birth

Do I Need Cervical Checks in Late Pregnancy?

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vaginal exams in pregnancy

If you’ve had a baby before or even talked to friends who have, it’s likely you’re aware that many prenatal healthcare providers routinely perform cervical exams in the last few weeks of pregnancy. Questioning this practice could very well have never even crossed your mind. Maybe you’ve even been led to believe that the results of these cervical checks are an important piece of the information needed to determine how your pregnancy is progressing and how soon you may deliver your baby. The truth of the matter is though that while yes, a cervical exam can assess effacement and dilation, it is not a reliable predictor of when you may go into labor. Instead, these cervical exams are more of a relic of prenatal care of the past and are done out of routine rather than out of true clinical need. While cervical checks can be useful in the case of an upcoming induction to determine how favorably one’s body would respond, there’s no true evidence-based reason to do repeated routine cervical exams in a typical pregnancy. 

Aside from the lack of necessity, cervical checks do also hold some level of risk. The risks associated with cervical checks include possible infection as well as the potential for premature rupture of membranes (breaking of water prior to labor-onset). 

When any foreign object, in this case, the gloved finger(s) of a healthcare provider, is inserted into the cervix, there is a risk of infection. The act of entering an area that otherwise is biologically sealed off and meant to dilate in its own time, can be problematic. Bacteria from the provider’s hand or even from your own vagina can be pushed into the cervix and create an infection. Infection is obviously something one would want to avoid at any time but certainly during the last weeks of pregnancy.

The premature rupture of membranes or PROM, the breaking of your water prior to the onset of labor, is another risk that cervical checks introduce. PROM can lead to longer labor, infection for the parent and/or baby, and possibly the need for induction. Cervical checks have been linked to PROM. In fact, a study done on this exact issue, revealed that people who had routine cervical checks starting at 37 weeks were three times as likely to experience PROM as those who did not have the routine cervical examinations. A second study (mind you, shockingly, only two studies have been done on this specific subject) showed that there was no risk nor was there a benefit to routine cervical checks. The potential reasons for the discrepancy are beyond the scope of this post but it certainly indicates the need for more research to be done on this topic and should act a red flag for this procedure. 

Whether there is truly a significantly higher risk of PROM and infection when having routine cervical checks or not, a procedure that carries no benefit should always be considered a potential risk and deserves to be weighed thoughtfully by the patient. If your provider does not need the information to plan a potential induction or for a valid reason that goes beyond simple routine, you may want to ask questions and consider if it’s a procedure you’re confident in having done. You always have a choice in the matter. Refusing a cervical exam is your right and a healthcare provider cannot compel you to consent to such an exam (or any other medical procedure for that matter). Informed choices only exist when “no” is an acceptable response. 

For more information, visit Evidence Based Birth.

 

Help! I’m Unexpectedly Considering a Home Birth

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With the current COVID-19 pandemic, the number of home births has been on the rise. Understandably so, many people now have hesitations about birthing in a hospital. Whether that be fear of being exposed to the coronavirus while there, being uncomfortable about the new protocols that have been put in place in many hospitals (ie wearing a mask while laboring, separation from baby after birth, etc), or some combination of the two, those who may not have previously considered home birth are now finding it a very real option. Having had 5 home births myself, I’m here to let you know some things that may help you make your decision.

The Mess
It’s not nearly as messy as you might think. Seriously, I promise. Midwives are great about protecting your home environment from mess. Yes, there will be some fluid and yes, there may be some blood, but that does not, I repeat, does not wind up all over your birthing area, splashed on walls, covering the floor, looking like some horror movie as some may imagine (and even if it did, your midwife is still amazing enough to clean that up too). While laboring, your midwife will strategically place chux pads (absorbent disposable pads) in your birthing area; these are easily picked up, thrown away when they get soiled, and replaced. Your bedding, if you choose to labor on your bed, will be stripped, stain-treated if necessary, and swept away to be washed before your midwives leave. You’ll be able to lie down and recover in a bed with fresh linens ready for your baby-snuggle sessions.

