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As told by her mother, Laura. 

On January 15th, at 2:22 am, my water broke. I was asleep in bed and the sudden soak (BIG SOAK) woke me up. Yes, like in the movies – although they kept telling me it was not going to happen like that. I was 39 weeks pregnant on the dot and although I had been having early labor symptoms for five weeks (starting at week 34 with rhythmic contractions, a “lightning feeling”, and lots of pressure…) I really didn’t expect that day to be “the day” when I went to bed (just two hours earlier).

I immediately jumped out of bed, turned on the light and woke my husband up saying, “My water broke” to that he responded, “It must be discharge.” (ha). So, I took my pants off and threw them at him and asked, “Do you think this is discharge”? As I was saying that, more water came out (a LOT, again). He jumped out of bed and rushed to put some things together in a bag (thinking we’d leave the house right away). But I told him to slow down, as I wasn’t having big contractions just yet.

I timed them and they were five minutes apart but not painful (just like the ones I had been having for the past few weeks). So around 3 am, I decided to call the midwives. Sarah picked up the phone and she said that, since my water broke, I would probably go into labor within the next 24 hours, but that it would not be any time soon, so the best thing to do would be to try to and get some rest (since I had only slept 2 hours and it would be a long day). She told me to call her back when my contractions got more intense, instead of closer together (as they had been for so many weeks already).

I got in bed and tried to sleep, but more and more water kept leaking every 5 min (it really surprised me how much water there was!). So, a few minutes later, I got out of bed and I decided to take a shower. I could feel my contractions picking up, pain-wise, but I could still tolerate them completely. When I got out of the shower, I felt them getting more intense and woke my husband up. He went downstairs to make some food. By the time I came downstairs to eat, at around 4 am, I was in pain. Contractions were still every 5 min. and they lasted a whole minute. They were tolerable but I already breathed differently, and my body asked me to be on my hands and knees through them. So, I ate my eggs on the floor 🙂

By 4:30 am, contractions were much more painful, so we decided to call Sarah again. I told her that since they were picking up so quickly, I preferred to head out to the birthing center to see how dilated I was. We were 30 min. away without traffic (from Beverly Hills to Pasadena) and I did not want to have my baby at home or in my car. LOL.

Sarah said Hayley would meet us at the birthing center instead of her, because she had to head out to a another mama’s labor at home. My husband got everything in the car (bags, camera, tripod…) as I dealt with the pain on the floor. By 5 am, we were in the car, headed to the birthing center!

The car ride was not fun at all. It was smooth and there was no traffic, but as I mentioned, my body asked to be on my hands and knees, and sitting in the car, was the opposite! And those little road bumps and movements added made everything extra painful. The ride made my breathing and the contractions way more intense. And by the way, I kept leaking through every contraction still, my car seat was a mess and the towel I had brought got soaked too – incredible!

We got to the birthing center at 5:30 am. Hayley met us and right away helped me calm down through my breathing – it worked quickly. Then she took us to the room to check my cervix where I suddenly threw up (apparently, it’s a common labor symptom), and kept leaking water, she checked me to find out I was only 1 cm dilated. Crazy! But as I had had early labor symptoms for so long, my water had broken 3 hours prior, and my contractions were picking up very quickly, she told me she could check us in, but if I didn’t have make any progress in 2 hours, she’d have to send us back home as still would be considered ‘early labor’.

We went into the birthing room and she got the tub ready. I got in and it helped me relax immediately (since my water had broken, I couldn’t get in the tub at home because it was technically too early but since I was actively working with them it was decided it was okay). It was nice to get a bit of peace, but I was also worried that it would make my contractions slow down and we’d be sent back home! I did not want that as I was ready to have our baby!

I stayed in the tub during those two hours, where I threw up a few more times. Every contraction got more intense than the prior one. I could do nothing but wait. My body kept asking me to be on my hands and knees, so every time I had a contraction, I turned around and dealt with it, and once it was done, I turned on my back again to relax in between contractions, now only a couple minutes apart. Meanwhile, my husband slept. Seriously, there was nothing he could do to help me. Even Hayley told him to sleep. He didn’t rest that night either but since he was going to drive home later and take care of us, he needed to be well rested. During those two hours, I was focused on being present in the moment and I tried not to think. I felt my body get closer and closer to having our baby, and I trusted it would be more dilated by the time Hayley checked two hours after arriving. But of course, I was also nervous and wanted to know.

At 7:30 am, it was time to check! She had me step out of the tub to properly check my cervix, and we couldn’t believe it, I was already at 6 cm! I was so happy my body opened so quickly, and I could stay! (6 cm is considered active labor and when you can be admitted to the birthing center). I got back in the tub and the mental game began. Having expanded 5 cm in two hours did not necessarily mean that the remaining 4 cm would be dilated in the next 2 hours, so not knowing if it would be 2 or 20 hours really was hard, especially because the pain kept increasing. It was another level of pain at that point.

Hayley suggested trying the nitrous oxide gas. She said it would help relax and not tense up/fight the contractions. With a drug-free labor, and just dealing with the pain in a bathtub all alone, I thought it was a good idea to at least try, so I did. It really helped because it kept me busy and helped me inhale and exhale slowly through contractions. I also felt immediately more relaxed – given the situation! During that first hour after checking my cervix (third hour in the tub) I kept focusing on one contraction at a time. Hayley had to help me telling me things like, “Ride the contraction. Ride the wave”. It’s so true! You kind of have to let go, not fight it, and let the contraction take you to that place that feels like a cloud. It’s like your body wants to take control and if you fight it, it’s so much worse, “riding the wave” and feeling the contraction peak was somehow better. At that point, during this hour, I didn’t have any breaks in between contractions, it was one after the other, the peak was the worst part, but as one ended another one started, it was extremely exhausting. So then, I was on my hands and knees all the time inside the tub.

