America Needs More Black Providers

Wednesday, April 21, 2021

America Needs More Black Providers

Being Black in America is hard, but giving birth while Black in America is downright deadly. The United States of America is one of the richest countries on the planet and has one of the highest rates of maternal mortality..how does that happen? For a country that attracts talent from all over the world, there seems to be a disconnect in the intelligence and the results. Black birthing people in American are three to four times more likely to die due to a pregnancy-related complication than white birthers, and if you are in NYC—that increases your risk even more. 


What Needs to Change?

Well, that’s a 7 layer dip plus some, but a great place to start is increasing access to Black and brown doctors for Black and brown patients. This does not mean that Black and brown people should only be seen by Black and brown doctors, but that they have that as an option if they would like. Because, as it stands now, many Black and brown people in the US do not have that option, even if they wanted. Access to care has been a long standing problem in our country. There are a few new apps that are revolutionizing the way that patients can find care providers that are skilled in culturally competent and sensitive care. 

Black MD Cares - On their website, they state “ Eliminate healthcare disparities by connecting patients with physicians and other healthcare providers that will listen to their patients and care for them at the highest quality regardless of race and ethnicity.” They stated that providers are screened, but did not define what that screening process entailed. You can sign up for free here or download the app in the App Store! https://blackmdcares.com/providers 

Health in Her Hue App - As described on their website, they are “a digital platform connecting Black women to culturally competent healthcare providers, telehealth services, and health content.” Black and brown women have a higher mortality than that of any other race. In America, a large majority of this is due to systemic racism. You can read more about that here.  This app is on the forefront of combatting the lack of access to culturally competent providers! You can download the app in the App Store! 

HUED App - “Diversifying the patient-physician experience” is the first thing you see on their website and I dig it! It’s powerful and calming. You can search for providers by state, insurance coverage, specialty, and in-person/virtual. They are devoted to changing healthcare delivery for Black and Latino patients by 2025! You can read, “Access to (quality) healthcare remains a prevailing problem for people of color. In fact, African Americans and Latinos experience 30 to 40% poorer health outcomes than White Americans,” on their website making their mission very clear. This app is so needed and will change the landscape of care in America! 

Irth App - Their tagline is “Birth, but we dropped the b for bias.” This is a platform to find prenatal, birth, postpartum and pediatric care providers and reviews! This is key to decreasing the infant mortality rate in Black babies.  On their website, Irth shares that it is “The #1 “Yelp-like” platform for the pregnancy and new motherhood journey, made by and for people of color.“ This is a crucial step in helping decrease the disparities in the current birth culture. 

Ayana App - This app is geared toward connected people of color with mental health professionals of color and culturally competent care.  I just recently started counseling with Better Help and it has been life changing. It was so easy to sign up which I had seen them advertise about, but was skeptical at the actual simplicity of it all. But it’s true. It was literally as easy as ordering something online. I answered a series of questions and had a chance to write a brief intro/what I was looking for, if I wanted, which I happily obliged. You should know I am not new to the idea of therapy. I have gone to therapy several times in my life. I know very well the benefits of mental health support. The general anxiety of life is a lot, but the general anxiety of life in a Black or brown body is so much harder and the mental health care accessible should reflect that. 

How about the bigger picture? Longer term? 

Great question! There is a piece of legislation called The Black Maternal Health Momnibus Act of 2021 that will hopefully begin to close the gaps we currently see in healthcare. It won’t be the final fix we need, but its a wonderful place to begin rebuilding this very, very broken medical care system of ours. So what do you need to know about the Momnibus Act

Congresswoman Lauren Underwood (D-IL), Congresswoman Alma Adams (D-NC), Senator Cory Booker (D-NJ) have created a caucus to combat the harrowing stats facing our birthers of color. Lauren Underwood is a Registered Nurse and knows more than anyone how devastating it can be to birth while Black in the US. 

This Momnibus collects 9 original bills, adds 3 additional bills, and proposes 12 accumulative ways that congressional leadership can help protect pregnant women and new moms, specifically people of color. It also promotes continuous coverage for 12-months postpartum by medicaid. 


Here are the things they are committing to: 
  • - Make critical investments in social determinants of health that influence maternal health outcomes, like housing, transportation, and nutrition. 
  • - Provide funding to community-based organizations that are working to improve maternal health outcomes and promote equity. 
  • - Comprehensively study the unique maternal health risks facing pregnant and postpartum veterans and support VA maternity care coordination programs. 
  • - Grow and diversify the perinatal workforce to ensure that every mom in America receives culturally congruent maternity care and support. 
  • - Improve data collection processes and quality measures to better understand the causes of the maternal health crisis in the United States and inform solutions to address it. 
  • - Support moms with maternal mental health conditions and substance use disorders. 
  • - Improve maternal health care and support for incarcerated moms. 
  • - Invest in digital tools like telehealth to improve maternal health outcomes in underserved areas. 
  • - Promote innovative payment models to incentivize high-quality maternity care and non-clinical perinatal support. 
  • - Invest in federal programs to address the unique risks for and effects of COVID-19 during and after pregnancy and to advance respectful maternity care in future public health emergencies. 
  • - Invest in community-based initiatives to reduce levels of and exposure to climate change-related risks for moms and babies. 
  • - Promote maternal vaccinations to protect the health and safety of moms and babies. 

Ready to take action? 

The Momnibus Act website has a few actionable steps you can take to get involved and help push this forward! 

You can: 
  • Reach out to your Members of Congress in the House of Representatives and the Senate to voice your support for this piece of legislation. Ask them support it and inquire about their plans to help close the disparities currently crippling women’s health. You can look up your Representative in the in the U.S. House of Representatives here and you can find information about your Senators here
  • Share posts like this on social media! Help your friends and family know what’s goings on in our healthcare. Momnibus provides a few templates for you, you can find those here
  • Connect with community-based organizations who are making local change and donate to organizations that are leading the fight nationally. You can find the organizations that we support here
  • Follow Black Maternal Health Caucus on social media to stay up to date on the latest news surrounding The Momnibus Act of 2021.

An Inside look at Obstetrical Violence

Wednesday, March 31, 2021

An Inside look at Obstetrical Violence

(Derived from a podcast conversation with Tranquility By HeHe team members HeHe Stewart and Caitlin LeBeau in Episode 136 of The Birth Lounge Podcast, find it here!)

