The Politics of Homebirth

To understand why insurance companies don’t pay well for homebirth in America, one needs to appreciate the absolute power and control of the American Medical Association.

The AMA spends hundreds of millions of dollars per year on lobbying it’s causes.  It lobbied against non-medical exemptions of mandatory vaccines, and for the ongoing use of animals in biomedical research, climate change and gun control.  The AMA spends the most money on lobbying, second only to the American Chamber of Commerce.

Consequently, when the AMA makes a resolution, insurance companies listen.  It so happens that the AMA recommends women deliver in hospitals or birthing centers within hospitals-not at home.

The AMA’s motivation to obstruct homebirth does not stem from concern for the safety of mothers and babies. Science supports homebirth as a reasonable and safe option.  The true motivation of the AMA is greed.

The AMA would lose money and power if they acknowledged the safety of homebirth for low risk women.  If the AMA endorsed homebirth, insurance companies would fall in line and pay for homebirth costs.  Doctors and hospitals would stand to lose up to 28% of the revenue generated by childbirth.

In countries where homebirth is a covered benefit, such as the UK, Canada, New Zealand, Netherlands, France, Germany, homebirth rates are as high as 30%, compared to 2% in the U.S.

The AMA is not only greedy, but also misogynistic to try to control women’s reproductive rights.  In the end, it is a woman’s choice how she births her baby. She shouldn’t suffer financial penalties for choosing Homebirth.

 

 

Bringing Baby Home

It’s 3 a.m. You’re up for the fourth time since you fell into bed at 8pm last night.

This beautiful, amazing creature is now nestled softly in your arms, content to feel the intensity of your love as you slowly rock, back and forth, back and forth. You never could have imagined how much you would love your baby. And watching your partner care for your child only brings more joy to your overflowing heart. But you’re exhausted.

Sleep never comes for more than two hours at a time…and that’s on a good day.

You can barely remember what food tastes like hot. You feel like you’ve scored a win for the day when you manage to sneak in a shower. Naptimes are the new “deadlines” you find yourself scheduling your days around. Babies are just supposed to eat, sleep and poop, right? So, why are you so, well, pooped?

The Gottman Institute has been researching couples, their behaviors, communication patterns and ability to connect for over 40 years. Through this research they can predict with over 90% accuracy whether or not a relationship is headed for divorce. Fortunately, for all of us, they have also determined numerous behaviors that happy and satisfied couples engage in that can help to keep your relationship strong. Evenwith the many changes that accompany welcoming a new member into your family as “Baby Makes Three”. The Gottman institute has developed a program specifically for expectant and new parents to help you navigate the ups and downs of bringing a new baby into your home and your hearts.

Certified “Bringing Baby Home” Facilitators Brittany Holmes, MFT and Jennifer Lundy-Aguerre, MFT

will guide you through the tried and true steps to maintaining and strengthening your relationship with your partner during this transition time. Come learn more about the tools to enhance your relationship for years to come!

http://www.pccounselingcenter.com/index.php/groups/

Positive Change Counseling Center  www.pccounselingcenter.com

Making Room For Baby www.makingroomforbabysd.com

Jennifer Lundy-Aguerre, MFT #42025
Licensed Marriage & Family Therapist

Office: (619) 733-6414
Cell: (619) 828-3306
Fax: (619) 303-3306
5480 Baltimore Drive, Suites 106 & 250
La Mesa, CA  91942

Effective 10/1/18! New North County Location!
11590 West Bernardo Court, Suite 230
San Diego, CA 92127

Sign up for Bringing Baby Home
Sat Jan 26 2019, 10-11:30 at our midwife office:
Mother to Mother Midwifery
1816 Howard Ave San Diego CA 92103
Registration is limited to 8 people
Cost is $25 for a single and $40 for a couple

Alternative Birth Options and Health Insurance Coverage

Although most women in the U.S. deliver babies in a hospital, that’s far from their only option these days. They don’t have to rely on doctors or obstetricians either. Doulas and midwives are increasingly common, as are birthing centers as well as home and water births. Here’s how health plans tend to treat them.

midwife touching pregnant woman stomach

In the early 1900s, nearly all American women gave birth outside a hospital. By the 1940s, less than 50 percent of them delivered their babies at home. And by the late 1960s, just 1 percent did so.

That’s pretty much where things stand today. Almost all babies in the U.S. are now delivered in a hospital–in stark contrast to what was commonplace a century or so ago.