By 8:30 am, 3 hours after having stepped into the birthing center, 3 houts of being in the tub, 1 hour after knowing I was at 6 cm dilated, I started feeling the need to push. It was like I could not deal with the contraction anymore, I had to push through it. Hayley told me I had to hold the pushing, and she taught me how to breathe through it, so I wouldn’t push, with short and fast exhales. I did it for a few contractions but I REALLY NEEDED to push. She did not want to check my cervix again so soon (slightly after an hour of having checked me being at 6 cm) because after the water breaks there’s more risk of infection with more frequent exams. So I kept breathing through those crazy contractions and dealing with the need to push, but after 15-20 min of that, at around 9am, I told her again I just HAD TO push, and she had me get on the bed to check. I was, in fact, ready to push!

(Please note, that even through all the pain, even through all the intensity, I never ever at one point thought I wanted, or wish I had the option to get an epidural! If you go in it knowing you don’t want it, knowing you can do it, and knowing there isn’t an option, you can totally do it and not miss it, at all!)

I was so excited for push time, it was what my body had been asking me to do for the past 30 minutes and I just felt SO READY! I was already on the bed and I did not feel like pushing in the bath, so I stayed on the bed but got on my hands and knees (again, same position my body had been telling me to do since the earliest contractions in my house, and throughout all labor). I started to push at 9am.

Now midwife Margo was also in the room, assisting Hayley bring Sofia into the world. They guided me through the pushing so amazingly. Of course, it was myself who knew and told them when a contraction came (when it was time to push) as there’s no monitor telling you, however, they kept telling me when to stop pushing, even in the middle of a contraction, so I wouldn’t push too hard and I wouldn’t tear. That was the most challenging part of pushing, having to suddenly stop, completely, in the middle of a contraction. It was a little bit frustrating too because I could feel her come out a bunch, but then go back in, they kept telling me that was the only way I wouldn’t tear, so I listened and did what I was told.

The pushing part wasn’t painful (or at least not after those last hours of contractions) and I was so focused and determined, I did not think of anything else but to push. The contractions were such a mental game, and this pushing part was a total physical thing (glad I worked out through my pregnancy!). The “ring of fire” was not as bad as I thought it would be, yes, it burned, but it was manageable, again, after those contractions my tolerance level was higher, ha.

A few more contractions and a few more pushes, and the whole head was out! But now Sofia had suddenly turned and her heart rate began to slow down, so they told me I had to turn myself as well (and quickly), from my hands and knees to my back (yes, with Sofia’s head out, another challenging part), but I was blocked (how could I turn like that?!). So Hayley, Margo and my husband had to turn me around and then, as soon as I got on my back, I pushed a couple more times and just like that, Sofia was placed on my belly at 9:25 am, just 25 min. into pushing, 4 hours after arriving to the birthing center, and 7 hours after my water broke.

She stared at me immediately and I was in shock! How did my body manage to do that? Such an incredible and empowering experience, by far, the best of my life! I remember thinking: I want 10 kids!

I did skin-to-skin with Sofia for about an hour, and then she was with my husband for another hour. We ordered breakfast and enjoyed those first moments with our baby. A bit later the nurse came to check on Sofia and I, everything was great and we could go home. Four hours after pushing, we were home with our sweet little girl, and a new life began!

I did not tear, and nothing was sore, it was so unreal. Working out really did help my pelvic floor be very strong for labor, and soaking in the bath for over three hours, also helped me expand. But above all, without the guidance of the wonderful midwives at Del Mar, I would not have lived the wonderful birthing experience this way, the best way.

 

By Hayley Oakes LM, CPM

Finding a pediatrician who’s right for you and your family’s needs is important – your child’s health and wellness will be in their hands.

Here are some things to consider when choosing a pediatrician:

Insurance coverage: It’s important to find a pediatrician within network of your insurance provider for the in-case scenario that your child falls ill and the need to be hospitalized arises. You want to be able to go to a facility where your doctor has privileges in order to receive optimal care for your little one.

I also recommend seeing a naturopathic doctor for “well visits”, whom unfortunately most likely won’t be covered by insurance. The benefit of supplementing your medical care with a more holistic approach is that there’s an emphasis on looking at the whole body – physically and emotionally to maintain your child’s health. This can be especially beneficial for chronic illnesses instead of treating only the symptom at hand. In the long run, this can prevent your baby and/or child getting sick more often by focusing on maintenance, wellness as well as treatment of the whole system. Here is a great article about the ‘whole kid’ philosophy and how it can complement more ‘traditional’ western medical care.

The downside about this approach is that these practitioners are usually not covered by your insurance. This care would be an out-of-pocket cost. However, I feel it’s worth it in the end. If finances are tight (as they usually are when planning and caring for baby), perhaps some adjustments can be made in order to save up here and there for these visits.

Location: ‘Location is everything’, as they say. You don’t want to drive across town with a sick kid. Finding someone local will be less stress and obviously more convenient for everyone. Some care providers offer home visits, however, that comes at an additional fee.

When you begin your search for your child’s health care provider, consider if he or she offers consultations about their services. Some practices offer group information sessions and tours of their offices. If not, then I recommend having a phone consult with a prospective pediatrician to get a sense of their services. One way of getting to know your doctor’s true colors as well as their philosophies, education and background are mentioning the following ‘hot’ topics:

Out-of-hospital birth: Is this practitioner familiar, on board, and/or educated about the option and safety of birth center or home birth? When you deliver in a hospital, if your pediatrician does not have privileges at that facility, the pediatrician on duty will discharge your baby and then your little one won’t need a follow up for 2 weeks. With out-of-hospital birth, we assess the baby’s vital signs and do a full physical exam after the birth, however, midwives and even OBs who practice outside of the hospital are not specialists in pediatric care. Therefore, someone with that skill and expertise should have eyes on your baby within the first week. Inquire as to when he or she would like you to come in for your baby’s first visit after the birth?

Breastfeeding: What’s their stance or philosophy on breastfeeding? Do they have referrals for lactation consultants at the ready? How often do they recommend formula supplementation?

Co-sleeping: What are their feelings (pros/cons) about bed sharing, side-car arrangement, or a different bed in the same room?

Vaccines: More and more parents want options and if not, at least the discussion and right to informed consent about risks, benefits, and alternatives to the vaccine recommendations. How flexible is this care provider? Will they even care for you if you decide a delayed schedule is better suited for your family’s needs?

