Respecting the Golden Hour

Wednesday, September 30, 2020

Respecting the Golden Hour

The time immediately following your birth is crucial to the well being of our child. Research says that respecting what is called “The golden Hour” can help give your child the best possible start. If it is possible, requesting that your medical staff and birth team respect this time can help your baby adjust to life on the outside before they are poked and prodded with newborn tests and passed from person to person for birth stats. 

The way in which the golden hour mentality is carried out varies from culture to culture. In some cultures an extended golden hour called “lying in” is a practice in which women are waited upon and only allowed to do minimal tasks such as getting up to use the bathroom, but not to shower. It is said to be supportive of postpartum healing and mother-child attachment. However, in some cultures, parents aren’t afforded any paid time off of work to recover from birth and bond with their baby. 

Visitors are no exception to the rule. It varies widely from culture to culture and family to family. Some parents choose not to have visitors for at least a few days after the birth and some parents prefer to be surrounded by family and friends immediately following. Whatever your preference, respecting The Golden Hour can be done in a quiet, intimate room or a room that looks like a birth after-party! 

What’s the Golden Hour?

This typically refers to the first 60 minutes of your child’s life. This hour will feel like a lot of emotions and physical feelings and, sometimes, feels a little blurry looking back. This is all the more reason to take the first 60 minutes after your birth to do nothing but let your medical team repair you, hold your baby, relish in the fact that you did it, and just soak up this magical moment. Your baby will be so delicate. The first hour of life can be reserved as a gentle and tender time to help your baby transition. 

What to say to visitors?

The Truth: You can always be straight forward and let them know they you are excited to share your baby, but you’ve made a decision to delay visitors until [when] except for [who] because [why]. Most people will understand. Don’t be afraid to stand your ground if something is important to you. 

My Midwife/Doctor Said No: ie. for the people who didn’t understand above reason. You can always blame your provider. Even your doula might agree to be the blame. Your birth team will understand why it is so important. 

What’s the low down?

Consider requesting delayed cord clamping and immediate skin to skin contact. This can help keep the environment as calm and comforting to your baby as possible. Delayed cord clamping has several benefits and allows your baby to remain supported while learning to breathe on the outside. Your body will adjust its’ temperature to be whatever your baby needs so you’re a natural heat lamp for your baby. There is research suggesting an uninterrupted golden hour for low-birth weight infants to help support their temperature and their blood pressure. Babies generally make attempts to breastfeed within the first hour of life. Allowing them this uninterrupted time to explore and figure out the breast can be crucial to breastfeeding. Your baby is born knowing how to do what is called “The Breast Crawl” and is able to get their way from your belly (when placed there after birth) to your breast on their own. It is incredible to watch. You can watch it for yourself here (It takes a minute, not a process you want to rush). 

Laying your baby on your chest has benefits for you such as pain relief. Skin to skin with your baby will elicit certain chemicals to release in your brain and they will help deliver your placenta, but also block pain receptors. Your baby can benefit too because your body and breast will have germs that “initiate” your baby, if you will. These are germs that your baby needs to help build their immunity and letting them just lay on your chest for an undisturbed hour will give them so much exposure to your healthy bacteria. (Chapter 2, part 2 of this book does a great job explaining this. Disclaimer: this book was published by InTechOpen which has some controversial funders. You can take a look and make your own decision if you want to seek out other sources for yourself here.)

Don’t Feel Bad 

If you feel strongly that you want to ask visitors to wait a certain period of time, then you have every right to do so. If you know that people holding and kissing and snuggling your baby will make you anxious, then it’s worth considering. Please know science has your back on this one! You can see our blog about asking visitors to wait here! If you feel it will be lonely without your parents and siblings and partner’s family, then do just that! Whatever you choose should be what makes you most comfortable and what makes sense to you. 

At the end of the day, you don’t get to do this birth over. Being able to request things that are important to you and have those decisions respected and honored by those around you is essential in making this a spectacular memory. Don’t be afraid to advocate for yourself. 

What *actually* starts labor?

Wednesday, September 23, 2020

Can We Predict the Start of Labor?

