Chatting Menstruation, 'Learning Up', and more with Rebecca Alvarez of The Bloomi

Wednesday, February 24, 2021

Sex, Menstruation, Re-evaluating Cultural Norms, and more with Rebecca Alvarez of The Bloomi
(Part 2 of 2 of our interview derived from Podcast episode )

HeHe: So we talked a little bit about the stigmas and the shame about menstruation. Go into that a little bit more, like, just share your thoughts.
Rebecca: It makes me kind of upset to think that there's still such a huge portion of us that feel that sex is shameful or dirty. Or menstruating is shameful or dirty.

I'm Mexican. Both of my parents immigrated here and I grew up with a lot of cultural norms that had to do with these topics where the idea of staying clean. Meaning when you're on your period, wash yourself really well using these very fragrant products. Those ideas were just part of my cultural norms, I'll say. And I think that's the case for a lot of women, especially women of color. 

Then the idea that sex is more on the dirty side. A lot of like the douching practices that are still being used today, those blow my mind.  The fact that there's still a lot of douching that happens after sex, because of ideas that it's dirty.  Like I've heard a lot of different examples of how these taboos are affecting the things that we do and the things that women want to do to 'stay clean'. But overall, I had to do a lot of soul searching when I was going into this industry.  To really understand, what is something that I have to unlearn and that I want to unlearn. I think that one of the things I really want to do for our community for The Bloomi community is help people make the decisions that they want for their bodies. 

So I don't necessarily think you need to do a hundred percent organic or that you need to be a hundred percent pro masturbation everyday. There's nothing extreme about what we're trying to advocate for. It's more just find what feels good for you. Don't necessarily trust that everything you learned as a child or as a teen is something that you should continue with in terms of your sexual self.  Empower yourself sexually and make sure that these taboos that you feel are what you want to continue thinking and carrying through, into like your relationships and your own sex life and your practices. 

I think at the end of the day, when we stop to reflect on what makes us happy, pleasure makes us happy. So, making sure that we advocate for ourselves makes us happy. A lot of that happens naturally when you have information. 

HeHe:  I could not agree more.  I love that you mentioned reevaluating what you have always believed.  Is that serving you?  And if you decide, no, give yourself permission for that to be the answer and know that that is totally fine. Don't shame yourself for feeling like you want to take a turn. It makes sense from a human development standpoint, which is how I come to every conversation. 

Then the second thing is the psychology piece.  The psychology piece in sex is so much mindset. If you're excited about the way that your vagina smells and tastes and you're excited to share that with your partner, they will adopt that same energy. Research shows that partners who are like very close to your perfect match will be attracted to your sweat cells. So they did a study where they had people exercise and then their partners came and were able to correctly identify their partners sweaty shirts. So your partner, if they don't like the way you smell, throw the whole partner out and try again.  There's so many fish out there. Somebody will like it. 

Rebecca:  It's crazy. Even if you think of the business side of all of this and the business side of sex, you probably have heard a lot of this already, but sexual wellness companies cannot advertise. So from a consumer standpoint, it doesn't feel like that big of a deal, but this is how companies survive. This is how, we can get these cleaner products to you. There's a double standard because we can see advertisements for Viagra, for example, but we can't see them for sexual pleasure for women.  It doesn't make sense to me. It's not a new thing, but that's just one small example. 

So to me, from the business side, we need to do better. We need to invest in these female founded companies that are doing such great work with the products that they're creating. That means that consumers can have more options.  It goes back to our issue of, there's not a lot of options, so to have those options, we need to help those companies grow. And I think VCs and investors should really take a closer look at at what the demands are and what women and femmes are asking for. 

HeHe: Yes! Support clean, small businesses.  Support female-focused and founded businesses. Be smart with your money.  You will see those companies grow and they will eventually be able to be the big dogs. And then you have access to this kind of stuff. But you're really crucial on this. Consumers are everything.

So back to having these conversations, they can be a little awkward. How do you actually make an impact and have these conversations with people that you don't know super well, but you think can benefit?

Rebecca: That is a great question. It's not like makeup, right? Like you try a lipstick or lip gloss. You like it-  and then you just have a casual conversation. Sometimes some of these topics can be a little bit more personal. 

So I would recommend two things. One, I would recommend trying to make these conversations more casual by having more of them from just like a wellness standpoint. So for example, you know how we have the big talk sometimes when we talk about sex with younger kids, I am a big advocate for, don't make this a one-time conversation, make this an ongoing life conversation.  Your health and your sexual health are going to change as you grow. So for me, if I can recommend anything to women, it's try to have these casual conversations as if you were talking about your blood pressure or as if you were talking about going to the doctor for anything else.

So what, what that means sometimes is stepping out of your comfort zone and just sharing a personal experience. But I think with practice and doing it more often, it does become easier and more of the norm. I think the second thing is I would expect people who you're speaking to, to want to also have a conversation with you. I think a lot of times we hold back on some of the things that we want to share with our friends, but to be honest, they probably are more receptive than you're thinking. They probably want to have these conversations. For so long, we've had the narrative come from white men on what we should be thinking about our sex life and the products that we're using, but that narrative is changing. And the best way to do that is to have conversations with people and share your experiences. 

Stepping outside of your comfort zone a little bit can go a long way. Viewing this as a general health topic, like sex, intimate care, and periods. This is all just part of our health. So it is a little bit of a shift and a pivot in the way that you're thinking about it from like a health standpoint. Really making it something that you can drop little conversations here and there. If a friend of mine has a product that she's loving, I want to know about it. I want that option as well. 

HeHe: You touched on that the narrative has always come from white men. You have to think that their perspective was their end goal was - pleasure for themselves. I think women, we're seeing this shift because we're taking the conversation back.  I think women are starting to realize there are consequences. So yeah, absolutely share these products. And I like how you say, do it kind of incrementally. 

Make it kind of a normal thing that you talk about. If it's on your mind, bring it up. Don't hesitate because here's the thing. They have a period too. And if they don't, they still have something to talk about. They don't have a period. Like you have something automatically in common with this person that you can bond over and you can take the opportunity to educate them.  I think the best way to share something you love is to share your story of how it has impacted your life. Sharing the noticeable differences that you are seeing and letting them know that there is an option. Chances are, they might not know about it. Or they know about it, but they've never taken the time to, to look into it. 

Rebecca: I want to mention that there's a new shift in the way that conversations are happening from generation to generation right now. The fact that there's so many millennials doing what is called 'teaching up'. So traditionally, there was a lot of women's health education that was passed from generation to generation. You sort of just took their word for it. Used the products that they would recommend. They were the big generation of using those mass produced products. But now, there's a lot of education that's happening from the daughter to the mom.  It's kind of crazy, but I have an 11 year old daughter and she is so educated on her body. 

It's all age appropriate, but the way she talks to her friends is very different than the way my mom used to talk to her friends.  Even the way I used to talk to my friends. So it's nice because you can see there's this more progressive open-minded perspective building with the young generation. They are aware of the millennial buying power - it is something that they own.  

I recommend products to my mom all the time and she loves maybe half of them, but still that's like a handful of products that she probably would have never known about. And my daughter the other day, asked me,  if she could get a period underwear that was in boxer brief cut.  And so we did research. She just started her menstrual cycle a couple of months ago. So we did some research and she found a brand that she loved and we're actually going to carry them on The Bloomi now. 

A second thing that came to mind is you said something about, if you could make this switch to something healthier, you would be all for it. But one thing I didn't mention is the compound use of products. So for example, the average woman will use a tampon or pad 15,000 times in her life. There's a lot of people who don't want to make any switch and they like the brand that they like, and that's fine and they've never had any issues, but say you are 10 years into your menstrual cycle and now you make the switch to cleaner. You're still probably impacting 20 to 30 years of your life with cleaner options. So the compound effect that you are going to have on your future health by making the switch, it's pretty big. If you think of your health longterm. Making small tweaks now does have a big impact on your reproductive health and on your sexual health. 

HeHe: Absolutely. You can make small changes and then eventually you have this really beautiful thing. In this case, it's your health. You're doing a lot of talking of products see use in products to care for our vaginas. What does that average like vagina care routine look like? Because we know we shouldn't actually wash our vaginas.  What should we know about cleaning ourselves? 

Rebecca:  Most women's health clinicians will say to just rinse your vulva with water. And I completely support that. However, I also know there's that other side where the majority of people do like to wash with something just the same way we like to wash the rest of the skin on our body and our face. A lot of people like to have an option. So if you are going to use a wash, you only wash your vulva or like your labial skin. You want to make sure you are not over washing. The wash that we currently recommend on our website with Healthy Hoo Hoo, you can use every day.  It's light and gentle enough to use every day, but you certainly don't need to. I personally have recommended to people that want to use a feminine wash is try a couple of times a week. Or if there's certain times of the month that you feel like you could really benefit from it. 

And in terms of moisturizers, there's this big shift right now towards really paying attention to labial skin because it's so different than the rest of our body.  I'm a huge advocate for moisturizers. The reason is because depending on the time of the year, the time of the month, our hormones really fluctuate and they do change the makeup of the labial skin. Sometimes it's very dry, it can feel even irritated. 

