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What I Won't Do As Your Doula

7/5/2019

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do I need a doula
Photo by henri meilhac on Unsplash
I love doula work.

I will wake up early on a Saturday morning to finish up a blog post.

I will enthusiastically jump out of bed at 3:00am, sneaking into our bathroom so as not to wake up my husband, and help a client figure out if it’s time to head to the hospital.

I will hold a client’s emesis bag, get her a cool cloth to wipe her face and jump right back into a hip squeeze. With a smile on my face.

But there are some things I won’t do for my clients, and there are good reasons why.


1. Give medical advice. Doulas have a scope of practice; I did not go to medical school or midwifery school and it would be out of line for me to tell you to take a particular medication or supplement, or to ignore the instructions of your care provider. If you ask, I can give you information about medical issues or options, and then you can talk to your care provider about those if you wish. 
Boise midwives
You hired your doctor or midwife for a reason: to care for the health and safety of you and your baby. You hired me for a different reason: education, continuous labor support, comfort measures, help for your partner, etc. We each have a role, and it’s in your best interest that I stick to mine!

​Now, if you describe symptoms to me that can be signs of a more serious issue, I’m going to suggest that you talk to your care provider. But again, I’m not diagnosing or treating you. I’m leaving that up to your care provider.


2. Make decisions for you. There is something about being pregnant that makes you and your partner stop and examine what’s important to you. You have to make decisions about what life will look like after your baby is born, what you will change, what you will hold onto. 

This usually translates into setting up a space for your baby, acquiring gear and supplies, making plans for a temporary or permanent leave from work, taking classes, and thinking about how, where, and with whom you want to give birth.

Research is often involved, and as you learn more about pregnancy and your birth options, certain things resonate with you, and you develop your preferences and values. 

Now, imagine if someone else decided those things for you. They arbitrarily picked your care provider; they told you which hospital you were going to give birth at, they told you which pain medications you would or would not receive and when. They told you that you had no control over what was done to your baby when he or she was born. How would you feel about your birth experience? Empowered? Confident? Positive? Likely not.
childbirth class boise
When you and your partner make decisions for yourselves, based on what you both value, you are in control of your life. If you aren’t sure about a decision you have to make, you can ask me for information about your options or alternatives, and I can help you figure out the benefits and risks.

But the decision should be yours to make. And for me to support wholeheartedly.


​
3. Replace your partner. First of all, it’s impossible for me to do. Your partner is your primary support person in labor, and in life. They are irreplaceable.

Second, I don’t want to replace them! They are an integral part of your birth experience. Their love and presence literally helps with labor progress. They are my clients, too, and we are all on the same team with the same goal in mind.

What I can do, is give them a break when they need it. You are more likely to feel relaxed if your partner gets a chance to grab a bite to eat, take a nap, use the restroom, or leave for a few minutes to attend to other kids, or run interference with family members.

What I will do, is help them help you more effectively. I will make suggestions on what they can physically do to provide you comfort during contractions. I will give them the space to support you the way only they know how, while I step in when needed. I will reassure them if things veer off course, and make them feel as safe and supported as you feel.

Sometimes partners want a more hands-off role, and that’s okay, too. Whatever the two of you need to get through labor, I’m there to provide.
childbirth classes boise
4. Mess with your mojo. Often in early active labor, but sometimes throughout labor and into transition, you are handling labor beautifully. You are in a groove; you need to focus on each contraction, you may be vocalizing or moaning, but your breath is steady, your body is relaxed, and you are doing just fine on your own.

I will not interrupt this magic of yours.

I may softly let you know I’m there, I may compliment you occasionally, but this is not my show, it’s yours. 

At some point in labor, it becomes apparent that you may benefit from some physical support, you may need suggestions for a position change, or nourishment, or a reminder to breathe and soften. You may need more vigorous encouragement, you may need your whole birth team to get you through to the next level.

And I’m ready to step in exactly when you need it.
​I am certified birth doula, postpartum doula, and childbirth educator serving clients in Boise, Meridian, Eagle, Nampa and the Greater Treasure Valley.
Interested in learning what a doula does (and doesn't do) for you in pregnancy and labor?
Let's Chat!
elevated birth

Copyright 2019
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How to Bring a Bit of Home to the Hospital

5/17/2019

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Boise doula hospital
How to make the hospital feel more homey
No matter what your birth preferences may be, whether you want an unmedicated birth or you know you’ll opt for an epidural, feeling as calm and unstressed as possible during labor is usually a part of everyone's birth plan.

It’s one reason why some people opt to birth at home, where they feel most comfortable and are surrounded by familiar sights, sounds, and smells. This sense of comfort contributes to the production of oxytocin, also known as the “love hormone.” Oxytocin is a crucial part of labor, responsible for uterine contractions, labor progress, attachment to baby, and even breastfeeding.

