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. 

Magic Words in Birth

Wednesday, January 6, 2021

Magic Words in Birth

Hello, happy 2021 friends. I cannot wait to see what this year holds. And you know what, when I look back over 2020, it hadn't all been bad at, if you look at Episode 121 of The Birth Lounge Podcast, I actually talk about some of the positives that have come up for women's health from Coronavirus, specifically within the birth world. But in general, I think we're going to start to see some positive strides. I know that 2020 has been a hard year for so many people in, in the birth world. I was just actually talking to the birth workers and we were all sharing that collectively things just feel heavier in the birth space. It feels like outcomes aren't as great and that there's a lot more medical manipulation (Check out Episode 136 of the podcast on medical manipulation).

Recently, we had a really amazing birth at TBH. It was so beautiful. Total hours was only 11 hours. And this birthing person only pushed for 20 minutes and she had zero tearing and we did eight of those hours at her home and three of those hours at the hospital. It was just so idealic, it just really was, it was so beautiful and it was such a refreshing dose of how birth can be. When I came home from that birth I recorded a snippit to share within The Birth Lounge Community. And I've gone back to this clip several times over the last week, because like I was telling you, there's been this collective heaviness in the birth world and this birth was so refreshing. 

So it's just been nice to remind myself throughout these last couple of days that, you know, times are hard right now, but it doesn't mean all is lost. And if you prepare in a very intentional way, and if you prepare with the right preparation and with the right information and with the right team, then, you know, things can go beautifully. 

Even though you won't hear my voice. I feel like the message of this birth carries through in text. So, here are my thoughts at 2am after returning home from this birth:

"Hi, it is 2:15 in the morning. I just got home, but look, I just got home from a birth. Literally just walked in the door, beautiful birth. Oh my gosh. Beautiful vaginal delivery, pushed for 9 minutes. Zero tearing. Did about 11 hours of labor at home. 3 hours of labor at the hospital. It was so good, but we faced some rocky parts at the hospital and it all came down to a provider who was really struggling to respect consent and to respect the fact that this person had already shared their birth goals. And this provider just kept on suggesting and scaring and encouraging different decisions. 

At one point there was the conversation about having an IV placed, right? 

Birthing person: 'I do not want that. I have been hydrating. I do not want that.' 
Provider: 'We have to draw blood anyway and run some labs anyway. So we just need to place it.' 
Birthing person: 'No, you can just draw the blood. And then I don't want that IV'. 
Provider: 'You know, you really need to get this IV'. 
Birthing person: 'Why do I need this IV so badly? Why can't we just do this IV later if I need it?'
Provider: 'You know, if there was an emergency, the one minute that it could take to get in an IV can mean life or death for your baby'. 

Now, this statement is probably true in SOME cases, BUT the same is probably not true in a lot. In most cases. You also would hope that if someone held a job on an L and D unit, that they would hold the skill, the very core competency to place an IV in an emergency.

The way that this was presented. And the words that were used were so guttural. My heart right now is racing actually just reliving this, because it was very scary in the moment, the way that this doctor presented it. And I think it's important to note that we spend months preparing our clients to birth. We are not a traditional doula service. We are a maternity concierge service.  We're with you for months preparing you for very tiny details, exactly like this. 

This is why I want to share this with you as it plays out exactly how it is supposed to. We know that in America, we like to give IVs. So this birthing person says, 'You know, I would like to wait until an emergency arises in order to get an IV. I don't want an IV right now.' And she turns to me and says, 'Hehe, what does the evidence say?' And I say, 'Well, we know that the evidence says there is no benefit to having an IV placed. If you have been hydrating on your own, and you're not getting sick to the point that you're dehydrated and you're being able to keep down fluids, however, your doctor has a very valid reason for wanting an IV placed.' The doctor comes back with some more reasons as to why in an emergency being without an IV can be very scary. 

And again, this goes back to the skillset of, if someone is holding a job on an L and D unit, we hope that they're able to place an IV, whether it be in an emergency or not, it comes along with the job. And so this birthing person says, 'I don't want an IV'. And she turns to me and says, 'I don't want an IV'. And I said, 'I think that's fine'. 

This is where informed consent comes in. And I say, '...and this is where informed refusal comes in as well'. And you know, all about that and that provider, her tune changed. The wind in her sails went a different direction. It was like night and day. They were like, 'All right, no IV. We understand you've been hydrating. We are all set with understanding about the IV. If it comes to that, we are going to need to place it'. And the whole room was like, 'Well, of course'.

No lie. I was like, Wait, are these magic words? Did I just say magic words? I was legit taken back. I'm still taking back the whole situation when I paused the room. And I reminded everybody informed consent is definitely a thing, but that's a buzzword these days doesn't mean very much. Right? But I guess it means a lot. Everyone's talking about informed consent. 

But at some point it gets muddled. The message gets muddled. And I think that's where we've reached with informed consent. People are so tired of hearing about it. It's legitimately real. People are tired of hearing about it. So they've, they've tuned it out. That's what I'm trying to say. (Please remember. It's like 2:30 in the morning.)

Informed refusal though. It was so different. They got it. It was just a reminder. I think every now and then birth has this tendency that everyone's really caught up in the moment. And we just want to pause the room, ask our questions and then evaluate our options. And that's how you pace your birth, right

A provider can not practice informed consent without recognizing and respecting informed refusal, period. End of story. No negotiations. Book closed. Informed refusal and informed consent go hand in hand like this. They are best friends. You can't have one without the other it's salt and pepper, the left and the right. 

Okay. That's what I came on here to tell you, I'm riding that birth high because that birth was so the universal. It was so beautiful. And you can have it. As cheesy as that sounds, you can have that too. And this just shows how it plays out. If you do work, how it plays out. You have to do the work. We have to have these conversations. You have to know these things. You have to be educated on your choices. You have to understand your options and your rights. Be prepared to have these conversations be prepared to stand your ground.

Their business is how to support you in making sure that you do get those or you don't get those. And if you can't have your preferences that you're getting as close to those as possible, that's what we do at TBH. Thanks for hanging out with me. All right, I got to go to bed. Bye guys."

Please, remember the value of informed consent AND informed refusal.

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