There's also a lot of trends with grooming, so women have chosen for the most part to just decide on what they want to do with pubic hair. What I mean by that is a lot of women or femmes, they're choosing to not do anything and just make it all natural.  So one of the products, for example, that we have it's called, Fur Oil. It's meant for pubic hair and labial skin, which I love because it promotes the idea that you should do whatever you want with your pubic hair. You can wax, you can shave, or you don't have to do anything.

So that again goes back to the hygiene practices for washing and moisturizing. They can really be your own regimen. You certainly don't need to do more than a couple of times a week, but if it feels right for your skin and your pubic hair to do something every day, you're welcome to do that. We just really advocate for products that don't have a lot of residue. Products that won't damage the skin- that don't contain glycerin. Certainly never to insert anything internally, because that's a whole different ball game. 

HeHe: If you want more information about washing your vagina and your vulva and all of that, you can check out episode #102 on the podcast.  I think there are so many missing conversations.  We should just know about these things.  That should just be part of growing up, kind of like you learn how to wash your feet and wash your hands and wash your face. But no one teaches us how to wash your vagina. 

Rebecca: I know it's so good to be having these conversations though, because it also inspires me, even though a lot of us, didn't talk about these things. I think about my daughter, my older one, that just started her cycle. And what do I want her to know? And we do these mini lessons, she picks a topic or I pick a topic. It's certainly come up where we've talked about how do you wash and clean that area. Giving her the proper, anatomical terms and making her feel comfortable in saying vulva or saying vagina.  It inspires me. I feel like we need to have more of this even on our blog, it's covering the basics too, because the basics are important and it sets the foundation for teaching your kids or talking to your girlfriends.

HeHe: If you're not new, you're used to me saying this, you should absolutely teach your child anatomical, correct terms for their body. You want them to be able to communicate what is happening with their body? Teach your child the right terms of their body.  Teach them the appropriate times to use them in the appropriate ways to use it and the people that are appropriate to talk about those things and those places on your body with. Those are the boundaries that you want to set, not make those terms off limits. 

Thank you ALL for coming along on this two part chat with Rebecca and I!  You can find Rebecca at and @thebloomi on Instagram and Facebook!

You may have seen me share one of my FAVORITE Bloomi products, but it would be a mistake not to mention it again! Check out the Vesper Vibrator Necklace, here.  You don't want to sleep on this. It is a discreet and powerful vibrator you can wear around your neck as jewelry.  Keeping sex on your mind with visual and physical reminders, like a piece of jewelry that doubles as a sexual wellness tool- is a sure fire way to heat things up in your bedroom at night.  Those subtle reminders throughout the day can help increase arousal and keep your sexual needs front of mind.


  • - The Bloomi- Your one stop marketplace for clean intimate care products. Use Code: HEHE10 for extra savings!
  • - Vesper Vibrator Necklace, here
  • - Find Healthy Hoo Hoo, here at their site. Or shop their products at The Bloomi, here.

The American Maternal Mortality Crisis: The Hospital System is Killing our Black Birthers Despite Numerous Alarms being Sounded

Monday, February 22, 2021


Photo: Larry Crayton

The American Maternal Mortality Crisis: The Hospital System is Killing our Black Birthers Despite Numerous Alarms being Sounded 

If you are unaware of the huge racial disparities in our country when it comes to having a baby, then you’re not paying attention. These are not new stats, but they are on the rise. Which is surprising for a country of such stature, education, and resources. As a leader of the nations, you would expect that we could keep people alive when they go to have a baby—a very natural event. The most natural, no?

Getting Back to the Basics

Call me crazy, but if what we are doing isn’t working—would it be crazy to think we should pump the brakes and get back to the basics? What exactly do I mean by this? Well, should we start to have low-risk women seen by midwives? Should we stop allowing hospital-sponsored childbirth education? Should we ensure access to ALL pregnant humans? Should we make sure that doulas are considered essential to birth and not made out to be fat that’s trimmed when crisis hits? Dare I say such a radical thing as should we move birth back to the home? That’s what I mean by going 'back to the basics.’ The basics of what truly makes birth work—safety, education, and support. It was a community event that was focused on making the birthing person as comfortable and doing whatever it takes to wait for this baby to do its thing. A hands-off approach that has worked for centuries and is based in listening to the natural bodily processes. Typical births should not require as much medical attention and intervention as many American births have today. With a 33% (and climbing) c-section rate, this country is ringing in at less than ideal.

Should we stop using Pitocin outside of how the FDA recommends it be used or should we stop using fear-based tactics? Should we make it easier for people to report doctors who act inappropriately? Should we begin to expose the toxic medical culture that so many doctors and nurses fear talking about? Should we start regulating the number of c-sections that are allowed by each facility based on a variety of factors and each one over that is investigated? Should we begin to investigate every c-section? Don’t tell me “that’s a lot of investigating,” because I will say you’re right, and one way we can fix that is to stop doing so many c-sections. Can you tell I’ve thought about this a lot? It literally keeps me up at night. By the pure nature of what I do for a living, I get to see the atrocities mentioned above often. I’ve dreamed (literally, not figuratively) of running hospital L&D units and it was my personal version of Grey’s Anatomy. I have long-term goals of being involved in birth centers. How and what that will look like is yet to be written, but stay tuned.

What’s the Current American Birth Culture Like?

Not great. 1 in 3 women will deliver via c-section and up to 70% of women report feeling their birth was traumatic. Our Black birthers are 3-4 times more likely to die due to a pregnancy-related cause than white women. This means for every 100,000 people to give birth, there will be 41 Back deaths and 13 white deaths. What if someone has a college degree (or more)? It helps white birthers by lowering their chances to 8 every 100,000 births, but if you’re Black with a college degree its remains at 40 in 100,000. We’ve recently seen highly educated Black physicians lose their life to complications in childbirth. Dr. Chaniece Wallace a medical professional herself lost her life to a birth elated complication and a broken system—the very system she served every day.

According to a 2016 study, medical students in the US held incredibly dangerous false beliefs surrounding Black patients with having a higher pain tolerances and therefore this should impact the care plan (medication, attention). I suppose it’s possible, but what are the chances that medical schools across our whole nation have overhauled their curriculum in the last 5 years…? It’s concerning that Black people aren’t listened to in medical situations, but especially so in maternity care because we know that life-threatening complications like Preeclampsia and postpartum hemorrhage are more common in Black birthers than white birthers. We also have reason to believe that Black patients fair better when care is given by a Back provider thanks to a 2018 study produced by the National Bureau of Economic Research. We also know that Black babies have a higher survival rate if they are cared for by a Black doctor. Black babies are twice as likely to die by their first birthday compared to white babies and pre-term birth is higher in Black pregnancies. 

What can you do to get involved?

Donate. Write letters. Listen to Black birthers. Believe them. Call out #baddoctors. Report #baddoctors. If white women don’t take the time to report bad doctors, what makes us think that the racism ingrained in our medical system would elevate Black voices reporting bad doctors? Even worse, many Black birthers won’t live to see the day to report bad doctors. If you have had a traumatic birth and would like to report inappropriate care, you can do so here

Black Birth Matters. Black Mother Deserve Better. 

Here are three organizations that Tranquility by HeHe and The Birth Lounge proudly support in resolving the crippling racism in our maternity care system:

The Birth Sanctuary- This is the first free-standing birth center in the state of Alabama. Dr. Stephanie Mitchell (@doctor_midwife on IG) is fighting the good fight in one of the states closest to my heart! It’s incredibly important that women have choice in where they birth and if your only choice is a hospital, that’s really not a choice at all. Roll Tide, Doctor Stephanie! You can make donations directly on their site! 

Birth Equity Collaboration- This organization is making big waves (@birthequity on IG)! They do policy watch to make sure new policies proposed and current policies being revisited are representative of all birthers and take into account the unique challenges POC color face in the American medical system. You can make donations directly on their site! 

Black Mamas Matter- This organization is filled with great resources to help Black and brown birthers navigate the hospital system, know their rights, and ensure better care! Their website is one of the most informative sites! You can donate directly on their site! 

So if what we are doing isn’t working—why do we keep doing it? 

I think we know the answer to this, it's just not anything anyone wants to hear. 

Don’t forget to check out our newest adventure The Birth Lounge, listen in to The Birth Lounge Podcast, and follow us on Instagram at @tranquilitybyhehe and @the.birth.lounge!

Sexual Wellness with Rebecca Alvarez Part 1 of 2

Wednesday, February 17, 2021

Sexual Wellness Products with Rebecca Alvarez

(Part 1 of 2 of our interview derived from The Birth Lounge Podcast Episode 130)

You GUYS. I am SO excited to bring this interview to life here on the blog. Did you know that 98% of all feminine care products has at least 1 toxic ingredient? That's scary! Rebecca Alvarez earned her BA in Women’s Health & Sexuality from UC Berkeley and her MA in Sexuality Studies from San Francisco State and is the founder of The Bloomi. She is joining me to dive deep into what’s wrong with traditional sexual wellness products, how to spot harmful ingredients and false labeling, and what you need to know about long term effects of these issues in sexual wellness and women’s health! So Let's have Rebecca introduce herself!