When you are feeling stressed or fearful, oxytocin production is inhibited, and labor can slow or stall. As a doula, I help my clients with relaxation, comfort, and helping their partners support them better (being near your partner, hugging and even kissing in labor can really get the oxytocin flowing!)​
boise hospital birth
Get close to your partner in labor!
In a hospital setting, creating that at-home state of relaxation and comfort can sometimes be a challenge. First there is the ride to the hospital— I don’t know of anyone who likes laboring in the car! When you arrive at the hospital, you spend some time in triage before being admitted to your own room. It can take a while for you to settle in and get back into a labor rhythm, which is why it’s not uncommon for contractions to slow or space out a little when you get to the hospital.

But when you take steps to a bring bit of home into your hospital birth space, getting back into that at-home state of comfort becomes much easier.
Picture
It’s all about the senses
Whether we realize it or not, what we see, hear, smell, feel, and even taste can affect our ability to relax. When we bring items from home that appeal to our five senses, we associate what we are experiencing to the comfort of home, even in a hospital setting.

​
Sight
Hospital lights can be very bright, or give off an unappealing florescent glow. It can be helpful to close the curtains in your labor room, or to turn off or dim the lights to create a “cavelike” space where you can burrow down and work through labor. You can bring in soft lighting like battery-operated candles, or you can hang up strings of twinkle lights around the room for a more personal touch.


Think about the mood that restaurant lighting creates— dim lighting promotes feelings of closeness (hello, oxytocin!) while bright, harsh lighting can be jarring and unnerving. 
hospital doula boise
There may be times when brighter lighting is best. Sometimes in labor the mood becomes stagnant, or tired, and so do the contractions— opening the curtains and letting sunshine in can bring in a needed burst of energy to move around and get labor going again.
​


Sound
Even if everyone in the room is silent, the sounds of the external fetal monitor, your blood pressure cuff, or even the air conditioning can cause an unwelcome distraction. Think about what sounds make you feel relaxed at home and bring those sounds with you to the hospital. You can bring in a sound machine, your Hypnobirthing soundtrack, or a playlist of your favorite music downloaded to your phone. Bring earbuds if you want to totally zone out.

I recommend that my clients add both relaxing music and upbeat music to their playlists. Sometimes some dance-inspiring tunes are a good way to lift the spirits and get my clients moving in labor.


Touch
Sense of touch can be very sensitive in labor. Hospital pillows, while functional, are thin and don’t have the highest thread count. Bring your own pillow from home, or your own pillowcase. Consider bringing your own blankets, too (if you are afraid of special items getting dirty, you can save them for postpartum recovery.)
hospital birth boise
Bring your own clothes to labor in, if you don’t want to put on a hospital gown. Bring your well-worn stuffed animal from childhood, or a lovey you plan to give your baby (these things can serve as a visual focal point as well!) 

Bring your favorite lotion or massage oil, your favorite chapstick, your favorite pair of socks or fuzzy slippers. Bring your own birth ball to bounce on, that is the perfect size for you and feels familiar. Bring your own cup or water bottle to drink out of. Bring the things you are used to at home that bring you comfort!

​
Smell
You know how certain smells can take you down memory lane, remind you of something, or instantly relax or repulse you? The same thing happens in labor, only that sensation can be intensified.


Sometimes, scents that usually relax you can become too much in labor, so instead of bringing in a scented plug-in or a diffuser, consider dabbing the scent on cotton balls in a plastic baggie. That way, if the scent becomes too much, you can easily remove it from the labor room. 

If you bring essential oils with you, make sure you know what possible effects they can have on your labor. Be very careful with oils that you put on your body as well, as some can be dangerous for newborns or can interfere with breastfeeding.

Consider food smells, especially if your partner or family members are going to be eating around you. That pepperoni pizza smell that usually makes your mouth water may be too strong of an odor for you in labor. Suggest that visitors eat outside of your hospital room so that food smells don’t linger.
restaurants near St. Lukes Boise
Be cognizant of bad breath, especially for longer labors or labor that lasts throughout the night. I always carry breath mints or chewing gum in my doula bag and offer some to my client’s partner— no laboring person wants to smell stale breath in their face!


Taste
Bring your favorite snacks with you to the hospital. I recommend high-protein snacks that can be quickly munched on or that can be eaten with one hand. Sometimes something sweet like your favorite candy can be nice when you need a little energy boost. Aside from water, bring your favorite electrolyte drink or juice so you can keep hydrated, which is very important as you labor.
I am a certified birth doula, postpartum doula and childbirth educator serving clients in Boise, Eagle, Meridian, Nampa, and the Greater Treasure Valley.
Are you planning a hospital birth? Discover how the continuous support of a doula can help keep you calm and relaxed in labor.

