause hemorrhage (excessive bleeding) or infection, your care provider will utilize various methods until the entire organ has been birthed or removed. But you don’t have to be too worried about this, as it’s pretty rare. According to an article in the International Journal of Women’s Health, a retained placenta occurs in only 1 to 3 percent of deliveries.

There are three types of retained placenta:

1. Placenta adherens occurs when contractions are too weak to push the placenta out and it remains loosely attached to the uterus. This is the most common type of retained placenta.

2. Trapped placenta is when the cervix begins to close before the placenta has been expelled.

3. Placenta accreta occurs when the placenta attaches to the muscular walls of the uterus, instead of the lining of the walls. This is sometimes diagnosed before birth and usually results in the care provider recommending a C-section.

You care provider will check your placenta after its birth to confirm that it’s fully intact. If they suspect part of it is missing, they may perform an ultrasound to confirm. From there, they’ll take steps to remove the remaining pieces. However, it’s possible for a care provider to miss that a portion of the placenta is still in the uterus. In that situation, you might experience a fever, excessive bleeding, constant pain, or stinky discharge.

How does my care provider get it out? One of the first things they’ll likely do is administer medication that encourages the uterus to continue contracting. (This is often done preemptively.) Breastfeeding can also trigger contractions. You might also be told to urinate, as a full bladder can impede the placenta’s expulsion. If these methods don’t work, they may have to move on to manual removal, or surgery. In the case of manual removal, the care provider administers anesthesia and/or analgesia, reaches their hand into your uterus, and “sweeps.” Essentially, they feel around and remove lingering placenta. This doesn’t feel great — but it usually works. Surgeries to remove the placenta include dilatation and curettage (aka D&C), hysteroscopy, and laparoscopy. A hysterectomy is needed in rare cases. Antibiotics are given after the treatment to reduce risk of infection.

What to do

While there’s not much you can do to avoid the rare occurrence of a retained placenta, there are a few ways to be proactive:

Avoid prolonged use of Pitocin. According to the article in International Journal of Women’s Health, prolonged use of Pitocin could increase the risk of a retained placenta. So use Pitocin only if it’s absolutely necessary — not just because a care provider thinks it would be cool to speed things up.

Pay attention to your postpartum symptoms. If your care provider believes the full placenta was birthed but you experience fever, excessive bleeding, constant pain, or stinky discharge, or you just feel that something is off, let your care provider know so they can confirm you don’t have pieces of retained placenta.


Know how to stay calm if you experience a retained placenta. Stick a few of these retained-placenta-relaxation tools in your back pocket for the unlikelihood of this happening to you:

  1. If you’re told you have a retained placenta, immediately start taking deep breaths, helping to prevent panic from taking over.
  2. Have someone on hand to hold the baby, as pain medication may need to be administered. However, continue focusing solely on your baby until a recommendation is made and you make a decision. This can help your mind from spiraling into a place of fear.
  3. Keep reminding yourself that you’re being taken care of by trained professionals. While it’s not fun to have a retained placenta, they’ll take care of you, and you’ll be fine.
  4. If a manual removal or surgery is needed, close your eyes and envision your body filled with and surrounded by a warm, golden light that’s keeping you calm and safe.

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Will I be judged if I want to eat my placenta? And is it worth it?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

Maybe, to both questions. I believe that anyone who judges you for your birthing or parenting decisions isn’t worth your time. Sure, people close to you have every right to not understand your decision, but they don’t have a right to make you feel shame for the decision. And what’s the deal with some people having such a strong reaction to those wanting to ingest their placenta? Well…

Many believe that consuming the placenta is a dangerous, “hippie dippy” thing to do. They’re not entirely wrong. It can be dangerous in certain circumstances, and I know lots of hippies who are all about noshing on that placenta. But I believe what’s really behind these conceptions is that the idea of someone eating their placenta brings up visions of dicing up the organ and tossing it in the frying pan, or even throwing a few raw chunks in a smoothie. While that’s been known to happen, it’s not what placenta consumption usually looks like. Most women get the placenta encapsulated and take a few of the pills each day.

Before I get into the specifics of ingesting the placenta, know that it’s a controversial topic because very little research has been done on it. And the studies that have been done were limited, providing inconclusive results. Because of this, I think it’s important to talk to your care provider before making this decision. Then do what feels best to you.

To increase your knowledge of what it means to consume your placenta, let’s look at some facts:

How is it encapsulated? The placenta is washed, steamed (sometimes with herbs), dehydrated, and ground, and then the powder is encapsulated.

How could eating it help? Anecdotal evidence has suggested that ingesting the placenta can do the following:

  1. Increase energy
  2. Balance hormones
  3. Prevent anemia through restoration of iron levels (However, it’s been found that most placenta pills contain a very modest amount of iron.)
  4. Lower chances of developing postpartum depression

Some believe these benefits are caused by the placebo effect. As a big believer in the mind-body connection, I don’t think there’s anything wrong with that. But I’ve also heard from women who felt that their placenta pills dampened their mood and energy. In addition, there are potential risks to consider.

What are reasons I might not want to eat the placenta?

* Group B strep: If you have group B strep (GBS), there’s a possibility it could infect the placenta. The infection could then be passed to the baby through breastmilk after you ingest the pills. I’ve known plenty of women who tested positive for GBS, encapsulated their placenta, and had no issues with their baby being infected, but it’s important you’re aware of the risk before making the decision.

* Infection: In addition to GBS, it’s possible for the placenta to be contaminated by other intrauterine infections. There’s also the potential for contamination during the encapsulation process, if it’s not handled properly.

* Hormones: Estrogen in the placenta pills could increase the risk of blood clots. And the presence of progesterone could impede prolactin, which is responsible for milk production. Estrogen can also suppress prolactin.

What to do

Talk with your care provider. If they simply tell you not to encapsulate, ask them why. Ask questions until you get a clear view of where they’re coming from. If you feel that what they’re sharing is primarily based on personal beliefs instead of more solid evidence, consider talking with a few placenta encapsulating specialists to receive a more well-rounded perspective. After gathering information from numerous sources, sit with the decision until you’re clear on what you feel most comfortable with.

If you choose to move forward with placenta encapsulation, here are questions to ask the specialist:

Did you receive formal training and certification? What did that consist of? Do you engage in continuing education?

How many placentas have you encapsulated?

What are the risks of placenta encapsulation? Have your clients ever had adverse effects?

Are there certain STDs or infections that would rule me out as a candidate for encapsulation?

How do you handle and store the placenta before you’re ready to encapsulate?

Where do you encapsulate? What are the sanitation procedures for your equipment and workspace?

Would you be willing to encapsulate in my kitchen if that’s what I’m most comfortable with?

How do you make sure my placenta isn’t mixed up with someone else’s?

How do you encapsulate the placenta?

What temperature do you use to steam the placenta? Is it high enough to kill potential bloodborne pathogens?

What do you encapsulate the powder in?

Will you be immediately available to pick up my placenta? If not, how should I store it until you arrive?

How soon will you deliver my pills?

Will you provide a dosage recommendation?

When you start taking the pills, pay attention to how they make you feel. If you start feeling down or notice a drop in milk supply, consider not taking the pills for a few days to see if the negative symptoms go away. Because there isn’t much quality evidence about this, each woman taking these pills is essentially acting as a guinea pig, which ends up great for some, and not so much for others. Each body seems to respond a bit differently.

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What’s it really like to push a baby out?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

It’s like pushing a flaming watermelon out a fleshy hole the size of a baseball. Just kidding. Actually, this experience is completely different for each woman. I’ll give you a couple of examples.

My client Chelsea had taken my HypnoBirthing class and was a devout believer in breathing her baby down (an alternative to pushing). For weeks beforehand, she practiced the birth breath every time she was having a bowel movement, and in her regular meditation practice she envisioned successfully helping her baby emerge in this gentle way. When she went into labor, the midwife and I were called to her house and she began a very long journey through labor.

Tired but determined, Chelsea worked her HypnoBirthing tools, continuously focusing on surrendering and expanding. Twenty-four hours later, the midwife said the head was almost out. Chelsea began doing her birth breathing, and ten minutes later the midwife said, “Give me one big push.” And just like that, her baby was born. I was shocked. Almost every birth I’ve attended consisted of a big announcement when the mom was fully dilated, and everyone getting in position to help her push. A nurse or midwife would then loudly coach the mom to press her chin to her chest and push like her life depended on it. It was usually a long process. But not this time.

My birth, on the other hand, was the epitome of the classic pushing you see in the movies. My feet were in those scary-looking metal stirrups, I had a spotlight on my vagina, a nurse was nervously watching the monitors, my husband looked like he was about to faint as screams, blood, and probably some poop came out of me, and the doctor kept telling me to “Push harder! Harder! Harder!”

I did as I was told. I wailed like a banshee and worked so hard I spiked a fever. I pushed for three hours before Hudson came out. When he arrived, his hand was pressed against his face (something called nuchal hand), which is likely what made the pushing such a long, hard process. But I don’t think that was the only reason. Even though I knew about the birth breathing technique I hadn’t really believed in the power of it , and I didn’t have a doctor who supported it. But who knows, even if I had Chelsea’s unwavering belief in breathing the baby down, I might still have needed to push harder harder harder, whether because of the nuchal hand or just the structure of my body.

I share these stories to make the point that the experience of pushing (or breathing) a baby out can range from gentle to super-duper intense. So much of it depends on the woman and the baby. And while how the pushing process unfolds is mostly out of your hands, there are ways you can prepare yourself for the experience, which I cover in the “What to do” section. Before we get to that, let’s look at the questions about pushing I get most often.

What does it feel like? For many women, pushing doesn’t feel nearly as uncomfortable as they think it will, even if they don’t have an epidural. Because of the pressure of baby’s head on nerves in the vagina, a numbing sensation is often present during pushing. This numbing is usually accompanied by intense pressure — essentially, it feels like you’re about to take the biggest poop of your life. Some women report a “ring of fire,” an intense burning sensation, when baby’s head is crowning. But most women I’ve worked with (myself included) said they never felt it. As strange as it sounds, I found pushing to be the most comfortable part of childbirth, albeit the most exhausting.

What can make it harder? A baby in the posterior, or “sunny-side up,” position is one of the most common situations that can make their emergence trickier. In this position, baby’s face is pointing toward the front of your body, which can make it challenging for them to get past your pubic bone. It doesn’t make vaginal birth impossible, just harder. There are tips for repositioning a posterior baby in the “What to do” section. You’ll also find a link for the video “How to Reposition a Posterior, or Sunny Side Up, Baby” in the book’s “Recommended Resources” section.

Numerous other circumstances can complicate pushing — here are the ones you can actually do something about:


􏰀 Lying on your back: This position doesn’t utilize gravity and can narrow the birth canal. Being on all fours, lying on your side, or squatting are all preferable for most women. If you have an epidural, ask if you can lie on your side while pushing.

