Language and Birth

Positive-words-about-birth-1024x537

Words matter. They settle deep in the psyche and impact our emotions, our beliefs – our overall outlook on things. This is never truer than with pregnancy and childbirth. All pregnant women, but especially a woman pregnant with her first child, is in new and unchartered space, and the people who surround her and the things they say impact her labor and first experiences as a mother.

Mind your words around a pregnant woman, and especially around a woman in labor.

Anthropologists and communication scholars write about two different paradigms of birth. Robbie Davis Floyd, Texas anthropologist and author, writes and lectures about the “technocratic” and “ecology” models of birth, arguing that there is freedom and space in the ecology model, but that in the technocratic model, the woman’s body is seen a machine and the baby as the product. Other researchers write about the “obstetrical” model, which includes the surgical training of obstetricians, versus the “midwifery” model, which includes the midwifery model of care and the importance of continuous support for the laboring woman. In each model you see a different lexicon of words.

For instance, who actually “delivers” the baby? It’s more common in the obstetrical/technocratic model to hear that the physician delivers the baby. But, the original use of the Middle English verb to deliver was passive. The Oxford Dictionaries site points out that “a woman was delivered of a child. When active use first arose, the midwife or doctor was the agent, and the woman the object: ‘they sent, and beg’d I would deliver her’ [1676].” In the beginning, deliver referred to the woman’s experience, whether liberation or rescue from the labor, or the woman freed from the burden of pregnancy. Next it moved to the active form that focused upon the woman’s agency in her birth experience, and today it has moved the main action to the attendant. “Dr. X delivered my baby.”

At the core, within the midwifery model, pregnancy is viewed as a natural life event for childbearing women. And out of that belief, words such as power, trust, love, empowerment, choice, and energy are often used to describe pregnancy and birth. There might be references to the power of nature/ birth or the power of the mother’s abilities in labor. Doulas and midwives use words such “rushes” or “waves” or “surges” to refer to a woman’s contractions, words that conjure up the image of a powerful ocean crashing against the seaside or strong electrical currents. And the midwife serves as facilitator, not director, in the mother’s natural life event.

By contrast, within the obstetrical model, pregnancy is viewed in terms of norms, with the male body as normal. Floyd takes this idea further by saying the woman’s body is seen as machine, the baby as product, and that pregnancy is something to be controlled: the doctor or midwife “deliver” the product through their control over the process with words like induce, intervene, and medicate. If the norm is to not be pregnant, then the labor needs to be actively managed. The action is focused not on the woman who is in labor, but on the staff who perform the management.

Somewhere in between is the reality of birth, right? There are times when a labor or pregnancy can move outside the norm of regular birth. While the woman’s body is designed for giving birth, labor can get complicated. In that case, the obstetrical model, with its emphasis on management and intervention and the provider in action, is a necessary model. But, given that approximately 90% or more (some researchers believe the more accurate number to be 95%) of women can give birth, can deliver their babies without intervention, why are obstetrical/technocratic words so commonly used? And why does it matter?

Women in labor are highly sensitive and intuitive. For example, if a woman is in active labor, moving quickly through the stages, and arrives at the hospital only to hear a nurse tell her that she won’t be giving birth until the next morning, guess what? The labor slows and the baby is born in the morning. If a soon-to-be-grandmother is anxious about the birth and present in the delivery room, the slightest slip of the tongue can have a negative impact on the laboring woman. If she says, “All the women in our family have cesareans, you’re no different,” the labor will be harder, the woman will have to fight against the negativity, and if not adequately prepared or supported, she might end up with a cesarean that may or may not have been needed if the words that surrounded her were positive and affirming. If a nurse tells a mother who is ready to push that the doctor needs to arrive to deliver the baby, the mother may lose her sense of agency over the delivery and the contractions may slow or the pushing become difficult.

The power of suggestion takes on a heightened meaning during birth.

In an article on the Birth International site, Abby Sutcliffe writes:

During labour, women are particularly alert to what is being said by caregivers. Even though she may look as though she is lost is concentration during contractions, the labouring woman will hear, often acutely, what is being said around her. She looks to the midwife for confirmation that she is doing well, particularly with handling the pain. A few well-chosen words of encouragement and support can be far more effective than [medication] in achieving relaxation and confidence in the labouring woman. The midwife at a birth has great influence on the woman’s reactions and impressions, so be careful not to introduce your own feelings and biases into the room. This woman is not a “poor thing” who won’t cope without you — she is a strong, innately capable woman uniquely designed for giving birth easily, safely and enjoyably. If you truly believe this then you won’t need to watch your language, you will already be consciously feeding this information back to through your language and responses.

Birth is a highly personal experience. Each laboring woman brings into the birthing room a personal story that includes the past birth experiences of the women in her family, her own hopes and fears, and any other past experiences that impact the natural process of birth, such as past sexual trauma or body image issues. Birth is a natural life event, a part of a women’s greater sexuality and biology. The words that she hears can help or heed her progress; it’s up to the people who surround her to make it the most positive and successful experience possible. Care providers: pay attention to the words you use around a pregnant or laboring woman. Family members and support team: think before speaking—everyone in the labor room should examine their own biases and experiences, their own fears, or even trauma that may not have been dealt with in the past. For the laboring woman, words really do matter.

Pregnant women deserve to feel supported and respected – empowered – to deliver her baby. No matter the final outcome—whether natural, or a birth with medication or a cesarean section—positive language in the birthing room puts the woman at the center of the action, so that she is in the best position to successfully deliver her baby.

 

Herbs in Pregnancy

Herbs

We’ve written in the past about a pregnant woman’s lowered immunity. Good nutrition, sanitation habits, rest, and exercise all help to strengthen the pregnant woman’s immune system—yet she will inevitably be exposed to viruses and other immune challenges. Pharmaceutical remedies may prove too strong or be contraindicated in pregnancy, so we wondered about herbal remedies. What herbs are safe in pregnancy and what herbs should be avoided? We turned to an herbalist with training in the use of herbs during pregnancy and postpartum to find the answers. *

Before receiving clinical training in Herbal Medicine for Women, Julie Pettler worked as a physical therapist. Later, while teaching her young children at home, Julie built a large garden in her yard and began to keep bees. As her love of gardening grew, so did her fascination with the power of herbs—herbs that grow naturally and herbs that can be cultivated—to treat common ailments. “I study history, science, anatomy, and human health [as an herbalist],” Julie says. “Sometimes I walk barefoot through my yard to gather dandelion greens to add some bitter to my diet. Sometimes I order a strong tincture to stimulate a client’s lymphatic system.” In her current herbalist practice, she combines her love of teaching with her love of plants by leading workshops on foraging, herbal medicine making, the holistic use of plants for health and well-being, and the history and science of plant medicine. Studying herbs for women’s health combined another of her passions: advocacy for pregnant women and evidence-based childbirth.

We started the conversation by asking Julie when the pregnant woman can use herbs during pregnancy. “Herbs may be used for general nutritional support during pregnancy, such as with the use of pregnancy “teas,” and confidently used to address common mild discomforts such as nausea, itchy skin (topical use), and heartburn,” she says. “If a more serious issue arises during pregnancy, herbs may be considered in consultation with a knowledgeable practitioner.”

Julie offered a list of categories of herbs traditionally avoided in pregnancy. “Stimulating laxatives, such as Cascara sagrada, [and] aloe and rhubarb should not be used during pregnancy.” She suggests instead non-stimulating bulk laxatives such as flax or psyllium. Tansy, Mugwort, wormwood, and yarrow stimulate menstrual flow and should not be used. Julie points out that the literature on the safety of herbs in pregnancy is often conflicting, so she suggests a conservative approach to the use of herbal remedies.

The following are some of her suggestions for use in pregnancy:

Nausea

Nausea is a common complaint among pregnant women, in particular in the early months. Julie recommends ginger. “It’s the most studied herb for nausea in pregnancy,” she says. “And the studies support the traditional use of ginger.” Ginger can be taken as a tea (simply shaving fresh ginger into a teacup and steeping it in hot water, can create the tea), as ale in the form of ginger ale with real ginger, in capsule form, or as a candy.

Colds and Flus

For immune support, Julie recommends Echinacea initially, at the first sign of a cold or a flu. “It can be combined with elderberry for extra immune support,” she says. “If a cold or flu sets in, Echinacea should be discontinued. Many times though, the use of Echinacea will prevent illness.” Echinacea is best used for a short duration and can be taken in tincture form every few hours for two-three days.

