It was an honor to attend my tenth birth as a doula this week.  Over the past year I have supported families at three different birth centers, three hospitals, and home.  I have seen strong women and steadfast partners. 

Sometimes people think of babies when they think of doulas.  Babies are great.  They are beautiful, snuggly, and sweet.  They make adorable sounds.  If it weren't for babies there wouldn't be any work for me to do.  But I'm not in this because of babies.  I give my life to this work because of women.  I want women to walk away from birth educated, supported, and confident.  I want my clients to look back on their births knowing that they had the information needed to make the best decisions they could, feeling supported when it was hard, and confident that they are prepared to meet the challenges of parenthood.  I also want to be the one who remains focused on her when everyone else begins to focus on the baby.  Postpartum life is hard.  There is lack of sleep, stress over feeding and baby's weight gain, feeling overwhelmed with a baby who doesn't stop crying.  Everyone wants to see and hold the baby.  But what about this new mom?  Is she able to rest and allow her body to recover properly?  Is she being well nourished?  Is she feeling burdened as she tries to meet the needs of older children whole also trying to rest and care for the helpless new one?  Even in this time - especially in this time - I want to focus on her.  

I am wired for emotional and relational connection.  I think this is why I have found this role to be so satisfying.  Midwives and OBs have to be focused on physical well being.  As a doula, I can jump into the depths of the experience with HER - not just her body, but fully present with HER.  "Bringing heart and hands to support your birth" isn't merely a slogan, it is the core of my work.         

This week I am excited to share a guest blog post with you.  Dr. Kim Nguyen is owner and pregnancy and pediatric chiropractor at Aligned Family Chiropractic in Tomball, TX.  Below she shares her top 3 reasons to see a chiropractor during pregnancy. 

A lot of people think that you only see a Chiropractor because of neck or back pain, but that’s a big misconception! As a Chiropractor, we work with your nervous system, your brain body connection. Chiropractors check for any subluxations (misalignments that cause interference to your nervous system) that prevent you from functioning at 100%.  Health is not about being pain free, but rather how well you are functioning. You live your life through the nervous system, wouldn’t you want it functioning at 100%, especially during pregnancy? During pregnancy not only is your body undergoing many changes, it is doing the important work of supporting your growing baby! The healthier your nervous system, the better your body will be able to adapt to the changes of pregnancy. Here are the top 3 reasons you should see a Webster Certified Chiropractor during pregnancy.

Reason #1-Webster Technique
The term Webster technique is mentioned a lot during pregnancy especially when baby is mal-positioned in utero. As Chiropractors we do not “turn” babies with the Webster technique. The Webster technique can actually be performed on anyone with a pelvic imbalance! Dr. Jeanne Ohm states that “The Webster technique is a specific chiropractic analysis and diversified adjustment. The goal of the adjustment is to reduce the effects of sacral subluxation/ SI joint dysfunction”. Dr. Larry Webster, founder of the Webster Technique, noted that “the restoration of pelvic neuro-biomechanics with this adjustment also frequently facilitated optimal fetal positioning” in pregnant women. So in correcting sacral and SI joint dysfunction with an adjustment, it creates the optimal space for baby to position itself in the best possible position for birth. Also, the more room baby has to move in utero, baby is getting great brain development! Having optimal pelvic and sacral alignment also helps with a smoother labor and birth for mom and baby. Research shows that moms under chiropractic care have shorter labor times! Getting checked frequently throughout pregnancy ensures proper nervous system function, which has many overall health benefits for mom and baby!

Reason #2-Uterus is a muscle!
Your uterus is a muscle that expands exponentially during pregnancy. According to the American Pregnancy Association the uterus goes from about the size of an orange to the size of a watermelon by the third trimester! Going back to your body is controlled by your nervous system; your uterus is supplied by the nerves in the lumbar (low back) and sacrum. It’s vital that the nerve supply to the uterus is flowing without any interference so it can contract and relax when it’s time! Contractions are called contractions for a reason. The uterus is contracting as it should to push baby out along with other factors. If there is interference to the nerves that supply the uterus, the uterus will not be functioning at 100% as it should. Who wants to be in labor and have their uterus tire out before baby gets here and other interventions are being introduced? Not this gal, and I can’t imagine any other woman wanting that either.  Failure to progress is one of the leading causes of a Caesarian section. The uterus is attached to the pelvis by ligaments so when the pelvis is misaligned, it can cause tension and torsion to the uterus as well. Getting checked is a preventative measure that can benefit all pregnant women

