Tis the season...for inductions

As a doula and child birth educator I am always a bit unnerved come November, the number of inductions always seems to spike between November and December. I know that the thought of a bundle of joy arriving as the holidays arrive is lovely, but unnecessary inductions carry a lot of risks. Often it’s the OB who pushes the induction,  frequently citing reasons that aren’t founded in evidence. Risks of induced labor can include:

·        Increased risk of needing an emergency cesarean section (C-section)

·        Complications from Pitocin  

·        Respiratory complications for the baby

·        Oxygen deprivation, which can reduce your baby’s heart rate

·        Infection, uterine rupture, and excessive bleeding for the mother

·        Complications with lactation and breastfeeding

And a number of other issues. Statistically speaking women who have an induction are significantly more likely, according to the national library of medicine , to have a cesarean which carries it’s own risks including:

·        Your incision, uterus and other parts of your body, like your belly and bladder, may get infected. 

·        You may lose a lot of blood and need a transfusion.

·        Organs near the uterus, like the bladder and intestines, may get injured during surgery.

·        You may get blood clots in your legs, pelvic organs or lungs

·        You may have bad reactions to certain medicines, including anesthesia you get during surgery.

·        You may have an amniotic fluid embolism. This is a rare condition that usually happens during or right after a tough labor and birth. It happens when some of your baby’s cells, hair or amniotic fluid (fluid that surrounds your baby in the uterus) gets into your bloodstream and moves to your lungs. This can cause the arteries in your lungs to become narrow, which can cause problems like a fast heart rate, irregular heartbeat, heart attack or death.

·        Although it’s rare, you’re more likely to die during a c section than during vaginal birth

While there are many legitimate reasons to be induced in today’s modern world it is often pushed without merit. I want to address something, I am not a doctor but you do not have to be one to notice the direction our maternal healthcare is headed. In the united states we have extremely high rates of infant and maternal mortality, more than other developed nations. This is especially true for birthing people of color who are 4-6 times more likely to die during childbirth. It is impossible to talk about the overuse of inductions without mentioning the issue of maternal mortality.

So what can you do about this unfortunate trend? Well let’s talk through some common reasons that babies are induced

-baby is “big”

-“slow” labor

-multiples

-“overdue” / full term

-high blood pressure (when pre-e has been ruled out)

-“small” pelvis

-breech baby

-birthing person with gestational diabetes

-OB wants to be home for Christmas finally (yes this does happen but no it will not be what your doctor tells you is the reason)

So let’s talk about a few of these, jumping in with the myth of the “big baby” … Yes big babies happen but here’s the thing ultrasounds to predict big babies are wildly inaccurate and many women are fully capable of going into labor and delivering said big baby without induction. The failure of labor to progress on the timeline that your OB feels is best is another common reason we are induced. The supposed “slow” labor is easy to explain, sometimes person “A” will take longer to bring baby earth-side than person “B/C/D/E” ect. Okay so next on the list “full term” (let’s also talk about “overdue” as well because they go hand in hand), you know what else is wildly inaccurate? DUE DATES! Yes, as you might imagine due dates are quite hard if not impossible to guesstimate based on last menstrual period. This causes many birthing people to be pushed (no pun intended) to induce when this mystical “due date” arrives. This is why we hear stories of folks delivering at 43 +5 or whatever other hard to imagine overdue gestational date. Babies are not cakes, they do not need to be removed from the oven right at 40 weeks nor are they going to necessarily overcook if left to arrive on their own time. Finally let’s talk about the OB who wants to FINALLY be home with their family for Christmas, yes this is a hypothetical but it does happen. OBs are people and this means that they can make choices based on their own needs, not necessarily based on the needs of their patients. With how spooky-common inductions have become many OBs are happy to induce if the birthing person seems willing and they can come up with a reason. This is not meant to be an OB shaming post, many OBs are fantastic people who care for birthing people with skill and love. I do not want to come across like I think all OBs are bad so I had to make that clear.

