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By Taylor Morrison, CNM

Circumcision is one of the most controversial topics in newborn care. Parents of male newborns are tasked with making a decision about their baby’s foreskin – to leave it intact or to remove it by way of circumcision.

What is foreskin?

The foreskin (or prepuce) is a double layer of skin that folds in on itself, forming a covering for the glans (head) of the penis. The outer layer is a continuation of the skin of the shaft, while the inner layer is a unique type of mucous membrane. The foreskin serves several purposes: to protect the glans from feces and foreign bodies, to protect the glans from friction and abrasion, to moisturize and lubricate the glans, to provide sufficient skin to cover an erection by unfolding, to aid in masturbation, foreplay, and intercourse, and to serve as erogenous tissue due to its rich supply of erogenous receptors (Bullough & Bullough, 1994).

What does a circumcision involve?

Circumcision is the surgical removal of the foreskin. It involves estimating the amount of skin to be removed, dilating the preputial orifice (the opening at the tip of the foreskin), separating the inner layer of foreskin from the glans with surgical instruments (they are adhered in infancy), placing a device (devices reviewed later), leaving the device in place long enough to staunch bleeding (several minutes to several days), and surgically removing the foreskin (either by cutting it off with a scalpel or tying it so tightly that it necroses and falls off) (American Academy of Pediatrics (AAP), 2012).

The rate of circumcision of newborn males has been declining in the United States and vary widely by geographical region, race/ethnicity, and payment method (public vs. private). A current review estimates that an average of 55-59% of male babies born in the United States in 2010 were circumcised, with rates as high as 74% in Midwestern states and as low as 30% in Western states (AAP, 2012).

In 2012, the American Academy of Pediatrics revised their policy statement on newborn circumcision to state that the “preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure… Although health benefits are not great enough to recommend routine circumcision for all newborn males.” They go on to state that “parents ultimately should decide whether circumcision is in the best interests of their male child… in the context of their own religious, ethical, and cultural beliefs and practices” (AAP, 2012).

So what does the research show about the health benefits of circumcision?

HIV and STI Transmission

It must be noted that the majority of data comes from studies conducted on the circumcision of adult males in regions with high rates of heterosexual male HIV and STI transmission (mainly sub-Saharan Africa), thus there is debate on the applicability of this research to newborn males in the United States (Boyle & Hill, 2011; Earp, 2015).

Research on adult circumcision conducted in African countries shows a relative risk reduction of 40-60% for circumcised vs. uncircumcised heterosexual men (AAP, 2012). In these studies 1.18% of circumcised males contracted HIV, while 2.49% of uncircumcised males contracted the virus. This translates to an absolute risk reduction of 1.3% for circumcised males (Earp, 2015). The CDC attempted to extrapolate this data using a mathematical model to estimate the risk reduction for males born in the United States. When considering differences in overall HIV transmission rates, timing of circumcision, and differences in culture and hygiene, the CDC study estimated the relative risk reduction in U.S. to be 15.7% (AAP, 2012). This would translate to an absolute risk reduction of <1% for U.S. born male infants. It is also important to note that many studies show no difference in HIV transmission rates for circumcised vs. uncircumcised men, while a few actually show that circumcised males have an increased rate of HIV transmission (Boyle & Hill, 2011; Earp, 2015).

Similarly, studies of rates of syphilis, genital herpes, and HPV showed circumcision to have “some protective effect” in African studies (AAP, 2012). Again, the applicability of this data to male newborns in the U.S. is questionable (Earp, 2015). Circumcision has shown no effect on rates of chlamydia or gonorrhea transmission (AAP, 2012).

Essentially, research suggests that circumcision may be protective against transmission of HIV and some STIs; however, these “health benefits are not great enough to recommend routine circumcision for all newborn males” according to the American Academy of Pediatrics (2012).

Penile Cancer

Some studies have shown a reduced relative risk of penile cancer in circumcised men. Because penile cancer is a rare disease (estimated between 1/200,000 and 1/1,000,000), and because rates of penile cancer are declining worldwide (in countries with both low and high rates of newborn circumcision), it is difficult to determine the actual effect of circumcision on the development of penile cancer later in life (AAP, 2012; Earp, 2015). Some research estimates that 909 circumcisions would need to be performed to prevent one diagnosis of penile cancer, while other studies estimate that 322,000 circumcisions would be required to prevent one case (AAP, 2012). This is an incredibly wide range of very small numbers of actual reduction in penile cancer rates.

Urinary Tract Infections

Research has shown a reduction in the rates of UTIs in circumcised vs. uncircumcised infants under 2 years of age. Studies estimate that 1/100 uncircumcised infants will have a UTI before 2 years old, while 1/1000 circumcised infants will have a UTI (AAP, 2012). It is estimated that 100 circumcisions will prevent one urinary tract infection (AAP, 2012).

What are the risks of circumcision?

The true incidence of complications due to newborn circumcisions is unknown due to a lack of data and varying definitions of complications and adverse events. It is estimated that “significant acute complications” (occurring during or immediately after circumcision) occur in about 1/500 circumcisions (AAP, 2012). Hemorrhage from excessive bleeding occurs in about 1% of circumcisions, infections occur in 0.06-0.4%, and penile injury occurs in about 0.04% (AAP, 2012). Late complications of circumcision include incomplete circumcision, excessive skin removal, adhesions, meatal stenosis, urethral damage, phimosis, and epithelial inclusion cysts. The prevalence of these complications is unknown due to inadequate data. Severe complications of circumcision are rare and difficult to quantify. These include amputation of glans or penis, herpes transmission after mouth-to-penis contact by a mohel, MRSA infection, urethral fistula, glans ischemia, and infant death (AAP, 2012). One study suggests that the rate of infant death attributable to complications from circumcision is 1/50,000 (Earp et al., 2018). Other possible complications that have been inadequately studied include impacts on sexual function and emotional trauma.

