Which Pelvis Model to Buy?

Sep17

The content in the post was originally made in response to a question on a message board regarding what type of pelvis model do childbirth educators suggest for use in birth classes. I’m posting similar content here for any fellow childbirth educators who may come to this blog looking for pelvis feedback 🙂 Some people had expressed disappointment with a very tiny pelvis model that is out there for sale (and looks deceptively larger in photos) and others were concerned about whether the pelvis was flexible or not and also whether it had “bolts” at the joints for flexibility. Here is my response:

I have a non-mobile pelvis I bought from ebay (around $50) and like it quite a lot. It doesn’t have the flexibility elements, but I point to each joint and describe how it can flex, and that seems to be enough for most people. (The seller was “vanscience” when my husband got it for me for Christmas, not sure what is on there now.)

Then, I have the very tiny one as well (purchased from ebay, not from the Doula Shop). It is only about two inches probably. This is the one I actually prefer to use to show some of the cardinal movements and posterior/anterior positioning of the baby. I have a tiny fetus that I picked up from Birthright. It is a “12 weeks fetus,” but in an odd twist of providence, it fits PERFECTLY through that tiny, cheap pelvis that I regretting having for a long time. Now, I love it and find it really useful. My mom knitted me a tiny uterus with dilating cervix that exactly fits the tiny baby as well! The tiny baby even gets “stuck” on the back of the pelvis when it posterior and then when it rotates to anterior, it slides right through with a little “push.” It is like they were made to go together. The baby is hard plastic, so I can’t flex it to show all the movements, but they get the idea. I just share that babies go through a series of cardinal movements, but I don’t go through a big demo of exactly each one, I just show the baby rotating and slipping through.

I find the tiny set really easy to manipulate and convenient to demo with. The large one works well for tipping back and forth to show how different positions might compress or open and to point out the parts that are flexible in real life. But, I actually find that people seemed more interested in the positioning of the baby when I started to use the tiny set to show that part. I generally teach private, one-on-one classes, so that might be why it works so well for me. It would not work well in an up-in-front-of-a-class setting.

So, I use the big pelvis and big uterus and big baby each as separate teaching tools and then the little pelvis and baby as a “unit.”

Just wanted to share that that tiny pelvis isn’t all horrible! (though, man, was I disappointed when I got it and saw its microscopic nature. I was like, “this is a rat pelvis!”)

Movement and pain

Jun14

A brief quote from Biance Lepori an Italian architect who specializes in the design of birth rooms:

“Even pain dissolves with movement; pain killers are a consequence of stillness.” (emphasis mine)

This architect specifically designs rooms that support physiological birth–birth that unfolds accords to the natural biological processes of the woman, on her own timeline, and under her own power.

I emphasize active, normal (physiological) birth in my classes. I feel like the use of movement is one of the single most important ways we have to embrace labor and its rhythms and also to support healthy, physiological birth. Though I teach a variety of positions for labor and birth, “birthing room” yoga poses, and encourage practicing them, I believe that the movements you need during labor come from within and arise spontaneously during labor, not from specific training and practice. The key is the FREEDOM to use movement in the way you need to (many women end up being denied the right to free movement during labor 😦 ). The benefit to practicing different positions and movements prior to birth is that you gain a “body memory” of how to move your body in labor supporting ways.

Birth Talk Podcast

Jun6

Late last month I participated in a fun podcast interview with childbirth educator Donyale Abe of Birth Talk. You can download the podcast here. We had a great time chatting about birth, fear, homebirth, educating women, ACOG’s statement against homebirth, and our passion for birth and for talking with other women about birth! The audio is a little difficult to hear sometimes when I am talking (maybe that is just on my computer).

As a funny side note, the whole reason this blog ended up being called “Talk Birth” instead of “Birth Talk” is because when I went to get a gmail address, “birthtalk” was already taken. So, I settled for my second choice, “talkbirth.” Later, I set up this site/blog and called it the same thing as my gmail address for consistency 🙂 Then, several months after that I ended up making contact with Donyale via some blog posts I’d made and discovered during our emails to each other that lo and behold, SHE was the person who has the “birthtalk” gmail address I’d originally tried to get! How funny!

Lamaze: Pregnancy, Birth, & Beyond

Jun4

In addition to the Healthy Birth guides I posted about in my last post, I also received my first shipment of Lamaze’s new publication, Lamaze: Pregnancy, Birth & Beyond. This magazine is excellent! I was very favorably impressed. It is brief, but provides an excellent, positive, overall overview of pregnancy, birth, and early parenting. I found myself thinking that if I could give only ONE handout in class, this would probably be the one to choose, since it neatly touches all the important bases and in the tone of confidence, trust, and respect that Lamaze does so well. There is a particularly good article called “Position Statement” that reviews the pros and cons of 11 different positions for labor. It has great photo illustrations as well as clear, accurate information.

