Episi-What?

You’re going to cut my wife where? Let’s take the episiotomy one step at a time,
in a simple, less perplexing way. No pictures…I Promise!
We all know that a baby has to wiggle out of a small space during birth. This space grows
larger with each dilation of the cervix. Dilation is measured by finger-span. One centimeter dilation allows the doctor to measure with one fingertip. Two centimeters, the doctor can measure with two fingers, etc. At ten centimeters, the cervix is about the size of a grapefruit. Wow- crazy, I know. This process of dilation takes time, by once mom is at 10 centimeters,
she is complete and is ready to push.

So, what happens if 10 centimeters isn’t enough? There are gradual ways to help stretch the tissue just a bit larger. It can be done by your care provider. They can use mineral oil or even the application of a warm compress around the area and along with a gentle massage/stretch. If these methods don’t work, there may be risk for tearing of the tissue around the perineum, maybe even leading down toward the rectum. Tears often heal rather well; however, if it is a large tear, there can be severe damage.
What’s a doc to do? Well, that is up to mom. Mom may choose to try the methods above, but she could be open for a little assistance. Doctors can control a tear by cutting. This is called an episiotomy. Unlike a tear, this is a more directed cut that helps to alleviate or prevent a severe tear. You can ask your doctor to cut a little at a time, as needed. The healing of a tear can be easier than an episiotomy; however, both tears and cuts will need to be cared for and given time to mend. Please note that it is possible to get an episiotomy, but continue to tear.
Types of tears:
· Superficial-tears at the outermost layer of the vaginal tissue (no stitches required).
· 2nd Degree-deeper tears into the muscles (stitches required).
· 3rd Degree-vaginal tissue tears, perennial skin and perennial muscle tear
· 4th Degree- tears around anal area and sometimes through the anal area
How do you help your wife try to prevent tearing or the need for episiotomies? Remind
her remember to do her “Kegal” exercises. Kegal exercises decreases risk of developing hemorrhoids and leaking urine in late pregnancy. It also prepares the pelvic floor for childbirth, improves healing of the perineum from episiotomy, and can increase sexual pleasure for you and her. How does she do this? First, identify your pelvic floor muscle. One way to do this for women and men is to contract the muscle that stops the flow of urine. (Avoid doing Kegels while urinating; this can actually weaken the muscle. Only do Kegel exercises with an empty bladder). Contract the muscle and hold for 2-5 seconds, then release it, being careful not to contract the muscles in your abdomen, thighs, or buttocks). She should repeat this 10 times in a row, three times a day.

Please talk to your care provider about your wishes, before the time comes. No one wants to tear or be cut, but discussing alternative options and choices can help tremendously.

Does Your Breastmilk Look Different Today?