Rebecca: I consider myself a sexual wellness expert. I'm also an entrepreneur and my passion is bringing clean intimate care products to women and femmes. I'm sure we'll talk about why that's important and what's going on with the industry right now. I'm also a mom and I just had a baby, so I have two girls. I'm very passionate about female health, women's health, motherhood, all of that mixed together. I founded Bloomi last year and it's the first marketplace for clean, intimate care products.

HeHe: That is amazing. I am here for that. Why should we care about period products and our sex toys in terms of ingredients?

Rebecca: This is the one topic that I feel super passionate about. My background is in research and I have a lot of experience in regulatory aspects of bringing a product to market. What I learned over the 10 years, working as a consultant for all these women's health companies was that there's not a lot of thought unfortunately, that goes into the ingredients in our intimate care products. There's lots of reasons for that. The main one is because it's a heavily unregulated field. So that means that somebody who's making a feminine wash follows the same guidelines as someone who's making like a lipstick. Those are two very different parts of the bodies that really require a completely different makeup. There's a stat that we like to share from our company when we were doing our research, that we found that after reviewing about 5,000 products, about 98% had at least one toxic ingredient.

So you can kind of get an idea of what I'm talking about. When I say the majority of the products on the market still have a lot of work to do. And by toxic ingredients, we're talking about things that could just irritate your skin, like cause an infection, meaning like a yeast infection or a rash, or even bacterial vaginosis. But sometimes even more aggressive health implications that are affecting your entire body. A lot of these ingredients have been linked to cancer. So overall, the reason that we're so passionate about these products clean is because they're so few of them actually meeting the bar and doing right by women.

HeHe: I feel like if you're gonna call yourself a health product or like a health care product you should certainly help my health, right?

Rebecca: It's pretty wild how unregulated it is. I think there's this wave of education that's happening, where a lot of people are more interested in the natural and the organic. So there is a shift of consumers wanting companies to be transparent, but it just blows my mind how crappy these ingredients can still be. Let's take a step back just to share what intimate care products mean is it's everything from hygiene- like your feminine wash, your wipes, your moisturizer (like a labial moisturizer), period products (tampons, pads, reusable products like menstrual cups), and then also sexual wellness (Lubricants, sex books, toys, etc).

HeHe: I think that, again, a lot of people do not think about this when they're thinking about clean living. I just don't think that vaginal care like feminine care products is on that list. So it is well known that a lot of ingredients aren't disclosed and that a lot of them are really icky, but what does that mean? No one ever really tells us what's actually in tampons and pads.

Rebecca: You know, I feel like tampons and pads in particular have gotten a lot of like heat in the past couple years. So you don't find as many that have bleach, but the main problem with organic or not organic with cotton products is that the majority of the cotton that people are using to create these products- they have contaminants. So those contaminants come from just raising the crops. So herbicides, pesticides, and a lot of times there are additional ingredients that manufacturers like to put in to make them highly absorbent. And that's where companies really get into trouble. Because something as simple as like absorbency means that there's hidden ingredients in there that we may not know about, like the Kotex scandal about their tampons being made with an ingredient that unraveled inside of women and was causing a lot of like reproductive harm. There's also other ingredients like dioxins and ingredients that normally are an aftermath of raising the cotton. So that's why it's really important that if you are able to, to choose products that are made with organic cotton that way you can just pretty much avoid all of those contaminants that are used when growing the crop.

HeHe: So we keep talking about organic and I honestly feel like everyone these days says they're organic. How do you really know? Because it's still really unregulated. Right?

Rebecca: Yeah. Another thing that we learned at The Bloomi when we were doing our research before we even launched is that 95% of claims that you see on packaging is greenwashing. Greenwashing means they're using marketing claims that are not completely true, or they're saying things like organic lubricant, but it's not truly an organic lubricant. That's just the name of it. So what consumers like us can do is if you're looking for a cotton product, like a tampon or a pad look for the USDA certified organic label. That's pretty easy to find that way that the cotton is really following the strict standards of organic.

Our company just launched something called the banned list. So if you see that a product you are using contains an ingredient that's found in our banned list, I would not recommend using it. And we put a lot of thought with a lot of experts into creating that list. It lists out why we banned them and what they're used in. So I would honestly just take a free evening that you have take the products that you're using. If you don't see the ingredients, that's a bad sign because companies don't have to disclose all the ingredients. So I would not use those. Now, the ones that do have the ingredients - screen them against our list. If there's something on there that's fishy, maybe switch.

And one of the things that I really advocate for is I know that when we say organic, it can be more expensive. So I'm really a big fan of slower transitions or making things as affordable as possible. And we have an article on our blog that talks about making the switch to clean products in a affordable way. And one of the things we recommend is to change the one thing that you use the most. So if you use tampons the most, maybe start there just switching that to a cleaner version will have a positive impact on your health.

HeHe: So, our audience can get the ban list on your website, right? Your emails are amazing as well, if you're going to be on an email list, I do suggest Bloomi's. It's always a good one.

Rebecca: So first of all, the range of topics that you're covering, it's amazing. Like you, I love everything that you're talking about because it's all intertwined. Motherhood, pregnancy, sex- it's all literally something that we should be talking about across the board. One of the things that I'm trying to help the public understand is that I personally support like other brands and specifically female founded companies. I am a big advocate for supporting each other at the same time. I have to be very transparent about what we're doing for The Bloomi and the fact that there's a lot of companies that have false claims. And I can mention to you that out of the feminine washes that I know that you have recommended so far, we have screened them all. The only one that I would personally recommend and that the company recommends today is Healthy Hoo Hoo

The reason is because part of our screening processes, we take the products and we send them to an independent lab for testing. We send them for pH testing specifically. I know you had a really great podcast on pH testing. Everything was spot on and I love everything that you talked about. People should go back and listen to that because it was really helpful, but, unfortunately some of the feminine washes that say they're pH balanced, contained ingredients on our banned list, like for example glycerin, which is not something that we recommend as a company, because it can damage rectal cells that can potentially cause yeast infections. So long story short, if you don't see a brand or a product on our marketplace, there's a reason behind that.

I have screened hundreds and hundreds of feminine washes. The only one, unfortunately, right now that passes our criteria is the Healthy Hoo Hoo brand. So that's the one that we really advocate for right now.

HeHe: I love the idea of the banned list.  The underlying problem for me is kind of the lacking choice. Talk to us a little bit about that. Like what's going on there.

Rebecca: Yeah. So if you go on our website, you'll see that there are certain products that we have very limited selections for. That's because it's really tough to find clean options in this space. And as much as we, you know, we try to provide as much variety as possible. Sometimes even though we've done the homework to understand and screen lots and lots of products, it boils down to, there's only a couple that we recommend at this time.

I have done a lot of research to understand what the ingredients that most companies are still including that they shouldn't be. We are in communication with a lot of really great brands about that. So you can expect slow, positive change moving forward. But for now, the choices that we offer on the website are the ones that have passed our criteria. 

HeHe: And this is just a bigger problem. It's not really about, your individual website, we just don't have the options to make these recipes with safe ingredients for women to have safe options. It just sounds so silly, but that's the underlying problem. So how did we get here?

Rebecca: You know, so there's so many things I can say about that. Mainly this has to do with a lot of cultural taboos and a lot of men that were in charge of product manufacturing for these brands. So I am happy to say that there's been a shift in the last few years and you can start to see there's a lot more options and a lot more female-led companies. At the same time, there's just been this whole cultural taboo atmosphere that we've been living in where there's a lot of shame in, for example, vaginal odor. To some extent, some of it is normal, but the idea that a vagina should smell like flowers has really created this industry where there's a lot of fragrance in the items that we use. There's also a lot of money to be made in this industry. 
So what happens is a lot of these manufacturers will use cheaper ingredients. It drives up the profit. So that combination of like cultural taboos mixed with companies trying to squeeze out all the profit they can in these products, I think has just created an industry where we have so many products that unfortunately have crappy ingredients. I do think that there's this wave of consumers are driving what we want and people are asking for cleaner options. There's a stat that I read in a new study that said 75% of women are seeking out healthier alternatives to current intimate care products. And that's huge. That means three out of four of us are trying to find cleaner products. So that makes me happy. That means that we're on the right track here. 

HeHe: That is amazing. I'm actually a little bit shocked, but in a very proud way. Yes, women. Yes. Yes. I also think that it's kind of unrealistic, unrealistic to think a hundred percent. You're just going to have some women who this is not their jam.

(Stay tuned for part 2 of this AMAZING interview with Rebecca!)


  • - The Bloomi - One stop marketplace for all your clean intimate care needs. Use Code: HEHE10 for extra savings!
  • - The Bloomi Banned List: here
  • - Find Healthy Hoo Hoo, here. Or shop it on The Bloomi, here.

Nubain: A magic Pill?

Wednesday, February 10, 2021

 Nubain: A Magic Pill?

I think that a lot of times when people think about pain relief in labor, they think about unmedicated or they think about at the general use and it doesn't necessarily have to be one or the other. There's actually a spectrum of pain relief that you can choose from when it comes to your birth.