Have you ever heard the term “obstetrical violence” and wondered what it meant? Or maybe you envisioned this blatant act of disrespect or an assault of sorts. These are both examples of obstetrical violence, but there is another side to it, too. A sneaky side. We're going to share a few instances of medical manipulation in the birth room. Not always aggressive, not violent. And that is a tactic- they are trying to get you to do what they want. Which is so hard to say because we are conditioned to trust our doctors, we want to trust our doctors.

This isn’t about batting heads- this is about questioning, looking into research/evidence, looking into policies so you know if they are being influenced/pressured. Have that open communication if you can. You can say, 'That's not, evidence-based, I'm really only interested in evidence-based research and policy. If the hospital policy prevents you from giving me like the most current stuff, I would just appreciate you giving me that heads up. I understand you can't suggest that, but I would love if you would just let me know the last year that the policies of the hospital have been revisited.'

This should feel like a two sided convo. You can push back a little. they should be able to give you answers- and if they don’t you need to do that research on your own before game time.

Bait and Switch

But a bait and switch- which basically means, you earned my trust and then you tricked me. So heartbreaking because during the pregnancy, they were amazing. This one that we last had where the mom was overdue and went into an appointment and they basically had told her, 'You know, we're going to have to do an induction because your baby has passed 40 weeks and 2 days'. Which we know average first time mothers deliver most typically between 40-41 weeks.

So they went home, they did the research. They decided to try a natural induction method instead over the weekend first. After the weekend, they gave their doctor provider a call and the doctor said, 'Oh, we don't have any beds until Tuesday in the evening.'

What is that? If I NEEDED an induction four days ago and now I'm comfortable coming in for a medical induction, but your pushing it a day and plus? How does that make sense? I just can't handle being told that you need to have your baby without having gotten out of that window of where we know a first time baby is likely to be born around 40 plus 5. And then you have providers calling it a late baby or an overdue baby. And that is instilling fear in these parents, especially when you're at the end of pregnancy.

'This is a long labor...'

We had a birth recently that was going well at about 16 hours- we had just hit the mark where her provider said the baby could 'come at anytime'. Then shift change at the hospital happened. The nurse we we working with literally said to us, 'Be careful with the doctor coming on call.' How horrifying that a nurse felt compelled to warn us about the doctor that was coming into our space.

The doctor on-call comes in, says, 'Let's get you prep for a C-section.' This was the first time we were seeing the doctors face. They hadn't introduced themselves. Also, and most importantly, this is the first time we're hearing these words. You haven't even checked in with us on what is happening, what our birth goals are, how long, how long we've been in labor. It had been 16 hours. What happened? The fear that that doctor brought in the room and then said, 'Your labor is so long. I don't think this is going to happen for you, kiddo.' I feel nauseous thinking about those words. That is so rude and disrespectful.

16 hours is a long time, but is it a long time in birth? Not really, not at all. It's not even the average amount of time for a first time mother. But then you have a doctor coming in a doctor who sees this every day say, 'This labor has really taken a long time'. And birthing people start to question themselves.

If there isn’t an immediate emergency, you should be able to think things through. Catch that manipulation when it's happening and push back on it. Ask the questions that you should. Your doctors aren't always going to tell you everything unless you ask. It's all in your approach of how you say this. Don't try and catch them tripping up in a lie, simply say something like, Oh, I was thinking X, Y, and Z, because the research I had seen showed X, Y, and Z' or 'I was actually wondering if X, Y, and Z would be an option. I know you didn't mention it. But I was wondering if we could explore that or I have some questions if I might be able to use that or not'. Your approach is not you against them. That's not what this is meant to suggest.


But what can you do?

Your job is to take this preparation, evidence based knowledge, this idea of shared decision making and put it in your toolbox. Make sure it feels aligned with you. Make sure that it's evidence-based and then go for it. Take the time and come up with a couple of questions that you have. Even one question can spiral into a conversation or your doctor giving you more information. This information could shape the path of your birth.

You can go in being the calmest person ever to the hospital, and then you go in and you hear these medical providers talking nonsense around you, or just hyping you up in the wrong ways. You just completely forget about what was happening 10 seconds before that. You're just focused on what your nurses and doctors are doing or saying. Even them using bad language around you and not being mindful of the words they are using. It doesn't have to be intentional. Just be aware of this when you go into the hospital. It can be startling and alarming. 

You can also use this as an opportunity to remind your medical team to take conversations outside or to ask them not to have conversations over/around you. Sometimes all your doctors or nurses need is a reminder that they are negatively impacting the birthing persons space with their words. You can also ask for a new nurse or doctor when you feel like they are negatively impacting your birth.

If a doctor does comes barging in and says, 'Let's go, you know, time for a c-section'. You can say, 'We haven't decided right now if we want a C-section. We would actually like a few minutes'. And you know, if it's an emergency, they will be very upfront with you and let you know that there isn't a few minutes to spare. It's rarely an emergency C-section, but we don't have a word for non-emergency sections. We have scheduled C-sections and then we have emergency C-sections. We don't have any sort of like unplanned terminology. This was just unplanned. We gave it a try and it didn't work.

Birth as a Business

So if we want to look at this as a business, birth is a business. If you haven't seen that documentary, you1000% should. It is called 'The Business of Being Born'. It's will open your eyes to how much birthing people can be cash cows for hospitals. We can go from bringing in like a little bit of income to like being a major source of income depending on choices and pressures put on birthing people.

And you have to think for the typical hospital labor you're looking at less than $10,000. For a C-section, you're looking at $30,000 to $55,000. That's how we go from being a small stream of income to a main source of income for a hospital.

I don't want you to feel fearful of this. I want you to do your own research. There are things that are good for you to know. There are a ton of things that you can read, listen to, or watch to educate yourself on the business side of birth, which is important to know as a consumer, because it actually does impact you. It impacts their bottom line, but it impacts you your body and your life after this. It's not meant to be scary. It actually gives you a lot of power if you'll dive into it in the correct way.


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!

Food First Nutrition with Ryan Kipping

Wednesday, March 24, 2021

Food First Nutrition with Ryan Kipping


Today Ryann Kipping, a Registered Dietitian Nutritionist, Certified Lactation Educator, and Author of The Feel-Good Pregnancy Cookbook is here to break down how to get the majority of your crucial vitamins and minerals from food first! So many foods can be solutions to problems that pop up in pregnancy--constipation, nausea, heartburn. Ryann is sharing how to find the perfect prenatal, how to spot 3rd party testing, and how to identify trustworthy brands!