Believe it or not, you will notice changes in the consistancy and even color of your breastmilk. A mom recently asked me if it was normal to have watery milk in the morning and thicker milk later in the day. This is absolutely normal. Why does it do this? Long explination short, your milk consistancy, smell, color, and amount vary throughout your breastfeeding experience from day one to the last day.
For this mom, she had just mentioned that her baby was sleeping longer hours thru the night and during this last week, she noticed that the consistancy was changing. Why was it thinner in the morning? There are two levels of milk that you provide to your baby. The first 2-5 minutes will be "foremilk" or front milk. The consistancy is thinner and has few calories. Your "hindmilk" or the milk behind the foremilk is thicker and packs a lot of fat and calories. If your baby is sleeping in longer, your breast fills up with excess milk, thus at first causing you to overfill. At first, you may notice that your breasts are swollen and full, until they adjust to your baby's new schedule.
You may nurse or pump and notice that you have a lot more of the foremilk than usual, again, the thinner-watery consistancy. This is great for building up your stock of breast milk, but this can cause your baby to have looser stools because their bodies excrete foremilk at a faster rate. If your baby misses a feeding, it is okay to do self-expressions or pump a bit before breastfeeding, 1-3 minutes. Or, if you are pumping and noticing that baby is having very loose stools, you may want to discard your first 1-3 minutes of pumped milk.
Color and smell of breastmilk is also affected by changes in your diet. If you eat a lot of green vegitables, you may notice a green tint to your milk. If you eat a lot of garlic, your milk may smell a bit like garlic. Remember that what you take in may affect what comes out of your breastmilk. This includes alcohol and medication. If you have any concerns about what is being passed to baby, please ask a breastfeeding counselor or your physician.
The amount of milk pumped will also fluctuate, based on the needs of your baby. When your baby goes thru growth spurts, your baby will nurse often. When your baby nurses often, your milk production will increase. Remember supply and demand? Well, this is the best description to give when talking about the amount you see pumped. Moms are often concerned about if their baby is getting enough. In the majority of cases, they are, but if you notice any issues or have concerns, please seek help. If you slow down on the amount of times you breastfeed, your milk production will slow down. Keep this in mind when you notice any changes. A breastfeeding counselor does have ideas on how to naturally increase or decrease milk supply. Often times, issues can be resolved rather quickly with just some helpful hints or reminders.
This was one of my great questions of the week. Send me your questions and I will help! I guarantee that you are not the only mom with your question.

Who Can Eat During Labor?

You have probably heard that eating during labor is not allowed, nor advised. Did your mom get ice chips only during labor? Times have changed and the voices are speaking out about choices in childbirth.

Originally, in the 1940's doctors prohibited eating and drinking during labor amidst some concerns about aspirating during emergency anesthesia. They found that aspirating stomach contents would cause severe health concerns, such as pneumonia or even death.

Research has shown that these results are very minute and there are fewer women having anesthesia.

According to the American College of Obstetricians and Gynecologists (ACOG) guidelines, it is okay for moms-to-be to drink clear liquids if they're having uncomplicated labors. But physicians may still draw the line at solid foods (like toast).
Most moms often loose their appetite during labor and choose not to eat. Small doses of water and other clear liquids are great during this time. I usually recommend eating small snack foods in early labor. This will help increase your energy and it helps keep the momentum throughout labor. As a doula, I let families know that it might be a great idea to find your favorite popsicles or protein bars that they will use at home or during the first 2-4 hours of labor. I do not suggest eating full meals once you know that you are in labor. This is strongly discouraged, because it can make you feel awful when your contractions start becoming stronger; it often leads to increased nausea.

I encourage mom to drink a bit of water after every 2-3 contractions, to avoid dehydration and IV fluids.

What happens if you don't eat? Restricting food in labor can cause problems of its own. Besides the stress factors, restricting intake during labor can cause dehydration and ketosis.

What other items do I recommend during labor?

Tea,

Fruit juice, and

Broth

(All of which more and more hospitals already have on hand for birthing mamas).

For Dads:

Dads, although I recommend that you also eat during labor, please be considerate and eat outside the birthing suite or bring items that do not have a strong smell. Mom may become sick because of what you are eating. It may also make her feel a bit jealous.

What happens if mom has nausea?

I love Preggie-Pops!

Slow way down on liquids-mom is most-likely in transition and will be pushing soon!

NOTE: Ask your doctor/midwife about their policies about food and drink during
labor. If they do not reflect the current medical studies you may share the
information with them and see if they will go along with your plan. Many
hospitals and birth centers have special labor diets now and the women report
being very satisfied with the outcomes.

For more questions, please ask me.