Reason #3-Get more SLEEP!
Number one reason pregnant women can’t sleep during pregnancy is that they can’t get comfortable or something hurts. Millions of regular pillows and the newest S shaped pregnancy pillow fad later and we still can’t sleep. It’s bad enough that baby is already on our bladder and we’re getting up 5 times a night to pee, now we can’t even get comfortable. I couldn’t imagine not getting adjusted throughout my pregnancy just because it helped with being able to sleep more comfortably so much. It’s true as our bodies change and our abdomen grows during pregnancy its harder to get into comfortable sleeping positions. With chiropractic care, we can reduce any undue stress on the nervous system that may be interfering with sleep. Correcting structural imbalances will help to reduce the typical pregnancy aches and pains. Getting adjusted also helps to calm the nervous system to get you quality sleep and give you the proper energy during the day. With everyone moving so fast paced these days our nervous system has become wired to be more on the go. Basically stuck on the gas pedal what we call sympathetic over drive. When we get adjusted it tells the sympathetic part of our nervous system to calm down by activating our “brake pedal” or parasympathetic system. Restoring this proper balance helps our body to adapt to stress a lot better (such as the changes that come with pregnancy) and we can get quality sleep even with a belly the size of a watermelon on us!

Hopefully you learned something new about the benefits of Chiropractic care for pregnancy. If you’re interested in getting checked or finding a Chiropractor near you reach out to us via our website www.alignedfamilychiro.com we would love to help! Thanks for reading and stopping by!

Dr. Kim Nguyen, Webster Certified Chiropractor



Aligned Family Chiropractic is dedicated to providing holistic and the best effective health care for you and your entire family. We strive to educate our patients and our community about the benefits of chiropractic adjustments and making healthy choices. Our office is committed to taking care of the family as a whole, with an emphasis on pediatric and pregnancy chiropractic care. We believe each child and parent should be as healthy as they can be from conception to birth. Health begins before you’re born, let us help guide you in this journey.

Last week I promised to share a few gems from my Spinning Babies training with Gail Tully.  Did you know that you can start a routine at 20 weeks to balance the pelvis?  Possible results of these exercises include less pain in pregnancy, greater relaxation in pregnancy, a better positioned baby, and a faster labor.  If those results sound appealing to you, keep reading.

Gail refers to this routine as the "Three Sisters of Balance".  You can find visual explanations, contraindications, and more information on her website at SpinningBabies.com.  Please make sure to visit the Spinning Babies website prior to attempting any of these exercises. 


Rebozo Sifting - The rebozo is a great multi-purpose tool for pregnancy and labor.  In this application of the rebozo, muscles and ligaments in the abdomen are gently jiggled which causes them to relax.  Ideally this exercise is done at least once a week, and for 2.5-5 minutes at a time.  The rebozo is spread across the belly and mom assumes a hands and knees position.  Her helper holds the ends of the rebozo and with wrists facing inward, moves hands in a pedaling motion (not a sawing motion).  

Forward Leaning Inversion - This exercise looks a bit complicated, but can be so beneficial.  Begin with your knees on a couch or stair.  Place your hands on the floor and walk them out as you lower your body.  Once you are inverted, place your weight on your forearms rather than your hands.  Your bottom should be in the air.  Remain inverted for 3 breaths, approximately 30-45 seconds.  Do not use pillows as this can increase risk of slipping.  Tuck your chin and do not allow your head to rest on the ground.  This exercise lengthens and stretches the uterosacral ligament and also takes the uterus off the pelvic bones.  Be sure to come straight up out of the inversion rather than walking out of the position.  Aim to do this on a daily basis.

Side-lying Release - Tension and twisting in the pelvic floor can cause discomfort in pregnancy, and slow progress in labor.  This exercise helps release that tension and restore balance to the pelvic floor.  It is essential that mom has a helper for this exercise.  Mom lies on her side on the edge of a bed or table with her belly hanging over the edge.  Her helper must support her and keep her from rolling off!  The helper stabilizes the hip in vertical alignment and applies gentle downward pressure.  Mom's bottom leg is straight, shoulders are stacked, and top leg hangs freely in front.  This can be done for 5 minutes per side and must be done on both sides.     


