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What You Need to Know About Nitrous Oxide in Labor

12/12/2018

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nitrous oxide for labor
Curious about nitrous oxide as pain relief in labor?
If you are pregnant, sooner or later you will think about how to manage the pain of labor. Some clients know they want to get an epidural, and others would prefer to either forego pain medication entirely, or see how they feel in labor and make a decision in the moment.

Pain management and comfort measures are topics I discuss at length with my clients in our prenatal meetings. When clients want to avoid or delay pain medication, we talk about natural pain relief methods like counter pressure, hydrotherapy, heat therapy, and position changes. 

When clients are open to pain medications, but want to avoid or delay an epidural or narcotic medication, nitrous oxide can be a great option.

Nitrous oxide has been used by laboring people in the United Kingdom, Australia and Canada for decades. The ACNM (American College of Nurse-Midwives) supported its use in a 2011 position statement, affirming nitrous oxide as a pain relief option that fits into the midwifery model of care. 

​While nitrous oxide was once frequently used in United States, in the 1970’s its use declined as epidural analgesia surged in popularity.  As of 2017, one report stated that nitrous oxide was available in only around 150  hospitals and 50 birth centers nationwide. 

Fortunately for those in the Treasure Valley, both major hospital systems, St. Lukes and St. Alphonsus, offer nitrous oxide, also known simply as “nitrous,” in their labor and delivery rooms.

With all interventions, there are benefits and risks. Here’s what you need to know if you are considering using nitrous oxide in your upcoming birth:​

The Benefits of Nitrous Oxide in Labor

  • It doesn’t affect the normal progress of labor. Often with an epidural, pitocin (artificial oxytocin) is used to compensate for reduced uterine contractions. Nitrous doesn't interfere with the normal course of labor.  It can also be used at any stage, from early labor to the pushing stage.
  • Your movement is not restricted. Although you may have to remain close to the nitrous tanks to utilize the gas, you can labor in any position: standing, squatting, bouncing on a birth ball, on all fours, etc. While you can lie in bed while using nitrous, you aren't limited to the bed as you would be if you were administered an epidural.​
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  • You are in control. You administer the nitrous oxide yourself by holding your own mask; when you don’t want it anymore, you remove the mask. With other pain medications, like narcotics and with the epidural, if you have a negative reaction you may have to wait until the medication runs its course through your system, or you may not have the option to discontinue its use until after your baby is born.
  • Its effects are immediate. As soon as you breathe in the gas (which is actually a 50/50 mixture of nitrous oxide and oxygen), you begin to feel its analgesic (pain relieving) effects. As soon as you remove the mask, the gas dissipates quickly and its analgesic effects stop almost immediately.
  • It may help you breathe more efficiently. Often people tense up during contractions, and they forget to take the deep breaths which help them more effectively manage their pain. Because you have to take deep breaths into the nitrous mask to get its full effects, you may be better able to regulate your breathing, ensuring you get enough oxygen and helping you to remain calm.
  • It does not affect infant alertness at birth or interfere with breastfeeding. Pain medications like narcotics and the epidural can cause your baby to be “sleepy” at birth, which can delay the initiation of breastfeeding, or result in lower Apgar scores. These effects are not seen with the use of nitrous oxide.​
boise doulas
  • No drop in blood pressure, so no need for an IV. Epidurals cause a decrease in blood pressure. An IV is required when you get an epidural to help keep blood pressure stable.
  • No catheterization is required. When you get an epidural, a catheter is inserted into your urethra to catch urine. There is no such need when using nitrous.
  • No risk of maternal fever. When you get an epidural you are more likely to experience hyperthermia, or a rise in body temperature. Sometimes this manifests as a clinical fever, which can pose risks to the baby.
  • Continuous fetal monitoring is not required. When you get an epidural or narcotic medication, you will be continuously monitored for signs of fetal distress. (With narcotic medication you can usually revert to intermittent monitoring after a time). While this monitoring is usually external, sometimes internal fetal monitoring becomes necessary. No additional monitoring is required when using nitrous.​

The Risks, or Downsides of Nitrous Oxide in Labor

  • Nausea or vomiting. Some people don’t tolerate the gas well, and find that it makes them feel nauseous. If this occurs, you can discontinue its use and move on to another method of pain management. Know that nausea and vomiting are common symptoms in active labor, whether or not you utilize any pain medication.
  • Dizziness. Some people experience an uncomfortable dizziness or lightheadedness. You may choose to stop using the nitrous, and this feeling should go away.​
labor support boise
  • Nitrous oxide doesn’t completely eliminate pain. My clients who have used nitrous explain that they can still feel their contractions, but they feel more relaxed when managing them.
  • You must hold the mask yourself. The laboring person is required to hold the nitrous mask to their own face as a safety measure. If you become too dizzy or faint, the hand holding the mask will naturally fall away from your face, and the nitrous will dissipate. Some people find holding the mask cumbersome or tiring.
  • Long term effects on fetuses and newborns are unknown. While the use of nitrous oxide has been shown to have no effect on newborn alertness, the long term effects of exposure are unstudied. One study showed neurological dysfunction in rodents when given at high doses, and there have been some concerns about harmful reproductive effects from prolonged exposure in heath care workers.
  • Certain populations may have negative side effects. Those with Vitamin B12 deficiency, the MTHFR gene mutation, acute asthma or lung disease, or bowel obstruction are at risk for harmful side effects from using nitrous oxide. Consult your care provider if you fall into one of these at-risk groups.
I am a certified labor doula (birth doula) and postpartum doula serving clients in Boise, Eagle, Meridian, Nampa, and the Greater Treasure Valley. 
Are you considering using nitrous oxide in labor? Would you like more information about it?
Let's Talk!
elevated birth
​Copyright 2018
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5 Tips to Handle the Holidays While Pregnant

11/19/2018

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Boise doulas
Modify your plans, minimize your stress
It’s the holiday season, and that means interaction with family members you may see just a few times a year. Even if you have wonderful relationships with your extended family, if you are pregnant around the holidays, conversations can get difficult when talk turns to your plans for birth. Everyone seems to have an opinion to share about what you should or shouldn't do, or they offer a prediction of how your birth will go. 

