Breech Birth

Wednesday, January 26, 2022

Breech Birth

Breech birth is a variation of normal. Hopefully you’ve heard this before, but oftentimes parents carrying breech babes are met with dead ends and discouragement that leaves them with the idea that their baby or body hasn’t done its job properly. Before we go any further, allow me to repeat myself. Breech is a variation of normal, occurring in 3-4% of term pregnancies. Breech fetal presentation means our body, which has answers no text book can teach us, has chosen this position for reasons we may not understand. Remember, things are not inherently bad or dangerous just because we don’t understand them. It just means we have knowledge to gain.

What’s important to know is that vaginal breech birth is absolutely possible, and not only that! Vaginal breech birth, when properly supported, can be totally safe. While many providers may push a planned cesarean, you have the right to decline.

The Safety Factor

If breech presentation is normal, why are discoveries of Breech babies met with a frenzy of ECV conversations, cesarean planning, chiropractics, and desperate attempts to flip Baby head down? Allow me to be realistic with you. When a breech baby is born vaginally, there are some risks. In most cases these risks do not outweigh the risk of a major abdominal surgery, but they are there. Having a head down baby does alleviate some of that worry and in all cases, lower risk means safer. If we can encourage baby to flip, let’s do it! So what are the risks? The hot topic risks we hear of are cerebral palsy and neonatal mortality. A study published in 2017 looked into these risks and found that vaginal breech birth showed no variation in cerebral palsy rates in comparison to head down vaginal birth. However, it did find an increase in rates of neonatal mortality. While a sure increase was noted, the increase is marginal in comparison to neonatal mortality rates in breech cesarean birth. The risk of fetal demise in a head down vaginal delivery is 0.3 per 1,000 births. The risk of fetal demise for breech cesarean is 0.8 per 1,000 births. The neonatal mortality rate for vaginal breech birth? 0.9 per 1,000 births. 

Another risk of breech birth is umbilical cord prolapse. This occurs when the baby’s body compresses the cord against other structures within the womb and in some situations the cord may even slip into the birth canal. Umbilical cord prolapse is considered an emergency. When the cord is compressed, it reduces, or entirely cuts off the flow of blood and oxygen being delivered to your baby. If not addressed quickly, this event can lead to fetal demise. It is important to note that umbilical cord prolapse is a risk even in head down deliveries, and can be the result of too much amniotic fluid, water breaking before labor begins, you have a low lying placenta, or you have a small baby. 

The bottom line? Breech birth comes with risk, but with proper support these risks can often be managed and avoided.

The Education Factor

Another reason we meet breech discoveries with attempts to flip baby is because a majority of providers refuse to vaginally deliver a breech baby and instead immediately push parents to consent to a cesarean. If asked why they recommend this, they will cite the risks we discussed above. Here’s what many won’t tell you- 1. It comes down to liability over patient satisfaction and 2. They don’t know how to deliver a breech baby. Why? Because they were handed a license to practice medicine without ever having to learn how to handle and deliver this totally normal and often safe fetal presentation. This fact is disparaging when you put it into perspective. We entrust obstetricians with our entire pregnancy, our well-being, and our baby’s well-being. They are supposed to be the experts, yet here they stand before us scheduling us to have a major abdominal surgery because they don’t possess this very basic knowledge. What a broken system it must be to have experts who lack expertise. In fact, it’s midwives who are most often taught how to deliver breech babies, while a majority of obstetricians continuously fall short on the knowledge.

The Options

Let’s say you get the news that your baby is breech. What are your options? Thankfully you have a few. First and foremost we always try to start with the smaller things and work our way up to the larger ones. Safe sitting is always a great starting place. Things like ensuring that your belly button is always parallel to the floor, sitting on a birth ball instead of an office chair, etc… We have a great safe sitting guide you can find here. Along with safe sitting we use spinning babies to help make enough space to encourage Baby to flip. From there we might do moxibustion, acupressure, chiropractic work, etc… If all else fails we may explore the option of an external cephalic version (ECV). An ECV is a procedure where your provider will manually turn your baby from the outside by pressing against your belly. 