Freely Eat and Drink
One of the most wonderful things about birthing in your own home, out of the hospital setting, is that you are no longer subject to hospital policy. So, that ban on eating during labor that you may expect? It doesn’t exist in a home birth setting. In fact, midwives generally encourage you to eat and drink freely throughout your labor so as to keep your energy up and to assure you remain hydrated for optimal labor and delivery. And what’s even better than being encouraged to eat and drink during labor, you ask? Being able to eat and drink your favorite foods and beverages during labor. After all, it’s your house, it’s your kitchen; you have access to the foods that will sit best with your body and that you enjoy. This is also a huge advantage for your first post-birth meal!

What if Something goes Wrong?
This is usually one of the major concerns for people who have never previously considered home birth. Considering the unpredictable nature of birth, it is a legitimate concern. That being said, midwives are trained to respond accordingly when the unexpected occurs. They are present during your labor to monitor you and your baby and if at any point they believe that something is amiss, they will make certain you get necessary care. Midwives are in the business of safe outcomes even if it means they need to recommend transitioning your care over to a local hospital when an identified-issue is outside her area of expertise. In a scenario that involves immediate attention, midwives are trained in and equipped to provide resuscitation to both mother and baby and they also have necessary medication to stop excessive bleeding. Midwives are trained health professionals and they take the health of their clients very seriously.

No Interruptions
Birthing at home means your labor won’t be interrupted by shift-change, you won’t have to endure hearing medical codes being called out over the loud-speaker during labor or through the night. You won’t have to labor in one room on the labor/delivery floor only to have to wait to settle into another room after baby is born. You won’t be awakened near-constantly to have yours and baby’s vitals taken after you’ve given birth. The list of hospital-birth annoyances could go on. In comparison, at home, you get to relax into your own bed, surrounded by all your everyday comforts. Yes, your midwife will stick around for a couple of hours after you’ve delivered, to make sure you and your baby are feeling well and nursing well, and you’ll be made aware of any warning signs to look for in case of problems but you won’t have frequent knocks on your bedroom door for two days after having a baby when all you want to do is rest and snuggle. Your midwife will also come back to visit you and your little one soon after you give birth to make sure you’re both continuing to do well.

True Freedom of Movement
Home birth gives you freedom to move about your environment as you see fit. You can pace your bedroom, walk your stairs, lie on your comfiest couch, or even stroll your neighborhood! You’re not confined to a single room or even a single building while you labor. Your comfort is a priority to your birthing team and your comfort is more easily achieved in an intimately familiar environment like your very own home.

While home birth is not for everyone, if your pregnancy is low-risk, you’re a great candidate! These tidbits of information are just the tip of the iceberg but hopefully you’ve learned enough to determine if home birth will be a further consideration for you. Even if you’re later on in your pregnancy and feel like you may be too late in the game to change providers and start planning a home birth, I encourage you to reach out to some local midwives. Many are willing to take on clients very late in pregnancy barring any high-risk indicators. No matter where you birth, here’s wishing you a happy and healthy pregnancy, labor, and delivery!

Birth Trends & COVID-19 Pandemic

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birthing during covid

Many expectant couples are facing a decision that is changing the way they envision their births unfolding. Deciding between continuing through with their original hospital birth or beginning to shift their mind to a planned homebirth is at the forefront of many couples’ minds these days. As hospital protocols are shifting and units are becoming coronavirus battle stations, couples need to decide if this is, in fact, the safest and best choice for their families. These changing policies and tightened restrictions leave many families unsettled and anxious. As a result, homebirths are appealing to a greater number of couples.

Homebirth midwives only care for and attend the births of low-risk parents. The following criteria explain who may fall into this category. 

Low-Risk Homebirths (These can vary among care providers.)