􏰀 An epidural: As an epidural can make it difficult to feel and coordinate the birthing muscles, pushing when you have one can be tricky, but not impossible. I’ve witnessed many midwives tell moms with an epidural who had fully dilated to not push, and let contractions do the work instead. In many of these cases, the mom didn’t have to push until baby was almost out. Some call this delayed-pushing technique laboring down. You can also ask if the epidural can be turned down when you’re ready to push, so some sensation returns.

􏰀 A tired uterus: If you’ve had an incredibly long labor, your uterus might get tired, and tired uterine muscles can complicate baby’s descent because they may not be able to contract as effectively as needed to push baby out. Some care providers recommend Pitocin if they suspect the strength of contractions is waning, as it can give the uterus a much needed pick-me-up.

How long does it take? Unfortunately, there’s no answer for this one. Some women push for ten minutes and the baby is out, and others push for hours and still need the support of forceps or vacuum. Following the tips in the “What to do” section can increase your chance of shortening your push time.

What is it like for baby? While it’s impossible to know what baby is thinking during this process (I suspect it’s something along the lines of “WTF is happening?”), monitors tell us that many babies experience a dip in heart rate every time their mom engages in heavy-duty pushing, as there’s usually a drop in oxygen during this time. The heart rate usually bounces back up when the contraction and push are complete. This is another reason why the gentler pushing methods can be beneficial — they don’t require mom hold her breath. However, if there is a special circumstance requiring that baby come out as soon as possible, the more intense pushing could be worth it. Your care provider can help you determine what is safest for you and baby.

What to do

While there’s no way to know what type of pushing will be most effective for your body and baby, or how you’ll process that experience, these techniques will help you go into the event as prepared as possible.

Do the perineal tissue massage. This massage will prepare your perineum for baby’s head.

First, coat your pointer and middle finger, or your pointer and thumb, with an unscented, organic oil.

Then insert the fingers two inches into the vaginal opening, and move them in a U-shape along the inner edge of the perineum.

I recommend applying more pressure when you reach the tautest skin (area between the vagina and anus), as this is the skin most likely to tear during birth.

As you push to the point of discomfort, utilize pain-relieving techniques like deep breathing and facial relaxation. This makes the perineum become more elastic, and helps mentally prepare you for the vaginal stretching during crowning.


I recommend doing this nightly for about ten minutes, starting at around week thirty-four or thirty-five of gestation.

Get baby in the optimal position. Cephalic presentation (the best position for baby to be in) is when baby is head down, facing your back, with their chin tucked to their chest. Your care provider can help you determine if baby is in this position.


If they’re not facing your back, here are a few things you can do to give them the space to get into it, which they’ll usually instinctually do if they’re physically able.

Get into the yoga position called “child’s pose” and really stick your butt into the air. You can also gently sway your hips. Stay in this position for at least five minutes (unless you feel woozy), and practice once a day.

Get on your hands and knees and gyrate your hips.

As often as possible, sit in a position where your pelvis and belly are tilted forward. The easiest way to do this is to sit on a wedge cushion. If you’re sitting on a birth ball, make sure your knees are lower than your pelvis.

Sleep on your side instead of your back.

Avoid sitting in bucket seats, or leaning back into the sofa.

Prepare your pelvic structure. A deep squat (with the support of a spotter) or the yoga poses “child’s pose” and “cat-cow pose” can all help relax and lengthen your pelvic floor muscles.

Practice birth breathing while pooping. Because the “birth breath” stimulates the natural expulsive reflex, it can help you poop and get a baby out with minimal pushing. Many mamas don’t believe this until they experience its effectiveness while having a bowel movement. So . . .

While sitting on the toilet, take in a quick and strong inhalation through your nose.

As you slowly exhale, feel the power of the breath being pushed down the back of your throat, through the uterus, and out your vaginal opening.

While you exhale, you’ll organically create a low sound and gentle vibration in your throat. You’ll also feel your expulsive muscles bearing down.

Repeat until you expel that poo!

Ask your care provider how they typically guide women through baby’s emergence. Gaining an understanding of the instructions your care providers usually provide through this phase of birth helps you determine whether their process resonates with you. If it doesn’t, talk to them about how you’d prefer to navigate pushing.

Think of how you want to be guided through pushing, or breathing baby down, and add it to your birth preferences. After you’ve determined if you’d like to try birth breathing or want to go with more traditional pushing, add it to your birth preferences. I also recommend listing how you’d like to be guided through this experience. For example, women I work with often use the phrase, “I request calm prompts from only one person. No loud ‘cheerleading’ please.”

Utilize the “laboring down” technique. In laboring down, you allow the uterus to push baby out with only contractions, and not your pushing efforts, after you’ve fully dilated. This can conserve energy, reduce your chance of tearing, and provide a gentler experience for baby. Many women I’ve supported use this technique until they can no longer suppress the urge to push.

Choose a position that takes weight off the tailbone. Standing, kneeling, squatting, being on all fours, or lying on your side allow more expansion in the pelvis, potentially leading to an easier emergence for baby. Changing positions can also help if pushing progress seems to stall.

Apply a warm compress and oil. Help the perineum soften and expand (which minimizes tearing) by asking your care provider to place a warm washcloth on your perineum, in addition to massaging it with oil.

Go limp between contractions. Contractions and pushing can take a lot of energy. Allow yourself to recharge between push sessions by closing your eyes, going totally rag doll, and taking slow easy breaths. You can also ask that no one talk to you unless absolutely necessary.

Consider having a mirror held between your legs. Seeing the top of baby’s head between your legs can be an incredibly motivating visual. If you’re into this idea, bring a hand mirror to your birth, and ask someone to hold it between your legs when baby is crowning.

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I’m very reserved and cringe at the idea of screaming or cursing, or having strangers see my vagina, butt, and breasts during birth. Will this impede my ability to labor?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

It’s unlikely that your sense of modesty will impede labor, primarily because even the most modest mamas will tell you their modesty almost entirely dissolved when they were in labor. But even if that doesn’t happen, you’ll still be fine because you have control of who’s in the room with you, and how covered you are. While many believe this is a given for birth at home or in a birth center, somehow they don’t feel they have power over who is in the room at the hospital. But you absolutely do. You can make it clear in your birth preferences that you don’t want hospital staff in the room when you’re laboring, with the exception of the nurses needing to monitor you every hour or so and an occasional visit from your doctor. In regard to delivery, you can request that only absolutely necessary hospital staff be present.

You also have control over the nonmedical staff who are with you. You don’t have to say yes to that friend or family member who really wants to be at your birth if you don’t think you’d be comfortable with them present. You don’t even have to have your partner there if you think their presence will throw you off. (For more on this, see question 38.)

Essentially, you have every right to go into labor with your modesty intact — you don’t have to change. But again, birth might change you anyways, especially if you have an unmedicated birth, as the intensity of the sensations will likely eliminate your concerns about nakedness, cussing, and so on. If you get an epidural, you’ll be more aware of your modesty, but you’ll also have more energy and focus to advocate for your wishes for privacy and coverage. And if you have a C-section, nothing but your abdomen and upper bikini line area will be exposed.

What to do

Home in on the elements that make you uncomfortable. For example, are you hesitant to have your vagina exposed? Do you not want your breasts shown? Are you nervous that you won’t be able to control what you say, or how you sound? Does the idea of your partner seeing birth fluids come out of you make you nervous? Write down everything that’s making you uneasy, then try the following:

Put your needs in your birth preferences. In this document, you can ask to be assigned only female care providers (whenever possible), and that no medical or midwifery students be allowed in the room. You can also request that people knock before entering your birthing space, only stick around if their presence is absolutely needed, keep your lower half covered with a sheet during vaginal exams and baby’s descent, or anything else you think will make you more comfortable. And when making these preferences, don’t worry about offending anyone. This is your birth, and you get to ask for what you want.

Talk with your care provider about your concerns. Discussing your qualms with your care provider will not only help them better understand your needs, but will also give them a chance to offer fresh ideas for keeping you comfortable during childbirth.

Make a “Please Knock” sign. In addition to putting this in your birth preferences, make a sign for the door of the room you’ll be laboring in that says, “Please knock, and wait for permission before entering.” This ensures no one surprises you when you’re in a state of undress, or any kind of state you’re not comfortable certain people witnessing.

Pick out super comfortable clothing. If nakedness is a concern, consider finding a really comfortable nursing bra. You could also bring a robe, and wear underwear that’s not too restrictive. Just make sure these are items you don’t mind getting birth juices on.

Wear earbuds. Nervous about cursing, moaning, or screaming? Pop in your earbuds and play your favorite music or guided meditation, so you’re less aware of what you sound like. As for the people in the room who don’t have earbuds in, I can almost guarantee they won’t care about profanity or any loud noises you make.

Determine how your birth supporters can help. Making a plan for how your people can advocate for your desire to stay covered and maintain privacy helps ensure you don’t have to do anything but focus on birth. Discuss with them beforehand what’s important to you, and offer ideas for how they can best support you.

Request the bare minimum number of vaginal exams. In many cases, vaginal exams aren’t required during birth, so if they make you uncomfortable, opt for none, or few.

Have your partner stand by your head when baby is being delivered. If you’re uneasy with the idea of your partner witnessing the release of discharge and blood, a potential vaginal tear, or other components of your vagina’s journey through childbirth, talk with them about staying away from that area as baby emerges. It’s good to talk about this well before you go into labor, as your partner might have strong feelings about seeing your baby come out. You, of course, have the final say over who sees what during birth, but your partner’s feelings might sway your decision.

Ask that the room be cleared as soon as possible after baby’s delivery, so you can begin breastfeeding (if you’re choosing to breastfeed). If breast exposure is a concern, remind everyone that you want only absolutely essential care providers in the room after baby is delivered. You can also drape a blanket over baby after you place them on your bare chest.

Remember that your care providers have seen it all. The wonderful people who support women through birth have seen all degrees of nudity, heard birthing women scream and curse the wildest of phrases, witnessed them pooping, and observed the whole range of other raw displays that birthing evokes. Essentially, there’s nothing you can do that will make them blush.

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I know everyone asks about pooping during birth, but let’s be real; will the care providers pull a face behind my back if I poop?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

While no one enjoys wiping poop off another human, your poop is the least of your care providers’ worries. They just want you and baby to be healthy. And they’ve likely seen so much poop during deliveries they won’t have much of a feeling about you doing it. They’ll just silently jump into “poop protocol” and swipe it away before you realize what happened. Every mom I’ve seen poop during birth had no idea they’d done so — they were more concerned with other situations, like pushing a human out of their vagina.

Something else to consider is that when people talk about pooping during birth, they’re not referring to a full bowel movement. They’re talking about little bits and pieces popping out. “Rabbit turds” is what a midwife I know lovingly calls birth poops. (Yes, I got into this business for the glamour.)