In the end, hopefully you choose the right care provider for you and your family. But know that if you go to your first appointment and it’s not the right fit, you’re not married to this person. So don’t hesitate to switch to a different provider. You won’t hurt their feelings. It will be more stressful to stay as it will only create distrust and suboptimal communication, which can negatively impact your child’s health.

Do your research, narrow down some options based on insurance and location, and then use your gut instinct. Good luck!

Our sweet Finley Rose was born on January 2nd, 2018 at 8:39 pm, weighing 7 lbs. 4.4 oz. and measuring 20.75 inches – changing our world in an instant forever!

We thought we were going to have a Christmas baby, just like her Papa…our technical due date was the 27th of December. Next thing we knew it was New Year’s Eve, and still no baby…we were sure she wanted to come on the 1st day of the year. We went to get the famous “birthing salad” at Pizza Caioti in Studio City, (that’s claimed to induce labor within 24-48 hours), and spent New Year’s Eve with our dear friends, the Morrisons, who also had their baby just two months earlier at Del Mar.

We rang in the new year together, having fun eating the “induction salad” and doing labor induction pressure points and baby belly massage! On New Year’s Day we woke up, with still no sign of baby to our curiosity and surprise. We went to pick up lunch that day and noticed that everything was closed for the holiday and decided our baby girl wanted her own special day to be born. We were right. The very next morning, on January 2nd, I woke to mild cramping, and went to the bathroom and proceeded to throw up! I thought that could be a good sign, but also didn’t want to get my hopes up, thinking it could just be pre-labor signs. It was about 8:30am, and my partner, Steph, wanted to start timing my mild cramping “just for fun”, so we started observing. He reported that they were coming consistently every 15 minutes, but they were so mild that I was still in denial, thinking this could last for days.

We had some breakfast and proceeded to just chill and relax at home throughout the day continuing to time them and by 5pm my cramps had become much more substantial and were now 4 minutes apart. We knew it was happening! Things were getting exciting! Steph told our doula to come over. As we were waiting for her to arrive, I got into the tub around 5:20pm to keep “relaxing” as the contractions intensified. Steph handed me a glass of red wine (as we had been taught in birthing class) but I was in no mood to drink it, haha it was game time and I was totally in the zone now focusing on getting through each wave of contractions.

I noticed that my contractions were actually speeding up to every couple of minutes! Steph and I were concerned. We had been told that the bath could slow them down a bit, but this was not the case, it felt like I was on a fast moving train now – my baby was on her way and it was happening! By 6 pm my contractions were becoming even more intense so Erin, our midwife on call, asked us to send a video of me going through one, and after seeing that she said, “Come in right now!” By this time it was 6:15 pm. We collected ourselves as quickly as possible, and dashed out of the house!

I had started feeling pretty woozy at this point, reluctantly getting into the car, and before we had even left our street, we had to stop and pull over because I felt like I was going to throw up. At that point I felt that we had waited too long, and I just wanted to go back inside the house and birth my baby! Apparently I refused to get back into the car, saying that my baby was coming and that it was too late. Steph sternly told me to get back into the car! Haha and I decided he was right even though my body said otherwise and I was dreading the long 45 minute drive.

We pulled onto the 405 freeway to find a parking lot of red lights, with horrific rush hour bumper to bumper traffic. I was even more convinced at this point that we just needed to go back home to birth. I told him to either take me home or drive along the side of the road. I didn’t care if we got pulled over, I was in labor and would be birthing in the car if we had to sit in that traffic! So he opted to drive on the shoulder of the freeway LOL, all the way to Pasadena! I was laying down in the back seat the whole time, focusing on getting through my now extreme contractions, so I didn’t get to see the spectacle but I sure could hear the honks! Especially when he drove up on the sidewalk once we had exited for Del Mar! Lol

We whirled into the back parking lot where we were immediately greeted by Erin’s calm smiling face. I remained on my side in the back seat with her out the open door waiting until my current contraction subsided, and then we rushed inside! By this point it was about 7:30 pm. (Little did we know just an hour later we would be seeing our baby girl for the first time!) Our doula met us there at the birth center, as she had never made it to our house. My reiki master bestie also met us there to assist and support.

Erin checked me right away and to my surprise I was only at 6 centimeters. I felt like I was entering transition quickly as Erin prepared the tub for me. I got into the tub and immediately threw up (into a convenient baggie) all the coconut water I had just consumed. Our birthing room was so soothing with the lights dimmed and my twinkly lights and candles glowing. I listened to my Hypnobabies tracks as well as my kundalini yoga music playlist that I had prepared specially for her birth. The mood was set. I had my birthing team all around me ready to go, it was game time! I got through a few more – five or six deep, intense waves of transition contractions (“like a champ” says Steph) and then looked down and saw that my mucous plug had released! Wow! Shortly after that I felt my body begin to bear down – I was feeling like I needed to PUSH!

Already?! I thought. It seemed so sudden. Erin swiftly checked me and said that I was at 10 centimeters! She called the nurse and head midwife, Margo, to come right away. Before actively pushing, Erin wanted to check our baby’s heartbeat again. She felt that it was lower than she liked to hear, and told me to get out of the tub to my shock and confusion. I had planned on a water birth, but I didn’t question it, following her orders instantly. I could tell she meant business in her tone and clear concern.

As I stood up I could feel my baby descending out of me! I was asked if I could pee quickly and I replied “No she’s coming! Right now!” as I lay down on the bed. Margo came in just as Erin had told me to feel down where my intact caul (amniotic sac) was protruding and pushing out of me! It felt like a smooth, silky water balloon. Margo said to go ahead and break my water. Erin broke it and put her hand up to block the water as it sprayed out of me. Erin quietly said “Meconium” to Margo. It must have just happened from the distress of her shooting down my birth canal so quickly! Thankfully most of my water was still clear! They then listened to her heartbeat again still not liking what they were hearing with the Doppler… telling me not to push yet. After that the energy in the room shifted into a sense of urgency. They said, “We need to get your baby out now” and flipped me up onto all fours, like a horse! (I prefer unicorn) and finally said to “PUSH!!!!!”. I remember hearing Margo, matter of factly say “We may need to help baby breathe when she gets out”. In that moment I went into wild-warrior-mama-bear survival mode and all I could think about was getting my baby girl out to safety. I didn’t even notice or care what I was feeling physically, all I could think about was my baby girl. With all my might I pushed with everything I had in me… so hard…. and with ONE PUSH out she popped!!! Perfect and pink!!! Crying!!! The sweetest sound of relief!!!! We all exhaled with pure joy. It all happened so fast, no one even caught it on camera, except for a very blurry photo. I pulled her out from underneath me and stared down over her (still on allfours!) in total awe and complete wonder and love for her. The feeling is utterly indescribable. It’s simply perfection.