Important Considerations for Circumcision

Techniques

There are three methods of circumcision that are commonly used in United States: the Gomco, the Mogen, and the Plastibell.

The Gomco clamp is used by many practitioners. A slit is cut in the foreskin to allow space for the device, the bell of the device is placed over the glans of the penis to protect it, the foreskin is pulled over the bell, and the arm of the clamp is fitted and tightened. The device remains in place for 3-5 minutes to staunch blood flow before the clinician cuts the foreskin off with a scalpel. The device is then removed. The Gomco method protects the glans of the penis and produces good cosmetic results. The overall complication rate (including bleeding, infection, redundant prepuce, and phimosis) is 1.9-2.9%. However, some studies suggest that there is an increased risk of bleeding and removing too much skin compared to other methods (AAP, 2012; Bullough & Bullough, 1994).

The Mogen clamp is the oldest technique still commonly used. It consists of two flat blades with a small slit. The foreskin is drawn into the slit, the blades are locked together to crush the skin and staunch blood flow, and the foreskin is removed with a scalpel. The device is then removed. Studies suggest that the Mogen method is the quickest method and causes the least bleeding and pain. However, the Mogen is the only method that does not protect the glans of the penis, allowing the possibility of partial or total amputation (AAP, 2012; Bullough & Bullough, 1994).

The Plastibell device places a plastic ring under the foreskin and a tie around the outside of the foreskin to staunch blood flow. The device remains in place for 7-10 days until the foreskin dies from lack of blood flow, necroses, and falls off. The overall complication rate for this method is 2.4-5% and includes bleeding (0.8-3%), infection (2.1%), urinary retention, and “issues with the Plastibell ring” that may lead to swelling and compression of the penis (3.6%) (AAP, 2012; Bullough & Bullough, 1994).

Pain Control

According to the AAP Task Force on Circumcision, “adequate analgesia should be provided whenever newborn circumcision is performed” and “nonpharmacological techniques… are insufficient to prevent procedural and post-procedural pain and are not recommended as the sole method” (AAP, 2012). There are three commonly used analgesic options for circumcision: topical lidocaine, dorsal penile nerve block, and subcutaneous ring block.

Topical lidocaine prevents pain better than a placebo but is less effective than injectable analgesic options. Topical lidocaine needs to be applied 60-90 minutes before procedure. Complications occur in 8-14% of cases and include redness, swelling, and blistering. These complications are more common in premature or low birth weight infants. For these infants, topical analgesia is not recommended (AAP, 2012; Lemer, 2018).

The dorsal penile nerve block involves two injections of lidocaine to the base of the penis. It has been shown to be more effective than topical analgesia in reducing pain. Complications include bruising (11% of cases) and hematoma (0.2%). This method only takes 5 minutes to be effective (AAP, 2012; Lemer, 2018).

Subcutaneous ring block involves a series of injections around the base or mid-shaft of the penis. Studies show that it is more effective than topical analgesia and dorsal penile nerve block. However, there is up to a 5% failure rate. No complications have been reported from this method (AAP, 2012; Lemer, 2018).

Who Can be Circumcised?

According to the Task Force on Circumcision, “elective circumcision should be performed only if the infant’s condition is stable and healthy” (AAP, 2012). Contraindications to circumcision include significant prematurity, blood dyscrasias, a family history of bleeding disorders, and congenital abnormalities of the penis. Circumcision should be delayed for any premature, low birth weight, or ill infant. Additionally, babies should receive vitamin K supplementation before being circumcised to help prevent excessive bleeding (AAP, 2012).

The decision of whether or not to circumcise is complex and personal. Parents of male newborns should exam all the evidence and have a discussion about the importance of culture, religion, and ethics before making such a decision. The AAP states, “parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families.”

 

References

American Academy of Pediatrics (AAP). (2012). Technical report: Male circumcision. Pediatrics. (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).

Boyle, G. J. and Hill, G. (2011). Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns. Journal of Law and Medicine, 19, 316-344.

Bullough, V.L. & Bullough, B. (1994). Circumcision: Male – Effects upon human sexuality. Human Sexuality: An Encyclopedia. Garland Publishing: New York, NY, 119-122.

Earp, B.D. (2015). Do the benefits of male circumcision outweigh the risks? A critique of the proposed CDC guidelines. Frontiers in Pediatrics, 3(18). doi: 10.3389/fped.2015.00018.

Earp, B.D., Allareddy, V., Allareddy, V., & Rotta, A.T. (2018). Factors associated with early deaths following neonatal male circumcision in the United States, 2001 to 2010. Clinical Pediatrics, 1:9922818790060. [Epub ahead of print].

Lemer, H.M. (2018). Eight common questions about newborn circumcision. MD Edge: ObGyn. https://www.mdedge.com/sites/default/files/document/january-2018/obgm0300127_lerner.pdf.

By Laura Gimbert, Mother, Business Owner and Influencer

Motherhood and work are two big life roles, and each deserve a lot of attention and dedication. And although balancing both can be challenging, it can also be satisfying – helping you maintain your identity through postpartum (if working was a big part of your life pre-baby), and keeping your mind stimulated. So, what are some top tip and insights about balancing your business and baby?

