Embodied Birth Ease, Forty Years in the Making

Forty years ago I was lucky enough to begin my doula career witnessing broodmares foaling. Watching their calm undisturbed labors unfold instilled in me a deep trust of the process of birth. To be sure they went through pain and they WORKED, but their instincts were so strong on how to physically go WITH the process. My mare even knew what positions to take when one of her foals took an unusual position in the birth canal. The first hello nicker from the mare set the bonding into motion and the foals knew exactly what to do. Their first latch unfolded around a set pattern of reflexes and responses which, when left alone, guided the foal to reconnect physically with the mare via her teat. I was in awe of this embodied approach to birth which was so different than what I had been told about human birth. This set me on my birth career path. 

My path took me through my own looong hospital birth which negatively impacted my body. It wound through hundreds of births in hospitals, birth centers and homes. It called me to become more and more educated on all facets of birth, bonding, feeding, and parenting. It called me out to learn more about how to heal myself and others from birth. Now after 10 years of study in various hands-on modalities I have decided to completely revamp my birth classes.

After many years of teaching women all the things they DON'T want people to do to them in labor or birth, while at the same time trying to impart calm and fearlessness, I have come full circle. I have decided the BEST way to prepare people for labor is by helping them become more like broodmares. To get more into their bodies, into their instincts, and into the birthgiver baby connection.

So here it is. My new baby. 

          An Embodied Approach to Birth Preparation; Embodied Birth Ease

A NEW sensory based approach to birth education which helps you tap into your unique powers to bring forth life. Typical birth classes apply a one size fits all approach. In reality no two birthing people's physical and emotional history or structure is alike, therefore each of us needs to move through birth in our own way. My classes will get you in touch with your own unique positions and
movements which you can use to move through labor and birth with more ease. They will bring you into awareness of your individual body patterns and how to shift them as needed to birth vaginally. This series teaches deep physical and emotional self awareness and acceptance of what is currently happening in one's body and the temporary nature of sensation. Each participant's sensory perceptions of themselves drives the individualized nature of the learning and actions. This opens the door to instinctual birth, trauma informed personal care, embodied ways to communicate with those around you without the need to speak, and self directed movements, breathing and vocalizations based on sensory input from baby to birther. You will also learn your baby's current position, the positions he/she needs to take to move successfully through your pelvis, and how to support your wee one in their birth process. Using Ortho-Bionomy® I teach simple ways birthgiver or partner can tap into the body's innate corrective reflexes. I open minds to CranioSacral therapy's concept of an inner wisdom that resides in all of us which knows more than anyone outside our bodies or often even our own conscious brain.

These interactive experiential classes are based on my unique Moving Toward Ease gentle bodywork and my decades of doula experience. They are grounded by the principles of Ortho-Bionomy and Upledger CranioSacral work woven into Gail Tully's Spinning Babies information and the Institute for Birth Healing's Opening the Birth Door work.

Group or private.
Online or in-person (Currently only meeting on Zoom.)
FOUR Class Holistic Birth Series!
Week 1: Body Awareness; How to Help Move Yourself through the Birth Process
Week 2: Bringing Baby into Your Awareness; The Baby's Journey
Week 3: Learning the Mother/Baby Birth Dance; Putting It Together
Week 4: Staying Rooted Sets You Free
It can be taken at any stage of pregnancy.
It is encouraged for first time mothers, those preparing for a VBAC, or women who previously had long or stalled labors or pushing phases.
It is relevant no matter where or with whom you are planning to birth because your body is the birth giver.
Be prepared to be an active participant. A partner is helpful.

DATES: Labor of Love Events 

Don't see dates that work for you or want to do a private series? Contact me directly @ (805) 459-8145

Group FEE: $225 (per couple)

Private FEE $600

You must pay in advance at paypal.me/MTEpay
Please label your payment EMBODIED BIRTH EASE.

Once payment has been received you will receive an invitation to the private Facebook group attached to your class. Details on items to have on hand, pre-class "homework", what to wear and Zoom link will be posted there. 

Ortho-Bionomy is a registered trademark of the Society of Ortho-Bionomy International, Inc. and is used with permission.

Why Can’t I Heal? Or Am I Going to Be Like THIS for the Rest of My Life?

Diastasis Recti, Pelvic Problems, Breathing Issues

Are you struggling with a Diastasis that just won’t heal? Have you tried exercise programs that target the issue, but it didn’t help or worse you injured yourself? Are Kegels doing nothing to stop you from “peezing”? Do you feel like ever since your baby arrived your body just can’t take a deep breath, or you find yourself only able to get air into the top half of your chest? Guess what? All of these seemingly unrelated problems are part of the same issue. Your bones can’t MOVE!

Let’s look at how this works. Muscles move bones and they always work in pairs. One muscle moves the bone one direction and a second is required to move it the other direction, so back the way it came. Each muscle has one job, to move a bone in one direction. This means if a bone doesn’t move the muscle pairs are fighting with each other rather than working cooperatively and one is WINNING. One is turned on so strongly that his buddy can’t turn on enough to make the bone move.

Now let’s look at our abdominals and breathing.