So if you need to be induced for some reason- what the reason is may also play a role in what your options are for pain relief. These are all discussions that you'll have to have with your doctor, but you really need to be having those discussions if you don't know what your options are. You need to empower yourself going into your labor. So that is why I wanted to talk about Nubain and Staidol in labor.

A lot of people, when they think about having a baby, the first thing they think about is the pain and what it is going to feel like to actually have a baby. While this is a valid thought and concern, it is not necessarily where you need to start. You need to . And it's going to be like to actually feel having a vape maybe while this is obviously a super valid thought and concern. And you know, you definitely want to, to be mindful of that. That's not enough sincerely where you need to start. You need to start with understanding normal physiological birth and the normal variations of labor.

I believe this SO strongly it's literally part of the CONTROL method that I teach in The Birth Lounge. We spend time reviewing just what does normal physiological labor look like? What are all the normal variations? How can you stay in control from start to finish? That's where I would recommend you start.

But now that we're having this conversation about pain relief a lot of people, they think there's only two options, unmedicated or epidural. THERE ARE NOT. You have more choices! So in between there, you have saline papules, you have nitrous oxide, you have injectable narcotics (where Nubain and Staidol fall).

Before I dive into the risk and the benefits, I want to tell you why I particularly love Nubain and Staidol as a resource for pain relief during labor. Also, just to clarify, Nubain is a drug and Staidol is a drug, but they are very similar drugs so we generally use them interchangeably. I find that a hospital will generally offer one, not both.

So why do I love them? Well, because I've seen both do really amazing things. I have been with clients as they labor for a long time, they decide to head into the hospital hoping to be 7-9 centimeters, and they find out they are 2-4 centimeters along. We know that if we get an epidural before that 6 centimeter mark, it has a potential to really slow down labor. So what do you do before that? This is where Nubain or Staidol can come in. This is where I love to offer it as a discussion point for you and your doctor to say, you know, 'Is this an option? Is this safe for me to use right now?'

What are the benefits? I love it so much because it's short acting. It is going to be an injectable and then within about four hours later, you're probably going to start to feel the medicine kind of wearing off. During this time, you're going to get some good sleep and rest to prepare for the rest of your labor. However, it does not stop your contraction. So this is nice. It allows you to sleep and get some rest, take a little nap, but your contractions still are working. Your body is still working.

So we get there at 2-4 centimeters. We get the Nubain or Staidol. You take a little nap, you recharge your battery. You wake up. It is possible that you are somewhere 7-10 centimeters when you wake up. You may be ready to push when you wake up, that is so ideal. You get to rest, your body still does the work. It doesn't slow down your labor. It allows your body to relax, right? This narcotic allows your muscles to relax. If there's any tension, if there's anything that's really holding up your baby, this is going to allow for your body to open up and create space for your maybe and allow your cervix to dilate.

You will have to be on electronic fetal monitors and your blood pressure will be monitored. We are injected in narcotics. So we want to make sure that we're keeping you guys safe. Also, with these narcotics we can't really administer it past 6-7 centimeters because of that 4 hour life cycle. We don't want your baby to come before that because there are some things you need to be aware of as far as risk. This is going to come along with the use of any sort of narcotic.

The first thing to be aware of is that it does cross the placenta. So it is going to impact your baby or get to your baby. The risk of it impacting your baby is with things like central nervous system, respiratory challenges at birth impaired, it can impact early breastfeeding, altered neurological behaviors, and decreased ability to regulate their own temperature. Now, some of these are also associated with epidural use. So when you comparing, you want to just bring it back and make sure that we're comparing apples to apples here and that we are truly looking at things across the board. However, that is the reason that we can't give it pass that 6-7 centimeter mark.

There's some things for you to know too about yourself if you choose to take Nubain or Staibol. You might experience nausea, vomiting, itching, dizziness, sedation, decreased gastric motility, loss of protective airway reflexes (respiratory distress), and then hypoxia due to respiratory distress (low oxygen levels). These are all things associated with epidural use as well. So again, make sure that you're just comparing apples to apples.

I'm bringing this to the table today so you can have it in your toolbox. So that if you get to the hospital and you get numbers that are not what you expected, but you have a healthy respect and concern for not slowing down your labor with an epidural being administered too early. Yet, you really need some medical pain relief. A lot of times this kind of, feels like an impossible challenge to people, but it really doesn't have to be because you have options here. You were hoping that you were more dilated than you are and you don't want the epidural yet. You could ask about Nubain or Staidol. You might be able to get some rest, wake up , and then you can evaluate things.

Nubain is so cool because it really is that magic pill. It allows your body to relax enough, to give your baby the space that they need to navigate out, and allows your labor to continue to progress. While you get to rest and you get to sleep. One other big key is that with the epidural, it is placed in your spine for the narcotic use. With Nubain and Staidol it's going be an IV. So it'll be in your arm rather than in your spine. So keep that in mind as well. That's a, that's a pretty big difference.

Of course, you guys know I'm a huge fan of Evidence-Based Birth. So I had to take a look and see what Rebecca Dekker has up for opioid use and narcotic steering labor. And I actually found out about a drug that I had not previously known about, um, and it's called Remifentanil. It is going to be done through an IV. You get relief in about 20 to 90 seconds after the dose is administered, whereas for Nubain and Staidol all it's generally 5 to 10 minutes after the dose. So it is much quicker. Remifentanil has a higher risk of breathing problems in the birthing parent, but a lower risk of breathing problems in the newborn. So, definitely something to be mindful of. Finally, there was actually a Cochrane review done to compare a bunch of randomized trials that looked at Remifentanil compared to other narcotics use in labor as pain relief. They actually did not find that it was more effective in pain relief, however, they did find suggestions that having it being controlled with a PCA might give a placebo effect that it provides more pain relief. Very interesting psychology there.

I want to help you be prepared so that you can have an informed and confident birth, no matter what comes your way during labor. And we can do that through intentional preparation and research fact education. This is what to do in The Birth Lounge. I teach you the CONTROL method, where I teach you how to protect yourself against all of the like slippery slopes of labor and how to make sure during labor you are in control. And if you're not in control, I help you to identify where the control is and how you can take the control and put it back in your hands. I am preparing you for all of the variables in those normal variations in labor and what is a cause for concern in labor. That is how you stay in control. We hand control over when we get into a place where we don't know the research and we don't have the backing to have these informed conversations so that we can confidently navigate birth.

Gifts for Every Badass Lady in Your Life

Wednesday, February 3, 2021


Gifts for Every Badass Lady in Your Life

Valentine's Day is such a commercialized holiday, I get it. Not everyone loves to recognize love, but… I’m not one of those people! I love V-day! 

Sometimes in pregnancy, the spark can be lost or the intimacy is forgotten. Sometimes our gratitude for one another takes a back seat because of the overwhelming to-do list that comes along with having a baby. I challenge you to take this Valentine’s Day to recognize the love that it took to get this child here and remember the passion you have for your partner. If you’re expecting a baby, your life is about to change forever. In a really good way, but in a way that is going to test your relationship and you need compassionate understanding and love to help you through those seasons. If you are new parents, remember this is a season. It too shall pass and I promise it does. Everything is temporary in this stage-- the lack of sleep, the fussiness, the feeding challenges, the blowouts. It will eventually resolve, and you’ll be on to a new challenge. Don’t forget to lean on your partner in these times of frustration and overwhelm. Use this Valentine’s Day to share the love and relight that spark before your baby arrives. 

I’ve put together a list of incredible gifts for the women in your life-- your mom, your bestie, yourself..*uh hmm, share this with your partner*, and all the other badass ladies you have in your life. 
  • - Boob Necklace - Now I know this doesn’t strike you as ‘self-care,’ but every time she sees this hanging around her neck it will serve as a reminder of just how strong she is. She will remember the hard work her body puts in everyday from growing and birthing babies, to feeding those little humans, to standing on her feet for endless hours in the kitchen and driving hundreds of miles carting around the kids to here and there and everywhere in between.

  • - CBD - I truly believe this is the secret weapon to motherhood. CBD is such a powerful tool that simply plays off the natural systems in our bodies. Every human has what is called an endocannabinoid system that is responsible for helping to regulate our memory, mood, appetite, and sensory system. Now, you must be very careful with which CBD products you trust to be in and around your body, so we’ve already vetted them for you! I exclusively use Elmore Mountain Therapeutics for many reasons and some of those are: they are a woman owned business founded by a mother who discovered CBD was a solution to her postpartum depression and anxiety. I also love that they use a method of CO2 for extraction and therefore produces an incredibly pure product. I use their tincture everyday to keep me sharp and anxiety free and the CBD balm is a lifesaver for headaches, backaches, and menstrual cramps!