I believe that everything starts during pregnancy. Planning and prepping for postpartum is a must. When the baby comes you want everything to be ready. This not only includes baby must-have items and having the home ready to welcome your little one, but also your work-world must be prepared. This means that during pregnancy, you should train whomever will be taking over your work, talk to all your clients and colleagues about your postpartum plans so they don’t bug you unless it is necessary, and get ahead of the game taking care of as many projects as possible so you have the least amount of work once the baby arrives. I personally had no maternity leave (business owner life!) but, I prepped perfectly and was able to work while enjoying my daughter since day 1.

Knowing where to delegate is another must. We moms are superwomen, and can do it all. But to do it all RIGHT we need to delegate and invest! Since the day Sofia was born I have managed my business and daughter all on my own. My husband works away all day, our families live across the country/world, and I personally decided I didn’t want a nanny until she goes to preschool because they grow up so fast and I don’t want to miss a thing. So, where do I delegate? I don’t have time to go to the groceries: I grocery shop online (farm fresh direct). I don’t have time for cooking: I order a meal prep delivery service that brings us healthy dinners fresh not frozen. I don’t have time to deep clean the house: I have maids come in regularly. I have no time to run work/personal errands: I have a personal assistant. You choose what works for you and where to delegate!

Balancing both roles can be hard mentally too, so prepping your mind is equally important. You should know that some days you won’t get anything done, that work will constantly be interrupted, that you won’t feel as rested, and that you may have to work more from your phone/laptop on the couch instead. But if you understand that this is your new life and learn to be okay with it, if you adapt to this new way of living quickly and with a positive attitude, then you will balance everything the best way you can. After all, remember babies are only babies once, and if we get frustrated at these changes we won’t enjoy this short and special stage as much. They will change again in the future, so we must learn to enjoy and embrace all the changes!

And finally, if you are thinking about balancing motherhood and work, you will be BUSY! So please stop and think about self-care activities that you will do for yourself, every single day. A relaxing bubble bath with candles, reading a book cuddled with a blanket and a tea, going for a hike with your favorite music, getting a massage… Whatever it is, taking care of yourself and feeling good inside and out is also key to having a positive attitude and feeling more relaxed. This will help you balance it all! Sit down and write a list of things you will do for yourself at the beginning of every week. Just as business goals, you should have personal goals set up too. You deserve it.

You can read more on my mom boss life tips & tricks, and personal experiences at www.mombosslife.co

By Jess G., Mother

I had a really great pregnancy. Minus weeks 5-10 when I was extremely nauseous and exhausted and eating snacks constantly at work to try to keep from throwing up, I actually really enjoyed being pregnant. I loved talking to my little girl and bringing her everywhere with me. I wasn’t scared about the birth process at all. Mostly I was excited to have what I envisioned to be the powerful experience of bringing my baby into the world and just couldn’t wait to meet her. Leading up to my due date, I enjoyed visiting the midwives at Del Mar, I drank lots of date shakes, ate super well, went for long walks, and was generally really motivated to do everything I could to keep myself and baby happy and healthy and in shape for a natural birth.

About a week and a half before my due date, one of my best friends, Sara, who is about to become a certified nurse midwife, arrived at our house to stay for a month. She was going to be my doula and basically everything-support during this whole exciting time. The same day she arrived I also had friends over to our house to eat Indian food and draw henna patterns on my belly in anticipation of the birth. These friends also wrote and brought me birth affirmations to save for when I needed to hear them during my labor. After that day, I really felt “ready” for whatever happened next!

For about four days leading up to Philippa’s birth, I was noticing my contractions more than usual. I had been having plenty of Braxton Hicks contractions throughout my pregnancy, and while I knew that while BHs were generally mild and “real” contractions much more intense, I wasn’t quite sure when I would start to know “the difference”. My friend/doula Sara assured me that I would know. Several people I talked to compared real contractions to really bad period cramps, which I have more than a little experience with, and I’ve always thought of myself as having a high pain tolerance. I wondered- when my contractions began in earnest, should I expect them to be like MY period cramps at worst possible level, or more mild cramps that others experienced as painful? Or was this just a poor analogy in the first place? It would be impossible to know until it happened! Either way, I took comfort in knowing that the ramping up in number of contractions meant that my body was in some way beginning work towards birth and was a positive sign! My job now was to soak up as much oxytocin as possible until baby decided to come; the plan for her due date (Friday, June 15th) was facials in the morning and The Incredibles 2 at night, with plenty of games and pool floats before and after. I had been reminded many times that most first time moms give birth after their due date, and I didn’t want to think too much about when exactly little Pip would arrive, although I hoped that it would be soon (after 42 weeks, the birth center would no longer have been an option…plus, I believed it would be in my favor for baby to continue to gain weight outside of me rather than inside…I’m a pretty small person!)

On Wednesday the 13th, my husband Levi and I had our 40-week appointment at Del Mar at 12:30. After talking with midwives Hayley and Taylor and meeting nurse Anna, we left saying, “See you next week…or hopefully sooner!” and went out for a nice lunch and tea date (oxytocin!). I was craving a burger, which is pretty unusual for me, and ordered a delicious grass-fed burger at True Food Kitchen–it really hit the spot. Now I’m pretty sure my body wanted to give me a mega-dose of iron before the big event! We bought Father’s Day cards at the tea shop and wondered if Levi would have his baby before Sunday. After we got home, I went straight over to my in-laws house to hang out at the pool with a few friends. Nothing like the anti-gravity effect of swimming when 40 weeks pregnant!

