Jan 23 – Belly’s Night Out!

Come join me at Belly Bliss for a Belly’s Night Out Party!

belly-night-out

I will be there decorating the lovely Mama’s-to-be with henna and Rachel Kemble will be there taking professional photography.  There will also be someone giving massages while you wait to be hennaed!

Register here with Belly Bliss – Just click on the “Workshops” tab in the upper right corner

Hope to see you there!

6-10 pm
Belly Bliss
300 Josephine St. Suite #10
Denver, CO
303.399.1191

Advertisements

Tips on Writing a Birth Plan

Here are some things to consider when writing a birth plan:

Some people like birth plans, others feel it’s too restrictive.  If you’ve thought about what you want and talked with your provider and feel comfortable that everyone’s on the same page and you just want to go with the flow, please do!  If it feels better for you to have things organized on paper rather than in your brain, here are some tips to help you along!

  • Know your options – They say if you don’t know your options, you don’t have any.  Research different elements of labor, birth, and postpartum.  A great place to start is to read The Thinking Woman’s Guide to a Better Birth by Henci Goer and Gentle Birth Choices by Barbara Harper
  • Keep it brief – No hospital staff is willing to read a 20-page manifesto!  Keep it simple and use bullets or numbers.
  • Prioritize – There are so many things you might want in your birth but choose the few that really mean a lot to you, ie, keeping the baby with you skin-to-skin after birth.  Don’t put things in your birth plan that you know aren’t allowed, for example if the hospital doesn’t allow waterbirth, it won’t mean much that it’s in your plan.
  • Use positive language – No one wants to deal with a belligerent person!  Instead of “We don’t want the baby taken away” say “We prefer the baby to be examined on mom’s chest and to stay skin-to-skin as long as possible”
  • Separate wishes into categories – By organizing the list into “Labor”, “Birth”, “Postpartum”, and “Newborn Care” staff can easily find what your wishes are.
  • Talk with your Partner – It’s important you’re on the same page
  • Show the plan to everyone involved – Make sure your midwife/OB/doula know what your wishes are and can respect them.  If they can’t respect a vital point, it may be time to find a new care provider.  Remember, it’s never too late to make a change that could mean a world of difference to your birth!
  • Find out about waivers – See if you need to sign waivers to decline something in hospital/birth center policy.  For example, you may need to sign a waiver if you don’t want eye drops for the baby because you don’t, say, have a venereal disease.
  • Have care providers sign the plan – Keep the plan in your chart and carry one with you in your bag if it makes you feel more at ease.
  • BE FLEXIBLE! – Everyone has an idea of their ideal birth but it’s important to be flexible if something unexpected happens.  The main point is that you feel respected and consulted at every twist and turn of labor and birth.

Red Raspberry Leaf Tea Story

Many women and midwives swear by red raspberry leaf tea during pregnancy.  Here is information on the benefits of drinking the tea during pregnancy, though as always please consult your provider before taking any herbs:

This is from Rodale’s Encyclopedia of Natural Home Remedies:

The Raspberry Leaf Tea Story

Tea made from raspberry leaves is the best-known herbal aid in pregnancy. Rather than go into all the traditional lore about this herb, we present the following lengthy account, because it is both contemporaneous and highly specific.

“My mother was born and raised in Scotland, coming to America at the age of 26. Whenever a member of her family became ill or had a health problem, her mother had consulted an herbalist or herb doctor. As a result of this, I was treated with herbs as a child.
“Mother had always told me that red raspberry leaf tea would prevent miscarriage and was excellent for pregnancy and childbirth. When I became pregnant, I immediately sent for some raspberry leaf tea and began taking one cup of it each day, made from one teaspoon of dried leaves added to one cup of boiling water and steeped for 15 minutes. I had a very normal pregnancy. Then I went into labor, I truly expected to have an easy labor and delivery because I had faithfully taken the tea. While it is true that I did not have a complicated or extremely difficult time, it was not by any means easy. The tea had not lived up to my expectations.

“It was not until sometimes after the birth of my daughter that I read a book my mother had brought with her from Scotland entitled Dragged to Light by W.H. Box of Plymouth, England. In it I found the secret of just how to take the tea so it would truly work wonders during labor and delivery. Box said, ‘On one ounce of raspberry leaves pour one pint of boiling water, cover and let steep for 30 minutes. Strain, and when the time for delivery is approaching drink the whole as hot as possible.’