People (me included) say all the time, “Babies come on their own time.” And, this is true, they do. But, they don’t just randomly choose a day. It isn’t luck of the draw or even chance. So if there is something more to it, what *actually* starts labor? Let’s dive a bit deeper!

I know you’ve heard this before if you are not new around here, but your baby’s body and your body literally work together to start labor. They have been working together this whole time during pregnancy and will continue to work throughout birth and as long as you breastfeed. My mama would argue she can still feel when something is off from me (I live in Boston and she’s in Mississippi!) Your mama instinct is so strong. There are so many birthing people who say they feel like an induction isn’t the right choice for them and there’s research to show that you might be right! 

*You’re going to notice that some of these articles seem old. They are old because this isn’t new. This is something we are well aware of in the birth world. 

So, What Starts Labor?

Your baby’s lungs! That’s right, when your baby is ready to be born, their lungs will actually produce a hormone that mixes with your amniotic which triggers labor. “During the last part of your pregnancy, your baby's lungs mature and he or she puts on a protective layer of fat, taking on the characteristic chubbiness of a newborn. Researchers now believe that when a baby is ready for life outside his mother's uterus, his body releases a tiny amount of a substance that signals the mother's hormones to begin labor (Condon, Jeyasuria, Faust, & Mendelson, 2004). In most cases, your labor will begin only when both your body and your baby are ready.”

It’s also super important to remember that in late pregnancy your body is doing tons of work that is unseen. I’m not talking about dilation or effacement--things we can measure. I’m talking about things we can’t/don’t measure for like hormonal changes, the dropping of your baby, or the positioning of your baby’s head (more than facing forward or facing backward). There are so many things that your body does, like your hips and pelvis slowly opening up (an additional 30% in late pregnancy and throughout labor!) to make more space for baby and your breasts beginning to make and store colostrum! Your baby’s hormones will be speaking to your hormones and that will tell your body what to do. “The fetal hypothalamo-pituitary-adrenal axis plays a fundamental role in stimulating increased estrogen production in late gestation. Estrogen then activates maternal circadian rhythms that increase oxytocin secretion. As a result, uterine contraction patterns are switched from contractures to contractions.” (Nathanielsz, 1998) There’s plenty of research out there sharing the importance of your baby’s development in birth and some researchers suggest that answering critical questions about the hypothalamo-pituitary-adrenal axis can be key to reducing the number of preterm births and decrease the number of NICU stays (Wood and Wood, 2016). 

As your baby begins to produce these hormones, your body will begin to respond by prepping itself. This, for many pregnant people, looks like walking around a few centimeters dilated or effaced a bit! Your body is designed to be on the lookout for these signals from your baby! “Oxytocin receptors are probably crucial for the onset of human labor, and the stimulus for the increase in uterine prostaglandins may be oxytocin originating from the fetus.” (Fuchs, Fuchs, Husslein, Soloff, Fernstrom, 1982)

Remember, your baby is a separate being from you, but still dependent on you! They work together, but we shouldn’t force your body to try to control your baby.

So, What about Past Due Babies?

Don’t worry! Nature has that figured out too! We have to keep in mind that birth is a natural event--NOT a medical event. If you think about birth, humans are the only ones who trust other folks to birth their baby, birth in a medical environment, have tons of interventions and procedures “just in case”....If we step back and give nature the space to unfold as it’s intended to do, we can usually trust things to go right. 

So, if your baby isn’t here on your due date (uh hmmm, please remember that first time babies are usually born 40+5 to 41+2), there’s some research to take a look at before making your next move! “They found that changes in telomeres, part of our DNA that responds to aging, become present in the amniotic fluid as the placenta and other pregnancy tissues get older (source). These cells could be telling the baby that it's time to be born. "What made us suspect this signal is that we have always believed that labor can be triggered by the baby,"says lead author Ramkumar Menon, Ph.D., an assistant professor in the department of Obstetrics and Gynecology, and co-author George R. Saade, M.D., a professor and chief of Obstetrics and Maternal Fetal Medicine.”

So while babies will ‘come on their own time,’ they are actually still developing up until that point. We want to make sure we are balancing having a healthy respect for your baby’s growth and development when we talk about due dates and inductions! You can see more information on how your risk of c-section increases if your birth is augmented by way of induction here

The science is very clear what starts labor and that IS the baby’s body communicating to the gestational parent’s body via hormones and secretions that increase oxytocin and estrogen in the parent that then stimulates contractions. 