Need hands on instruction for these and other Spinning Babies techniques?  Contact me to schedule an a la carte session focusing on Spinning Babies, or to learn more about my complete doula services.

Isn't head down enough?  So often care providers reassure their patients by telling them baby is head down.  That is important, but not the end of optimal positioning.  In a baby who is presenting head down, position can be occiput anterior (OA), occiput posterior (OP), or occiput transverse (OT).  The OP baby is sometimes referred to as "sunny side up" because in this position baby is born face up and is often associated with back labor.  The easiest position for baby to be born is OA.  If you are now thoroughly confused, you can view these positions here.

Everyone wants an easier labor, so how can you influence baby to an OA position?  There are several big keys.  First, avoid sitting in a reclined position from 32 weeks until birth.  This means no sinking into your comfy, saggy sofa.  This means not kicking your feet up in the evening in your favorite recliner.  This means your birth ball becomes your favorite tv chair, and you are intentional about keeping your knees lower than your hips.  You want to assume forward leaning positions that encourage your baby's back to swing towards your belly with the help of gravity. 

Second, see a chiropractor on a regular basis throughout your pregnancy.  Seek out a chiropractor who specializes in the treatment of pregnant women as he/she will be familiar with the bony structures and the soft tissues of the pelvis, and know how to work these to create space for baby. 

Third, practice Spinning Babies exercises daily starting at 20 weeks.  The goal of Spinning Babies techniques is to balance the pelvis and make space for baby to settle into an ideal position for birth.  Come back next week as we dive deeper into Spinning Babies and I share a few gems from my (very) full day training with Gail Tully, the creator of Spinning Babies. 

I believe that prenatal education and planning go a long way in setting things up for the birth you desire.  This doesn’t guarantee anything, but it lays a good foundation.  I will help you determine what is important to you in your birth – This is YOUR birth, and then guide you as you write that out in a way that your care providers should respect and remember.  I am there to encourage you at the end of pregnancy when you are just ready to be done.  I am there as a sounding board when you want to bounce off your care provider’s suggestions.  I can guide you in finding relevant research to support your decisions.  In early labor I will offer lots of phone support.  I will encourage you and make suggestions based on what is going on at the time.  In active labor I will either join you at your home or place of birth depending on your preference.  I will be there to encourage you, offer physical comfort measures, remind you of things we talked about prenatally, and help you in positions that encourage labor progress.  I do NOT speak to your doctor for you, encourage you to go against medical advice or perform any clinical tasks.  I remain with you for two hours after birth to assist you in breastfeeding if you choose to do so, and to make sure all is well.  I follow up frequently in the first two weeks postpartum to make sure you and baby are doing well, and to offer guidance or referrals if needed.  I will especially be looking for breastfeeding difficulties, difficulties in adjusting to life with a newborn, and signs of postpartum mood disorders.  I maintain contact through six weeks postpartum, supporting you through the adjustments and helping you process your birth.
 
I support all types of births.  I saw a graphic this week that said “You’ve got this.  I’ve got you”.  I think that really sums up my heart.  I believe you already have within you the power to have a positive birth.  I am there to walk with you through it, to encourage when things get hard, to hold you up when you think you are going to fall, and to see you through the struggles and into the victory.  I am passionate about birth and compassionate towards women.  This is what makes my heart sing.  This is the very work I was created for. 

"What is a rebozo" you ask?  By definition, a rebozo is a simple piece of fabric.  It originates from the Mexican culture.  It varies in length and width depending on the use.  In Mexico, these special cloths are used from birth, throughout life, and into death.  The heritage of the rebozo is deep. 

I attended a class this weekend to learn more about how to use the rebozo in pregnancy, labor, and birth.  The one thing that stood out to me the most was how beautifully the rebozo incorporates the partner.  So many times partners are afraid the doula will take their place, or are uncertain of what they can do to help the laboring woman.  Never fear, the rebozo is here! 

Prenatally the expecting woman and her partner can practice relaxation and comfort measures with the rebozo.  "Under the tent" they will find intimacy and absence of distraction.  They can discuss the day as the rebozo is used in "roving body relaxation" and massage.  As the rebozo is used prenatally, it becomes associated with peace and relaxation so that it evokes those same feelings when used in labor.