No one is likely to argue the tide is racing back toward out-of-hospital births, but it does seem to be leaning in that direction–if only slightly.

According to the Centers for Disease Control and Prevention (aka the CDC), the percentage of out-of-hospital deliveries increased from 1.26 percent of all U.S. births in 2011 to 1.36 percent in 2012.

Most of these “alternative” deliveries occur at home, although a good number take place in freestanding birthing centers. (In 2012, just over 35,000 of the nearly 54,000 out-of-hospital births in the U.S. happened at home. Birthing centers served as the setting for around 15,500 of them.)

Having babies at home or in dedicated centers isn’t the only alternative birth option American women are embracing these days. They’re also increasingly utilizing doulas, midwives, and night nurses to help them through their pregnancies and deliveries.

The most recently gathered statistics associated with doulas, for instance, suggest about 6 percent of U.S. women use them during childbirth. A little over 8 percent call on midwives while pregnant, according to another study.

That’s all well and good, you say, but how much does a doula or a midwife or a birthing center cost? And how do those price tags compare to the ones attached to their more traditional counterparts, like doctors and obstetricians and hospitals? Also, does health insurance usually cover these alternative birth options?

Keep reading for answers to all of these questions and a few more.

By the way, if you’re currently uninsured, check out our article about how to choose the best health insurance plan for your pregnancy.

Doulas

Americanpregnancy.org says “doula” is a Greek word that means women’s servant.

Most modern doulas would balk at being called servants. “Helpers” might prompt a nod of agreement, though. Even better options: birth assistants, labor companions, labor support professionals, or labor support specialists.

That’s because, as americanpregnancy.org puts it, a doula is a professional trained in childbirth who provides emotional, physical, and educational support to a mother who is expecting, is experiencing labor, or has recently given birth. The doula’s purpose is to help women have a safe, memorable, and empowering birthing experience. (Although some doulas help women through abortions or help people who are dying, too.) Specifically:

  • Antepartum doulas assist pregnant women who are put on bed rest to prevent preterm labor.
  • Birth or labor doulas provide care during delivery.
  • Postpartum doulas support new moms in the first few weeks after they give birth.

Note: doulas aren’t medical professionals. They don’t actually deliver babies or offer any other kind of medical care. Many doulas are certified, however. To earn their certificate they must complete a training program and pass an exam.

Doulas may not have professional medical training, but many pregnant women swear by them anyway. Why? Because with their assistance you may be able to:

  • avoid a Cesarean section (or C-section) delivery
  • give birth without needing as many–or any, in some cases–pain medications
  • spend less time in labor

Studies also have found that women who work with a doula while pregnant are more likely to describe their deliveries in a positive way.

All of that positive support comes at a cost, of course. How much you pay depends on where you live. If you call a more rural area home, for instance, you may only pay a few hundred dollars. On the other hand, it isn’t unusual for pregnant women in urban settings to pay thousands of dollars for a doula.

Also impacting the potential price tag here: how long you employ a doula. In other words, if you only need one for a portion of your pregnancy, you’ll pay less than if you need one for the whole nine (or more) months.

As you might expect, health insurance coverage of doula services is all over the map. Some plans help pay the associated costs, while others do not.

The best way to find out how your plan treats doulas: pick up the phone and call your insurer. Or send them an email.

Do the same if you’re on Medicaid. A couple of states currently require their Medicaid programs to cover certified doula services and others may cover them even without legislative involvement.

If your plan or coverage won’t help in any way, head to Google (or your search engine of choice). You may find doulas willing to volunteer their time and expertise to women who can’t afford to pay them. Or you may find some who charge less in such situations.

Midwives

Unlike doulas, midwives are trained medical professionals. Like doulas, however, they can care for women before, during, and after their pregnancies.

You may think of midwives chiefly as pregnancy and birthing assistants–much like doulas. Although they sometimes take on that role, they’re just as likely to lead a woman through labor and delivery.

Something that differentiates midwives from physicians or obstetricians is they tend to be proponents of natural childbirth. At the very least, they usually try to minimize unnecessary interventions during a pregnancy.

Something to pay close attention to if you decide to hire a midwife: their level of certification. In particular, you’ll probably want to look for a certified nurse-midwife (or CNM). These midwives are registered nurses. And to earn this certification, they have to graduate from an accredited education program and pass a national exam. Certified nurse-midwives can practice in all 50 states and in the District of Columbia.

