Mother to Mother Midwifery Blog

Riding the Postpartum Waves: Understand the wide range of feelings

By Brooke Ray, April 26, 2018

Riding the Postpartum Waves: Understand the wide range of feelings that come with a new baby and how to let your community support you

Becoming a mother is the biggest transition a woman goes through in her adult life. We’re taught to think and plan for the birth: Will I have an epidural? Pitocin? Vitamin k? I’ll bring music, wear an eye mask… There’s such a huge range of considerations. But what about after the birth? We anticipate happiness, love, deep connection with our partner and an instant bond with our baby. How will we foster these emotions and experiences? Will they just happen? And what else might I expect?

When baby is up all night and your partner is snoring, how will that impact you? What about the emotions coursing through your body after a few weeks in the NICU—is it anxiety or the oxytocin you’ve heard so much about. Despite your text-book home birth that you planned to a T, you might find yourself crying uncontrollably for what feels like no good reason. The postpartum period can feel unpredictable to a new mother and even like a roller coaster at times.

So what does it feel like to be a mother? What is normal? In this workshop we’ll discuss the common range of emotions new mothers may experience. We’ll talk about the baby blues and if what you’re feeling is something more, like depression, anxiety or post-traumatic stress disorder.

We’ll also talk about some of the many (many) myths of motherhood that can contribute to feelings of guilt, fear or shame and strategies for cultivating more joy while coping with the challenges of motherhood.

Bio

Rachel Rabinor, LCSW is a psychotherapist and licensed clinical social worker. She has a private practice in Banker’s Hill where she specializes in reproductive and maternal mental health. She is passionate about supporting women (and those who love them) on their journey to and through motherhood. She has specialized training in treating pregnancy and postpartum mood and anxiety disorders, traumatic birth, infertility, miscarriage, loss, and early parenting. She believes in the healing power of community support and enjoys facilitating groups for new mothers and women experiencing infertility. Rachel is a member of ASRM, Resolve and San Diego’s Postpartum Health Alliance where she was the former training chair. She is often featured on podcasts and webinars, and regularly presents to local groups and organizations on topics of maternal mental health.

 

Diastasis Healing with Dr. Stephanie Libs

By Brooke Ray, April 16, 2018

We were so fortunate at MothertoMother Midwifery this weekend to welcome Dr. Stephanie Libs to our Fourth Trimester Talk in the Garden.  Dr Libs is a chiropractor and owns her practice, Cafe of Life in San Diego.  She has a daughter and is expecting a second baby.  So she has personal and professional experience of the subject she shared with us: Healing the diastasis after having a baby.

I learned so much from Dr Libs. She is knowledgable, energetic and personable in her presentation.  I’m eager to pass on to my own clients all the tips Dr. Libs shared with us.

“Diastasis is when the linea alba (midline) separates from the rectus abdominis. During the second and third trimester the linea alba starts to thin due to babys growth. The linea alba is made of connective tissue which has little blood supply, and makes it difficult to heal”, according to Dr Libs.

To feel your own diastasis, use your fingertips when you are lying down and your head lifted to feel the separation of the muscles. It seemed like everyone in our group of mothers had a diastasis at least three finger tips wide.

Diastasis doesn’t just cause tummy bulging but actual back pain and even urinary incontinence.  It’s challenging to accept these changes in the body after having a baby.  It can even lead to some depression.   Women don’t realize they don’t have to accept these changes though.

A lot of women continue their entire lives with a gaping diastasis after childbirth and consider it to be normal.  But it’s not normal and there are some very simple things to do to heal the diastasis.  We discussed within our group that most care providers do not give instructions how to heal the diastasis after having a baby.  It’s unfortunate these instructions aren’t common knowledge because they can make a big difference for a woman’s comfort and her self-esteem.

How to heal the diastasis after childbirth

It’s possible to have a strong core after childbirth.  Those abdominal muscles can be knit back together to close the diastasis.  Here are a few highlights from Dr. Libs presentation.

Did you know bone broth and wheat germ oil are excellent for healing the connective tissue of the diastasis?  Yes, it’s true.  I will add here that organic gelatin powder is an easy and affordable alternative to bone broth.