Diet culture is crazy right now. It's hard enough to eat when you aren't pregnant to figure out what to eat when you aren't pregnant. Then when you throw a pregnancy in the mix there's like so much confusion. There's so many do's and don'ts floating around. One source says something and another source says something completely different. That is why I'm here- to clear that confusion and make you feel confident. Not only that, but just so you have informed decisions, because like I always say, I'm not trying to steer you one way or the other. I'm just trying to give you the science and give you the information. So you can make the best choice for you and your pregnancy, because with all these diets floating around out there, ultimately nutrition should be individualized. You shouldn't be following the exact same diet as your neighbor, right? We are all so unique and we all have different health backgrounds and nutrition concerns.

So at the end of the day, it's definitely going to be individualized to you. With that being said, of course, during pregnancy, there are nutrients that are super important and things we do want to focus on. So to start us off, I think that one nutrient that most people immediately think of when they think of pregnancy is folate or folic acid, which are commonly used interchangeably. We're talking about the same nutrient. They're just different forms of that nutrient.

Folate vs. Folic Acid

So folate is the kind that's naturally found in food and folic acid is the synthetic form. So folic acid is generally the more common type found in supplements. It's also the kind that food is fortified with. So whenever you see these like flour/grain based products that are fortified - it is with folic acid. So that means it wasn't naturally there. They companies and organizations actually took folic acid and put it in that food.

I like to give a little background here, because the reason they did that was that there was a lot of neural babies being born with neural tube defects. Folate is the nutrient that helps close the neural tube. So it's super important for baby's brain and spinal cord development. So they companies decided to fortify the foods that people eat the most with folic acid and we'll fix this issue- and they did. So we saw a major decline in neural tube defects, which was great. But to me, I'm thinking, is it smart to be promoting the increased intake of processed refined grains essentially? And I'm not saying we can not eat those things. Just to pull back a little bit. I'm not saying we can't include those. We just want to include them within moderation. So all that being said, my focus and my recommendation is to put the majority of our focus on natural sources of foliage.

So that's the folate that's naturally there in dark leafy, green vegetables, avocados, asparagus, citrus, fruits, nuts, seeds, eggs. There's a lot of ways you can get natural folate. So that's the kind I say, we spend the majority of our time focusing on and that's also the kind we should look for in supplements too. We want to pick a supplement that has folate versus folic acid because that's what the body prefers and it's absorbed better in the body.

Choline

So another nutrient we want to talk about is choline. Choline has been compared to folate and it's important, although it is a new, relatively new nutrient in the science world. So not many people talk about it and not many providers even know that it's so important. They haven't seen the research out there, especially, doctors that went to school in like the sixties before it was like even discovered, right?

So choline has been compared in pregnancy to folate. It's important in brain and spinal cord development. It's mostly found in eggs, specifically in the yolks. So I always like to say, make sure you eat the yolk whenever you're eating eggs, because a majority of the nutrients are in the yolk.

Iron

Iron is obviously super important too. I think iron is the second nutrient people think of when we think of what nutrients are important for pregnancy, because your risk of iron deficiency is extremely likely because your blood volume is continuing to increase as you get bigger and bigger. As baby grows bigger and bigger- iron is super important for overall development of baby. Also, just for you to have energy, because pregnancy is so hard and you experience fatigue a lot in the first trimester. And I mean, throughout the whole pregnancy, but iron is a nutrient that's super important to make sure you're maintaining your energy levels. Super important, if you are feeling super fatigued to get your iron levels tested. Cause that's definitely a red flag.

Testing is so important because not everyone needs iron supplements, sometimes providers will just put blanket recommendation out there. They'll just like list off nutrients. When in reality it should be individualized to you. And if you don't need to supplement with iron, you shouldn't. It can cause stomach issues and constipation and things like that. So if you don't need to supplement with iron, if your levels are looking good, then we don't need to put you through that. So test, if you can. If your iron levels are looking good then I would honestly recommend finding a prenatal without iron because for lot of people, it does cause constipation and things like that.

There's different forms of iron, too. So if you are someone who does need iron try different forms of iron. Try food first, I'm totally a food first dietician. So the best way to increase your iron levels is by through food. So definitely work on increasing high iron foods. There's heme iron and there's non-heme iron. Heme iron is the kind that's better absorbed by our bodies and that's the kind that's found in animal products. So that's kind of where we want to put our majority focus is getting iron from animal products. Ideally from red meat, chicken, those kinds of things. You can include plant sources too, those aren't going to be like the best to increase your levels. Spinach is one of the best sources of iron from plants. Pumpkin seeds are great too. My final tip is to pair them with some source of vitamin C, especially with the non-heme sources because vitamin C will enhance iron absorption.

How much should we be eating to know we're getting enough from food?

So I say food first because ideally we want to strive to meet our nutrient needs through food. Then use supplements as an insurance policy that we're getting everything that we need. So a prenatal vitamin is not going to provide everything you need. It just doesn't. And it won't. So you have to think about your food. There are certain times in life that I think it's necessary to supplement and pregnancy is one of those times because your needs are heightened.?Your needs are higher for nutrients than they will likely ever be in your life during pregnancy and breastfeeding. Your needs are so high, so it can be challenging to meet those nutrient needs, especially if you're like a smaller person and you don't eat that many calories.

So if you are eating around 1600 calories, you won't be able to meet your nutrient needs because you're just simply not eating enough food. So in that case you definitely need to be taking a well-rounded prenatal vitamin. I have worked with people that don't want to take anything that they don't want to supplement with anything. I say maybe we can just take a few like individual nutrients to make sure you're good to go, but yeah, if you don't want to supplement- you're going to have to be really on top of your planning.

You're just going to have to be able to run through the nutrients in your head and look at your days and plan them out. You can't just like wing it and go by the fly. I think we should all do a little bit of planning, even if we are taking a prenatal vitamin, but pregnancy is hard too, right? There's so many ups and downs. There's morning sickness, heartburn, fatigue. There's so many things that you're going to go through that make it challenging to stay on top of your nutrition. We just want to make sure we're doing the best we can.

How Do we Know What Prenatal to Pick?

So I always say, I wish that people spent the amount of time and money on their nutrition and food and planning versus the time they spend on finding supplements and spending money on supplements, because truly the food you eat is way more important.

So just to preface it with that, however, we do want to find a supplement that is quality and that is going to work. The number one thing to look for is if the brand is third-party tested. So essentially that means they've paid a third party to take their supplement, run it through tests, to make sure that it is free of certain harmful things. That what they're saying is in there, if they're saying so much of a certain vitamin in there, that that is actually true.

