“To understand the vagina properly is to realize that it is not only coextensive with the female brain, but is also, essentially, part of the female soul.”
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This is a powerful read. I see the complete truth in this article during labor and births, and even during pregnancy. I think one of the most powerful quotes of the whole article is by Wolf – “The way in which any given culture treats the vagina — whether with respect or disrespect, caringly or disparagingly — is a metaphor for how women in general in that place and time are treated.”

I think everyone should read this article and really think and ponder what she is saying. Women are complex creatures, and so are our bodies, When you negatively affect one area – you negatively impact others. There is a lot more cause and effect than we think, or admit.

Click to read the article –> The Science of Stress, Orgasm and Creativity: How the Brain and the Vagina Conspire in Consciousness

So, how do you treat the vagina? How do you see it? Do you have slang-terms you use when you refer to the vagina? How are you respecting women? How will this impact your labor and birth?

The American Congress of Obstetrics and Gynecologists recently released a committee opinion on the safety of water births. (Read it here) This opinion was met with some concern from the American Association of Birth Centers (AABC) who say “the document has the potential to introduce inappropriate fear about the safety of water birth for families, providers, facility administrators, insurers, and others who want to make informed decisions regarding immersion in water for labor and birth.” The AABC have collected and analyzed 3998 water births and the outcomes over the period of January 1, 2007 through December 31, 2010 and have found the following:

• Rates of postpartum and neonatal transfer from the birth center, and neonatal procedures were low for the sample in general, and were slightly lower for births in water when compared to non-water births.  This has been reported elsewhere.1

• This suggests that if labor is not progressing smoothly, women were unlikely to give birth in water and speaks to the importance of anticipatory and skilled water birth providers.

• Rates of newborn transfer to a hospital were lower following water birth (1.5%) than non-water birth (2.8%)

• Rates of adverse newborn outcomes (5 minute APGAR < 7, respiratory issues, presence of infection and NICU admission) were each below 1.0% in the water birth sample.  The total rate of any respiratory issues was 1.6% in the babies born in water and 2.0% in those not born in water.

• There were no incidences of pneumonia, sepsis or other respiratory infection following water birth and there were no reports of ruptured umbilical cords or newborns breathing water into their lungs associated with birth underwater.

• Midwives practicing in birth centers are trained, anticipatory water birth providers, so data generated by midwifery care provides the most accurate view of the safety of water birth.
  
  

They concluded that “water birth, with careful selection criteria and experienced providers, does not negatively affect mothers or newborns.”

As with all aspects of pregnancy, labor and birth, make sure you:

• Talk with your Midwife/OBGYN
• Talk with your spouse/partner
• Read, research, educate yourself
• Make a decision for YOU and YOUR BABY.
  
  Read the complete responses from AABC - AABC Position Statement – Immersion in Water during Labor and Birth

Inspired by Dr. Seuss. Author Unknown. 

​Cesarean delivery is over-used. The lowest cesarean rate in the United States is 23%, the highest is 40%! In Oregon the cesarean rate is 29.4% (from ACOG article). The new statement by ACOG and SMFM will hopefully change those numbers.

The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine issued a joint Obstetrics Care Consensus statement: Safe Prevention of the Primary Cesarean Delivery. This is a big game changer for the medical field of labor and delivery. It discusses the rate of cesarean in the United States, the causes and the outcomes of the over use of cesarean and suggests steps to take to change the cesarean environment. The study states “the alarming and sustained increase in the cesarean rate in the United States has not improved either maternal or neonatal outcomes. In fact, data suggest that there is increased maternal mortality and morbidity associated with cesarean delivery.”

The authors provide a new set of guidelines that offer ways to lower the cesarean rate and make labor and birth more safe for the mother and baby. The guidelines also offer a more hands off approach to the management of labor which would allow moms to labor longer, doctors would be forced to be more patient towards the natural (and sometimes slow) progression of normal labor. They suggest a respect for and understanding of women’s ability to give birth.  This impacts hospitals as well, as they will have to plan for longer stays for women in labor and delivery. A safe and healthy mother and child are the end result; cesareans are not the only (and shouldn’t be the first choice) for that result.

