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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!

By Nkem Ndefo MSN, CNM 

I became a nurse-midwife because I realized what a special time pregnancy and birth are in the life of a person, their child, and family. It’s a time when we know that what we eat, what we do, and how we feel has deep and lasting impact. Sometimes that responsibility can be a source of anxiety, especially for first time parents. In my practice, I quickly realized that providing excellent midwifery care and great nutrition education wasn’t enough to compensate for the stress some pregnant people experience and the harm that toxic stress creates.

Changes to the body, concerns about the health of the baby, facing the unknowns of the birth process, uncertainty about what it will be like caring for a newborn, all of these are very real fears that can be worrying and stressful. And that’s not even touching on other factors that can contribute to stress. If, on top of the normal worries surrounding pregnancy, you have financial struggles, relationship problems, or lack of support, it is worth considering how stress may be affecting you and your baby. Add into the mix the tense social and political climate we are living in. It’s a stressful time to be bringing a child into the world.

So many people think if they plan hard enough or stay busy enough, they can win against the stress from their current lives, their childhood, and from the culture itself. But chronic and/or acute stress contributes to anxiety, depression, pain, high blood pressure, digestive problems, immunity problems, disrupted sleep, and, yes, even pregnancy complications. Stress gets lodged so deeply into our systems that it changes our hormones and even how our DNA expresses. Research shows that parental stress has a toxic effect on babies in utero and beyond. These are the reasons that I’ve spent the last 10 years learning everything I could about how stress works on all levels and developing programs that help people address stress head on at its root in the body. As a healthcare provider, I am always looking to solve the real problem behind the symptoms. And most of our current health issues are caused and/or exacerbated by stress.

As perinatal providers become more aware of the adverse affects of stress on both parents and babies, many are broadening their health paradigm to include mental health screenings and services. While there are many approaches to treating mental health concerns like depression and anxiety, very few providers are addressing the core, underlying issue of parental stress. And for the few that are looking at parental stress, even fewer know how to help those who are suffering.

The most common suggestions for stress reduction like meditation and yoga can be great, but they aren’t for everyone. Depending on a person’s past experiences, it can be triggering to jump right into a body-based practice like yoga. Plus not everyone has the time or resources to begin a safe yoga practice. And many people struggle with meditation. Sitting can be highly uncomfortable for someone with an activated nervous system.  Because of my research and experience, I knew there were a variety of ways to relax the nervous system that are universally adaptable, safe, and accessible to all people. I hand-selected what I believe to be the most effective, quick, and practical tools for bringing relaxation and building resilience to create The Resilience Toolkit.

The Resilience Toolkit consists of a suite of mindfulness and movement tools that help regulate the nervous system, reduce stress, and build emotional capacity.  By teaching people how to recognize the varied symptoms of stress and giving them quick, simple tools for self-regulation, The Resilience Toolkit empowers people to address stress early, reducing the toll it takes on the body, mind, and spirit, and making them more resilient in the face of life’s challenges.

It’s never too early to address stress, and that’s why I’m thrilled to be offering The Resilience Toolkit for parents at Del Mar Birth Center. Providers at the center want clients to have happy pregnancies, births, and babies, but they also want to prevent stress-related complications. Del Mar Birth Center does their due diligence, screening for anxiety early in the second trimester. Now clients who score high and those who self-refer, have a resource for addressing the stress they are experiencing in The Resilience Toolkit.  Lest you think the bar is high, we ALL experience stress and we can ALL benefit from taking conscious actions to reduce stress. Reducing stress and connecting to a sense of safety and calm produces more positive outcomes for parents and babies, while also undoing the culture of fear around birth.

If you think you might be experiencing stress during your pregnancy, talk to your midwife, and join us at an upcoming session of The Resilience Toolkit. Bring your partner. The Resilience Toolkit is for everyone. You can learn how to calm your body during a time of big changes, and begin your child’s life as a more resilient parent.

To find out more, see http://lumostransforms.com/calendar/the-resilience-toolkit-for-pregnancy-at-del-mar-birth-center/2017-10-16/

By Hayley Oakes LM, CPM

A mother choosing an out-of-hospital birth with a midwife might not consider hiring a doula for labor support. The usual rationale is that she has her midwife and partner for support, so a doula is one extra person who may not be necessary. Plus, it’s an added cost to an already out-of-pocket experience. Most people think of doulas as important roles for women planning a natural birth in the hospital to help navigate the potential ‘cascade of interventions’ that can take a woman far from her birth wishes. So why would one hire a doula for a planned birth center birth? When stacking the odds in your favor of having the birth you want, a doula is one of the top tools to make it happen.