It's pretty apparent if this is something that they have done. They usually have stickers that will say, 'third-party tested' on the bottle. If you're doing online research, usually it's clear on their website. That's definitely a good way to know if they're a quality supplement brand.

You definitely want to do your due diligence. People are always asking, which one do you recommend? Which one do you recommend? And I never bulk recommend one, because that really doesn't make any sense. It should be individualized. There's so many factors that come into play, but of course always third-party testing.

Nausea and Prenatals

If you think it's your prenatal vitamin that's causing the nausea, I would definitely say changing your prenatal vitamin and trying another. You can also try taking it with food, because that can absolutely help. There are also gummy or powdered versions of prenatal vitamins. If you have one that's a large pill, you can absolutely cut it and break it up to see if that helps too.

So there's just a lot of options when it comes to that. Again, considering what is in your prenatal- iron could be causing some nausea too. So do you need iron? We can look at that. And then nutrients that specifically help with nausea. Magnesium and vitamin B6 can definitely help. I'm going to bring up the point that we do want to try food first. We want to try more natural options. So we want to try increasing our food intake of high magnesium foods, high B6 foods. We want to try ginger, ginger tea or anything like that smells like lemon, eucalyptus, or lavender. If none of those things are working, we can talk about supplements. Your doctor might also want to talk about medications like Zofran and things like that for nausea.

There are so many options out there to help you manage morning sickness and nausea. So try everything. And you never know what might work. A lot of times too, women will say the only thing they can tolerate is carbs. You want to be able to eat something. Some calories is better than nothing at all. But I usually say is try to follow them up after with some source of protein. So, if you can eat a piece of plain toast and then maybe 30 minutes later, have some nuts, a piece of chicken, or have a piece of cheese. Something that has protein and fats in it. So you're getting some other nutrients that will be better to manage your blood sugar, all of those types of things.

Constipation in Pregnancy

As far as constipation goes, the two things we want to focus on are fiber and fluid. So increasing fiber foods, like cooked vegetables. Vegetables in general, but cooked is usually more advantageous because women often experience bloating and gas in pregnancy. So cooking vegetables can help with that. Fruits and vegetables are really high in fiber. Apples, brussel sprouts, lentils, chia seeds. Chia seeds are unique in that they can actually help with diarrhea and with constipation. You do want to make sure anytime you're increasing your fiber, you also increase fluids because it could make you more constipated.

What about Heartburn in Pregnancy?

One of the best things I say is walking after a meal, I know that's not super food related, but walking gets your digestion going. So the worst thing you can do after a meal is lie down. So don't lay down on the couch after a meal, because you're only like helping gravity pull that acid back up your esophagus. So at the least you want to sit up straight on the couch and work on your posture to make sure digestion is moving. But best case scenario, you go for like a 10 to 20 minute walk after you eat.

So you can eat small frequent meals throughout the day can really help your body is having a hard time, digesting it all. Trigger foods is another and super important tip. A lot of people have that one or two food, food groups, or specific foods that will trigger it. A lot of times it's tomatoes because they're super acidic. So it's important to find what your trigger food is. Sometimes dairy will help, but some people say that dairy makes their heartburn worse. So again, it's individualized and you just kind of have to figure out what helps your heartburn and what are your triggers. That way you can avoid that food or minimize it.

Healthy Fats

Fats are super important and fats do not correlate to the fat on your body. So I think that that's definitely something we want to bust as a myth. Your baby's brain is like 60% fat and it's being made from scratch. So you definitely need healthy fats. And then to that point as well, your need for fat soluble vitamins increases during pregnancy. So you have to eat fat for your body to absorb those vitamins. So it's super important that you have healthy fats in your diet.

So very specifically in oils like cooking oils, we want to do our best to avoid processed vegetable oils. Instead use like avocado oil, extra virgin olive oil, real butter, coconut oil is fine. Also nuts and seeds, avocados, olives, the fats that are naturally found in meats, fatty types of fish. Definitely lots of healthy fat options. We also don't need to limit our fat in dairy. I actually recommend full fat dairy during pregnancy.

If you're lactose intolerant and you can't eat dairy at all, that's okay. Dairy is a huge source of calcium, but there's plenty other foods that have calcium. You just have to kind of be a little more cognizant of like where your calcium is coming from.

Most milk alternatives can all generally fit in your prenatal diet. You just want to be aware of what nutrients you're missing and where you're getting those nutrients. Because most of those milks don't have protein like cow's milk does. So those aren't going to be a source of protein for you. They aren't going to be a source of B vitamins like cows milk is they aren't going to be a source of B12. So if you are choosing like a plant-based milk, we do want to try to pick one that is fortified with some nutrients. Dairy can be a source of vitamin D one of the only sources of vitamin D, because vitamin D is so hard to get from food. So that's another nutrient to think about. Dairy as a major source of iodine. So there are definitely nutrients you want to kind of think about if you are not including dairy in your diet at all.

Looking for more? You can find Ryan at https://www.theprenatalnutritionist.com/.  She has also created The Prenatal Nutrition Library, which gives you clear answers to guide you through a healthy, feel-good pregnancy using food first.  She has also shared her Recommended Grocery List! You definitely want to check out Ryann's resources if you are trying to conceive, pregnant, or even postpartum as you try to balance your nutritional needs! 

The Beginning of Home Birth with Kaitlyn Fusco

Wednesday, March 17, 2021

The Beginning of Home Birth with Kaitlyn Fusco


Today, we are chatting with Katelyn Fusco, Host of Happy Home Birth Podcast. We are covering home birth and how birth has transformed over the years. Katelyn is sharing who is right for home birth and the top home birth myths. We are also diving into stickier topics like the business side of birth and how legislation can impact women’s health. We shine a spotlight on consent and continuity of care as well. I'll hand it over now for Katelyn's thoughts!

We are so ingrained now, especially in the United States, to think that birth is a medical event that just has to take place in the hospital. I mean, that's just in our minds. I know growing up, that's how it was for me. My mom had all three of her children as C-sections. So when I was growing up, I thought, 'Okay, well, I'll have C-sections for my babies. Birth is surgery the end'. I don't think I'm alone in that whether, you know, you were born from a cesarean section or however you got here, it's very likely that you grew up thinking that birth was a medical event. It's kind of crazy because we haven't even had hospitals for that long. So the fact that birth has transitioned from something that was just a it's kind of like the extraordinary normal, you know, like birth is extraordinary, but it is normal. It's transitioned from that to something that we have to have like flashing lights and warning signs.