Plans for the evening evolved and we ended up picking up pupusas and bringing them over to our friends Jason and Ruth’s house for dinner (Ruth was 38 weeks pregnant at the time, her little girl was born just 9 days after our daughter!) As we were playing a game, I noticed that the contractions I had been having on and off seemed to be getting slightly more regular and a little more “period cramp”-y. I was sitting on Ruth’s birth ball while playing and there was one contraction in particular that I remember breathing a little more intently through and bouncing on the ball just a little bit. Ruth got excited about this (being a fourth time mom I think she was much more clued into the signs than I was). I was still thinking that there was no way this was the night.

By the time we got home though, I was beginning to reconsider. It was already late-ish (10:30?) and I thought I could go to bed and sleep through what were now mild but undeniably regular contractions. Sleep didn’t come right away and I soon got up to make sure that I had a small glass of wine and two Benadryl on my bedside table…this was the midwives’ suggestion for if it seemed like early labor was starting but it was bedtime and rest was needed. I laid back down again, and shortly thereafter wanted to take the Benadryl and wine. At this point Levi also called Del Mar for the first time–we were connected with an answering service and then with Hayley, who was on call for the night. It was funny since we had had our appointment with her earlier that day! She told us to keep an eye on the contractions, making sure they were getting longer, stronger, and closer together. Levi also texted Elisabeth Millay, our birth photographer, letting her know that I was having contractions and that the birth could be in the morning (at this point we still had no clue how quickly everything would move). Elisabeth responded saying that she would keep her phone next to her and to call her any time. (By the way, all the pictures that follow were taken by Elisabeth. I can’t even describe how thankful we are to have these precious moments recorded. If anyone reading this is deciding whether or not to have a birth photographer…please do it!!)

From here, my memories are a little blurrier. The time frames are rough estimates.

12:00-1:00 am. I laid in bed dozily, I was able to rest and be peaceful during that time thanks to the wine combo, so I’m glad I took it. The contractions had begun to need focus and I would breathe through them like I’d practiced in our classes with Julie from Two Doulas. Levi could hear me start to breathe at the beginning of each one and would hit “lap” on his phone stopwatch. I remember thinking it was funny because he seemed sound asleep to me other than timing and I didn’t know how he was managing to do that. I could see from the screen that the contractions were really just about 5 minutes apart, if that. At some point towards the end of this I wanted to plug in an electric heating pad and put it against my back.
1:00-2:00 am. I got out of bed, the contractions were getting more painful and were by now more like four minutes apart. By now I realized that this was labor and that we would likely need to head to the birth center in the near future. I was moving around, thinking about what else I’d practiced besides breathing…leaning on a birth ball, having Levi “belly sift” my belly with a long scarf…I wanted to do each of those once…instinctively when I got out of bed I pulled out my yoga mat and started moving around gently on the mat (Philippa being no stranger to yoga! I am so happy about all of the great yoga classes I attended with her in the belly…Thanks to Carol Corpuz at Yogaraj!.) Hayley had suggested at some point when things got really intense that I get in the shower, which I did around the same time we called her for the third time and got Sara out of bed. Levi was holding me through a contraction before I got in the shower and I said “I’m going to throw up,” then got in the shower and got on my hands and knees and did just that. Easy clean up at least. The hot water felt good on my back but at this point nothing felt “good”. The pain was getting more real. I got out of the shower and sat on the toilet at Sara’s suggestion. She sat in front of me and put my feet up on her legs and helped me adjust my breathing (which was now much louder, like a moaning) so that I was making lower-pitched sounds. Hayley said we could come in if I felt like it was the right time, after listening to me through a contraction. I had always pictured being in “early labor” at home for hours and hours but something told me Philippa didn’t have that kind of time, and I asked to start getting ready to leave. I didn’t want to be alone with the contractions ever, so Sara and Levi took turns getting the car loaded, finding my blue nightdress, and getting dressed themselves, until we were all ready to leave the house.

3:00-3:45 am. We drove to Del Mar. Levi put Sara Groves on right away (my favorite artist, her music has a calming effect on me like no other). Sara sat in the back seat with me while Levi drove. We tell Pip now that she picked a good time to avoid traffic!! The car ride is kind of a blur to me but I don’t think it was as bad as I expected it to be. Somehow the darkness outside calmed me down. The contractions were very painful but I still had several minutes in between each one to catch my breath and relax.

3:45 am. We arrived to South Pasadena, Hayley was already there. I had my vitals taken and peed, stopping to hold onto whoever was closest for contractions every few minutes. I don’t know exactly what I pictured a cervix check would be like but I had definitely never thought about how uncomfortable it would be! The report was that I was 4 cm dilated, 80% effaced, and baby’s head was in the -1 position. Technically the birth center doesn’t admit before 5 or 6 cm dilated, but Hayley assured me that I was making progress quickly and that I could go straight to the room we had chosen ahead of time to see what took place in the next hour or so. At no point was I worried about being sent home or felt that was an option for me. I couldn’t see this being a false start, I was well into a rhythm by now and I knew Philippa was well on her way. Elisabeth the photographer arrived by 4:00 am.