About Birth Support
elevated birth

​Copyright 2019
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When Others Share Birth Horror Stories

4/18/2019

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treasure valley doula
What is it about pregnancy that invites other to share their birth horror stories?
You announce your pregnancy to your family and friends, and it begins: you are subjected to birth horror stories. Sometimes others recount stories that aren’t even theirs--- they may share with you a scary news article they just read, or a third-hand account of someone else's traumatic birth experience.

What is it about pregnancy that makes others want to share negative news? When you announce an engagement, people don’t start telling you about their marriage problems. When you share the news about a work promotion, they don’t dump on you about their own workplace drama. But pregnancy seems to open an invitation to others to give you unsolicited advice and warnings.

Negative comments from others can interfere with your ability to keep your own worries and anxiety at bay, or to simply enjoy your pregnancy. And when the negative stories are related to your personal birth choices or preferences, or used as a way to discourage you or shame you for those choices, the emotional impact can be great. 

Here’s how to deal with those birth horror stories:

1. Understand the motivations behind sharing them.
There are several reasons why people overshare the negative aspects of birth. Often they just want to connect with you, and they feel that sharing the hard parts of pregnancy and birth is a way to do it. What they don’t realize (or remember) is that you’re still in it! You’re pregnant and haven’t given birth to this baby yet. Even if this isn’t your first birth, each pregnancy and labor are unique and you really don’t know how it will go until you actually give birth.

Sometimes people haven’t yet processed their own birth trauma, and instead of speaking to someone who can help them work through it, they are dumping their negative feelings onto you. Perhaps their concern for your well being creates a need in them to tell you about what can go wrong, as if speaking it aloud is all that’s needed to keep you safe.

Some people are talkers with no filter. They see that you’re pregnant, and they blurt out all of the pregnancy-related things they know, even if they are negative. They don’t think about the impact on you.

And sometimes, people just think they know more than you, and know what’s best for you. But they aren’t you. This is your pregnancy, and your baby. ​
natural birth boise
2. The story is incomplete.
Someone can tell you something negative about their birth experience with all the gory details, but here's what you may not know:
  • How were they feeling physically? How did labor feel to them and how did they cope?
  • What kind of emotional support did they have? Were they scared, or did they feel disrespected or abandoned? 
  • How did their partner feel? How did their partner respond in labor?
  • What kind of preparation did they have for labor? Were they informed ahead of time about interventions, alternatives, and their benefits and risks?
  • Was their care provider or the on-call care provider a good fit for the type of birth they wanted? Were they supportive of their choices?
  • How did their labor match their expectations for their labor?
  • Were there complications or extenuating circumstances that affected their birth experience?
  • Did they plan for the postpartum period? Did they have the physical and emotional support they needed? Did they have enough help?

You don’t have all the facts about someone’s birth story. What’s missing may explain what contributed to a negative outcome, or their negative feelings about their birth.

I'll say it again: Every pregnancy and labor are unique. Even if you have the same care provider as someone else, birth at the same location, at the same time of year under the same full moon, your experience is uniquely your own.


3. Consider the source.
There are aspects of birth that can be painful, uncomfortable, and difficult. Knowing what to expect during labor and during your postpartum recovery, learning about the warning signs so you know when to seek medical care or when to see a specialist-- these things are valuable and important to share. But there is a difference between education and fear-based story telling. 

Consider who is giving you the information-- what is their knowledge of birth, of perinatal research, the policies and practices of your care provider, or of your unique medical history? 

Very rarely does an event or experience have only negative aspects. Is the person sharing information with you not aware of or are they withholding the positive aspects of a situation?  

Your care provider, childbirth educator, doula, lactation consultant, or informed friend may be a more reliable source for information than someone recounting a horror story.

boise c-section
4. Challenging births can still be positive births.
You can’t predict or control how your birth will play out. Birth, by nature, is unpredictable. That doesn’t mean it’s necessarily dangerous, or to be feared, or that things will go wrong. And it doesn’t mean that what happened to someone else will happen to you. The way someone else feels about their birth experience, will not have to be the way you feel about yours.

Even if you face challenges that you didn’t anticipate or want, or if things veer off course from your birth plan, you can still feel positively about your birth. When you feel informed and supported throughout, when you feel like your birth team cares about you and respects your wishes, when you feel safe and loved, then you are likely to feel more positively about your birth experience.

Inductions, Cesareans, very short or very long births, unintentionally unmedicated births, high intervention births, or any birth that didn’t go as desired— these can all still be positive births. Birth is in the eye of the beholder.

*************************

Preparing yourself by taking a childbirth education class, knowing your options in labor, choosing a care provider who supports your goals, and surrounding yourself with a strong birth team-- these steps themselves can help to buffer you against others' birth horror stories.