What is a doula?

A doula is an emotional, informational and physical support person for both the laboring mother and partner. (1) She is a continuous support person (versus intermittent support of nurses, midwives, etc. due to shift changes) from the time the mother needs her to the birth. A doula is trained in childbirth education, comfort measures and massage techniques, exercises to help encourage a baby into a more favorable position (both in pregnancy and in labor) and works with the partner in reminding him or her that the mother may need water, a cold cloth, counter pressure to hips, etc.

“Having a doula wasn’t just for me but for my husband as well. There is no doubt that having a female energy around helped me during labor. She coached both of us and when he didn’t know what to do or say he would mimic her. She was such a wealth of knowledge prior, during and after the birth.”

How much does a doula cost?

Most doulas range from $750-$2000, however, there are doulas who work on a sliding scale depending on the family’s budget, income and planned birth setting. There are newly trained doulas (called “new-las”), who charge a significantly discounted fee.

What are the benefits of a doula?

Studies show that mothers who have birth doulas have more positive experiences and tend to use less pain medications. (1) Also, women are less likely to have cesareans. This is because when a woman feels safe and supported, she can trust the laboring process better and progress more efficiently without needing external interventions.

“When I was in early labor at home, the moment she walked in the door I progressed because we had already established such a wonderful relationship and I felt comfortable with her, which allowed my body to advance in the labor.”

At Del Mar Birth Center, we cannot admit a laboring woman until she is in active labor and/or at least 6 cm. New studies show that a dilation phase of less than 6 cm is still considered early labor and the risks of interventions for ‘failure to progress’ increase. In the case of a birth center, the risk of transferring to a hospital for this reason also increases. In order to minimize the risk of unnecessary interventions, the best advice is to labor at home until the mother is active.

A doula also acts as an advocate for the mother, reminding her of her birth wishes and prompting the mother and partner to ask for more information when discussing the plan with their care provider. A doula does not speak for the mother or become a body guard protecting the mother from the medical staff, she acts more as a concierge of the birth experience and/or mediator between mother and care provider. She helps a mother and partner understand their options so they can better make informed decisions. This is true in both a hospital and out-of-hospital setting.

Don’t we just go to the birth center at the ‘4-1-1’ contraction pattern?

The midwife will be on the phone with the mother in labor or texting the partner, and maybe even asking for a video of the mother during a contraction to get a visual. When the contraction pattern is consistently strong and close together and the mother is actively working with them (i.e. moaning with the contraction without much conversation in between.), the family and midwife will decide on a time to meet at the birth center.

In most instances, when a mother has rhythmically strong contractions for a few hours, her cervix will also be dilated. However, there are instances (a baby’s mal-position) when a mother arrives to the center and her cervix is checked and it is not quite open enough to be considered ‘active’ and/or to be admitted to the birth center. (Read previous post “Right Sided Babies”) The best thing the mother could do to conserve her energy is to go home and rest until the labor pattern is more active. This could be hours or a day or two.

While one may think of ‘early labor’ as still a mild and manageable phase when one can simply rest, watch a movie, or bake a cake, there are early labor patterns that are quite active. This is when it’s incredibly helpful to have a doula. Since one doesn’t know what kind of labor she will have until she is experiencing it, it’s best to have this back up tool, just in case.

A doula is called to the mother’s home to help her cope and settle into the contractions more easily despite their increasing strength and frequency. There is a lot of pressure on the partners to remember everything from the childbirth education class, be in communication with the midwives, while also maybe meeting his or her own basic needs. When a laboring mother has a doula with her at home, the partner can also remain calm and more likely him or herself, which inevitably will help make the laboring mother feel more at ease.

“My doula helped my husband by setting an example for what he should do. This way they could communicate without her verbally telling him what to do but he could just mimic her.”