As we can see from this image our muscles are a complicated pattern of multiple layers. The Serratus, Pectorals, Lats and External Intercostal muscles create inhalation by moving our ribs out as the respiratory diaphragm pulls down allowing air to rush into our lungs. While the Obliques and Internal Intercostals plus the Transverse Abdominis create exhalation by moving the bones of our ribcage in towards our midline to help the diaphragm push air out. If our ribs can’t move, we can’t inhale or exhale deeply. If we can’t move our ribs together toward our midline, we can’t bring a diastasis recti together. It will never shrink or strengthen. If we can’t make our pelvic bones move when we engage our pelvic floor, we will never be able to strengthen. We’re stuck!

So why did we get stuck and how do we get MOVING again? Our body adapted in order to accommodate a third trimester baby. The ribs moved outward to get out of the way of our growing baby. To do this the inhalation muscles, such as the serratus muscles in the image, went into a certain amount of constant contraction.  

Meanwhile the muscles of exhalation, pictured in this image, went into release mode to allow for the stretching that needed to take place across our fronts which also allowed our ribs to stay flared. 

It was a perfect adaptation for pregnancy which is why 100% of women have some amount of diastasis immediately after birth. In other words, it is normal. It is meant to happen. It is a helpful pattern in pregnancy but is an unhelpful pattern once you no longer have a human inside of you to carry around and instead have a human outside of you to carry around. To carry and care for your wee one you need your core to come back online. This is one of the reasons why you need to rest, to be horizontal as much of the time as possible, even while feeding your newborn. Horizontal allows the core to relax and for some women this will be enough. The ribs will relax. The pelvic floor will soften and then begin to strengthen again. But for many women rest isn’t enough. Their bodies will remain frozen in pregnancy adaption. Stuck for the rest of their lives. This is why I can find this pattern in women decades after their last birth impacting how they stand and move and breathe.

But why doesn’t the body just go back after it no longer needs the adaptation? Well imagine working the biceps of your arms 24/7 for 3 or 4 months. You’d look like Pop Eye the Sailor Man with your great big guns. Simply putting your arm down would do nothing to change the strength you had built up in that bicep. Would you even be able to put your arm down? Unbending your arm means relaxing the bicep muscle so its buddy triceps can unbend the arm. Think how weak triceps would have become after 3 or 4 months of no work.

Another reason our muscles don’t let go can be fascia. Sometimes fascia has rushed in to help the ribs stay in expansion during pregnancy. Fascia is an amazing type of tissue with lots of quirks. It can be either incredibly strong or soft and supple, slidey-glidey or matted and dense. It rushes in when something in our system needs to be stabilized and sets to work immobilizing. It also carries messages to the brain just as our nerves do. Whereas, the nerves carry sensory messages fascia carries emotional messages. Since fascia is wrapped around every muscle bundle and each individual muscle fiber it can tell a muscle to stay in tension if there is an emotional component to the need for tension. When a woman is pushing her baby out, if there is fear, she may get stuck in inhalation.

Let me explain. When we bear-down we naturally inhale first. Then when we are at our fullest expansion our diaphragm goes into ejection mode. The respiratory diaphragm has an interesting feature where it can either help eject things upward out of us, think coughs and vomit, or it can eject things downward, as in feces or babies. If we are suddenly afraid during this process fascia can decide to hold our ribs in bearing down position. Here’s another quirk fascia has. Once it set, it tends to stay in immobilization mode until someone outside the body asks it or forces it to let go.

We also use our transverse abdominis, and obliques to move our babies through our pelvic bones by having them squeeze in and down around the baby. Our pelvic bones and pelvic floor is another dynamic complex multilayered muscle/bone system. This image gives you a peek at a few of the layers. 

Now normally when the muscles of respiration go to work, they are bringing ribs together at the same time as our pelvic floor is bringing our pelvic bones together.

But pushing a baby out is a unique situation which is why some first-time moms have trouble figuring out “how to push”. It is natural and spontaneous but can feel confusing to the body and even more to the brain because the brain may sense it as discoordination of a primary function; breathing. Both the ribs and pelvic bones need to stay in expansion during the pushing effort. This out of synch pattern can get programmed into the brain and leave women out of synch for the rest of their lives. To heal from a diastasis or leakage or prolapse we need to be able to breathe correctly. To breathe correctly we need to be able to move our bones together and apart in correct synch with our breath.

And finally, our old friend fascia is often helping our rectus abdominis stay in this open diamond pattern by sticking them down to surrounding tissues. While this is supportive when the abs need to stay in this awkward constant spread, it is working against your efforts to bring your muscles back into perpendicular lines. When it comes to holding, our fascia is stronger than our muscles. That means no amount of exercise by you will budge or coax or break that fascial grip on your muscle bundles.

So, what’s a woman to do if she thinks this could be her story? Most traditional cultures have a person skilled in “closing bones” after birth. It is woven into the fabric of their postpartum care. Unfortunately, in the U.S. this art has almost been lost. Closing the bones goes beyond making sure the bones are balanced, as in a chiropractic adjustment. It requires being able to sense into muscle tension patterns, fascial restrictions, left over emotions, and how all of this is affecting a woman’s breathing pattern. Once the bones are closed, balanced and moving, and the fascia has been made to loosen its grip, work can begin to retrain the brain in a correct breathing pattern. Finally, she is ready to experiment with how to correctly engage her abdominals and pelvic floor to re-engage the muscles that turned off so she can use her muscles in correct balance and coordination. This is what I do as a Certified Birth Healing Specialist at Moving Toward Ease.

Do you need help? It is NEVER too late to move yourself toward ease.