Thank you Del Mar Birth Center for your sacred space. Her birth was so incredibly special and empowering. Powerful and peaceful, full of joy and magic. A unicorn birth. Just as I had envisioned for her. The most sweet, calm, gentle soul I have ever known, that I have had the blessing and privilege of growing inside me all these months. This infinite love… takes my breath away and brings me to tears. It’s so vast and so deep, that it hurts. She’s so precious and so pure, my heart has exploded wide open and never felt more expanded. I’m so grateful and honored to be her Momma, and that she chose me for this sacred gift.

By Hayley Oakes LM, CPM

One of the most common questions we are asked by prospective clients is, “What happens if my baby is breech?” The short answer is we don’t deliver breech (‘bum’ down versus head down) babies at the birth center. We are an accredited birth center (via the American Association of Birth Centers) with Certified Nurse Midwives on staff; therefore, it is out of our scope of practice.

Why?

The safest mode of delivery for a breech presentation has long been a debate in obstetrics

The risk with delivering a breech baby vaginally is fetal head entrapment. This means the legs and lower body are born but the head (and possibly one or both arms) is stuck causing asphyxia. Today most babies who are breech are delivered via cesarean section. However, a cesarean is not risk-free as it is major abdominal surgery and there are higher risks to the mother including infection, bleeding, or injury to internal organs.

“So what can I do if my baby is breech?”

Well, most babies are breech at some point in the pregnancy. Babies are small so they can flip, swim and turn in the womb and that’s normal. Only 3-4% of babies will persist in a breech position at birth. That means that most babies will turn head down by 36 weeks. So this might be a worry that naturally resolves itself by the time you are due to give birth.

“Is there a medical reason why my baby is breech?”

Some factors that predispose a mother to carrying a breech baby include uterine malformations or fibroids, polyhydramnios (too much amniotic fluid), placenta previa (the edge of the placenta partially or fully covers the cervix), fetal abnormalities, and multiple gestations. Otherwise, might just be a structural preference for the baby.

How do you know if my baby is breech?”

 

At the birth center we make sure your baby is head down by 34 weeks gestation. We wait until 34 weeks because a baby is still quite small at this point so we want to give the baby enough time before initiating the discussion of interventions, however, it still leaves a few weeks to try and help the baby turn before we start talking about breech birth options.

Throughout your care with us we assess the baby’s size and position with our hands via Leopold’s maneuvers. This helps the midwife become familiar with your baby’s constitution, position, and growth. At 26-28 weeks, most babies start to move in a head down position. At this time, the baby’s head becomes the largest and heaviest part of the body and naturally with the mother’s upright nature and with the help of gravity, a baby’s head is guided into the mother’s pelvis.

If the baby is not head down by 32-34 weeks, or we are not 100% convinced of the baby’s position, we have a small ultrasound machine at the birth center to visually see the baby’s position. Why we don’t use an ultrasound 100% of the time is because it’s not medically indicated to do so up to this point, it can be expensive, and we try to limit the amount of ultrasound exposure to babies unless necessary.

What can I do to try and turn my baby?”

 

If a baby is still not head down at this time, we advise the mother to start getting bodywork and engaging in specific positions and exercises multiple times a week. This can help encourage the baby to turn naturally.

Acupuncture has been used for centuries in China to turn breech babies.

Additionally, the use of moxibustion (a treatment involving the Chinese herb, Moxa, that is burned by the acupuncture points on the foot) has been shown to be very successful. Some practitioners have an 80-90% success rate in turning breech babies with only this modality. The treatment is said to release hormones that both stimulate the uterus to contract and the baby’s heart rate to increase, which facilitates fetal movement.

Chiropractic care specifically the Webster technique is helpful in releasing tight round ligaments that could possibly be preventing a baby’s mobility.

Spinning Babies techniques i.e. inversions off the couch and hand stands in the pool can help turn a baby head down. This along with ‘belly sifting’ – an exercise that uses a rebozo (a Mexican shawl but you can use any fabric that can easily wrap around the mother’s abdomen) – to support the mother’s abdomen can be very helpful to soften the round ligaments.

Go away from the cold and towards the party”. Babies respond to external temperature changes, light, darkness and sound. You can apply an ice pack under your ribs, by the baby’s head as well as shine a flashlight and play music (or have your partner talk to the baby) down by your pubic bone. This can encourage the baby to go towards the warmth and familiar sounds and away from the cold.

Emotionally and the more ‘woo-woo, hippie-dippie’ reason for a baby turning breech is that a baby wants to be closer to the mother’s heart. This could be because it has been a stressful pregnancy physically, emotionally, or financially (or all of the above). Or the baby wants to get the mother’s attention if she has not been able to make the health of her pregnancy a priority. This happens with unexpected pregnancies and apprehensive feelings about being a mother; a woman with a full time job, or a mother with other children to care for.

 

Hypnosis guided visualizations and affirmations can be great for this. It only takes a couple of minutes and can be done as one is lying in bed. Otherwise, try to set an alarm on your phone every day to remind you to stop, take deep breaths, and talk to the baby. Not only will this bring down your blood pressure and pulse but also decrease the levels of adrenaline and other stress hormones coursing through your body, placenta and baby

“What if my baby is still breech after all this?”

If all of these natural measures don’t work, then around 36-37 weeks, one can try an external cephalic version. This is an attempt to turn the baby manually to a head down position. This is usually performed by an OB-GYN in a hospital setting for the in-case scenario that a baby doesn’t tolerate the procedure well and needs to be born ASAP. While it’s not a highly successful intervention (50% success rate), it can be one last thing to try before discussing how and where to deliver your breech baby.