What to do

Talk with your care provider about that aforementioned poop protocol. They’ll be able to assure you that pooping is nothing to be worried about, and that the people caring for you won’t be offended if that’s part of your story. They can also tell you how they typically handle this incredibly common occurrence. In addition, these steps can help you feel more confident:

Don’t do an enema. This could cause unneeded discomfort and doesn’t make much of a difference during childbirth. The beliefs that an enema could shorten labor or decrease the risk of infection have been debunked.

Stay on top of your fiber and fluid intake as you near that due date. Constipation is always uncomfortable, but it can be especially unsavory when you’re in labor. Drinking plenty of water and eating avocados, lentils, chickpeas, raspberries, and other fiber-rich foods will keep things moving, helping to ensure you don’t have a backlog when it’s baby time. (If you really want a treat, whip out those prunes.)

Visit the bathroom at least once an hour during labor. Even if you don’t feel like you need to go, spending time on the toilet gives your body the freedom to purge any urine or fecal matter you might not know you need to release. And this release enhances comfort.

Tinkle Tip: If you have trouble peeing, put a few drops of peppermint oil in the toilet bowl, place your bare feet on a cool surface, and dip your hand in a cup of cold water. (Who said those prank scenes in summer camp movies weren’t teaching us valuable life lessons?)

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I’m getting really focused on what I’ll look like during and after labor. I’m especially concerned about looking bad in photos. Should I bother with doing my hair and makeup when labor starts?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

Before I get into the specifics of this question, I want you to consider that your decisions regarding your looks during labor should be totally based on your feelings about yourself, and not on how you think others might judge you. Anyone around you during birth will be so in awe of what you’re doing they won’t give a hoot what you look like. You’ll look like a goddess to all who lay eyes on you, even if your hair is a mess and you’re covered in sweat.

With that said, I definitely wouldn’t bother with makeup (no matter how much you love it), as it will probably end up running down your face when you sweat, get into water, or cry. Regarding your hair, I can almost guarantee it will also get mussed up during labor. But because the undoing of the hairdo won’t cause anything to run down your face or sting your eyes, there’s no harm in doing your hair beforehand, especially if it ups your confidence and provides a distraction during early labor.

Something I would do during early labor is take a shower — if you have the time. And I would go all in with that shower: wash your hair, shave your legs, exfoliate your butt. Do whatever you need to do to feel super fresh. I did not do this before I went to the hospital to birth Hudson, and I remember many moments of feeling grimy. No one seemed to notice my griminess (nor would I have cared if they did), but I didn’t like the feeling — it was distracting. If you’re wondering why I didn’t just take a shower while in labor, the answer is that I had to use every drop of my mental and physical facilities to move through each contraction — there was nothing left for shampooing.

What to do

As mentioned, let’s skip the makeup, only do the hair if you really, really want to, and say yes to a shower. Regarding photos, if you’ve hired a birth photographer or would like your partner or doula to take photos, and you are concerned about what you’ll look like in the photos, there are a few things you can do to prepare:

Become one with raw images. Consider that you might enjoy having photos that capture the unfiltered realness of your birth experience, wild hair and all. Of course, if that’s not your thing, no worries. Just be your brand of Beauty.

Ask your photographer to check in before taking a photo. Setting this parameter lets you decide in the moment whether the taking of the photos will make you too aware of how you look, distracting you from the task at hand. Or you might decide that you don’t care how you look and are happy to have them capture some of these once-in-a- lifetime moments as is.

Request touch-ups. If the photographer is someone you feel really comfortable with, ask them to touch you up before they start snapping. For example, they can push the hair off your forehead, readjust your robe, or move the barf bag out of the frame.

Bring beauty basics. When you get to the blissful period when baby is in your arms, you might want makeup applied before taking the shots that’ll be texted and posted. You might also want a hair touch-up. If you think this is something you’ll desire, pack a bathroom bag with a hand mirror, hairbrush, and your makeup essentials (e.g., some concealer, blush, and mascara), so your birth companion can easily retrieve the goods while you bond with baby.

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Will it be weird if I want to be totally nude during labor?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

Not at all. For some women, having clothes on during birth can feel distracting and restrictive. Taking it all off can leave your mind clear to focus on breathing, moving, or doing any other relaxation techniques that help you move through contractions. And no one supporting you during birth will think twice about you being naked. Doctors, nurses, midwives, and doulas are totally used to all states of undress when supporting a laboring mom.

To ensure you stay comfortable with your nudity during birth, be really clear about who is and who isn’t allowed in your birthing space. For example, if you don’t want your father-in-law dropping in when you’re doing naked hip swirls, let everyone know that no one is allowed in the birth space unless they get explicit permission from you.

What to do

Keep reminding yourself that there’s nothing wrong with being buck naked during birth. Then consider the following:

Put it in your preferences. Add the following line to your birth preferences: “I request complete privacy during birth. In addition to the necessary medical care providers, only the following people are allowed in the birth space [insert names].”

Tell your partner. It can be helpful to give your partner a heads-up about your desire to be nude, especially if you think they’ll be uncomfortable with it. But don’t let them dictate what you do and don’t wear during labor. You can give them the courtesy of a discussion, but you get the final say in what you wear.

Bring “just in case” birth clothes. It doesn’t hurt to have a nursing bra, robe, and loose, comfortable clothing on hand in case you feel like being clothed during certain phases of labor.

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Will my vagina look like minced meat after a vaginal delivery?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

I’ll not mince words (hee-hee) — most vaginas look pretty beat up after vaginal childbirth. With all the stretching and potential tearing, the vagina won’t be easy on the eyes for a while. But the good news is, it won’t stay that way. Tears heal, and stretched skin (slowly) bounces back. The one thing that might be permanent is a darkening of your vulva, as it could experience a shift in pigmentation. So while your petunia will never look exactly like it did pre-childbirth, it will go back to a semblance of its former self after six to twelve months.

Something else to expect from the first few days of life after birth is that you will have heavy discharge. There will be lots of blood, mucus, and tissue coming out of you, requiring you to don a diaper-like pad. While the load will likely lessen within a week, you’ll probably need pads for four to six weeks.

What to do

If you’re squeamish, or if you experience more pain when focusing on a sore area of your body, don’t stick a mirror down there for a while. However, if you want to marvel at everything your courageous vagina went through, take a look — it’s pretty fascinating. And don’t be embarrassed by its appearance. The two of you went through a lot, and you’re allowed time to heal. Tummies are squishy, stretch marks are prominent, and vaginas aren’t pretty in that fourth trimester — and that’s okay. Be patient with your body, and grateful it helped you grow and birth new life.

Regarding how you can minimize tearing and make your perineum more elastic, check out the “What to do” section from question 63.”

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Is a vaginal tear as scary as it sounds?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

No. My perineum tore during birth, and I had no idea until they started stitching me up. And I didn’t have an epidural. But I get why women are horrified by the idea of a tear in one of the most sensitive parts of their body. It sounds awful. The thing is, the combination of a buildup of

endorphins, the numbness caused by the pressure of baby’s head, and the Goddess-like determination to get the baby out makes many women oblivious to a vaginal tear, regardless of whether or not they have an epidural.

To provide further insight about vaginal tears, here are answers to the most common questions I get about this topic:

How likely is a tear? It’s common for a first-time mom to tear, but again, you probably won’t even notice it until after birth. The recommendations in the “What to do” section can help reduce the likelihood of a severe tear.

How big are the tears? While tears range in size, they’re usually much smaller than we imagine. First-degree tears are only a few centimeters, while a fourth-degree tear (the most intense) is rarely longer than an inch.

How are tears repaired? Minor tears usually don’t need any repair beyond time and rest, while more extensive tears require absorbable stitches. The area will be numbed before the application of the stitches. In rare cases, anesthesia is used.

What is the recovery like? It’s not too bad — you just feel really sore for seven to ten days. Depending on severity, tears take anywhere from a few days to a few weeks to fully heal. The “What to do” section provides recovery tips.

What to do

To help the emergence of baby be a gentler experience for your perineum, thus minimizing your chance of a severe tear, follow all the suggestions in the “What to do” section from question  (the one about pushing). I would especially focus on the perineal tissue massage — make it your part-time job starting around week thirty-four or thirty-five of gestation. It’s one of the best things you can do to make your perineum more elastic and less susceptible to tearing.

If you feel the fear of a tear might hinder your ability to birth with calm and confidence, listen to this fear-release guided meditation: yourserenelife.wordpress.com/fear-of-tearing/. I also recommend envisioning your perineum as a rose that gently and easily opens. You can also watch time-lapse videos of flowers opening, focusing on how easily their soft petals unfurl — there’s no strain in their bloom. As you do this, remember that your perineum was also designed to soften and expand when it’s time to bloom.

In regard to what to do after a tear, here are a few strategies for soothing discomfort and promoting healing:

Kegels: Attempting Kegels (even if you can’t feel them) promotes circulation, which can speed recovery.

Sitz bath: Soaking your perineum in warm water can ease pain and itching. You can also ask your care provider if there are medications or additives you can put in the water to aid healing. If you’d rather not bother with sanitizing your bathtub, purchase a sitz bath kit that fits in the toilet and allows you to dunk your perineum. As an added bonus, a sitz bath also works wonders on hemorrhoids! Yay!

Witch hazel pads: These medicated pad liners — soaked in witch hazel extract— are the vagina’s best friend, offering instant cooling relief when slipped in the underwear.

Anesthetic spray: In addition to the witch hazel pads, ask your care provider to recommend an anesthetic spray to numb the perineum.

Fiber: Your first bowel movement after childbirth might be nerve wracking. I felt certain I would bust my stitches and poop out my innards — but I didn’t, and you won’t either. However, the essential act of clearing your bowels could be uncomfortable if you’re passing hard stools. Soften up that poo by eating fiber-rich foods and drinking lots of water. You can also ask your care provider if they recommend using a stool softener the first few days after birth.

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I want to have an orgasmic birth. Is it possible?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

Yes, ma’am, it’s possible! But that might not mean having an actual orgasm. Only about 6 percent of women have orgasms during birth, and much of that is due to genetics — those ladies aren’t Aphrodite, they’re just lucky. According to a study in the journal Biology Letters, genes account for 34 to 45 percent of a woman’s ability to climax. However, it’s near impossible to know if you have orgasm-inclined genes. What you do know is how easy it is for you to have an orgasm. If you’re a climax machine, maybe your genes are helping you out, or maybe you just have your finger on the pulse of what turns you on. Whatever the reason, if it’s fairly easy for you to orgasm, you have a better chance of orgasming during labor. That doesn’t mean all hope is lost if you really have to work to get that pleasure-explosion — the “What to do” section will help you up your chance of floating in a sea of orgasms (or at least a little lake) during birth.