Pregnancy Tea for Uterine Support

Pregnancy teas support and tone the expanding uterus in the second and third trimesters. Julie recommends equal parts Red Raspberry Leaf, Nettle Leaf, Oat Straw, and Alfalfa (measuring one cup combined). Using one quart of boiling water, cover and steep the herbs overnight to make the nourishing tea.

Postpartum

Julie suggests using herbs for after pains and for healing and antiseptic support of the perineal tissue. Antispasmodic herbs include chamomile, catnip, motherwort, and cramp bark, and can provide relief from after pains. Sitz baths, warm compresses, or peri-rinses to support the perineum postpartum can be made using comfrey leaves, calendula flowers, lavender flowers, sage leaf, yarrow blossoms, and rosemary.

A longitudinal study in 2001 on the use of pharmaceutical medications in pregnancy concluded that 91% of conventional medications had not been proven safe in pregnancy; physicians had inadequate information on the safety of medications in pregnancy. The World Health Organization studied the safety of vaccines in pregnancy and reached a similar conclusion—there are not enough studies conducted on pregnant women for obvious ethical reasons.

Most pregnant women have healthy pregnancies despite the lowered immunity. Herbs can provide a safe and low-risk option for women wanting to boost their immune systems when they’ve been exposed to a cold or flu, when they are preparing for birth, and during the early trimesters for nausea or in the postpartum period when their bodies are healing. “I love that the plants are simultaneously simple and complex,” Julie says. “I love the ways herbs can nudge our bodes toward health by nourishing us and supporting all of our body systems. This is an excellent time to slow down and embrace the healing power of plants.”

*Always consult with your healthcare practitioner before using herbs in pregnancy

The Physiology of Birth

baby-being-born-adelaidebirthphotography

photo courtesy of Adelaide Birth Photography

Birth is often a mystery—at least that’s what we’re led to believe. But closer examination reveals basic physiological truths that underpin normal birth for both the mother and baby. Certain truisms can indicate risk, such as a pregnant woman’s prenatal nutrition and medical history, but, in the end, birth is a complex orchestration of hormones, proteins, neurology, and basic psychology for the mother. The teasing apart of these elements allows us to understand the perfectly designed biological process of childbirth.

What We Know About the Onset of Labor

There is surprisingly little known about what causes labor. In the beginning of pregnancy, the woman’s immune system is suppressed to insure that the forming embryo implants successfully and the biological process sets in motion. In fact, if a woman’s immune system is too active, miscarriage can occur in the early months. Later in the pregnancy, when the baby is full term and labor begins naturally, though, there is less consensus about the exact cause of labor. Science is only just beginning to understand the onset of labor.

There’s strong evidence the baby may have something to do with initiating labor. When the baby reaches 32 weeks, a surface protein, a soap like substance or surfacent, coats the inside of the baby’s lungs to keep the alveoli open, a critical shift that will allow the baby to breathe outside the uterus. The surfacent consists of six fats and 4 proteins and continues to be produced until around the child’s eighth birthday, when the lungs are fully developed. Eventually one of the proteins, SP-A, is produced in the baby’s maturing lungs in utero. This protein activates immune cells (macrophages) to migrate to the uterine wall, creating a chemical, inflammatory, reaction, which may be the official start of a natural labor. Studies have been done with mice in which the SP-A is blocked; the mice remain pregnant beyond normal gestation. So, in a nutshell, the baby’s development—more importantly, the baby’s maturing lungs that signal when they are ready to breathe outside the uterus—may be the instigator, signaling for labor to begin.

On the mother’s part, hormones play an important role. Prostaglandin is the hormone that softens the cervix and oxytocin increases and triggers contractions. Also at play are estrogen, progesterone, cortisol, and CRH—corticotrophn. When the baby drops in the mother’s pelvis, the hormones assist, and the cervix begins to relax and thin.

The hormones; the baby’s position; and the immune cells, in concert with the uterus, all work together to trigger the full onset of labor. And hormones continue to work to the mother’s advantage as she progresses through the rest of the labor.

Hormones in Undisturbed Labor Defined

Any woman who has had a natural birth or observed a natural birth knows that undisturbed labor is intuitive and powerful, an intricate dance between mother and baby and the people assisting the mother. The mother often knows what she most needs, even in the most complicated of situations, because of the uninterrupted intuitive interplay between mother and baby.

Sarah Buckley, MD, an Australian obstetrician, writes and speaks extensively on the hormones at play in undisturbed birth. The key hormones in birth include oxytocin, beta-endorphin, adrenaline (epinephrine), and noradrenaline (norepinephrine), and are identical to the pattern of hormone release in lovemaking. “As the hormones of love, pleasure and transcendence, excitement, and tender mothering, respectively, these form the major components of an ecstatic cocktail of hormones that nature prescribes to aid birthing mothers of all mammalian species,” Buckley writes in “Gentle Birth, Gentle Mothering.”

The cocktail of hormones build up and peak around the time of birth or soon after and subside and reorganize over the hours and days after the birth. All of these hormones are produced primarily in the hypothalamus and each serve an important function in natural labor: oxytocin, the love hormone, stimulates contractions, and higher levels of oxytocin are also beneficial for contracting the uterus after birth to prevent hemorrhaging; beta-endorphin serves as a stress hormone, more specifically as a pain-reliever that in high amounts can slow the production of oxytocin, thereby helping to modulate the pain of labor; and adrenaline and noradrenaline—fight or flight hormones—rise at the end of labor, giving the mother extra energy for the pushing and initiating the ejection impulse necessary for the final stage of labor.

Karen Strange, CPM, who teaches NRP training from the baby’s perspective, teaches birth workers to observe and expect the laboring mother to “pause” after the baby arrives. Strange teaches that there is a natural sequencing to birth for both mother and baby, and the pause or resting allows them to have a time of integration. Oxytocin, the love hormone, is at its highest in the hour after the birth, and mothers and babies begin the bonding process during that sacred hour. But noradrenaline also plays a role. “Noradrenaline, as part of the ecstatic cocktail, is also implicated in instinctive mothering behavior. Mice bred to be deficient in noradrenaline will not care for their young after birth unless noradrenaline is injected back into their system,” writes Buckley.

Why Environment Matters

Michael Odent, French obstetrician and surgeon, studied the environments for birth in the 1980s. He introduced low lighting, birthing pools, and singing into the birthing rooms at the hospital where he practiced in Paris. Eventually he became involved in home birth and started a research center in London. He found that low lighting, less observation, warm water, and a more homelike environment aided women in labor. Looking at the hormones at play—the very same hormones that are involved in lovemaking—it’s easy to see why a woman’s labor might be aided by the elements he studied. Traditionally women have birthed in a home, or even outside. The hospital environment became a new normal in the 20th century as surgical and other interventions began to rise, an environment Odent refers to as the masculinization of the birth environment.

Buckley writes, “For birth to proceed optimally, this more primitive part of the brain needs to take precedence over our neocortex—our “new” or higher brain—which is the seat of our rational mind. This shift in consciousness, which some have called “going to another planet,” is aided by (and also aids) the release of birthing hormones such as beta-endorphin, and is inhibited by circumstances that increase alertness, such as bright lighting, conversation, and expectations of rationality.”

Finely Tuned Dance

Low lighting, quiet, and support for the increasing irrational and more instinctual feelings of the birthing mother all support undisturbed labor. Midwives are trained to follow the mother. By following her cues and trusting in the complex orchestration of hormones, the healthcare provider receives vital information for understanding how the labor is progressing. What is most important is that the mother feels safe to travel to that other planet and that labor starts naturally and remains undisturbed. Biology most often takes care of the rest.

The physiology of birth includes a finely tuned dance between mother and baby, between immune cells and proteins and the uterine wall, and between the mother and her environment. If birth is treated more like a medical procedure, more like a masculine [refers to culture, not to men specifically] and rational endeavor, the more removed the mother will become from all the benefits nature provides. The physiology of birth, when allowed to proceed uninterrupted in normal birth, provides a hormonal roadmap for a successful birth and bonding.

“Giving birth and being born brings us into the essence of creation, where the human spirit is courageous and bold and the body, a miracle of wisdom.”