“There were a number of testimonials in the book written by women who had used this herb. Several took the strong solution over a period of time before going into labor. They were instructed in that case to take a wine glass full three times a day. They had ‘only two stiff pains and it was all over’ or ‘no after pains and very slight before.’ They never made it out of the house. Box’s instructions were, ‘But those who take the tea considerably before the time should not leave the house when the time is approaching as many mothers are delivered almost suddenly when at their work, to the great vexation of doctors and nurses.’

“When I became pregnant again I was determined to try it that way. I still took a cup a day as I had before. but this time when I went into labor I made a strong solution of it as I had read in the book. I put it in a container and took it to the hospital with me. I wasn’t sure how quickly it would work and I didn’t want to have the baby in the car. I didn’t think they’d allow me to drink it in the hospital so I drank half of it in the parking lot. I was afraid to drink all of it as it was so strong and I didn’t personally know anyone who had taken it this strong before. I had been having strong contractions but by the time I registered and was taken up to the labor room the contractions were so mild I hardly felt them. Upon examination they said I was ready to deliver and would not even give me an enema. In the delivery room I was quite comfortable and hardly felt anything. One hour after entering the hospital my son was born.

“In the recovery room there were several other young women who had just given birth also. They were moaning and groaning. I couldn’t imagine what they were making a fuss about as I felt like I could have gotten up and gone home. I had always read and heard about women getting after-pains with a second child. I never had even one. This was also the testimony of a number of women who were treated with the tea by Box.

“Later I thought I would have had an easy time anyway since it was my second child. I was anxious for someone else to try it.  A friend of mine was expecting a baby in a few weeks and she had been taking a cup of the tea daily and was also going to take the strong solution when she went into labor. She had had two previous pregnancies and both times nearly miscarried and had to take drugs and be in bed a good deal of the time. Both deliveries were extremely difficult. When she became pregnant this time she began spotting and it looked like she would have to go through the same kind of trouble she had before. Having used an herb I had given her for another problem, with success, she asked if there was an herb for this problem and I recommended raspberry leaf tea.

“She started taking it and the spotting stopped immediately and she had a normal pregnancy, much to the amazement of her family who remembered her difficulties in the past. When she went into labor she took the tea as I had and told me she had only 25 minutes of hard labor before her baby was born.

“I have told a number of women about this amazing herb through the years, but no one else seemed interested enough to try it. However, 1978 my daughter became pregnant and she was very much interested in having an easy delivery. She took the tea each day and had a normal pregnancy. She, too, took the strong solution of the tea with her to the hospital and also being a little wary drank only half of it. When the doctor examined her, it was late in the evening. He said the baby wouldn’t be born until six o’clock in the the morning so he went home. She was having hard contractions at this time and I was very disappointed and felt the tea hadn’t worked. An hour and a half later we recieved a call from our son-in-law saying we had a little grandson. The tea started working and the doctor had no sooner reached his home when he had to turn around and come right back to the hospital. My daughter said the next time she is going to drink all of the tea.”

Feb 12 – Meet The Doulas (Wash Park)

house-of-doula

Thursday, Feb 12
6:30 pm

Green Monkey Baby
1511 S. Pearl St.

RSVP

House of Doula is a great company that allows you to register for doula services just like you would register for a stroller or carseat.  This mixer is a place where you can mingle with the House of Doula doulas (myself included!) and find one you’d like to interview one-on-one at a later time.

Light refreshments will be served, bring your husband and/or children!

Call Amanda Glenn with any questions, 720.219.8482

Choosing a Birth Attendant

Most people see pregnancy as a time to prepare for the baby.  I see early pregnancy as a time to figure out what you want before you even go to your first appointment.  A lot of women don’t even think about the actual birth until a few months or weeks before the baby is born!  It can be difficult to make a change that late in the game.  You should choose the provider who has the same philosophy as you instead of hoping to change them by the end of the pregnancy.