Beyond genetics, what’s the deal with orgasms showing up amidst an experience many tout as exceptionally painful? First of all, two of the regions in the brain that are active during orgasm — the anterior cingulated cortex and the insula — are also active during painful sensations (Oh hi there, contractions). In addition, orgasm and childbirth both produce strong surges of blood, oxytocin, and endorphins and stimulate the birth passage, cervix, clitoris, and vagina. So there you go — orgasm and childbirth aren’t the antonyms many believe them to be.

But now I want to shake up this question. I want to propose we shift the term orgasm to orgasmic. Because even if you’re not rolling in orgasms as you’re getting that baby out, you can still have a birth filled with euphoria, empowerment, transformation, joy, connection, and love: essentially, an orgasmic birth. Think about it — although we all love our orgasms, can’t you think of hundreds of instances in life where you weren’t orgasming but still felt incredible? You can bring that goodness into birth.

What to do

Set yourself up for orgasms during birth, and/or an orgasmic birth, by releasing preconceived notions about pain, shame around sexuality, and doubt about your ability to birth.

Prepare. Most women who have orgasmic births prepare thoroughly, often taking at least one childbirth prep class, reading the book Orgasmic Birth by Elizabeth Davis and Debra Pascali-Bonaro, and watching the documentary Orgasmic Birth: The Best Kept Secret. They then practice many of the techniques learned from these resources on a daily basis, specifically fear-release practices. As my grandma would say, they didn’t go into birth all willy-nilly.

Hold a belief in an orgasmic birth. Going into labor with the belief that an orgasmic birth is possible can transform your experience and make it more likely to lead to an orgasmic birth. As I mentioned, this orgasmic birth might not be filled with orgasms, but it will be composed of a trust that birth isn’t all about pain; can be infused with moments of deep connection with your body, baby, and partner; and can unleash a power and confidence that will make you feel like a total goddess. This type of birth is just as good (or at least almost as good) as a birth sprinkled with orgasms.

Examine your beliefs about sexuality. Did you grow up with a belief that sex and masturbation are taboo? If so, you’re not alone, and it’s not too late to reprogram. You can begin shifting your perceptions of sex and masturbation by first examining what your beliefs are, and where they came from. Are they things you actually believe on the deepest level? Or are they ideas planted by someone else? Next, connect with your sexuality in a new way by partaking in the art of masturbation, and taking note of what turns you on. What type of pressure and speed does it for you? Where do you like to be touched? Share your findings with your partner. Then, talk with them about getting more creative during sex by playing around with positions, dirty talk, eye contact, or anything else that piques your arousal. And finally, do the things you’ve just talked about.

To support this sexual reprogramming and awakening, listen to this guided mediation: yourserenelife.wordpress.com/orgasmic-birth/.

Edit key birth words. Remove fearful, constrictive terminology from your childbirth lexicon by making a few substitutions. Begin by swapping the term contractions (it sounds so restrictive!) with the word surge, as it sends more fluid, pleasurable messages from the mind to the body. And instead of saying or thinking the word pain when you’re having a surge, name the actual sensations you’re feeling. For example, “I feel a pulling up in my abdomen, a tightening in my back, and pressure in my vagina.” These swaps give you a better chance of tapping into the ecstasy that can live in childbirth.

Consider a birth center or home birth, or create a soothing hospital room. Because it’s easier to have an orgasm, or feel orgasmic, in a space that feels homey, soothing, and private, choosing to birth in a birth center or at home will likely increase your chance of having an orgasmic birth.

However, if the idea of birthing in a hospital comforts you, you might experience anxiety if you birthed anywhere else. If that’s you, think about how to transform your hospital room into a birth sanctuary. For example, you could bring battery-powered candles, a soft robe and cozy socks, a silk pillowcase, a portable speaker and playlist of relaxing music, an essential oil diffuser and your favorite oils, honey sticks, and anything else that comforts one of your five senses. In addition, hiring a doula can add an incredible layer of support to a birth in any location, but especially in a hospital.

Ask for complete privacy. You’re unlikely to have an orgasm while your midwife and her assistant whisper about birth stuff in the corner or a nurse checks your vitals. Up your chance of feeling free enough to let waves of pleasure wash through you by asking anyone you don’t feel comfortable moaning in front of to leave the room.

Stimulate your clitoris. Clitoral stimulation is one of the surest paths to an orgasm, and it can make you less sensitive to painful stimulation — it’s like a medication-free epidural. But many women are hesitant to masturbate during birth because they feel strange mixing this sexual act with bringing their baby into the world. There are two ways to get around this.

One, go into the bathroom for ultimate privacy, or as I just mentioned, ask everyone to leave the room, with the exception of your partner, if you’re comfortable with them being there or even helping you.

Two, if the sexual component of masturbation is tripping you up, change the way you think about it. Think of it as just another pain-relieving tool you’re using for childbirth. It’s not masturbation, it’s a “pain-soothing vaginal massage.” And if you really want to up your chances of reaching that sweet O, do as many women before you have done and use a vibrator.

Moan. When you feel yourself at the tipping point between pain and pleasure, let out long, low moans to release painful energy and call in euphoria.

Rub your nipples, and make out with your partner. These sensual acts awaken arousal and release oxytocin, which can speed up your birth by triggering more effective surges.

Breathe. As you feel a surge coming on, take in a long, deep inhalation through your nose, allowing your lower and upper abdomen to fully expand. When you reach full capacity, exhale through your nose at the same slow pace. As the surge intensifies, you’ll likely hit a “wall of resistance.” When this happens, your mind will try to trick you into thinking that continuing to breathe in and expand your abdomen will cause an explosion of pain. But the opposite is true. Continuing to inhale and expand will bust past that wall and help you access the relief that can lead to pleasure.

Remember that pain isn’t the enemy. Many have the misconception that an orgasmic birth is free of pain. But often an orgasmic birth consists of repeatedly coming to a tipping point between pain and pleasure, and swaying between both until you make the decision and take the actions to tip fully into pleasure. And sometimes you’ll tip into pain, and that’s okay. Pain isn’t a bad sign during childbirth, it doesn’t mean you’re doing anything wrong — it’s an organic part of the journey. When you can surrender to it, instead of resisting or fearing it, it often transforms. Almost every woman who has had an orgasmic birth will tell you that she danced with both pain and pleasure, and it made for a fuller experience.

Connect to an orgasmic energy orbit. Envision a never-ending supply of warm, golden energy spiraling down from the stars, becoming more and more concentrated as it swirls through your body. This energy is most potent as it moves through your uterus, out your cervix, and finally washes over your vagina and clitoris. Feel this energy activating your endorphins as it moves down. Train your mind and body to easily tap into this orgasmic energy by practicing this visualization every morning and evening.

Submerge yourself in warm water as much as possible. The relief that warm water provides allows your muscles to relax and become more susceptible to orgasmic sensations. If you don’t have access to a tub during birth, sit in the shower.

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Is there any chance an epidural could paralyze me?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

Yes, but it’s really unlikely. A study published in the British Journal of Anaesthesia reported the estimated risk of permanent harm following a spinal anesthetic or epidural as less than 1 in 20,000. This risk is often considerably lower for women in labor, as they tend to be healthier than those people receiving an epidural because of illness or injury.

The rare times paralysis has occurred, it was because of direct injury to the spinal cord; a spinal hematoma, which is an accumulation of blood in the epidural space; or an epidural abscess, an infection between the outer covering of the brain and spinal cord. However, even these are circumstances that don’t always lead to paralysis.

What to do

If possible, don’t let fear over this miniscule risk stop you from receiving an epidural if you really need one. It’s more likely you’ll be struck by lightning than experience paralysis from an epidural.

In addition, be sure to tell the anesthesiologist if you have a blood clotting disorder or have been on blood thinners. This should all be in your chart, but it’s still wise to mention it.

If you feel an epidural is the right choice for you but you’re afraid of paralysis, ask the anesthesiologist to reassure you. Hopefully, they’ll be able to outline how experienced they are and what an excellent track record they have, and to explain that with modern-day training and tools, paralysis doesn’t need to be a concern.

They should also tell you which sensations to expect, and which to report, as the epidural is being placed. Many women experience stinging, burning, pressure, a sensation of coolness, or all of these in their back as the numbing medication is applied and the needle is inserted. It’s not

supposed to be too intense. (The worst part is having to hold still while you have contractions.) But if you have any of the following sensations, you should tell the anesthesiologist immediately:

  • Sudden loss of sensation in one or both legs
  • Sharp, shooting pain
  • Uncontrollable shaking in your legs
  • Intense hot flash
  • Anything else that feels “off ”

Relaxation tool: Download this guided meditation and listen to it as the epidural is being placed, or anytime throughout labor, to re- duce anxiety and enhance calm: yourserenelife.wordpress.com/epidural -meditation/.

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What is my care provider not telling me about Pitocin and epidurals?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

Potentially, a lot. Because significant research is being done on these drugs, some care providers hesitate to share all the details because the data is always emerging and evolving. But there are also care providers who hold back information that has been well proven, in favor of supporting their agenda.

One mama I was the doula for (let’s call her Sasha) was told by the ultrasound tech at her doctor’s office that she had low amniotic fluid levels. When Sasha was retested at the hospital, she was told her fluid levels were normal. The on-call doctor said she and baby were healthy and good to go home. But when Sasha’s doctor arrived, he disagreed and insisted she be induced with Pitocin immediately. She asked why. He said, “Because your baby could die if you don’t induce.” Stunned, Sasha asked if Pitocin came with risks. “No,” he said. “The risks only come with not inducing.” She turned down the Pitocin, but he had scared her and she didn’t feel comfortable going home.

Sasha allowed this doctor to give her three rounds of Cervidil— a medication used to soften the cervix — over three days, but she stood her ground about not receiving Pitocin. Despite her and the baby’s continued health, the doctor kept suggesting she was putting her baby’s life at risk by not inducing. He wore her down, and she accepted the Pitocin. But it didn’t work. After twelve hours on it, Sasha had only dilated to four centimeters and was exhausted. The doctor insisted she get an epidural so she could sleep. The epidural gave her a headache so intense she could not sleep. When the doctor insisted on a C-section, Sasha fired him and hired a midwife with privileges, or permission to treat, at that hospital. The midwife gave her medication for the headache, and she was finally able to rest. I knew this midwife, and she pulled me into the hallway to share all the information about Pitocin and epidurals that the doctor had failed to provide. This is the summary of what she shared:

Regarding both drugs…

You’ll be stuck in bed. Once Pitocin or an epidural is started, you will need constant monitoring and will be connected to an IV, meaning it will be tough to move around.

You’re not allowed to eat. Because of concern over aspiration during an emergency C-section (which isn’t actually a risk if general anesthesia isn’t used), most hospitals won’t let you eat after receiving Pitocin or an epidural. While many mamas don’t have much of an appetite while on these drugs, this moratorium on food can lead to exhaustion if you have to be on them for an extended period.