-Harriette Hartigan, midwife, author, and photographer

How to Get Healthy and Stay Healthy During Pregnancy

 

maternity-pictures-1_carmenhibbinsEach woman arrives at a new pregnancy from a different starting point. One woman may have planned for months to get pregnant, taking vitamins, eating healthy, and exercising. Another might be classified as medically obese and is worried about how that will affect her pregnancy—should she lose weight or focus only on eating healthy? While yet another may have, not intending or wanting a pregnancy at the time, been drinking heavily or using illicit drugs. Of course, most women are somewhere in the middle. Ultimately it’s most important that a woman work at getting as healthy as possible, so that she and the baby have the best outcomes.

So how does a woman who is already pregnant get healthy and stay healthy? And what are the risks if she isn’t healthy?

Lets look at the central tenets of a healthy pregnancy:

Good nutrition

Eating right helps to build a strong and healthy baby, and it helps the pregnant mom as well. A healthy diet can help to prevent high blood pressure, preeclampsia, gestational diabetes, and premature labor. A healthy diet can help to ensure against the baby growing too big, which could lead to a difficult birth.

Earlier this past year, we outlined a healthy diet for pregnancy. Be sure to eat plenty of protein and whole grains, and focus on color and variety in your fruits and vegetables during pregnancy. Good sources of protein include meats (limit seafood because of the high mercury content in many sources of seafood), dairy, eggs, nuts, beans, and seeds. And the less processed and milled the grains, the better. Drink plenty of water and salt to taste. Eat small, nutritious meals often. And, most of all, limit sweets and high-sugar-content food and drink.

A good prenatal vitamin is important for a healthy pregnancy as well. Prenatal vitamins are specially formulated for a pregnant woman’s needs. In particular, the pregnant woman needs at least 400 mcg of folate (higher if a BMI over 30) and Vitamin D. Folate in the first trimester helps the baby’s developing nervous system and strengthens the mom’s immune system. Vitamin D also helps with the mom’s immune system and helps the baby to develop strong bones and teeth before and after the birth. Vitamin D can be continued postpartum and can help to decrease the risk of postpartum blues.

What if a woman has a high BMI when she finds out she’s pregnant? There is no evidence that dieting to lose weight is good for mom or baby. In that case, she should focus on the healthy pregnancy diet, balancing the pregnancy needs for quality protein, whole grains, and plenty of fruit and vegetables. Many women who struggle with weight before pregnancy discover that eating healthy for the pregnancy helps them to maintain a healthier weight during and after the pregnancy. Most moms-to-be who have a higher BMI at the start of pregnancy can expect to enjoy a healthy pregnancy.

Exercise

Exercise helps the pregnant woman prepare for birth by strengthening and toning her body. It can also help to manage weight, and, combined with a healthy diet, can lower the risk of giving birth to a large baby. The adage is that if a woman already has a regular exercise practice, she can continue the practice. But, if the mom is new to exercise, low-impact exercise with a gradual endurance plan is just as beneficial.

The shift in the woman’s center of gravity and increase in joint laxity can make exercise more challenging. Water sports, such as swimming or low-impact water aerobics, can help support the pregnant woman’s body. Mild exercise in general can help the woman meet the greater oxygen demand that pregnancy creates. However, too aerobic of an activity can decrease her oxygen consumption and lower her overall oxygen volume. Ultimately, exercise can make pregnancy more comfortable and shorten the woman’s labor, and even reduce the need for interventions.

Exercise can also:

  • Reduce back aches
  • Reduce constipation, bloating, and swelling
  • Boost energy levels
  • Help with mood
  • Help with sleep
  • Prevent excess weight gain
  • Promote strength and endurance, which in turn helps the mother in childbirth

If the pregnant woman hasn’t exercised in awhile, but would like to add an exercise routine during pregnancy, she should start slowly, beginning with five minutes and building her endurance by five minute increments until she reaches a thirty minute practice.

What exercise should be avoided during pregnancy? Some forms of exercise are not advisable, such as:

  • Exercise that forces you to lie flat on your back after the 1st trimester
  • Scuba diving, which puts the baby at risk of decompression sickness
  • Water skiing, surfing, and diving, which cause you to hit water with a great deal of force
  • Contact sports such as ice hockey, basketball, volleyball, or soccer
  • High altitude exercise (less oxygen for you and the baby—and risk of altitude sickness, which causes headache and nausea)
  • Any activity that could cause direct trauma to the abdomen, like kickboxing
  • Hot Yoga or Pilates
  • Sports with a high risk of falling, such as downhill skiing, gymnastics, or horseback riding at fast speeds

A regular exercise practice during pregnancy can lead to an exercise practice postpartum, which can help the new mom shed weight and regain muscle tone and strength for her non-pregnant body. Exercise should be avoided for the first month while the woman establishes breastfeeding and recovers from the birth.

Education

In addition to prenatal counseling with a maternity care provider, there are several ways a pregnant woman can educate herself about pregnancy and childbirth:

Childbirth education (CE) classes

CE classes can help the pregnant woman stay focused on pregnancy-specific issues, such as nutrition, lifestyle practices, and preparation for childbirth. Some options for childbirth education classes include: Hypnobirthing, Birthing From Within, Bradley, Lamaze, Birthworks, Centering Pregnancy, Sacred Pregnancy, and others. Local doulas and midwives often have extensive lists of local childbirth education providers, and some midwives offer childbirth classes at birth centers and in their communities.

Books

Books are a powerful way for the pregnant woman to prepare for birth and to learn coping mechanisms for the changing nature of pregnancy. Some favorites include: Spiritual Midwifery, Ina May’s Guide to Childbirth, Diary of a Midwife, Birth Without Violence, Birth with Confidence, and Homebirth Cesarean. There are also literary memoirs about pregnancy and birth, and pregnancy loss that can be powerful and impactful narratives, depending on a mother’s perspective and needs.

Documentaries

Documentaries about pregnancy and childbirth often include interviews with experts, snapshots of individual women’s labors, and commentary on an overall maternity care system. Documentaries, if appropriate, can help children understand an upcoming birth and help pregnant women (and couples) make decisions about what they most want from the birth experience. Some of the better documentaries include The Business of Being Born, Orgasmic Birth, The Face of Birth, Birth Into Being: The Russian Waterbirth Experience, and Pregnant in America. Check out this TED talk by Ina May Gaskin, the international childbirth luminary midwife.

Support

Rhea Dempsey writes about the “circles of influence” that surround the pregnant woman—from friends and family to the wider culture. These circles ultimately impact the woman’s pregnancy and birth experiences.

The people with whom the pregnant woman surrounds herself make a big difference in how healthy, physically and emotionally, the woman will be during pregnancy. The following are important questions to ask:

  • Is the pregnant woman’s home a safe place?
  • Does she have emotional support?
  • Is she more concerned with the anxieties and fears of her mother, her sister, her husband, her friend, than her own?
  • Is the pregnant woman able to decide how and where she wants to birth based solely on her needs and wants?
  • Is her maternity care provider supportive of her wishes?
  • Can she ask questions without fear of belittlement or of her fears being minimized?
  • Does she have access to healthy food and clean water?

A healthy pregnancy hinges on physical elements such as a safe place to live, the opportunity to exercise, access to healthy food and clean water, and good prenatal care, but it also hinges on emotional health, and support is central to a pregnant woman’s emotional health. Support often means more listening than talking, and support means something different for every woman. And, ultimately, after pregnancy, the birth is most about the woman and her baby, not the people who surround her. Sometimes the best support is the most minimal support, support that allows the woman to decide how she wants to birth and who she wants to support her during the birth.

Getting healthy during pregnancy will mean something different for each woman. For instance, a woman who struggles with alcohol and drugs may need to first focus on addiction recovery. After she is clean and sober, she can move on to good prenatal care and nutrition, as well as creating a circle of support that is healthy and best for her and the baby. For a woman who doesn’t have good nutritional habits, getting healthy may mean focusing solely on nutrition and exercise. And for a woman who lives in an unsafe home, getting to safety may be the first step toward a healthy pregnancy.

Focusing on the main tenets of a healthy pregnancy will help a woman get healthy and stay healthy throughout pregnancy, with great benefits to both mother and baby.

The Immunological Paradox of Pregnancy

pregnancy-photography-45

photo credit: Carmen Hibbins

For most women, navigating pregnancy is difficult. There are decisions to be made: maternity care, labor preferences, place of birth, newborn care, breastfeeding, etc. Not to mention vaccines. Currently the CDC recommends the influenza vaccine for all pregnant women. When making the decision to accept or decline the flu vaccine, it’s important to first understand a pregnant woman’s immune system, as well as the ingredients in different kinds of flu vaccines.