Call Jennifer Stover

Founder of Moving Toward Ease

(805)459-8145

Welcome After 25 years of educating pregnant couples in San Luis Obispo County and supporting many women in labor I decided I wanted to connect with women in a new way to share the wisdom I had gleaned; my new baby, a doula blog, was born. It is dedicated to all the women who have come before; a gift from them to you. Please use it to help create the birth you want. Read, enjoy, empower yourself! 

I Believe

Loving Guidance Mama Mentoring

Pregnancy, birth and early parenting are a very special season in the cycle of your life. I believe every woman deserves to be treasured during this transformational process. True care and nurturing for the entire family throughout their journey empowers them and creates deeper bonds. An educational foundation rooted in the natural abilities of women to birth their babies instills confidence and is a critical component of empowerment. My classes prepare the heart, mind and body for the journey ahead. Through the birth of my son I came to understand the critical role a doula plays in helping couples achieve a harmonious and uplifting birth experience. A doula is a vital member of your team no matter where you birth or who you choose as a care provider. As an experienced guide providing one-on-one continuous care throughout your birth I allow everyone to relax and be fully present in their roles. As a communication facilitator I help insure your voice is heard and respected, as well as, translating medical information and options; providing you the opportunity to make your own choices. I have been helping birthing women here on the beautiful Central Coast of San Luis Obispo county since 1992 and am passionate about protecting and preparing women during this most vulnerable time. Please use the words I have written in this blog to learn more about my beliefs surrounding birth.

Certified Intuitive Birth Doula
Certified Intuitive Postpartum Doula
La Leche League Leader
Positive Birth Movement Facilitator
CranioSacral Pracitioner
Ortho-Bionomy Associate
Institute for Birth Healing student
Central Coast Breastfeeding Coalition Member

A Spectrum of Pregnancy, Birth & Parenting Services to Meet Your Needs

After working with San Luis Obispo families for over 20 years I am more strongly committed than ever to helping families find what feels right to them for pregnancy, birth and parenting. I have a broad perspective and a depth of knowledge which is grounded in the work I have done with families making a wide variety of choices. As a doula I have been blessed to be part of over 100 births. Working beside doctors and midwives I have witnessed inspiring births both in and out of the hospital. As a birth educator I have impacted the births of several hundred babies and through my work with the Birth & Baby Resource Network, La Leche League, and the International Cesarean Awareness Network I have touched the lives of countless families in our community and beyond.

I offer a variety of support/education options to match your unique needs. Our journey together may start at any point along the spectrum. Please feel free to mix and match and make the exact support and education package that meets your needs. All classes are offered both as group or private experiences with flexible schedules.


Before You are Pregnant

Private consultations over tea: learn about options & resources in our community or review and process a past birth and discuss possible effects on future births. We can meet in the privacy of your home or at a coffee shop.                              

 

Early in Your Pregnancy

Classes: learn how to nurture your body, your baby and your relationships in my Healthy Beginnings/Healthy Choices classes.

                                                        

Preparing for Your Birth

Classes: My small group classes held, in the privacy of a home, foster a sense of belonging as we eat, laugh, learn and share together this amazing adventure. My Heart, Mind & Body series empowers and inspires you to create the birth you want.

For each class group I create a private on-line community for extended sharing of ideas, inspiration, connection and support which continues until your baby is sleeping blissfully in your arms.

Labor Land Practice: My Birth Connection Date Nights are serene spaces where all learning is experiential through relaxation, guided imagery and touch. The focus is encouraging oxytocin, the “love hormone”, to flow between you, your partner and your baby, and to teach you how to move through labor land together. These “practice” sessions are ideal for experienced birthers, homebirthers, or as an expansion of more intellectual birth classes.

Private Classes in Your Home: Every family has different needs; bed resting moms, changing schedules, or simply a desire for privacy. I try to be as flexible as possible to let you create your unique education package. Let my Class Outline be your guide. I am happy to create a series just for you!



Doula Service: I am happy to join your birth team no matter where you are planning to birth; home, birth center or hospital. We start building a trust relationship with prenatal visits in your home. Through listening I learn what you need and want to feel confident about your coming birth. I facilitate thinking and dialogue between partners to help clarify and prioritize what is important to them and help craft a birth plan which reflects these values while being well received by your care provider and staff.

I am available via phone, email or Facebook to answer questions and lend support throughout the pregnancy.

                    Once labor begins. . .

 I will stay continuously by your side
 where ever you are laboring until. . .

your baby has arrived. . .

and is blissfully breastfeeding for the first time!

I will visit your home a few days after your birth to ensure breastfeeding is going well, check on your postpartum recovery, and help you process your experience with tears, talking and laughter. I will answer questions, clarify and enlighten you on issues you may not have understood. I want you to have a thorough grasp of what happened, why, and how necessary it was, to empower you for future births.

After Your Birth

Private consultations over tea: When women suffer after a difficult birth experience it is very helpful to share your story to a listening heart who is knowledgeable enough to review your birth, answer your questions, and help you move forward in your process. I can connect you to resources for your recovery and discuss things you will need to think about for future births.

Private Postpartum Visits: I believe new mamas need to rest and adjust to motherhood in the comfort of their home. I am happy to travel to you. The first days and weeks of parenthood many new families need some additional guidance. A little hands-on help from an experienced mother/doula can give a new mama just the boost of confidence she needs.

Welcome to the parenting community!

Classes: My Fourth Trimester Parenting Support group meets every Tuesday from 10:30-12. I provide this free to the community because I believe deeply that women need support during this important transition in their lives to grow fully into confident motherhood.