That’s not to suggest you should ignore certified midwives (CMs) or certified professional midwives (CPMs). Not all states permit CMs or CPMs to practice, though, and that may give some women pause.

Regardless of whether you hire a CNM, CPM, or CM, your midwife should be able to help you in a variety of locations–your home, a private office, a birthing center, or even the hospital.

What does “help” mean here? Typically, a midwife can do most of the things a physician or obstetrician can do while caring for a pregnant woman.

Generally, that means they’re knowledgeable about prenatal care, labor, and postnatal care. More specifically, it means they often can help with:

  • prenatal exams, tests, and screenings
  • diet, nutrition, and exercise advice
  • medications
  • emotional support
  • lactation and breastfeeding counseling or education

In addition to leading or assisting with your delivery, of course.

One catch to all of this: most experts recommend using a midwife only if you’re at a low risk for complications. As such, if you run into any problems during your pregnancy, you’ll probably want your midwife to at least consult with a physician, obstetrician, or other specialist. (On a related note, read our article about unexpected pregnancy costs and how health insurance covers–or doesn’t cover–them.)

Although you’ll typically pay more for a midwife than you will for a doula, you may not pay too much more. According to pregnancycorner.com, the average cost of a midwife in the U.S. is around $2,000. That means you’ll sometimes pay a good deal more than that amount, but it also means you’ll sometimes pay less.

Where you end up on that spectrum mostly depends on where you live and what services you need.

In any case, you can expect to pay less for a midwife than you’d pay for traditional obstetrical care in a hospital, the cost of which can go far beyond $5,000 or even $10,000.

Granted, those savings won’t mean much if your health plan doesn’t cover at least some of your resulting bill. And that’s a distinct possibility given how insurance companies currently treat midwives.

Some insurers don’t cover midwife services at all. Some cover them if the midwife helps you deliver your baby in a hospital setting or birthing center, but not if you deliver at home.

Because of this, talk with your insurance company before you start looking for a midwife so you know what your plan will cover and what it won’t in this regard.

You should have better luck if you’re on Medicaid. But even then you’ll want to check with your local agency before you shake any hands or sign on any dotted lines.

Night Nurses (or Night Nannies)

Don’t be fooled by the name “night nurse.” Although many of these women (and men) are registered nurses, many are not.

Some night nurses or night nannies are certified in various ways, while others simply have a lot of experience taking care of newborns.

Regardless, they all help new moms in basically the same ways. Primarily that means spending nights in their homes and feeding and otherwise taking care of their babies while they sleep.

A lot of mothers hire night nurses for the first week or two after they give birth. Others wait a while, such as until they’re ready to return to their jobs.

As helpful as night nurses or night nannies can be in these situations, their assistance isn’t cheap. Most charge between $25 and $40 per hour, according to various sources. (Once again, what you wind up paying probably will depend on where you live and how much experience a particular nurse or nanny has.) That means you could spend upwards of $200 a night, and more than $1,000 each week, for this specialized sort of care.

Unfortunately, you’ll most likely have to pay for a night nurse out of your own pocket should you decide to make use of one. Few, if any, health insurance plans cover them at this point–even though they cover a lot of other forms of postnatal care. (To learn more, see our article: “What Does Health Insurance Cover After Pregnancy?“)

That said, if you or your baby come home with any special health needs, it’s possible your plan will pick up some of the cost. You’ll obviously have to talk with your insurer to find out one way or the other, however.

Birthing Centers

According to CNN, the number of babies born in U.S. birthing centers increased 55 percent from 2007 to 2015.

Medicaid is responsible for some, if not most, of that growth, thanks to the Affordable Care Act (also called the ACA or Obamacare) requiring state Medicaid programs to pay these centers a facility fee. Still, their appealing nature probably played a role as well.

Basically, delivering your baby at a birthing center is more like doing so at home than in a hospital. Birthing centers tend to be cozy and low-tech. Midwives, rather than obstetricians or physicians, typically serve as their primary care providers. And natural childbirth is emphasized over the kinds of medications and medical interventions common in more clinical settings.

One of the main benefits of using a birthing center is the mother’s recovery time often is far shorter than it would be if she delivered her baby in a hospital. In fact, many women spend just a few hours in a birthing center after giving birth, while a couple of days isn’t unheard of in a hospital.