In labor, the rebozo can be useful in techniques to relieve back pain (without causing the partner pain!).  Again it can be used to block out distraction and bring the same relaxation practiced prenatally.  This is a very concrete, hands on way for the partner to participate in labor.  It is a way to bring the laboring couple close, both physically and emotionally.  

Have you ever wondered, "Exactly HOW do I push, WHERE do I push?"  We can use the rebozo during this part of the birth process to help focus pushing efforts and bring your baby down and out.  The rebozo can support the laboring woman as she squats to birth.  It can be used in bed, in the tub, sitting, standing, squatting. 

The rebozo is a versatile tool that will become a beloved symbol of peace, strength, support, and intimacy throughout pregnancy and beyond.  I am now offering an add-on rebozo package to my complete labor doula package.  This will include an additional 2-3 hour prenatal visit where I will show you how to use the rebozo, a written guide of different positions and techniques, and a new rebozo for you to keep.  Contact me today to learn more about this new offering.   

Essential oils are a very popular natural medicine.  Essential oils support the body as the body balances and heals itself.  Essential oils do not carry as many contraindications or side effects as pharmaceuticals, making them a good choice during pregnancy and beyond.  Be sure to discuss your use of essential oils with a trusted care provider as the information here shall not be considered medical advice. 

1.  Lavender - Lavender is often associated with calming and restfulness, but it also has many other uses.  Try lavender when dealing with morning sickness, leg cramps, sore muscles, stretch marks, sore breasts, or water retention.

2.  Peppermint - Not only is peppermint a great oil for alertness, but it is also a digestive soother.  Peppermint might be helpful if you have morning sickness, constipation, or heartburn.  Other applications for peppermint include sore muscles, hemorrhoids, and possibly encouraging a breech baby to turn.

3.  Cypress - Cypress is a great oil for circulation.  As such, it is great for leg cramps, varicose veins, hemorrhoids, and swelling.

4.  Orange - That unmistakable smell when you peel an orange comes from the essential oil in the peel.  Enjoy this uplifting aroma when you are fatigued or feeling blue.  It might also soothe morning sickness and heartburn.

5.  Lemon - Lemon is another oil that might be helpful when dealing with morning sickness.  Also consider this oil for varicose veins, constipation, swelling, and fatigue.     

Disclaimer – I am not a trained aromatherapist.  I have studied essential oils as personal interest.  Essential oils are very potent.  The source of your oils is a big factor in safety.  I have decided to use DoTerra for my family because of the in depth multi-stage testing to guarantee safety, potency, and purity.  If you would like information on how to purchase and use DoTerra essential oils, please contact me.

Third Stage of Labor: Active vs. Physiological Management
 
The third stage of labor is considered the time between baby’s birth and placenta being expelled.  Active management and physiological (also called expectant) management are the two approaches to this stage.  What is the difference between these two approaches?  What are the risks and benefits of each? What will be best for you? True informed consent means analyzing risks and benefits in the context of your medical history, and taking responsibility for that decision.
 
Active Management
Active management of the third stage is a medically managed approach.  Medication is given (ie – Pitocin) within one minute of birth.  The umbilical cord is cut and cord traction (gently pulling on the cord) is applied to hasten the release of the placenta.  After the placenta is expelled, the uterus is massaged.  The American Congress of Obstetricians and Gynecologists considers active management of third stage to be the best practice standard of care.
 
There are risks to this approach.  We know that 1/3 of a baby’s total blood volume is in the placenta at the time of birth.  By immediately clamping and cutting the cord, baby is deprived of this blood.  This means baby is starting life in a compromised state.  Some medications used in this stage can cause nausea, vomiting, and high blood pressure.  Be sure to ask your doctor what medication is being used and what the risks are of that particular medication.  If medication is administered before the cord is cut, baby will be exposed.  Another risk is that pulling on the cord increases the likelihood of partial detachment where some blood vessels are torn open but the placenta is still in the uterus so the uterus cannot clamp down to stop bleeding.  Cord traction also contributes to placental fragmentation.  It is also possible to completely detach the placenta prior to medication induced contractions which are needed to stop bleeding.  Ironically, some of these risks lead to the very thing active management seeks to reduce – excessive blood loss.   
 