You can also just stop them before they start. Change the subject, find an excuse to hang up the phone, or tell your family and friends what you do and don't want to hear when you are pregnant. Surround yourself with what will help you approach your labor with confidence, calm, and joy-- start your positive birth experience now.
I am a certified birth doula, postpartum doula, and childbirth educator serving clients in Boise, Meridian, Eagle, Nampa, and the Greater Treasure Valley. 
Learning about the birth process and having caring, knowledgeable support throughout pregnancy and labor can make or break your birth experience.

About Birth Doula Support
elevated birth

​Copyright 2019
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Water Isn't Just for Water Birth!

1/10/2019

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natural birth Boise
Water immersion in labor has many benefits

You can use water in labor, even if you don't plan on a having a water birth!

Water is one of my favorite pain management tools in labor. Whether you give birth at home or in the hospital, at some point my clients end up in the tub or in the shower.

Here’s why hydrotherapy can be a wonderful option in labor:

You can relax!
​
Even for those who aren’t pregnant, a nice, warm bath after a long day of work can make you feel more relaxed and calm. Immersion in water can lessen anxiety and promote relaxation. These same benefits apply when you are in labor.

The calming effects of water can actually help with labor progression. When you are feeling relaxed and calm, your body releases endorphins, which promote the production of another hormone called oxytocin. Oxytocin plays an important role in labor, stimulating contractions. (Known as the "love hormone," oxytocin is also involved in attachment and breastfeeding).

When the oxytocin is flowing, your labor can progress. Conversely, when you are feeling stressed and anxious, adrenaline is produced, which can interfere with oxytocin production. So taking a warm bath, combined with other relaxation tools such as music, meditation, dim lighting, massage, and self-hypnosis, can help your labor keep a nice, active pattern.

Note: In early labor, taking a bath can slow down contractions. This is just fine-- early labor should be a time of rest, since it can take hours or even days to turn into active labor. If active labor is imminent, taking a bath won’t stop it!
boise natural birth
It provides pain relief.
Water is sometimes referred to as a “liquid epidural.” While water doesn’t take away all sense of pain (although some clients report that at times it comes pretty close), it definitely helps to make the pain of labor more manageable.

The website Evidence Based Birth gives a review of the evidence behind water immersion as pain relief in labor. In a meta-analysis of several studies, it was reported that people who labored in water were less likely to use epidurals or spinal anesthesia for pain relief.

Submerging your body in water isn’t always necessary. Standing in the shower, with the hot water pointed at the part of your body where you are feeling the most pain or discomfort, is also very effective for pain relief. 

​

You can move.
While submerged in water, it may be easier to move your body into positions that may be more difficult or uncomfortable "on land," like hands and knees, or in a squat. Being in water can help take pressure off of areas of your body that ache. You may feel more buoyant and lighter, contributing to feelings of relaxation.
water birth Boise
It’s accessible.
If you are laboring at home, you can use your own bathtub or shower. (In early labor, I encourage my clients to take a bath and then try to sleep for a while, to reserve their energy for active labor.)

At the birth center, there are tubs and sometimes showers for your use. And more and more hospitals are offering tubs to labor in (although most hospitals still don’t allow pushing or giving birth in the water).


Fortunately for those in the Treasure Valley, both St. Lukes and St. Alphonsus offer labor tubs, either in each room or in a single-use shared space on the labor and floor. Some tubs sport jacuzzi-style vents for additional comfort.

For low-risk pregnancies, you can labor in the tub at just about any time, including after your bag of waters has broken, or if you have been induced. When laboring in the hospital tub, the nurses can monitor you intermittently without you having to get out of the water; if you consent to cervical exams, these can often be done in the water as well. (Note that with narcotic pain medications and epidurals, you won’t be allowed to labor in the tub for safety reasons.)



​You can try it again.
At some point, if my clients aren’t planning a water birth, they decide to get out of the tub, either to push out their baby or to continue laboring on land. At this point, I can help them maneuver out of the water and wrap them up in a nice, warm towel so we can try some other comfort measures.

Sometimes, my clients decide to try the tub or shower again, and they easily can.

With some pain medications, you can have only a certain number of doses, and your mobility may be decreased for a while. With hydrotherapy, you can return to the tub or shower at just about any time during labor.

If you are worried about an accidental water birth, your doula and care providers can often get a sense of how close you may be to pushing based on your behavior and sensations you are reporting. We can recommend getting out of the tub to give you enough time to get to the place where you intend to birth your baby.
I am a certified labor (birth) doula and postpartum doula serving clients in Boise, Meridian, Eagle, Nampa, and the Greater Treasure Valley.
​Do you have questions about using water in your upcoming birth?
Learn About Birth Support
elevated birth

​Copyright 2019
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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.​
Picture
  • 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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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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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.
​
​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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elevated birth
​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!
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 a little 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, celebrities, 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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