Tips for choosing a birth attendant

  • Think about your core birthing philosophy.  Do you feel that birth is a natural physiological process?  If so, a midwife is your best bet.  Do you have physical issues that dictate that there could be a potential problem?  Do you see birth as dangerous with lots of opportunities for things to go wrong?  Then an OB might be your preferred provider.
  • Visit The Birth Survey, a consumer reporting site dedicated to birth.  Go to rate your OB, midwife, and place of birth.  As of now the site is just up and running and they should have formulated the results by Fall of 08
  • Get recomendations from people who share your birthing point of view, visit online forums (like mothering.com) and ask questions.
  • Interview your potential care provider.  Remember, they are working for you, not the other way around.  Related posts:  Interviewing your OB, Interviewing your Midwife, and Interviewing your Place of Birth
  • Create a birth plan well before your second or third trimester.  Going to your provider interview with a birth plan or at least an idea of what you want can help you ask the right questions.  Just make sure to not be negative or badger the doctor!
  • How much one-on-one, hands-on support do you want during pregnancy? Midwives generally treat the whole woman:  mentally, physically, socially, psychologically, spiritually.  Prenatal appointments generally last about an hour and they are usually there for the majority of labor and birth.  OBs on the other hand are primarily surgical specialists who have a prenatal appointment time of about five minutes and generally just come in at the end to catch the baby.
  • How much involvement do you want in your pregnancy and birth? Many times in midwifery practices the mom gets to do her own urine dip and weigh herself at her appointments.  The midwife tries to explain things to her and tries to get her to interact during her visits.  An OB visit is more in-and-out with the nurses doing everything behind the scenes.
  • Where do you want to give birth? Some women just go to an OB because they think they’re supposed to and then realize late in pregnancy that they want a home birth!  Where you give birth automatically dictates who will be there.  For example in Colorado at this time, OBs work in the hospital, only Certified Nurse Midwives (CNM) can work at a birth center, and Certified Professional Midwives (CPM) and CNMs can do home births.  Most CNMs (90-95%) work with doctors in the hospital.
  • Do you want to have a waterbirth? Some hospitals allow it, some do not.  If you have to give birth in a hospital and want to fight a policy that does not allow waterbirth, having a provider who supports it can go a long way.  Yes, it is possible to change hospital policy!  In Gentle Birth Choices Barbara Harper talks about how to do this.
  • Choose someone you’re comfortable with. If you’re not comfortable with your provider there is no way you can let your body open up and relax enough to have a baby.
  • If a provider or place (like home or birthing center) is out of your insurance network, talk to your insurance provider.  Also, often times a home birth or birthing center is cheaper even though you have to pay in full.  For example, in Colorado a typical, no-intervention birth in a hospital usually costs around $12,000-13,000.  In an insurance plan where you pay 10% of hospital and doctor’s costs you’re looking at a few thousand dollars.  A home birth or birth center birth usually costs around that if you’re paying in full.
  • Do you feel more comfortable with a male or female doctor?  Remember that just because a doctor is female doesn’t mean she believes in the same birthing philosophy as you do.

Interviewing Your Midwife

Know your Midwife

It is so important to know what you’re getting into before you’re in labor!  Interview any OBs, midwives, hospitals, and birth centers you are considering and make the best decision for you.  Also, a great new website, The Birth Survey, provides consumer reporting for doctors, midwives, and hospitals (at this point you can take the survey, but the results are said to be formulated by Fall 2008).

Here are some questions to ask your Midwife to make sure you find one who is on the same page with your birthing beliefs.  These are taken from Gentle Birth Choices, written by Barbara Harper, 2005, p. 249 (a great book, also in my library).