The immune system is a complicated system of cells, tissues, and lymphoid organs—a giant communication network. When cells receive alarms about antigens in the body (viruses, bacteria, parasites, fungi), they produce chemicals that seek to destroy the antigens ability to invade the body. Recently research has shown the importance of a healthy gut for a strong immune system – and for brain health. Really, we are only just beginning to understand the complexity of human immunity.

What we do know is that a woman’s immune system changes significantly from the moment of conception. The innate immune system, the immediate response part, is activated, which results in an increase in white blood cells (monocytes and granulocytes) and the pregnant woman’s production of natural killer (NK) cells decreases. Research has shown that a critical balance of immune cells as well the factors they produce are vital to a healthy pregnancy. Interfering with a pregnant woman’s immune responses is thought to have a negative effect, in particular in the early stages of the pregnancy. The decreased immunity and increase in white blood cells ensures implantation and the development of the placenta. Without it, the fetus can be rejected. Thus, the vast majority of vaccines aren’t indicated for pregnant women and they are generally avoided if possible.

The immunological paradox of pregnancy is complicated, delicate, and beautiful in the way only nature can be.

So what exactly are the risks and benefits of the flu vaccine? The benefit is easy to define: influenza poses a substantial risk for the pregnant woman, in particular during the later months of pregnancy. The woman’s altered immune state can leave her susceptible to certain infections and viruses, and when she contracts the flu it can be hard for her fight it. The CDC states:

Flu is more likely to cause severe illness in pregnant women than in women who are not pregnant. Changes in the immune system, heart, and lungs during pregnancy make pregnant women (and women up to two weeks postpartum) more prone to severe illness from flu, as well as to hospitalizations and even death. Pregnant women with flu also have a greater chance for serious problems for their developing baby, including premature labor and delivery.

The risks of influenza are real, despite the large number of women who have healthy, safe pregnancies without contracting the flu. So what about risks associated with the vaccine? Most of the research on vaccines is conducted on non-pregnant subjects, so researchers are careful to qualify results. The consensus tends to be: less vaccines overall for pregnant women, but the flu vaccine is indicated given the risks associated with the flu.

Current research focuses on the type of flu vaccines. Most flu vaccines are considered “non-adjuvanted.” An adjuvant is an additive used to increase the immune response to a vaccine. Adjuvant vaccines are important during pandemic times, as adjuvants allow more vaccines to be produced using less antigens and are therefore more cost effective. But adjuvants are pro-inflammatory and can aggravate other immune issues. Given the altered immune system of a pregnant woman, most researchers suggest that only non-adjuvanted flu vaccines be administered.

vaccine

The WHO organization issued the Safety of Immunization during Pregnancy report in 2014. The research is far from conclusive, but the WHO takes a careful look at results from studies around the world. In terms of the flu vaccine, they conclude:

Pregnant women and infants suffer disproportionately from severe outcomes of influenza. The effectiveness of influenza vaccine in pregnant women has been demonstrated, with transfer of maternally derived antibodies to the infant providing additional protection. The excellent and robust safety profile of multiple inactivated influenza vaccine preparations over many decades, and the potential complications of influenza disease during pregnancy, support WHO recommendations that pregnant women should be vaccinated. Ongoing clinical studies of the effectiveness, safety, and benefits of influenza vaccination in pregnant women in diverse settings will provide additional data that will aid countries in assessing influenza vaccine use for their own population.

If you’re pregnant, weigh the risks and benefits, and take into account any specific immunity issues. Is your immune system weakened for any reason? What is the risk of exposure? Do you tend to contract the flu? What is your family history in terms of vaccine reactions? Are you high risk for any other reason? Talk over the risks and benefits with your care provider. Ultimately, the decision is yours. Your pregnancy is your pregnancy, and a mother’s intuition is often the best guide.

If you choose to have the flu vaccine administered during your pregnancy, be sure that the vaccine is non-adjuvanted/inactivated. In the next blog post on Birth Outside the Box, we’ll discuss ways to naturally boost your immunity during pregnancy – ways to help you counteract the altered immune state that nature has carefully designed to ensure a successful pregnancy. Garlic? Diet? Sleep? Exercise? We’ll cover it all!

The Differences Between Hospital and Out-of-Hospital Birth

SONY DSC

People who have never given birth outside of a hospital may have no idea of the differences between hospital and out-of-hospital birth. What’s the big deal? You can have a natural birth in the hospital. Why would someone want to have their baby at a birth center or (gasp!) at home? The answer is not so black and white.

Can you have a natural birth in the hospital?

Well, that all depends on what you call “natural,” but yes, to varying degrees, you can have a “natural birth” in the hospital. There are many labor & delivery nurses who are excellent at supporting natural hospital births, and there are many doctors and midwives who are supportive as well. Some hospitals have adopted policies that are more tolerant (even encouraging) of birth plans or that allow doulas in the birth room. Those are steps in the right direction. And many women have found creative ways to ensure a natural birth, such as waiting until transition to head to the Labor & Delivery floor, or laboring while roaming the halls of the hospital with a labor coach (a partner or doula or friend). Of course, a birth plan as an avoidance of interventions, rather than as a vision of an ideal birth, seems to really miss the point in a lot of ways. Should birth really be about strategic plans for dodging unwanted interference in your baby’s birth?

Let’s break this down. You’ve hired your care provider because you’ve heard great things about them, they have a great reputation, their statistics are great.. etcetera… Pushing the boundaries within a set system is one thing, but can you ask your care provider to be someone they’re not? A great hospital-based provider is skilled at hospital birth and what hospital birth has to offer you. A great birth center or home birth midwife is skilled at the midwifery model care. The models are not the same. As anyone who has seen birth both in and out of the hospital will tell you, there are a few key differences between the two:

The provider on call attends the birth at the hospital.

If your care provider is part of a group practice, who will actually attend your birth? If it’s a combination of physicians and midwives, are you guaranteed a midwife to attend you? Are all of the providers on board with your birth plan? You may have a favorite midwife or physician in the practice, but what are the chances that your favorite provider will attend the birth?

Most out-of-hospital practices are solo providers, although some are small group practices. In a solo practice, there is a rare possibility that your midwife will be unavailable due to illness or family emergency-after all, we’re only human! If you hired an out-of-hospital provider, do you know who the backup provider is?

All of the above are important questions to ask as you consider your birth options and whether to give birth in the hospital or out. What is most important is that you are comfortable with your decisions and ultimately your birth experience.

In the hospital, it’s the nurses who take care of you, not the doctors.

You spent weeks researching practices, settling on the one practice you think will best support your birth plan. Your doctor is a local superhero. But, who takes care of you at the hospital?

During your time in labor, the nurses will take care of you. Nurses are the amazing unsung heroes in the hospital. They are the ones who do the heavy lifting (literally, as well as figuratively) in patient care. They’re often over-worked and underpaid. We love nurses, yet even though they are awesome, they are also people you’ve never met before. Nurses are the ones who will be with you, almost single-handedly helping you with your labor. What if your philosophies on birth don’t match? Nurses vary in their training in natural labor support techniques. How do you know if you’ll be the lucky mom to get the super nurse who really knows her way around a rebozo or who does her best to be at the bedside as often as possible? Answer: You don’t. It’s a roll of the dice.

Once you get to the hospital, you’ll be checked in by the L&D staff. If you are seen by a doctor or midwife, it might be a provider from your group, or it might be an OB hospitalist, a physician who only sees patients in the hospital and does not have a private practice. If you’re admitted, you’ll most likely be monitored and “treated” per your provider’s standing orders. It’s good to know beforehand what orders are standard for your care provider. Your nurse will keep in contact with your provider and will update and consult with them, as needed, typically by phone. If you have questions about the orders or want to refuse something, you will have to wait until the nurse can reach the provider.

The provider may briefly check in during your labor, but typically they are not continuously present until you are pushing and the head is visible. Their training rests on the ability to take action if something unexpected happens. They are surgeons and the best option for a high risk situation, which happens in a small percentage of births.

Out-of-hospital midwives are the people who take care of you at your home or birth center. Together, with a birth assistant, they provide continuous labor support from beginning to end – and they determine when and if you need someone as highly trained as an OB or a transfer to a hospital. Rather than treat every laboring woman as if they are the minority of women who have complications, out-of-hospital midwives treat laboring women as the if they are the majority, who will not have complications, all the while keeping an eye on whether a complication could occur and when/if to transfer the mother to an OB’s care – much like the maternity models in most of the developed world.