What can you do if your doctor wants to induce you for a non-emergent reason? Well this might seem overly simple, but the answer is……… say no. You must remember you are the boss in this situation. Your body, your choice. Polices are also not laws, maybe your hospital or doctor doesn’t “like” folks to go past 40 weeks but that does not mean that you can’t. You can advocate for yourself or you can enlist the help of your partner or family member. As your doula I can help you advocate for yourself and I will always be happy to provide you with evidence based information. I want to reiterate a few things

-I’m not a doctor

-sometimes inductions are medically needed

-sometimes they aren’t

-I’m not shaming all OBs, rather I’m pointing out the issue of the overuse of induction

-you have the ultimate say in what happens to your body during pregnancy, labor and birth

-holidays are not a reason to induce

I truly hope this blog post can help folks this holiday season be able to identify when they might be being pushed towards an unnecessary induction. If you are in need of a doula, child birth educator or lactation professional please be in touch. Be sure to like my page on facebook.

 

It's normal to feel crazy! Postpartum mood disorders explained

 

Trigger warning: mention of intrusive thoughts, mental illness and postpartum psychosis

 

This blog is going to focus on postpartum mood disorders, what is normal and what isn’t. 70% of new moms experience something called “baby blues” it usually comes on quickly and resolves itself 10 or so days after making its appearance. Baby blues symptoms include:

 

-feeling of malaise

-mood swings

-tearfulness

-exhaustion/fatigue

 

Sounds pretty normal since we all know how much birthing takes out of us. It is reasonable to expect some level of emotional disturbance while adjusting to life as a new mom. Tracking your mood is a brilliant idea if you’re someone who has a mental illness, as this can predispose you to a higher likelihood of postpartum mood disorders. Baby blues is fairly benign and resolves itself within the first few weeks postpartum.

If it’s been more than two weeks since the onset of these issues you might be experiencing something called postpartum depression, which affects some 30% of new moms. Postpartum depression is more severe and long lasting than baby blues. Postpartum anxiety is another condition many women face after birth. PPA & PPD are both treatable, the main way to find relief is to get enough support. We all know in this day and age few moms have the “village” we are all told we need to raise children, many of us are isolated and over worked. Especially here in the US where we are not guaranteed paid maternity/parental leave. With older folks needing to continue to work to stay afloat we also don’t always have the “grandma” or “grandpa” figurehead to look after our little ones or more importantly us. Our culture looks over how transformative and traumatic giving birth and caring for children can be. I feel, personally, that if moms and parents had the proper support and education we’d be able to cope and thrive so much better than we currently can. Finding support to help with your PPD is still possible though, it can come in the form of a PPD support group or new moms support group. Simply use google or contact your local hospital to find information. The other pillar to caring for yourself and healing from PPD/PPA is self-care. If you are overworked, dehydrated, exhausted, hungry and lacking physical movements it is to be expected that you will feel shitty. I know many of us are not privileged enough to be able to take care of ourselves in the optimal way but we all can try to focus on pieces and work towards better self-care. Even carving out an early bedtime or 15 minute pre-bedtime yoga on youtube can go a long way.

There are some aspects of PPD and PPA that we don’t hear enough about. First of all as a society we need to let the fuck go of equating struggling with not being a good mom. It’s okay to be sad or anxious, that DOES NOT mean you are less than or that you don’t love your kids. Our society does a pretty piss poor job in normalizing how rough and dark parenting can be. I’m going to get a bit personal here so bear with me, I had PPD& PPA with both of my kids. With my first I had just turned 16 and knew literally nothing about postpartum mood disorders. I thought if I said I was sad or anxious or had “bad” thoughts one of two things would happen