Support Group: I lead a La Leche League Mothers’ Meeting once a month in the South County which is free and open to all mothers for breastfeeding advice and support.

 

Loving Guidance Workshops: These periodic workshops cover my Five Steps to Creating a Healthy, Happy, Whole Family empowering parents to move through the normal ups and downs of parenthood, take control of their own learning, and make their own decisions on how they wish to parent.

Support Group: I created “Whole”istic Mamas and Papas to provide community for families choosing to parent from an alternative point of view; attachment parenting, co-sleeping, extended nursing, baby wearing, individual vaccination choices, homeschooling, etc. It is a safe space; both in our face-to-face play day meet ups and private on-line group for asking questions, gathering information, sharing and learning from each other.













Parenting is much more fun when we share and play with others!

Let's connect! I am happy to answer questions and get you started on just the right path for you.            Call: 805.459.8145
jenniferstoverdoula@gmail.com

The First Forty Days

Heng Ou

reviewed by LLL Leader Jennifer Stover

Not all wonderful books will appear in the International League's recommended book list. This book was published in 2016 and is too new to have completed the LLL evaluation process. But I can tell you it aligns beautifully with League's views on the postpartum period. It is a LLL New Baby at Home meeting within the pages of a book. Leaders know cocooning, rest and nutrition is the name of the game if you want to be sure to bring in a full milk supply. All cultures around the globe have known this through the centuries. Taking care of the mother during this critical time in the life of the newborn ensures the infant's survival. The author weaves the ancient wisdom of China, embracing and supporting new parents, with the practicalities of modern American life. Chalk full of tips, recipes and insight into the physical, emotional, and energetic changes happening as pregnancy and birth are over and lactation begins. 

It is broken down into helpful sections. These are the 4 sections I found the most helpful. The Gathering gives you comprehensive lists of what to do to prepare for life after birth. The Gateway divides the postpartum time into 4 phases, each with a unique tone and therefor support needs. Filling Your Cup gives general ideas about the categories of foods you need to consume and why. The last 100 pages are all delicious looking recipes! This book makes it so simple to ask for the help you need.

An ideal gift for a pregnant friend. A must read for your partner so he or she can understand and help you prepare your pantry and your life. Perfect to loan to friends and family BEFORE baby arrives; especially if they plan on helping during your postpartum days. Growing into parenthood doesn't happen over night. It is an unfolding over the first days and weeks. This book will help you get your feet underneath you as you set off on your nurturing at the breast adventure. 

Quotes I Love

"Nourishment is more than a bowl of soup: It is the sensation of being cherished and sustained. It comes from the way you feel inside your home, or the way an intimate friend sees and hears you fully. But it starts with a bowl of soup, because that is the simplest and most satisfying way for your cup to be filled."

"This gentle retreat-claiming the right to draw your world closer around you for a while and stay home to cocoon with baby instead of venturing out-is the first insight of the first forty days. It is a sacred act of self-care and preservation that allows you to be raw and exposed-literally and metaphorically."

"Food feeds the cells and fills the senses, and it also nourishes the vulnerable and hidden parts of ourselves that may be crying out for encouragement and comfort"

"And you've probably experienced more exhaustion, more frustration, and more love than any other woman on earth. Except for that mother over there. And that one over there. And that one..."

"For the new mother, this meant meals rich in iron to rebuild blood, protein to repair tissues and support hormones, fatty acids to enrich breast milk, vitamins and antioxidants to speed tissue healing, and therapeutic herbs and spices to counter inflammation or boost milk flow, if needed."

"No book or healer can tell you more than your own body can. So, rather than following strict rules, use gentle recipes, designed to be low in gas-forming compounds, and focus on baby and notice how he reacts after certain meals."

"When it comes to filling your cup, it's all about the bowl."

"Forty days of care today, is thought to lead to forty years of vital womanhood tomorrow."

Support a local mother owned business.

Buy this book at Len Collective in SLO.

Are you interested in reviewing a book for us?

We'd love you to!

Contact a Leader

805-242-2294

Your Fexible Pelvis

Yesterday this flexible pelvis model arrived. It got me thinking.

Imagine you are in a dark cave. The only way out is through this opening...

At first the walls of the opening appear to be rigid, like stone. But what if they are not?...

What if there are places in the walls of the cave that will move, that can flex and shift if you push against them?

What if someone on the outside of the cave could help you by actively moving these pieces changing the shape and size of the passageway you are trying to squeeze through? What if?...

We are looking through the bony cave that your baby will fit through. We are looking at it from the direction of the top of your baby's head, from above your pelvis, rather than the direction midwives and doctors look at it, from below. At the bottom of the picture is the sacrum bone. The two illia, or hip bones attach to the sacrum and create the sides and front. They wrap around and meet each other at the pubic symphysis  joint at the top of the photo.

Here is the same pelvis from the side. Notice the angle of the sacrum pointing down with the tail bone the sharper point at the very bottom. My hand is holding the pubic synthesis. Notice the shape of the opening in each of the photos.

Now let's go back to our cave with the flexible walls. Bones aren't flexible right? Well actually bones have more flex than we imagine. They are living tissue. When they are alive, versus hanging in a skeleton, they have more ability to move. Plus there are joints! Your pelvis has 4 joints; the pubic symphysis at the front, 2 sacroiliac joints at the back, and the joint between the sacrum and tailbone. All of these should be able to move or shift. Your baby can move them by pushing against them and YOU can move them by activating certain muscles and deactivating others. Certain body positions can either allow or enhance this movement.