Your nurse is taking care of more than one person at a time.

No matter how awesome your nurse is, she is only one person, and is most likely taking care of multiple women at the same time. It’s not realistic to expect a one-on-one continuous physical presence and support from your labor nurse. The hospital system is set up with floors of patients who are typically divided among the nurses for twelve hour shifts. The care will fluctuate based on caseload, changing shift hours, and the preferences of the nurses in term of hands-on care. There will be no chance to meet the nurses who will attend you before you are admitted. And no choice in terms of which nurse is assigned to you.

On the flip side, hiring a midwife means that you have a chance to interview and pick the right provider for your care, including a back-up midwife. Whether the primary midwife or the back-up midwife, you will have a good sense of exactly who will be providing continuous labor support during your birth.

They work in shifts.

Nurses typically work in 12 hour shifts. Unfortunately, labor doesn’t often fit neatly within one 12 hour shift. Your labor will typically straddle two shifts, or maybe more. While getting through contractions, you may have to shift gears and adapt to a new support person- right before transition, or even right in the middle of pushing.

The typical out-of-hospital provider does not work in shifts. She’s there with you from the beginning to the end.

A different team takes care of your baby.

Every hospital has different protocols and rules about labor and delivery care. The nurses who attend your labor and delivery will likely not be the nurses who take care of your new baby. With the lack of continuity in care for the family, mistakes can be made, such as giving a breastfed baby formula or giving a baby a pacifier when the mom doesn’t want one offered to the baby (in the event it causes nipple confusion and adds stress to the new breastfeeding relationship.)

Usually, the father or another family member can be assigned to accompany the baby whenever he/she leaves the mother, to ensure that no unwanted procedures were carried out despite their wishes to the contrary. Even with this safeguard though, the pediatric team still can’t possibly know the whole picture.

They haven’t been with the family throughout the entirety of prenatal care and birth, so they don’t know you in the same way your midwife would.

Yet another team takes care of you during postpartum.

With midwifery care, the mother’s care, the baby’s care, and the family’s care are all provided by the same team. In fact, the postpartum care is also provided by the midwife who attended the birth.

A different philosophy.

You’re “allowed” to do something, you’re “not allowed” to do something. If your wishes conflict with a physician’s preferences, you might be asked to sign an AMA (Against Medical Advice) form, which can feel intimidating when in the throes of labor. It’s important to remember that hospitals are large institutions with rules and regulations that are applied to every woman, despite the wide differences between them.

Obstetricians handle emergency situations well. In emergencies, the obstetrician is the necessary authority and operates from that perspective.

But in the case of normal birth, the woman is just as important of an authority. When she is able to follow her intuition and pay close attention to her body, with minimal interruption, she can communicate valuable information to her caregiver.

Midwives are trained to respect this authority in normal birth. The philosophy of midwives is that the midwife/client relationship is a partnership and decision-making is shared.

A different outcome.

Hospital and out-of-hospital birth are two very different things. It’s hard for me, as someone who has had it both ways, and who has seen many births both ways, to minimize the difference in outcomes. Personally, my hospital births left me feeling less powerful and capable as a woman and new mother. My home births helped me to feel empowered, intelligent-like I was the expert when it came to my new baby’s needs. There really isn’t a way to quantify that kind of effect, or to easily measure how it impacts your mothering in the long run. Or even to measure how it affects the child long-term. It’s easy to measure the physical benefits of a natural birth.  But it can also have an unexpected and very healing impact on a mother’s life, just when she is embarking on new motherhood with a newborn. The unquantifiable effects of home birth may, in some ways, be the very reason that home birth is the optimal birth choice for so many women. And this may be the biggest difference of all.

There’s a Midwife for Every Woman

It’s been said there’s a midwife for every woman, and I truly believe that to be true. I’ve been to many midwifery conferences and other midwifery gatherings, and while we all share that common bond of midwifery, it is clear that there can be big differences between us. To generalize, there are “hippie midwives,” Christian midwives, parteras – Spanish for midwives, young or old midwives, male midwives, married midwives, single midwives, Amish midwives… the list goes on. Midwifery is what we share. At the core, we agree on the value of serving women selflessly, helping women through the life journey of womanhood into motherhood, honoring women and their families in the ways that only the midwifery model of care can offer.

Yet, there are differences, even within the same community. So, when considering your options, how do you know which midwife is the right midwife for you?

Create a clear picture of who you want to serve you at your birth, before you begin your search.

14322655_648236645345467_8727819073420623281_n

It’s easy to get caught up in the excitement of creating the plan to have your baby at home or at a birth center, but, be sure to take a moment to consider what you truly want from a midwife before starting your search. What is your personal birth philosophy? How do you feel about laboratory testing and ultrasounds? Do you want all of your visits at home, or are you OK with going to an office? Do you need someone with a strong, authoritarian personality or someone with a more cooperative and gentle personality? Visualize what would make you most comfortable. Sit with that image awhile. This exercise is akin to creating a mission statement for a company. When there is clarity around what you want, everything else will fall into place.

Do your homework before you interview a care provider.

Lucky for you, in the Internet age, researching a midwife is not terribly difficult. You can start with Googling her name. If your midwife has been practicing for awhile, chances are that people will have written something about her online. Most midwives have at least some sort of online presence. Just about all have a website or Facebook page. Some have blogs (like me!).

Birth Partners, and Mothers Naturally are great online directories of midwives. You can do a Google search for your zip code and midwife, and you should be able to come up with midwives who are local to you.

Look on FacebookYelp or Health Grades for reviews from people who have used her services.There will likely be blog and message board posts, as well as reviews on Healthgrades, Facebook, and her Google Business page.

Check with the state corporation commission to see if the midwife’s practice has registered with the state. The state midwifery board (for CPMs) and state nursing board (for CNMs) will have information about the status of a licensed midwife’s license (CPM) or status of a licensed nurse practitioner (CNM), including any complaints against her or disciplinary actions from the appropriate regulatory board. Keep in mind though, there’s always more to the story than what you see online. A midwife who has been in practice for many years is more likely to have come under scrutiny than someone who is newly licensed, and the birth culture of your state can have an impact on such scrutiny . Read the information ahead of time to give you a starting point for the discussion. The way she responds about the information you found will tell you a lot about her character and professionalism.

Ask friends for recommendations.

Many will say, “I just loved my midwife!” All midwives hope for that response to their care from clients. But be sure to dig deeper and ask, “What was it that you loved most about your midwife?” The aspects one person loves may be the aspects that another person would not like. Be specific and ask about the things that you’ve already identified as important to you. Maybe your friend liked that her midwife was opposed to using a Doppler to listen to the baby’s heartbeat and prefers to use a fetoscope, but you really want to use a Doppler. Or, perhaps your friend liked that her midwife was very “hands-on,” and you want someone who is very “hands-off.”

Ask the birth workers.

The birth world is a small world. Doulas, childbirth educators, and your friends probably know a lot about the local midwives. Ask them about the midwives you’re considering – someone may have first-hand experience with them.

Look to the mom groups in your community.

Just about every community has a birth circle or La Leche League group or some sort of birth advocacy group. These groups can be a great way to meet women who have used the services of local midwives and can give you feedback about their experiences with them. And many midwives offer meet and greet sessions at birth circles or attend the meetings as members of the community.

Contacting a midwife

Most important is the “click” factor. Many moms report knowing that a midwife was right for her because they just “clicked.” Follow your intuition to make the best decision for you and your baby.

If you’re not sure which midwife to hire, consider interviewing several midwives until you find the one who is the right fit. Set up an appointment and prepare for the interview with a list of specific questions, concerns, and wishes.

Up Next… 20 Interview Questions to Help You Find the Right Midwife for You

 

 

If I’m hiring a midwife, why do I need a doula?

I’ve often been asked, “if I’m hiring a midwife, why do I need a doula?” To me, asking a midwife why you would also need a doula is like asking a schoolteacher why you would also need books. No, you wouldn’t absolutely have to have books in order to learn. You could use the Internet. You could listen to stories your teacher recites from memory. But, you would be limited to your teacher’s perspective.

World Doula Week 2015A birth doula is like a library of tools for labor support that goes beyond the clinical skills a midwife or a doctor can offer you. Labor support is her specialty. That’s the whole reason she’s there. A midwife is there for your safety. That’s her primary role. Yes, she does also provide labor support, but that’s secondary to your safety. Doulas have unique skills to help you progress, feel more comfortable, and support you emotionally, spiritually, and physically, so you can have the best possible birth experience.