In the event that you have decided to vaginally deliver regardless of how your fetus is presenting, you can skip right to finding a breech educated provider, as well as a breech educated doula, and work on a plan of action with them. It may be that some parts of your dream birth plan can’t work out, but with the right provider and doula you can and will maintain a sense of control over your birth. All in all, breech presentation is a hiccup, but it most definitely doesn’t have to derail your entire birth, and it certainly doesn’t mean your baby or body are broken.

This blog was written by a former Tranquility by HeHe birth doula.

Guide to Galactagogues

Wednesday, January 19, 2022

Guide to Galactagogues

Chances are that if you’ve ever had a baby, you’ve faced some of these agonizing anxieties: am I making enough milk?, is my baby getting enough milk?, is my baby gaining weight properly?, etc… While these questions may or may not be unfounded, we’ve all spent time wondering where we even start to look for answers.  Thankfully the options are plentiful, from basic body mechanics, to herbal support, all the way to off label prescriptions. So let’s die in and review the risks, benefits, and the mechanisms that make them effective.

Body Mechanics

Before jumping headfirst into costly supplement regimens, consider making an appointment with a recommended lactation consultant, or purchasing a scale for doing weighed feedings at home. This involves weighing your naked infant just before a feed and just after a feed. The increase in your baby’s weight will reflect how much your baby has eaten. Being able to visually see that your baby has taken in three to five ounces in a single feed may help calm your anxieties. Other emotional physical adjustments include skin to skin, breast compression during feeds, wearing loose fitting bras, shirts, and tank tops, and more frequently offering the breast. These simple adjustments can make breastfeeding not only more effective, but more comfortable. Comfort is a major part of breastfeeding. To produce adequate milk we need hormones like oxytocin and prolactin to be excreted which trigger milk production and flow. In situations where we feel physical, mental, or emotional discomfort, our bodies are more likely to excrete stress hormones. Stress hormones will always impede milk production and flow. Restricting breast tissue with too tight bras or clothing also signals to the body that it doesn’t need to produce as much because the ducts are confined and unable to transfer milk as easily.

Lactation Diet

Let’s say adjusting body mechanics shows some improvement, but the boost didn’t quite get you over the hill. Now would be a good time to look into dietary additions. Oats, brewer’s yeast, raw nuts, and leafy vegetables are all wonderful options for supporting and increasing milk flow. Adding brewer’s yeast and oats into a cookie, brownie, or breakfast bar recipe has shown great success and comes highly recommended. Just be sure that you’re maintaining a healthy sugar intake. It is entirely possible to incorporate these items into low sugar options as well. Brewer’s Yeast is hypothesized to be effective because of the many nutrients it can replenish in a nursing parent’s body. These nutrients include Vitamin B, easily digestible proteins, amino acids, and chromium. All of which support milk production. Fair warning though, many have reported uncomfortable gas, bloating, and headaches with the routine use of brewer’s yeast. Similarly, oats support lactation with their high source of iron. This super food can be especially helpful if you experienced excessive blood loss during or just after delivery. Oats are also thought to lower stress levels based on its hot and soothing nature. Unless you’re gluten intolerant, there are no reported risks of using oats to boost supply.

Herbal Boost

Herbal supplements are where we tread lightly until footing is sure. Not only can supplement regimens be costly (though arguably worth it if they work),they each affect individuals so differently. Where one person reports incredible results with fenugreek, another reports decreased supply and horrible digestive issues. Of all the herbal supplements, we’ll go over the most popular ones.

Fenugreek: Fenugreek is a plant that has white blossoms, stands about two feet tall, and its blooms contain small golden seeds. The seeds are what we’re after. While studies as recent as 2018 ensure its efficacy, this herbal supplement comes with a long list of side effects that are responsible for its recent decline in use. These side effects include diarrhea, gas, an off putting maple syrup smell, fussiness in baby, and even low blood sugar. While not everyone will experience this, it is widely reported. It’s also important to note that researchers still aren’t entirely positive why fenugreek works. The hypothesis? The plant contains phytoestrogens which closely mimic human estrogen and this supports the production of prolactin. It’s unknown mechanisms and long list of side effects make this supplement one you should tread lightly with, but not one you have to cross entirely off the list. If the side effects of fenugreek prove to be intolerable Milk Thistle is a very similar supplement with less side effects that may be worth looking into.