You can grab a free download to help master your mindset at the end of pregnancy! It can be so hard to patiently await your little one! I hear that 100%, but I also want to remind you to leave a healthy amount of space for your baby to work their magic as they are designed to do! If you want to learn more information to help you have an informed and confident birth, join our waitlist to be the first to know when The Birth Lounge opens again!

Ps. If you want a good birth story and one that empowers you to wait to trust in your baby, read this one

Feeling snotty? There's a reason!

Wednesday, September 16, 2020

 

Mucus Production & Pregnancy

Doesn't sound awesome, but doesn't sound too bad, does it?

You're probably thinking a runny nose and you're not too gar off, but it can also look like ear infections and sinus infections. During pregnancy, your hormones rage (duh!), but the specific surges in estrogen does helpful things like increasing blood supply to your vaginal area and creating your mucus plug.

Since you're pregnant, you can't take most medications. Even if you could, many people choose to limit medication consumption during pregnancy and nursing. So what are you to do? Just be a walking snot factory for 9+ months? No, not at all. Like everything else, you have some choice here on your approaches.

Here are a few remedies to clear mucus:
- Drinking lots of water
- Adding electrolytes to your water
- Eating garlic + onions
- Cutting down (consider eliminating) dairy
- Netti pot
- Drinking hot liquids
Turmeric health shot
- Eating soup
- Rest, rest, rest
- Acupuncture

You may also experience ear infections. Here are some remedies:
- Check in with your doctor (you may require an office visit)
- Mullein Garlic (purchased at whole foods, ear drops)
- Eating garlic + onions
- Avoid dairy
- Turmeric health shot
- Netti pot
- Hydrate!!!

A neat trick that I learned recently from a nurse was to bend over and put your head below your heart. If the stuffiness drains and the throbbing stops, it is due to pregnancy. If it doesn't drain and the throbbing doesn't stop (or gets worse) it's most likely stopped up and could be a possible ear infection. *This in no way constitutes medical advice, diagnosis, or a cure and should not be taken as such*

If you get a fever, no matter how tiny, check in with your healthcare provider. Be sure to avoid colloidal silver as it is bit safe for pregnant or nursing people.

Pregnancy changes everything in your body...and I mean everything. Right down to your sinuses, your baby is already controlling you in every sense. Now that you know you have a reason to nap and decline Friday night's invite to supper club, do it. Take advantage of growing this tiny human. Take the time to honor the messages your body is sending you (rest, hydration, and slowing down).

You only get to experience this pregnancy once. Stop and enjoy it.


Don’t forget to join our private Facebook group and follow us on Instagram at @tranquilitybyhehe or @the.birth.lounge!


Heartburn in Pregnancy

Wednesday, September 9, 2020

 

Heartburn in Pregnancy

Why does it happen?

Heartburn is incredibly common and will plague between 17%-45% of pregnant people (Vazquez JC. Heartburn in pregnancy. BMJ Clin Evid. 2015;2015:1411. Published 2015 Sep 8.).

This happen because of two hormones: progesterone and relaxin. They are responsible for relaxing the muscles in your body during pregnancy to allow for growth and stretching in order to accommodate your baby. This causes your esophagus and the sphincter that keeps it closed to relax as well. Also, as your baby grows your “real estate” gets smaller and smaller.

With this change, your stomach gets squished which forces stomach acid back up into your esophagus. Not pleasant, but there are ways to combat this physical change and discomfort!

First, what not to do!

  • Do not stop eating. Your baby needs to be nourished. Not eating will actually increase your stomach acid making your heartburn worse.

  • Do not munch on antacids (TUMS, Rolaids) like candy as this has been linked to calcification of the placenta*. This means your placenta will begin to develop these very hard, rocklike spots and obviously this is not healthy for your baby. Also too much calcium can block iron absorption so be mindful of that. Many actiacids use aluminum as an active ingredient such as aluminum hydroxide or aluminum carbonate and should be avoided in pregnancy. Antiacids can cause constipation and due to the high sodium bicarbonate in some formulas, it can elevate your blood pressure which is not great for anyone at risk for preeclampsia.