  • Pregnant people without pre-existing conditions, such as Type 1 diabetes or hypertension
  • Pregnant people with previous uncomplicated births
  • Pregnant people having a single birth
  • Pregnant people without pregnancy-related conditions, such as preeclampsia and gestational diabetes 

Midwives also stress that birthing at home is not just a variation of a hospital birth but it is a completely different experience altogether. No pain medication or doctors are available, so preparating mentally and physically for an unmedicated birth is crucial.  Aleksandra Evanguelidi, a Los Angeles based midwife, said she has received 30 calls in the previous six days where women were rethinking their birth plans. Michelle Palmer, chair of the Home and Birth Center Committee of the American College of Nurse-Midwives, said that with COVID, it has brought an opportunity to bring home birth and midwifery care into the health care system where more people will have access. 

Considering all of this, if birthing at home isn’t the right choice for you, below are some tips to help you have a safer hospital birth in the time of COVID-19. 

Is homebirth the only option? How can you minimize the risk of exposure?

  • Birth education classes to learn relaxation and coping measures to avoid unnecessary interventions and a longer hospital stay. 
  • Laboring at home as long as possible with the presence of a doula (since additional support in most areas are not allowed into the hospital room during the pandemic). 
  • Video conference your doula or support person once you arrive at the hospital.

As couples wrestle with these thoughts, they must know that what they decide for their family is the best choice. Allow your parental instincts to light your path. This time is unprecedented and overwhelmingly challenging. Warrior on, parents. Bringing in a new life in the time of a global pandemic is an act of heroism. 

A Sample Birth Plan

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a sample birth plan

I vividly remember someone asking me if I had a birth plan when I was pregnant with my first baby and immediately googling what this was exactly. I had no idea this was a thing. I mean how would I know? You don’t know until someone tells you. This blog is me passing along information that I did not once know, but now believe helped me achieve my birth goals. Feel free to modify and make this sample plan your own. Wishing you a beautiful birth and a peaceful postpartum.

Sample Birth Plan

Name:
Care Provider:
Pediatrician:
Birthing Team:

  • Partner:
  • Doula:
  • Midwife/OB:
  • Other:

To all present at the birth of our baby, we are so grateful. Without you, we know these preferences would not be possible. We appreciate your advocacy and commitment in providing the most natural delivery possible for the mother and baby.

ENVIRONMENT

Requested room with birthing tub, if available. Please help us keep the room restful by:

  • Closing the door
  • Dimming the lights
  • Minimizing noise

LABOR

  • I wish to be able to move around (including walking) and change positions at will throughout labor. Please do not restrict positions unless absolutely necessary.
  • I would like to use a birthing ball, moist heat wrap, massage ball, essential oils and affirmations throughout labor.
  • I would like to eat and drink as needed, including ice chips.
  • I would prefer to keep the number of vaginal exams at a minimum. Please ask for consent.
  • I do not want a hep-loc.
  • I do not wish to have continuous fetal monitoring. Intermittent checks are preferred.
  • I do not wish to have my membranes ruptured.
  • I would prefer to be allowed to try changing positions and other natural methods if the labor seems to stall. (walking, nipple stimulation, etc.)
  • I have been educated on the available pain medications. I will ask for them if I need them. Please do not offer them to me.
  • I prefer to tear and do not want an episiotomy.
  • Please do not verbally guide pushing. I would like to push when I feel the urge.

DELIVERY

  • I would like to be able to choose the position in which I give birth.
  • I would appreciate having the room lights turned low and having the room as quiet as possibly for the actual delivery.
  • I would like to have the baby placed on my stomach/ chest immediately after delivery.
  • Please delay the cutting of the umbilical cord until it has stopped pulsating.
  • I wish to keep the placenta. Cooler has been brought for transport to home.