Fennel: Fennel is similar to fenugreek in the way that it contains natural estrogen like properties that raise prolactin levels. While it’s unlikely that fennel alone will raise milk levels quantifiably, when used in combination with other galactagogues it does seem to show improvements. However, fennel is a rather finicky herb and carries some rare, but worth mentioning risks. In some cases parents with a history of seizure activity may want to avoid the use of fennel as it has shown to increase the risk of seizure. Many babies that drink milk boosted with fennel may be more likely to fall asleep at the breast as it tends to make babies a bit more drowsy. Finally, fennel also carries a risk of lowering blood sugar which should be weighed carefully by parents with a history of hypoglycemia or other metabolic conditions. All in all this herbal supplement is likely a safe option for increasing milk supply, though taking too much fennel has shown to decrease milk supply.

Goats Rue: Goat’s rue is a personal favorite of mine. As a mother with insufficient glandular tissue, I saw so much improvement with this supplement because it doesn’t just work as a prolactin boost, it facilitates the growth of new breast tissue! Goats rue is a plant related to the pea family and has shown many lactation benefits. Particularly useful for parents that have insufficient glandular tissue, previous breast surgeries, are trying their hand at relactation, or are simply just seeking a general boost in milk supply. Unlike the supplements above, goats rue has actually shown to stabilize blood sugar as well. However, goats rue should NEVER be ingested as a fresh plant as it is very toxic and considered poisonous in its live form. Skip this one when you plant your garden and leave the formulation of this supplement to reputable sources.

Off-label Prescription Use:

The use of prescription medication for low milk supply most certainly isn’t new, but you may want to regard it as a last ditch effort. While these medications have shown promise, not all of these medications and their long term effects have been thoroughly researched. This is not to say that prescription medication should be avoided altogether, but more so to stress that the decision to use them should be a highly informed one. The medications most commonly used for milk production are considered dopamine antagonists (like Domperidone and metoclopramide), anti-psychotics (like reserpine, sulpiride, and thioridazine), and medications that work with blood sugar and the pituitary gland (like metformin). Of these medications we will cover the two most researched and most common, domperidone and metformin.

Domperidone: This medication was developed for the treatment of nausea and stimulation of movement within the gastrointestinal tract. Throughout its on-label use it was also found to raise dopamine levels in the brain and in turn it raises prolactin levels. Soon this medication was being prescribed for the off-label purpose of increasing milk supply. This medication has been, and is currently, a widely researched medication for this use. However, side effects of this medication include breast tenderness, galactorrhea, itching, breast enlargement, dry mouth, and menstrual irregularities. Increased milk production will usually be noted within 48 hours of use and is generally considered safe.

Metformin: This prescription shows milk production improvement in a particular group of people and will not be for everyone. For parents with a history of polycystic ovarian syndrome, gestational diabetes, diabetes, and general insulin resistance metformin may be particularly helpful as it helps stabilize the pituitary gland and the hormones it secretes and creates more consistent levels of blood sugar. Hormone regulation is a paramount part of breastfeeding. Without this the production of milk will be inconsistent, and oftentimes insufficient. If you have concerns with your postpartum hormone levels and how they’re impacting your breast milk production, it is always worth running a blood test to check these levels and addressing them from an individual aspect.

But, what if that doesn't work?

If you’ve found yourself reading this article you’re likely sitting in so much uncertainty. You could try every single thing on this list and still struggle with low supply. First, it’s okay to keep trying. If exclusive breastfeeding is your goal, keep going.  It’s also okay to protect your mental well-being and decide that breastfeeding isn’t something that aligns with you anymore.  Second, I want to tell you breastfeeding is not an all or nothing sport. You don’t have to regard formula as the enemy. Low supply doesn’t mean you won’t ever be able to breastfeed. It means you may need a little help. That can mean that help will only be needed for a couple weeks, or maybe you and formula will team together to keep baby thriving and also maintain the bond of breastfeeding. 