Another common benefit: birthing centers are almost always cheaper than hospitals. The average cost for a birthing center is around $3,000, while hospitals charge many times that amount.

There are a few downsides to using a birthing center. One is they’re not the best places for complicated pregnancies or deliveries.

Also, insurance coverage can be spotty. That said, more U.S. health plans cover birthing centers than in the past. So, if you want to go this route, contact your insurance company and ask how your plan treats this type of care. Talk with the birthing centers you’re considering, too; they may be able to help.

And what if you’re on Medicaid, as many women are during their pregnancies? You’re in luck. As mentioned earlier, Obamacare requires state Medicaid programs to cover the services of licensed birthing centers. For more information, get in touch with your local agency.

Home Births

There’s quite a lot of overlap between home births and midwives. Which makes sense, as midwives often run the show, so to speak, during home births.

There’s also a good bit of overlap between birthing centers and home births. Which is to say that women who give birth at home often do so for reasons that are similar to why women deliver their babies in birthing centers.

In other words, they usually want to give birth in a comfortable setting. They want to be surrounded by family or friends. They want to avoid all the medications and medical interventions or interruptions that are so common during hospital deliveries. And they typically want to feel more in control of the entire birthing process.

Cost tends to be a concern, too. As in, many pregnant women choose home birth so they can bypass the sky-high bills associated with most hospital births.

So, how much does a home birth usually cost? Around $3,000–or about 60 percent less than you’ll pay if you give birth in a hospital.

The thing is, you may have to pay some of all of that amount out of your own pocket whether you have health insurance or not. Although a number of U.S. insurers now cover certain midwife services, many still balk at covering planned home births.

Why? The most common answer is they consider home births to be “not medically appropriate.” They also often consider them to be risky.

Speaking of which, here’s what one health insurer, Aetna, has to say about the subject:

“According to the policy statement on home delivery of the American College of Obstetricians and Gynecologists, labor and delivery, while a physiological process, clearly presents hazards to both the mother and fetus before and after birth. These hazards require standards of safety that are provided in the hospital setting and cannot be matched in the home situation.”

There are health insurance companies that cover home births, though, so don’t give up if that’s how you want to deliver your baby. Contact yours to see how–or if–your plan treats this sort of situation.

And even if your health plan covers home births, don’t be surprised if it ties some requirements to that coverage. One example: you may have to use a midwife who has been certified by state regulators. Also, you might need to pay for various supplies or pieces of equipment.

Water Births

Once again, there’s often some overlap between water births, home births, birthing centers, and midwives.

This is because many water births take place at the home of the mom-to-be or at a birthing center. (Though some do take place in hospitals.) And midwives typically oversee these deliveries.

As for what a water birth is, it’s usually a birth–and this can mean labor, delivery, or both–that happens while the woman is in a pool or tub filled with warm water.

Some of the benefits associated with water birth are that it can:

  • ease pain
  • keep the pregnant woman from needing anesthesia or other medications
  • speed up labor

How much you pay for a water birth depends on a number of factors. For instance, if your water birth takes place in a hospital, you’ll probably pay what you’d pay for a more traditional birth. (The hospital may bill you extra for the tub, however.) The same is true if your water birth is done at a birthing center or at home.

What about insurance? Again, your health plan is most likely to cover water birth if it’s done in a hospital or birthing center. If yours takes place at home, you’ll face the same insurance challenges any woman who wants to give birth at home faces.

Few, if any, state Medicaid programs currently cover home births, so they’re also unlikely to cover home water births. Still, contact your local agency before you decide to pay for one out of your own pocket.

Actually, that’s good advice no matter where you get your health coverage. It’s never a bad idea to have a conversation with your insurance company about whether or not it covers certain services or situations.

Frequently Asked Questions

Q: Does health insurance cover doula services?

A: Unfortunately, it’s hard to answer this question with a simple yes or no. Some U.S. health plans cover doula fees, and some don’t. Yours is more likely to do so if you deliver your baby in a hospital, but don’t assume that to be true across the board. The only way to be sure about how your plan treats doulas is to contact your insurer before you hire one.

Q: Will my health plan pay for a midwife?

A: Some good news for a change: your health insurance is more likely to pay for, or help you pay for, a midwife than it is to pay for a doula or night nurse. That said, there are plenty of insurers and plans that don’t cover midwives, especially if they’re attending a home birth. Your best bet to get your health plan to pay for some or all of your midwife bill is to deliver your baby in a birthing center or hospital.