The hope and the goal is for women to have confidence in their ability to give birth and for all those involved (doctors, nurses, staff, friends, family, etc) to also respect a women’s body and ability to progress through labor on her own, in her own time and through her own means.

Some of the new guidelines are:

• Continuous labor support, including support provided by doulas, is one of the most effective ways to decrease the cesarean rate. The authors note that this resource is probably underutilized. (YAY DOULAS!!!!)
• Induction of labor can increase the risk of cesarean. Before 41 0/7 weeks induction should not be done unless there are maternal or fetal indications. Cervical ripening with induction can decrease the risk of cesarean. An induction should only be considered “a failure” after 24 hours of oxytocin administration and ruptured membranes. 
• Recurrent variable decelerations appear to be physiologic response to repetitive compressions of the umbilical cord and are not pathologic. There is an in depth discussion of fetal heart rate patterns and interventions other than cesarean to deal with this clinically. Amnioinfusion for variable fetal heart rate decelerations may safely reduce the rate of cesarean delivery.
• Ultrasound done late in pregnancy is associated with an increase in cesareans with no evidence of neonatal benefit. Macrosomia is not an indication for cesarean. 
• Perinatal outcomes for twin gestations in which the first twin is in cephalic presentation are not improved by cesarean delivery (even if the second twin is a noncephalic presentation).
• Before a vaginal breech birth is considered, women need to be informed that there is an increased risk of perinatal or neonatal mortality and morbidity and provide informed consent for the procedure. 
• The Consortium on Safe Labor data rather than the Friedman standards should inform labor management. Slow but progressive labor in the first stage of labor should not be an indication for cesarean. With a few exceptions, prolonged latent phase (greater than 20 hours in a first time mother and greater than 14 hours in multiparous women) should not be an indication for cesarean. As long as mother and baby are doing well, cervical dilation of 6 cm should be the threshold for the active phase of labor. Active phase arrest is defined as women at or beyond 6 cm dilatation with ruptured membranes who fail to progress despite 4 hours of adequate uterine activity, or at least 6 hours of oxytocin administration with inadequate uterine activity and no cervical change.

​The American Academy of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine are to be applauded for their careful research and willingness to make recommendations for labor management based on best evidence. They have provide direction for health care providers and women. This is a most welcome change.

​
Read the full ACOG article here
Read the full overview of the ACOG article from Science & Sensibility here

Birth plans are a great way to learn about birth and labor! It is a way to research what you want to have happen during the birth and what you don’t want to have happen at the birth. It helps you learn how to talk about birth issues/things with your spouse, your doctor, and your friends. If you have any questions, your health care provider is a good place to start. When your birth plan is finished, make sure you show your health care provider and ask them to sign it. If you are taking any health care classes, the instructors are also good people to ask for help with your birth plan.

 10 Tips for Writing a Helpful/Informed/Concise Birth Plan:
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#1    DO keep your birth plan short, simple, and easy to understand (1-2 pages max).
#2    DO keep the language of your birth plan assertive and clear.
#3    DO use your birth plan as an impetus for doing your own personal research about your preferences for childbirth. (One great place to start is: www.mothersadvocate.com).
#4    DO include your fears, concerns, and helpful things for the nurse to know.
#5    DO review your birth plan with your birth attendant and ask him/her to sign off that he/she read and understands it.
#6    DO make your birth plan personal (don’t just copy paste) and DO make sure that you understand and can elaborate on everything in the birth plan if asked.
#7    DO look at examples of great birth plans online to get some ideas. (Some good places to start: www.birthingnaturally.net; www.babycenter.com; www.mothersadvocate.com).
#8    DO run through scenarios in your mind about how labor could unfold and actually talk these scenarios out with your labor companions and Doula (or perhaps even your childbirth educator or birth attendant too!).
#9    DO try to treat researching and birth plan writing as a fun and exciting experience, not a chore!
#10 DO discuss your birth plan with your partner/friend/parent/Doula.