What to do? (Please check with your provider before using/adopting these remedies): 

  • Begin with eating smaller meals. I recommend also snacking every hour with just a handful of something light, but filling like almonds, popcorn, 3-5 crackers, a handful of grapes or blueberries, a bowl of strawberries or watermelon, a hard-boiled egg, etc. Eating smaller meals will benefit you in several ways: it will allow your belly to digest before adding more since the space is limited, it will provide you and your baby consistent fuel (and energy), and it will support stable blood sugar. Along with eating small meals is eating slow. Do not scarf down your dinner in 10 minutes flat and be shocked that your heartburn is out of control. Your tummy just can’t digest that amount of food consumed in a matter of minutes at once anymore.

  • Drink a glass of milk. Milk can coat the inside of your stomach and help dilute the stomach aid. Yogurt can do the same thing for you! You can also try a shot of Apple Cider Vinegar, eating ginger or sipping ginger tea, a spoonful of honey or chamomile tea with honey.

  • Papaya Enzymes. Caution here because papaya FRUIT (vs. the extracted enzyme) is contraindicated as a possible cause of pre-term labor. The caveat here is that it’s UNRIPE papaya fruit but since you don’t ever really know the ripeness of fruit you purchase in the store, it’s best to stay away altogether (unripe papaya has also been linked to miscarriage in a few studies when consumed in the first trimester).

  • - Orange Peel Extract: I have never heard of this and have never recommended this, but this is a very interesting article and the sources are provided at the bottom. 

  • Stay hydrated. Rather than downing a glass of water once an hour, it’s better to consume liquids consistently throughout the day. The recommended amount of water for an average pregnancy and average sized female is 8-10 cups (equal to 65-80 ounces or 2-2.4 liters).

  • Avoid laying down after eating. You should not lie down for at least 45-60 minuets after eating. This is most difficult after dinner so I say find an activity that requires you to be upright—either standing or sitting. If you lie down too soon, the stomach acid that is working to digest the food in your stomach will slip right up and you might even feel nauseas or find yourself throwing up.

  • Avoid eating right before bed. I always say if you can eat 2 hours before bed, then that’s enough, but some doctors would say you shouldn’t eat anymore than 3 hours before bed. I believe this truly depends on your body and only you will know what that time is for you. However, try not to eat super hearty meals before bed because this will have your stomach working in overdrive. If you need to eat right before bed (trust me, I feel you), I recommend something water based like grapes, watermelon, or celery. These are easy things to digest, but be mindful that the sugar from the grapes and watermelon may spike your blood sugar or make your baby have a dance party.

  • Sleep Elevated. You can achieve this several ways. You can purchase a wedge pillow or you can stuff rolled up towels (or a yoga mat) under the top of your mattress to create an angle at your head. This will prevent stomach acid from going back into your esophagus while you’re lying flat.

  • Chew sugarless gum after eating dinner (or any large meal). This is a very interesting one, but it works similarly to giving a baby with acid reflux (or just really bad spit up) a pacifier after feeding them (before burping) to keep them sucking. This continuous sucking, despite not eating, keeps their gastrointestinal system activated which keeps them digesting longer and we generally see a decrease in spit up. Same with adults, but our gastrointestinal system is activated by chewing since we are not infants anymore. The chewing gum will keep your stomach activated. The increased saliva might also help to neutralize the stomach acid.

  • Speak with your doctor. They may suggest a H2 blocker like Tagamet or Zantac. Be mindful that long term use of these have been linked to pH unbalance in your stomach and gut.

*CALCIFICATION OF THE PLACENTA

  • - This is a condition where the placenta begins to harden (calcify) in specific spots. These spots are indicators of the “age” or “ efficiency” fo the placenta meaning the more calcification the “older” and less efficient your placenta is considered to be. 

  • - This is a great informational article but provides no evidence-based citations or any real sources. 

  • - It’s not regulated by the FDA nor has it been evaluated by any formal study that it is safe to consume daily TUMS during pregnancy. 