Q: What’s the difference between a midwife and a physician or obstetrician?

A: Although obstetricians, physicians, and midwives all are highly educated professionals, they don’t go through the same training. That doesn’t mean your average midwife–especially if she or he is a CNM–isn’t more than capable enough to help you through your pregnancy or deliver your baby. On the contrary. The key is to do your homework before you make a hire. Of course, the same could be said whether you’re looking to work with a midwife, obstetrician, or physician.

Q: What’s the difference between a doula and a midwife?

A: Doulas usually take a supporting role in a pregnancy and birth. They help mothers-to-be feel comfortable and provide assistance wherever and whenever it’s needed. Also, they usually don’t have formal medical training.

Midwives, on the other hand, tend to be registered nurses or certified professionals. As such, they can offer women a wide range of health and medical care over the course of their pregnancies. And of course they can deliver babies, too–something doulas aren’t trained to do.

Q: Does health insurance cover birthing centers?

A: Although more health plans cover birthing centers now than in the past, it’s still not uncommon to come across ones that don’t cover them. So, talk with your insurance company–and talk with potential birthing centers, too–about your plans before anything is set in stone. The last thing you want to do is have to pay for this out of your own pocket because you assumed insurance would cover it.

Q: Will my health plan pay for a home birth?

A: Probably not. It’s not completely out of the question, though, so contact your insurer about it before you’re too far along in your pregnancy (if possible, of course). You never know, they may surprise you and tell you they’ll cover every aspect of your planned home birth.

Originally posted at https://quotewizard.com/health-insurance/alternative-birth-option-coverage

Birth story for Augusta

  • Name: Melanie Keeton (Founder of Returning to Birth)
  • Baby Name: Augusta Nicole
  • Weight: 7lb 6oz
  • Length: 20 in
  • Birthday: November 8, 2017
  • Gestation: 40 weeks (born 15 min shy of her due date)
  • Time of Birth: 11:44 pm
  • Location of Birth: San Diego, CA Home birth with Mother to Mother Midwifery


I had a few days of feeling a little crampy on and off where I thought maybe something was going to happen but it always stopped.  I never had Braxton Hicks with my first pregnancy so that was a little confusing. The day she was born was just another day and I felt fine for most of it.  Later in the afternoon I felt more and more uncomfortable but wasn’t having contractions. Around 8pm I was uncomfortable enough that I just wanted to be by myself and not have to worry about my toddler Eleni (read her birth story here). The plan was for her to go stay with my sister in law Nicole when I went into labor but I wasn’t sure if this was another false alarm.  I called my mom (she’s also a doula) who told me it would be a good idea to have Eleni picked up.  That way maybe I could relax enough to let my body go into labor.

I think Eleni was picked up around 8:30 or 9pm. My mom was now at the house with us convinced I was in labor (I wasn’t so sure yet) and Nicole’s boyfriend Ian was on his way over. Ian is an acupuncturist who agreed to come to the house to give me a treatment. I hate the crampy feeling of early labor. It’s actually more uncomfortable and harder for me to cope with than actual contractions so when he asked if I wanted needles that would help me relax or get things going I said “get things going”. My mom thinks I was crazy to say that as my first baby’s labor was pretty quick (9 hours total). I laid on my bed on my side so Ian could place the needles in my back. Almost as soon as I laid down and got two or three needles in, I got intense heartburn where I needed to sit up. I also had a couple small contractions. He took out the needles and I sat up which felt much better. We then had the idea to sit me backwards in a chair in the living room so I could stay upright and still get the acupuncture treatment.

While sitting in the chair, my husband Clinton was on the phone with the midwives to let them know tonight is looking like the night so they can be ready for our call when it’s time for them to come over. Our midwife Kayti said to call her whenever we wanted her to come over as it would probably be awhile. She ultimately decided to head over to the house now and just sleep on the couch until we were ready for her help instead of waiting for a call (good idea on her part as I soon found out). Right about as Clinton got off the phone, Ian continued with acupuncture in my new upright position. It almost instantly put me into active labor! This was about 10:00pm. The contractions were strong enough that I needed to move and could no longer sit still enough for acupuncture. These were really intense contractions and they came one after another with barely any break in between. It was very difficult to stay relaxed and focused with how intense it was and this felt completely different from labor with my first.