“Crunches” and traditional abdominal work outs are the worst for healing the diastasis. I guess those “Abs of Steel” videos 30 years ago were counterproductive!  You can check for yourself if your work out is working against you.  Feel the diastasis when you’re working out and check if it’s more pronounced.  It should be getting smaller and closing together.  By the way it’s possible to place tapes on your diastasis to better support it’s closure.  Dr Libs can help you with this.

The best exercises for healing the diastasis are done with the umbilicus drawn in and the abdomen engaged as if bracing for a strike.  With this posture, mindfully sit down and stand up.  This should be your first abdominal exercise after having a baby.  Dr Libs says mindful baby wearing with the core engaged is another of the first postpartum work outs.  Don’t forget to breathe!

Never hoist yourself to sit up. This makes the diastasis worse!  Always roll to the side and then sit up when trying to heal the diastasis.  Twisting and leaning down are also a big culprit.  Avoid twisting when you reach down to pick up your child.

There are several progressive exercises to do to heal the diastasis.  They all involve lifting one leg at a time, never two. One is to lie down with your knees bent and feet flat on the ground. Draw in your umbilicus and engage your abs.  Now lift one bent leg at a time to a perpendicular position and then slowly lower.  This exercise is one of the first to do to heal and to close the diastasis.  There are several more as you continue your progress toward your mother strong core.  I recommend looking at youtube for demonstrations.

Most importantly, instead of thinking about trying to get your former body back, think about going forward, toward a stronger, wiser, mother body.  Work out wise and strong like a mother!

 

 

 

Cord Blood Collection and Homebirth

By Brooke Ray, March 23, 2018

Cord blood collection is possible at your home birth.  Mother to Mother Midwives will help interested families collect cord blood at their Homebirth.

The stem cells in your baby’s umbilical cord blood are a valuable resource.  They are undifferentiated cells that can be used to treat many diseases such as stroke, heart disease, Parkinsons Disease  and Diabetes.  This could be a life giving donation from your baby to another individual and an early act of good karma..

Unfortunately, due to our current scientific limitations,  it is very unlikely the stem cells collected from your child will later benefit him or her.  The likelihood your child will benefit from his/her own stored stem cells is approximately 1/100,000.

It’s much more likely that these stem cells could benefit an ill family member or an anonymous individual in need.

There are two options for collection and storage of stem cells, private companies or local, community blood banks.

To collect stem cells for a family member, consider a private stem cell collection company such as Stemcyte. Such companies charge for collection and storage of your baby’s cord blood.

A practical option for those who want to donate to the public is the Community Blood Bank.  They will collect and store cord blood at no charge. Best of all, they match the donated stem cells to needy, sick individuals.  If your motivation is to help someone in need, blood banks are the best option.

Altruism aside, the individual most likely to benefit  from his or her own cord blood is your baby.  Allowing a baby to keep all of his or her own cord blood means he will receive all the benefits from the precious stem cells, red blood cells and platelets.

Delaying cord clamping for at least 30-180 seconds after birth results in higher concentrations of hemoglobin and hematocrit and blood volume during the neonatal period and less iron-deficiency anemia at 4-6 months of life.  There is also a correlation to improved neurological function for those who kept all their own cord blood.

For families who do choose to collect stem cells, our midwives prefer to delay cord clamping and cord blood collection for 30-180 seconds after birth before collection. This is a compromise between collecting all or none of the cord blood.

Mother to Mother Midwifery preferred method of cord blood collection is delayed clamping and collection. For families who choose it, this is a good compromise.

ohhh the vernix-Birth Photos

By Sunshine Chrispeels, March 2, 2017

“The International Association of Professional Birth Photographers has announced the winners of their 2017 contest, and the photos they chose show the struggles mothers go through to bring new life into the world, and the sheer joy that follows.

We took your breath away with last year’s contest, and these new photos will leave you even more amazed. Each one tells a story of pain, perseverance, and finally, relief. They document a baby’s first moments of life, and a family’s first moments of unity.”

http://www.boredpanda.com/professional-birth-photography-competition-winners-labor-2017/?page_numb=12&utm_source=Epictexts&utm_medium=referral&utm_campaign=SBP

one of the many waterbirths

SO many raw images…careful if you are sensitive to images of cesareans. Many Midwife and Homebirth pics…tons of beautiful images.  Enjoy

Why a Doula? But we have a midwife…

By Sunshine Chrispeels, February 22, 2017

One of the big questions that we get asked at Mother to Mother Midwifery during our interview process is ” Do I need a doula at our homebirth?”