Let's look at the shape of our cave if we move the sacrum in at the top and out at the tailbone end.


Wow there is a lot less space at the top, the inlet of the pelvis. The cave just got really tight if I am just beginning to wriggle through but...

Look what happened at the opening at the outlet of the cave! Way more room.

Now let's see what happens to the shapes if we move the sacrum backward at the top. Or our pelvic floor muscles are pulling the bottom third of our sacrum and our tailbone forward.

It is a little hard to see in this photo but the distance from pubic symphysis to top third of sacrum is much longer. So the bone moved out of the way of baby getting INTO the cave but what happened to the outlet of the cave?...









YIKES! That's going to be one tight fit.

In actuality my "flexible" pelvis model isn't nearly as flexible as YOUR pelvis. Your sacrum doesn't just tilt forward and back. The whole sacrum can also shift left and right. It can tip left or right pointing your tailbone either left or right. It can also rotate or tilt taking one side closer to your pubic symphysis and the opposite side further away. To learn more about the mother/baby birth bone dance  and how Moving Toward Ease sessions can help prepare your pelvis to move during birth visit my Moving Toward Ease page.

Looking at Group B Strep Testing

Evidenced Based Birth's update to their Beta Strep information gave me LOTS to think about...

Most mothers in the US are tested for GBS during the final weeks of pregnancy. Like every test or procedure there is lots to learn before you decide to say yes or no thank you to your care provider. An excellent place to gather info is the Evidenced Based Birth site. I encourage you to read the section about Group B Strep carefully. Ask your doctor or midwife informed questions based on what you have read. Craft a plan of action. Be prepared to change it if your circumstances change. Don't forget to be proactive about repopulating your gut flora immediately after birth and include baby too. Understanding Beta Strep; risks, tests, treatment Many women have Beta Strep in the vagina. Many of those women if not given antibiotics will colonize their babies during the birth process. This means Beta Strep will be found on the skin and mucosa of the infant. BUT this doesn't mean the baby will necessarily become sick. Being colonized doesn't always equate with sickness. Most babies who actually become ill with Beta Strep have been colonized in utero before birth and show signs of illness within hours of birth. Most babies who die from Beta Strep were born preterm. Universal GBS screening followed up with antibiotics in labor for all women who tested positive has cut the number of neonatal Beta Strep deaths in half in the US. Very few babies actually die from Beta Strep but to cut this rate in half is significant. Whether this is from the Universal screening OR from the push to use antibiotics in labor is debatable. You'll see why I say this later. Most babies who become ill with Beta Strep need NICU care for days or weeks; disrupting the bonding and breastfeeding process. This is a big strain on the family emotionally, physically and financially. This article doesn't have stats on if we have lessened our NICU admissions with universal screening and antibiotics in labor. It may be difficult to know because many babies are taken to the NICU because they MAY have Beta Strep. They are started on a course of IV antibiotics just in case. We can only know if they actually have it after a culture has grown which takes a number of days. So some babies are receiving NICU care and antibiotics who need it, and some are receiving it who don't. To Screen or Not to Screen? Different countries use different approaches. U.S. uses Universal screening followed up with insisting on Penicillin during labor for all GBS positive women. Great Britain uses Risk Based screening. So only women with certain risk factors are screened. I don't know how insistent they are about antibiotics but the language in their National Institute of Health and Social Care Excellence (NICE) documents use various levels of insistence depending on situation. They range from offered, to considered, to prescribed. Here is their current thinking on why they choose Risk Based screening: Dr Anne Mackie, Director of Programmes for the UK National Screening Committee, said: "At the moment there is no test that can distinguish between women whose babies would be affected by GBS at birth and those who would not. This means that screening for GBS in pregnancy would lead to many thousands of women receiving antibiotics in labour when there is no benefit for them or their babies and the harms this may cause are unknown." Dr. Mackie ties this decision to the microbiome which we'll discuss more in a minute. "The results showed that the infant microbiome was influenced by antibiotic exposure during labor, birth route (Cesarean or vaginal birth), and breastfeeding." These are the unknown harms she is referring too in the first quote. New Zealand uses Risk Based Treatment rather than screen. Like the UK they have a set of risk factors that they use but rather than screen they simply begin antibiotic treatment in labor. They also seem to move from suggestion to insistence depending on risk factors present. They have a flow chart to show when to move women into different management. It appears that using THIS approach they too have cut their GBS mortality rate in half! So which approach has the lowest baby mortality rate associated with it? New Zealand! Comparing GBS Baby Mortality Rates UK: .38 per 1000 babies born US: .24 per 1000 babies born NZ: .2 per 1000 babies born Does this mean a risk based treatment approach is best? Not necessarily. Being associated doesn't prove a causal link. There may be more going on here; genetic factors, other labor management factors, or immediate newborn care factors, even a less virulent strain of GBS is possible. Other possibilities? Dietary changes and other cultural changes that could effect the bacteria present in the birth canal before or during labor. Bottom line? No one knows for sure yet. The Good and Bad of Antibiotics How does IV Penicillin in labor work? From the EBB link: "Penicillin rapidly crosses the placenta into the fetal circulation (at non-toxic levels) and can prevent GBS from growing in the fetus or newborn." Pretty straight forward. They are dosing not only you and killing your Beta Strep bacteria but also any already in your baby's system. Of course they are also killing all your good gut flora and your baby's too. This may be why there has been a rise in the rate of preterm babies dying from E. Coli sepsis. So to actually decide if we have done a good thing giving antibiotics in labor we would need to add baby mortality from Beta Strep to baby mortality from E. Coli and compare that rate to before we began using labor antibiotics. Didn't find those statistics in my research and it isn't in this link. Stumbled onto this possible connection with E.Coli rise in a different research paper. Back to Dr. Mackie of the UK's concern about causing harm in some unknown way. Here is what Evidenced Based Birth says, "Research is needed to determine if there are any long-term effects associated with the temporary reduction in beneficial bacteria". Understanding the human microbiome is a rapidly evolving science. So far we know that some bacteria seem to turn on or turn off various genetic switches. Having evolved over thousands of years in a symbiotic relationship with the bacteria in and on our bodies we are linked right down to our DNA or gene expression. We are just beginning to understand this. It will be some time before we understand all of the impacts of this relationship with our body's flora. We know different women carry different balances of various microbes. What the perfect balance is? No one has a clue yet. But good or bad, passing down your microbiota is part of your genetic inheritance to your children. We know there are properties in breastmilk designed to feed certain bacteria and resist the growth of other bacteria. So the body knows what balance is best. This is why breastfeeding can help mitigate the effects of the labor antibiotics. Evidenced Based Birth says, "Research is needed to determine if giving probiotics to mothers and/or newborns can help lessen or reverse the impact of IV antibiotics on the infant’s microbiome." Well first we need to determine what all the impacts are. We know mother and baby have double the risk of developing thrush if she has antibiotics. Thrush impacts breastfeeding big time. Taking probiotics and breastfeeding appear over time to bring back the gut flora but it can take anywhere from a few weeks to a year. When do microbes effect gene expression? We don't know. Immediately after birth? During the first days or weeks? We don't know. Does it happen while in utero or in labor? We don't know yet. But there is bound to be a critical period for this. We just haven't a clue when it is because we don't even know yet how they are doing it. Can You Lessen Your Risk? Is there another way to lessen your baby's risk of GBS? EBB shows a study that says, "probiotics (lactobacilli) may lessen your chances of being colonized with GBS." Wait a MINUTE! So perhaps we need to talk to moms about their DIET and how to lessen their potential Beta Strep load. In other words PROACTIVELY support women in bringing their bad microbe load of ALL types down as a way of circumventing the need for antibiotics by teaching them how to bring their body's flora into better birthing balance. The study EBB refers to shows that even putting probiotics onto panty liners can be helpful. What if moms did that starting after their first prenatal visit, and took probiotic capsules and ate and drank probiotic foods? What if we studied the difference between that group of women and the women being universally screened and automatically given Penicillin? What would we find at their 36 week screen? Would we prevent preterm births? Would we be able to maintain the same mortality rate from GBS? Or perhaps even do better? What would happen to the E. Coli death rate? I have no answers to these questions but they are IMPORTANT questions. Final Thoughts Please do not think I am telling you to blow off your GBS test. Please read all the research EBB presents. Consider carefully all the known risks, your current risk level (which can change), and the possibility of unknown risks. Please DO NOT use probiotics and dietary changes as a way to get a negative GBS test and then revert to old eating habits and discontinuing probiotics. Definitely read the article and talk carefully to your care provider.