If your baby turns head down then you continue care with us at the birth center. If not, then we talk about your breech birth options: seek out one of the three care providers who offer vaginal breech (in the Los Angeles County) or schedule a cesarean. If you’re interested in vaginal breech, here is a great video of a home breech birth with an Ob-gyn and midwife present.

“Why are there such limited options?”

This is in part due to the higher risks associated with breech delivery (the ultimate risk is if the head becomes trapped in the mother’s pelvis), as well as the simple fact that it’s just not practiced anymore due to liability and higher malpractice premiums. Most importantly it’s no longer taught in medical school so a lot of care providers just don’t know how to deliver a vaginal breech baby. This can be frustrating for mothers as it leaves them with very little options.

In navigating this tricky system, it’s important to remember that you can only do your best. If your baby still presents breech and that means you have to let go of the birth center or vaginal birth you hoped for, then know that it is not personal, something you did wrong or a sign that you are failing at motherhood. There are wise and difficult teachings around being a mother and raising a child, but the biggest one is to ‘control what you can and then surrender to the rest’. We often forget there are two peoples’ wishes during the pregnancy and birth (and especially afterwards) and sometimes the baby’s doesn’t match that of the mother’s. So grant yourself a lot of grace, patience and trust with whatever outcome as those will be your best tools in your journey of motherhood.

By Hayley Oakes LM, CPM

‘I just found out I am pregnant.’

‘Congratulations! We will see you in 5-6 weeks.’

‘What? What do I do until then?’

Many women assume they need to be seen right away after finding out they are pregnant. But there’s not much to do in monitoring the baby until about about 10-12 weeks gestation. This is when the baby’s heartbeat can be heard via a Doppler (a hand-held ultrasound) and when genetic screenings are offered.

If you want to be seen earlier, you can get an early ultrasound (between 6-8 weeks) to confirm the viability of the pregnancy and to better estimate your due date based on the size of the baby. You can also have your pregnancy hormones assessed (aka Human chorionic gonadotropin) via a blood draw to confirm the levels are appropriate for how far along you are. Until then, try to remain relaxed and let your body continue to nourish and care for your growing baby.

Let’s do a quick review of the early physical development in utero. A baby’s heart begins to beat during week four. An ultrasound won’t be able to pick it up until week six to seven. There are arm and leg buds with facial and neck structures. At this stage, a baby is a quarter of an inch long.

At week 5-6, the nose, mouth and palate take shape. The arms and legs have developed and by the end of the seventh week the baby has clearly defined wrists, elbows, knees, fingers, and toes. A baby at this age is one-half inch long.

At 10 weeks, the baby’s essential structures – both internal and external have been formed and just require further growth and development. This is when you will begin prenatal care. (Romm)

‘What can I expect from my first appointment?’

Your vitals will be taken i.e. blood pressure, pulse and weight. This will serve as a baseline to compare to throughout your pregnancy to ensure your body is adapting well and you are healthy.

Your care provider will review you and your family’s medical history along with any surgeries you have had in the past. He or she will also go over your gynecologic history including when your last menstrual period was to confirm your best estimated due date. A thorough discussion around work, relationship status, stress, nutrition, and exercise are all very important aspects in maintaining a healthy pregnancy that will be reviewed as well.

There will be blood work and other labs performed to assess iron and thyroid levels, immunity to infectious diseases, and/or the presence of sexually transmitted diseases. There is also the option of screening for genetic abnormalities in the baby.

A physical exam will be performed. This includes listening to your heart and lungs as well as feeling your throat and neck for thyroid abnormalities or inflamed lymph nodes. Lastly, an examination of the breasts and pelvis will take place.

You will return for routine check ups monthly until 28 weeks. Then, you will be seen more frequently of every 2 weeks until 36 weeks. In the final weeks, you are seen once a week (or sometimes more frequently) until you have your baby.

Here are some things you can do to support your body in developing and growing your baby until you meet with your care provider.

Take a prenatal vitamin for the folic acid. Extra folic acid (found in leafy green vegetables, eggs, whole grains, lentils, nuts, milk, and liver) is needed in pregnancy to prevent anemia, miscarriage, premature birth and birth defects. I recommend a food-based vitamin so it is better digested in the body.

Rainbow Light is a great brand. If not this one, I recommend choosing a brand that requires consuming multiple pills a day versus one a day. The pills are usually smaller in size and better digested. When one large pill is consumed this can make your digestive system work harder causing stomach upset, nausea and constipation. Plus, your body doesn’t need all those nutrients at once, so you may end up flushing out much of the benefits of the extra vitamins. Rainbow Light makes a prenatal petite mini-tablet that you take three times a day. If you are someone who doesn’t like taking pills, then at least take one in the morning and two at night.

Avoid toxins such as alcohol, cigarette smoke, foods that are high in mercury and nitrites/deli meat. Also beware of environmental toxins i.e. pesticides and chemical fumes, toxic cleaning products, prescription and over-the-counter medications. This is especially true from weeks three to seven as it is the most vulnerable phase of development for the baby.

Combat nausea during weeks 6-13.

– Eat small meals every two hours to prevent low blood sugar

– Eat something protein-rich as that will sustain blood sugar levels longer

– Eat before rising in the morning

– Rest (take extra naps)

– Don’t take prenatal vitamins on an empty stomach and/or stop taking prenatal vitamins during this time

– Moderate exercise will help mobilize toxins and high levels of hormones coursing through your body

– Avoid spicy or greasy foods

– Drink ginger or peppermint tea

– B6 is helpful in maintaining blood sugar levels. As much as 50 mg can be taken every 4 hours along with 400 mg of magnesium. In more extreme cases of nausea and vomiting, intramuscular injections of B6 can be very helpful. (Frye)

Don’t Google symptoms as it always leads to worst-case scenario. Instead, contact your care provider, if possible. Otherwise pick up a current, non-fear based book about pregnancy, birth and early motherhood. Nurture by LA-based doula, Erica Chidi Cohen is informative, comprehensive and non-judgmental (of birth plans or desired birth settings).

Try to live life ‘normally’, unless specifically indicated not to by your care provider. While avoiding toxins as mentioned above, keep up with your routine of exercise, sexual intercourse, travel, work, etc. If something doesn’t feel right then modify the activity and contact your care provider.