The short answer?  Yes

We as midwives have very refined doula skills.  We know what words to use, what touch works, positions for you to get into, how to engage the father in the process, we know about aromatherapy, homeopathies etc….  We do all of the things that a doula does.

What we can’t do is provide that support continuously as a good doula does.

We ask that you have an extra person at your birth especially for first time mothers and you will frequently hear us say that we can provide some labor support but our focus is on the clinical aspects of labor, birth and postpartum.  We ebb and flow in our physical support, always on alert for you and the baby but we can’t always be hands on.  Often we need to conserve our energy and focus for the important moments of the baby’s emergence and the postpartum period.  This means that we may rest while you labor and we are doing other clinical things while you may need hip squeezes.

Do we need to pay for one?  That depends…

We have a regular and low cost doula list in the office.  You don’t need to pay for one but…

We encourage you to have someone who has experienced natural birth, ideally in a home setting.  We ask that the person have some labor support skills and some awareness of what it is to be on continuous call for someone.

That person could be a close family member or a friend as well.  As long as they possess the above, then you will have a solid team of support.

For 2nd and subsequent babies we just ask that you have someone that is not your partner there if your other kids are in the house with you.  Most laboring mother’s want their partner with them, not looking after the toddler, so the third person fills another role for the family.

It is one of our big topic at prenatal visits.

#keeptheoxytocinflowing #mothertomothermidwifery #homebirth

Sunshine supporting a laboring mother with belly binding and rebozo

Evidence Based Birth Practices

By midwife, January 3, 2017

One of the goals of midwifery care is “Evidenced Based Birth Practices” which means that our care is guided by more than just our personal experiences and instincts.  We strive to provide what we think  is a blend of available science and technology as well as good old fashioned nurturing…

A webisie that families can reference when making decisions is
Evidence Based Birth
We feel strongly in this model of care that empowers families to make good decisions.

This article on GBS is something that we reference from the website…there are many informative articles and we invite you to explore  when making important decisions that impact your care.

 

ENJOY!

 

#homebirth #mothertomothermidwifery #Midwife #licencedmidwife #CNM #midwifeminds #evidencebasedbirth

NIPT: Early Genetic Testing

By Kayti Midwife, December 18, 2016

Non-Invasive Prenatal Testing (NIPT)

Introduction

NIPT analyzes cell-free fetal DNA circulating in maternal blood. It is obtained from a simple blood draw. It is a relatively new technology in prenatal screening and testing for trisomy 21 and other fetal chromosomal aneuploidies. It differs from the California State-sponsored Prenatal Screening program in the following ways:

NIPT CA Prenatal Screening
Cost Cost is based on your insurance; out of pocket max, $200 Free with most insurances
Tests The most common chromosomal disorders only: Down Syndrome (Trisomy 21) trisomy 18 & 13. Can also tell if your baby is a boy or a girl.  More advanced testing also available. Screening for chromosomal AND “mid-line defect” issues (spina bifida, Open Neural Tube Defects, gastroschesis)
Accuracy 97-99% Sensitive and Specific (almost diagnostic) Accuracy varies: up to 90% accurate for Down Syndrome, 80% for ONTDs
Timing Can be done any time in the pregnancy from 10 weeks. Done at particular intervals; Final results available after 16 weeks

 

NIPT Test Characteristics

Genetic testing using cell-free fetal DNA

DNA from the fetus circulates in maternal blood. Unlike intact fetal cells in maternal blood, which can persist for years after a pregnancy, circulating cell-free fetal DNA (ccffDNA) results from the breakdown of fetal cells (mostly placental) and clears from the maternal system within hours. Fetal DNA detected during a pregnancy, therefore, represents DNA from the current fetus. Although only about 10-15% of the cell-free DNA circulating in maternal blood is from the fetus, it can be detected and measured. Quantitative differences in chromosome fragments in maternal blood can be used to distinguish fetuses affected with trisomy 21, and a few other fetal aneuplodies, from those that are not affected.