As early labor progresses into active labor, there may be signs or symptoms that can be alarming to the inexperienced partner. This includes vomiting, shaking, vaginal bleeding, leaking of fluid, diarrhea, etc. and when a doula is present to reassure the family that all is well (and to also check in with the midwife) the laboring mother and partner are more likely to settle into these new changes more easily.

Personally, I feel that clients who have doulas are less likely to arrive at the birth center in early labor to then be sent home. There is an extra level of confidence and ease when a woman has another woman present in labor who is experienced – like a Sherpa. A doula guides the mother through this foreign trek of childbirth looking at her, reminding her to breathe, letting go of the tension in her shoulders, giving her some water, etc.

Well, if that’s what the doula does, what is the midwife’s role?

The midwife’s role is managing the safety of the mother and baby. While the midwife can suggest the same comfort techniques and activities as a doula, she will not be with you at home in early labor or in the room with you continuously once you get to the birth center. The midwife has to reserve a certain amount of strength and effort for the birth and immediate postpartum, whereas a doula is there with the mother for every contraction she needs the doula for. The midwife is present in the room at least every 30 minutes to check on the mother, listen to the baby’s heart rate with a Doppler ultrasound and discuss plans for progress, if need be.

Having a doula present can be especially helpful if it has been a long labor and the mother maybe losing motivation and steam. A doula is there to encourage her of her strength by reminding the mother of birth affirmations or suggesting ways of augmenting the labor. Or if her partner needs to lay down for a bit in order to regain some energy for the postpartum, her doula is there with her.

“…This made him feel safe so that he could step out when he needed to without feeling like he was abandoning me.”

In the case of a transfer to the hospital, if there is no one else in labor at the birth center, the midwife will follow the family to the hospital to get the mother set up and then leave to return for the pushing phase, if available. (See previous post “Transferring to the Hospital” to read what that process is like).

If there is someone else at the birth center, then she cannot go with the family but is available by phone. A doula continues to give support, no matter what birth setting, and can be very helpful during an unexpected transition like transferring to the hospital from a planned birth at a birth center. While in the hospital, the doula’s role is less about helping a mother turn down interventions (as that is why we are transferring) and more about helping the mother gain informed consent, process the experience and rest as much as she can in order to still achieve a vaginal birth.

Where can I find a doula?

There are many doulas in the Los Angeles area. You can look through Doulas of North America (DONA), Yelp, or Google. I personally like working with the doulas from Two Doulas Birth registry as they also teach a childbirth education series specifically for out-of-hospital birthers. I encourage all clients to at least meet with a few doulas to see if there is a fit or someone who suits their needs. There is no harm in meeting with someone, it’s a free consultation, and think of it as checking off more one more box in preparing for the natural and empowered birth you envisioned.

Resources

1. “What Is a Doula.” DONA International, www.dona.org/what-is-a-doula/.

I had my 39 week appointment with Callie on the afternoon of June 29th. I told her I was eager for labor to start and asked her to see if I was dilated at all yet (even though I knew that my dilation and effacement would not tell me when I was going into labor). She checked me, and I was 1 centimeter dilated and about 70% effaced. My husband, Mike, told me not to get too excited, because we might still have weeks to wait. But later that evening, around 8pm, I lost my mucus plug and had bloody show within an hour or so. I was pumped and went for a long walk.

At about 11 pm that night my labor began with contractions coming every six minutes. I tried to sleep through them because I knew I’d need my energy, but the pain and excitement didn’t let me. I called Del Mar at 3 am and spoke to Margo. She encouraged me to rest and relax and let labor take it’s course. I woke Mike up and he helped encourage me through the contractions. We were really savoring the excitement of our anticipated first meeting with our little boy.

Mike went to work around 6 am so that he could wrap up loose ends before his paternity leave. I spent the morning sitting on the couch (laying down was uncomfortable!) and breathing through the contractions. When he came home at 11 am, I told him he was just in time, because it was getting more intense. We played a couple games of Trivial Pursuit, pausing for each contraction, until finally I needed to get up and move. I walked around and tried different positions for the contractions, and suddenly I had one that brought me to my knees.

I burst into tears, partly from the shock of the pain and partly from all the emotion that this birth was actually happening!

After that, I spent most of the contractions on my knees. Mike was in contact with Hayley, and she encouraged me to lay on my sides and to take a shower. I really didn’t want to move around and didn’t want to get in any other positions, because it seemed to hurt more, but I tried.