What Gives with Fetal Monitoring?

In 2011, six years ago, ACOG published in their FAQs for patients a section about fetal monitoring. In it they supported ALL the different methods used for assessing babies' heart rates; continuous monitoring with external or internal monitors, AND intermittent auscultation with hand held doppler or old fashioned noninvasive fetascope. Here is what they tell women about YOUR choices (not the doctor's or hospital's choices), "If you do not have any complications or risk factors for problems during labor, either method is acceptable." In a recent ACOG committee opinion they stated that, "The widespread use of continuous electronic fetal heart-rate monitoring has not improved outcomes when used for women with low-risk pregnancies."

Here's my question. Why then in the last 6 years have none of my clients laboring in our local hospitals EVER been offered to be monitored using a hand held doppler? Not once. 

Please consider printing out the linked pages from ACOG and sitting down with your doctor or nurse midwife while you're pregnant, long before labor begins, for a heart to heart on this issue. Find out what perameters your care provider uses to define low risk or complications that would place you out side the group of women this recommendation applies to. Questions might be: After 40 weeks or between 41 and 42, between 36 and 37 weeks, what pre-existing conditions, what medications, what if your bag of waters has ruptured and you are in active labor versus broken waters in early labor or no labor? Get a feel for how comfortable or uncomfortable they are with this protocol; how wide or narrow their boundaries will be. 