  1. What is your education and training as a midwife?
    It is good to discern if you are hiring a certified nurse-midwife (CNM), a certified professional midwife (CPM), or a direct-entry midwife.  Find out what their training or midwifery school was like.  The three groups represent vast differences in educational experience but not necessarily in the way they practice.
  2. What kind of testing or licensing procedure did you go through to become a midwife?
  3. How many years have you been practicing?
    Do you want to trust a midwife who is just starting out in independent practice or do you continue your search for a more experienced midwife?  Find this out right away.
  4. What is your general philosophy about pregnancy and birth?
    Midwives in general hold the philosophy that normal birth is not a medical event and needs to be respected for the creative process that it is.  I would be surprised if you found a midwife who viewed birth as a potential emergency to be prepared for.
  5. Are you a mother yourself?  How old are your children now?
    If you are choosing a midwife with young children, how will she be able to attend your birth if there are family needs?  Are you open to her bringing her young children and perhaps nursing child with her to your birth?  Ask her to share her birth stories with you.  Many women become midwives after a not-so-wonderful birth experience.  Find out about your midwife’s births.  Some argue that midwives who have never given birth cannot be as good as those who have had children.  I don’t agree with this assumption; I know some wonderful, talented, caring midwives who have not had the opportunity to give birth.
  6. Do you work alone or with a partner or assistant?  If you work with someone, what is his or her experience?
    It is important to meet all the people who will have any responsibility concerning your prenatal care, labor, or birth.  Some midwives take on apprentices or students.  Find this out in the beginning.
  7. How many births have you attended as the primary caregiver?
    How long has your midwife been in independent practice?  Has she always worked with an experienced partner?  You may ask for references from former clients.  Some midwives provide a chance for past clients and future clients to meet each other at informal classes or support groups.
  8. Do you attend births in a birth center or hospital?
    Perhaps this midwife has hospital privileges or attends births at home or in a birth center.
  9. How many births do you typically attend each month?
    For a home-birth practice, the most births that one midwife with one assistant can possibly attend is six to eight per month.  If she tries to attend more, there could be two women in labor at the same time, leaving one with no coverage.  Midwives in birth centers can handle many more births per month because they can attend more than one laboring woman at a time.
  10. Who takes over for you if you go on vacation or get sick?
    A very important consideration is who will take over the midwife’s practice if she is unable to continue or needs to leave for a certain period of time.  Make these plans with your midwife early on in your pregnancy.  Know that if you will be covered if anything happens to your midwife.
  11. Do you have guidelines or restrictions about who can give birth at home?
  12. Are these your policies or those that the state licensing requires?
    A midwife should have the same screening criteria as a doctor screening for risk factors.  Depending on licensing status, some midwives must refer to a physician for cases of breech or twins or even VBAC.  Other states have less restrictive or no guidelines.  This must be discussed.
  13. Do you require that I see a physician during my pregnancy even if everything is all right?
    A visit to a backup physician is usually in order just so you can meet and he or she can establish a chart on you.  If your midwife does not have an active relationship with a backup physician, it may be your responsibility to obtain a doctor and see him or her.
  14. What are your fees and what do they include?
    Just as with a doctor, most midwives’ fees cover all prenatal care, birth, newborn assessment, home care, and follow-up for six weeks.  Any lab tests, diagnostic tests, or extra doctor’s visits are not included.  Also not included are the costs of a hospital transfer, including ambulance, hospital, and doctor’s fees.
  15. Can you submit your charges to my insurance company?
    Many CPM and CNM services are covered by health insurance plans or state-funded Medicaid programs.
  16. What payment arrangements do you make?
    Most midwives will make an affordable arrangement to take payments throughout pregnancy.  Many even have payment forms and billing systems on their computers.  Payment of services in full is usually required before the birth.  Be considerate about the midwife’s bill and make clear and early arrangements for payment.
  17. How often will I see you?
    Visits are scheduled once a month until the seventh month, every two weeks until thirty-six weeks, and once a week after that.  Extra appointments can be scheduled at any time between regular visits.
  18. What are your guidelines concerning weight gain, nutrition, and exercise?
    Nutritional status will be monitored throughout pregnancy.  Most midwives focus on the importance of a healthy balanced diet and work with women to get the most out of what they eat.  Many midwives have special education in the use of herbs, food supplements, and homeopathy for pregnancy.
  19. Do you require that I take a childbirth education class?  Do you teach a childbirth preparation class?
    Midwives will often teach their own preparation classes.  Some midwives feel that they give so much individualized attention that couples do not need extra classes to prepare for birth.
  20. If I am planning a home birth, do you visit my home before I go into labor?
    Midwives generally make at least one home visit before they come to the house for labor.  They assure that the home is adequate and clean, and they help plan any necessary details with the couples, such as where the birth pool should go.
  21. When should I call you after my labor begins?