With low supply can come feelings of failure or resentment towards your own body. Put that burden down and listen for a moment, the fact that you’re here reading these words is proof of what an incredible parent you are. You’re not giving up at the first sign of struggle, you are here making a ten mile list of vitamins and recipes, you are here learning about the plants and herbs that might help your body produce more and more, you are here reading through side effects and likely thinking “I can deal with that if it helps my supply enough”.  How lucky your baby is to have such a dedicated and determined parent. Try to be gentle with yourself.  Thank your body for all it’s doing for both you and your child. 

This blog post was written by a former Tranquility by HeHe doula.

Tearing in Birth - What is the Norm?

Wednesday, January 12, 2022

Tearing in Birth: What is the Norm?

If there was ever one hill almost every doula would die on, it would almost certainly be that episiotomy and tearing are not by default, a normal part of birth. While episiotomy is blog for a different day, now is the perfect time to dive headfirst into perineal tears, labial lacerations, and everything in between. Let’s discuss why they occur, how to prevent them, how to know how severe they are, and how to heal them.

When we think about tearing during childbirth, we often jump to thoughts of torn perineums, but the truth is that tears can affect almost every part of the vagina and vulva. Each tear comes with its own set of challenges, and some are more avoidable than others. However, no matter the location(s) of your tearing, healing will require care, delicacy, and kindness towards yourself.

  • - Perineal Tearing: Tearing of the perineum is the most common and widely discussed area where tears take place. This is the tissue located between the vaginal opening and the anus. These tears are typically graded in degrees, which we’ll dive into in a moment, but generally the less tissue/structures involved the lower the degree. The perineum is the area of the vagina and vulva that stretches the most as your baby descends down and out of the birth canal. In cases of natural, physiological tearing your perineum will be the area most affected.
  • - Labial Tearing: Labial lacerations are far less common than tears in the perineum, but are seen most often in situations where an episiotomy is performed, a birth is instrument assisted, or a baby is born quickly. While these tears are easily repaired with a few stitches, it’s not uncommon for doctors to leave them to heal naturally, or even miss them entirely. In many cases these tears may leave behind a slight deformity. These deformities can be fixed with reconstructive surgery in most cases.
  • - Periurethral Tearing: Periurethral tears are tears to the tissue around your urethra, the tube that drains your bladder. These tears are often superficial and only require stitching if they bleed freely. Because these tears don’t involve muscle they typically heal faster than perineal tears and typically heal without complication. These tears are most often observed when a baby is born face up, also known as sunny side up.
  • - Clitoral Lacerations: While the thought of having your clitoris tear is admittedly worrisome, rest assured that these tears are rare, occurring in an estimated two percent of births. Similarly to periurethral tears, clitoral tears are observed more often when a baby is sunny side up. They can also be the result of instrumental or precipitous birth. In most situations clitoral tears will heal within one to two weeks.

Perineal Tears and their Degree

To rate the severity of perineal tears we use a 1st, 2nd, 3rd, and 4th degree rating system. These degrees relate to the depth and involved structures affected by the tear. For example, a first degree tear is considered a “graze” or “skid mark”. They affect only the top layer of skin and often won’t require any stitching. A second degree tear will affect the skin, and some of the muscle in the perineum. Second degree tears will require a few stitches to heal properly. A third degree tear refers to a laceration that affects the skin, muscle of the perineum, and extends into the anal sphincter muscle. Third degree tears will require stitching and may be done in an operating theater. Finally, fourth degree tears refer to tears that extend all the way into the lining of the rectum. Stitches will be required, as will some level of reconstructive work. Complications of third and fourth degree tears can include scar tissue buildup, fecal incontinence, and pain with intercourse.