Here are five tips to navigate the holidays while pregnant:

1. Modify your holiday plans. Modify your plans, and minimize your stress. If you usually host a family gathering, ask someone else to host this year. Plan on bringing in prepared foods instead of cooking, or make the dinner a potluck event. 

Can you limit family time this year? Use your pregnancy to your advantage. Perhaps you stay for just a few hours at your sister’s house instead of the whole day. Or take a nap while everyone else is watching football. 

If you are nearing your estimated due date, your care provider may actually warn against you traveling more than a couple of hours from your home. That means you can avoid a prolonged visit with family altogether, if that is your preference.


2. Prepare for difficult conversations. Chances are, your family members are excited about the new addition to their own extended family. But instead of only sharing in your excitement, they may also feel the need to share their opinions.

Conversation will inevitably turn to your pregnancy, and will likely consist of three topics:
  • Questions about where and how you plan on giving birth 
  • Their opinion on your answers, and
  • Negative stories about their own births or those of people they know

If you are making choices for your birth that are different from those your family members have made for themselves, be prepared for push back. You might hear things like, “Just you wait! You have no idea!” or “You’ll change your mind!”

If your choices are vastly different, you may even hear things like “You are putting your baby’s life in danger!” or “You are being selfish.”

With pregnancy hormones at play, and if you yourself are still navigating your birth options, these conversations can get heated, emotional, and very difficult.

If you anticipate these conversations in advance, you can avoid feeling blindsided. You might tell your family before the event (or have your partner tell their family) that you don’t want to have these conversations at all. Or, you may choose to be more selective or vague in your answers to probing family members.
home birth boise
Expect difficult conversations about your pregnancy
3. Practice disengaging. Sometimes these difficult conversations can’t be avoided. Maybe your relatives already know your plans for birth and they are using this holiday gathering as one more instance to voice their disapproval.

In these situations, don’t try to defend your choices, or try to convince your family members to accept them. Instead, answer their questions or comments with a neutral phrase, like, “Hmmmmm” or “Huh!”

​Or you can make them feel heard and say, “You know, that gives me something to think about.” 

Sometimes, you may feel the need to stop the conversation entirely. You can say, “Thank you for your concern. I don’t want to talk about this anymore.” Or redirect the conversation to another topic: “Okay. Hey, congrats on your promotion. How do you like your new job?”
pregnancy massage boise
Do whatever you can to relax during the holidays
4. Make time for self care. Taking care of yourself is always important, but especially so during the busy holiday season. Book a prenatal massage, take a long bath, make time to exercise, or plan a night out with your partner. Enjoy the time you have now that is all yours.

Whatever brings you relaxation and calm increases your oxytocin levels. Oxytocin is  the "love hormone" that plays a role in labor, attachment, bonding, and breastfeeding.  Taking deep breaths, centering your mind, and finding ways to relax amidst the tension around you is also excellent practice for managing labor. 

​
5. Create your own holiday traditions. With a baby on the way, your life will be changing in just a few short weeks or months. Whether this is your first baby, or you are adding a sibling, take the time to reassess what you and your partner want for your growing family. What traditions will you adopt? What will you let go? What is important? What’s not?

These answers look different for everyone. They may not fit into what your extended family has chosen. But when you take the time to pause and think about what you want for your own family, the stress and furor that accompanies this time of year lessens-- which makes for a better holiday season, and a better pregnancy.
I am a certified labor doula and professional postpartum doula serving clients in Boise, Eagle, Meridian, Nampa and the greater Treasure Valley.
​This holiday season, ask for doula support! Elevated Birth gift certificates are available in any denomination and can easily be added to your baby registry.
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Copyright 2018
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Embrace the Parenting Season You're In

11/1/2018

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boise doulas
These gorgeous photos are courtesy of Natalie Koziuk Photography. Clients of Elevated Birth get discounts on sessions with Natalie! 
Find Out More

New Baby? Pregnant? Trying?
​What's Your Season?

back to work new baby boise
Fall is in full swing here in the Treasure Valley. The hardwood trees are showing off their splendent colors like a proud peacock, while the evergreens are happy to provide an understated contrast to their brilliance. The air is crisp in the morning, but often mild enough in the afternoon to encourage bathing in the warm light of the sun. 

This is the season for pumpkins, and jewel tones, and scarves and boots. It’s also the season of extending the time between shaving my legs a little (okay, a lot!), and sleeping in as long as possible in the mornings because it’s dark outside, and then without fail, rushing on our way to school.

The seasons are a time of transition, of moving from one state of being to another. The same is true of the seasons of our lives, especially when we have children. When we transition from not pregnant to pregnant, from pregnant to raising a newborn, through toddlerhood, teething, returning to work, deciding to stay home, our relationship without kids and then with kids—these seasons look different because they are different.