  • - The Placenta is in charge of filtering all calcium that crosses the blood-brain barrier. If there is too much, your placenta will actually hold the extra calcium —causing calcification of the placenta. Calcification of the placenta has been associated with pre-term labor. TUMS should never be taken at the same time as prenatal vitamins due to a possible adverse interaction between the two. 

  • - Calcium Carbonate is the active ingredient in antacids and too much calcium has been shown to block iron absorption. Iron is extremely important in pregnancy. Your body uses iron to make hemoglobin, a protein in the red blood cells that carries oxygen to your tissues. During pregnancy, you need up to double the “normal” recommended dose to increase the red blood cells to in-turn increase the oxygen levels reaching your baby. 

  • - There are a few studies that show (one of these is as a journal of veterinarian medicine—not too far off as we generally test on rats, pigs, or rabbits for pregnancy related research) an almost toxic level of calcium in fetal blood compared to mothers. Read more about these studies  here or here.

  • - Another product similar to TUMS, called Tame the Flame, is provided by Healthy Mama. 

  • - It is possible that magnesium or Vitamin D can help offset the potential “overdose” of calcium.

Calcium During Pregnancy:


Remember: It is not our job to tell clients what they should and shouldn’t take during pregnancy. Our responsibility is to share with them the potential risks, the sources we have available, and alternatives choices they have as options to consider.

If you are looking for more resources and support surrounding diet and nutrition in pregnancy - join us in The Birth Lounge to have an informed pregnancy and confident birth experience!

7 Slippery Slopes of Labor

Wednesday, September 2, 2020

7 Slippery Slopes of Labor

How to stay in control during labor is one of the most FAQs that I receive on a daily basis! Good news! So many of the “unknowns” of birth can be alleviated with the proper education and preparation! 

But there is a catch here! The catch is.. how you prepare is uber important. Meaning you can read all the books that you have been told to read, but if you're not reading the right books, then it's really not going to prepare you. You can take all of the childbirth ed classes that your hospital has to offer. But, if your hospital isn't presenting you with all of the options during the childbirth ed course, and they're only presenting you with options that they want you to know, this prevents you from being able to truly make an informed and confident choice. 

Being able to freely make a decision after open discussion with your doctor is what we call shared decision making. This means you, your medical team and your support people come together to do exactly what it sounds like-- making a decision after sharing suggestions, opinions, and alternative options. It is important that the birthing parent shares their fears and concerns at this point, too!With this, the birthing person should feel supported and safe in their decisions. You want your medical team to feel like we are choosing a safe and reasonable option, as well! You should also feel confident that you are making the right choice and your medical team should feel comfortable with the choice made. 

Nature’s Role 

Remember that nature is always going to play a role in birth. That's life; nature will always play a role in everything we do and we can’t control that. But, as far as being able to control labor, you can control 90% of it (the part that isn’t dependent on nature). I like to think about labor as seven different categories that you can control 100%. These are places that I call the slippery slopes of birth

The Slippery Slopes of Birth 

These are seven places of your birth story that you can control, but if you aren’t preparing intentionally and you don't prepare in the correct way with the correct information (research-backed information), then you risk going down one of the slippery slopes. Each of these 7 categories is a mountain that you can conquer (control) or you can slip down during labor. 

Here's the thing, it's not about having a straight arrow birth when making your birth plan. It won’t be this A to B type route. There will always be what I like to call ‘loop-di-loo’s’ along the way! Knowing how to control these seven places in labor is mey and we will do this by showing you the variables and the normal variations of labor and birth. This enables you to understand what's normal and what is a cause for concern, what are worrisome numbers and what is expected with typical labor patterns. With this understanding, you will be able to have educated discussions with your doctor to find what option is best for you. You will be able to ask the right questions using the right words to feel informed about all of your choices. 

There are some things in birth that no matter how hard we try, we're not going to be able to control. And, that is the nature piece. That's literally the only piece of this journey that we can’t control. But, you want your birth to unravel how it's supposed to and your job is not to control it. (Remember, birth is a very natural thing) You're safe to have your baby and your job is to relax so your body can do its job. Your job is to be so prepared and so informed and have done all the research so that if you run into any of those variables, you know how you can react and what your options are--in each of those situations.