 IMMEDIATELY AFTER DELIVERY

  • My partner wishes to cut the cord. In an event s/he is unavailable, the doula will cut it.
  • I plan to keep the baby near me following the birth and would appreciate if the evaluation of the baby can be done with the baby on my abdomen, with both of us covered by a warm blanket, unless there is an unusual situation.
  • I do not want eye ointment on my baby.
  • Please delay Hep B shot. We will discuss this with our pediatrician at our first visit.
  • Please administer Vitamin K.
  • If the baby must be taken from me for medical treatment, it is requested that my partner be with the baby at all times.
  • I would like to hold baby for one hour before he/she is examined.
  • In case of emergency, please do not cut the cord during resuscitation.
  • I do not wish to be separated from baby. Please speak with my partner or me first if required for health reasons.

BREASTFEEDING

  • I plan to breastfeed the baby and would like to begin nursing the baby right after birth.
  • I do not wish the baby to be given a pacifier.

 CESAREAN

  • If a cesarean delivery is needed, I would like my support team to be fully engaged in the decision making process.
  • I would like my partner to be present at all times.
  • If the baby is not in distress, I would like he/she to be placed on my chest immediately after delivery. If this is not possible, I would like baby to be given to my partner for skin to skin.
  • If baby is in distress, I would like my doula to be with baby at all times and my partner to remain with me.
  • I would like to attempt breastfeeding as soon as possible.

 

 

The Birth of Olive June

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Birth has the tendency to unveil your greatest fears and expose areas of strength that you never knew existed. For me, this third baby has freed my soul and changed me in ways I’m not quite able to put into words. But before the days of toddler messes and newborn cuddles cloud my memory, I must put my best foot forward in jotting down the details of this triumphant day. The day our Olive June arrived.

Our home birth story came at the start of a new decade. Quite literally, too, as Olive made her grand entrance earth side twelve days after the new year. A due date babe. A baby born after 29 hours of physical, emotional and spiritual turmoil. 29 hours of facing my physical fears and pleading with God to remove the pain and to offer supernatural strength. Strength I knew I could not muster up in my own doing. 29 hours of trusting the process. Trusting my body to do what it was born to do. After 29 hours, light transcended the darkness and my daughter was in my arms.

This was my third pregnancy in four years. The first two were beautiful, unmedicated hospital births that I was fortunate enough to have no complications pre or postnatally. Both of which I felt supported, heard and validated in all my birthing requests. However, with the switch from healthcare insurance companies, doors opened for our family to pursue my desire for a home birth. To us, our home is sacred. A space we moved into as newlyweds. Our first big purchase together as a married couple. A space that allowed us to begin our family of three and then soon after our party of four. With the plan to move within the year, we could think of no better way but to celebrate the birth of our third child within the walls that already held so much love and memories and togetherness.

While the name we chose for her was a nod to the peaceful olive branch, the labor she and I wrestled through couldn’t be further from this. Right away, contractions were close together and filled with intensity. The birth team gathered shortly after I contacted them and the house soon filled with feelings of anticipation and excitement. A baby was soon being born into the world! Who could think of a better way to spend the weekend?!? The clock ticked and labor progressed, slowly but surely. The birth team patient, kind and plenty encouraging. My husband, my dear husband, working tirelessly to get the hose attached so I could labor in the tub.

The tub was filled and located in the center of our bedroom. A symbol of tranquility. During intense contractions, I wanted to be nowhere else except in the water. Unfortunately, though, the water slowed my labor down drastically and even stopped contractions all together. This prompted my team to encourage me to get moving. Lunges, squats, stairs. Dilation was slow, tumultuous and incredibly painful. My midwife, Deanna Kopf, and her attendant Tina Overton thought the unpredictable labor pattern I was experiencing was due to Olive’s positioning in the womb. Katie Kirkpatrick, my doula and best friend, educated in Spinning Babies and other positioning exercises, thought it best to use asymmetrical movements which would help Olive descend into the pelvis. After laboring for close to 20 hours, the team needed a little rest. The labor gods were kind to both Olive and I as the intensity paused for a few hours and Tyler and I were able to get some rest. Deanna and Tina found a bed in the basement and Katie snoozed on the floor of my daughters’ room.