Active management of labor aims to reduce total blood loss, length of third stage, and severe postpartum hemorrhage.  Studies indicate these benefits more clearly in the hospital setting. 
 
Physiological Management
In a physiologically managed birth, the mother expels the placenta on her own.  She waits for post-birth contractions and pushes gently.  The umbilical cord is typically cut after it stops pulsing, which indicates that baby has received the full volume of blood. 
 
The risk to this approach is increased chance of postpartum hemorrhage. 
 
The benefits include full blood volume for baby, no risk of medication reaction, and no risk of manually separating the placenta.
 
It is important to note that if a physiological approach is taken and excessive bleeding does occur, there are measures that can be taken to reduce bleeding whether at home or in a hospital setting. 
 
Other Considerations
It is important to consider the place of birth when deciding which approach to take for third stage management.  In a natural birth taking place in a home setting, natural oxytocin is plentiful.  Dim lights, quiet and calm atmosphere, love and support all facilitate the release of natural oxytocin.  The same natural oxytocin that causes contractions to birth the baby also causes contractions to release the placenta and stop bleeding.  Natural hormone production is further stimulated thorough skin to skin contact between mother and baby, and nipple stimulation of baby suckling at the breast. 
 
On the other hand, if labor was induced or augmented with synthetic oxytocin (ie – Pitocin) the production and release of natural hormones is altered.  When used to induce or augment labor, Pitocin can overstimulate the uterus leaving it less effective at clamping down in the postpartum period (uterine atony).  Saturating the oxytocin receptors with synthetic oxytocin can make the uterine response to natural oxytocin inadequate.  Epidural anesthesia inhibits the natural production of oxytocin.  These and other interventions in the natural birth process increase the risk of postpartum hemorrhage by disturbing the natural hormonal changes that take place in labor, birth, and the postpartum period.  When natural oxytocin is inhibited, it might become necessary to use synthetic oxytocin to prevent hemorrhage. 
 
Look at your own health history.  What is your nutritional status?  Ask your care provider about nutritional supplements (vitamins, minerals, herbs, etc) that might help reduce the risk of excessive bleeding in birth.  Do you have a history of postpartum hemorrhage?  Discuss this risk factor with your care provider. 
 
Conclusion
There are risks and benefits to both active and physiological management of third stage.  You must consider these risks and benefits, along with the context of this birth (interventions such as induction and augmentation, anesthesia, place of birth, etc) and your own health history when making a decision on the best approach for your birth.                  
 
 
References:
 
http://sarahbuckley.com/epidurals-risks-and-concerns-for-mother-and-baby
 
http://midwifethinking.com/2012/05/05/an-actively-managed-placental-birth-might-be-the-best-option-for-most-women/
 
http://www.acog.org/~/media/Districts/District%20VIII/ActiveManagementThirdStageLabor.pdf?dmc=1

There are common ideas regarding the kind of woman who should hire a doula.  Some think doulas are only for hippy, crunchy moms.  Some think doulas are only for those without a partner.  Perhaps you think doulas are only for those seeking unmedicated birth.  So that leaves the question, are you the kind of woman who should hire a doula? 

1.)  A woman who is planning a medicated OR unmedicated birth should consider a hiring a doula.  Doula support is about so much more than pain management.  The prenatal support of a doula is invaluable.  In addition to that, a doula can help with comfort measures prior to the administration of pain medication (sometimes it can take time for the anesthesiologist to be available, and sometimes the doctor will not allow an epidural until a certain dilation is reached).  There are also times when pain medication is ineffective, and times when labor progresses too quickly for an epidural.  Doulas can also help with position changes to encourage labor progress in women with and without epidurals.  Even if you have an epidural, that does not mean you must labor on your back!  Hire a doula with knowledge of comfort measures and different positions for labor and birth regardless of your plans regarding pain management.

2.)  A woman who has a partner, family member, or friend present to support her in birth OR a woman who is birthing alone should consider hiring a doula.  Studies show that the presence of a doula yields different results than just having friends and/or family present.  Your friends and family bring an intimate knowledge of and love for you, and your doula brings knowledge and experience in birth support.    