How To Prevent Tearing

Before we talk about preventing tears, we should talk about why they sometimes occur naturally. The obvious answer? While your birth canal can stretch up to three times it’s typical size, it takes a little work to get it there. Is tearing sometimes part of physiological birth? Absolutely. Does it happen 100% of the time? Absolutely not. Here’s how we can work with our body to give it the best opportunity to birth your baby without tearing.

  • Perineal massage: This massage technique involves the use of your or your partner’s fingers to gently stretch and mobilize the tissue just inside the lower wall of the vagina and the tissue between the vaginal opening and the anus. These gentle stretches prepare the perineum to expand and mold around the shape of your baby. Always start with clean hands, use a warm lubricant like grape seed or olive oil to lend more moisture and hydration to the tissues so they can stretch more freely, and build up the intensity of the stretch slowly.
  • - Avoid pushing on your back: In order for the vagina to expand to three times its size, we have to give it the room to do so. Pushing on your back can close the pelvis by up to 30%, which will in turn impede the birth canal’s ability to fully expand as your baby passes through. Pushing in a side lying, hands and knees, or even squat position removes any outside pressure that could close off the pelvis and will in turn greatly reduce your chances of tearing.
  • - Say no to purple pushing: You’ve probably heard the phrase “ring of fire” in relation to the moment your baby begins to crown. It can often be instinct to forcefully and quickly push your baby through in attempts of shortening the time spent with that sensation. This is an almost sure path towards a third or fourth degree year. In parents who have gotten an epidural, providers may use purple pushing, or coached pushing.To learn how to push with your body instead of against it, check out The Secret Sauce to Pushing. This is another sure path to severe tearing. To combat this instinct or coaching technique, we say “blow out the candle”. As your baby crowns, the sensations will build until they seem bigger than you. This is when we tell you to blow out short small breaths, as if you were blowing out a singular candle. This pause in pushing will allow more time for the blood flow to rush to the surface of your tissues which allows them to stretch more. The more blood flow, the more expandable.

How To Heal A Tear

While most tears will heal within four to six weeks, they still require care in order for them to heal well and bring about the least complications. Avoiding any further trauma to the area is most important. Instead of wiping with toilet paper as you usually would, try using a peri bottle to cleanse the area and gently pat dry. Sitz baths come highly recommended as they can increase blood flow to the area which in turn soothes the affected area and promotes a quicker healing process. As your tears heal they may become itchy and tender. Using something like dermoplast spray can relieve the itching and tenderness you encounter as you heal. Monitor the area for any signs of infection, such as a green or yellow discharge and/or a strong foul smell. If you begin to think you may have an infection, touch base with your provider right away.

Tears Happen

In closing, it’s important to understand that tearing naturally is sometimes part of physiological birth, but is by no means a given. Taking control of how you birth, where you birth, and who catches your baby are all factors that play into your likelihood of experiencing a tear during birth. It is perfectly possible and normal for first time mothers to make it through childbirth without anything more than a graze. Your body knows how to make space, it just asks for your steadfast cooperation and commitment.

This blog post was written by a former Tranquility by HeHe doula.

Consumer Complaints: Essential To New Wave Maternity Care

Wednesday, January 5, 2022

Consumer Complaints: Essential To New Wave Maternity Care

What Is A Consumer Complaint?

Certainly we’ve all received a long awaited package, torn it open out of excitement, and come face to face with disappointment. This product we purchased is not the product we were sold. When faced with this situation, a vast majority of us will go back onto the website we purchased the item from to leave a review explaining why the product does not live up to its advertised quality. We do this not only to let the company know we’re not happy with our service, but also to warn other consumers that this product isn’t worth their time, energy, and money. This is a normal part of life, right? An online consumer’s right of passage, if you will. What if I told you that you can do the same exact thing with Drs, Hospital Staff, and Nurses? What if I told you that doing so doesn’t just warn others that they shouldn’t waste their time and money? instead, it actually sends a clear warning that their body, baby, and well being are greatly at risk in the hands of the professionals in question. Perhaps your honesty could not only bring you closure, but also save lives.

So How Do I File A Consumer Complaint?