~Tina

Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia, Anesthesiology:Volume 106(4)April 2007pp 843-863.Providing Oral Nutrition to Women in Labor, American College of Nurse-Midwives, Journal of Midwifery & Women's Health - May 2008 (Vol. 53, Issue 3, Pages 276-283, DOI: 10.1016/j.jmwh.2008.03.006)Restricting oral fluid and food intake during labour. Singata M, Tranmer J, Gyte GML. January 2010 Cochrane Review Additional Resources: References
1. Swift, L., 1991, ‘Labor and fasting’, Nursing Times, vol 87, no 48, pp. 64-65. ACOG.ORG

http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Oral_Intake_During_Labor.aspx2. Roberts, C.C. & Ludka, L.M., 1993, ‘Eating and drinking in labor: A literature review’,
Midwives: hear the heartbeat of the future, proceedings of the International
Confederation of Midwives 23rd International Congress, May 9-14 1993, Vancouver,
Canada, pp. 1559-1572.
3. Enkin, M., Keirse, Marc J.N.C., Neilson, J., Crowther, C., Duley, L., Hodnett, E., &
Hofmeyer, J., 2000, A guide to effective care in pregnancy and childbirth, Oxford
University Press, New York.
4. Sleutel, M. & Golden, S.S. 1999, ‘Fasting in labor: relic or requirement’, Journal of
Obstetric, Gynecologic, and Neonatal Nursing, vol 28, no 5, pp. 507-512.
5. Hazle, N.R., 1986, ‘Hydration in labor: is routine intravenous hydration necessary?’,
Journal of Nurse Midwifery, vol 31, no 4, pp. 171-176.
6. Carp, H., Jayaram, A., & Stoll, M., 1992, ‘Ultrasound examination of the stomach
contents of parturients’, Anesthesia and Analgesia’, vol 74, no 5, pp. 683-687.

Brenda's Birth Story

Here is the birth story of our sweet baby boy…
We had a traumatic emergency c-section with our 2nd baby, so when we found out we were expecting again I knew I wanted to use a doula this time around to increase my chances of a VBAC. I met Tina at a Doula Network meeting and asked her to be our Doula shortly after finding out I was pregnant.
On August 17th I woke up with contractions that seemed stronger than the Braxton hicks I had been having. I had some bloody show and the contractions continued about 5-10 minutes apart the whole day…they slowly got stronger. Around 10:30 p.m. We decided to call Tina. When she arrived the contractions slowed way down. We thought it would be good to try and rest so she went home and I went to bed around midnight. At 2am I woke up with a decent
contraction. I stayed in bed till 5:30am. I was able to rest in between the contractions but needed Clint to rub my back each time I had one. They were getting stronger but still staying about 5 minutes apart and staying about 60 seconds in duration.
We called Tina and she came over around 8am. We walked a couple of blocks around the
neighborhood…stopping with each contraction. They were getting more intense and I was starting to feel really exhausted and somewhat nauseated. I continued to labor at home…pretty much just wondering around…and eventually feeling most comfortable in my bedroom. I decided I wanted to take a shower to help relax…right before I got in I started throwing up. I felt much better after that and was able to be in the shower alone. Clint stayed in the bathroom in case I needed anything but the hot water really helped me relax. Around 11:30 or 12pm Clint and I decided we wanted to go to the hospital.
We got our things together and headed over…Tina would meet us there. Things seemed to calm down on the ride over. I still contracted about 5 minutes apart, but they seemed much more manageable. We parked and walked up to labor and delivery. After we got up and into Triage, Clint had to go back down to admitting. Tina was there so she stayed with me while the nurse got me on the monitors to watch the contractions/baby’s heart rate. After Clint came back up and the nurse got all the info she needed, she checked my cervix. I as an 8! I started crying out
of relief! Relief that it was close to the end and relief that we had stayed home long enough...I was so worried I would get there and only be 3cm!
We got into our room and got settled. My Dr. was out of town so the on-call Dr. came in to see how I was doing. I was very thankful to see that it was the same Dr. we saw for our OB care with our first son. He offered to break my water and we decided we would since I was progressed so far.
Immediately after he broke my water, the contractions got INTENSE. I did need to be on the monitors but was able to labor out of bed. I would squat or lean my elbows on the side of the bed
with each contraction. Shortly after my water breaking I felt pressure, the nurse checked and I was still an 8. I remember thinking…”I can’t do this much longer!” I had a few more contractions and this time I felt PRESSURE! I think I even was pushing a little because I just “needed” to. This time I was at 10cm and ready to push. They called the Dr. and I ended up having to wait a little bit before he got there. That was really hard! The nurse and Tina were really helpful in helping me breath through the contractions…In retrospect I think I would have just started pushing. Finally, the Dr arrived and I started to push. I needed help with my breathing
and had some oxygen…It was so intense and I was ready for it to be over! It felt like I was pushing for a really long time but I guess it was less than 5 pushes and our baby boy was here! I looked down and saw his sweet face…The feeling of seeing him and the relief of delivery being over was unlike anything I have ever experienced.