Again, it's not about controlling your labor, your birth experience. It is about controlling the seven places that you have ultimate control and allowing nature to take control of the rest. We will prepare for and react to whatever nature throws your way. 

The CONTROL Method

Communication. Options. Navigating labor. Team. Research. Opinions. Location. 

Let's just take the first one C, communication. Ideally throughout your pregnancy, as you're meeting with your provider (whether you see one provider the entire time or you see a rotation of providers), you should be setting boundaries along the way. You can gently do this through communication. Let's say, for example, you have a very strong preference to do whatever you can to avoid a C-section and otherwise you’re really open to a lot of things. 

Since your main goal here is to have a vaginal delivery, we want to gently be saying this throughout your prenatals with your provider or providers, so that they start to get the idea of your birth goals. This sets the tone for your birth in pregnancy. The more direct you are with your doctor, the less room for error. In communicating your goals, you’re providing them with constant reminders over time, so that they're less likely to forget during your labor. This also ensures this doctor is a good fit for you and can support you in your goals. Communicating before you’re in labor prevents us from having to have this conversation during labor because your team already understands your birth goals. That boundary has already been set. 

You can see how this is a slippery slope if we don't do the very tiny steps of setting these boundaries and communicating during your prenatals, asking the right questions, using the right words, getting really right down to the bottom of your provider's thoughts and your goals, but also finding that happy middle ground. One last thought: making your goals clear before you’re in labor is incredibly helpful should you have a provider you've never met attend your labor.

Let’s chat about R. Doing the research before allows you to have a solid foundation of understanding about what common practices are in the birth world and what the evidence says about each of those practices. These are certainly things that you don't want to be making big decisions about during labor. These will be things that are going to impact the way your birth goes now or the way that your birth goes down the line a bit. Making decisions on whether you want an IV placed or whether you can eat during labor isn’t what you’re going to want to be doing while you’re also trying to use your mental and cognitive energy to focus on your contractions. 

One of the best things you can do to take control of your birth is to plan for all of those variables and learn those normal variations in labor so that you know what's normal versus what is concerning during labor. The research you do leading up to your birth gives YOU all the power. You know what to expect, what your options are, what is considered ‘not normal,’ and what to do if your labor does take a ‘not normal’ turn! 

It’s All Connected.

If we look closely, we can see how it's all intertwined. It starts with communication, then understanding your options at each stage. Those two allow you to navigate labor and your team + your research allow you to stay in control from start to finish. Finally, when you control for the opinions in your inner circle and the place you give birth, you greatly increase your chances of achieving your birth goals! 

Now, sometimes you're going to have to advocate harder for yourself than other times, but in labor, that’s really a nonnegotiable. You have to speak up for yourself. It is a must. If you're going to stay in control, you have to speak up. Period. You have to absolutely speak up for yourself and advocate for your birth goals in order to stay on track for reaching your dream birth. 

If you find that your doctor is giving you pushback on your birth goals and they don't really have a lot of flexibility-- it's really worth considering if this is the right doctor for you. If they are inflexible in your pregnancy, it's unlikely that once labor begins that there's a lot of change in that department. So, if you're already feeling that tension, it is worth thinking about finding a provider that is better aligned with you. This goes back to the core value of T, team. 

Remember that there are so many outdated policies in women's health. Like, you know, one of my favorite examples to talk about is the policy restricting food and liquids during labor women. The research is very clear that birthing people should be able to eat and drink during labor, even with an epidural. Like, the science is very, very clear about this. There are so many things that hospital policies have not caught up to the research. This is very important for you to know, and this is exactly what the control method teaches you. This is all part of the research you will do along the way (or, in The Birth Lounge, I’ve done the research for you!). It's up to you to know what your hospital policies are, but the birth lounge will break it down further so that you know how to look into those policies to ensure that they are based on the latest research. (There's no doubt they're based in research, but it is possible and highly likely that they are based on outdated research, meaning from the 1990s. Your hospitals are not intentionally trying to treat you poorly. Many hospitals just haven't revisited the research and their policies in ages.) 

The Birth Lounge teaches you how to have these conversations with your provider so that no matter what happens in your birth, you are the one in control. You will understand how to identify the control, you know how to take the control and you know how to remain in control.

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