We make different choices; we approach life differently than we did last season. We are, in many ways, different people.

And despite what social media presents, or what your friends are doing, or what your critical inner voice is telling you, it’s okay to just embrace the season you are in. Here’s how:

1. Identify your season.
After I had my first child, I gave away all of my high heels. I decided I was going to quit my corporate job to stay home with him, and since my Friday nights now looked exactly the same as my Tuesday mornings— in yoga pants and flats— they were just taking up space in my closet. Purging a small section of my closet felt like a big step toward embracing my new life.

What season are you in? Are you getting out as much as possible before your baby arrives? Are you hunkered down at home with eternally sick toddlers? Are you freezing breastmilk for an upcoming return to work? Are you trying to get pregnant?

When you recognize where you are, you can then:

2. Accept both the joys and the limitations.
I miss breastfeeding. It surprises me to say it now, because my daughter never took a bottle and wanted to nurse all the time, until she was almost two years old. Dinnertime was the hardest, because she always wanted to be on my lap nursing and I could never seem to finish a hot meal.

In that season, eating my dinner without a child attached to me wasn’t possible. But being able to comfort her in a way only I could, was. In that season, my dream to pursue doula work wasn’t possible for our family. But now that my kids are older and don’t need me in that way, I’m able to help other families as they begin their early parenting journeys.

Each season has its joys and limitations, even if you aren’t always able to see them until you’re out of it. So,

It’s okay to let the dog hair accumulate on the floor because nursing a newborn takes forever, and a shower was more important than spotless floors.

It’s okay that all you did today was hold your baby. That was all you needed to do. Everything else really could wait.

It’s okay that your body looks different than it did before. It’s a different body, an amazing one, that grew and birthed a human! And in three months, one year, or three years, it will be a different body again because you will be in a different season.
boise doulas
Photo credit: Natalie Koziuk Photography
3. Say no to what doesn’t fit into this season.
When you say no to one thing, you are often saying yes to something else. And vice versa. Only you and your partner can determine what does and doesn’t fit into this season.
  • If you say no to hosting visitors, maybe you are saying yes to getting enough rest and sleep.
  • If you say yes to a messy house, maybe you are saying no to added stress and physical strain.
  • If you say no to allowing a particular person into your birth space, maybe you are saying yes to establishing healthy boundaries.
  • If you say yes to giving your baby a bottle, maybe you are saying no to neglecting your own mental or physical health.
  • If you say no to returning to work right away, maybe you are saying yes to establishing breastfeeding.
  • If you say yes to the expense of outside help, maybe you are saying yes to more time to take care of yourself.

And so on. Embracing your season means making choices that align with what you want and need from this time.

And when the next season begins to unfold, take a deep breath and open your eyes to the beauty to be found at any time. Even in the biting cold of winter there is warmth in the nuzzle of a baby's soft cheek. At any time, this amazing, exhausting, incredible world of parenting has so much to embrace.
I am a certified labor doula (birth doula) and professional postpartum doula serving Boise, Eagle, Meridian, Nampa, and the Greater Treasure Valley. What season are you in?
Do you need support for an upcoming birth, or help with your new baby?
Let's Talk!

​elevated birth
Copyright 2018
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Labor Isn't Quite a Marathon

10/9/2018

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preparing for birth boise
Labor is often compared to a marathon. Both are lengthy tests of physical and mental endurance, with a payoff at the end. There are, of course, major differences. Like that payoff— the sense of exhilaration you feel as you are handed a finisher medal infinitely pales in comparison to meeting your child, who you created, grew in your body, and will love until the end of time. 

You also can’t just quit the race and try again next year. Your baby will be born someway, somehow, and no matter how your birth transpires, you will be an active participant. Your participation will continue for weeks, months, and years, as you grow into your role as parent to this child.

One of the problems with the marathon metaphor is that unlike a 26.2 mile race, there is no real end to birth. Yes, you pushed out your baby, and the ring of fire is no longer, or your surgeon has made the final stitch and you are wheeled out of the O.R. to recovery. But in reality, your baby’s arrival is not the end game.

There is the very real work of healing, and learning to breastfeed, and your hormones rebalancing, and your life looking like something very different than what it once was. Forever.

There’s this new little human being already growing and changing at every moment.

There is the eternal spring of elation, and surprise, and discovery that having kids opens to you.

There is the change in you, unrecognizable at first because all you see is the bags under your eyes from lack of sleep, or the engorgement of your breasts, or your unwashed hair. But it’s there— a confidence and knowing that snakes its way into your being, until one day you are flipping pancakes one-handed, with a toddler on your hip while you field a business call, and realize you are capable and strong and a mother.​
working mother boise
Labor, birth, postpartum, parenthood— it’s messy and hard and joyful and gratifying and exhausting and every single emotion you've ever felt amplified. Before this experience, there is really nothing to compare it to, which is why we grasp for metaphors, like the marathon, to describe what cannot be fully understood until we experience it ourselves.
​
Birth is the beginning. You cross the finish line and never stop moving, you never stop learning and growing. You get to hold a little hand in your own and learn to walk together. That’s the real payoff.
I am a certified labor doula and professional postpartum doula serving clients in Boise, Eagle, Meridian, Nampa, and the Greater Treasure Valley.
Learn more about how I can help you prepare for your "marathon."
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Five Facts About Newborns You May Not Know

9/20/2018

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Postpartum Doula Boise
He will teach you what you need to know
newborn Boise
One minute they are in your body, the next minute they aren’t. It’s pretty insane when you think about the moment of birth, when the baby who grew from a speck of cells inside of you, is now an individual, still very much dependent on you, but now distinctly their own--although tiny--person.