  • - Primally Pure Spa Set - What is better than giving the woman in your life the gift of health? But not just any health-- products that will not only keep her body safe and her skin glowing, but also rid her systems of toxins and harsh chemicals! From deodorant to my daily skincare routine, I love Primally Pure products and have been using them well over 3 years. Last year, they launched a baby line which I automatically fell in love with...and use these products, too...for myself! Don’t judge me. They have baby powder, baby oil, baby soap (that clears up any and all skin irritations in your baby), and butt balm! The reason I love Primally Pure so much is that their products are plant-based. They believe in a “less is best” when it comes to their certified organic ingredients that they source from local farms! My farmer’s daughter's heart is literally shrieking with love. Their less is more mindset means they make their products with as few ingredients as possible. Personally I have eleven of their products. If you have questions about their products, just ask--chances are, I’ve tried it! Their spa set is to die for and the perfect gift for a mom friend--expecting or not! (Pro tip: Use code 'HEHE10' to save!)

  • - Thinx Underwear - This is a gift of pure love! This gift is for the gal pal in your life that you want to be around in 100 year. This is also for the expectant mama friend who you want to transform her postpartum bleeding experience. How’s this gift going to do that? Well, Thinx underwear solves two very big problems--it saves our earth and it saves your friends vagina (and hormones!). Have you ever taken a look at what is in traditional period care products? You might be shocked (even nauseas) to learn that bleach, carcinogens like Glyphosate (think.. Round Up), and fragrances that are known hormone disruptors. Whether you realize it or not, your vagina is one of the most permeable and absorbent places of the human body and each month we expose it to chemicals like Dioxin, one of the most dangerous chemicals in the world. The argument is that it’s in such low amounts that it’s not harmful, yet we are finding research to prove otherwise. While it may be low amounts, we are talking about residual build up from continuous use month after month. Do your bestie a favor for the restie (literally) and invest in Thinx underwear for her. Thinx can be used for roughly two years--that’s 24 periods! It’s so much safer than toxic period products, it keeps those icky chemicals and waste out of our landfills, and it’s nice to know you’ve interrupted one pathway of toxins from entering your best friends body!

  • - Love Crave - Okay, this is one of my favorite pieces of jewelry I own and wanna know why? It’s secretly a vibrator and it’s TSA approved so you can take it on all your vacays! This is a great necklace for date night and absolutely perfect to give to the love of your life on the morning of Valentine’s Day and be told, “See you at 7pm. xo, Me” *cues song: When a man loves a woman by Michael Bolton* It’s so discrete and actually very quiet! I’ve also never had anyone ask me what it was other than once at a festival in Boston. I was going through security and had accidentally put it on with the teeny tiny button facing outwards. The security lady asked me if it was a vape! Ha! The look on her face when I said, “No, it’s a vibrator” was absolutely priceless. It was shock followed by an approval smile and nod that said, “I’m ordering one of those tonight when I get home.” I was gifted mine by The Bloomi (which is also one of my go-to women’s sexual health and wellness resources) Grab yours here and make this V-day spicy. (Use Code 'HEHE10' at checkout for all your wellness needs at The Bloomi!)

  • - Birth Mantra Cards - This gift is for the expecting mama that is in touch with her spiritual side. She understands the power of mantras and is truly mastering her mindset around birth to prepare for her little one’s arrival. I was given a set of these mantra cards and I love them so much. I pull 3 a day and somehow they are always exactly what I need to hear. The mantras I pull each morning are the mantras I use throughout my day. A few times, I have pulled a card in the morning and been called to a birth throughout the day where I used one of the mantras I pulled that morning. They are always immensely helpful! If you’re new around here, you should know this about me: I believe that birth is 90% mindset. If you can master your mindset around the expectations you have set for birth, then you will, no doubt, stay in control from start to finish. These cards are incredibly helpful in helping you master your mindset.

  • Bloomi Massage Oil- You all know I love The Bloomi! Bloomi Massage Oil is formulated with organic, full-spectrum hemp extract to help relax the body, soothe sore muscles, and make you feel good. Great for solo massages, works as a moisturizer, and of course- massages with a partner! Use code: HEHE10 to save on all things The Bloomi!

  • - Moraccan Magic - You know those folks that you should get just a little something for, but you want it to be thoughtful? Morroccan Magic is your answer! This lip balm goes on so silky smooth and leaves my lips so hydrated. I honestly have MM in all of my bags, purses, backpacks, overnight bags, and yesterday I counted three in my bathroom in various places (I even keep one in the shower for when I do steams). Elderberry & Manuka Honey is my favorite flavor! One of my favorite things about Morroccan Magic is their ingredients list.

  • - A Journal - We love these journals! And can't stop hearing everyone raving about them. They have journals for pregnancy, postpartum, newlyweds, kids - the list goes on! And the BEST part- they are guided journals, so you'll never find yourself sitting and drawing a blank when the urge comes to write! Check out their Valentine's Deal here!

  • - The Birth Lounge Membership or Courses - The Birth Lounge will literally change your life. I teach you the 3 core components on how to prepare for your baby and avoid birth trauma. The easy three step process of controlling your environment, controlling your choices, and controlling your mindset will help you birth confidently and without fear. We unravel the “unknown” of birth and show you exactly how you can find faith in the process. We also break down how to manage the pressures and waves of birth including medical and non-medical pain relief. The Birth Lounge empowers you to feel in control from start to finish and helps dispel the anxieties caused by fear based information around pregnancy and birth! Find more information about how to join The Birth Lounge here.  Our doors are closed until the first week of March, BUT you can buy your favorite lady a gift card toward a Birth Lounge Membership, here. (You can customize the amount for whatever suits your budget/needs!)

  • - Doula Support for Birth or Postpartum Care- We now offer gift cards for Tranquility by HeHe services! We know supporting your loved ones can be hard right now as people limit socializing and travel.  Give the gift of support through virtual doula care or local doula care.  Our team is following stringent COVID protocol to keep our beloved families safe and supported. Buy a gift card here! (You can customize the amount for whatever suits your budget/needs!)
Valentine’s Day is a day to recognize the special people in your life that make you feel safe and loved. This is huge. This is a feeling that humans crave and will chase all over the world. Take the time to show thanks to the people closest to you. 

Xoxo, HeHe

Don’t forget to check out our newest adventure The Birth Lounge, listen in to The Birth Lounge Podcast, and follow us on Instagram at @tranquilitybyhehe and @the.birth.lounge! 

When Nurses Perpetuate the Patriarchy

Wednesday, January 27, 2021

When Nurses Perpetuate the Patriarchy

All right. I had something planned for you, but then, after being in a birth I decided to bring something different to the table today.  It's just something that I walked away with a reminder of and I wanted to pass it along so if you are having your baby soon, hopefully you will remember this and you'll come back to this conversation and find that confidence to speak up. 

So what I want to share today about is how nurses can perpetuate the patriarchy of birth. And when I'm talking about the patriarchy of birth, I truly am talking about the medical system taking the power away from birthing people.  I think that there is a place where our medical system can be second tier, right? And that birthing person is the top tier. They're literally the top of the totem pole. They are number one on the pyramid. They are the peak, right? And the medical system, the medical staff, the doctor are below them. I truly believe this.  So, so deeply because I've seen it be practiced. I have seen practitioners who practice like that. And they're like, 'Hey, whatever you want to do!'. They really respect their place in the hierarchy. They really understand consent and they truly understand informed consent and informed refusal. They are happy to be respectful of reformed informed refusal. 

BUT, this is not the practice across the board.  So much so I really believe we have to stop the way that we are 'helping' people birth and we have to do do things differently. That means putting these birthing people on top of that pyramid at the top of that pole, totem pole, number one on the list- EVERY SINGLE TIME. This is your birth. Right?

I want to make very, very clear. Most nurses are so good. I really do believe that most nurses are amazing. I think very seldomly, are you going to encounter a nurse that is a bit of a sour Apple.  I don't believe you get those very often. However, here's what I will tell you again, we have to go back to their training.   We have to go back to what is being taught to these people. And they probably have no idea how it comes across to birthing people. They probably have no idea because this how they were taught to take care of people and help keep people safe in this way. 

So your job as the consumer to say, actually, that doesn't feel great. To say 'We're going to do this a little bit differently because I remember that I'm on top of the totem pole. This is my birth, and I'm getting to make the decisions here'. Right? 

So how do we do this? Let's just go through some examples. Anytime a nurse tells you flat out, 'No' or 'I wouldn't recommend that'-  I would encourage you to clarify. Are they saying no, because it's a safety issue or are they saying no, because that's their preference? Because if that's their preference, unfortunately that is not going to actually be a 'no' in our book. This is your birth. So if it is to keep me and that baby safe, of course, happy to listen to their advice.   However, if it's your preference that I stay on my back, I'm probably going to be moving, right?

If it's your preference that I don't eat something and you're saying that because that is the 'hospital policy', I am happy to inform you that the recommendations actually have been updated based on more current research than what seems to be the hospital policy.  You can say things like, 'I want to be honest and upfront with you, but I'm going to make this decision and you have a science to back it up.'

Even if you don't have the science to back you up, and this is your preference, this is your birth and your preferences should be abundantly clear.  Just because this person is the nurse, or just because this person has that higher education in medicine, or just because this person is your OB-  does it mean that they make the decisions for you? It's not how that works. This is shared decision-making.  We have to be mindful of that. Just because this person holds a certain degree or is a certain provider does not override informed consent. 