 Remember to bring your birth plan to the hospital!!

Birth Plan Resources: 

Birth Plan from a Mommy: http://thehumbledhomemaker.com/2012/08/a-sample-hospital-birth-plan.html

Birth Plan Worksheet: http://www.babycenter.com/calculators-birthplan
This is a good one to look at for all kinds of ideas. I would not recommend using this whole thing – it is 4 pages long. You could choose all the boxes you want and maybe transfer them to a shorter birth plan.

Birth Plan Organizer - Choices in Childbirth (from a Doula): http://choicesinchildbirth.com/Birth_Plan_Organizer.html
 
American Pregnancy Association - http://americanpregnancy.org/labornbirth/birthplan.htm

Earth Mama Angel Baby - http://www.earthmamaangelbaby.com/free-birth-plan

I’m sure you have heard people talk about the “dangers” of co-sleeping, or maybe a friend gave you that look when you mentioned you and your family had decided on co-sleeping, or maybe a parent has lectured you on the dangers of sleeping with your baby (that they heard or read in the news!)…maybe all of the above. While the risk of SIDS is very real and very scary, it does not go hand-in-hand with co-sleeping or bed-sharing. If you safely co-sleep with your baby you do not increase your risk of SIDS, but you can enjoy: heightened awareness of your baby, similar protective sleeping patterns with your baby, easier breastfeeding, more sleep, a healthier baby, and much more.  You can safely co-sleeping with your baby in your bed (as with bed-sharing) or right next to your bed – as with a bassinet or a bed created for co-sleeping like the Arm’s Reach beds, you just need to follow safety steps keep the lines of communication open. Co-sleeping does not have to mean bed-sharing.
​A respected and knowledgeable Dr. in the field of babies and co-sleeping is Dr. Sears. He has done scientific research and studies as well as anthropological research on co-sleeping. His research shows:

• Cultures who traditionally practice safe co-sleeping, such as Asians, enjoy the lowest incidence of Sudden Infant Death Syndrome (SIDS).
• Trusted research by Dr. James McKenna, Director of the Mother-Baby Sleep Laboratory of the University of Notre Dame, showed that mothers and babies who sleep close to each other enjoy similar protective sleep patterns.  Mothers enjoy a heightened awareness of their baby’s presence, what I call a “nighttime sleep harmony,” that protects baby.  The co-sleeping mother is more aware if her baby’s well-being is in danger.
• Babies who sleep close to their mothers enjoy “protective arousal,” a state of sleep that enables them to more easily awaken if their health is in danger, such as breathing difficulties.
• Co-sleeping makes breastfeeding easier, which provides many health benefits for mother and baby.
• More infant deaths occur in unsafe cribs than in parents’ bed.
• Co-sleeping tragedies that have occurred have nearly always been associated with dangerous practices, such as unsafe beds, or parents under the influence of substances that dampen their awareness of baby.
• Research shows that co-sleeping infants cry less during the night, compared to solo sleepers who startle repeatedly throughout the night and spend 4 times the number of minutes crying. Startling and crying releases adrenaline, which can interfere with restful sleep and leads to long term sleep anxiety.
• Infants who sleep near to parents have more stable temperatures, regular heart rhythms, and fewer long pauses in breathing compared to babies who sleep alone.  This means baby sleeps physiologically safer.
• A recent large study concluded that bed sharing did NOT increase the risk of SIDS, unless the mom was a smoker or abused alcohol.
  
  

Here are some steps to safely bed-share:

• Place babies to sleep on their backs.
• Be sure there are no crevices between the mattress and guardrail or headboard that allows baby’s head to sink into.
• Do not allow anyone but mother to sleep next to the baby, since only mothers have that protective awareness of baby.  Place baby between mother and a guardrail, not between mother and father. Father should sleep on the other side of mother.
• Don’t fall asleep with baby on a cushy surface, such as a beanbag, couch, or wavy waterbed.
• Don’t bed-share if you smoke or are under the influence of drugs, alcohol, or medications that affect your sleep.
  