Keep a journal to help process all of the new physical sensations and emotions that can arise. There is a lot of change with pregnancy and what that means as a woman, partner, mother and person in the world. Thus, experiencing a range of feelings is normal. Please reach out to your care provider if you are concerned.

Enjoy and have fun getting to know your body and baby!

Resources

Frye, Anne. Holistic Midwifery: A Comprehensive Textbook For Midwives in Homebirth Practice. Labrys Press, 2010.

Romm, Aviva Jill. The Natural Pregnancy Book. Ten Speed Press, 2003.

Written by mother, Stephanie with midwife commentary by Callie Clark, CNM

Alistair June, “Sunny”, was born on a Thursday, May 11, at 11:43am. He was eight days early. I was fully prepared to be two weeks late, so when I woke up just after midnight Thursday morning with horrible stomach cramps and diarrhea it never crossed my mind that I might be in labor. But after an hour or so, Dave said that the cramps seemed to be coming in regular intervals and he started timing them. (He had been saying all along that the baby was going to come early.) They seemed to be coming every three minutes so he decided we should call the midwives.

Hayley was on call and advised Dave to give it an hour and call back if they hadn’t slowed down. During this hour Dave managed to pack some things to take with us (I hadn’t bothered to pack a bag yet since I was so sure the baby wouldn’t be coming for another three weeks). I spent the hour curled up in a fetal position on the floor of the shower, trying to relax and visualizing my cervix opening with each contraction. When Dave phoned Hayley back to say the contractions weren’t slowing down, she told us she’d meet us at the birth center. The 10 minute drive to the birth center was AWFUL. I was on my hands and knees in the back seat trying to ride through the contractions.

We got there around 3:30am. Hayley did a quick exam and I was already 8cm dilated. Both my mom and her mom h

ave a history of short labors so I thought maybe I was going to get lucky and this baby would pop right out. But, that’s not what happened.

Hayley prepared the tub. (We’d read that a water birth could potentially lower the risk of infecting the baby with GBS and I had tested positive, but didn’t want to take antibiotics.) I labored in the tub for a while until I felt like I wanted to push and called Hayley in. She said there was a little lip of my cervix left, but I could try and push over it. That didn’t work so she said we’d have to wait until it receded. I let myself float in the tub and meditated and moaned through the pain. I have no idea for how long. (It was another 2 hours and 45 mins until the cervix was completely dilated) Hayley came in to check on us at regular intervals and her presence was really calming.

At 7am Hayley came in to say her shift was over and Callie and Erin were going to take over. Erin did a check and said I could start pushing, but all that floating and meditating had gotten me pretty relaxed and my contractions had slowed down. After pushing in the tub for a while with no success, Erin and Callie moved me to the birthing stool. After a couple of ineffective pushes there, Erin asked when the last time I peed was. It was a while ago and Dave had been giving me lots of sips of water, so she said to try and pee. I did. I peed bucketfuls all over the floor. Every time they thought I was done I just peed a ton more. The nurse was wiping it up with pee pads, but I just kept peeing. Erin suggested we move to the toilet. When I finally got all that pee out, my pushes started being more effective and the baby started moving down. (If the bladder is full, it can take up a lot of space in the pelvis and impede the baby’s descent into and through the pelvis. Because of all of the sensations of labor and pressure from the baby’s head on the bladder and urethra, sometimes it becomes very difficult to empty the bladder. Sometimes we need to use a catheter to empty the bladder, but luckily this time that wasn’t necessary.)

I pushed on the toilet for a while. I have no idea how long. I had lost all track of time. I was exhausted and it seemed like the baby would never come. I was ready to give up, go to the hospital, and have him cut out of me, but Callie wasn’t going to let that happen. She kept reassuring me that I could do it. (At this point, it had been 2 ½ hours of active pushing. Stephanie was getting really tired from all of the hard work and the uterus was getting tired too. The contractions were spacing out from every 2 minutes to every 5 minutes. By this point we had tried many different positions for pushing to see what would help Stephanie best: laying on the bed on either side, squatting, birth stool, in the birth tub, and what seemed to work best was sitting on the toilet.  This is often a very effective position since we are used to pushing effectively in this position.)
Later, Dave told me that around this time the baby’s heart rate started to drop and the mood in the room was that I had to get the baby out soon. Erin said she thought maybe the baby was sunny side up. At the time, however, I didn’t notice any of this. I wasn’t really an I at all. The pain was just rushing over me. My legs were weak from squatting for so long over the birth stool and the toilet. Callie said if I was going to have the baby on the toilet, I’d have to stand up when I did. (Standing up when the baby is born is important to make room to bring the baby up to the mother’s chest.) I didn’t think I could, so we moved to the bed. I tried a few positions, but after reading so much about not birthing on your back and being intent on not birthing that way, it was the only position that seemed to work.

After some pushing there, Callie started milking me to get the contractions to come closer together and stronger. If I had been in any state of mind to make judgments or narrate what was happening I would have thought she was milking me like one might milk a cow, but I wasn’t really thinking at all at the time. It’s true what they say about really losing yourself in the moment. (Nipple stimulation is an effective way to get the contractions stronger and closer together. A breast pump is one way to stimulate the breasts. Sometimes the mother stimulates her breasts herself but in this case, Stephanie was too tired. The partner is sometimes helpful with this as well, but in this case the midwife demonstrated how to effectively do manual nipple stimulation and it seemed to work well. Nipple stimulation is most effective when it mimics a baby nursing at the breast.In the hospital they surely would have started IV Pitocin by this point. Nipple stimulation encourages the mother’s body to increase its own internal Oxytocin levels, which does the same thing that synthetic Pitocin does.)

I still wasn’t managing to push very effectively so Callie was pressing somewhere inside of me where she wanted me to push and she had Dave start counting through the contraction so I would push for the whole count. Whatever Callie was pressing was really, really painful, way more painful than the contractions themselves, but Dave told me later that it seemed to be the only way to get me to push with enough power and in the right spot. (Usually we encourage the mother to follow her instincts and push according to her urge, but in this case that was not effective enough at getting the baby out so the midwife was assisting in showing Stephanie how to push effectively. At this point Stephanie had been pushing for over 3 hours.)