  1. 1. Write down your story as soon as possible— a stream of consciousness— if you can record it on video or voice recording is even better as it capture the true thoughts without the hindrance of having to write it down
    • ● Think about the scope of the complaint—was this an ongoing issue or a one time offense?
    • ● Was it an overall safety concern or one incident/person?
    • ● Is this a system issue or specific to your situation?
    • ● Provide them with feedback as to how they can improve to avoid this in the future. 
  1. 2. Research your hospitals process for reporting complaints. There is usually a “patient advocacy’ or ‘patient relations’ department that handles all complaints. Making sure your complaint gets into the right hands is crucial. If it lands in the wrong inbox, there will be no forward progress because they won’t be able to do anything about it. DO NOT FILE YET! 
  2. 3. Obtain your medical records and operative reports
  3. 4. Report to your states medical board, HERE.
  4. 5. File a report with the Joint Commission (manage patient safety concerns) HERE.
    • ● If you need to edit your complaint, do so HERE.
    • ● Their priority is patient safety so coercive care, abusive providers, and failure to gain consent is very important to them and will be investigated.
  1. 6. Visit My Patient Rights and file a complaint
  2. 7. If you are a POC and/or your provider is a person of color, visit and file a complaint.
  3. 8. If this was a OBGYN or midwife (reproductive health providers), report to The Birth Monopoly Map.
  4. 9. File with your state—where you file will vary state by state, but you can check with your states Department of Public Health.
  5. 10. Now file with your hospital directly.

Why Should I File A Complaint?

Whether you were deeply traumatized, dehumanized, spoken to unkindly, or touched without consent, these reports hold providers accountable for their transgressions. It is lack of accountability that has bought our way into a medical industrial complex run on trauma and dehumanization. So these reports, whether dismissed or investigated, hold intrinsic value that our attempts at reform desperately need. That’s the selfless side of it. Then there’s the other hand where filing these reports can give us clarity, closure, and help us make sense of our experience. Writing down your story is an intense process, but putting that pen down after it’s done is cathartic. It’s not just this experience that's memory is isolated to your mind, but a clear and concise retelling of what shouldn’t have happened to you, and what needs to change as a result. That feels GOOD. Your report could save lives. Your report could open the provider’s eyes enough to make them change something about their routine care. Your report could even affect change and reform within your hospital. No effort to affect change is too small.

The Nursing Code Of Ethics

While misconduct is overlooked on a near daily basis, nurses are ethically obligated to report colleagues and providers who are practicing bad medicine. You may have heard the term “Mandatory reporter” and thought of domestic abuse, child abuse, and sexual abuse, but in fact, nurses are also legally and ethically bound to report malpractice, obstetric abuse, etc.. If you know the names of the nurses that witnessed the actions you are reporting to the board, it may be wise to include their names in your complaint. Doing so raises the likelihood that they will be questioned if an investigation is opened on your behalf. While nurses may overlook these abuses on their labor and delivery ward, they are more likely to be transparent and forthcoming when sitting before their state medical board, especially under oath.

The Big Picture

Reporting a provider’s bad medicine, especially when it’s been practiced on your body, can be scary and emotional. As a person who has filed these reports twice, I understand how monstrous and consuming the mental aspect of this can be. I understand that sitting down at your kitchen table and typing out your trauma line by line can feel like you’ll come entirely undone. You won’t. At least, it won’t be entirely, and it won’t be forever. If you feel that the emotions that will arise could overpower you, there is no shame in asking a friend or partner to help lead you through the process or simply sit next to you as you do it. While many people approach reporting with the mentality that their words could protect others, I think there is just as much good to be said about reporting with the intention of raising your voice loudly enough to say “What this Dr/nurse did to my body and my baby was not, nor ever will be, acceptable. I am here to make that claim over and over until somebody truly hears me”. Just as filing these complaints can be scary, they can be empowering too! It takes bravery to hold a human with a medical license accountable for their actions. After the fear and emotions of writing out that report, comes the closure and courage you’ve gained by doing so. I wholeheartedly believe in that bravery of yours, and I wholeheartedly hope you don’t have to use it again for quite some time.

This blog post was written by a former Tranquility by HeHe doula.

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