    Each midwife sets her own protocols about when and the reasons why to call after labor begins.  Generally midwives want to know as soon as contractions begin so they can plan their day (or night).  Some midwives will have apprentices who come right away, others arrive when they are needed.  Most encourage women to enjoy the early stages of labor and to get plenty of rest and eat if they are hungry.
  22. How do you handle emergencies?
    Ask very carefully just what kind of emergencies she is prepared to deal with and has dealt with in different situations.  A very experienced midwife may have different answers from someone just graduating from midwifery school, but their protocols should be very similar.
  23. In what situations would I need to go to the hospital?
    Find out exactly why you might be transported.  Transports can sometimes be an emergency, but more than likely they are for women who have been laboring for more than a day and become exhausted.  Find out what your midwife’s transport rate is and evaluate it.  Most home birth midwives and birth centers have a rate of less than fifteen percent.
  24. Would you stay with me in the hospital?
    Most midwives can accompany their clients into the hospital and stay with them, but in some states where midwifery is still illegal, the midwife cannot come into the hospital and admit that she has been attending a home birth.  Find out if your midwife has a good working relationship with a local hospital.
  25. What is your experience with water for labor and birth?
    Midwives traditionally have used water for pain relief during labor.  Many are now advocating its use by all of their clients.   It is difficult to find a midwife today who doesn’t use water in labor or for birth.
  26. Can I give birth in water?
    Ask if your midwife has access to a birth pool for her clients or if she knows where you can rent or purchase one.  Find out if she truly supports the option of waterbirth.  I have talked with many women who have said that their midwives talked about waterbirth prenatally and even encouraged water labor, but then asked the mother to get out of the birth pool at the last minute.
  27. How ‘hands off’ are you during a birth?
    Is your midwife is willing to “allow” the family to conduct the birth under her supervision?  Ask if she is willing to give you complete control.  Will she encourage or instruct you and your partner when and how to catch the baby?  Will she leave you alone in another room if that is what you want?  How involved can your children be in the labor and birth?
  28. What is your experience with breech births?  How many have you attended?
    Breech may be beyond the scope of practice for some licensed midwives.  Others handle it just like any other birth and specialize in breeches, especially in water.
  29. What in your experience with twins?  How many have you attended?
    Twins may also be beyond the scope of practice.  Find this out before you make further plans. (It is also illegal to have twins anywhere but in a hospital in Colorado)
  30. Do you cut episiotomies and suture perineal tears?
    Home-birth can birth-center midwives usually have an episiotomy rate of close to zero, but tears do sometimes happen during birth.  Unless your midwife sutures well, you may need to travel to a hospital if you need stitches.  This might influence your choice of practitioners.
  31. What is your experience with a VBAC?
  32. Will you attended a VBAC at home? in the hospital?
    Many midwives cannot legally attend a first-time VBAC at home because of licensing restrictions.  Some are willing to look the other way in order to give the woman a chance.  This is a very serious consideration that requires much discussion with your midwife.
  33. Have you ever had to resuscitate a baby?
    Assess the resuscitation skills of the midwife.  Midwifery organizations and nursing schools teach courses in neonatal resuscitations, and your midwife should have a current certificate.  As to see it.  Ask if her resuscitation course focused on the latest information about the consciousness of newborns.
  34. What kind of equipment do you bring to a birth?
    Find out what kind of drugs, oxygen, resuscitation equipment, intravenous (IV) equipment, and other emergency equipment your midwife keep sin her bags.
  35. Do you examine the baby after birth?
    Midwives perform a normal newborn exam on the baby usually an hour or two after the baby has been born and breast-fed.  Assess from the midwife what her routines are for newborn exams and what she uses for eye drops and vitamin K.  She may use alternatives such as oral vitamin K.
  36. Will you help me with breast-feeding?
    Midwives should be on call twenty-four hours a day, seven days a week, for all problems after birth, especially breast-feeding.  Many even have special classes or private sessions to evaluate breastfeeding readiness and answer any questions.  Some have great relationships with lactation conselors or consultants for more difficult problems.  Babies born without medications usually have an easier time breast-feeding, but that doesn’t mean every mother automatically has an easy time.
  37. How often do you come to see me after I give birth?
    Home-birth midwives generally come back for follow-up visits after twenty-four hours, two days, five days, and ten days.
  38. Do you provide or know of anyone who will help new mothers after birth?
    Some home-birth services provide a postpartum doula or can recommend one for help after the baby’s birth.  There is generally an extra charge that is well worth every penny.
  39. Do you have a pediatrician you work with or recommend?
    Some naturopathic doctors who attend home births automatically become the pediatrician.  Midwives often have collaborative relationships with pediatricians who support home birth and possibly delayed immunizations or not immunizing at all.  Interview pediatricians the same way you would your provider.
  40. How do you feel about circumcision?
    I don’t know of very many midwives who will present both viewpoints about circumcision unless their clients are Jewish or Muslim.  If there is a religious consideration, the thoughtful midwife will support her clients’ decision.