Let's go ahead and start back. I mean, biblically look in Genesis, midwives are mentioned in Genesis. Like this is from the very beginning we have been giving birth and women have been supporting other women in birth. So this is not new. Midwifery is not some new age woo-woo thing. This is literally from the beginning. So I love to start there. I also like to talk about the fact that when in the past we were giving birth, it was not so isolated. So now, even if you have a doula, even if you have your partner with you, you are going into a hospital typically where you're giving birth. And it is a teeny, teeny, tiny little group, maybe, maybe a threesome. You, your partner, your doula- it's a small group that we're giving birth with. Back before the hospital and before this became the norm birth was a community event. We were growing up seeing women give birth hundreds of times before we gave birth. Seeing, 'Oh, wow, this, this works. Of course, this is what we do'. Moms, sisters, aunts- were at the birth together- we were all there and we were all supporting the person giving birth. So birth wasn't this crazy shocking thing and we knew our bodies were made to do this. We knew that we were created, we were designed to be able to give birth.

That doesn't mean that every single time it goes perfectly, of course birth is wild. It is a wild event, but it is something that is not supposed to be just deeply in our bones that we're fearful of. I think that that is the biggest issue is there's just become this shift, especially in the United States. If you compare our maternity system to other places, you know, it is so different. Home birth is, is highly more common in other countries. The way that The American Medical Association formed, it was a business. One of the things that they did was instead of working with midwives, it was, 'These people are not educated. We are educated'. So they realized that they could trash these midwives who had decades and centuries of knowledge passed down one to the other one to the other, you know, these amazing established communities. There were smear campaigns and they talk about this in the 'Business of Being Born', which is a great documentary. I actually spoke to a midwife, my friend Janell, about this and about how there were actually transcripts in Varney's midwifery book from the AMA where they were talking about how they were going to convince the public, that midwives were not quality even though they knew and acknowledged that their outcomes were worse than those of midwife attended births.

How did we get from a primarily home birth to hospital?

It started off where doctors had become prevalent as a career, but birth was left untouched there for a minute because that was, that was woman's work. Then they realized, 'Wait, hold on a second- we could make money out of this'. So that is what happened. It did start at home. Doctors did begin attending births at home, but the shift to the hospital was massive. It revolutionized everything, because it turned into, 'Why would you have your baby in your home? It's dirty, it's unclean. It's unsterile.' It began like, 'Oh, I'm going to be fancy. I'm going to go to the hospital to have my baby.' Then it filtered down throughout society and became the norm. like, Oh, well, you go to the hospital.

It was not like the hospital today, like women were going into the hospital, but their partners were not with them. They were going into these back rooms. We don't know what happened. The partner has no idea what's going on. They would use like sheepskin wraps around their arms so that when they were held down with all of these drugs, they wouldn't leave marks. The drugs that they were giving them actually didn't help with pain management at all. It was knocking them out. They're basically in and out of consciousness this entire time. Do you think it's easy to have a baby that way? It is not my friend. It's just disturbing to think how behind the times they were with their practices, as opposed to what was going on in the community beforehand, when using midwives, you know? The hospital was seen as the safe option, but in reality, if you looked at what was going on it was the last place you would want to be.

Understanding Your Home Birth Options

So many people have no idea that home birth is an option. Hw can you have informed consent when you don't know all of the options? When it comes to home birth, it's not talked about a lot. 1% of the population gives birth at home right now in the United States. 1% that's, that's teeny. But my thought, and the reason that I created the Happy Home Birth Podcast is it would be a lot higher if people knew that it was an option and that it was safe.

That's where we need to be going. No home birth is not for everybody. Home birth is for low risk mothers. The majority of people do fall into that category over 90%. So 90% of people would be safe to have a home birth. That doesn't mean that they would be comfortable. That doesn't mean that I'm saying, well, you, if you're low risk, you just should, but that the safety factor is there. The great news is that midwives, you know, if, if you're choosing to use a midwife, they are trained in low-risk birth. There they are so competent at assessing what is and is not low risk. If you ever crossed that threshold of safety they will go ahead and transfer your care over. This would be the appropriate time to transfer care.

Also, it's important to note that though, there are different types of midwives and they do practice in different ways. Typically there is an overseeing type of provider that will also be able to check off and say like, 'Yes, you are low risk. You are qualified for a home birth.'

But your house is so...germy.

As the research with the micro-biome has just taken off in the last few years. We are realizing that theory of all germs being bad and scary and dangerous, it's just not accurate. The other neat thing that's going on with the micro-biome is that we're learning a lot of people have always assumed the placenta, the amniotic sac is sterile, but it is not. We are finding there is bacteria already there. So when the baby's not in this sterile vacuum, they're already being exposed to your microbes, to the microorganisms inside of your body. So they are already attuned to the environment. So it's kind of cool to think about the fact that, 'Okay, we are giving birth in the place that we created the baby- the place that we have grown and nurtured this life- we're giving birth to that new life in this atmosphere.' Is that not actually the safest place t be? We're not exposing them to something new, we're exposing them to the friendly things that they've already grown accustomed to.

Let's talk about the business of being born. What do pregnant people need to know to be informed?

The first thing I think is the most surface and the easiest for us to wrap our minds around. So 99% of people are giving birth in the hospital? A large percentage. It's busy, OBGYNs are busy. So the first issue is that the way that this system has been created. You go in for your prenatal care and the majority of your appointment is not with your doctor. The majority of your appointment is sitting in the waiting room. Is there a lot of education going on between you and your provider? Not often.

The other question is, is how often are you seeing the same person? How often are we having continuity of care? We don't know who the heck is going to show up when we're having our baby. So there's overcrowding of practices. There are so many patients coming in. There are so many doctors to take care of all of those patients. And of course they want to grow a business. They want to be able to add more doctors to generate more money. So these practices are getting larger, larger, larger.

There's no time for connection. It's not even that it's this evil situation or intentionally evil. It's that it's just a busy place. So we're going to get in, we're going to do what we got to do and we're going to get out.

The second issue that we could discuss is the fact that these obstetricians are well-versed in surgery, right? That's what they went to school for. However, do we need to be looking for pathology in every single birth? No, we don't because like I said, 90% of us are low risk. And then of those 10%, how many actually need a c-section? It's a very small percentage of the 10%. Which is not what we're seeing across the country.

We're putting these people who are trained to see pathology and who are trained in surgery in a situation where they're not really needed. It doesn't make sense that their job is to care for all pregnancies. And, if you look at other places, that's not how they divvy up the responsibilities. Midwives are taking care of the majority of low risk clients.

We've got another situation to consider: How are we looking at birth? Are we looking at it as a normal event? Or are we looking at it as a pathology?