Experienced parents will tell you that babies are born with a particular personality, and that looking back, traces of that personality were evident as early as birth. Some strong-willed tots emerged from the womb with mighty wails from their freshly-initiated lungs, and more pensive kids met the world with a quiet awareness. It’s one of the greatest lessons I personally have learned as a parent— that there is so little about my children that I can control. They are who they were when they were born.

Still, newborn babies share many common characteristics. The various newborn reflexes that have been identified are the same in babies the world over. Many of these reflexes are designed as survival mechanisms, or to facilitate finding and latching onto the breast.

Newborn sleep cycles, those initial smiles and coos, the surprisingly tight grasp of a baby’s hand around your finger (or strand of hair— ouch!) We take classes during pregnancy and read books to prepare ourselves for life with a newborn, but often most of our learning comes from on-the-job training. They teach us how to be their parents.

And there are some things the books don’t tell you, or even if they did, you may have glossed over. So here are five newborn facts you may not know, that may help you as you meet and learn to care for your new baby:


1. Babies sometimes take a while to breathe.  When babies are born, it can take about ten seconds—sometimes longer— until they begin to breathe with their lungs. Because the umbilical cord is still attached to the placenta, which at this point, is still attached to your uterus, your baby continues to receive oxygen through the blood that is traveling from the placenta to your baby. As soon as the umbilical cord is cut, the placental oxygen supply is cut as well. (This is one reason why parents and care providers choose to delay clamping of the cord, so that baby receives as much blood from the placenta as possible.)

Babies can appear blue or purple in color for minutes after birth; once their bodies are fully oxygenated, they begin to “pink up.” Parts of their bodies, especially their extremities, can still appear bluish after birth, but this usually improves after their circulatory system begins to mature.


2. Babies benefit from the breast even before your milk comes in. Your breasts don’t begin to fill with milk until around 2-3 days after birth, sometimes even longer. However, babies benefit from latching onto the breast as soon as they are born, if possible, and then every few hours after that.

At birth (and sometimes during pregnancy), you produce colostrum, a concentrated form of early breastmilk that contains antibodies and nutrients. Even though it may not seem like they are getting much from the breast, colostrum is usually all your baby needs until your milk comes in. Plus, the very act of sucking at your breast puts in your baby’s “order” for milk later on. The more your baby latches on, the more your body gets signals to produce milk. So if you intend on breastfeeding for any length of time, have someone help you get a good latch going and get lots of nursing practice!


3. You may want to opt out of that first bath. Not yours— a nice, hot shower after labor can feel like heaven! I’m talking about your baby’s first bath. Many hospitals have changed their policies to delay bathing newborn babies for at least 24 hours, or not at all. Here are some reasons why you may want to wait to bathe your baby:
  • Some babies are born with vernix caseosa (known simply as “vernix"), a thick, white substance coating your baby’s body. Vernix has antibiotic properties, and along with colostrum, can help protect your baby’s vulnerable immune system. You can rub it in like lotion, or wipe off areas that may have been stained with baby poop. (Note: later-term babies tend to not have vernix at birth, and that’s perfectly normal!)
  • The stress hormones released by the bathing process can cause baby’s blood sugar levels to drop, which may have a negative impact on feeding.
  • The more time a baby spends with his parents, bonding and breastfeeding, the greater the rates of breastfeeding success. Oxytocin, the hormone responsible for contracting the uterus during labor, is also called the “love hormone,” because it plays a role in bonding with your baby, bonding with your partner, and breastfeeding. Delaying that bath keeps the oxytocin flowing.

4. Newborns are noisy. Your baby's cries can feel like the loudest sound on earth. But newborns are noisy when they sleep, too. They grunt and grimace, whimper and yelp. All while they are sound asleep. While it is important to respond to your baby's cries and offer immediate comfort, you may be unintentionally waking a baby who is actually asleep!

If your baby is due for a feeding soon, look for cues like rooting or sticking their hands in their mouths. These are more reliable sign of hunger than the noises you hear when they are actually asleep. If you co-sleep with your baby, you may find that you become more quickly familiar with the noises she makes, and begin to anticipate your baby's needs before she begins to cry.


5. Newborns learn with their hands. You may look back on photos of you as a baby, hands covered by cotton drawstring baby mittens, and assume that mittens are a must for your baby registry. This thought is confirmed when your baby’s dagger-like nails are already scratching up her cheeks with red marks just days after birth. Or maybe you feel she needs mittens to keep her hands warm.

However, baby development experts now advise to ditch the mittens. Babies learn by touch, and when their hands are covered by mittens, they miss out on valuable tactile learning time. Instead, use a baby nail file to shorten and smooth out their nails, and allow them to explore their new world through their sense of touch.

​So let those baby hands free!
baby registry boise
Let those baby hands free!
I am a certified labor(birth) doula and professional postpartum doula serving Boise, Eagle, Meridian, and the greater Treasure Valley. 
Need help preparing for birth or need help with your baby? Let's talk!
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Visualize Your Positive Birth

8/20/2018

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Boise doulas
What will you choose to "see" in labor?
Visualize labor Boise
Visualization is a proven tool commonly used by professional athletes, corporate leaders, speakers, and marathon runners that is free, effective, and powerful. It can also be used by anyone birthing a baby, in any setting, in any position, for any type of birth. It's one form of childbirth preparation you can do just about anywhere.