It might not work. If you’re already having contractions, the Pitocin will likely make them stronger. But if you’re showing no signs of labor, Pitocin may do very little. And while an epidural almost always provides the desired effect of significant numbing from the waist down, it’s possible (although unlikely) that you receive little to no relief from it.

There’s an increased chance of cesarean birth. There’s something called a “cascade of intervention,” which implies that each intervention could lead to the need for another intervention. One of the ultimate interventions during childbirth is a C-section. While plenty of women who receive Pitocin and/or an epidural have a vaginal birth, both of these labor drugs might increase your chance of needing a C-section.

Regarding Pitocin…

Contractions might be so unbearably strong you need an epidural. Many women who do not want an epidural find that it’s a necessity after receiving Pitocin, as it can cause extremely strong (and painful) contractions.

Fetal distress could occur. If Pitocin creates contractions so strong and close together that your body and baby don’t have time to rest, the baby may not receive enough oxygen, which could lead to distress and the potential need for an emergency C-section.

Regarding an epidural…

You’ll likely need a catheter. Because you won’t be able to walk to the bathroom, a catheter is almost always inserted after the epidural has taken effect.

It could lead to a need for Pitocin. Sometimes, an epidural slows down contractions so much that Pitocin is needed to keep labor going.

It could extend labor. According to a study published in the journal Obstetrics & Gynecology, women with epidurals typically have to push for nearly two and a half hours more than women without epidurals.

Instrumental birth is more likely. Because it can be trickier for a mom with an epidural to push baby out (or breathe baby down), epidural use means a higher chance that forceps or vacuum extraction will be used to deliver baby.

You might have a drop in blood pressure. This could also make baby’s heart rate drop. However, the IV fluids you’re given before the epidural is placed reduce this risk.

Fever could occur. A study done by Harvard Medical School found that women who receive an epidural are more likely to develop a fever that could lead to the baby having poor muscle tone, a low APGAR score, seizures in the newborn period, and the need for resuscitation and evaluation for sepsis. The study also noted that high maternal fever has been linked to brain injuries like cerebral palsy.

You might get itchy. The opioids in the epidural may make you itchy, which can often be alleviated by changing the medication or giving you an itch-relieving medication.

Nausea or vomiting is possible. This is another potential side effect of the opioids in the epidural.

There might be breastfeeding complications. Because an epidural blocks oxytocin — the hormone that helps milk come in and facilitates bonding — it could cause breastfeeding challenges. In addition, a mom and baby impacted by an epidural are more likely to be drowsy after delivery, which could make breastfeeding more difficult.

A spinal headache might be triggered. A rare phenomenon, a spinal headache is caused by an accidental puncture being made in the bag of fluid surrounding the brain and spinal cord when the epidural is placed. If spinal fluid leaks out, an intense headache ensues — it can last for weeks.

Nerve damage is possible. Another rare side effect is nerve damage caused by the epidural needle. If a blood vessel is damaged while the epidural is being placed (also uncommon), blood may collect and press on the nerve. This is one reason why women with a blood clotting disorder and those taking blood thinning medication may not be able to receive an epidural.

An epidural abscess is possible. In rare cases, women develop an epidural abscess, which is an infection of the central nervous system caused by bacteria entering the epidural space. According to the book Spinal Epidural Abscess, only 1.2 in 10,000 women experience this.

Those are the potential outcomes of Pitocin and epidurals that are widely recognized — the possible side effects your care provider should share with you. But what about the potential outcomes they won’t share? The outcomes that haven’t been conclusively proven, but are interesting to consider? Following are possible risks with labor drugs still being researched, as of 2020:

There is a possible increased chance of baby developing autism. Limited research has found that babies of women who had Pitocin and an epidural during labor were 2.77 times more likely to exhibit an autism phenotype. Because not all babies of women who received labor drugs in these studies went on to develop autism spectrum disorder, it’s believed the drugs must interact with other factors to cause autism. These other potential factors are being studied.

There is a possible link between Pitocin and bipolar disorder. A study published in the Journal of Affective Disorders found that babies exposed to Pitocin during birth had 2.4 times increased odds for developing bipolar disorder than babies not exposed to Pitocin. They also found a potential connection between Pitocin and cognitive impairment in childhood.

While this is compelling research to keep an eye on, I don’t believe it’s a reason to turn down labor drugs if they’re really needed. Both studies acknowledged that continued research is needed.

So what happened to Sasha? She had her baby, after crazy-high amounts of Pitocin were used to force her body into labor, and the epidural was kept in for over twelve hours so she could handle the abnormally strong contractions. She had a vaginal birth but was exhausted and dissatisfied with her birth experience. She and baby both had an infection, which a nurse suspected was caused by all the vaginal exams Sasha received over four days in the hospital. When we processed the birth experience, Sasha said she never would have said yes to the labor drugs if the doctor had provided all the information.

On the flip side, I’ve been to many births where Pitocin and epidurals were used after the mother received all the up-to-date information and made an informed decision she felt good about. But the key here is receiving all the up-to-date information. While this section provides a jumping off point for arming yourself with information, ongoing research means this information is ever changing. There’s a lot you can do to make sure you’re getting as much current data as possible.

What to do

Ask a lot of questions before saying yes to any intervention, and don’t let anyone brush away your concerns or questions. Demand thorough answers.

Here are questions to help ensure you’re well informed about your unique situation and options:

Is this an emergency? If the situation is actually an emergency, the care provider should be able to succinctly state why it’s an emergency, and what the wisest course of action is. This is the primary reason we have care providers at birth — in case of an emergency.

Is there an evidence-based medical reason you’re recommending this intervention? If so, explain it to me. Some care providers recommend an intervention based solely on their personal experiences, and not on evidence-based research. This is fine if they’re up-front about it, but you can better understand where the recommendation is coming from by including the term evidence-based in your question.

Is this intervention really necessary? What are the alternatives? An article published in the Journal of Perinatal Education reported that when these two questions are asked, the rate of unnecessary intervention significantly drops. It’s believed this occurs because these questions inspire meaningful discussion that allows the mother to make a well-informed decision.

Can you give me time alone with my birth companion so we can discuss this? This one’s in the form of a question just to be polite. If it’s not an emergency, the caregiver should absolutely give you privacy to make a decision with your birth companion.

After you’ve received all the information, make a decision that feels right for you. Maybe your questioning revealed that an epidural, Pitocin, or both could actually minimize your chance of needing a C-section. Or maybe you determine the potential benefits of receiving the labor drugs aren’t worth the risk. It’s not a black-or-white choice — the decision to accept or reject these drugs is never “right” or “wrong.”

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I keep hearing that everyone ends up getting an epidural. I want an unmedicated birth, but should I just give up hope?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

No way! While women who had unmedicated births used to be like unicorns in places like the United States, birth norms are changing. Childbirth preparation classes and books that teach the power of the mind-body connection, fear release, and how to wield our innate ability to find calm in the face of intensity are helping women who want to have an unmedicated birth to have one. And if you don’t really want one, or if you change your mind about wanting one in the middle of labor, there’s absolutely nothing wrong with that. It’s also important to know that really, really wanting one doesn’t guarantee you’ll have one. You have no way to completely know how your birth will go. However, dedicated preparation will give you a much better chance of having that unmedicated birth.

Let me tell you about Stella. She raved about unmedicated birth but wasn’t planning on taking any classes or practicing any pain relief techniques. She wanted to wing it. She ended up with an epidural. Of course, she might have needed an epidural even if she had thrown herself into preparation, but she came to me afterward saying, “I felt totally unprepared. I had nothing when the big contractions came. I felt like they were eating me.”

When Stella became pregnant two years later, she signed up for my HypnoBirthing class, my online course Childbirth Preparation: A Complete Guide for Pregnant Women, and a Birthing from Within class. She also loaded up on books. Stella became a dedicated student of unmedicated birth. She was so curious and so passionate about practice.

A week before her due date, she told me, “While I still want an un- medicated birth, I don’t think I have to have one to be happy with my birth. I feel really satisfied by all the prep I’ve done — it’s made my pregnancy more enjoyable. And the best part is, the classes have helped me feel so empowered and confident in my unique journey that I don’t feel like I have anything to prove. I don’t need the ‘unmedicated medal’ I’m pretty sure I was striving for the first time around.” Stella had an unmedicated birth. But I believed her when she said she would have been satisfied either way.

I share all that to emphasize that while an unmedicated birth is absolutely possible and it’s not a foregone conclusion you’ll have an epidural, much of the wonder of wanting an unmedicated birth lives in the preparation. With that in mind, consider the ways to prepare listed below.

What to do

Find a type of preparation you jive with, making sure it’s a method that provides tools for an unmedicated birth. HypnoBirthing and Birthing from Within are my favorite options. After you find your class . . .

Practice the techniques. In addition to practicing the breathing, mas- sage, and movement techniques as often as possible (I recommend practicing a minimum of one tool every day), put significant focus on the mental and emotional support your class provides. Many of the biggest barriers between a woman and an unmedicated birth are in the mind. Working the practices that help you replace negative, fearful beliefs about birth with hopeful, inspiring messages can remove those barriers. One of my favorite parts of the mental and emotional work found in many (good) classes is that they spill over into the rest of life. For example, after doing the HypnoBirthing fear-release practices, I felt like I had gone through intensive therapy.

Let it go. After you’ve done the preparation and go into labor, let it all go, trusting that your birth will unfold in the way it’s supposed to. And as I mentioned before, that might not be an unmedicated birth, but that in no way means you failed or didn’t prepare enough. It just means that for whatever reason, your birth needed to take an unexpected path.

Remember, if that’s how it shakes out, those folks who were sure you’d get an epidural don’t get to say, “I told you so.” No way. No one has the right to make you feel shame about your birth experience. You deserve to feel pride in your body’s ability to move through birth — even if birth involved Pitocin and an epidural, or a C-section. Your body still went through so much and should be worshiped as the powerhouse it is.

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Is a cesarean birth the only option if my baby is breech?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

No, you have numerous options. But before we dive into those, know that it’s common for babies to turn out of breech position up to week thirty-six of gestation. It’s certainly still possible after that, but it’s less likely, as baby is getting bigger, leaving less room for the turn.

If you are nearing week thirty-six of gestation and are feeling nervous about baby turning, the first step in encouraging them to turn is using the gentle turn techniques outlined in the “What to do” section below. From there, I discuss a more intense turning technique, called external cephalic version (ECV), and then help you explore what it would look like to vaginally deliver a breech baby. And finally, we’ll look at the process of coming to terms with a cesarean birth, if that ends up being the best path for you.

What to do

Try the following techniques, after getting the go-ahead from your care provider:

Gentle turning methods: If you’re past thirty-four weeks gestation, you can try natural techniques for turning baby into the vertex (head-down) position. Many of these methods are based on the belief that if your uterus is relaxed and your pelvis is optimally positioned, there’s more space for baby to get into the ideal position. And because their head is the heaviest part of their body, gravity helps them rotate if there’s room. These natural techniques are listed in the sidebar below.