Around 5:15 am the next day, I texted Deanna for my (and Olive’s) vitals to be checked. Both of which came back normal. While my family and friends were wondering where this baby was and what was the hold up, my team remained calm and assured both Tyler and I that time was the only thing this babe needed to emerge. And more movement and exercise. I pleaded desperately with them to let me just get back into the tub. They heard my request but explained that draining and refilling (since the water was cold and at risk of containing bacteria at this point) would take an hour or more. Katie gave me a peanut ball and I laid on the bed to labor there while the tub refilled. My contractions became incredibly intense and my laboring sounds changed. Both Tyler and Tina were downstairs heating up pots of water on the stove to hurry the tub filling process along. I felt the urge to push powerfully and deeply and Olive’s head appeared! Katie yelled that the head was born and Tyler and Tina hurried upstairs. Three strong pushes later and a midwife’s hand assisting Olive’s shoulders in sliding out, she plopped on my bed. Stunned, I stared at my crying baby. Tyler announced the gender and I slowly repositioned so I could hold her on my chest. All the pain was gone. Never to be felt again. The contractions vanished. The vomiting subsided. The uncontrollable shaking disappeared. Never did I think this moment would emerge but as with all suffering and pain, dawn eventually emerges. A beautiful birth story etched in my memory and never to be physically, emotionally and spiritually felt again.

While, in the moment, I wanted nothing more than relief and for it all to be over, I do not regret a single decision I

made leading up to her entrance into the world. I had to experience the pain of January 11th to gain the joy of January 12th.

Welcome to the world, sweet girl.

 

** A huge heart of gratitude and overwhelming love goes out to my extraordinary team. Katie, Deanna, Tina and Tyler, Olive and I were so blessed to have you by our side every step of the journey.

birth story

 

 

Building Your Birth Team in San Antonio

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pregnant woman on the phone. Building your birth team

Congratulations on your pregnancy! As you prepare for your pregnancy, birth and postpartum, it’s important to build a supportive birth team to support you throughout this transformational experience.  Choosing care providers that align with your birth goals and values is essential to having the experience you’re hoping for, so research your options and meet a variety of providers to see who is the best fit.  There are so many decisions to make during pregnancy, but be assure, this is the most important one. 

Care Provider: A care provider is who you choose to do all of your prenatal care. This person/group focuses primarily on maternal and fetal health. There are two different models of care, the Midwifery Model of Care and the Medical Model of Care. It cannot be understated that this is the most important choice you will make your entire pregnancy as it will greatly affect your desired outcome. Fully trusting your care provider brings peace and confidence as you prepare to meet your baby, so it is important that your provider’s philosophy of birth aligns with your goals. Remember, it is also never too late in pregnancy to change care providers if you are unhappy with decisions and/or approaches to your care.

  • Midwifery Model of Care- Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle. Providing the pregnant person with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support. Midwifes can work in a variety of settings and generally utilize interventions less and only if they are indicated. The midwifery model is for low risk pregnancies and if a pregnancy is determined high risk, care will be transferred to an obstetrician.
  • Medical Model of Care- This model of care focuses on preventing, diagnosing, and treating the complications that can occur during pregnancy, labor, and birth. Prevention strategies tend to emphasize the use of testing, coupled with the use of medical or surgical interventions to avert a poor outcome. In many cases, low risk people find themselves having the same testing and interventions as their high risk counterparts.

Doula: A doula is a professional trained in childbirth who provides emotional, physical, and educational support to a mother who is expecting, in labor, or has recently given birth. The doula’s purpose is to help people have a safe, memorable, and supported birthing experience. The support of a doula has shown to have a 39% decrease in cesarean rates, shorter labors, less interventions, and a 31% decrease in the risk of being dissatisfied with their birth experience.  Because the doula is not medically trained, she does not attend to fetal/maternal physical health but more so focuses on mother’s emotional well being before and during labor.