Visualizing a specific action has been shown to activate nervous system responses that are similar to actually performing that action, impacting your heart rate, blood pressure, and hormones. Visualization can help you stay calm and focused in a challenging situation; it can reduce physical symptoms of stress and anxiety and promote feelings of relaxation.

Consider this tool a “mental rehearsal” for your birth. You can visualize the entire process, from imagining yourself feeling the earliest labor signs, to arriving at your birth place, to pushing out your baby and bringing her to your chest. Or, you can focus on just one thing, like your cervix opening up or your baby descending.

Whatever you choose to visualize, keep the following tips in mind:

Practice throughout your pregnancy. You won’t get the benefits of visualization from trying it out once or twice. Make the time to practice your visualization often throughout your pregnancy, so when you are actually in labor, it is familiar to you and easy to go back to when you need it.

Get creative. Some people find it helpful to imagine their actual uterus pushing baby down with each contraction, or to imagine their baby’s head pressing against their actual cervix, thin and ripe.
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​Others prefer to imagine something more abstract or metaphorical, like a flower opening, or waves crashing. Some may find an image of themselves passing through a barrier representative of “moving through” contractions, and in turn they become an active participant in their labor rather than a passive onlooker. And some choose to visualize something completely unrelated, like their favorite vacation spot, or some other peaceful location.

Personalize your visualization so that it works for you.

Break it down into steps. Whatever you choose to visualize, break it down into small steps. For instance, if imagining a flower opening, you might visualize each petal of the flower slowly unfolding until you can see the center. If imagining ocean waves, visualize the wave building far from shore, gathering momentum until it crests and then falls against the rocks; see the ocean spray, the bubbling foam, maybe even sand crabs scurrying around as the water is pulled back into the sea.

​If your visualization can be broken down so it lasts roughly 60-90 seconds— the approximate length of a labor contraction— you will find yourself with a tool you can use to manage each surge.
Write it down. Write down the steps of your visualization to help break it down, and to get a clearer picture in your mind’s eye of what you will “see.” Pay attention to detail; incorporate your other senses, imagining what you might smell or hear if you were actually at the ocean, or in a field, or even in your place of birth.
Doulas in Boise
Incorporate affirmations. Think about how you want to feel as you visualize, and tie this into any birth affirmations you may utilize in labor. You might think of your affirmation, or even speak it aloud, as you work through your visualizations.

As author and speaker Dr. Wayne Dyer says about the power of affirmations,“I use the inner mantra I am, seeing myself as already having arrived at what I’ve placed in my mind.”

During your labor, you might think or say aloud, “I am strong,” “I am open,” “I am calm,” or any number of phrases, while you are actively using your visualization.
Birth affirmations boise
You can use visualizations to distract yourself from any pain or discomfort you may experience, even outside of labor. Afraid of needles and about to have blood drawn? Consenting to a cervical check or having your membranes swept? In the OR having your baby by Cesearean? Having an IUD placed?

​Go to your visualization to distract your mind from your physical discomfort, and bring you back to a more peaceful  state.
I am a certified labor doula and professional postpartum doula serving Boise, Eagle, Meridian, Nampa, and the greater Treasure Valley.
​As a doula, I can remind my clients of their visualizations and affirmations and help them have a supportive, positive birth experience.
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​Copyright 2018
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Who Gets to Be at Your Birth?

7/31/2018

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Boise doulas, birth doula Boise
Build a better birth team and have a better birth experience

Who will be invited to your birth?

This question can be a loaded one for expecting couples. The amount of stress and anxiety around who should be at your birth can be overwhelming.

Can you relate to any of the following scenarios?

You’re not sure if you want your mother in the room, but she’s your mother, so shouldn’t she be there? And if she’s going to see her grandchild’s birth, it’s only fair that your mother-in-law should be there, too, right? 

You really want one sister to be with you but your other sister will be loud and obnoxious while you’re trying to concentrate on labor. But how do you explain that you want just your one sister in the room?

You don’t want anyone in the room except your care provider, your partner, and your doula. And both sides of the family are making you feel guilty. What should you do?

Here are some things to consider to help you make a decision on who will be invited to your birth space:

1. Identify the most important person in the room. The person having the baby, the one whose usually-clothed body parts will be exposed, who is experiencing one of the most physically and emotionally challenging events of their lives, is the ultimate decision maker. Some couples will negotiate who will be allowed to visit during or after labor, and the partner’s need for emotional support can definitely be a part of that discussion. But if the laboring person has a strong desire to include or limit a particular person’s presence, it’s important for that to be respected.

In birth, it’s imperative for the laboring person to feel safe and supported. The hormones involved in labor are directly affected by whether or not this is the case. When it’s not, it can impede labor progression. An unhealthy emotional state can have physical implications for both the pregnant person and the baby.

We want oxytocin to flow in labor— this “love” hormone has a hand in contracting the uterus, breastfeeding, and in creating attachment with baby, and its production is supported when the person in labor feels safe and supported.

Also keep in mind that some survivors of trauma, or those with severe anxiety, are managing more than just their contractions when they are in labor. Creating a birth space that puts their emotional and physical safety at the forefront is necessary for their own well being.