When it comes to laws, most doctors, have a three year period where somebody could sue them. When it comes to OBGYNs it's 21 years. because they can look back and say, 'Oh, well, they're having this issue that's related back to birth.' So obstetricians are legally in a tough place. They can get in a lot of trouble. And so it's a lot of money to cover them insurance wise. They really want to prove that they did every single thing that they could do to get that baby out safely. So if there is even the slightest of like, 'Oh, well the heart rate went down for just a dip- take her to surgery.' Let's do, do, do to prove that we did everything, everything that we could to make sure that this baby came out safely the end. What that leads to, is it way more intervention than is actually necessary.

We add these three pieces up and it's kind of scary if we're not super confident in our care provider. If we don't feel that we are completely aligned with them and that they totally understand where we are and see our pregnancy as an individual and unique pregnancy.

I think that it's so easy for us to say, 'Oh yeah, OBs are the worst. Doctors are just awful.' And that's of course that's not true. It's just like any other profession, we've got great ones. We've got ones that are in it for the right reasons. And then we've got trash. Some humans just don't care as much. That's the reality. It's important for us to remember that. These people, these people are people and they are doing their best even if it is misguided.

The other issue that I didn't touch on is the fact that the information that they are working on is outdated. It takes so long for information to be trickled down to practice. So ACOG might come out with a statement about episiotomies. It'll take 25 years for a episiotomies to not be done. It takes that long for things to go down into practice. These doctors are so busy. They went to medical school 25 years ago. They learned the stuff in medical school. And now they're in the trenches. Their head is down. They're working on these massive patient loads. They're in the hospital, they're in their clinic. It's busy. Do they have time to sit down and read like the evidence based birth website all the time? No. So we are there, they're practicing on with, with standards that are just outdated.

That's one of the most frustrating parts to me. If you are going to be dealing with people's lives and the lives of their babies, you just have to care, there's no other way around it. You're going to have to find the time you said you would. You promised. You took an oath to take care of people- to give them the best care. And that's truly how I feel. I hold myself, my doulas and, my team to that same standard. We're not medical professionals. And I get that. They are 1000% busier than we are, but you promised as an OB to take care of people and you've got to do that. It's one of the priorities.

We are consumers of this broken system. We have to start saying, 'Listen, I'm not going to accept this.' That's a lot easier said than done, but I will give a great recommendation- 'Shared Decision Making: Bring Birth Back Into The Hands Of Mothers' by Dr. Brad Bootstaylor. He talks about the fact that you've got to hold your care provider accountable. To be upfront about the the things that you are looking for in your care provider. So you can see if you are an ideal fit. Now, the important thing for us to remember is, like I said, a lot of these practices have how many providers? We need to make sure that all of these providers are fitting. If they're not, then we're saying, 'Okay, I'm going to go look for someone else who closely aligns with me.'

A lot of times I think that we just go with what's easiest. We need to be very serious about this. This is the birth of our child and this is our birth into motherhood. This is a day that will be remembered forever. So we need to have the right people supporting us. We need to be asking them questions on all of the things that are important to us and make sure we're getting the straight answers.

And then of course, from, from my perspective, we need to be considering other care providers. We need to be considering care providers who are trained in physiological childbirth like midwives. They're trained in the fact that birth is an, a beautiful ordinary, extraordinary event.

So really considering if a midwife is an option for you. When you go to see your OB, how often, like how long do you talk to your OB? When you go to see a midwife, I'm just letting you know, your appointments are usually 30 minutes to an hour and only a brief period of that time. It is so holistically focused on you and the baby and all of this hands on care and attention during the prenatal period so that they can be hands off during the birth. The more positive birthing experiences that we have and that we share with others and tell them of their experiences, the more people are going to feel empowered to do the exact same thing. And that's how a revolution has started.

How do you know if you're right for home birth and then also, how do you go about finding a midwife?

We do know that 90% of moms are low risk. So if you do not have anything that's labeled high risk, you are more than likely a great candidate for home birth. As for hiring a midwife, I would recommend going to https://mana.org/.You can get a breakdown of your state and what the regulations are, what is, and is not considered legal from a care provider standpoint. Then you can start to search for your midwife.

BOOKS MENTIONED:

Dr. Brad Bootstaylor —book: Shared Decision Making


PODCAST MENTIONED:


Ep 59: "But What if Something Goes Wrong?"- How Midwives Handle Emergencies at Hom‪e‬




When Checking in Hinders the Process

Wednesday, March 10, 2021

When Checking in Hinders the Process

Today I'm going to be talking about when checking in, actually hinders the process. Now specifically, I'll be talking about birth today, but I think you're going to find this makes sense in other places of your life too. So specifically when, when hindering the birth process, I want you to think about physiological, from a natural standpoint, from an undisturbed undisrupted standpoint. So if we were to allow your body and your baby to do its own thing.

Cervical Checks

So the first place that I often see checking in disrupting our natural processes is that vaginal checks in the later part of pregnancy. So it used to be routine. And I mean, it still is routine in a lot of places to do vaginal checks starting at 37 weeks. However, the science is actually pretty clear that there's no benefit to having cervical exams before 40 or 41 weeks. Now this all goes back to your due date, right? And we know that first time babies are more likely going to be born between 40 weeks 5 days and 41 weeks and 2 days. I think the stats are something crazy like 80 or 90% of first-time babies are born in this time. That entire chunk of time is AFTER your estimated due date.

Why is that important? There actually are a few risks for vaginal checks in later pregnancy. Many providers will pose these vaginal checks to patients as if they are mandatory. And that's just simply not true and they're not evidence-based. Obviously every single time you go in there, you are going increase your risk of infection. So every time we do a vaginal check, both in pregnancy and during labor, we are introducing bacteria and there's a risk of infection. It also increases your risk of rupture in your membranes early. Now this particular study showed 6% of pregnancies had premature rupture of membranes, which simply means that your membranes rupture before your contractions begin. So with no check 6%, but with checks with weekly checks, starting at 37 weeks, you'll eat, it was a threefold increase up to 18%. It tripled your risk of having premature rupture of membranes. Crazy.

This is especially important for birthing people who tested positive for GBS, because the minute that your membranes rupture, you will need to head to the hospital to have IV antibiotics administered for the GBS.