1: I’d be labeled a bad mom

Or

2: I’d be labeled as crazy

I did not want my mothering skills further questioned. I was already young, beyond broke and overall ill-equipped at this whole motherhood thing. I visited a therapist once after coming to terms with the fact that I needed help but walked out mid-session because I felt he was blaming my mood on my baby, which in retrospect wasn’t wrong. I was just so overly sensitive and ill-informed that I would not let the connection between my new baby and my mood be made. It is worth noting that prior to being pregnant and giving birth I struggled with anxiety and OCD. My OCD manifests (present tense because I still struggle with it) as intrusive thoughts. Usually now it’s more along the lines of “where is your wallet, it might have disappeared get up at 2am and go make sure it’s still where you left it” but during my PPD with my oldest it was “what if I put my baby in bath and walked away” “what if I jumped into the river” let me say these thoughts were NOT things I WANTED to do, I didn’t want to hurt myself or my baby. These thoughts were intrusive meaning they came when I did not want to be having them. Aside from speaking with my partner about this I’ve never really mentioned this to anyone, but it needs to be said. I never hurt my baby or myself, there is a very clear line between intrusive thoughts and thoughts of self-harm. If you are experiencing the desire to hurt yourself or someone else that is the more rare “postpartum psychosis”. PPP is dangerous and needs immediate care, if you feel any of the following get help ASAP:

 

-desire to hurt yourself or your baby or anyone else

-hearing voices or seeing things that aren’t there

-a feeling that you or your baby are connected to god or the devil

 

PPP is a tragic illness that has resulted in the loss of life for moms and babies. We hear terrifying stories like that of the mom who drowned her kids in the bathtub to reunite them with angels or whatever it was. We all are so quick to assume that moms who snap like that are evil or bad when in reality they might just be mentally ill. A break from reality and time unsupervised can be all that’s needed for a tragedy to happen. I think the more we can openly discuss how normal mood disorders are the less stigma and shame they will carry. With less stigma and shame we can better ask for help and care for ourselves.  If you feel crazy talk to someone it is normal darling! PPD and PPA are temporary, you will feel better one day. PPP requires immediate treatment, if you or someone you know has any of those symptoms call someone and get to the hospital IMMEDIATELY! Having support can be immeasurably helpful for mood disorders. Take care of yourselves and check back for more blogs later!

Love & light,

@amberthedoula

@villagebirthandpostpartumcare

Why hire a doula

This is a question I’ve heard asked many times. There are many answers depending on who you ask. I’m going to focus on the evidence-based answers first. According to the 2012 Cochrane Review birthing people who received continuous labor support were:

-more likely to give birth spontaneously

-less likely to give birth via c section

-less likely to need interventions like forceps or vacuum

-less likely to use pain meds

-more likely to be satisfied with their birth experience

-had shorter labors

In addition to these demonstrable benefits there are also several other possible pluses we can discuss. First, I want to say that there are a variety of types of doulas including (but not to limited) birth doulas, postpartum doulas, fertility doulas and infant loss/still birth doulas. I am a doula who offers all those options. I personally offer virtual services in addition to in person services. The advantage of this is support on demand, all you need is access to your phone and you have the support of an experienced and trained doula. Doulas don’t just benefit the birthing person they also help support your birthing partner and family. I offer help to partners in how they can best support their birthing partner during pregnancy, birth and during the postpartum period. I also offer education on how to prepare older siblings for the new baby’s arrival. I offer classes as well, they are still being ironed out but will be available soon and will cover a range of topics including pregnancy, birth, baby care, home birth, breastfeeding, postpartum meal prep and a few other subjects (feel free to email me with any ideas you might have). The postpartum period can be very bewildering and having someone to lean on during this time can be a huge help. Wondering if baby is eating enough? Worried about your mood? Give me a ring and let’s chat, while I am not a medical professional (yet... I am working to get my IBCLC certification) I do have an extensive education and can point you in the right direction. Even if all you need is someone to cry to about how happy/sad/tired etc. you are I am here, doulas do that too. I personally specialize in doula support for teen parents, LGBTQ parents and sex worker parents. I offer low cost services to folks in these groups (and to low income folks) based on your abilities and I will work with any budget. Hiring a doula can be helpful regardless of the type of birth you want. What kind of birthing person hires a doula?