4:00-5:00 am. I went straight to the big jacuzzi-like tub. The playlist that Levi and I had made the afternoon before while waiting for our lunch order went on (mostly Sara Groves, some Audrey Assad, Rivers and Robots, and other comforting, familiar spiritual songs). The birth playlist had been sort of my last real “to-do” that needed to happen before baby came, so the timing on this was perfect! Lavender oil went into the diffuser. I asked for these things to happen, but part of what was so lovely about the whole experience is that I felt everyone around me already knew exactly what I wanted…even things I didn’t know that I would want…like the cold rag on my head and shoulders as laboring in the tub made me hotter and sweatier but I still couldn’t picture getting out….and the orange Recharge drink in a glass with a straw and ice cubes that tasted so much better than water could have in the moment…I would motion for it throughout labor by bringing my hand to my mouth. I became aware very quickly that I needed every ounce of my energy to bring Philippa into the world and I didn’t want to waste a bit of it. I switched positions in the tub several times…most of the time my back was to the edge of the tub and I held onto Levi’s or Sara’s arms above me as each contraction came. Some of the time I was on my hands and knees or in more of a squatting position. Levi read a few of my birth affirmations to me. Some made me laugh if I wasn’t in the middle of a contraction. At some point it was too hard to even focus on or listen to these. I had prepared phrases for myself to motivate myself if I needed them, like “Your body is not a lemon!” from Ina May’s Guide to Childbirth…but everything was so intense that I really wasn’t thinking about much besides taking each moment as it came, the sounds I was making and keeping them low (I didn’t know I was capable of making sounds like this. Sara referred to it as the birth song). Hayley was in and out of the room for this first hour and would say comforting and quiet encouragements to me and check baby’s heartbeat with the Doppler intermittently.

5:00?-6:30 am: At one stage the contractions came over and over right on top of each other. I remember saying, “I’m really going to need a break soon,” which seems now like a funny thing to say. It was so intense and I didn’t know how I was going to be able to keep going. And then I felt a strong urge to push which scared me a lot and I said “I’m pushing!! Is that okay?” Last I had heard was that I was 4 cm dilated and while I was sure that wasn’t the case anymore it seemed too soon to me to be ready to push. Hayley checked me again while I was still in the tub and told me that I was over 9 cm and that there was still a small lip of the cervix present but that I could push past it, so yes, if I felt like pushing, I definitely could from now on, and to listen to my body. During the pushing phase I felt very relieved that the contractions once again had breaks in between but shocked by the power of the pushing urge I had with each one. I was asked not to let so much of my energy out in sound while pushing but to channel that energy towards the actual pushing and keep the sound in…very hard to do but good advice that I understood how to follow. Throughout the whole labor and especially this part, I had a very strong sense that Philippa was working with me to come into the world and that each contraction was effective and had its purpose–so while I was getting exhausted, I also was reassured by how quickly things seemed to be going and how well she was “cooperating”. It was getting light outside and there were gardeners working right outside the window, we could hear weed whackers. It didn’t bother me in particular but just a funny detail.

I don’t really have words to describe how intense the pushing feeling became. It was like nothing I have ever felt before. Definitely very similar to a pooping sensation, like everyone always says, just 1000 times stronger–I felt like I had no control over my body and it was delivering Philippa on its own. When she was getting close to emerging, Hayley asked me if I wanted to feel her head inside of me and I was able to put a finger inside my vagina and feel something there. When she started crowning the burning sensations were very strong, I could feel her head stretching everything at the surface and then retreating backwards several inches. This felt like it happened at least 5 or 6 times before her head was actually born, but it could have been more than that. After the head was born, I felt a sense of relief knowing that the hardest part was likely over. By this point there was a nurse in the room, and a little while ago Hayley had asked Sara if she wanted to do the catch, so I knew the end was in sight.

They had me take off my bra so it wouldn’t be cold on my chest when I held the baby. Hayley asked me if I wanted to feel her head once it was out and I said, “No, I’m sorry!” I was just so focused in that moment and felt like I couldn’t shift forward or even reach my hand down because I needed to stay right where I was and push the rest of her out. We waited until the next contraction and I don’t remember her body being very hard to push out, I was so determined that she would come out with that contraction. When Philippa’s head was born, Levi could see it and he started to cry a lot and I found out afterwards that he had to step away briefly, which I didn’t really notice at the time (he came right back!) Even though I knew exactly when I was pushing her body out, I was still shocked when suddenly Pippa was being lifted out of the water and placed on my chest (and towels immediately covering her to keep her warm. She cried right away. I felt like I had never held a baby before and couldn’t believe my eyes. I was so relieved that the pushing was over and so amazed that she was finally here, this little person I had been talking to and feeling move around inside me and carrying for what felt like forever. She seemed big to me and it felt unbelievable to actually know what she looked like after so much speculation and recurring dreams (I’d always pictured her with dark hair and she was so, so fair). I could tell right away how healthy and perfect she was and it was overwhelming to me. I was helped out of the tub by several people after I had held her for just a couple minutes, the cord still coming up from between my legs, and I laid on the bed holding her when I delivered the placenta soon afterwards. It was placed in a bucket next to me on the bed so that the cord could stay connected to her for some time (after about 30 minutes or more, Levi cut the cord). I found the placenta fascinating and asked Elisabeth to take a photo of it. What an incredible design. That sums up my feelings about the whole birth process. I believe in a loving Creator God and everything I learned about the body and what it is capable of throughout pregnancy and birth just affirmed that 100 times over for me.

The moments after Philippa’s birth were so sweet. I felt like I had lots of time to just stare at her, hold her on my chest and be amazed by how amazing she was. I had the thought that I had never experienced joy in my life ever before in comparison to this. Over the next 6 hours before we went home, she and I were cared for by a wonderful nurse (Laura) and midwives Taylor and Margo (Hayley went home shortly after Pip was born). Philippa breastfed soon after she was born like she knew instinctively what to do (she did, of course!) which was incredible to see. I needed some stitches for first degree tearing and Sara read me the rest of the birth affirmations (and the ones I had already heard, too) while Margo took care of the stitches, it was great to have the distraction. (This was hours after the birth, Levi was holding little Pip and doing skin to skin with her at this point.) Pip’s vitals were consistently great although her temperature was a little low, so we were keeping a hat on her and doing lots of skin to skin. She gave us a tiny scare coughing up and sounding like she was choking on amniotic fluid and I got to experience what I’m sure I will again many times over, of my heart just hurting to see her struggle..but all was well. Levi heated up enchiladas that he had made the Sunday before (his last pre-baby to-do!) and they tasted great. By noon, we were ready to head home and start figuring out what life with this new little being would be like. Our hearts were just bursting with love and thankfulness!