Sometimes providers will just be like all up in your vagina. They want to feel if you're making progress.  They probably do have a reason, but if you have no idea why I think that it should be clarified. I mean, nobody should be in your vagina without you understanding why.  I feel like if this provider has something that they need to go up in there for, they just need to clarify it with you. Then ultimately you also have the right to say, 'Yeah, totally. Go ahead.'

Positioning is often an area of control in the hospital.  Some providers prefer women to birth on their backs.  Most babies actually progress more favorably in side lying or being on hands and knees. Being on your back, it's not really the best position. I mean, women are still told not to sleep on their back in pregnancy. So why would we have you lay down during labor all these hours? It's very bizarre. Well it's not really bizarre. It's patriarchy, right? Like what's good for the goose is actually not good for the gander here. However it should be. Here is where we can see nurses perpetuating the patriarchy in a way that they probably don't even know. They don't realize that they're taking the control out of somebody. We've got to start challenging these patriarchal kind of ideas. 

Here's another example. When your baby is actually crowning your legs are going to naturally close so that your perineum can stretch open and close as needed as your baby is turtling out. Remember, you want to listen to that reflex. (This is going to be unmedicated. If you have an epidural, you are likely not going to feel this.) If you feel this, you want to give into it. It's a good reflux. We want your legs to closed, to protect that perineum. What do nurses do? They yank those knees back.  You can speak up here and say it is your preference to allow your legs to close.  You can ask the nurse or provider not to touch your legs.  You don't have to be super aggressive. You can be in control and just requires you stepping up and kind of speaking up.

You have that right to say, if there's no medical necessity necessity right now, can we wait? They're going to tell you if it's not okay that you can wait.  If you're coherent and you're safe and your baby is safe and there's a conversation being had that you're not looped into it...something is wrong with that picture. 

You have to be in control of these conversations and it starts with you being involved in the conversation.  That goes back to shared decision making and ultimately comes down to you, making sure you're in shared decision-making that you're involved in those conversations, that nothing happens to your body, that you don't first have a conversation about, right? It's important that you are in control of these conversations.  

I want you to know that your nurses are so important. They really do play a crucial role. And that's why it's so important to get a good nurse and  a nurse that you align with.  I don't think nurses intentionally perpetuate any of this patriarchal stuff.  I really do think it is the way that they're taught.  I think that these patriarchal ideas are just so ingrained in medicine and it's gonna really take us pointing these things out and saying, 'Actually, I'd like for things to be done a little bit differently'.   So these things are just important to me that you know them as a consumer of medical care of obstetrical care, women's healthcare.  

Why Your Baby's Position Matters

Wednesday, January 20, 2021

Why Your Baby's Position Matters

Today I want to talk about why your baby's position is quite possibly the most important thing that you need to be focused on at the end of pregnancy. And when I say end of pregnancy, I pretty much mean the entire third trimester. Your baby's position is literally everything as your baby starts to snuggle into position and the real estate, if you will, your belly kind of gets smaller.

Your baby is going to start to push on these nerve endings, ligaments, and tendons, and the pressure, those sensations that your baby is sending to your body are intentional. Your body is looking for specific nerves and tendons and ligaments to be pressed. Your body is looking for specific signals and your baby is looking for specific signals too. Your baby's position is everything for this process. 

We want to make sure that in the third trimester, we're really working on your baby's position. Now I'm not going to give you tips on how to get your baby in the right position, because that is something I teach in The Birth Lounge. I teach you exactly what to do week by week, starting at week 34, I tell you every step to do it. And that is actually how our secret sauce to pushing work so well. 

You have to account for nature for some of baby's position, but you also have responsibility in helping your baby get into the right position too. So here's why your baby's position actually matters as your baby drops down into the birth canal- if you are unable to get baby into an optimal position for birth your chances of a planned or unplanned c-section increase. 

As they grow in pregnancy, your baby's going to do this corkscrew movement. They're going to drop and spin and drop and spin and drop and spin just like a corkscrew. And this is a very specific path. Remember that your body and your baby go together like a plug and a socket. And so everything that your baby does, your body is receiving that. Your body is looking for a very specific message and sensation from your baby throughout the entire process, because remember, your body was made to do this. So your body knows what to expect, even with your first baby. Your baby and your body know what to expect. You don't know what to expect, because you don't know mentally and emotionally what to expect, but if you surrender and let nature take over, your baby and your body actually do know what to do. 

If we can get your baby in optimal position, you are going to have a shorter labor. You are going to have a less painful labor (and a lot of times we see no back pain!). I am a huge believer that back labor is not a normal thing in, in birth. I think it is the biggest indicator that your baby is in a difficult position. And we need to try to get that baby, in a different position. 

So, how do we get your baby in a different position? That's something that I teach in The Birth Lounge too. So that if you find yourself in this situation during labor, you know, if you're a member of The Birth Lounge, you know how to get yourself out of that situation. You know how to get your baby out of whatever position is causing you that back labor, because we've broken down back labor and why it might be happening. 

So shorter labors, less painful labors, reduce back labor, if any, at all. These all seem like great reasons to work on positioning, right? Here's another: the position of your baby can reduce tearing (what?! YES.). 

Now I've got a couple of research articles, because I want you to see a, how the position of your baby can impact your tearing. If your baby's on the right position, it can actually cause you more tearing. Check out how the position of your baby can reduce tearing, here.

I also want to show you the midwifery approach, linked here. They actually allow your baby's head to be born with one contraction, then the shoulders to be born with a different contraction, and finally the rest of the body to be born with a different contraction. The OB model of care is much more hands-on and doesn't leave so much room in the approach for restitution, which is your body's way of naturally turning your baby, right? Their head comes out and then their body is going to turn and come out as well. 

A final article I'm gonna link for you is how an epidural has the potential to interfere with this. So one of the things we have to think about when we get an epidural is: Are we doing it too soon?

One of the other things that I feel obligated to tell you about is anytime you introduce any sort of medical pain relief, like an epidural, it has the potential to make baby's heart tone be funky. I encourage you to do a lot of research on normal and abnormal heart tones. And what are your options with each of those?

The second thing I want to tell you about is that if your baby's in the right position, it's more likely that you're going to have less complications. You are less likely to see your baby gets stuck. If your baby is not in the right position, there are very quick and easy maneuvers that we can do. Spinning babies is a great resource to check out for getting your baby in the right position as well. 

If your baby is in the right position, you are less likely to have complications like shoulder dystocia. And remember, we want to really respect that restitution. So, the key here is finding a provider that has that healthy respect for restitution and also understands the fine line of sitting on their hands and allowing your body to do what it is meant to do. Also, a provider who understands the right time to intervene in order to keep you and your baby safest. 

I just got done reading the book, called 'Birth, the Surprising History of How We are Born' by Tina Cassidy. She actually explains the evolution of the pelvis as we learned to walk upright. I found it so fascinating so I wanted to share a few concepts she shares with you in the book. Honestly, it's no wonder birth, doesn't go smoothly- the physical frame leaves little room for error.

She explained that the birth canal became larger, but more important, it also became different in shape with the exit now widest between the pubic bone and the tailbone. As a result, the big head is able to descend through a pelvis, fine tuned for walking. The baby must begin to turn sideways as much as 45 to 90 degrees in order to align its body with the widest pelvic outlet. In most cases, babies can navigate the space, unaided. But every time we are are rolling the dice to see if the parts will align. So why not eliminate the guessing before labor begins? 

That sent me personally down the rabbit hole of what can we do to make the most room for baby and to get baby in the perfect alignment. So I started to look into like, what are the things I'm telling our clients to do? And how can we start to replicate this? And so that's why I wanted to share this with you- to share how important your baby's position really is. We want your sacrum to be free. We want you to not be on your back. We would ideally like you to be upright. So we could be using gravity to our advantage. You really want to be considering your baby's position and what you can do all throughout the third trimester to help them into that optimal position for birth. 

Looking for more information? Follow along with us on Instagram at @TranquilityByHehe or @The.Birth.Lounge. Or check out The Birth Lounge Membership to see if doors are open/get on our waitlist!

Talking Torticollis, Hip Dysplasia, Tummy time, and more with a DPT!

Wednesday, January 13, 2021

Talking Torticollis, Hip Dysplasia, Tummy time, and more with a DPT!

Originally a 'The Birth Lounge Podcast' Interview with Kara Masse, DPT. 

I'm really excited about this because I think these are things that you're going to want to know before your baby gets here, but nobody tells you.

Today we are sharing an interview with Kara Masse, who graduated with her doctorate in physical therapy in 2013, from Simmons college. She's been a pediatric physical therapist for seven years now. And she started her career in early intervention, just like me. She's a certified early interventionists and now she actually works in outpatient setting for Mass General in Boston. It seems like we all kind of know bits and pieces babies, but nobody knows the nitty gritty about their physical development. And that is what Kara is going to share with us today.

What is it that you do with infants every day as a pediatric PT? If you know, if somebody is out there listening and they've never heard about that, what would someone come to you for?