Clinton started filling up the birth tub while my mom suggested I get in the regular bathtub in the meantime. The water helped a lot. We had prepared hot washcloths with lavender essential oil in the crockpot and I draped them over my belly with each contraction. It felt amazing! The calming smell helped to distract me from the contractions. At this point we sent Ian on his way as I assumed it will be a few more hours and I didn’t want him to just be sitting around with nothing to do.

At about 11:15pm Kayti arrived and started getting her supplies ready. My mom was with me in the bathroom and helped me over to the birth tub. The water heater ran out of hot water before we got the birth tub filled but it was suggested that now would be a good time to get in. The warm water felt amazing. In the birth tub I could be upright and lean over the side with each contraction which was so much more comfortable than trying to be on my back in my bathtub. This is when my mom could switch into photographer mode and my Husband could step in as my support. He had been getting the tub and bedding all ready while I was laboring so it was nice to reconnect with him.

I had some intense contractions in the tub. I remember burying my head into the towel Clinton had draped over the side and holding on to his arms for support. I looked into his eyes between each contraction and felt like I was telling an essay long story with each glance. This was HARD….way harder than my first baby. These contractions felt completely different; they had the force of a train thundering through me. It took all my focus to relax and surrender to the intensity but they were still getting away from me. It felt like riding a tsunami and I was holding on for dear life.

At this point Kayti was still unpacking her supplies (it was about 11:30pm) so my mom called her over to check on me. Turns out the baby was crowning! Since we didn’t get the tub filled all the way up, she said I needed to change positions so the baby would be born into the water (In a water birth you want to make sure they are born under the water and then come up to the air for their first breath). Kayti and Clinton helped me get from hands and knees flipped over to my back. Once you’re in pushing mode its extremely difficult to move so that was interesting. Once I was on my back, I was able to do some much deeper breathing and try to slow down. The downward force of my body pushing for me was insanely strong. I tried my best to relax and open with each breath and use Hypnobirthing “J Breathing” instead of pushing to “breathe baby down”. It felt like the baby was exploding out of me!

I heard Kayti say she was coming as I felt her move down and out into her Daddy’s hands. That’s right, Clinton got to catch her! As I closed my eyes and took my sigh of relief I heard Kayti say she was born en caul! This is extremely rare and means that she was born completely still inside the amniotic sac (my water never broke). I got a quick glimpse of it before she broke out of the sac on her own on the way out. She was handed over to me and I got to say hello for the first time to my beautiful Augusta at 11:44pm. About an hour and 45 minutes of active labor! No wonder it was so intense. Shortly after she was born, our second midwife Sunshine arrived. She couldn’t believe she missed the birth but was there to help with all the postpartum care for me and baby for the next few hours before leaving us to bond with our new little one.

I laid in bed with Augusta and nursed her for the first time while we waited for the cord to stop pulsing. It was actively pulsing for around 45 minutes! Then we asked my mom to cut the cord. Augusta took to nursing no problem which is always a relief. She was calm and alert. The midwives stayed until around 3am to make sure everyone was doing well. I had a bit ore bleeding than we wanted so after a few rounds of painful fundal massage and the most disgusting Chinese herbal drink I’ve ever tasted, I asked for the postpartum pitocin shot. That stopped the bleeding almost right away. We then settled in for the night for the first time with our little “Gus”.

This birth experience taught me that I am strong and capable of amazing things. By trusting my body and my support system, I was able to surrender and be truly present for the birth my baby needed. This birth taught me that I deserve to feel safe and supported and that I have amazing people in my life like my husband and my mom that want that for me too.

Thank you Augusta!

Read more birth stories here at www.returningtobirth.com

WHAT is Postpartum Rehab, and WHY should EVERY mother have it?

By Sheri DeSchaaf, PT, DPT

http://www.shefitpt.com

Most women are familiar with the common postnatal recommendation of “no exercise for 6 weeks,” or until she is seen for her postpartum check up. But is doing nothing really the BEST way to restore a woman’s body and prepare her to care for a growing child, and all the responsibilities that come with it?

After any physical trauma, minimizing strain on healing tissues is crucial to allow the body to heal and recover, and the same applies to childbirth. After any comparable athletic trauma, rehabilitation (physical therapy) would be a standard part of the plan of care – helping the patient to regain mobility and strength, and educating them on what not to do to avoid reinjury, as well as what TO do to restore injured muscles, fascia, tendons and ligaments, and regain strength and stability. After any significant surgery, such as a rotator cuff repair or knee arthroscopy, patients are immediately referred to 6-16 weeks of structured rehabilition from a qualified physical therapist. I think we would ALL classify a C-Section as significant surgery, and yet no such referral is made – mothers are simply instructed to go home and “rest” for 8 weeks, then go back to doing “whatever feels good”.

