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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!
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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. 

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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?
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​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.​
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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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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.
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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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"Give Me All the Drugs!"

5/8/2018

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Picture
"Give me all the drugs!"

This is a humorous way some people inform others that they don’t want an unmedicated birth. You or someone you know may have used those exact same words during your pregnancy. As a doula, I’ve heard it from clients, too.


There is a misconception that people hire doulas only for unmedicated births. While I definitely have had clients who value “natural” labor, and give birth without pain medication or other medical interventions, I also serve clients who know ahead of time that they will get an epidural, or will utilize some other form of pain medication.

Why would you want a doula if you know you will opt for drugs in birth?


1. You want to wait as long as possible before opting for drugs. Some clients want to see how far they can get without pain medication, for a variety of reasons. Some are concerned about the side effects of certain medications, or the interventions required with their use, like continuous fetal monitoring, I.V. fluids, catheterization, etc. Some have concerns about slowing down labor, or taking medication too soon and being left with fewer options for pain relief later on. Others want pain medication as an option, but are okay with using it only if needed.

Until the client decides to utilize medication, they may need help with natural pain management, coping with contractions, and emotional support. As a doula, I can offer suggestions and provide whatever support is needed to get my clients to the point at which they feel they are ready to accept pain medication.



2. You want more information about the pain medication available to you. During pregnancy, we discuss your goals and intentions regarding pain management, and your options at your particular place of birth. You may know that nitrous oxide is offered at St. Alphonsus and St. Lukes hospitals, but you may not know how administration of the nitrous actually works. You may consider a narcotic for pain relief, but want to know the potential side effects before deciding. You may want an epidural, but be unaware of what positions you are likely to push in after getting one.

There are risks and benefits to every intervention, and knowing these before you are in labor can help you determine which medications you want to prioritize, and which you want to avoid. You can learn some of this information during a childbirth education class, or by doing your own reading, but having an in-depth discussion about your options with your doula brings the conversation to a more personal level. We discuss what support you may need for various pain relief options, and what you can expect to follow. The information is tailored to your individual needs, your personality, and your specific goals and values.


3. Sometimes medications don’t work as you expect.  You may have heard stories of an epidural “not working,” or working only on one side. You may experience an unpleasant side effect from a certain medication, like nausea and vomiting, loss of sensation, or severe itchiness. A doula’s calm, comforting support and encouragement can help to get you through unexpected pain or discomfort. I have utilized coached breathing, visualization, light massage, and other techniques to get clients through a difficult episode. When things take an unexpected turn, being able to turn to your doula for reassurance is sometimes all a laboring client needs.


4. Some births involve medication from the start.  You may need or opt for an induction or Cesarean birth, or you have a high-risk pregnancy that requires medicalized care. Just these circumstances alone can bring up fear and anxiety that a doula can help you work through. Even when a birth doesn’t go as planned, there are often options that may be available to you that you hadn’t considered or known about. For instance, there are different ways to induce labor-- pharmacological, mechanical, or low-tech options like trying an in-office membrane sweep. Your doula can inform you of these options, so you can discuss them with your doctor or midwife and see if they can be incorporated into your birth.


5. Continuous care is continuous care.  No matter how you choose to birth, or how your birth unfolds, having continuous support can make all the difference in how you feel about your birth.

It’s not always feasible to rely solely on your partner to provide this support; they may not feel knowledgable enough to support you, they may be nervous and require their own support, or they may need periodic breaks to best serve you in labor. It isn’t common or the norm for your doctor or midwife, or even your nurses, to be able to be with you at all times during labor. And often the on-call staff can be strangers, whom you’ve just met.

As your doula, I am a familiar face. During our prenatal visits, we've gotten to know each other. I am at your side, as long as you need, to help you get through whatever your labor brings. After the baby is here, I can help with breastfeeding, check on you at home postpartum, and serve as a resource for questions and referrals. As a postpartum doula, I can provide in-home care to make the transition to life with your new baby easier. The continuity that doula care provides is reassuring, convenient, and maximizes the chances of a positive birth experience.
I am a certified labor doula and professional postpartum doula serving clients in Boise, Eagle, Meridian, Nampa, and the greater Treasure Valley.
Are you planning on utilizing pain medications in your labor? Do you want to know more about what options are available at your birth place?  Let's talk!
Contact Me
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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