For this blog post, I’m referring to birth doulas. There are other kinds of doulas, too (LOVE THEM!). More on other doulas in a future blog post…

Doula work is HARD! It requires a strength that is almost impossible to put into words. Doula work and midwifery work are not the same. Sure, some doulas become midwives, and some midwives also do doula work. Our skills overlap in some areas. But, the roles are very different and require very different skill sets.

In addition to support for the mother, doulas are support for the mother’s partner. That, to me, is one of the biggest benefits of having a doula at a home birth. I’ve heard partners express concern that the doula will somehow replace him at the birth or diminish his role. Nothing could be farther from the truth! A good doula will help the partner so he can be the best possible support person. Sometimes, a little direction (“maybe try a little pressure here on her back”) or suggestion (“some labor aid might be good”) can be priceless when you’re going on very little sleep and are wondering what to do next. Sometimes, a break so the partner can get a catnap can help bring some fresh energy back to the room. Laboring women benefit from endorphins to help them get through the labor; laboring dads don’t, but they can hire a doula to help them out!

A mother talks about her home birth experience with her doula:

11069562_10102134401309617_319468984_oMy doula taught my husband how to help me. She went so far as feeding him lines from the other side of the door where I couldn’t see her. That was what he and I needed. I needed reassurance from him and he didn’t know what to say. After our first birth with a doula, my husband said he didn’t want to have any more babies without her involved.

An experienced doula shares her own experience in having a doula serve her at her birth:

I had doulaed a few moms but had our first 5 children with only my husband. When our 6th came along a friend asked me if she could come to our birth and help as our doula. We decided to have her come, even though my husband was just perfect for me at our births. He is a man that NEVER shows emotions and says very few words. After that birth he said with GREAT EMOTION as he swung around and threw his hands in the air, ‘that was GREAT!!! I am NEVER doing that again with out a doula! It totally took the monkey off my back!!!’ We had a doula for the last 4 births. I loved it and he did too.

Doulas at home births can help in so many ways. Whether it’s taking pictures, cooking meals, making cold compresses, fanning mama when she’s hot and sweaty, giving a pep talk, massaging away a leg cramp, getting the birth pool ready… whatever… doulas are an important part of the birth team.

And, of course, whenever you plan a home birth, you do need to plan for the possibility of a home birth transfer to the hospital. It does happen sometimes. Your midwife will be with you as a support person, and depending upon the situation with her backup doctor it can be a really positive experience. But, experienced doulas are very accustomed to supporting women at hospital births. In fact, they may be better at supporting you at the hospital than many home birth midwives are (don’t throw rocks at me please, sisters!). Doulas just see a lot more hospital births than we do, have more experience with a wider variety of hospitals, and, for many reasons, are likely to feel more comfortable working in a hospital setting than we do.

This week was World Doula Week. Birth Outside the Box featured at least one doula every day this week on our Facebook page. A total of eleven of our local doulas were featured this week. In addition to what Birth Outside the Box did, there was a blog challenge and a flurry of other activity all geared towards increasing awareness and towards honoring the work these incredible doulas do to support families. It was nothing short of amazing to see the outpouring of love for this profession. Clients commented about their skill and about how much their presence meant to them during their births. I hope these doulas felt boosted by this affirmation that their work is important and worth the sacrifices they make in order to serve their clients.

Here is a sampling of the local doulas our area is blessed to have serving our families (listed in no particular order!):


Kaylie Groenhout

Kaylie Groenhout, Doula: Carte Blanche Doula Co.

Kaylie Groenhout, Doula: Carte Blanche Doula Co.

Carte Blanche Birth Co.

Birth can be awesome, intense and transformative. My hope is for pregnant women and their partners to find their collective inner voice and author their own birth story.

Families ought to be respected, honored and loved during the birth process, not treated as patients along for the ride. I help mothers and their partners explore their options during pregnancy so they can make whatever decisions are best for their family. As your doula, I support whatever those are. I believe in you, your body and your baby.


Bergen Howlett

Two Rivers Childbirth

I have been a doula in Loudoun county for more than four years. The challenges we faced after our first daughter was born brought to stark attention the gap of postpartum care in our country and I felt called to became a postpartum doula to help fill that gap. Last year I trained as a birth doula to better provide continuity of care to my clients. I firmly believe in a family’s right to welcome their children in whatever setting they choose. I love supporting my clients at local hospitals and birth centers, but I have a true soft spot for homebirth families. In fact, in 2011, when I noticed a lack of childbirth education designed specifically for homebirth families I wrote my own with the guidance of local midwives and teaching is one of my greatest joys. There are few things better than watching a new family blossom and grow right before my eyes. I love reminding mothers and fathers of the strength and intuition they already posses.


Shannon Klee

Wise Path Birthing

Shannon Klee, Wise Path Birthing

Shannon Klee, Wise Path Birthing

I was blessed to discover, early in my Mama career, that birth can be a peaceful, quiet, and epic experience…lots of hard work, sure, but not always the terrible horror that the movies make it out to be! My first birth was totally unmedicated, and I would not have chosen to do it any other way. Of course, when my second child was born surgically, I also discovered that medical interventions can be wonderful and lifesaving! My job as a doula is to help you discover what your best birth looks like, and support you and your partner in giving you your best odds at achieving that. I serve the entire northern Virginia area, and want to be there for you as you birth at home, or at your chosen birth center or hospital.


Jen Clancy

Jennifer Clancy: Birth Services

Jen Clancy

Jen Clancy, doula from Jennifer Clancy Birth Services, and her beautiful family.

We know the value of supporting mothers in pregnancy. Nutrition and emotional well­being are the two of the top factors that determine the success of pregnancy and level of confidence in parenting one’s child. As a doula and student home birth midwife, I learned quickly that outcomes are more favorable when mothers were optimally healthy. I saw first hand in my own two pregnancies how much impact my diet, environment and lifestyle choices had on my gestation length and health of our babies. My confidence grew when I listened to the needs of my body and spirit as a new parent; allowing inner balance and healing to take place. I believe every new mother desires to achieve not only a healthy baby, but a healthy woman who feels successful and supported. Teaching child birth classes and providing doula support, counsel, prenatal health coaching, encapsulation and birth pool rentals enables me to help other families identify and reach their own personal and family health goals during their childbearing years. My goal is to continue work towards credentialing as a Certified Professional Midwife while helping to sustain a community of birth professionals who promote time honored and evidence based practices with the families at the helm of informed decision making.


Emily Smith

Doorstep Doula Birth Services

Emily Smith: Doorstep Doula

Emily Smith: Doorstep Doula

You are Unique! Emily Smith provides personalized support for your birthing year and beyond! Meet Emily L. Smith- Professional Doula, Childbirth Educator, and Placenta Encapsulation Specialist:

I have more than 17 years of experience working with women, babies, and children, beginning as an au pair and nanny, then training as a labor doula in 2008. I soon expanded my skills as a trained hypnodoula, postpartum doula, childbirth educator, placenta encapsulator, and Blessingway consultant. Contact me at www.doorstepdoula.com or doorstepdoula@gmail.com, 719-373-3069.


Mari Stutzman Smith

Celebrated Birth

Mari Stutzman Smith, Doula, Celebrated Birth

Mari Stutzman Smith, Doula, Celebrated Birth

Mari has always enjoyed working with people. Even as a young child, she knew her passion included serving individuals and helping them when they needed it the most. Mari has been a part of organizations and missions that have kept her serving around the world. She has traveled from Australia to Central America and throughout the USA helping others. It wasn’t until she became pregnant with her first child that she realized a calling to become a doula. Throughout her pregnancy, Mari focused her energy and resources into getting informed about her birthing options. Naturally, she hired a doula and experienced first hand the benefit of having an advocate and rich resource during her birth journey.

Mari is doula trained and certified through toLabor. She has attended over 100 births and has been working as a full time doula serving Northern Virginia and Washington D.C. for over 5 years. In the past, Mari has taught childbirth education classes. Mari is knowledgeable about birth, experienced in interpersonal relationships and excited to share in your birth journey.

Other passions include spending time with her family of 5, traveling, extended breastfeeding, cloth diapering, supporting local/organic farmers in providing sustainable food, and environmental accountability- both globally and individually. Mari has a B.S. in Marketing from George Mason University and has long-term aspirations of attending Midwifery school.