Remember if they agree to have the hospital staff use a doppler write this into your birth plan, have them sign the plan, initial this part and initial the printed page from ACOG where you have highlighted the pertinent info. You might also wish to include something about having had a conversation about what does and doesn't constitute low risk.  (If you don't agree or are not comfortable with your care provider's views about low risk then if at all possible you should find a doctor or midwife who is a better match rather than attempt to force a provider to provide care in a way they don't believe in.) Staple your plan and your printed pages together and don't forget to take them to the hospital!

http://m.acog.org/Patients/FAQs/Fetal-Heart-Rate-Monitoring-During-Labor

http://m.acog.org/Re

Breastfeeding, Pitocin and Epidurals; a new look

Did you know there are predictable stages babies move through during the first hour after birth? First they rest. This is soon followed by searching for the voice they have been listening to in the womb. As soon as they have identified her voice, from among a myriad of new sounds, they are driven to raise their faces and gaze into their mother’s eyes attaching the familiar voice to the unfamiliar face as they begin bonding outside of the womb. Once satisfied, they move on to innate behaviors meant for finding their food source and receiving immune boosting, brain stimulating colostrum. By pushing with their feet and knees on mom’s tummy they wriggle and squiggle their trunks up to find the swell of her breasts. They head bob or bump on mother’s chest breathing in her smell. Their eyes search for the bull’s eye of her darkened areola. Then they open their mouths or push out their tongues getting ready to taste. They explore her nipple with their hands; squeezing it in their tiny grasp. Giving themselves tactile information. Then they move their fist to their mouth, sucking the flavor of mother off their hands, and filling their intestinal tract with the good bacteria they need to promote internal health. Finally they latch on and taste the colostrum. After several uncertain tastes they get down to business and suck deeply; flooding their bodies with oxytocin; the love and bonding hormone.

These behaviors are repeated whenever a baby is born. Not just a human baby but every mammal baby has a repeatable, quantifiable process. What happens to this process when a mother is given an epidural or Pitocin during labor and should we care? Ethnographic Researcher, Dr. Brimdyr, PhD, CLC, and her team of obstetricians, lactation consultants, nurses, midwives and anesthesiologists wanted to find out. In their newly published study they divided sixty-three low risk mother/baby dyads into two groups; medicated and un-medicated. All the pairs were filmed during the first hour of life. Then the team of researchers did what ethnographers do; they studied the pairs to watch for clues. Ethnographers observe and analyze “symbols” that their target users use. In this case the predictable innate behaviors which initiate bonding and breastfeeding in human babies; a basic survival skill.

So what did they find out? Both IV Pitocin, the most used labor induction or augmentation drug, and Fentanyl, a drug in the typical epidural, significantly impact a baby’s abilities to move successfully through the normal first hour of life behaviors. The amount of medication and the length of time the mother was receiving these drugs were also found to be significant. The more mothers had, the longer they were on them, the greater the impact on the babies’ abilities. The worst case was the typical 2015 birth scenario in U.S. hospitals, long Pitocin induced labors with an epidural for pain management over an extended period. This study shows a direct correlation; a direct impact on skills considered basic survival behaviors.

These mothers were given fentanyl via an epidural which we have been told for many years doesn't reach the baby. Still we can see a correlation between amount fentanyl and poor survival efforts by the babies. 

In my observation as a doula I believe those caring for and about the new baby; mom, nurses, midwives and doulas, also have an internal innate clock ticking from the moment of birth which further complicates matters. I have certainly felt it inside myself. Our intuitive senses are telling us if the baby is struggling to complete the tasks on the normal timeline. Unfortunately what happens next is very damaging to the programming process. Babies who are “helped” through assertive positioning, holding of heads, and nipples being pushed into their mouths, or faces being shoved onto breasts, are not only unable to complete the correct programming but have an incorrect program laid down in their systems. This often takes many tech support trips to a lactation consultant to uninstall.  Meanwhile mothers are in their homes spending many weary hours pumping while quietly shedding lots of tears. They incorrectly assume they are the ones to blame; there must be something wrong with them. It takes a very strong mother not to give up on breastfeeding. Not just for this baby but for any future siblings as well.

So should this be a cause for concern? We know these stages lay down the initial programming for successful breastfeeding. Other studies have observed a connection between moving through these steps in an hour and ultimately being a successful breastfeeding mother/baby dyad for at least 6 months. Exclusive breastmilk for the first 6 months is recognized by the World Health Organization and the American Pediatric Association as providing the best start for babies’ bodies and brains. Studies have now shown that even just one bottle of artificial human milk can alter the microbes reproducing in an infant’s gut. Cutting edge research is showing us our intestinal flora balance is tied to many diseases. Further consider other ways we may be inadvertently installing wrong programs in our children. We know babies are flooded with hormones as they leave the womb. One of these is adrenalin; fueling their drive to survive. It creates a hyper-alert state where sensory information of all kinds is heightened. This is initially needed but adrenalin is very draining to our systems. The system is designed to down regulate within an hour. Oxytocin and endorphins, the hormonal antidote to adrenalin, are released during suckling changing their body and brain chemistry. So what happens to an infant’s brain when it continues to be bathed in fear flight hormones beyond an hour? What happens when our babies’ bodies are wired to assume this level of adrenalin should be their baseline? What programs could we be installing for life?

Although this study was small the results are important and point in the direction for a much larger study to be done and a review of the true risk of these drugs to babies. For many years I have heard doctors, nurse midwives, labor nurses and anesthesiologists telling mothers there is very little risk to their babies. The only risk they perceive is in the here and now. Their responsibility for this new life ends soon after birth. Their risk assessment is grounded in a fear of doing nothing about other known risks, such as, going too long past the due date or a labor lasting too long. But when we consider the now known impacts to breastfeeding and breastfeeding’s impact to life-long health the true risk comes into clearer focus. Projected, possible risk, is like looking into a crystal ball. No one can know the true risk for any individual baby of either saying yes or no to Pitocin and or an epidural but at the very least mothers need to have good quality evidenced based information of the total picture to make their decisions.