Birth Educator: A birth educator is trained to teach childbirth education classes to expectant families, so they can be informed consumers. Childbirth educators are a resource for families providing information they may not have access to outside of a birth class. They help couples learn valuable coping skills and strategies to have an empowered, informed birth experience. While your birth educator may not be present at your birth, she is considered part of the birthing team.

Placenta Encapsulation Specialist: Placenta encapsulation is the process of turning your baby’s placenta into capsules to aid in your postpartum recovery. The placenta encapsulation specialist adheres to all OSHA & EPA guidelines regarding blood-borne pathogen transmission, infection prevention, standards for sanitation, and safe food handling. The encapsulation process happens within 72 hours of baby’s birth and is believed to help with increasing energy levels, lactation, postpartum anxiety/depression, increased levels of CRH (stress-reducing hormone), and restoration of iron levels in the blood.

Chiropractic Care: There are many hormonal and physical changes you’ll experience during your pregnancy. Some of changes will have an impact on your posture and comfort. As your baby becomes heavier, your center of gravity shifts, and your posture will adjust. This may also create added pressure and misalignment in the pelvis. A misaligned pelvis may pose complications during delivery. When the pelvis is out of alignment, it can make it difficult for your baby to move into the best position to be born, which is rear-facing and head down. In some cases, this could affect a person’s ability to have a natural, low intervention birth. A balanced pelvis also means your baby has a lower chance of moving into a breech or posterior position. When your baby is not in an optimal birthing position, it can lead to a longer, more complicated delivery. Evidence points to improved outcomes in labor and delivery for people who’ve received chiropractic care from a Webster Certified Chiropractor during their pregnancy. Chiropractic care can help balance the pelvis, allowing baby the room need to get in the most optimal position possible, while also allowing for a comfortable pregnancy. In fact, chiropractic care may even help reduce the length of time you’re in labor. Locate a Webster Certified Chiropractor, one who specializes in pregnancy and pediatric care, today!

Acupuncture: Many people sing the praises of acupuncture during pregnancy to ease some common discomforts such as back and pelvic pain, nausea, heartburn, swelling, and constipation. So how does it work exactly? Researchers have found that acupuncture points correspond to deep-seated nerves, so that when the needles are placed, the nerves are activated and the energy flow will regain balance. This, in turn, triggers the release of several brain chemicals, including endorphins, which block pain signals and help to relieve a number of pregnancy symptoms.

Clinical Psychologist: This support person cannot be encouraged enough. This particular birth team member will allow you to prepare for the birth as well as process and heal post birth as you enter into parenthood. Benefits of a mental health therapist encompass well being, which ultimately affect baby and partner’s well being. Becoming a new parent has the possibility of bringing in unexpected stress and anxiety. Having a safe space to process this can make all the difference.

Pelvic Floor Physical Therapist: This particular support involves biofeedback and exercises to encourage relaxation and strengthening of the muscles of the lower pelvis, which have the tendency to weaken in pregnancy and through postpartum. A physical therapist measures muscle tone and the strength of muscle contractions, which give you the information you need to proceed with tailored exercises. When necessary, the therapist may use a massage-like technique called myofascial release to help stretch and release the connective tissue between the skin and the muscles and bones in your pelvic region. Pelvic floor PT may strengthen your pelvic floor, re-training your abdominal function, help libido levels or painful intercourse, and treat incontinence.

Give yourself the gift of a well-rounded birth team, ready to support an expectant family every step of the way. Being uplifted and encouraged during labor makes all the difference prenatally and postnatally. Investing in getting information and support while you embark on one of the greatest (yet challenging) adventures in your life will have big pay outs in your wellness long term. Physical, mental, and emotional supports are vital in attaining the wellness you deserve.

Stay well and best wishes.

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