So if your doctor is saying things like 'We want to know', 'we need to know where your baby is', or 'I wouldn't want your baby to come early and us not know it' - then they are either really misinformed and not practicing evidence-based medicine, or they're using this as a scare tactic. Honestly, neither one is okay. So we, we have to be limit the vaginal checks at the end, because there are no benefits, but there are actual risks. Now, one thing I do want to mention is that if you're curious and that's impacting you negatively as in you have anxiety, because you don't know, and you would be less anxious if you knew that is a valid reason to get a cervical exam. However, if we're doing it out of curiosity and it's just a check in, typically that's not a good reason to do that only because of the risk you are taking on. But that is a personal choice. You will be able to weigh what matters to you- what risks are worth it and what benefits are worth it. Right.

Electronic Fetal Monitoring

Number two is somewhere along the same lines- electronic fetal monitoring. I want to go into the different types because there are types that don't hinder the process and that is what you could be requesting. So the first thing we need to understand is there are two types of fetal monitoring.

We have electronic fetal monitoring which involved computer monitoring where you're hooked up with cords. There are two types of electronic monitoring. We have continuous monitoring and this is going to have you hooked up to computers and monitors and wires. Here you'll be limited in your mobility limited in your ability of what you can and can't do under continuous monitoring. You also have the wireless mobile option. You'll be able to move about the room freely and some of the mobile options are even water resistant. Not all mobile options are water resistant, so this is a great question for your provider about your birth hospital.

Also under electronic, you have intermittent fetal monitoring. Where you hook up to the monitors every so often - maybe once an hour, once every two hours, whatever feels good to you and your provider. Great question again for a prenatal visit with your provider.

Now, all hospitals should also have Dopplers available, but that doesn't always mean that your provider is going to be trained in it. Dopplers have incredible benefits. So never hesitate to ask, to get someone in there that can use a Doppler if you have a strong preference. Dopplers are more comfortable to you. It really allows you for more personal space. You can be in the water. It allows you to labor in and all sorts of positions. Everyone in the room can still hear the baby's heart rate too.

The second type of monitoring is hands on monitoring. We also have hands-on monitoring options. This can be done by a Doppler, which is going to be a little battery pack with a monitor on the end of it. It's going to be wireless and allow you to stay mobile. You do also have a fetal stethoscope which can be used to monitor the baby as needed.

Electronic Fetal Monitoring was brought into labor rooms in the 1970s, despite the fact that there was no research or evidence to show that it was safe or effective. So why did we do it? Well, we did it because we thought we could save more lives. However, what studies have actually shown is that it increases your risk of a C-section without providing the benefits that we first thought it would. We thought we would see lower infant mortality, but those are actually on the rise. We thought we would see better APGAR scores, but we haven't seen better scores there either.

Hands on listening is evidence-based and produces better outcomes for birthing people and babies. So again, I want to bring up that any provider that cannot provide you with hands-on listening at your request, it's worth requesting a different provider if you have a preference. It has the potential to change the outcome of your labor. It's important for you as the consumer to understand that there are some things that your provider is not going to be able to offer you without you suggesting or asking for it. This is going to be one of those things.

We need to understand that a lot of hospital policies do suggest and require that their providers suggest to you continuous fetal monitoring. So you're going to have to request alternative options. You do have some science on your side. The American College of Obstetrics and Gynecology has endorsed hands-on listening as an appropriate and safe alternative to electronic fetal monitoring since 2009. In the UK, The National Institute for Health and Care Excellence actually recommends doing hands-on listening with all low risk pregnancies and not to even offer electronic fetal monitoring.

'Don't Push'

The third thing that I want to talk about is when you have the urge to bear down and someone tells you to stop. We can actually disrupt the natural process of birth, because what you're feeling when you have that urge to push is the fetal ejection reflex. You want your body to help you eject your baby with this natural process that your body already has- the fetal ejection reflex.

This is something I teach with our clients- how to recognize it, allow it to activate itself, and how to work with it in order to push your baby out. When we are able to teach clients how to work with this reflex, with our 'secret sauce to pushing', we consistently have women who push for less than one hour with zero tearing. Also, it's so powerful to know that if you, as a birthing person, really understand your body and the natural processes that your body gives you to help you to support you in birth, and make this labor and delivery easier. How much more powerful you are in birth as a birthing person? That for me, oh my gosh, I love it.

If someone is telling you not to push you, you don't have to necessarily listen to that. There is science on your side, proving that if that's what your instincts are telling you, you can go with that and you should go with that. Even if there is not research and your instincts are telling you something, you should go with that. But regardless if you're a very logistical person and you like the data and the hard numbers, I can appreciate that. Listen to episode 135, it breaks down how, if you have a cervical lip or you're not 10 centimeters, that pushing can actually a alleviate some pain and help that cervix go ahead and dilate the rest of the way. It also kicks in your fetal ejection reflux. This generally shortens the time of not only the second stage of labor, which is active labor, but also the pushing time. Check it out. You guys episode 135.


Boundaries

My final one - is boundaries. Ugh, who wants to talk about boundaries? Nobody ever, but we got to do it. So here we go. The end of pregnancy, when people are constantly checking in with you, your friends, your family, your coworkers, your neighbors, your laundry people, your mail man, the barista at Starbucks, your doorman. Everybody's going to be asking you if the baby is here or not.

Keep in mind, people ask because people love you and they care about you and they want to love on your baby. I hear you that it can be so annoying, overwhelming, and also just a big reminder that your baby was supposed to be here, but they are not.

(Side note. That goes back to you having a healthy, realistic expectation of what a due date is. If your due date is here, you know that you really need to add five to nine days so that if you're a first time parent based on the stats. You really don't want to set yourself up for additional stress or anxiety around the due date unnecessarily.)

You get to decide who gets what updates and how often. You can go with a narrower group of family and friends with who you update with what. You don't have to feel pressure to keep up with it all. This can be a super hard one. Keeping boundaries and not feeling the pressure or guilt. It's a little bit easier with coronavirus. That's a very easy excuse to keep people at arms length, which has been helpful for a lot of people. A double-edged sword, because it's also extra lonely as if new Parenthood wasn't isolating enough. However, it has also provided us the space that we need to keep people at bay and protect our mental health.

And remember: you are about to this sweetest, hardest, and probably most valuable transition of your whole entire life. I am so honored to share this information with you. To help educate you to advocate for your ideal pregnancy, birth, and postpartum.

Links:

  • - Secret Sauce to Pushing Course: JOIN HERE!
  • - Longer Labor Times with Directed Pushing: Here
  • - Early Pushing Urge: Here
  • - Dilation and the Cervical Lip: Here
  • - Pushing: Leave it to the Experts: Here
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!