Gentle Breech Turning Methods

Guided meditation: I’ve created a recording to support you in relaxing your uterus while envisioning baby turning into the ideal position; you can download it at the following link: yourserenelife.wordpress.com/breech-baby/. Beyond focusing on the physical act of creating more room in the uterus through relaxation, the essence of this meditation is to energetically connect with your baby and encourage them to turn. This is a helpful track to listen to as you engage in the following baby-turning techniques.

Moxibustion: In this exercise, a witch rubs eye of the newt, unicorn poop, and breast milk on your belly. Just kidding. But the real thing might seem a little out there. Derived from Chinese medicine, moxibustion consists of a licensed acupuncturist burning mugwort close to each of your pinky toes (the Bladder 67 acupuncture point). The idea is that the stimulation of heat by these points encourages the release of estrogen and prostaglandins, which in turn stimulate mild contractions that encourage the baby to turn, without causing preterm labor. Moxibustion is usually most effective when used in conjunction with acupuncture and positions used to turn a breech baby (after you receive the moxibustion).

Acupuncture: In addition to moxibustion, an acupuncturist can apply needles to points that will promote relaxation in your uterus and create an overall sense of calm.

Child’s pose: Encourage your baby’s feet or bum to lift out of your pelvis and flip to the upper portion of your uterus by settling into child’s pose. To do this, kneel on a soft, stable surface with your toes together, and knees hip-width apart. Then, lean forward and settle your forearms on the surface in front of your knees, and rest your head on your hands. From here, focus on getting your butt into the air. If you become light-headed or uncomfortable, ease out of the position.

On-all-fours belly dancing: Give baby gentle encouragement to make the turn by getting on your hands and knees on a soft surface (e.g., your bed or pillows on the floor) and gyrating your hips like you were belly dancing. You can make this less boring by popping on a show or music that makes you want to gyrate. And be forewarned that this hands-and-knees-hip-swirl has been known to make baby-making partners randy.

Pelvic tilt: Get back on that soft surface, lie on your back with your knees bent and feet planted on the floor, then lift your hips into the air. This is the bridge pose used in yoga. But we’re going to make it easier by having a friend or family member stack pillows under your hips until you’re able to rest in this position. Hang out here for ten to twenty minutes, listen to the guided meditation I keep touting, and repeat the process at least once a day.

The Webster technique: Performed by a chiropractor, this technique helps realign the pelvis to provide more room for baby to get into the vertex position. Ask your care provider for a referral for a local chiropractor skilled in this technique.

Music: While this is based on an old wives’ tale, it’s worth a try. Grab a portable speaker or some ear buds, turn on a funky jam, and place the speaker against your pelvis. The idea is that baby will be curious about the music and turn their head toward the speaker to investigate. At the very least, this provides an opportunity to develop baby’s good taste in music.

Spinning Babies Aware practice: Check out the following link to see if there is a Spinning Babies practitioner in your area: spinningbabies.com/spinning-babies-aware-practitioner -directory/. The Spinning Babies organization trains medical care providers and bodyworkers to help pregnant women utilize many of the techniques mentioned above. A practitioner can also guide you through a series of helpful daily activities, found here: spinningbabies.com/start/in-pregnancy /daily-activities/. In addition, you can take a class with a Spinning Babies Parents Educator, who you can find here: spinningbabies.com/spinning-babies-certified-parent -educator-directory/.

ECV: If you’re not able to turn baby with gentler techniques by week thirty-six or thirty-seven of gestation, ask your care provider if you’re a candidate for an ECV. In this not-too-fun-but-sometimes-effective technique, a trained practitioner will press on the outside of your abdomen, trying to turn baby’s head down. It usually takes just a few minutes, but it doesn’t always work.

Factors that increase your chance of a successful ECV include having given birth before and the care provider being able to easily feel baby’s head. Reasons you wouldn’t be able to have an ECV include placenta abruption, severe preeclampsia, or signs of fetal distress. In addition, some care providers won’t perform an ECV if you have low amniotic fluid levels or the cord is wrapped around baby’s neck.

While ECV is usually an uncomfortable procedure, it’s worth a try, as it has fairly good success rates. A study published in Obstetric Anesthesia Digest reported that 33 percent of first-time mothers and 61 percent of mothers who have given birth before will have a successful ECV. And there are ways to potentially increase those success rates. An article published in the Cochrane Database of Systematic Reviews reported that the following treatments may improve the outcome of an ECV, but that further research is recommended.

  • Relaxing the womb with drugs like beta stimulants and calcium channel blockers
  • Stimulating the baby with sound through the mother’s abdomen (see “Music” above)
  • Increasing the fluid surrounding the baby
  • Injecting an epidural or spinal analgesia to promote relaxation
  • Giving the mother opioid drugs to help her relax
  • Using guided meditation, which you might have heard about once or twice in this book

Breech delivery: If the ECV doesn’t work, you can start the search for a doctor who attends breech births. While these doctors do exist, they’re becoming harder to find, as many medical schools no longer teach doctors how to deliver a breech baby. Your best bet is to contact a university hospital and ask if they have care providers who support vaginal delivery of breech babies. You may need to contact numerous hospitals before finding someone. And sadly, the search may reveal that no one in your area attends breech deliveries. If you want to discuss breech deliveries with a doctor famous for his work in this area of obstetrics, and possibly receive a referral, reach out to Stuart Fischbein, MD, OB-GYN, through birthinginstincts.com.

If you find a doctor with the expertise and willingness to attend a breech birth, have a conversation with them about the risks and how they would support you through worst-case scenarios. After reviewing your medical records, they can also tell you whether you’re a good candidate for a breech birth. Circumstances that could make you a good candidate include the following:

  • You’ve given birth vaginally to one or more babies who were around the same size as the baby now in utero.
  • Your baby is in frank breech position, which means their butt is down, instead of feet first. It’s also ideal if their head is angled forward, chin to chest.
  • You don’t go into labor before week thirty-seven of gestation. Coming to terms with a C-section: With all that said, you might find that a C-section is the option you feel most comfortable with, and there is nothing wrong with that. Not feeling determined to have a vaginal breech delivery does not mean you’re “giving up”; it just means you’re following the path that feels intuitively right for you. And that path is different for each woman.

Part of your unique experience might also include disappointment over not having the vaginal birth you’d hoped for. You can feel frustrated by the turn of events, while still trusting that you’re having the birth you’re meant to have.

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I want to have a VBAC but can’t find a care provider in my area who will attend one. What should I do?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

One of my past doula clients — we’ll call her Jamie — interviewed fifteen care providers in her search for one who supported VBACs. After two months of searching, she discovered there wasn’t a doctor in a fifty-mile radius of her home willing to attend a VBAC. During that time she was shamed by almost every care provider she interviewed, being told she cared more about her ego than her baby’s life, was uneducated and irresponsible, and would likely fail at having a VBAC. “I’m totally disgusted and disheartened,” she told me after one of the worst encounters. “All these doctors care about is not being sued.”

She then decided she wanted the VBAC enough to drive two hours to the nearest city to be cared for by a group of pro-VBAC midwives at a university hospital. The midwives and doctors she met with at this hospital, after confirming she was an excellent candidate for a VBAC, shared with her the latest information about how much safer VBACs were than repeat C-sections for women in Jamie’s position. Almost all the data they provided contradicted what she had been told by the “fear-based gang,” as she called the local doctors she’d met.

Jamie’s labor came on strong and fast. She made it to the hospital thirty minutes before she was fully dilated. To lower her high blood pressure, she was given a walking epidural and quickly slipped into a state of serenity — she couldn’t stop smiling and telling everyone how empowered and excited she felt. Jamie then started to push. And push. And push. After four hours of pushing the baby hadn’t come out, but Jamie and the baby were in good health. I overheard a nurse say to the midwife, “If we were at the last hospital I worked, they would have forced a C-section on her hours ago.” But that didn’t happen. They kept gently supporting Jamie, ensuring her the baby was coming, albeit slowly. And then the baby arrived, healthy and screaming.

When I talked with Jamie a few weeks after her birth, she said, “I’m really happy I had the VBAC, but I think I would still be happy if I had to have a C-section. I felt so supported, heard, and respected by everyone at that hospital that I know they would’ve recommended a C-section only if it was really needed. I felt like I could trust them, and that made me okay with the idea of a C-section.”

This is the essence of what many women are looking for when seeking a care provider for their VBAC. They’re usually not looking for someone who will go to any length to get them a VBAC. They of course want someone who understands the value of a VBAC and is willing to support it when a woman is in a safe position to have one, but above all, they want someone they trust — someone who supports them in their choices and is one of their staunchest advocates. Being cared for by someone like that often allows women to loosen their grip on the desire for birth to unfold in the exact way they’d envisioned, and instead trust that it will play out in the way it’s supposed to.

What to do

Begin the process of finding quality VBAC support by reaching out to friends in your area who’ve had a VBAC and asking for their care provider’s information. You can also go to the ICAN website (ican-online.org /education) to find the nearest chapter, which can provide quality information on VBAC policies and pro-VBAC care providers in your area.

If you live in a smaller town that doesn’t have pro-VBAC care providers, research doctors and midwives in the nearest city. You’ll probably have the best luck with those who deliver at hospitals affiliated with universities, as they often have the most up-to-date information about VBACs, the risks of repeat C-sections, and how they can best support a woman through a VBAC. Finally, create a list of care providers you would like to interview. Before you meet with each candidate, call ahead to confirm they’ll attend a VBAC, as you don’t want to waste your time.

To conduct illuminating interviews, ask the questions below. They’re intended not just to elicit information but also to provide you with the opportunity to read the care provider’s body language, tone of voice, and overall vibe as they answer your queries. These nonverbal signs might be more telling evidence of whether they’re a good fit for you than what they actually say.

  • Do you feel comfortable with VBACs? The most honest component of the care provider’s answer to this question will likely live in their initial reaction. If they immediately seem enthusiastic, that’s a good sign. If they seem ambivalent but say they “might be willing” to support you in a VBAC “if all goes well,” be wary of their timidity.
  • How many VBACs have you attended? What were the outcomes? You want the care provider to have attended many successful VBACs. If they’ve attended VBACs but most ended in C-sections, take this as a potential sign that they’re actually most comfortable with repeat C-sections.
  • What is your cesarean birth rate? You want this number to be low.
  • What is the general VBAC philosophy of the hospital I would deliver in? If for whatever reason your VBAC-supportive care provider isn’t able to attend your birth, you want the hospital you’ll be delivering in to be supportive of VBACs and to have a low C-section rate.
  • Am I a good candidate for a VBAC? I placed this question after the previous ones because it’s important to gain a sense of the care provider’s philosophy on VBACs before having them assess whether you would be a good candidate. If it seems clear they don’t fully support VBACs, this may skew their assessment of your candidacy. Legitimate reasons a woman would not be a good candidate for a VBAC are a twin pregnancy, a breech baby, placenta previa, and fetal distress. Take comfort in knowing that according to the American Pregnancy Association, 90 percent of women who have had a cesarean birth are candidates for a VBAC.
  • How confident are you that I’ll have a successful VBAC? While there’s no way for a care provider to guarantee you’ll have a VBAC, your experience will be more positive if they express confidence in your body’s ability to move through a VBAC and in their ability to ensure your safety.