Thank you to all the staff at Del Mar for guiding us and giving us such valuable resources, information, and support while Philippa was growing and in the weeks following the birth. I honestly can’t imagine a better experience. Thank you, thank you. <3

Thanks again to Elisabeth for the invaluable photos. <3 https://www.elisabethmillay.com

By Renee M., Mother (Adapted from Renee’s Instagram account @reneemorrison)

…our birth story…@_matthew.morrison_ & I were playing around & unpacking our stroller and car seat for the first time. Then we proceeded with our weekly massage that induced my labor! My @_r.e.v.e.l.a.t.i.o.n_ was ready, to say the least. For a few weeks he had been giving Mama signs that he was coming, but I was trying my hardest to convince him that the womb is where he wanted to be for several reasons, but 2 important ones being PAPA was in CHINA! and Mama really, really, really loved being pregnant!! However, 9 days early, this little angel gifted us with his presence!

Massage started at 7pm, slight crampy rushes (my preferred name for contractions) began around 8pm. Mama took a bath while Papa was on the table to distract myself & possibly stop the rushes. It did, kind of.. then Papa helped me out of the tub & we began getting ready for bed. At midnight the rushes were pretty steady, all between 2 1/2-8 minutes apart & I had the shakes.. we were confused since the birth center said to contact them at about 10 minutes apart.. we skipped that completely.. I was in denial cuz I was told the POWER of the rushes had to be present & to me it just didn’t seem like that was happening quite yet.. I know I have a high pain tolerance but I’ve also experienced intense cramps my entire life so I was just waiting for the power I had imagined to be labor.. At 1am we contacted our Midwife & she said I was definitely in early labor, to have a glass of wine & try to rest then to call her in the morning cuz it was about to be a journey.. Mama cried cuz Papa was leaving for NYC for a show that morning & I knew so much went into this concert & all the people who were counting on him we didn’t want to let down. But we are powerless to the timing of delivery in the end.. 2am we call Auntie & labor photographer who timed my contractions with me over the phone cuz I was pretty much still in denial that it was going to happen anytime soon. 3 contractions all at 5 minutes apart! She hung up & was on her way from Fresno, a 3 1/2 hour drive to LA..

I told Papa to go to sleep & I was gonna try to “rest”. Even though they weren’t what I had imagined in my mind, they were still the most painful thing I’d ever experienced! I allowed my body to surrender to the waves of each rush & moaning was how my wonderful vessel wanted to respond.. So, to let Papa rest, I got back in the tub, put a photo of my mommy and me as a baby next to me, lit some candles and labored for who knows how long in a quiet, meditative glow. I loved the bath. My mother used to make me a bath when I had extreme menstrual cramps, so those moments I felt her so close cheering me on.. I suddenly got really hot & with every movement at this point another rush would begin. I held on to the wall as I walked to the toilet to relieve myself. Suddenly I noticed my mucous plug… of course I had to grab my phone to take a photo of it! At that point I knew it was all happening & had to push aside the denial. I laid back down in bed next to my ever so deeply sleeping husband. I had a few rushes & was able to doze off in between. Then 1 rush came that made a sound come out of me that woke M! He started tickling me, cuz I LOVE to be tickled.. & I said “it’s ok baby, you don’t have to do that right now”… 😳 I NEVER deny tickles.. then another rush came & my moan started elevating to epic proportions & suddenly I felt my child shoot down my birth canal! I said “wait… woooah baby noooo no no no what’s happening..” and I felt this insane, guttural and primal urge to push.. I put my hand on my vagina and felt my Revel’s HEAD!!!!! I started yelling “he’s coming! I feel his head!”

M later told me he thought I was being dramatic cuz it all happened so fast and like I said we were BOTH confused by the experience.. HA! so it is around 5am & he proceeds to call the birth center & I think at that moment the night operator took a bathroom break cuz NO ONE WAS ANSWERING! I move to the toilet cuz I feel like I’m going to explode all over our bed & that was probably not the right move because gravity started to step in. The sounds are indescribable.. feeling the innate power & will of your body to push this child out & all of my being & might to keep him inside is extraordinarily out of this world! I wish I had those sounds recorded. But I will honestly never forget them. M at one point hung up the phone after his stepmom, who is also a midwife, heard me & and said go now! He looked at me & said “we have to go to the hospital”.. I closed my eyes & went inside myself because I knew that was not the path for me. He made 1 more phone call to the birth center & Voila! A voice on the other end. She asked to hear my sounds & immediately said “connecting now!!” My midwife at Del Mar Birth Center was everything I needed at that moment. The peaceful & tender sound of her voice guiding my moans, telling me to pant cuz that would help me hold him in. She said that I will be having this baby at home & she was on her way but first she had to stop at the birth center to grab a few things. M told her that there was no way I would make it. Just then he looked at me & said “can you make it to the car?” I said “yes! I got this!” I finished another rush & then we both got up- M helped dress me, grabbed our freshly packed @sherpapa_life gear bags, & a pillow for me to labor in the back seat of the car & we headed out the door…