Your Responsibility in Labor

Wednesday, March 3, 2021

Your Responsibility in Labor

I am bringing you my takeaway from recent births today on the blog. All of them had a layer of nature that we could not control, which is something I talk about all the time. You can control 90% of labor and birth, but that other 10% is nature. That's life, right? Those are the pieces that no matter how hard we try as humans or even medical professionals, we'll never be able to control nature. Nature will always kind of reign above us, because it's nature. We are the smaller beings when we think about nature and humans, humans actually depend on nature. Nature does not depend on humans. Nature will always have this way of playing its hand in birth. So your responsibility with that 10% is not to give up on it. Your responsibility is to know what could happen within that 10% of birth. To understand what your options are at each of those places.

When you find yourself in some of those situations, because remember it's inevitable, nature will always reveal its hand in labor. You want to feel in control and prepared. You need to do the work to educate yourself on your options, on the research, on your provider/hospital. We can help you do that work, as doulas and through The Birth Lounge Membership, but YOU have to take responsibility. You have to help carry through that preparation. So that since when. you do find yourself in a situation, you know how to respond and react.

The final piece of your responsibility in this is actually speaking up and advocating for yourself. Here's the deal: Your providers definitely have the space. There is room in birth for them to be in total control. This is oftentimes what we see in something called 'active management', where we try and actively control birth and control what happens in birth. And usually it's done under the guise of 'trying to prevent something bad from happening'. But really, if we look at birth and labor, birth is a natural thing. Birth is a very natural event. So what we actually see is when we intervene as humans, as medical professionals, as providers, we see our numbers kind of decrease in certain things. Our C-section rate is increasing. Meaning we are decreasing the number of vaginal births and vaginal births is obviously obviously the preferred birth method, because it's so much easier for the body to heal from.

Now don't get me wrong. I am SO grateful we have C-sections for those times we do need a C-section. But again, if we go back to the research (Check out Ep. 107 of The Birth Lounge Podcast!), I talk about the astronomical rate of C-sections in the US. I also cover what you, as a birthing person, can do to reduce your C-section. I chat with Dr. Neil Shaw, who is really pioneering the science on how do we use C-sections appropriately and save lives, but drastically reduced the number of unnecessary C-sections because it truly does have a soured aftermath for so many birthing people. It increases your risk of chronic pain, increases your risk of pelvic floor dysfunction, increases your risk of abdominal dysfunction, and increases your risk of infection. There's so many complications that are added on once we introduced the idea of a C-section. Your power here, your responsibility here is actually speaking up in labor. There is room for your doctor to be in control, but only if you allow them to be in control.

So let's play something out. Let's say your doctor comes in and says, 'You know what? I'm suggesting a C-section.' and it's the first time that you've heard this. And they say, 'I really think you need a C-section this is not going to happen for you'. And you're like, 'Wow, this seems kind of all of a sudden and I have questions about it. Can we have a few minutes?' And you ask for a few minutes and they come back in and they go, 'All right, let's get you prepped up for a C-section'. This is not consensual care. That is not informed consent. That's not shared decision-making. That is your provider being in control. There needs to be consideration for your birth goals, your thoughts, your questions.

I've seen this exact situation way more times than you would even believe. And there are two very distinct outcomes and the power in that totally lies in your hands. So in this moment, when you're having this immense pressure from your provider to make a decision that you're not even sure you want to make. The first place to start is to ask questions. You're gonna want to say, 'We're not sure that we want a C-section right now, we have a few questions that we would like to discuss with you'. What this does is it takes the control from your provider's hands and it stops the ball from rolling in the direction of a C-section and puts the control in your hands of asking questions until you're ready for the ball to roll. And at that point, you get to choose what path you go down.

It's hard in labor to not feel overwhelmed. It can be very hard to advocate for yourself. This is why it's extremely important to have the education and the preparation, but also to have someone there with you that can advocate for you, whether this be your partner, whether you join The Birth Lounge, whether you hire us for virtual services, or you hire us/a local doula to be present at your birth. Someone that you trust needs to be in that room. Someone who is not afraid to speak up, but can also speak to medical professionals in an educated and polite way so that you're more likely to get a provider to be open to your suggestions.

Now, I want to be extremely clear here. It is not up to your provider what happens to you. It is up to you, you get to make the decisions for your body and your baby. Of course, your medical professional is someone that you've hired. You're paying them for a service. You chose to have your baby with this practice. Or maybe even this particular doctor - so don't lose sight of that. But every now and then people do find themselves in what we call a 'bait and switch', meaning that all of your pregnancy went great. You were feeling supported and then all of a sudden, now that you're in labor, a switch has seemed to flip and your provider is not as supportive as they told you they were going to be. When you're 24 hours into labor, this bait and switch can be really hard when you find yourself in it, but you still have the power and you still have the responsibility to speak up.

You can speak up. Having discussions with your doctor and saying, 'I hear you. And I'd like to discuss my options, but I'm not sure X, Y, or Z is the right answer for me right now. I still have questions.' You can even say, 'I would like to take 20 minutes to discuss with just me and my partner. Please.' You can request a new nurse or a new doctor at any point in your labor. Please remember that nobody gets to do anything to you that you don't consent to, but it's your responsibility to set that tone, to hold that boundary, to ensure that no one does anything to your body without asking you.

That means if someone simply taps the inside of your leg in order to put in a catheter, which I have seen done before, the nurse did not even tell this patient what she was doing. You can take the control back here to say, 'Oh, I'm sorry, are you tapping my leg? Do you need to, do you need to do something?' You can be more direct and ask straight out, 'What is that? And what are you trying to do?' The control here is in your questions. The control here is understanding exactly what is being done to you before it is done to you. This is called shared decision-making. This is something that your provider should actively be engaging with you all throughout your labor. If you find that things are being done to you and they're not being explained, and consent is not being gotten, and discussion is not being had before these procedures are done- you have to do is take a pause and ask the questions. What are they doing? Why are they doing it? And are there any alternatives you might want to inquire about?

Remember that it's your responsibility as a birthing person to understand normal birth variations, common practices, and what your options are at each of those twists and turns. When you do encounter them, you can control 90% of labor. The rest of that 10% is totally up to nature. 100% out of our control. But, what we can do is be prepared to be able to respond and react no matter what comes your way in labor. This is exactly what I teach you in The Birth Lounge. If you are reading this the week it is posted- you are in luck! Our doors are open for Spring members through the first week of March! Join us here!

Also, don't miss out on our free training: How to Avoid a C-section!

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 www.thebloomi.com 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.

Links:

  • - 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.

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