You may be surprised to discover that there actually IS specialized phsyical therapy for women to repair their bodies after childbirth. However unlike in France, where every new mother is referred for 6-8 weeks of postpartum therapy, American doctors almost never refer to PT, leaving women to sort out the myths and somehow make it back to fitness on their own.

Women in American society often feel far too much pressure to get their pre-baby body back within months of childbearing. And while we must encourage women to REST during the early postpartum phase, we should also consider that:

  1. Women HAVE to use their bodies the minute the baby is born and every minute after that – to roll over, stand up, lift and carry a 6-10lb newborn, breastfeed for long periods in various positions, and often care for older children and tend to their normal daily duties, whether or not they are “exercising”.
    The deep core muscles that have been overstretched, overloaded, strained and torn during pregnancy and childbirth often do not simply resume their perfect pre-pregnancy function and coordination. They often require careful, intentional retraining to function normally again. This does not magically happen at the 6 week time point.
  2. Every move we make as a human body requires a functional deep core system. Even something as simple as rolling over in bed requires the effective coordination and activation of more than 10 different muscles, including the diaphragm, transverse abdominis, pelvic floor, multifidi, and more superficial spinal and abdominal muscles. We need these muscles to turn back on or get stronger after pregnancy (babies get bigger, helpers go home or back to work, older children forget you just had a baby…). The key is, how do you progress appropriately in this delicate healing period, to restore normal core function and begin strengthening while promoting tissue healing and preventing injury. This is where postpartum PT comes in.

After any injury, the first task is to assess the muscles that are most impacted and restore their normal mobility, tone, and activation. Pelvic PT helps women manage and navigate pain, identify any red flags, ensure that the pelvic floor, abdominals, and other core muscles are functioning well, and that mothers are educated on proper body mechanics, posture and breathing for postpartum tasks like breastfeeding and carrying baby. After the trauma of childbirth (with about 25% currently ending in surgery), pelvic floor therapists assist mothers in careful retraining of the muscles most impacted by pregnancy and birth – the pelvic floor, transverse abdominis, superficial abdominals, and diaphragm. They help restore proper posture and breath patterns to allow a woman’s body to function in optimal alignment, avoid injury, and prepare for return to “real exercise” like running, weightlifting, HIIT training etc.

If a woman goes home from her birth experience and does nothing to strengthen her deep core muscles, retrain her pelvic floor, restore normal posture and mechanics, then the likelihood she will NOT be ready to resume exercise at the 6 week mark is pretty high. On the flip side, if she goes home and gets antsy and frustrated and starts up with her “normal” core exercises again at week 3 or 4, she is likely to hurt herself and further damage the healing soft tissues of the pelvis and abdomen. There is a safe, intentional way to restore the core and return to exercise, and it is imperative that women who want to return to rigorous exercise after their 6 week clearance take the necessary interim steps to rebuild the pelvic floor and core muscles, retrain the appropriate postural responses and breath patterns, and learn how to move optimally prior to resuming impact exercise, heavy lifting, or aggressive abdominal exercise.

There are a few things that most women will find beneficial to begin as soon as you are physically comfortable doing them, as they are natural ways to promote initial retraining of the deep core. The first one is walking. As soon as you are physically able, start walking a little more each day, focusing on good posture and deep breathing. (If you have any increased bleeding or pain, stop the activity and consult your doctor/midwife.) Second, mind your posture and breathing. When you sit, sit up straight. When you stand, stand up tall. And at all times remember to breathe evenly, never holding your breath. As you practice your posture and breathing, focus in the gentle expansion of the abdomen and ribcage with inhale, and the gentle contraction of the abdomen and pelvic floor with exhale. This focused awareness will help you get back in touch with these muscle groups while also focusing on restoring normal posture and alignment to your body.

If you’d like to learn more about safe and effective return to fitness after pregnancy and childbirth, please join us June 16th with Dr. Sheri DeSchaaf, DPT for Bellies, Bladders and Beyond.

Riding the Postpartum Waves: Understand the wide range of feelings

By Rachel Rabinor, LCSW

http://www.rachelrabinor.com

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

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

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

“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…

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