…I’m wondering now if I really grasped what was happening in those moments of walking carefully down those stairs as my hand was on the head of my child holding him inside of me… to sit & ponder on that significance now is mind boggling. However, I did have the wits about me to yell out for my husband to “grab the cameras!!” My mother filmed one of her births, also unmedicated.. it was the birth of my baby brother Brian, who is no longer physically with us, & it is one of my priceless possessions. So, going into this pregnancy, I knew I would want to record my child’s birth to look back on throughout the years. To see it through another perspective. As I listen back to the videos even now I cry as I can now empathize with the woman making those sounds…

ok so, where was I…? M & I are heading out the door… I am completely focused as I climb into the back seat & lay on my side as M gets behind the wheel & takes off. The following actions are like those from a movie scene. 100 MPH down 134 to the 210 FWY toward Pasadena. M is giving me a play by play as he drives & I am holding on to the back of his seat. As I mentioned before, it is a little after 5am at this point. The roads are clear & quite lovely at this time of day. The drive we had taken so many times before so it’s like a physical memory as my husband calls out the red light he is about to run & the train we are about to stop for… “really!? A train right now!?” He says… it passes & we proceed on our journey to Del Mar Birth Center, that on a normal day is about a 35 minute drive. Well, M got us there in 12 minutes! Ha! It is now 5:30am & my incredible midwife opens the door just as we parked & already has her hands up, gloves on, as if she’s ready to catch this baby the moment the door opens. I refuse to have my baby in the car, so as I finish my rush she says “it’s now or never. Can you make it inside?” I get up & they help me through the back door of the birth center, through the hallways I once stood only imaging this moment, & into the room we chose of the 3 birthing rooms there.

I laid down on the bed, ripped my Thinx underwear & slippers off & instantly felt this flood of relief & safety. I no longer had to fight against the natural urges of my body. I could lean into them.. yeah.. right.. the first 2 rushes were familiar at this point & I got thru them well as I sat back & allowed my vessel to do all the work. My midwife was talking about how special it was that Revel was still in caul, meaning my amniotic sac was still in tact. We decided to let it be & if it broke it would do so on its own. Before the next rush came, my midwife encouraged me to go ahead & push into it. That was the most intimidating statement I had ever heard in my life! I thought REALLY!? Do I have to!??? 😳 I’m pretty sure my body would’ve gotten it done, but I acquiesced. As I pushed, something else took over & the power behind it was massive! My little Revel’s head was crowning & my midwife told me to slow my push & breathe. We had to stretch my perineum which was something I had prepared mentally for. The feeling of it on the other hand was insane! The next 2 rushes came & went without the urge to push. I found that very interesting because in hospitals when women are given epidurals they are told by their OB when to push as the machine is detecting another contraction. But what if your body doesn’t want to push & you’re wasting precious energy?? I found those few minutes very helpful as I gained more strength & confidence to push on.

M was with me every step of the way, kissing my forehead, telling me how proud he was… every bit of encouragement built me up tremendously.. I was DOING IT!! I set my mind on something, fully & wholeheartedly & it was all coming to fruition. I refused to live in fear, to let the idea of the pain sway me from having the kind of Birth I truly wanted. I announced my rush as I felt the wave growing, “here it comes..” this time with the power of the rush & my pushing, my water broke! It exploded actually, all over the place. This actually made things more intense for me as I tried to slow his head as it came even farther down, no longer having the water as a padding. Not sure how long it was before the next one came, the one that changed my life forever.. as I’m pushing it felt as if I were delivering the SUN! There’s so much force, pressure, fire, stretch… LIFE… something started to grow inside of me & the word “fuuuuuuuckkkkkk!” spilled out. I look down & see my baby boys head! It’s so tiny & FULL of dark hair!!!

I know next I’m supposed to pant & slow the descent yet again, but before I could think the next thought, Revel torpedoes out of me & jumps right over Papas hands who was supposed to catch him & into the hands of our lovely midwife.. All these next seconds were the fullest & most gratifying seconds of our lives… I was in a bit of shock as my SON is placed on my belly. The words “oh my God” & “is this real?” were all I could say.. We did it! M & I had successfully created the most perfect human. Healthy, happy, & already so aware. An old soul with so much to teach us.

Revel James Makai Morrison.. YOU are PERFECT my SON. Our lives revolve around you from this moment forward. You have gifted us with a greater life than either of us could’ve ever imagined. Each breath is so full. So deep. Such peace. My reason is YOU. Thank you for giving me the greatest experience of my life… our pregnancy! The wisdom, comfort & tranquility you provided me was glorious & I will hold onto it till my last breath. You are the best teammate, my boy & I am forever grateful. Forever in awe of you my moon, my Revel.

To my midwife, Hayley, you were everything I needed, the cherry on top, to complete my journey of pregnancy & welcome me into motherhood. Your work along with everyone else @delmarbirthcenter is so important in our time & I thank you from the absolute depths of me! We need more people like you doing what you do! I will continue to be your champion & look forward to doing this AGAIN!!! Until next time world… #reveljames #birthstory

Much Love & Aloha, Renee M Morrison

By Hayley Oakes LM, CPM

As a midwife, I often am asked the question, “What do you think about placenta encapsulation?” Although, it’s reported that placentas have been used in traditional Chinese medicine since the 1500s, consuming the placenta (aka placentophagy) in the postpartum period has become a recent trend in the last 15-20 years. (1,2)

For those of you who don’t know about this phenomenon, placenta encapsulation is the process of steaming and/or dehydrating the placenta and pressing it into capsules to be consumed after the birth.