"It is crucial for new parents to be aware of the risks of intrapartum drugs, and medical professionals have an ethical obligation to inform parents of such risks, especially when these drugs are so prevalent in Labor & Delivery. The implications of this study are huge."
Dr. Brimdyr, lead researcher

To see the study: http://onlinelibrary.wiley.com/doi/10.1111/birt.12186/full

Listening

All the time we are hearing that good communication is the key to relationships. For many of us this translates to if I can just find a way to tell you what I need you to hear you will grant me what I want. Or perhaps you think of it as speaking your truth and assume that the truth will set you free? What if the key to relationships wasn't in the speaking but in the listening?

Julie Nevison, founder of Aware Parents Aware Kids, recently gifted me with a slim little gem of a book called Listening Partnerships for Parents, by Patty Wipfler targeted at listening skills. I have always thought of myself as a good listener and over the years have actively worked on improving my skills. Recently I am finding that there is WAY more for me to learn and put into practice with those I love, clients I work with, and friendships that lighten my life.

Eons ago my husband and I took a class together taught by Steve and Cathy Brody, a psychologist and therapist husband and wife team. We learned the skill of mirroring what someone said. This was supposed to help them feel heard. Unfortunately we only learned the basic rote skill. In practice we simply fed back the other person's words before rushing forward with our own ideas, complaints, or needs. My husband rightly HATED it. I had to wait for more than twenty years to see the art of mirroring done so gracefully by Christi Silva as she facilitated La Leche League meetings. Not only did she mirror but she organized and sorted the random thoughts, feelings and ideas presented without ever interjecting her own ideas or making the speaker feel judged. She handed this back to the speaker as a gift. I listened. I heard you. Thank you for sharing.

Struggling as a parent and feeling I wished to strengthen my relationship with my son I read, "How to Talk So Your Kids Will Listen and  Listen So Your Kids Will Talk" by Faber and Mazlish. Oh ho! So if I wanted my son to talk I needed to STOP talking! Now there's a concept. I still have a hard time with this at times. Sitting and waiting rather than engaging with questions isn't easy for me. Also this was the first time I heard the idea that as the listener, especially as a parent, it isn't your role to give them solutions or fix things for the speaker. If you just wait attentively, supportively, your child will begin to think of their own solutions. Then you can help them "try their solutions on" to see if they feel right to them or have the chance of actually working.

A few years ago taking Tory Blue's NVC class (non-violent communication) again shifted my whole perception of listening. She opened my eyes to all the critical dialogue going on in my head about myself and the person I was listening to; all the ways I thought I would, could, or should "fix" their problem. I also became aware of the concept of unmet needs creating dis-ease commonly felt by us as anger, frustration, sadness, or tension while met needs create happiness, satisfaction and joy. Communication is simply a way of asking to get unmet needs met. Sometimes others are willing and can meet those needs. Sometimes they can't or do not wish to meet the need. Often because meeting your need is in direct conflict with one of THEIR needs. This isn't wrong or bad. It just is. We may have to meet our own need or seek that need being met by a different person or in a different way. And guess what? That's okay!

La Leche League training puts a lot of emphasis on listening skills. We are taught to help a mother observe, look for clues, and sort through her own situation. We give her pertinent information she may not have which could help her clarify what she desires to do. We express confidence in her and her own abilities to know what to do and to do what needs to be done.  We tell her whatever she decides we know it will be best for her and her family. Or perhaps we are expressing confidence in her baby's abilities to learn or conquer a struggle, tap into their innate wisdom and abilities, or the hard wiring of their genetic coding. In essence we are modeling the behavior of listening to her baby rather than any other voices, especially if listening to those voices shakes her confidence in her mothering abilities.

My CranioSacral and Ortho-Bionomy studies and Feldenkrais explorations deepened my understanding of the many ways to "listen" to myself or someone else through physical touch. Again I saw that no real communication would happen if I was anything but completely accepting of what was, rather than what should be. Only after awareness and acceptance could I begin to explore other possibilities. Doors keep opening and new levels of understanding are revealed. Awareness and intention allow us to blend with another physical being through our hands. Permission has to be asked and granted on many levels before another human being will feel safe enough to reveal themselves to you. This is a sacred trust.

As an Intuitive Doula I listen with my head, heart, and hands. I listen to her hopes, dreams and plans. I listen to her birth struggles. I listen to her joy or sadness when the birth is over. So much of what I bring to a birth is simply my attentive presence. Feeling really listened to and honored through the intensity of birth is what is missing in so many women's birth stories. I listen with my ears, my brain, my hands, my intuition, my intention. Listening brings self-awareness.

Reading Patty Wipfler's little book I realized I STILL have so much to learn about active, caring listening and acceptance. Some of it was simply a good review; helping me brush up on things I already knew. There were also good reminders of things I had learned but still forget to use effectively in every day life. Most importantly it brought me a new layer of understanding about pain, hurts, and healing. Patty says unhealed childhood hurts leave scars that create rigid, irrational behavior. This makes sense to me. In order to heal those hurts we need to be LISTENED to. Feeling truly heard accepted and loved can help us release tears. Tears allow us to rid our bodies of trapped emotions. Emotional tears contain the harmful chemicals that have been trapped in our cells; frozen in rigidity. From my body work studies I know these unhealed hurts also leave physical scars in the form of physical rigidity or dis-ease trapped throughout our bodies; aching to be listened to, released, and healed. When our body feels listened to it finally is able to let go.

I am lucky to have Julie drop into my life at this time. "When the student is ready the teacher will appear." Thank you Julie.