So a lot of times, we will get referrals for delays in motor development like abnormal tone. So just the way that their muscles are moving or if they don't seem to be following their normal development. With infants we do see some common muscular skeletal problems, such as hip dysplasia, club foot, or a very common diagnosis called Torticollis.  Torticollis is tightening of the neck muscles, which can lead to Plagiocephaly- commonly observed as flattening of the head. 

And about what age are these children? Are you talking about newborns because there are some babies that, during birth they actually experienced and get hip dysplasia. Would they come to you as a newborn? 

It depends on the severity of it. it depends on sort of what the treatment protocol is for the different diagnoses.  For hip dysplasia, it depends if they end up needing bracing for example.  For Torticollis, I do see a lot of newborns. I will get referrals around two to four months of age usually. We do recommend the earlier the better, so you can get ahead of any sort of abnormal neck movements or tightness that's there. 

If your pediatrician doesn't give you a referral, can parents self-refer to you or where would parents go if they were concerned?

Most of the time you're not able to self refer to physical therapy in the outpatient setting. If your pediatrician is hesitant about referring, and you have concerns as a parent, I would push for it and just say, 'you know, I'd rather get it checked out now'. If you are noticing some flattening of the head or you really feel like your child has trouble turning to one side, or they always look in one direction you want to get referred for Torticollis.  I don't find too many pediatricians are reluctant to refer, but if they are, for some reason early intervention would be the way you could self refer.  They would evaluate your child and determine eligibility. 

Let's dive into Torticollis because I think there's so many parents out there that are listening thinking, 'Oh my gosh, what is Torticollis? Does my child have it? How do I fix it? What do we do? Where do we go? Who do I talk to?' So can you explain to us what Torticollis is, how it happens, and what can we do probably starting at birth so that we don't get to two months and start seeing signs of Torticollis. Is that possible? 

So most parents end up noticing the plagiocephaly, the flattening on one side of the head, first. A lot of times parents won't realize until a little bit later, 'Oh yes, my child doesn't turn their head to both sides easily'. What they will notice is that when they pick their child up, the head might look a little flat on one side and that's because they're spending more time on one side of the head than the other. Most of the time with plagiocephaly it's caused because one of the muscles in the neck, the sternocleidomastoid, which is the muscle in that's involved with Torticollis, that muscle is tight. This tightness causes the head to turn to one side and they kind of get stuck there. So typically they say that this happens because of the position that they were in the womb where they weren't moving as much and then they get kind of 'stuck' in a position.

This diagnosis is considered a congenital diagnosis, so it's something they're born with. It's not always preventable. The biggest thing is in the first few weeks to a month, you want to start noticing, are they doing visual tracking and are they able to follow you to both sides and move their head to both sides easily? A lot of parents also notice that when their child is sleeping, they may only have their head looking to one side when they sleep. There's been a huge uptick in plagiocephaly ever since the 'back to sleep' campaign in the early 2000s, because of the way they're positioned to sleep. The 'back to sleep' campaign has done so much more for other issues like SIDS and things like that, but it can make them more prone to neck preferences.  

So it kind of goes back to balancing that back sleep with enough tummy time throughout the day. So that that head gets that balance and they're not always laying on the back on their head?

Exactly. So the whole push for tummy time and pediatricians talking about doing that, that tummy time is actually there to counteract the back to sleep and to allow for more gross motor development. Most children develop those gross motor skills- lifting their head and all that head control through being on their stomach. They're now getting less of that when they sleep, so they need to balance that throughout the day during tummy time. So they recommend at least an hour of tummy time throughout the day. That can be broken up into 5 minutes chunks if needed, but to have accumulated hour throughout the day where they are on their tummy and working on those gross motor skills. 

That is amazing. So I personally love tummy time. I know a lot of children don't like it. You can totally make tummy time fun and engaging and like where your baby likes it. Remember your baby's going to have a learning curve. Everybody fights back on new things. So just to give them the space to learn to love tummy time, because it will eventually get to a point where they have independence there. They can lay on their tummy, they can reach things, they can bring it to their mouth. I have one last question about Torticollis. If your child is tight, let's say they're looking to the left and they are favoring the left the most. Does that tell us that the neck on the left or the right is tight? Is it the same side that they favor or the opposite side? 

So that is a tricky question.  There are a few different types of Torticollis.  Depending on how they are presenting and which muscles are really involved. With classic Torticollis if your child favors the left, as in is looking to the left, then most likely it's actually the right side that's tight. The muscle involved does opposite actions where it tilts the head to one side, but turns to the other. So their head would be tilted to the right, but turn to the left. Occasionally, there are certain instances where a kid may be tight on the same side. We actually see that a lot in kids who have reflux. There is relationship between Torticollis and reflux. It's more of a posturing effect that infants do to help relieve the pressure or the heartburn from reflux. Hence, they are both favoring and tight on the same side.

Isn't that so interesting that their body kind of knows how to cope with that reflux or that heartburn. Of course. I mean, I guess it's at the expense of their neck, but wow. At their body's intuition, I think I'm just kind of blown away by that. That is that's amazing. 

Right. So I think it's something if you feel like the child, if their head is sort of a little off center or they have trouble turning to one side and they either have reflux or you're just noticing that they're not moving it while it's great to have someone take a look to see if there's anything going on there. 

So what are some things that we can do at home if you do notice this and you're like, 'Oh yeah, this is totally my child. They're describing my child a hundred percent.' What are some things that we can do at home that maybe from the beginning?  What other simple things that parents can do?

Right. So, the biggest thing that we worry about first with Torticollis is the repositioning techniques for the plagiocephaly. So being able to reposition them and the flattening is not getting worse. So turning them on opposite directions in the crib when you put them to bed so they're not always facing the same way.  Tummy time again is just the best thing to do because they're off their back. But also tummy time is great for torticollis because in that position the muscle that is tight actually gets canceled out by the neck extensors when they lift their head. They're able to move side to side easier than when they're on their back.

So I think with tummy time really varying different positions of doing it- doing it over the boppy, doing it on your chest- that all counts as tummy time. Trying to make it successful for them. When they're early on in that newborn stage having them at an incline just makes it so much easier for them. When you want to work on sort of some of the strengthening for Torticollis, just trying to get them to track to both sides and also working in side lying.   Having them on their side and playing there will also relieve some pressure on the flat side of the head. So putting them on the opposite side that's flat. 

Amazing. Thank you so much for those tips. I'd like to circle back to hip dysplasia as well. If a child does have a need to have a brace after birth because of hip dysplasia, can you step us through that? What is that going to look like visually kind of on your baby and then what limitations do you have at home in those first few weeks with that brace? 

It depends. There are a couple of types of braces that they use. Most of the time if a child is at the point that they need that brace, they are wearing it mostly 24 hours a day. So it can be very challenging to have great sleep routines, to feed them, to change them.  Usually the hips are very outstretched kind of like a frogged out leg position. So it may also be challenging to do tummy time with them, because they're wearing this brace and they're in this position for 24 hours a day. So  a lot of it is finding seats, swings, or things that being able to prop them up that might be a little bit more comfortable for them. They might not be as comfortable just laying flat on the floor or trying to do tummy time with that. 

I think a lot of it would be trying to see if you could comfortably do tummy time at that point. You could try chest to chest to get some tummy time. You may also need to put a little bit of a blanket over yourself to make it a little bit comfortable. They aren't going to be able to lay flat so you need to prop them up or support them from underneath. 

I want to talk about tools and baby products and things that you can buy that are not the healthiest for your baby's hips. And if you are going to use them, you want to be mindful of how you use them. What do parents need to know about using those toys? Even the baby wearing- what do we need to know about our child's hip development when using carriers? 

So with those baby wearing and all the sort of baby carriers, there are certain carriers that really facilitate a better hip posture. What we ideally want to see is that their hips and their legs come out straight and that their knees come down at a 90 degree angle. So they kind of look like a frog leg almost. We don't want their legs hanging straight down because that's going to put pressure on the hip joints. So a lot of the baby carriers have really adapted to give more padding underneath and sort of look like they cover their whole thigh and all you see is their little knees hanging down. That's exactly what we want to see. 

When it comes to the exercisers and some of those other toys, we really want to wait on those until kids are a little bit older and they're closer to seven or eight months old. We want to wait until they have a little bit more head control and they have trunk control. As well, if you put them in, it's limiting how long they're in there- 10 or15 minutes at a time when you need to get something done and no more than an hour a day total.  

I wish you guys could see me because I'm like shaking my head, like a crazy person. Like, yes, yes, yes. The frog legs are key. You guys, you've got to protect your child's hips because it's going to impact their lower back and their knees and their ankles. We have to protect these, these newborns so that, you know, they crawl and they can walk and they can do whatever they want with their bodies, actually in the future, we just need to protect their little bodies. I love to hear you say, you can still use those things, those tools. It hurts my heart when I have people who recommend like, well, don't have them in your house at all. Okay. That doesn't work for all parents. So how can we give boundaries where it can be an healthy option. We don't want their hips to be hyperextended, they need to really have leg muscles to kind of stand up really in that exercise toy. Is that correct? 