Tara Beth Olson

Tara Beth Olson, Doula

Tara Beth Olson

I graduated with a bachelor’s degree in Economics in 2003. In 2007, after the birth of my second child, I became interested in birth work and decided to become a doula. In addition to homeschooling my four children, I have worked as a birth doula since 2008. I believe birth is a transformational moment in the life of a woman and her partner, and that a woman should be supported in the way she wants to birth. I also believe pregnancy and labor should be supported with evidence-based care. With support, mothers can trust themselves to make informed decisions about necessary, or desired, interventions. I help my clients learn relaxation and meditation techniques they can use during labor and delivery. Through education, planning, and practice, we build trust in each other, in your birth team, and in your body’s ability to birth.


Nicole Bruno

Sacred Journey Birth Services

Nicole Bruno, Doula

Nicole Bruno, Doula: Sacred Journey Birth Services

I graduated with a degree in Music from the University of RI. In preparation for the birth of my daughter I took a Bradley Method class and that is what launched me into the birth industry. I certified to become a teacher and in 2012 began working as a doula. My business model is continuity of care, from pregnancy through postpartum. My mission is to help local families attain their birth vision and gain confidence as new parents through support and education. My purpose and role in your birth and postpartum care is to leave you feeling empowered about your choices and happy with your experience, even if medical needs arise. In my spare time I enjoy being with my husband and my 4 year old daughter, as well as our 4 cats.


 Tiffany Shank

Peaceful Doula Services

Tiffany Shank: Peaceful Doula Services

Tiffany Shank: Peaceful Doula Services

Tiffany supported her mother’s VBAC birth in 2007, this birth sparked her passion to support women during pregnancy and childbirth. Tiffany has an enthusiasm for supporting each woman’s birthing philosophy. She is considered an amazing asset by all the families she has served over the past three years. Her wish is to help each family educate themselves about their birth options and to give birth with confidence.

Tiffany trained as a Doula and Childbirth Educator in 2012 and immediately began supporting women in her community. She lives in the Shenandoah Valley with her amazing husband and one year old daughter.


Jenn Whitaker

Jenn Shane Whitaker, Doula

Jenn Whitaker, Birth Doula

I’ve always known that birth was something I was passionate about, but it wasn’t until the birth of my first two sons that I realized that passion could be turned into action. After the birth of my first son, I knew there could be a better way. His induction resulted in a Cesarean I feel never would have happened had I had the right support and knowledge to help me make different choices. My second son was born at home with midwives and the two experiences could not have been more different. The two births together made me realize I could help other women achieve their best possible birth experience, with the safest and healthiest outcome. My third son, born at home in the water in June 2013, made me appreciate my calling as a doula even more! I’ve kind of “done it all” now!

I believe that every woman can have a positive birth experience when she feels empowered in her decisions. Just like no two labors, babies, or moms are alike, there is no one way to give birth. Whether it’s a hospital, home, or birth center setting, I am here to help women make the best choices for herself and her family, as well as provide her with my support before, during, and after the birth of her child.

Before becoming a doula, I worked in the corporate world as a Web developer for various government agencies in the area. I spent nine years as a contractor before staying home to be with my boys after the birth of my second son. Becoming a doula has been great for me to both follow my passion and tap into the adult socializing aspect of an office job–with less traffic. Sometimes.

I have a Bachelor of Fine Arts from James Madison University, and I am trained and certified with DONA International. I am currently studying to become a Hypno-Doula through Hypnobabies. I attended a Homeopathy for Doulas training with Dr. Diderik Finne in January 2012, and am now offering Homeopathy services for before, during, and after labor and birth. I also offer the use of TENS units for pain management in labor. My clients have been loving their TENS units!


Tara Campbell Lussier

Begin Within Birth

Begin With BirthI am a mother, wife, birth doula, yoga teacher and holistic nutritionist in the Northern Virginia area. I started Begin Within Birth to combine my loves of everything about birth, bellies, babies, and the childbearing years. I gave birth to my twins in August of 2009, and they became the best part of me. It wasn’t until I became a mother myself that I comprehended how much love my heart could hold. I needed a lot of support with the pregnancy, birth and postpartum/nursing time with my twins, and am forever grateful to those that helped me during this most important time. When we became pregnant again, I looked forward to a VBAC, or vaginal birth after cesarean. In February of 2012, I gave birth at home, and achieved that dream. I then went on to have another home birth VBAC (HBAC), in September of 2014. We are blessed to have four beautiful chidren and words can’t express how grateful I am for them every day.

I feel that as a birthing woman I have had a wide range of birth experiences to draw from… From my first birth, a cesarean at 36 weeks due to preeclampsia, to a long and arduous vaginal birth, and finally to a short and blissful birth. I am passionate about meeting you wherever you are on your birth and motherhood journey.


 Marina Kessenich

Transitions Doula Services

Transitions Doula ServicesI am a DONA trained, Madriella certified, and Hypnobabies Childbirth Hypnosis Doula as well as a Birth Arts International trained childbirth educator with a passion for supporting families from all walks of life through their journey to becoming parents. In addition to those services I am also currently working towards my lactation educator certification through Birth Arts International.

As your doula my goal is to assist you emotionally as well as physically throughout this wonderful and powerful time in your life. I hope to help you and your partner feel confident and secure in your choices before, during, and after the birth of your child. I especially encourage open communication between a woman, her partner, and her care provider. All women are entitled to seek the birth that feels right for them.

For a woman to experience the best birth possible I believe it is important for her to be in a place where she feels safe and comfortable, therefore I support and have experience with both in and out of hospital births. I am familiar with a variety of different childbirth education courses such as Bradley, Hypnobirthing, Hypnobabies, Lamaze and many, many more.

I am a doula because it is an amazing privilege to spend my life helping other women; because I believe birth is simply incredible; because I myself could have used the support of a doula during the birth of my own daughter.

As a Childbirth Educator my goal is to help you prepare physically, mentally, and emotionally for childbirth through a dynamic, thorough, and informative series of classes. I do not teach any one correct method of giving birth but instead help couples to equip themselves with the knowledge and self awareness they need to seek the birth experience they feel is right for them.


Jocelyn Bataille

Mama to Mama Doula Services

Jocelyn Bataille: Mama to Mama Doula

Jocelyn Bataille helps a mom by using a Rebozo

I found my way into doula-hood after the birth of my second son, and I greatly enjoy serving this wonderful community of mothers. Birth is such a pivotal moment in life and I feel so privileged to be able to help families enjoy the birth of their baby. At Mama to Mama Doula Services, LLC, you will receive the most premiere doula care in Northern VA.

Aside from my passion for birth-work, I also enjoy reading, traveling, running, and good conversation over coffee. I am also heavily active in volunteer opportunities in the community.

9 Essential “Must Haves” for Your Birth

I posted this question on Facebook:

Mama and baby waterbirth“People ask us what to bring to their birth center birth or to have at their home birth. What is the one thing at your birth that helped you the most?” The women who responded had a wide variety of answers, but there were some common themes.

1. The Right People

The most often mentioned essential item for a great birth was some sort of support person or team of support people. Having great support, the comfort of loving touch, and words of encouragement are so important for a great birth.

“Someone whose sole job is to remind me how strong I am and that my body was made for this work.”
– Chrysta N.

“To me, all that mattered was having my people around me and knowing I was in the safest, best environment possible.”
– Liz C.

“…the most important ‘thing’ was not a ‘thing’ it was the words spoken to me and around me, the touch given to me in the form of comfort and support (sometimes literally holding me up) and the countenance of those in the room…the loving smiles and the shared joy once the baby arrived…just like with a newborn baby, lots of ‘things’ aren’t necessary for birth…it is far more important to choose your ‘company’ wisely.”
– Carrie B.

Think about who you want at your birth. Support can come from many sources, but everyone present should, ideally, support your choices and help you feel safe and loved.

  • “My Husband.”

“… all I really wanted was my husband to let me pull his hair or push on him. All the rest was nice, good friends, a good meal afterwards, snacks, a favorite robe, but I didn’t really need those things. The straw and my husband’s hair were what I couldn’t have done without.”
– Kelly H.

“…most of all, my wonderful trusted birth team and the father of my children, love of my life, my strength and my inspiration!”
– Anne S.

“For me the #1 thing was having my rock of support with me (my husband). Everything else could be left at home.”
– Lindi J.

  • Other Family & Friends

“My amazing family helped me the most!”
– Meghan H.