3.)  A woman who is birthing with an obstetrician OR a woman who is birthing with a midwife should consider hiring a doula.  Obstetricians and midwives oversee the clinical aspects of labor and birth.  Their primary responsibility lies in the well being of you and your baby.  A doula does not carry this responsibility, which frees her to focus on supporting you physically and emotionally during labor and birth.  While your medical care provider might come and go throughout your labor, your doula will remain with you throughout your labor and into the immediate postpartum period.  

4.)  A woman who is hippy, crunchy, conservative, liberal, traditional, eclectic, OR anywhere in between should consider hiring a doula.  All women should be supported in pregnancy and birth.  Doulas themselves come from different backgrounds and different personalities and styles.  Interview until you find the right fit!  

5.)  A woman planning a spontaneous labor, induced labor, OR planned cesarean should consider hiring a doula.  While the support needs might look different depending on the circumstances of your birth, a doula is able to offer customized support to meet those needs. 

6.)  A woman having her first child OR her second, third, fourth, etc child should consider hiring a doula.  Every birth is different!  I have had five children myself, and I can tell you that not one birth was like any other.  While consecutive pregnancies and births might not carry the same uncertainty as the first, each and every pregnancy and birth is unique and benefits from the support of a trained professional.  

I could keep going but I'll bet you have noticed a pattern here.  There is no set type of woman who should hire a doula.  The right doula for you is out there, and I would love to chat with you further to share how I can support you in your birth, no matter which of the above categories you might fall into. 

     A profession of labor support has emerged over the last two decades.  This role is called “doula” from the Greek word “doule”, meaning “maidservant”.  The majority of labor doulas are women, though there are male labor doulas.  Doulas provide non-clinical services.  Doulas do not take the place of obstetricians or midwives, but round out the birth team by providing informational, emotional, and physical support to the pregnant woman and her family during pregnancy, birth, and the postpartum period.  Doulas support births in homes, birth centers, and hospitals. 
     Doulas are not licensed or regulated by the state.  There are many certifying bodies that train and guide doula practice.  By hiring a certified doula, you know that you are hiring a trained professional with scope of practice guidelines and continuing education requirements. 
     Most labor doulas will meet with you twice prenatally to get to know you and to help you sort through birth options and your preferences.  If you have a partner who will be involved with your birth, it is helpful if they are able to attend at least one of these meetings.  Your doula does not replace your birth partner if he/she wants to be actively involved.  She can guide your partner in ways to support you in labor, and your doula will also be able to support your partner.  Prenatal support is not limited to these meetings.  Your doula will remain in contact with you via phone, text, or email throughout your pregnancy to provide information, support, and to develop a relationship with you.   By the time you give birth, she won’t feel like “another stranger in the room”.  Many women say that by the time they gave birth, the presence of their doula is much like that of their best friend, but with the knowledge and skills to improve the birthing experience. 
     When you think you are in labor, your doula will meet you in your home or at your place of birth, depending on your contract agreement.  A doula will not monitor your baby or check your cervix.  She is educated in the emotional signposts of labor and is familiar with the sounds of active labor, and is able to provide support until you are ready to travel to your place of birth.  During active labor she offers hands on comfort measures. She can suggest position changes to encourage better fetal positioning and descent.  She will remind you of your birth preferences and encourage you towards that goal.  She is not there to talk to the doctor for you.  She is not there as a gatekeeper to fend off medical staff.  She is not there as a birth advocate.  Only you or your partner can make decisions.  She can help you gather information on which to make those decisions.  She will be there as a constant support no matter how those decisions might deviate from your original birth plan.   She cannot guarantee the outcome of your birth, but studies have shown that the presence of a doula reduces interventions, can shorten labor, and improves satisfaction with the birth experience. 
     Doula support does not end with birth.  She will remain with you until you are comfortable and have fed your baby.  This is typically two hours.  She will follow up frequently over the next two weeks to make sure you are adjusting well.  In the event of concerns regarding you or baby, she will provide appropriate referrals.  Between 4-6 weeks postpartum, she will visit you again to assess your current needs.  She will help you process your birth experience and encourage you on your journey of parenthood.  For more extensive postpartum support, postpartum doulas are available. 
     There are doulas to fit every personality and budget.  Most doulas offer complimentary consultations so that you can interview several doulas before hiring one.  Doulas combine their passion for birth and their compassion for women to help you have a satisfying birth experience.  Hire a doula – when everyone else is focused on the monitors, she will be focused on you!