NIPT is currently offered by a host of companies:

Natera: Panorama

Sequenom: Materniti21

Illumina

We like NIPT because it offers families early testing for genetic diseases that can affect their choices in pregnancy- like early follow up care, education about place of birth, or opportunities to consider further testing.   The drawback with NIPT is that it does not test for “mid-line” defects which could also impact a family’s choices.  So we’re very careful when counselling our families about the wise use of this new emerging technology.  People DO love to find out early if it is a boy or a girl.  We enjoy their reactions, too.

 

Cesarean births affecting human evolution: The female pelvis is not to blame

By Brooke Ray, December 9, 2016

Recently some British researchers came up with a dodgy, new spin on an old obstetric myth. They warn us that the high rate of cesarean births is afffecting human evolution.  They claim the female pelvis is shrinking through evolution.  They report, selection pressure from the overuse of cesarean deliveries is accelerating this evolutionary shrinking process. Consequently, more women now require cesarean births because the pelvis is too small and narrow to birth normally.

Rate of cesarean births is climbing

Researchers are baffled by how quickly the cesarean birth rate is increasing.  Their best explanantion for this phenomenon is evolutionary pelvic shrinking.

This isn’t a new conclusion, folks.  The size of the female pelvis has always been the scapegoate for complicated deliveries.  The original diagnosis for cesarean delivery was cephalopelvic disproportion.  Translation is the pelvis is too small to fit the baby.

It’s possible that high cesarean rates will lead over time to the an evolutionary smaller pelvis, but the size of the pelvis is not the cause of the high rate of cesarean births.

female pelvis

The pelvis is not the problem

The truth is, the size of the pelvis is not too blame for the high rate of cesarean births.

In fact cesearen rates for women who plan to birth at home in the U.S. have remained a steadily low below 10%. This proves the problem is not the pelvis.

Its imperative to lower the cesarean birth rates but not by blaming the female pelvis.

The Brits were on the right track two years ago when they announced their campaign to steer low risk women away from birthing in the hospitals.

In an effort to lower the rate of interventions and cesareans, in 2014 Great Britain’s National Institute for Health Care Excellence (NICE) recommended that women with low risk pregnancies are better served by giving birth at home.

More than half of cesareans are unnecessary

In our modern, developed countries the cesarean birth rate is more than twice what it should be. According to the World Health Organization, the ideal cesarean rate should be 10-15% for any country. The U.S. cesarean rate is 33%, meaning that more than half of the cesareans performed are unnecessary.

This is a good cause for all of our concern.

The overuse of technology is the real cause for increasing cesarean rates

The real problem for rising cesarean rates is not a shrinking pelvis, its the overuse of modern technology

While we are indebted to modern medicine for saving lives from time to time, it’s overuse is driving up cearean birth rates.  In time this may indeed cause selection pressure against normal vaginal birth!

Giving birth in the hospital with all its practices and technology directly increases the liklihood of delivering by cesarean.

Interventions such as labor induction with cytotec and pitocin, Friedmans curve, continuous fetal monitors and anesthesia increase the cesarean rates when over used.  Impatience of the providers, driven by production demands, also drives cesarean birth rates.

In order to decrease the cesarean rates, modern medicine needs to be used judiciously and only for delvieries that become high risk.

Planned homebirths have low cesarean rates

Planning a homebirth is the best way to avoid an unnecessary cesarean delivery.  The likelihood of requiriing a cesarean delivery for a homebirth mother is under 10%, well within the World Heatlh Organizations recommendation.

A woman planning a homebirth can trust that even if she ultimately delivers by cesarean, it is necessary and life saving.  It won’t result from the overuse of technology.  She should also believe that her pelvis is adequate and has not shrunk through evolution.Stages in human evolution

World Health Organization reommendation for cesarean rates

Cesarean births affecting human evolution

NICE recommendation for low risk mothers

Birth in the Caul

By Brooke Ray, November 26, 2016

It is rare and special for a baby to be born in the caul.  It’s also known as ‘born in the veil’ because the membrane covers the baby’s face like a veil at birth.

Caul- the amniotic membrane enclosing a fetus.

Caul- The amniotic membrane enclosing a fetus.

Benefits of strong water bag

To be born in the caul is the result of a strong amniotic membrane that doesn’t break.  There are many physical benefits to an intact water bag including decreased infection, protection of the umbilical cord, and more freedom of movement for the baby.

How to have a strong water bag

The best known method for an expectant mother to grow a strong waterbag is to eat a diet high in Vit C, amino acids lysine and proline and phytonutrients.