  

The decision to co-sleeping and bed-share is for you and your partner to decide. It is a personal decision and it can change with each child, but it should be based on research and communication, not fear and the unknown. I hope this blog helps you feel more empowered and knowledgeable to make the best decision for you and your baby!
Find the complete article by Dr. Sears and further research,  here.

Preeclampsia is pregnancy syndrome that is diagnosed when both hypertension and proteinuria (protein in the urine) are apparent  It can happen in any pregnancy, though it is more common in women pregnant with their first child. There are risk factors that increase a woman’s chance of getting preeclampsia, but it can happen to anyone.
Preeclampsia can come about suddenly or remain mild for weeks at a time before accumulating into something more intense. It mainly affects the placenta, although other organs like the liver, brain and platelets can be impacted by the syndrome. Preeclampsia causes a placenta to weaken and causes the delivery of vital blood and nutrients to the placenta and baby to decrease or weaken.
The signs of preeclampsia include:

• Hypertension
• Swelling
• Nausea / vomiting
• Proteinuria
• Sudden weight gain
• Headaches
• Lower back pain / abdominal pain
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The only treatment for preeclampsia at this time is placenta delivery. Women are put under observation and continual care until the baby can be delivered with the best outcomes possible. Preeclampsia is serious and can be life-threatening. Education and prenatal care are two great preventative measures every woman can take.
To learn more, please visit Science & Sensibility: Preeclampsia: Research Roundup and Information for Professionals and Consumers*.
Resources:

1. The Preeclampsia Foundation: http://www.preeclampsia.org
2. The Promise Walk – Walk for Preeclampsia: http://www.promisewalk.org/campaign
   
   

*This is the article where most of my information came from.