I was really pleased with this magazine. The articles are clearly written and easy to understand and takes a clear position on the normal, healthy nature of birth. I also appreciated the articles for new parents about taking care of yourself after the baby’s birth, safe sleeping, and breastfeeding. It is important to remember the continuum extends from pregnancy, through birth, and on to breastfeeding and newborn care! Childbirth educators can sign up to receive their own free shipments of these magazines here. It is published once a year, but shipped quarterly.

There is advertising for disposable diapers as Huggies is a sponsor of the magazine, but absolutely NO formula or bottle advertising, which, of course, is no less than I’d expect from Lamaze and their philosophy.

Speaking of Lamaze, I also really enjoy their basic guide, Giving Birth with Confidence.

Healthy Birth Guides

Jun3

I recently received a shipment of The 2008/2009 Guide to a Healthy Birth published and distributed free of charge by Choices in Childbirth in NYC. I ordered a stack of these nice little booklets for only the cost of shipping ($11 for 50 booklets). I really like the content and plan to distribute these in my birth classes and encourage other educators to do the same. The emphasis of the booklet is on being an informed consumer and it also touches on the politics of birth and the business of birth, which I really liked. The end of the booklet has an article by Dr. Harvey Karp about the 5 S’s. I particularly enjoyed the chapter called “The Purpose and Power of Pain in Labor.”

All in all, this is a fantastic and nearly free resource and I’m pleased to have them available! Check them out yourself! (You can also download the booklet for free as a pdf.)

I first learned of these booklets from the wonderful Passion for Birth blog.

Do Epidurals Impact Breastfeeding?

May10

There was a question recently on a list I belong to about the impact of epidurals on breastfeeding. The person asking the question had been told by several hospital based childbirth educators that epidurals do not “cross the placenta’ and thus do not have an impact on the baby. Since this is an issue of concern, I thought I’d share some of my response/thoughts regarding this question here. I was happy to hear Linda J. Smith speak at the LLLI conference luncheon session about this very issue–the impact of birth practices on breastfeeding–and she covered a ton of material about the impact of epidurals on breastfeeding (she also wrote a book on the same topic with the late Mary Kroeger). There is some good information, though much less complete, on her sit e. The biggest problems with epidurals are the impact on the mother rather than the baby, though the medications used in epidurals DO cross the placenta and get to the baby, they are much less seriously impactful than IV or IM narcotics. An epidural refers to the means of medication delivery not what is actually being delivered into the body, so it is hard to say definitively that one has no effect, because different anesthesiologists use different “cocktails” of drugs in their epidurals. They usually use bupivacaine as the anesthetic, but there are opoids included as well, such as *morphine* or other related opoids like that.

All the books I have as a CBE say that medications used in epidurals do make it to the baby, but effects vary. Most effects are connected to what is happening to mom—i.e. mother gets a fever as a side effect of the meds and that stresses baby. Fluid overloading leads to more fluid in baby’s lungs, etc. The main breastfeeding impact on the mother’s side is excess fluid retention in the breasts due to the fluid “bolus” administered prior to an epidural. Baby is a little sleepy following birth and then can’t latch to severely swollen breasts (which are not “normally” engorged, but excessively so due to excess fluid), and so it goes. You often hear from mothers that their nipples are “too flat” for the baby to latch on to and as you probe further you find that the flatness has NOTHING to do with the mother’s true anatomy, but has to do with that excess fluid. Women are so programmed to look inward and blame themselves for problems that it is really unfortunate (like mothers who “aren’t making enough milk” when it is really a pump with bad suction).

Basically most breastfeeding problems that have to do with birth practices are not correctly attributed to the source—the birth practices—and are instead blamed on the mother (“flat nipples”), the baby (“lazy suck”), or breastfeeding (“sometimes it just doesn’t work out”).

How to Use a Hospital Bed Without Lying Down

Apr30

In classes, I often suggest that when couples enter their hospital room in labor they pile all of their belongings onto the bed rather than the laboring woman hopping into it. I encourage people to start seeing the bed as a tool they can actively use during labor, rather than a place for labor and birth to passively happen to you. To that end, I’ve made a little handout called “helpful ways to use a hospital bed without lying down.” I’m uploading it here in hopes that others may find it useful as well.

For more about the importance of freedom of movement during labor, make sure to check out Lamaze’s Healthy Birth Practice paper: Walk, Move Around, and Change Positions Throughout Labor or this video clip from Mother’s Advocate.