-one who’s giving birth at home

-one who’s giving birth at a birthing center

-one who’s giving birth in the hospital

-one who wants no interventions

-one who wants pain meds

-one who’s having a VBAC


-one who’s having a HBAC

-one who’s having an emergency c section

-one who’s having an elective c section

-one who plans to nurse

-one who plans to bottle feed

-one who has a supportive partner

-one who is single

I could keep going but I think you get the point, ALL birthing people can benefit from the support of a doula. The cost of a doula might be a concern for you, but don’t fret, there is a huge range in price and cost of services. As I mentioned I offer discounts and low cost services for marginalized groups and to low income individuals. When I started this company my goal was to never turn someone away because of their financial status. If you’ve read my other blog about my experience as a teen mom you’d know I know just how important support, education and advocacy is. The lack of that contributes to birth trauma and infant/maternal mortality. The more we can normalize hiring doulas and make available birth workers to all types of birthing people the better we can manage these issues. To wrap things up neatly, hiring a doula has evidence based benefits and can help offer you emotional support. Doulas are for everyone and you don’t have to be a well off crunchy parent to hire one. Don’t hesitate to reach out to me about any questions you have about my services or about doulas in general. I’m happy to help!

@amberthedoula - Instagram

@villagebirthandpostpartumcare -Instagram & Facebook

You can't pour from an empty cup, take care of yourself

There's no shame in asking for help...
A phrase we hear thrown a lot these days is "self care" this blog is going to focus on what that is and how to make it a part of your life. Browsing IG you might see #selfcare loaded with pictures of lux bubble baths, spa days and a variety of expensive and "fancy" things. Self care can very well include these things but it doesn't have to. Self care doesn't need to cost a ton and it means different things for different people. Some ways to practice self care without spending a dime include:
-saying no to a commitment you don't want to do
-being sure to drink enough H2O/feed yourself
-going to bed early
-making time to call a friend and chat them up
-spending a few extra minutes in the shower
It really doesn't need to be complicated. 
As moms (or parents) selflessness is praised, the mom doing it all is like a super hero. We don't seem to acknowledge how exhausting and unsatisfying parenthood can be. How that "super mom" might be neglecting herself to get it all done. You can't pour from an empty cup though, eventually all that selflessness can catch up to you. Hello mental breakdown! Maybe it's not a full blown breakdown that will happen from over extending yourself but even a lingering cold or headache can really bring you down when you're not caring for yourself. Your family will fair better if you say no to the PTA's request that you make 1000000 cupcakes tonight or if you decide to call it an early bedtime so you can watch your favorite show and decompress. If we hope to raise well rounded people we need to teach them how to practice self care, no better way to do that than to lead by example. Our kids need to know that it's okay to be over it, tired or to not feel okay. It's how we react to those "bad" feelings that makes or break us. Sometimes doing nothing is the best thing we can do. Self care and mental health are intertwined and we can't talk about one without the other. We hold up the idea hat moms do it all and are always exhausted and tired but it doesn't have to be that way. I'd much rather us look up to the mom who says "no" when she needs to. The mom who skips a night of gymnastics because shes too tired and has her partner do it for once. We take so much on and seem to feel very guilty about doing any less than everything. We have to let go of that guilt, for our own sake and for our families. Guilt holds us back, it clouds our better judgement. There is no shame in taking care of yourself. There is no sham is saying no. If you take anything from this blog let it be those to things. 
Take care of yourselves :D Parenthood is a marathon not a sprint so take it slow. Say no when you need to. 