By evening on the 30th, I felt like I had to have made a lot of progress. It had been almost 24 hours since the first contraction, and now the contractions were coming less than 4 minutes apart – and they were intense! At 10:15pm, I knelt on the floor of the front seat and moaned through contractions on our drive to Del Mar. At the birth center, we found out I was only dilated 4 cm, much to my surprise. Hayley encouraged us to go home walk around, do some lunges and half on the curb/half off the curb steps to bring the baby down more.

Back at home, we tried to rest, but it was really hard. When the contractions had increased in intensity even more, we came back to the birth center again at 4:25 am. I was only dilated a little over 5 cm at that point, so we were sent home to rest again. At that point, Mike and I were both completely exhausted, and I was questioning whether or not I could make it. I was afraid that the baby was not in the right position and wouldn’t come out. I was afraid that I was going to go through all those hours of labor and still have to be transferred to the hospital. I was afraid that I wouldn’t have the strength and energy to push the baby out when the time finally came. And I was afraid that if I was in labor for that many hours trying to get to 6 cm, that I would be in labor just as long to get to 10 centimeters. Fortunately, Hayley knew we went to the Embodica birth class, so she said we were just at another turn in the labyrinth and that we were going to make it. The baby was going to come out. That was exactly what I needed to hear that morning, after 30 hours of labor.

At home, Mike went to sleep. I took Benadryl and had a glass of wine (per midwife orders) and also tried to sleep. The contractions kept coming, but I did sleep between them, even if it was only for a few minutes at a time. When Mike got up, he made me some oatmeal because he and I both knew I needed the strength. However, it was hard to get very much down. I also drank the castor oil smoothie that Hayley had sent with us. I spent the day sitting on the floor between Mike’s knees having contractions and trying to sleep in between them. It was a long day. At this point, he was in contact with Callie, and she encouraged me to get in the shower. That didn’t lessen the contractions, but it felt good.

Finally, we went back to the birth center around 2 pm. Erin checked me, and I was at a 6, so we could stay.

Erin told me to let go of everything and to stop trying to control my labor.

She said nature was in control, and I needed to let it be. Her and Callie were there to help and monitor it, so I didn’t need to worry. This really helped my mental state, and I turned my focus inward to just opening up and letting my body do what it was doing. I got in the tub soon after we arrived, and that really made the labor feel more tolerable. Callie and Erin made things very comfortable, giving me a lavender wash cloth, coconut water, and almonds. Mike sat next to me encouraging me the whole time, and I finally felt like I was going to be able to do it. I felt really at ease and had renewed strength from the nourishment.

A couple hours later, my water broke, and it was clear, which was another huge relief for me. Erin checked me and I was about 8 centimeters dilated then. I was having a really strong urge to push, and for each contraction her and Mike supported me to resist pushing. I did the horse lips, but it was so hard to not bear down (as doing so prematurely could cause the cervix to swell). When I got back in the tub, Erin encouraged us to put on some music to help pick up the pace. Everything seemed to go so quickly after my water broke. It wasn’t long before she was checking me in the tub, and she said that she could push back the last lip of my cervix over his head.

Pushing was the best feeling! I felt so strong, like I had all the power of all the women who had ever given birth before me helping me push. After the first contraction, Callie said I had birthed the hair. I was so surprised when I reached down and felt his soft head. We weren’t expecting any hair. On the next contraction, Erin had me pause for a minute so she could take the cord from around his neck. One the following contraction, he was out, and she handed him up to me. I put him up on my shoulder, and he immediately lifted his head and looked at me and Mike. It was amazing how alert he was, and we were overjoyed to meet him 44 hours after the adventure of labor began.

I pushed out the placenta in the tub quickly, while Mike and I marveled at our new son. After that, we all moved to the bed, Erin gave me a couple quick stitches. Callie, Erin and the nurses took excellent care of us and closely monitored our vitals while we all bonded and the baby breastfed.

Suddenly the incredibly long process that got us there seemed blurry and like it wasn’t that long at all. I felt like I had just conquered the world and received the best prize I could imagine for it!

I am so thankful for Del Mar and all of their support throughout the pregnancy. I am also thankful for my husband and the team of bad ass women who believed in me, and who believe in all women, and their ability to give birth naturally.

 
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