Top Five Birth Plan…

Apr29

Birth plans are a topic often discussed in birth classes. There are SO many things that could be put onto a birth plan that sometimes it is difficult to sort out the most important. I encourage couples in my classes to complete two different “values clarification” exercises to help them include those things on their plan that are MOST important to them, rather than trying to cover everything on a one page birth plan. They often ask what I think is important to include. So, recently I started thinking that if I needed to create a birth plan for a birth in hospital that was as normal and natural as possible and could only include five elements, what would be most important to me, my baby, and a normal birth?

These are my top five after first going into the hospital as late in labor as possible (this isn’t included on my birth plan and doesn’t need to be on anyone’s birth plan–“I plan to labor at home as long as possible”–because it isn’t relevant by the time you get there and people are reading your plan. It belongs on your own personal plan, but not in your “official” plan):

No pitocin.
Minimal fetal monitoring and preferably with a Doppler only.
Freedom of movement throughout labor (stay out of bed, use it as an active tool rather than as a place to lie down. Stay upright during any necessary monitoring.)
Push with the urge in whatever position works best for me (NO coached, directed, or “cheerleader” style pushing).
Baby immediately to me. NO separation.

Ideas for supporting your partner in labor

Apr16

One of my favorite handouts to give in birth classes is a “Cliff’s Notes” to labor support. It is a two page handout with a variety of reminders and ideas about supporting your partner or wife during her labor. There are small illustrations as well and a review of the stages of labor. The handout is available here from the website Transition to Parenthood. This site offers a variety of useful handouts for childbirth educators and for parents-to-be and I really appreciate the educator’s generosity in making her materials available online like this!

The handout referenced focuses primarily on physical support and comfort measures of the laboring woman. Some additional, less concrete things I like to remind fathers-to-be of are:

Follow her lead. Labor is like a dance and your partner is leading the dance! Anything I say in class or anything you’ve read about is less important than what she is actually doing and you responding to her.
The most important thing you can do is just love her. This is more important than learning “techniques.” Just love her the way you love her and she will feel your love and support.
Let it happen. I encourage women to “let birth happen” and to let it flow. As her support person, you can help her by letting her let it happen (instead of hushing her or telling her to calm down or asking her to do something different than what is working for her).
Don’t interrupt a woman who is coping well with a new technique or idea–if what she is doing is working for her, encourage THAT instead of trying to introduce new ideas or tips.
Remember that as a support person you may also experience the three “emotional signposts” of labor–these are excitement, seriousness, and self-doubt and they correspond to stages of labor. A woman in early labor shows the excitement “signpost” a woman in active labor tends to be very serious and “busy working” and during transition many women show a self-doubt signpost maybe saying they “can’t do this anymore” or “I can’t do this much longer.” It is okay to let your partner know that you are experiencing excitement and seriousness, but try to keep the “self-doubt” signpost under wraps and don’t show her that you are also experiencing that one! Be as calm and supportive and confident and trusting as you can as she journeys through the sometimes challenging time of transition in her labor.

Helping yourself while helping your wife or partner in labor

Mar28

Giving birth is an intensely physical process for the woman giving birth and sometimes we forget what an intensely physical process it is to assist a woman giving birth! Here are a few ideas of ways to take care of yourself while you are helping your wife or partner labor and give birth:

Bring healthy snacks for yourself (avoid anything that is strong smelling, like garlic, and don’t drink coffee)–granola bars, sandwiches, trail mix, crackers.
Wear comfortable clothes and shoes.
Dress in layers–the birth room may be cold or it may be hot.
Wear clothes that you don’t mind getting stained.
Use good “body mechanics” when providing physical support to your wife. Bend your knees slightly and keep your back straight when helping support your wife in a standing squat. If providing counterpressure on her back with your hands, keep your arms straight and lean your body weight down onto her back to provide the counterpressure, rather than using the muscles in your hands or arms to provide it.
Take breaks if you need to–it is okay to take a bathroom break or to get something to drink! If your wife or partner does not want to be left alone, have your doula or a helpful nurse serve as a quick stand-in for you. Use your judgment as to whether to announce to your wife that you are taking a quick bathroom break. Some women may be upset at being “abandoned” without warning, while other are so into the rhythm of labor that they will not notice you taking a quick break and it is better not to disturb their rhythm by making a big announcement that you are leaving.
If you feel yourself getting tense or anxious, take slow, deep breaths from your abdomen or do a few quick tension relieving stretches such as rolling your neck from side to side or rotating your shoulders.
I encourage women to use affirmations during pregnancy and then during labor to help them greet their labors with confidence and acceptance. Though it might seem silly or feel awkward, you may wish to develop some affirmations to use yourself as well as you assist your wife in labor–try things like, “I am calm and confident” or, “each contraction is bringing our baby closer,” or, “my mind is relaxed, my body is relaxed,” or, “her body knows how to birth our baby.”
Trust birth and the process–your wife’s body is well designed to give birth to your baby. She can do it! Believe in her and believe in yourself!