By asking these questions you’re being a strong advocate for yourself and baby, while also ensuring your care provider is one of your greatest advocates.

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Are VBACs really as dangerous as many assume? Why are they frowned upon in so many areas?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

In short, no, a VBAC (vaginal birth after cesarean) isn’t nearly as dangerous as some would have you believe. If you’re having a healthy pregnancy, at least eighteen months have passed since your last C-section, you’ve never had a uterine rupture, and your baby is head down (vertex position), a VBAC is likely a safer option than a repeat cesarean.

According to a report published in the journal Obstetrics & Gynecology, a VBAC often decreases the risk of maternal mortality, the need for a hysterectomy, and complications in future pregnancies by helping women avoid major abdominal surgery, which also lowers the risk of hemorrhage and infection and shortens postpartum recovery. The American College of Obstetricians and Gynecologists also affirms that a VBAC is a safe option for many women. Despite this data, some care providers are still hesitant to support a VBAC because of concern that the mother will experience a uterine rupture. But according to the Obstetrics & Gynecology report, if you had a previous cesarean with a low transverse incision (very common), your risk of uterine rupture in a vaginal delivery is less than 1 percent. They also found that 60 to 80 percent of women who plan a VBAC do deliver their baby vaginally.

Even with solid information backing the safety of VBACs for women who are good candidates, a number of care providers and hospitals won’t support VBACs because they think the liability risk is too high. They prefer repeat C-sections because a C-section is the most invasive option and gives them the highest degree of control, and if anything goes wrong, they can say, “We did everything we could.” A survey done by the American College of Obstetricians and Gynecologists found that 30 percent of obstetricians stopped offering VBACs because of concern about liability claims or litigation. The good news is there are still plenty of care providers willing to support a VBAC, and there are plenty of ways to increase your chances of having one.

Note: Medical professionals use the term trial of labor after cesarean (TOLAC) to refer to planned VBAC labor while it’s happening. In other words, TOLAC is the labor, and VBAC is the delivery.

What to do

Before you decide to walk the VBAC path, consider whether it’s what you really want. While research supports the safety of VBAC for many women, you still need to make sure you feel comfortable having one. If you wholeheartedly want a repeat C-section, and you know that’s what would make you most comfortable, there’s nothing wrong with going that route. But if you’re even a little bit on the fence, I recommend exploring the following suggestions, as they’ll shed light on whether a VBAC is right for your unique situation:

Find a care provider who is an advocate of VBACs. Some care providers say they’ll let you “try” for a VBAC, but they’re usually more comfortable with you having another C-section. If you really want a VBAC, you don’t want that type of care provider. You want someone who has not only attended numerous successful VBACs but also wholeheartedly believes in them being the safest option for women who are good candidates. If that’s you, you want the care provider you select to be 100 percent behind your decision. You want them to be your champion and do everything possible to help you get that VBAC, while of course, keeping your safety as the number one priority.

Get a copy of the surgical reports from your C-section. These reports tell you the type of incision and repair used on your uterus, why you received a C-section, and if there were any complications. This informs your care provider if you’re a good candidate for a VBAC.

Equip yourself with knowledge. Because many people don’t have an accurate understanding of the safety of VBACs, you might encounter naysayers when you share this birth preference. First of all, you don’t have to talk about this plan with anyone but your partner and care provider. But if you do want to discuss it with others, arm yourself with the following fun facts that will help you educate the uninformed:

  • For a healthy woman having a healthy pregnancy, a VBAC is usually safer than a repeat C-section, as it decreases the risk of maternal mortality, the need for a hysterectomy, and complications in future pregnancies. It also lowers the risk of hemorrhage and infection, and shortens postpartum recovery.
  • Their risk of uterine rupture during a VBAC is less than 1 percent.
  • Sixty to 80 percent of women who plan a VBAC do end up delivering their baby vaginally.

Utilize the International Cesarean Awareness Network (ICAN). This is a nonprofit aimed at reducing preventable C-sections through education and advocacy for VBACs. Their local chapters connect you with women in your community who have had or are hoping to have VBACs, and they can help you understand the VBAC policies of hospitals in your area and share information about the care providers that support them.

In addition, if you feel you’re being forced into a cesarean, you can call the ICAN hotline at 1-800-686-4226. As they go through the menu, you’ll hear the prompt, “If you feel you are being forced into a cesarean, press 3.” When you press 3, you’ll then be asked to press 2 if you’re currently in labor. If you press 2 you’ll be transferred to an ICAN representative, who very likely has legal or medical training; they can walk you through how to advocate for yourself and prevent an unneeded repeat cesarean.

Utilize VBAC affirmations. If other people’s fears of VBACs start get- ting to you, reinforce your resolve by filling your mind with these positive messages:

  • My C-section scar heals more and more every day.
  • My C-section scar is incredibly strong and will not rupture.
  • My body will do exactly what it needs to do to have a safe vaginal birth.
  • I will have a healthy and happy VBAC.
  • I trust my decision to have a VBAC. I am doing the best thing for my baby and myself.
  • I will be lovingly supported through my VBAC.

Listen to this guided meditation. Visualize yourself moving through a positive VBAC experience by listening to the meditation at this link: yourserenelife.wordpress.com/vbac/.

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Why to Listen to the Asking for a Pregnant Friend Podcast

https://www.podbean.com/media/share/pb-r7y7g-11c4496

Welcome to the Asking for a Pregnant Friend podcast. This podcast is based on the book by the same name and is all about diving into pregnancy, childbirth and motherhood topics our culture has made taboo. We’ll also explore topics that I, and you guys, find fascinating. With that said, this is a collaborative podcast. If you have a topic you’d like me to cover, please email me at BaileyGaddis@yahoo.com You can also learn more about me here.

 

Essentially, this podcast is like the modern day Dear Abbey for pregnant women and new moms, or just curious people, who want to get straight, yet loving, answers to the pregnancy, childbirth and early motherhood questions they’re too afraid to ask.

 

While the journey to motherhood unlocks a wonderland of joy and transformation, it also unlocks a flood of questions women often feel too embarrassed or ashamed to ask. They hold in queries and concerns about their swollen-to-capacity labia, an almost constant desire to masturbate, fears that their partner will cheat on them, strange smells coming from various orifices, being disappointed about their baby’s sex, and a litany of other question marks they stuff down, afraid they’ll be judged if the words spill out. 

 

So these women frantically search through pregnancy, childbirth and mothering books, and online forums, hoping they’ll find someone who has had these questions and found compassionate, accurate answers. But they don’t. They either find watered down versions of what they seek, or in the case of online forums or chat-rooms, the “shameful” question is often met with vicious judgments that make the woman feel mortified and confused. What they seek are candid answers to their questions no one wants to talk about in an uncensored way. They yearn to explore, and eventually move past, these topics in an upfront manner that’s free of judgment. 

 

As a childbirth preparation educator and birth doula I’ve found that once I’m able to get my clients away from the ears of their partners they spill these hidden questions. And as we work through them, I see the women lighten. They feel understood and less alone in what they perceived as their weird or shameful conundrums. 

 

This podcast and the book it’s based on is the culmination of all the questions I’ve heard in whispers after childbirth classes, from girlfriends who look over their shoulder at the cafe to make sure no one is listening, or from my YouTube viewers who email questions because they don’t want them seen on public comments. These women are leading a secret life in a scary pocket of their mind and want a way out. They want a way to free these hidden concerns by way of answers. 

 

My hope is that every time you listen to this podcast you’re relieved to find information about one of the questions you didn’t think other women had, feel more connected to the worldwide community of soon-to-be mothers and new moms, and find peace as you become informed about the aspects of your journey most shy away from.

 

So, why am I the one to do this podcast? As I’ve mentioned, I wrote the book on it, but more so this all stemmed from all the shame I felt during my own pregnancies. I had so many questions that I was sure made me other than. I wanted women and their partners to have a one stop shop to go deep into these topics.

 

In addition to personally relating to pretty much everything I talk about on this podcast I’m also deep in the fertility, pregnancy, birth and mothering world professionally. In addition to being an author of pregnancy and birth books, I’m a childbirth educator and birth doula, and own the egg donor agency Graceful Beginnings. I also write for publications like Working Mother, Fit Pregnancy, Pregnancy and Newborn, Redbook, Woman’s Day, Good Housekeeping, Scary Mommy, American Baby and other places about pregnancy and beyond. In addition, I write the website content and blogs for many of the biggest fertility clinics in the United States. So yeah, this stuff is my life.

 

The goal is that each week, you’re able to tune in and explore taboo topics and those that are just really wild and cool, so you can have a more enlightened, curiosity filled journey into a through motherhood. 

Thanks for joining me!

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What’s a cesarean birth really like?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

It’s intense in ways that are similar to and also completely different than a vaginal birth. Some say a C-section is the “easy way out,” but I don’t agree. While the physical sensations during the surgery are typically mild, significant mental and emotional stamina is often required. And the recovery is much more involved than what’s experienced by women who had a vaginal birth. I say all this because if you end up needing a C-section, I want you to know you haven’t “cheapened” your birth experience or failed to “prove your strength” through a vaginal birth. You’ve gone through an incredible process that requires immense courage.

Here’s what to expect from and keep in mind during a cesarean birth:

  • Scheduling: If you and your care provider decide a planned C-section is the ideal option because of a special circumstance, like your baby being in a breech position or another special circumstance, the surgery will be scheduled sometime around your due date.

  • The unplanned C-section: If you’re in the middle of having a vaginal birth, but something puts you or baby at risk, your care provider might recommend a C-section. If it’s not an emergency, ask them to thoroughly explain the reasoning behind their recommendation, so you can make a well-informed decision.

  • Consent: You have to provide legal consent before the surgery.

  • Safety: Know that the team performing your cesarean birth is composed of trained professionals who will keep you and your baby safe. Allow yourself to enter the experience with an energy of trust, as you’ll be in skilled hands.

  • Support during surgery: In nonemergency situations, your birth companion should be allowed to stay with you during the surgery. If they’re squeamish, consider asking another friend, family member, or doula (if you’ve hired one) to accompany you, as you don’t want the medical staff having to attend to anyone but you and baby.