I am a Birth Doula and have been in birth circles for over 5 years now. I know a lot about postpartum. I thought I knew what to expect when I gave birth to my first child, a girl, 3 weeks ago. Wrong!  I was amazed by the postpartum that I hadn’t heard about! Maybe you have heard some of these things and maybe you haven’t; hopefully you can relate to some, maybe learn something new, and feel better about yourself in what I have to share! 
1. Your vagina is going to hurt/be sore for weeks (and that is without tearing)!
2. Your bum could also join the sore party for weeks, although it could stop hurting sooner than your vagina.
3. Blood clots will come out of you – anywhere from tiny ones to ones the size of cherries. (If bigger than that – call your doctor)
4. You could have a sex drive! Say what?! Yes, you heard me! You could have a sex drive (strong even) right after labor! When you get home from the hospital…at night, while watching a movie…whenever. You could WANT sex! And you know what? You CAN’T! You have to let your body heal, and believe me, your vagina is going to be sore and painful and it doesn’t want to have sex, but the rest of you totally could…OR you could feel like you never want sex again. That is okay too. (Maybe don’t tell your husband that though…)
5. If you do find yourself with a sex drive, you could get creative and think of ways to orgasm that aren’t the typical way, but your vagina will hurt more afterward. The orgasm will feel good, the after won’t….
6. Your breasts will hurt! The first week or so – they can hurt all the time. You will probably have to work on them to help with engorgement (and keep mastitis at bay). Massaging the hard lumps as soon as you feel them is a good idea. Extra pumping can help too.
7. Once you think you are past the engorgement – hard lumps will still show up in your breasts and hurt. Massaging gets rids of them, along with breastfeeding and/or pumping. It hurts!
8. Breastfeeding really is an amazing and magical thing….except maybe at 1am, 2am, 3am, 4am…every night/morning when really you want to sleep. 
9. Be prepared to be pooped, peed and spit up on multiple times a day/week/hour. Be prepared for said poop, pee and spit-up to get EVERYWHERE. It is amazing how it can travel.
10. Be prepared to wash your clothes, sheets and baby’s clothes and sheets ALL THE TIME (due to above mentioned poop, pee and spit-up.)
11. Little girls can get pee everywhere if you do not have them covered. They are just a lot more covert about it than little boys.
12. Yes, you have heard that you won’t get a lot of sleep and you will be tired. You won’t get a lot of sleep and you will be TIRED. More tired than pregnancy, more tired than when you stayed up studying for a midterm or writing a paper, or partying. More tired than ever before!
13. Walking, which doctors, friends and family tell you to do as much as you can, makes your vagina even more sore.
14. The first poop could be very difficult! Or, you could have a pretty easy first poop…then you go home thinking happily that you are out of the woods and then BOOM…you can’t poop to save your life. This is called surprise constipation. It happens. Invest in prunes, good prenatal vitamins and eat healthy…
15. Holding your baby is the MOST amazing, incredible, awesome thing ever! It will bring tears to your eyes. You won’t believe that you made the little human in your arms. You will think your baby is the CUTEST baby ever! And you are right. It is a feeling like nothing else. Your heart will feel like it is exploding in love. You will walk around smiling…tired, but smiling.
16. People will want to come visit! Hold the baby! Hang out for hours! Learn how to set boundaries. Learn how to say no. Learn how to politely ask people to leave already!  It is fun to have people “ooh” and “ahhh” over your baby though. Stand/sit there with pride – you deserve it!
17. Learn how to accept HELP. You NEED it. Don’t feel guilty!! Don’t feel guilty! I don’t care if people are cleaning your bathroom and doing your laundry and walking your dog – take it! Enjoy it! Don’t feel guilty!
18. A new-born baby, I mean days old, is like a sack of rice…floppy, not heavy, but awkward, and floppy.
19. Seeing your husband with your child – priceless. It is amazing, wonderful, tender. You will fall more in love with him than ever before.
20. You will wake up in the middle of the night completely convinced your baby isn’t breathing. You will have to check. Sometimes multiple times a night. Your baby will make noises like it is choking – it is freaking scary! But your child is okay. And, it is okay to check on them. Seriously.
21. Your baby will fart like a grown man! I am not kidding. The noises that will come from your child will amaze you. Your husband is telling the truth – it wasn’t him. 
22. Baby sneezes = super cute! Babies sneeze a lot in the beginning because they are getting use to breathing air instead of water. They are not sick.
23. Get use to telling people when you pee and poop. Nurses have to know. Your doctor will ask you about it. Your Mom will probably ask you about it and any friends who just had their own babies will probably ask you about it. While we are on the subject – get ready to discuss your babies pooping and peeing with everyone too.
24. You will hear this question a LOT – “what kind of birth control will you use?” and you will think “I just gave birth! what the heck?!” And then they will say “Breastfeeding is not a form of birth control. You are a lot more fertile when you breastfeed” Just tell them “condoms” They will leave you alone.  But – you really do need birth control once your vagina is over the trauma and can handle fun again. You are more fertile when you breastfeed and breastfeeding is not a form of birth control. Just fyi.
25. Cluster feedings, aka “feeding frenzy,” aka “always on the boob!” This is when your child will nurse every hour and you will think all you do is sit with your breasts exposed and breastfeed. You are right. You might even begin to feel like a milk machine. It WON’T LAST FOREVER! I promise! It lasts a couple of days and then stops…but it will come back.
26. Diapers do not make a good backdrops to write on.
27. Being a new mom is a very isolating time in your life. Keep a journal. Talk to your baby. Reach out to friends/family – even if just on the phone. It’s okay to cry.
28. Sometimes the only way your baby will sleep in on your breast or on your chest (or the chest of your hubby).
29. You could be asked “do you know how to wash your hands?” “do you wash your hands?” “do people in your household know how to wash their hands” etc. You might even be gifted an info-graphic on proper hand washing. So, if you don’t know how – now is a good time to learn. You will be tested…
30. Baby brain – this has nothing to do with your baby and everything to do with YOUR brain. You will feel like your brain has somehow left your body, or at the very least become unattached to the rest of you. This can also happen to your husband. It is amazing (and terrifying).