At one point, I remember the nurse saying that it was almost noon and I had to get the baby out before lunch. And, finally, he was crowning. There was a mirror for me to watch the birth, but I didn’t want to watch I just needed to focus on pushing. Pushing the baby out was a different kind of painful–a stinging, burning that really was nothing compared to the horrific pain of whatever Callie had been pressing on.

(I was so proud of Stephanie!  By the time she birthed “Sunny” she had been pushing for just shy of 4 hours. What a strong mama!  When the babys position is Occiput Posterior, or “sunny side up” it is sometimes more difficult to give birth. Many of those babies will turn their position during the labor, but others just come out that way, staring straight up with eyes wide open as soon as they are born.)

When they put the baby on my chest, I couldn’t believe I’d actually done it. I remember saying over and over that I couldn’t believe that I’d done it. I really couldn’t. It didn’t seem real. I was SO exhausted.

Sunny was born just before noon. And, Erin was right, he was sunny side up (hence his nickname). Despite his position, I somehow managed to avoid having back labor. Thank god because I had all the pain I could handle.

I tore a bit and needed a few stitches, but after like four hours of pushing, a few stitches were nothing. And we had a beautiful, healthy baby boy.

By Hayley Oakes LM, CPM

So, what’s the deal with hearing that sleeping or laying on your left side is best while you’re pregnant?

Well, firstly, your liver is on your right side and with the growing weight of the pregnant belly, it’s best not to put pressure on it so that it can function optimally.

Secondly and most importantly, laying on your left side puts less pressure on the vena cava – a vein that comes up from the lower part of the body carrying oxygenated blood to the upper part of the body i.e. your heart and brain. When this is compressed, so is the flow of blood circulation. As a result, you can feel woozy, lightheaded, clammy, etc. This is called supine hypotension. This is characterized by laying completely flat (supine) and having the growing weight of the uterine muscle, baby, amniotic fluid, placenta, increased blood volume, etc. put weight directly on that vein, which compresses it and causes your blood pressure to drop (hypotension). If your circulation is not optimal than neither is your baby’s.

However, not everyone experiences supine hypotension. Many women will go to sleep on their left sides and then wake up on their backs and feel completely fine – other than the panic of “Oh no! I am not supposed to lay on my back”. If this has happened to you, know that most likely you and your baby are fine. But check with your health care provider if you feel concerned. Also, if you end up rolling on your back and feel those uncomfortable sensations, the best and easiest thing to do is roll to either side.

That’s right, you heard me. Left OR right.

I am an advocate for not just laying on your left side for 10 months with an 25-35 pounds of weight added to your body. This could also contribute to some serious aches and pains. I believe it’s important to alternate sleeping on both the right and left sides.

Often times when you sleep directly on your hips you can get pinched nerves that result in sciatica, a lower back pain that on a scale could be anywhere from just distracting to debilitating. While this is a common occurrence in pregnancy, it is not normal.

Also, babies often sleep where they are not squished. So if you’re always on your left side then babies will spend more time on the right. As mentioned in a previous post “Right Sided Babies”, this can lead to more issues with your labor pattern as right-sided babies tend to move towards your back in labor and then you can have what’s called “back labor”. This can make for a very uncomfortable and long labor process and increase the odds of transferring to a hospital from a planned out-of-hospital setting.

If you are switching sides, this not only will feel better on your body but also will encourage your baby to rotate and get to know your pelvic landscape better.

Lastly, when switching side to side even that can get uncomfortable. There is a great labor position that I recommend for sleeping and it’s called the exaggerated side lying position. In this position, you are laying a little bit more forward onto the front of your hipbone and a little more on your belly.

You can put a rolled towel or swaddle on the underside of your belly for support. Your bottom leg is straight and top leg is bent and in the shape of a right angle with a pillow under that knee. This not only takes the pressure off your hips (in preventing sciatica) but also encourages them to stay open resulting in your baby sitting lower in your pelvis (a more optimal position for labor) while also maintaining optimal circulation to both you and baby.

By Molly Mack, NP

“I’m a healthy woman, so why do I need an annual well woman exam?”

This is a common question raised by healthy, fit women of all ages. So, why do women need their annual exam? With the recent change in Pap smear recommendations now being every three to five years, many women feel that they can defer their annual exam until they are due for their next pap. However, according to the American College of Obstetrics and Gynecology (ACOG), for women ages 21 and older, having this exam annually is important for several reasons. Firstly, it is a time for women to discuss with their healthcare practitioner ways to maintain a healthy lifestyle and minimize health risks. Also, along with a routine physical exam, which encompasses an overall health assessment via blood pressure, weight, body mass index, etc., a well woman exam includes a pelvic and breast exam, which helps screen for breast and gynecologic cancers. At this visit, the practitioner can also discuss sexually transmitted disease screening, contraception, and pre-pregnancy counseling.

Because breast and pelvic exams are unique to a well woman exam, let’s discuss what these consist of. The pelvic exam consists of three parts and begins with an external assessment of the vulva and perineum for any signs that might require further investigation. The next part is an internal exam, and this is when the provider will insert a plastic or metal instrument called a speculum into the vagina so she can visualize the cervix and walls of the vagina. If due, this would be when the Pap smear would be performed. The third and final part is the bimanual exam, which is a combination of the internal and external exams, and it is here that the practitioner assesses the shape and size of the uterus as well as any signs that would warrant further investigation.

The clinical breast exam is another important part of the well-woman visit. This exam will begin with the woman seated so the provider can assess the overall shape and symmetry of the breasts. You will also be asked to move your arms in certain positions because these movements can help reveal any abnormalities in the breast tissue. You will then be asked to lie down so the practitioner can palpate your breasts in search of any suspicious lumps. This is also the time when you will be taught how to properly perform a self breast exam and what signs and symptoms to look for when doing so. And, if indicated, your provider will talk to you about mammograms at this time.

Your healthcare provider will guide you through each step of the visit so you know what to expect. Having an annual well woman exam is important for many reasons and an optimal way to maintain your health as a woman. So, come on by the birth center for your next well woman exam!