  • Pain and numbing medication: Before surgery, an anesthesiologist reviews your medical history and pain management options. They’ll likely recommend an epidural or spinal block to numb the lower half of your body. You’ll be awake during the surgery, but you shouldn’t feel anything from your waist down, with the potential exception of some pressure. In some emergency situations — or if you have a condition that would contraindicate an epidural, like a blood clotting disorder — you may receive general anesthesia, but that’s rare.
  • Further prep: After the epidural is placed, your bladder is drained with a catheter, and an IV is started to administer fluids and any additional medication you may need. You might also receive an antacid to neutralize your stomach acid, and antibiotics to prevent infection after the procedure.

  • The screen: To prevent you from witnessing the surgery, a screen is raised at your waist. You can request that the screen be partially lowered when your baby is lifted out. (You’ll find more cesarean birth preferences in the following pages.)

  • The surgery: When the anesthesia has fully numbed you, antiseptic is applied to your lower abdomen, and the surgeon makes a small horizontal cut above your pubic bone. They then cut through the underlying tissue — manually separating your abdominal muscles — until they reach your uterus. A horizontal incision is then made in the lower portion of your uterus, and the doctor retrieves your baby and the placenta. This typically takes fifteen to twenty minutes. You might be given Pitocin after the surgery to help prevent hemorrhaging and to ensure the uterus contracts back down to its original size.

  • Bonding: If you and baby are in good health, you’ll likely be able to hold them after delivery, while you’re still lying on the operating table.

  • The stitches: As you’re falling in love with baby, the surgeon applies absorbable stitches to your uterus, and stitches or staples to your abdomen. The incision is usually so low a bikini bottom can cover the scar.

After the C-section is complete, you start the recovery process, which is different for every woman. The recovery is covered in the next question.

What to do

Create cesarean birth preferences. A common source of resistance to a C-section is lack of control, as women often feel that because the birth is literally in the hands of the surgeons, they’ll lose their sense of empowerment. But this doesn’t have to happen. In the absence of an emergency, many hospitals are open to moms having a voice in how their C-section unfolds, typically in the form of cesarean birth preferences. I find that creating these preferences — even if you feel certain you won’t need a C-section — helps dissolve fear of the unexpected because you’re preparing for all possibilities.

Some cesarean preferences that can help you reclaim feelings of control and empowerment and ensure a gentle C-section are offered below. These preferences are just samples — you should take out any that don’t feel important, and add any that do. I also recommend bringing them to a prenatal appointment about six weeks before your due date to discuss with your care provider and to find out if any of the preferences go against hospital protocol. If so, you could choose to give up some preferences, or find a hospital that supports gentle C-sections.

Sample Caesarean Preferences

We request:

  • To have my arms free during the operation. Being strapped down can induce panic. Request that your arms remain unbound so you can hold baby as soon as possible after delivery.
  • To have a nasal cannula instead of a facemask for oxygen. Oxygen facemasks make some women feel claustrophobic.
  • To have medical staff refrain from personal conversations. Hearing the nurse’s thoughts on a new dating app is unlikely to fill you with positive anticipation for meeting your baby. So request that all people in the operating room swap personal conversations with encouraging words for you — or at least limit their comments to the task at hand.
  • To have medical staff talk to me, instead of about me, as much as possible. This can help you feel like you’re part of the process, instead of “just another patient” cycling through the operating room.
  • To have music or other recording of my choice playing. The sounds you hear during the C-section can set the tone for the experience, so ask for the ability to play songs or a guided meditation of your liking. You should also be able to bring headphones if you want a private listening experience. Use the following link to download a guided meditation created for cesarean births: yourserenelife.wordpress.com/gentle -csection/.
  • To have the screen lowered as baby is lifted out. Seeing your baby’s arrival is a powerful experience, especially for moms who cannot physically feel the emergence.
  • To have delayed cord clamping. This helps reduce the chance of baby developing an iron deficiency, because it allows the iron- and hemoglobin-rich blood in the cord and placenta to get to baby before the cord is clamped and cut. The cord usually stops pulsating within a few minutes after delivery.
  • To have skin-to-skin contact directly after baby is born. The release of oxytocin that occurs when you hold your baby on your bare chest supports bonding and eventual breastfeeding (if that’s something you’re choosing to do).
  • To have monitors placed so they won’t impede bonding. Dealing with a tangle of tubes and wires when trying to hold your baby isn’t fun.
  • To have baby stay with parents at all times, unless a medical complication makes that impossible. It’s ideal for a newborn to be with one of their parents as much as possible.
  • To have a vaginal swab applied to baby (also known as “vaginal seeding”). Stay with me on this one. When a baby is born vaginally, they’re exposed to a range of microbes that help reduce the risk for inflammatory illnesses, heart disease, infections, and other not-fun circumstances. A baby born via C-section can potentially receive the benefits of these microbiomes when the care provider collects a vaginal swab and wipes it on baby’s skin. It can also be wiped on your nipples before breastfeeding. Discuss this preference with your doctor or midwife, as the research is ongoing and controversial. To learn more, check out the article “The Microbiome Seeding Debate — Let’s Frame It around Women-Centered Care” in the journal Reproductive Health.

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What will happen if my baby needs serious medical attention after birth?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

If that happens, you should continually remind yourself that it’s not your fault. For a variety of reasons completely outside our control, baby’s medical status can become fragile during pregnancy or birth. While sadness and fear will likely be woven into the experience, regret doesn’t have to be a constant in this unexpected journey. And it shouldn’t. Because in many ways, all regret does is suck you out of the present moment — and this is a present moment that requires all your energy and attention to make informed decisions and to care for your baby and yourself. Regret makes you ruminate over past circumstances that can’t be changed. And sure, when everything settles down, you can review the series of events that led you here, and see if there’s anything you’d change if you become pregnant again. But for now, give yourself permission to be kind to yourself. This also applies to your partner. It’s natural to want to blame someone when something goes wrong, but often, that only alienates your support system. Just keep choosing forgiveness and kindness — at least in your interactions with yourself and others.

Anger will almost undoubtedly be part of your early experience as well, and that’s okay. It will probably feel completely unfair that your family is having to navigate something so painful and unexpected. And it is. You deserved to give birth to a perfectly healthy baby, and it sucks that you were dealt a different hand. Let all this anger flow through and out to create space for strength. (See below for an idea of how to do that.) Because when we’re constantly trying to suppress negative emotions, it’s hard to find our way into courage and trust that we will make it through. But you will. Even though this might feel like an insurmountable situation, you will make it through.

While much of what you’ll do during this time depends on the unique circumstances of your baby’s health needs, here are some universal strategies for getting through a heath crisis with your baby:

  • Keep bringing yourself back to the present. When our child’s health is in jeopardy, the mind tends to bounce back and forth between the past and the future — thoughts of the past, filled with unproductive regrets, and thoughts of the future, soaked in worst-case scenarios. Neither serves us. The most productive place for you is the present moment, where all you need to do is process and manage what is right in front of you. When your mind starts wandering to unproductive realms, pay attention to your five senses. Notice what you can see, smell, hear, taste, and touch, and let it pull you back into the now.
  • Keep a running list of questions. When your newborn has a health condition, the questions and the storm of new information can be overwhelming. Keep track of it all by writing down your questions the moment you think of them. Then, take notes as the questions are answered. If anything is unclear, don’t be afraid to ask for clarification. Newborn Intensive Care: What Every Parent Needs to Know by Jeanette Zaichin also provides helpful insights on this topic.
  • Request thorough communication. If your baby is in the NICU, you probably won’t be able to be with them 24/7, which could make you antsy for information. Ensure that you stay informed of baby’s health status by being adamant that the health care team regularly updates you.
  • Be treated in the same facility as your baby. If your baby needs to be transferred to a new hospital and you’re still in need of postpartum care, ask if you can be transferred to the same facility.
  • Ask to be part of baby’s care. While much of the care baby needs will likely require specialized training, there will be tasks like bathing, cleaning, and of course bonding that you can participate in. Work out a schedule with the care team so you know when to be present for these activities.
  • Create a physical anchor. When we’re crippled by fear, it can feel like we’ve left our body. This can be paralyzing. When you notice you’re floating into fear, ground yourself by utilizing a physical anchor. For example, you can hug yourself, push down on your shoulders, or press your palms into your eyes. When you use your anchor of choice, couple it with an affirmation, something along the lines of “It’s safe to come back into my body.”
  • Don’t blame yourself. Every time you try to blame yourself for what’s happening, mentally step out of yourself and firmly but gently say, “STOP.” After giving that stop message, treat yourself as you would a child who is broken up over something that isn’t their fault. You wouldn’t encourage them to be harder on themselves — you would nurture and reassure them. Do that for yourself.
  • Take time every day to let out your emotions. Get into a private space for an hour (or for however long you have to be alone) every day and let yourself go. Scream, rage, cry, beat your fist on a pillow — let it out. Releasing these emotions can provide the clarity and calm to get you through the most difficult days of this journey. You can also journal during this time, letting out all the thoughts you don’t feel comfortable sharing with others.

If you find it helpful to have a sounding board, ask a friend or family member if they’d be willing to be this for you. Tell them straight up that you’re looking not for advice but for someone to be an active listener. I would stay away from asking your partner to do this, as they’re too close to the situation. While you’ll definitely be a support for one another, it’s ideal for each of you to have someone else to vent to.

  • Go for a walk. Being in a medical facility for prolonged periods can be stifling, making it hard to think clearly. Refresh your mind, body, and emotions by going outside at least once a day and walking around the block, or to a local park. Amp up the benefits of the walk by listening to soothing music or a guided meditation.
  • Nurture your basic needs. Drinking water, regularly eating nutritious food, and sleeping helps ensure that your health doesn’t sustain too much damage through this challenging time. My client Sarah had a premature baby who had to be in the NICU for four weeks. She said she felt like she had to martyr herself during that time. She said the thought “My baby is suffering, so I should suffer” constantly cycled through her mind. This resulted in her depriving herself of nourishing meals, quality sleep, and regular showers. Looking back, she regrets this attitude, saying, “By doing that I made myself so physically weak and uncomfortable, which made it harder to deal with my emotions, make decisions, and even spend time with my baby. Anytime I was with her in the NICU, I would just break down.”

While you probably won’t feel like doing anything but worry about your baby, forcing yourself to take care of those basic needs can fortify your ability to be there for them. You don’t deserve to suffer more than you already are.

  • Join a support group. Having a child with unexpected health needs can feel very isolating — like no one else could possibly relate to your pain. But seeking the camaraderie of a support group for parents navigating similar situations can help you feel less alone, and talking with other parents provides an outlet for processing what your family is going through. Members of these groups are often wonderful resources as well, providing tips on the best care providers, helpful treatments for various conditions, and how to work with your insurance provider. Your baby’s doctor can likely provide recommendations for local support groups. the March of Dimes, National Perinatal Association, and shareyourstory.org can also connect you with helpful resources. In addition, platforms like Facebook have many online support groups.

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