2. Build your birth team mindfully. Approach the decision from a standpoint of value instead of a “should.” A “should” comes from an external pressure or rule. Someone who brings value to your birth space is a true part of your birth team. 

Your care provider and assistants bring their medical expertise to ensure you and your baby are physically healthy. Your doula brings knowledge about birth, comfort measures, and continuous care, to ensure you are emotionally and physically supported in alignment with your goals and values.

Think about the other people you and your partner are considering allowing into your birth space. What function will they serve? Will they bring joy, humor, welcome distraction, a shared bond? Or will their presence bring anxiety, discomfort, intrusion, negative energy, or doubt about your personal choices?

Anyone who is making you feel guilty for not including them in your birth is not acting like a teammate; they are not adding value. They are imposing their “shoulds” on you. As I recently wrote in my blog The Should’s of Pregnancy, make sure you are acting on your own core values, and not someone else’s. 

3. Know the why’s. When you have information, you can make informed decisions. Once you know that labor can be impeded by an unsafe or uncomfortable environment, because of the hormones at play, you can make a decision about keeping out people who make you feel unsafe or uncomfortable.

If initiating breastfeeding is important to you, and you know that it can be a challenge to learn how to latch your new baby, you may limit visitors for a few hours after birth so you can get uninterrupted practice.

If you know that you the wound inside your body after birth is roughly the size of a dinner plate, and you want to focus on resting after birth, then you may opt to limit the number of visitors you receive at home.

4. Consider timing. Sometimes, you welcome or can tolerate one person’s presence in early labor but you don’t necessarily want them there while you are pushing. Or, you may feel there are several people who would bring you positivity throughout your labor, but having them all there at once would be too distracting.

It’s okay to require flexibility from those you may want to include in your birth. It’s okay to impose rules, and it’s okay for you to change your mind at any time during labor. 

5. Practice setting boundaries now. Everyone has an opinion when it comes to pregnancy and parenting. Whether you are making decisions on breastfeeding, bottle feeding, medical decisions for your baby, bath products, types of diapers, who can hold baby, who can watch baby, who can visit you postpartum and when, where baby sleeps, etc. you will no doubt come across somebody close to you with a differing opinion. Sometimes those people can be outright disrespectful of your choices. 

Who you allow into your birth space can be a new parent’s first act of boundary setting, and it can be uncomfortable. But after your baby is here, there will be many more opportunities where setting boundaries is necessary, for the well being of you and your new family. Why not practice now, and take steps to ensure you have a more positive birth experience?


Even when you set boundaries, not everyone will respect your decisions. So here are some tips to fend off unwelcome visitors during labor, or when you are home after the birth:
  • Don’t post on social media that you are in labor or headed to the hospital/birth center
  • Be selective about who you tell about being in labor
  • Tell others to not post on social media anything about your labor or photos of your baby, without your permission
  • Post a sign on the door to your room asking visitors to check in at the front desk before entering (and have the front desk show them the door to the waiting room)
  • Designate a person on your birth team to be the uninvited-person “wrangler,” who will tell people to leave or where to go so you don’t have to. They can also be the person to communicate on your behalf about visiting hours or length of stay
  • Tell people ahead of time that they need to call or text before visiting
  • Put a sign on your front door asking those bringing food to please leave their meal in the cooler on your porch

​
You are entitled to a birth environment that will allow you to feel loved, supported, and safe, and to include or exclude anyone who doesn't contribute to that environment. Think about how you want to feel in labor, what you need to recover postpartum, and surround yourself with those who will help make that happen.
I am a certified labor doula and professional postpartum doula serving Boise, Eagle, Meridian, Nampa and the greater Treasure Valley.
Have you thought about who will bring value to your birth team? If that includes a doula, let's talk about how I can help you feel safe and supported as you birth your baby.
Let's Talk!
elevated birth
​Copyright 2018
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Childbirth Prep Done Your Way

7/23/2018

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Childbirth preparation Boise doula
Your version of childbirth prep might not look like someone else's!
“The aim of education is the knowledge, not of facts, but of values.”
William S. Burroughs
I encourage my clients to take childbirth education classes as they prepare for the birth of their baby. The more you know about the physiology of birth, and what you can expect at each stage of labor, the less fear there is surrounding it. 

Where you have your baby can also affect what what you experience— the procedures, care routines, people you will interact with, and what decisions you may have to make, can vary depending on whether you give birth at home, at a birth center, or even at different hospitals.

The amount of information you learn can be overwhelming. In the prenatal meetings with my clients, we sift through this information to find out what pertains to them specifically, based on their goals and how they want to feel during labor and birth. I help them identify what limitations may be present, and how to best work around them. I get to know my clients and their values, and what techniques, both physical and emotional, that will work best for them.

This is where childbirth preparation goes beyond childbirth education. 

Preparation for your birth is unique to you. Sometimes, it’s unconventional and maybe even a little strange. I’ll use my own experience as an example: When preparing for the birth of my daughter, I watched every episode I could find of a show on A&E called “I Survived.” The show profiled people from all walks of life who had endured horrible events, like attempted murder, natural disasters, near-death experiences, and trauma, and how they survived those experiences. Their outlook on life was usually gratitude, and a newfound strength. My mindset was that if these people could survive those horrific events, and still have a positive attitude, then I could make it through labor! 

That might not be the best form of prep for everyone, and that’s kind of the point. What preparation for birth looks like for me, will likely look totally different for you!