My body had been laboring for over 24 hours and was finally done. They put sweet Griffin to my chest and he was so beautiful and alert…He nursed right away and it was so amazing to have my
baby with me and not taken away. I had no tearing and really no trauma anywhere…my recovery was amazing. My back muscles were a tad sore but other than that I felt great.
Overall my birth experience was an amazing experience. Was everything we had wanted and more. God blessed me beyond words and I am so thankful for our beautiful baby
boy and such an incredible birth. I got to experience birth how God created it to be.
My body did what it was supposed to do and I was able to enjoy the experience vs. fear it. Having Tina serve as my Doula was so beneficial and I couldn’t have done it without her. She was such a blessing to us during this time and we will always hold a special place for her in our hearts!
~Brenda

Free Breastfeeding Support Group!

New breastfeeding group starting up in November! It will be every other Monday, from 7pm-8pm. Please let me know if you and/or your friends might be interested. Free group, sponsored by Blessings of Birth. More details to come. Become a Facebook fan, make a comment about why you chose to breastfeed, and you will be entered to win a free 1 hour massage!

Go 4th!

Thanks for all your support in the annual Longview Go 4th Parade.

We are excited for what this year will bring.

Be sure to let those who are expecting, thinking about becoming pregnant, and even new moms, know that I am here.

Visit: http://www.blessingsofbirth.net for more information.

Recommended Resources for Giving Birth in America

I am a birth advocate. What does that mean to me? It means that not only am I pro-life, I am pro-birthing experience. I believe that women have the right to birth in the way they desire. I also believe that many women do not know that there are choices in childbirth and for that very reason, end up with a birth experience that they did not expect.
A midwife recently sent me to this documentary and I am so glad she did. I want to share this with you and hope that this makes you more of a birth advocate.
Watch the video (available instantly on Netflix). This trailer will give you a glimpse.
-Also, watch The Business of Being Born. These two go hand in hand.

Support BABIES with me!

Every day, thousands of babies are born too soon, too small and often very sick. I'm walking in March for Babies because I want to do something about this. And I need your help. Please support my walk. Making a secure donation is easy: just click the 'donate now' button on this page. Thank you for helping me give all babies a healthy start! The mission of March of Dimes is to improve the health of babies by preventing birth defects, premature birth, and infant mortality. Your gift will support March of Dimes research and programs that help moms have full-term pregnancies and babies begin healthy lives. And it will be used to bring comfort and information to families with a baby in newborn intensive care. Visit my link to help support BABIES! http://www.marchforbabies.org/personal_page.asp?pp=3653655&ct=4&w=4660729&u=doulatina

Labor at Home for Early Labor

• During this phase you should just relax. It is not necessary for you to rush to the hospital or birth center. It will be more comfortable for you to spend this time at home, in familiar territory. If early labor is during the day you should do simple routines around the house. Keep yourself occupied but still conserve some of your energy. Drink plenty of water and eat small snacks. Keep track of the time of your contractions.If early labor begins during the night it is a good idea to try and get some sleep. If you can’t fall asleep, do things that will distract you like cleaning out your closet, packing your bag, or making sack lunches for the next day.