To schedule your appointment at Del Mar Birth Center, call (626) 577-2229

 

 

 

 

 

Resources:

ACOG. (2012). Well woman visit. American College of Obstetrics and Gynecology, Committee Opinion. 534, 1-3.

https://www.acog.org/wellwoman

By Jennifer Buchanan, CNM WHNP-BC, IBCLC

In the first year, many of you may be breastfeeding. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for the first six months of age. During this time, the sole form of nutrition should be breast milk (whether that’s at the breast or pumped and fed from a bottle). After six months of age, complimentary foods may be introduced into your baby’s diet. This may be in the form of rice, cereal, vegetables and fruit. These are some of many nutrient based complimentary foods AAP recommends in your baby’s diet.

According to the United States Department of Agriculture (USDA), the most important concern surrounding the decision of what to feed your child is to provide an “adequate amount of essential nutrients by consuming appropriate quantities and types of food.”

Some of these essential nutrients include protein, healthy fats, iron, vitamins D, A and B12. As long as your child receives important nutrients, whether it’s from homemade baby food or store bought, you are providing your baby with the building blocks for their future growth and development. I found this guide from US Department of Agriculture helpful in learning about the nutritional needs of my baby. I think you will to!

When your baby is at least six months and ready to begin eating solid food, your question may be, “Should I make my own baby food or buy it from the store?” Making your own baby food is a very personal decision. It is not always an easy choice because there are a lot of factors such as lifestyle, cost, benefits and risks to consider.

Making Your Baby’s Food

The biggest benefit of making your own baby food is knowing exactly what your baby is eating with no worry of extra “surprise” ingredients. While you know exactly what goes into it, that’s one of the downsides in that you are handling everything for your baby’s food which takes preparation, organization, planning and ordering the right supplies and storage products.

Here are tips to consider when making your own baby food:

  • ALWAYS follow strict food safety rules for preparing and storing homemade baby foods. Refer to this easy guide for details on baby food preparation and storing safety.
  • Wash fresh produce thoroughly.
  • Use fresh fruits and vegetables as much as possible. Prepare fresh produce shortly after purchasing in order to preserve the nutrients.
  • Remove peels, cores and seeds in any produce.
  • Remove skin and trim all visible fat from meats.
  • Cook meats by baking, broiling or stewing.
  • For younger infants, puree meat in a blender to desired consistency by adding a small amount of fluid. For older infants, chop meat and poultry into very small pieces.
  • Avoid using canned fruits and vegetables with added salt or sugar.
  • Serve food plain. Do NOT add seasoning and spices to your baby’s food.
  • To adjust flavors add other pureed foods that your baby has already eaten.
  • Never incorporate foods that your child has never eaten. There may be a food allergy you are not aware of.
  • Introduce new foods one at a time in order to make sure there is no food allergy connected with a particular food.
  • Avoid adding eggs or dairy before age one. Dairy and eggs at such a young age can cause a food allergy.
  • Homemade food kept in the refrigerator should be eaten within 48 hours after preparing.
  • If you are making large batches, freeze in BPA-free containers with proper lids. Label and date all containers.

Are There Ingredients to Avoid in Store Bought Baby Food?

Actually, no there is not. In my research, there aren’t ingredients to avoid in store bought baby food, but there are additives to avoid. Make sure there is no corn syrup or added sugars. Generally, baby food has fewer additives than other food. Purchase foods that have only fruits and/or vegetables and water added. Many families lean towards organic brands because they know the food is free of pesticides, growth hormones, antibiotics and other chemicals. If the cost of organic brands is too high, read the labels and make sure there are no additives like corn syrup, sugars or other ingredients that are not real food or food-based.

Are There are Benefits to Store Bought Baby Food?

The biggest benefit is convenience. It requires less careful preparation and cleaning, less pureeing, less freezing and less waste. Baby food manufacturers are constantly creating new products, which allows for easier and lighter carrying. Companies have started packaging their foods in pouches, which are easier to carry than glass jars.  Also, many companies package their baby foods in ways that are designed to help parents advance their baby’s diet at the right age.

At the end of the day, the decision to make your own baby food or buy food for your baby is a decision that needs to fit into your lifestyle. As long as you are providing your child with a healthy well-rounded diet, you really cannot go wrong.

Our journey through pregnancy and birth with Del Mar had been the most treasured experience. 

Here is the story of our birth:

Around 39 weeks, I had some bleeding after cleaning horse stalls, which worried me so I went in to the birth center to get checked out. Everything was fine, but as it turns out my cervix was already doing its thing and I was 4 centimeters dilated! We sort of assumed things would get going at that point, and my husband even exclaimed “We might have a baby in our arms by tomorrow morning!” Wrong! Fast forward 10 days, and we were still waiting around for something to happen. But nothing was happening. It was funny – we thought every little twinge might be it!

I went in to the birth center on our due date for an appointment and Hayley was very in tune to our discouragement. It felt like a long layover at the airport with delays! She asked if we would like to try the castor oil smoothie. We were very interested in that! Actually the dear darling husband had been hinting at that over the past week. The smoothie is actually pretty tasty. It’s no joke that it does taste like fruit loops! Well that did get things going! 

I woke up in real serious labor. It was intense! We headed right in to the birth center and were greeted by our bright eyed Hayley, despite having just had another birth!

My water exploded all over the bathroom floor and my cervix was at 10! WooHOO!

I got into the tub and that was a game changer. It felt so goooooooood. Our son came a short while later. My mom said he shot out like a torpedo. 

I had a little extra bleeding, so I got some medication and extra attention, and the thing about it is that NONE of that was scary for even a second. The midwife’s calm demeanor, instinct and capable hands took care of everything. 

It was so great heading home from the birth center, which by then seemed like our home away from home. It was a perfect day.

Breastfeeding was a challenge, but then the support was there, and it’s now the easiest thing in the world. Margo did some craniosacral therapy with our baby, and that made a huge difference; we also saw a lactation consultant and attended a breastfeeding support group.

It all feels like a dream now. The best dream. Nothing can really prepare you for how wonderful it is to be a Del Mar Mama. 

Thank you all!

 
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