Here are ways others have prepared for their births:
  • Kim saw a homeopath and chiropractor throughout her pregnancy. She  turned a quote she read in a book into her mantra, “Your body was designed to do this.” She used that mantra during labor and has even used it in the years since when doing difficult, physical things.
  • Susie valued research, and knowing the variables that can occur during labor. She watched TLC’s “A Baby Story” even while trying to get pregnant, and then throughout her pregnancy, to get a sense for the many different scenarios she might encounter when giving birth. She also made sure to tour her hospital so she could see exactly where she would check in, labor, and where she would recover postpartum. She says, “Whenever I felt a kick, or Braxton-Hicks contractions, or the real thing, I could imagine myself in that hospital, doing my breathing, or sitting on the Swiss ball, and getting ready to meet my baby!  As a visual learner, that picture in my head was very important.”
  • Regina, an athlete, tapped back into the mental preparation techniques she would use when she was a professional swimmer by, “visualizing success, a smooth birth process, and birthing in a calm environment." She kept active, doing a lot of walking and squats, especially during the last month of pregnancy. She downloaded a meditation playlist to stay calm and focused during labor, and printed out motivational banners with encouraging phrases to hang in her birth space.
  • Spring valued humor and practicality in preparing for birth. She read the Girlfriend’s Guide to Pregnancy to get the kind of information a best friend would give, in a format that was more light-hearted, and even irreverent. 

What have you used to get through a physically or emotionally challenging time? Laughter? Visualization? Music? The deep breathing you learn in yoga or meditation? Do you value knowing the hard facts?

You can tap into your own experiences, your own strengths, in labor. Use what has worked for you, or what speaks to you, to prepare in a way that is as unique as you are.
I am a certified labor (birth) doula and postpartum doula serving Boise, Eagle, Meridian, Nampa, and the greater Treasure Valley. 
How can I help you have a more positive birth experience, that is focused on you and your unique needs?
Let's Talk!
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Planning for the Unplanned Cesarean

7/9/2018

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Doula in Boise, Meridian, Eagle, Idaho
Planning for your Best "Worst Case"
Most people give birth vaginally, and the majority of birth plans focus on wishes and goals for a vaginal birth. Some desire very strongly to avoid a Cesarean birth, choosing to exhaust all other options before deciding that surgical birth is their best option.

But roughly 1/3 of the time nationally (and 18.1% of the time in Idaho according to cesareanrates.org), whether due to a medical emergency, complication, or other circumstance, people find themselves giving birth in the operating room. 

The circumstances of your pregnancy and labor, how prepared you are for the procedure, who is there to support you during the surgery, and how your wishes are respected during your Cesarean birth, are all things that can affect your birth experience. Even when the unplanned happens, you can still have a positive birth!

So even if a Cesarean birth is your "worst case" option, it can be helpful to plan for it anyway. Here are some things to consider, and ways a doula can help you plan for the unplanned:

1. If you are familiar with the steps of the procedure, you won’t be caught off guard. Policies and procedures can vary by hospital and care provider. Will you be alone at any point? How many support people can accompany you? Is it commonplace to have your arms strapped down? What medications will you receive? What will it feel like, sound like, smell like? Will you be able to see and touch your baby right away, or even initiate breastfeeding in the OR? What can you expect after the surgery?
​
Your doula can help prepare you for what to expect, and help you formulate questions for your care provider. Some policies and procedures are negotiable, and having a discussion with your care provider ahead of time can make for a more positive experience. She can also help you create a Cesarean birth plan to accompany your standard birth plan. 

2. You may have more options than you think. Some of what happens during a Cesarean birth is dependent on the reason for it. If it’s a true medical emergency, you may not have as many options as if you had an “urgent” or even planned Cesarean.

In a true emergency, you are likely to be put under general anesthesia and the baby born within minutes. This is a small percentage of Cesareans. Usually there is a lot more time, and more variability in the experience. You may have a choice in:
  • What type of anesthetic is used. If you already have an epidural in place, that will be your anesthesia for the surgery. If not, a spinal block is usually administered. There are pros and cons to each, which you can discuss with your doula and care provider.
  • What other medications are administered pre-surgery and post-surgery. Familiarize yourself with what sedatives, antibiotics, and pain relievers you may receive. 
  • How you will be supported during the procedure. Your partner is usually allowed into the OR, but may not be allowed back in if they accompany the baby to the nursery or NICU. What other support people can join you? Will your doula be allowed to accompany you? Can you play your own music, or bring in personal comfort items? 
  • Your preferences. Will you be restrained? Will you be able to see and touch your baby or breastfeed? Will you be able to see the baby being born if desired? Can you delay cord clamping? Will your uterus be repaired inside or outside your body? What kind of sutures will you receive? 
  • Your recovery. Who will be with you in recovery? When will you see your baby, given there are no medical complications? When can you begin to breastfeed? When can you go home?

3. Your postpartum needs may be different.  Do you have a support system at home that can also accommodate your needs after a Cesarean birth? Will you need extra help moving around, breastfeeding, someone to make you meals, someone to help out with the baby? Your doula can be a great resource to plan for what additional support you may need, as well as provide referrals to specialists. You can opt to hire the support of a trained professional in your home, like a postpartum doula.

4. Your emotional needs may be different. This is where a doula can really help to listen, provide a supportive presence, validate your experience, and if needed, help you find additional resources so that your emotional recovery is treated as importantly as your physical recovery. 