The Benefits of Laboring at Home

*You may be more at ease in the comfort of your own home.
*You can move around freely without the monitoring required by hospital staff and procedures.
*Labor sometimes improves at home.
*Family and friends can support you at home.

Comfort Measures
If you labor at home, these things might make you more comfortable:
~Taking a warm bath
~Resting in a bed
~Rocking in a rocking chair
~Listening to music
~Drinking liquids
~Having a massage
~Fold Baby Clothes

~Doing last minute things for the baby or for your other children
~Finish packing your bag/and partner's bag

~Don't wear yourself out with too much activity! This is a time to rest, relax and prepare yourself for the birth of your baby.

~Bake-Don't laugh, baking is a great way to spend early labor. This is a fun labor project that can help you relax and go about normal activities. I'd suggest baking some cookies or brownies to take with you to the hospital. Can you imagine how happy the nurses will be to see you with a plate of goodies? Some couples also choose to make a birth day cake to eat after the baby is born.

Also-Please contact your doctor/midwife and doula. Let them know what is going on. Watch for warning signs: bleeding, dizzyness, nausea, sharp cramping, water breaking.

Making families happy about their birth experience is my goal. I listen to your hopes and desires about the type of birth experience you desire. On my last birth experience, the mom had her desires set in place and was open to the idea that an epidural could help her and she may use it, but hoped to go natural (without any interventions). She did an awesome job and got to 8cm, but then asked for an epidural. She said she felt like a wimp and felt guilty that she resorted to the epidural. I told her that my job was not to make her feel that she could not choose a pain reliever. Because I am a doula, many feel that I only support moms who want to go all-natural. That is not the case by any means! I told this mom that I would support any decision she chose and walk her through the benefits and risks, but that her decision was for her best interest and I would support her with whatever she chose. Congratulations Holly! You did wonderful. Look at that family! It was a great birth experience and I was happy to comfort mom the whole way through.-Tina

I have a new website up and I am excited to present a $50 discount to the next person who signs up to have my doula services or $25 off any of my other courses or services. Please visit www.blessingsofbirth.net for more information about my services and contact me soon to qualify for this discount. **You must mention this promotion.


Home
www.blessingsofbirth.net

DADS-

You can help mom by attending childbirth classes with her, researching names, creating birth plans together, and being supportive during delivery. If you are unsure about how to support mom, I recommend reading "The Birth Partner" by Penny Simkin. Also, it is okay to ask for help. A doula can help you make mom feel comfortable before, during, and after the birth of your baby. She doesn't take your place, but helps you to help mom get thru this journey. It is much easier when the whole burden isn't on you. Doulas are team-players and offer many great tips and solutions to comfort mom.

I also offer a 2 hour "Dad Prep" class for any dad-to-be. Whether you are having a doula or not, I can teach you how to be a supurb birth partner. "Dad Prep" course does require mom to be there. You will learn: comfort techniques, massage, communication, and how to ultimately help bring in your bundle.

As a doula and childbirth educator, I am available for questions. Please visit my website for more information.

NEW Breastfeeding Support Group!

Are you breastfeeding and looking for support other mothers to connect with? This group will meet for coffee with babes-in-armes to talk about breastfeeding concerns and challenges. You will be encouraged and supported in your breastfeeding journey. This will be hosted by certified doula Tina Black, a former breastfeeding mom.

Any breastfeeding mom is welcome!

Meeting is April 17th at 9am. Location: Intermission Cafe 3187 Oceanbeach Hwy. Longview.

Visit http://www.blessingsofbirth.net/ for more information.

FREE "ASK A DOULA" WORKSHOP

I am hosting another "Ask a doula" workshop March 30th 1:30 and 6pm. Anyone is welcome!

If you may be interested in having doula support or learning more about how a doula can help, please join this (FREE) workshop. More information is available on my website http://www.blessingsofbirth.net/.