“My daughter. Seriously. From literally the first signs of labor, her snuggles, smiles, energy and love reassured me that every contraction was worth one hundred if I got another like her.”
– Jenn A.

  • Midwives and Doulas

“My midwife, my doula, my hubs…”
– Liz C.

“Bring Mari (doula). That was all I really needed.”
– Kate D.

“My doula and her bag of tricks.”
– Jessica G.

“The number one must-have would be THE MIDWIFE!!!!!”
– Angela S.

2. Food & Drink

Hydration during birth is super important. Water is great, but in order to keep your electrolytes in balance, varying your hydration drinks is really helpful.

“…coconut water, and labourade ice cubes…”
– Beth H.

“…plenty of gatorade!”
– Anna M.

“Popsicles to suck on, either homemade or not. I was so thrilled at the prospect of being able to eat what I wanted in labor at home, unlike at a hospital, and I didn’t eat or drink anything except water and like three popsicles.”
– Meredith E.

“…some snacks, coconut water…”
– Liz C.

“LOTS of cold water. This time, I’m planning to bring at least two huge jugs so that one will always be full and I don’t have to keep refilling my too-tiny-for-labor regular water bottle.”
– Sara D.

“Coconut water. Also, pre baggied snacks so your favorites are easily accessible.”
– Meggen H.

We’ve always included bendable straws in our home birth kit. People usually ask us “what are the straws for?” Our answer — “for drinking!” As these mamas will tell you, straws seem to be quite important!

“With my first, I made sure to bring plenty of electrolyte drinks. They were in individual containers with straws, like juice boxes. Really helped keep my energy levels up and the straw was helpful.”
– Holly D.

“A water bottle or cup with a straw.”
– Kelly H.

“Favorite drink with a bendable straw and lots of ice.”
– Anne S.

“Depends and a water bottle I could use to drink from any angle.”
– Rebecca S.

As one of our students often says, you need enough calories to get you through a 50 mile hike. While you don’t need to eat huge meals during your labor, unless you want to, it is important to eat little bits here and there to keep your energy up.

“Something you will eat and drink, even when you don’t want to eat and drink.”
– Meghan H.

“Peanut M&Ms.”
– Debbie S.

And, of course, after the birth, you’ll probably be quite hungry!

“I’d recommend some light snacks for afterward, like a double cheeseburger & waffle fries, or maybe an entire pot roast.”
– Kate D.

3. Clothing

We are often asked what to wear during the birth. Hospital gowns are unlikely to be part of your home or birth center experience. What should you wear?

“Comfy, large cotton tshirts.”
– Sheryl R.

“…some jammys to change into afterwards.”
– Liz C.

“…my favorite pair of oversized, comfy, dark-colored, yoga pants.”
– Katie R.

“Socks…yoga pants…I preferred staying clothed while laboring (it was December…cold!!). I went from the shower to the bed to birth tub then back to the bed…but I hated that my favorite nightgown was soaked. I ended up with my husbands huge oversized tshirt, which was too big and got annoying! So if I could go back…I’d have 3 or 4 of the same nightgown on hand.”
– Meggen H.

“I also brought a cozy pair of pajamas to put on afterwards. It was nice to have something from home to wear.”
– Holly D.

“The thing I greatly underestimated was the amount of clothing to pack. I had an outfit for the tub, a gown and the outfit I wore to the Birth Center. I didn’t imagine I’d get in and out if the tub several times and in an out of the shower several times. No one wants to put wet clothes back on, so I ended up naked for most of my labor. Turned out I was comfortable naked, but had I not been, I would have been very uncomfortable.”
– Jenn C.

“A comfy shirt with buttons all the way up the front. Easiest for nursing in the first hours.”
– Julie D.

Some people are happiest with no clothes at all.

“Getting naked.”
– Angela S.

Of course, clothing (for mom) is optional! Dads, bring your swim trunks!

4. Music/Videos/Distractions

Some women find it helpful to listen to music or watch movies. Early in labor, a movie can be a great distraction and can help you relax.

“My favorite Pandora station playing with some of our “special” songs was just the final touch that made (my baby’s) birth feel absolutely perfect! I can still remember specific songs playing at certain points during the labor/delivery. 18 months later when I sing those same songs to her it’s like I get to relive those beautiful moments all over again!”
– Elisabeth G.

“Something that relaxes you to keep your mind off the pain, mine was comedy DVDs…”
– Anna M.

“Harry Potter DVD. It relaxes me.”
– Hannah N.

“I watched my favorite Star Trek: The Next Generation episodes. I usually put those on just before bed, and fall asleep to them. Having that on in the background really helped me relax during the hardest parts of labor, because those shows were a relaxation trigger for me.”
– Kim P. (yes, me!)

5. Preparation

Birth is likely to be the hardest work you’ll ever do. It is a marathon. You wouldn’t show up to a marathon without at least going for a jog first, right? Preparing yourself mentally and physically for birth will help you have a much better experience.

“…overall the most helpful thing was the reading I did in the long last few weeks. Breathing exercises I learned from a pregnancy yoga book and tips/stories from Ina Mays Guide to Childbirth were the most useful things I used in labor.”
– Beth H.

“Hypnobirthing tracks….after 8 babies, I used the hypnobirthing tracks with number 9, and it was my best labor/delivery yet . Totally calm through the whole thing…and I would almost go so far as to say “pain free”….amazing!”
– Angela H.

6. Chux Pads

Chux pads are disposable pads used to catch all sorts of fluids at the birth. I was surprised to see this one on the list, but as a midwife, I can honestly say, there is no such thing as too many chux!

“Chux pads for a homebirth. They leave no trace of birth…like magic.”
– Sheryl R.

“From the Midwife perspective.. Chux pads…please have chux pads. Not newspaper, not paper towels, not extra bath towels..chux pads.”
– Jennifer R.

7. Birth Tub

Water is a wonderful tool for labor and birth. It takes the edge off the contractions and helps relax you. It is often called, “the midwife’s epidural.” It is a safe, low-tech option that many women enjoy.

“For the actual labor- the birthing tub was wonderful.”
– Makendra B.

“FISHY POOL…”
Anne S.

8. Birth Ball

Birth balls (aka yoga ball, exercise ball) are a great tool for birth. They come in various diameters to accommodate women of different sizes, and can be pumped up to the level you find works best for you. Birth balls can be something to lean on when you’re on hands and knees, and can be used to help the baby descend into the pelvis. Sitting on the ball and rotating your hips can help with discomfort during the contractions, too.

“A nice, firm yoga ball.”
– Sara D.

“For three births now, it’s been a birth ball. That’s what got me through labor and helped baby descend and my pelvis open up (roll those hips!)”
– Amy D.

“…I used my exercise ball to help me through both labors.”
– Kelly B.

“It’s funny, because I only used it for a few minutes at E’s birth, but I hung on my birth ball for almost the entire birth with M. That thing was a life-saver, as that was truly a freight train birth at just under 2 hrs. It gave me great support in a number of positions while I tried my best to relax and surrender while AJ was on the road back home. So, I say birth ball.”
– Kimberly F.

“…birth ball, birth song list, candles (flameless or real), Christmas lights, nursing bra and sarong.”
– Anne S.

9. Other Comfort items

“…beloved rice sock (more than one so there is always a warm one available), lavender oil (a few drops on the rice sock or in the birth pool).”
– Anne S.

“Some essential oils”
– Hannah N.

“Ice packs (that’s right, plural) for afterwards.”
– Angela K.

“Rebozo, for someone to do the double hip squeeze for hours.”
– Amy B.

“…birth affirmations, a yoga ball, wash cloths for cooling down.”
– Jessica R.

“Chapstick. Lotion. Post birth…pads, peribottle, soft icepacks, and plenty of people to help you at home!!”
– Meggen H.

“Birth affirmations were also very helpful and essential oils you think you might like to use.”
– Jenn C.

“Gum. lip balm. super cold pregnancy tea. music playing in the background. multiple tank tops (in case the others get wet). personal fan (I was always burning up).”
– Rissa J.

“If you have a pillow you love, you need it. Bring the things that give you comfort when you’re sick – maybe your thing is a rice sock or a nice smelling blanket – bring those things.”
– Natalie E.

“Didn’t help with labor but birth photos are priceless. Camera for birth and/or the first newborn pics.”
– Beth H.

You are unique. You will likely find other things that will help you during that time, but this list can give you a head start. Have a great birth!

P.S.: After your birth, come back and let us know what helped you most!