Planning for a Cesarean birth when you desire a vaginal birth isn’t thinking negatively, or setting yourself up for one. It’s preparation for one outcome, out of many. It’s the first aid kit in your backpack as you hike up the mountain. It’s a mental exercise.
​
And it’s something you can do with a supportive, knowledgable, compassionate person on your side, looking out for you no matter what happens or how you give birth— your doula.
I am a certified labor (birth) doula and professional postpartum doula serving Boise, Eagle, Meridian, Nampa, and the greater Treasure Valley. 
Feel confident and prepared no matter how you give birth. Let's talk about how I can help!
Contact Me
elevated birth
Copyright 2018
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The "In's and Out's" of Poop in Pregnancy

6/28/2018

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Poop in pregnancy, pooping while pushing
Let's talk about poop, shall we?
It’s one of the top sources of anxiety in pregnancy . . . . . . POOP. 

Whether it’s the constipation that arrives well before you have any sort of baby bump, or the fear some have about pooping in labor, there’s a lot of attention paid to poop when you are pregnant.

So let’s talk about it! Here's what you need to know about poop in pregnancy and childbirth.

1. Constipation is common. The hormones released throughout pregnancy, especially progesterone, make food move more slowly through your intestinal tract. You are able to absorb more nutrients for your growing baby, which is a good thing. The downside of this slower digestion is constipation. It can start in the first trimester, when you’re not even showing, and last throughout your entire pregnancy.

Constipation can be frustrating and uncomfortable. Straining to poop can in turn cause hemorrhoids, which can be downright painful. 

Some things that can relieve constipation include:
  • Regular exercise
  • Drinking plenty of fluids (hydration is important in pregnancy for many reasons)
  • Eating a healthy diet of fiber-rich fruits and veggies
  • Using a Squatty Potty or similar product to get into a better pooping position
  • Waiting until you absolutely need to go before trying to poop, to avoid straining
  • Talking to your care provider about switching to a different iron supplement, if that’s something you need
  • Asking your care provider about taking a fiber supplement or medication to alleviate your symptoms


2. Diarrhea toward the end of pregnancy can be exciting! That’s because it is one of the signs of early labor. Up to several days before you feel your first crampy contraction, your body may clear itself out in preparation for birth. Be sure to stay hydrated if you experience diarrhea, and keep yourself nourished by continuing to eat. You will need your strength for labor.

Note: If you have a fever or suspect that your diarrhea could be caused by food poisoning, then be sure to consult your care provider.


3. You will probably poop while you push. This is a big concern for some people. They get really anxious about the thought about pooping while they are pushing, and having their partner and birth attendants see it happen.

First of all, yes, it happens. It happens all the time. Your friends and relatives, that put-together mom at school drop-off, your great grandma-- they probably pooped while they pushed out their babies, too.

And trust me, nobody in the room cares. The birth workers have seen it many, many, many, many, many times before. It is a total non-issue. They will just discreetly wipe away any poop, replace the Chux pad if necessary, and continue on. 

In my experience, your partner doesn’t care, either. At this point, you are actively pushing out your baby, and your partner will be laser-focused on the baby, and on supporting you. They will be concerned, and excited, and hopeful, and probably won’t notice there is any poop at all, especially amidst what is infinitely more attention-worthy at that time-- like your baby being born. And when that baby is laid upon your chest and you hear those first cries, the last thing on anybody's mind will be whether or not you pooped a little.

Second, pooping during pushing is a sign that you are pushing effectively. You often hear birth attendants tell their patients to “push like you’re taking a huge poop.” Those are the muscles you need to engage to push out your baby. It’s a positive thing when you poop!

Third, if you are still really, really, stressed about pooping in labor, talk to your care provider about administering an enema in early labor. For some people, this gives them peace of mind about not having to think about poop at all.


4. Postpartum Poop. The first poop after birth can also be anxiety-producing for many. Your vagina has gone through a lot, and your perineum can feel sore as well. You may still have hemorrhoids, you may have minor tearing, or perhaps stitches.

If you had a Cesarean birth, pooping for the first time can also be uncomfortable. After a Cesarean, your first poop might take longer to arrive than with a vaginal birth. The muscles in your abdomen will be sore after surgery, which can make that first poop a not-so-fun experience.

Some care providers will prescribe a stool softener after delivery to make those first few bowel movements easier. Some will require you to have a bowel movement before you can go home, especially if you’ve had a Cesarean (true with any major surgery).

Staying hydrated after birth can help keep your stools loose. Waiting until you really have to go, and avoiding straining ,can be helpful as well.


5. Your poop situation will improve! The more you are able to rest and heal postpartum, the better you will be able to recover from birth. Eventually your poop won’t be such a source of tension in your life.

Your focus will shift to your baby’s poop, which will provide months (and years) of interest, antics, and discussion. If you don't talk much about poop now, just wait until you have a toddler. It's one of their favorite subjects.
I am a certified labor (birth) doula and professional postpartum doula serving Boise, Eagle, Meridian, Nampa and the greater Treasure Valley. 
​Do you have anxiety about anything in pregnancy or labor? Having a doula might help! 
Let's Talk!
elevated birth
​Copyright 2018
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    Doula Raquel

    I've worked in the forest, in the lab, and in an office cubicle. My favorite and most passionate work has been alongside clients as they reach inside to find their innermost strength, and give birth to their babies. Each birth is an honor to witness.
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