Why would a mother want to consume her placenta, you may ask? Firstly, some would argue that humans are one of the few mammals who do not consume the placenta, so there must be some nutritional benefit to the postpartum period. Plus, it is thought that there are iron stores (as it is technically an organ) and hormones in the placenta that can be potentially beneficial during this time. It has become a popular method to help prevent postpartum depression and increase milk supply, especially if a woman has risk factors for these issues.

Postpartum depression is one of the most common complications in the perinatal period and that’s only what’s reported (apparently only half of all cases are reported). (3) A postpartum mood disorder (depression, anxiety, obsessive compulsive disorder and/or psychosis) can happen ‘out of the blue’ or there can be risk factors that increase one’s odds in developing it. These risk factors include a history of postpartum depression experienced after previous births and/or anxiety or depression experienced prior to pregnancy. Other risk factors include, but is not limited to: high stress, lack of social support, a traumatic pregnancy or birth experience, and recent stressful life events i.e. moving, changing jobs or a death of a family member or friend. (4) Feelings of anxiety and depression can be triggered by the hormonal fluctuations experienced in the immediate postpartum period and negatively affect a woman, her breastfeeding experience and bonding with her new baby.

Some risk factors for low milk supply include having a history of this complication with previous children, previous breast surgery, premature birth, maternal obesity, pregnancy-induced high blood pressure as well as simply not breastfeeding enough or right away. (5)

Until very recently, I believed the purported benefits of placenta encapsulation were enough to sway my decision in favor of it. Also, from what I had heard the only ‘risk’ was feeling no difference in mood or energy and if anything it was simply a placebo effect. But then there was a recent article that came out by Sarah Hollister RN, PHN, IBCLC, who found that most of her clients with low milk supply issues were also consuming their placentas. While there are a lot of hormones in the placenta that could be beneficial in smoothing out the emotional ups and downs after the birth, there are also a lot of pregnancy hormones that could inhibit the milk let down hormone, causing low supply issues.

So, now, what do I advise? Full informed consent of benefits, risks and alternatives of this therapeutic remedy.

Going back to the idea that we are one of the few mammals who don’t consume our placentas – the reasoning could be more to do with survival rather than a nutritional factor. In the wild, it’s important for animals to hide the smell of childbirth to protect their young from predators. If there is a nutritional benefit, we have to take into account that animals’ guts process foods differently than humans. Also, animals consume their placentas in the raw and immediately after the birth, whereas humans ingest it in small doses over weeks and months after the birth. We might be missing the nutritional benefit when we consume it after being processed and consumed over a longer period of time.

To help prevent milk supply issues, one option is to wait until at least 2 weeks after the birth. This is when your milk supply is better established and the risk of it being negatively affected by the placenta is potentially lower.

Another option is to make your placenta into a tincture. This is made from a piece of the placenta steeped in high grade alcohol for 6 weeks. This method is believed to increase the potency, length and benefits of the placenta. This would be helpful for future hormonal shifts i.e. weaning, PMS, menopause or even for your child entering puberty. The latter may seem like a stretch (and again no current long-term studies on this) but since the placenta also consists the child’s tissues, it technically can be used for him or her as well. Who knows – this could be the future for hormone replacement therapy!

Then an alternative to ingesting the placenta altogether is to bury the placenta. In our Western culture, we think of the placenta as a medical waste product and after the birth it’s disposed of in a biohazard bag. However, in many other cultures around the world, the placenta bears a great significance to the pregnancy and baby and this is honored by having a proper burial for it.

In New Zealand, the Maori people bury the placenta on tribal land to help the child establish a personal and spiritual connection to their native roots. In Indonesia, a family may bury a paintbrush or a pen with the placenta to bring artistic talent to the child. (6)

It’s also a really good fertilizer given that it’s a life source for making a baby it will help make a beautiful rose bush too!

So, clearly there is not a ‘one size fits all’ answer to this question. It’s very individual to the woman’s needs and experience. As always with the midwifery model of care, we want you to have true informed consent in order to make a sound decision for you, your body and family.

For more information about the who, what, where and why of placenta encapsulation, please visit: Find Placenta Encapsulation

Resources:

1. “Placenta Encapsulation Methods.” Find Placenta Encapsulation, findplacentaencapsulation.com/.

2. Savadove, Bill. “Eating Placenta, an Age-Old Practice in China.” Inquirer Lifestyle Eating Placenta an Ageold Practice in China Comments, 25 June 2012, lifestyle.inquirer.net/54285/eating-placenta-an-age-old-practice-in-china/.

3. “Women’s Health Care Physicians.” Screening for Perinatal Depression – ACOG, 1 May 2015, www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Screening-for-Perinatal-Depression.

4. Mogielnicki, Juliana. “Postpartum Depression: Who Is at Risk?” MGH Center for Women’s Mental Health, 20 June 2005, womensmentalhealth.org/posts/postpartum-depression-who-is-at-risk/?doing_wp_cron=1524515167.9608330726623535156250.

5. LaFleur, Elizabeth. “Low Milk Supply: What Causes It?” Mayo Clinic, Mayo Foundation for Medical Education and Research, 22 Sept. 2015, www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/expert-answers/low-milk-supply/faq-20058148.

6. Holburn, Kirrah. “Placenta Traditions and Beliefs.” Placenta Wisdom, 4 May 2016, placentawisdom.com.au/blog/2015/08/10/placenta-traditions-and-beliefs/.

By Laura G., Mother

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!

By Taylor R., Mother

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.

 
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