My experience as a teen mom

I vividly remember finding out I was pregnant for the first time. I was nervous and overwhelmed. I was with two friends in the bathroom of a food lion, I had been suspecting I might be pregnant but was still shocked to see that little plus sign. I know for many people finding out they are expecting is a joyous moment, but not when you’re 15. Yep, that’s right I was a pregnant 15 year old. I gave birth to my son a few weeks before my 16th birthday. I was a sophomore in high school at the time. I was so scared and did not want to tell my mom, who I knew would be devastated. My mom herself had been a teen bride and mother and did not want the same experience for me. I planned to wait and tell her when I started to show and couldn’t hide it anymore but after educating myself on prenatal care I knew that wasn’t an option. After getting home from school I decided “okay, this is it I’ve got to tell her” so I found an almost dry brown marker and scratched out my profession onto a scrap piece of paper. When she got home from work I gave it to her along with a paper bag with a positive pregnancy test inside. She was devastated, she was crying and shouting and went outside and just lost it. The memory of her reaction is seared into my mind. I was so heartbroken that I had done this to her. Once she calmed down she told me it was my choice if I wanted to keep the baby or not, they would support me either way. The caveat to keeping the baby was I had to remain in school and take care of the baby. I decided to keep him, I vowed to do well in school and give my kiddo the life they deserved. I had a fairly normal pregnancy and gave birth to him around 37 weeks. His birth was traumatic, to say the least, and is in part what inspired me to become a birth worker. I had been complaining about swelling and headaches to my OB/GYN explaining that according to my own research my symptoms pointed to PREE. I was laughed off, told not to read webmd and overall ignored. About two weeks later I felt faint and was admitted to the hospital. Turns out I did have PREE, this experience of being ignored was very traumatic and greatly affected me as a mom and person. I was induced and given Pitocin, one intervention lead to another. I wanted to have a medication free delivery but clearly that was not happening. I at least wanted to avoid pain meds but was encouraged to use them, being told I didn’t need to be a hero and would get them eventually. I labored for 22 hours with no pain meds before getting an epidural because my cervix was not dilating. A dip in his heart rate made my OB insist I go for a c-sec, I remember him saying I could carry on with my labor but to do so would be selfish and risking my son’s life. I conceded and was given an “emergency cesarean” I put that in parenthesis because I feel perhaps under other circumstances my birth could have gone differently. I was grateful to have a healthy baby, that’s what they say “at least your baby is healthy” as a way to unwrite and undervalue the trauma of a “bad” birth. It took years for me to fully process what happened during his birth and I’m still working through it ten years and another kiddo later. I developed a keen intertest in childbirth and decided to become a nurse, I just had to finish high school first. I went back to school after 7 weeks at home, my son couldn’t start daycare until 8 weeks so a close family friend watched him for that inbetween week. Returning to school was hard, I was pumping so I could give him breastmilk. I showed up to school that first day with my backpack and pumo ready to see how hard this was going to be. I had arranged with my guidance counselor to pump during my lunch in the drama dressing room. The son of a bitch teacher I had to get the keys for said dressing room from was one of the most unpleasant people I’ve ever met. Everyday I’d go in and ask and he’d make me loudly explain why it was I needed the keys, like he didn’t remember. He’d then slowly remove the keys eating in to my precious 20 minutes of pumping time. I ate my lunch while pumping. I dreaded asking for those keys. I had pretty awful PPD and PPA and asking for “the keys” was a huge trigger. Despite all that I kept trudging on, I pumped the entire year and met my breastfeeding goal of 12 months. I made great grades in school and did what I needed to to secure a seat in a nursing program. My senior year was much better than my junior year. My baby was now a toddler and I was out of the woods with PPD. I was doing very well in school, making a 4.0 GPA for the first time in my academic career. I was on track for starting nursing school, which included getting enrolled in night school to get my CNA certification. I got my first job as well, no easy feat during the recession when many “teen jobs” were being eaten up by folks who needed the work. I was hired as a kitchen helper at Sonic drive in. It was a crappy job and paid shit but it was a job. I was so busy and exhausted but it was nice in it’s own way. Now at 25 I wouldn’t want to be so busy like that, looking back I see how damaging that was to my emotions to be stretched so thin. I received my acceptance letter into nursing school and I was pumped. I moved out on my own a few months before school ended and felt that I had overcame what many would assume to be a damning sentence (having a kid while still a kid  myself). Learning to parent, care for myself, care for my son and balancing it all took years. My oldest son just turned 10 yesterday and I felt it appropriate to get this out in writing. Starting my blog out with something so raw and honest felt right. I hope any young moms who read this find some comfort in hearing that while it is hard time passes and you will gain your footing.