Spiritual benefits of birth in the caul

Beyond the physical benefits, there are long standing beliefs about the spiritual gifts of caul births.  Supposedly these people inherit the gift of clairvoyance and healing abilities.

Legend tells us the “caul carriers” can never drown and are able to divine sources of underground water.  Best of all, birth in the caul bestows overall good fortune to these chosen ones. Parents and midwives used to save the membrane and keep it for the child for good luck and protection.  It’s possible to put the membrane a locket or wear it as an amulet.

Superstition and persecution

It’s not all good news though.  During the medieval inquisition, the inquisitors accused “caul bearers” of heresy,  along with midwives and healers, for suspicion of witchcraft and supernatural powers.  The penalties for heresy at that time were various tortures and punishments, including burning at the stake. In spite of persecution and torture, caul births have survived.

Modern birth in the caul

Even in modern times, we continue to recognize the rarity of caul births and respect them as such.  The majority of babies are born in hospitals nowadays, and attended by obstetricians. Only 9% of births are attended by midwives in the U.S.  Since doctors are more likely to artificially rupture the membranes to hurry along the birth, caul births are more and more rare.

We midwives still have the good luck to attend caul births because we do not routinely break the water bag.  It’s not our practice to rush the birth and we respect the benefits of the intact water bag. Allowing the membrane to remain intact increases the likelihood for a baby to birth in the caul.

How to deliver a baby in the caul

If the baby births in the caul, we simply wipe or peel the membrane from the face so the baby can draw his or her first breath.
Influenced by our predecessors, we modern people continue to unconsciously believe birthing in the caul bestows certain good qualities.
If we check, a lot of us believe caul babies and waterbabies, their waterbirth siblings, are lucky and have an affinity for water.  We might even believe they will grow to be talented swimmers, surfers and water people.

Caul birth and water birth

Nowadays many birthing women instinctively choose to birth in the water.  Water births and caul births are virtually the same because both result in the baby born in water.

Surfer

Surfer

Women can’t give precise reasons for their interest in water birth but I suspect their  unconscious attraction to it grew out of our ancestors  folklore about birth in the caul.

Would you like your baby to be born in the caul or in the water?

NY Times Midwife Article

Caul Birth and En Caul Birth

A Strong Water Bag-How to Avoid Premature Rupture of Membranes

By Brooke Ray, November 25, 2016

There are many benefits for a strong water bag.  The risk of infection for mother and baby remains low, the amniotic fluid insulates the umbilical cord, and the baby is better able to navigate the pelvis.  Here is an evidence based prescription for you to follow to grow a strong water bag!

The chorioamniotic membrane, fondly known as the water bag, is made of the connective tissue, collagen.

Nutrition for a strong water bag

Nutrition is the best known way to build and protect collagen. Eating a daily diet high in vitamin C, lysine, proline and phytonutrients will give you a strong water bag that is more likely to stay intact through labor.

Vitamin C Foods for a strong water bag

Vitamin C Foods

Vitamin C is necessary to build collagen and to prevent damage from free radicals.
Studies show that consuming Vitamin C 100mg daily decreases the rate of premature rupture of membranes from 24% to 7% of pregnancies.

Prenatal vitamins contain approximately 70 mg of vitamin C that contribute to building a strong water bag.

The best and safest way to consume additional Vitamin C is through dietary sources. Foods such as bell peppers, oranges, strawberries, broccoli and papaya are all high in Vitamin C.

Amino acids, lysine and proline, found in animal proteins and egg whites contribute to the formation of healthy collagen. A plant based source for both of these amino acids is wheat germ.

Phytonutrients in berries, dark colored fruit and green tea protect collagen from breakdown.

Our prescription for a strong water bag is a diet high in Vitamin C (strawberries, oranges, broccoli, papaya, bell peppers), lysine and proline (animal protein, egg whites, wheat germ) and phytonutrients (blueberries, raspberries, cherries, cranberries, green tea).

Qualities of Amniotic Membranes

Effects of Vitamin C on Amniotic Membrane

Next Page »

These are by far the best care providers I've ever had in any field. The gift they gave me was excellent woman based health care and an education on healthy pregnancy and birth. All of this nurtured the woman I am and the mother I've become. Thank you more than words, Mother to Mother Midwives.

~ Catherine Jones, mother of four

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