Infants go through a few different stages of developing through standing. So a lot of parents will be like, 'Oh, at four months, they're really pushing their weight through their leg!',  but certain things that you have to kind of take notice when they're doing that- Are their hips behind their shoulders? Are they straight under their shoulders? When are they able to really have that full head control, trunk control and everything from their head to their toes or in a line? If they're sort of flexed forward at the hips a little bit and they're not able to balance their whole trunk over their legs, they're not going to have enough, support and strength to really push through and support their legs. 

The next thing I wanted to dive into is sitting. If your child is not sitting by 4-6 months- how can we support our child sitting up? 

So I think what parents don't realize in general about child development is that there is a huge window for child development for all of these different milestones.  Just because your child isn't hitting that early end of the range, as long as they're within that range, it really doesn't matter. So really for sitting it can go up to about eight months and for rolling as well.  Rolling really goes, technically the end of the range of normal is nine months and parents think, 'Wow, that's crazy. That's late.' I think one of the things that we really want to look at are: Are they hitting all those milestones and where are they getting stuck? What movements are they having trouble with? There are some kids that sit really early, but they aren't enrolling at all. 

So we really want to know are they able to get some of those rotational movements in- how are they using their core? Can they reach across the middle? Can they turn to their side? So if a kid is hitting all of them sort of in sequence, but every milestone is a little bit on the later side, but they're hitting all of them- I would not be worried at all. It's more about the quality of the movement and how they're getting in and getting out of these movements.  Can they get into sitting, can they get out of sitting if they're stuck? If they can only sit, what does that do for them? So also, how are they participating in their environment? 

So if you do see this, is there something we can do as parents at home? Or is this something we should make a pediatrician appointment with? Is this something that we should call it early intervention? Where do we go from there? 

Yeah, I think a lot of it is giving different floor time opportunities.  Varying the play for them with different toys, putting him in different places, really allowing for as much tummy time as possible and letting them explore.  If they are doing well in sitting- can you get them to reach a little bit outside of their base to support where they're sitting to create more movement and see if they'll do some transitions? If you're getting to eight months and they're really not sitting well, or they're not rolling, that's when I would  contact your pediatrician to look into it. I would think you would start that discussion at the six month appointment, but you know, if they're kind of on their way and you're starting to see signs of it I would give it another month or two and follow up between 8-9 months. 

To define, 'not sitting very well'. What I imagine is a baby kind of slumped over not having a strong core, not being able to really engage with their environment.  What else should we know about, you know, kind of not great sitting, what are we looking for? 

Most infants will start sitting in what we call a prop sitting position, between four and five months. Where they'll be able to put their arms down in front of them and they can support their weight through their arms. When they're sitting between five and six months, we want to start seeing them sit upright more. They're not using their arms on the floor as much for support. They may put their arms on their legs for support, but by 7-8 months, we want to see them upright, with no arm support, and they can start reaching side to side for toys without too much falling to either side. 

Then after that, we are just looking for them what to be able to get out of that sit and probably crawl in and engage fully with their environment. Is that right? 

Exactly. We want them to be able to go from sitting to their stomach. To be able to crawl whether that's  an army crawling on their stomach or crawling on hands and knees, whichever they're starting to do. 

So let's dive in the army crawl, it freaks parents out. What do you say? Should we be worried about army crawl? 

No, definitely not. The army crawl is usually a phase. Most kids do army crawl. It's sort of that in-between where they don't have enough core strength to be on their hands and knees, but they're figuring out how to move and get themselves there. What we really look for with crawling is reciprocal motions. We want to see alternating arms and legs, because that coordination piece offers so much that it doesn't matter if they're doing it on their stomach or they're doing it on their hands and knees. 

And what about scooting? Some kids don't crawl because they learn that they can get around on their butt. Is this concerning? Should we be worried that they've chosen to scoot rather than beyond their belly? 

Most kids that learn how to scoot, have already sort of decided or have had difficulty with that tummy time. That's usually why it happens over the hands and knees crawling. It is something that it can be a little bit concerning. We want to develop some of that arm strength. We want them to be able to have that shoulder stability for later on. Also with crawling, those reciprocal movements- that coordination piece is huge. A lot of times when kids scoot, they use one side more than the other, and they're not getting that alternating piece. We do try if someone comes to physical therapy because they, were having trouble pulling up to stand or they are later walkers, and they scoot- we still try to encourage different techniques of being on their hands and knees and continue to promote that crawling. 

Kids with Torticollis will develop a scoot, or they may crawl on their hands and knees, but one of their legs is sort of up in this flex position. A lot of times it can either be on the same side or it can be the opposite side. Either due to some tightness that's throughout the rest of the body, because we do see some tightness down through the trunk as well as the hip, but the more dominant side may also be the one that is up when they're scooting because the opposite side is stronger. 

That makes a lot of sense. So now that our child is crawling or scooting, how long does that phase last and when should we expect our child to start walking in? What are those phases kind of look like? Plus when should we be worried if our child is not walking? 

Right. So the window is huge. People don't realize that the normal walking window is anywhere between 12 and 18 months. Yes. 18 months is normal. What are the opportunities for pulling up to stand and cruising. So still having that floor time where they can explore is important. The walker toys where the child sort of sits in the walker, that's not going to promote cruising and the weight bearing that they need for walking. Whereas the push toy walkers are great. Those model some of that forward walking that typical progression that we see. So, around 15 months, if they're really not pulling up to stand or cruising, I would start to look into maybe why aren't they, but I wouldn't be overly concerned. They're still normal. If they're starting to pull up to stand and cruise, they may start walking by 18 months. 

What do we need to know about shoes? I've always heard and kind of recommended not to put your child in these big, huge, clunky that the thinner, the better you really kind want to you're, I'm a huge fan of barefoot. After six months, I really kind of just think having their feet on the ground is the best way to really give them, you know, the lay of the land, if you will. So thin shoes is kind of what I recommend. What do you recommend? And then also in the winter time, especially here in Boston, we can't do thin shoes. What do we do? How do you manage that? 

Right. So the thought behind shoes is really the best thing is for them to be barefoot as much as possible. So when they're home, wherever they are being barefoot is the best. Winter time, creates some issues where you know, thick enough socks that they can wear that to still allow them to be barefoot or if they really need that extra layer- thin shoes would be better. After they start walking, if it's not too cold or not cold in your house and you can keep them barefoot or wear socks, that's ideally the best. 

Even as they are outside of that 18 month window, and they're toddlers, you still want them to be barefoot because that's how they're going to build up their arch. Their arch doesn't fully develop until they're close to school age, around five. So we really need to strengthen all those muscles in their feet. You get that feedback by being barefoot. That's how they strengthen all those muscles. 

You are speaking to my country heart. So I don't know if you know this about me, that I grew up in Mississippi and on a farm. Okay. I do have one final question. What do we do as parents that hinder our child's development? And for example, what pops into my mind is hip carrying. What are some things that we might do unintentionally as parents that we could do better or differently that might benefit our child and their physical development from a PT standpoint? 

I think one of the biggest things is just allowing their own exploration. Kids innately really have motor plans built into them. Giving them the opportunity just to be on the floor and to explore and to also really change up their environment. As they're getting close to that sort of 5-6 months of age and they're really starting to try to move, we want them to be able to learn from trial and error.  They learn the best from trying and failing and then realizing, 'Oh, I have to do it differently because that didn't work that time.' So if they're always in the same place or with the same toys and it becomes routine, they don't know how to change their play.  They don't learn to change their movements or how to adapt them. 

I know I said that was my last question and it's not, it never is. What do we do about lazy baby? So if you change your baby's environment and they literally just lay there and they're like, look, I'm not doing tummy time here. I'm not doing tummy time there. I'm not doing tummy time anywhere. Like I'm not doing tummy time. Um, you know, you lay them on their back and they're like, okay, I'm just gonna hang out here. What can we do to kind of get these babies engaged?

Yeah. I think a lot of it is finding distraction techniques.  What do they laugh at? What do they squeal at? You know, is it music? Is it those baby mirrors? Kids will love looking at themselves in a mirror. What are the different tools that you can do to distract them and start from ground zero and build it up.  You know- 1 minute is a success, 2 minutes is a success. How can you build off of that? Work with your child and meet them where they're at. Every baby is different. 

I love that so much. I love to say baby steps for your baby. It is insane. And so just age inappropriate to expect your baby to perform at an older child or an adult level, right? Oh my gosh. This has been such a fun conversation. Thank you so much for joining me. If there were any listeners who were concerned about any of the things that we might have mentioned today what should their first steps be after they listened to this podcast?

Yeah, I think the first steps would be if there were any concerns, especially if it's young infants and you're worried about sort of the flattening or your baby's only looking to one side, have those open conversations with your pediatrician. Really, you know, express your concerns about it. Most of the time the pediatricians are more than happy to have second look if you feel that you want a referral to physical therapy at any point.  Or seeking out early intervention, as a second resource, since you can self refer to early intervention to kind of just have your baby looked at and find where they are developmentally. 

I love that. Thank you so much. That is really the most empowering thing that you can ever tell a parent is, take it into your own hands, look it up and, you know, take it into your own hands. Self-refer start talking to people. The best thing you can do as a parent is just action. 

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