Midwifery and Postpartum Care From Generation to Generation – From Mexico to the United States

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Sarah and Her Mother Martha: The Cuarantena – From Mexico to the United States, by Imeinu doula and midwife in training Cristina Urista, was published by Squat Journal in the Winter 2012 edition. Please find the article here: Cuarantena Squat Journal Urista Postpartum Mexican

My mother Esperanza (right), a former Mexican partera, her mother Eufracia (pic) who taught my mother the importance of the Cuarentena care was also a Mexican partera, and me (left), currently training as a nurse-midwife at UCSF. -- Cristina Urista

My mother Esperanza (right), a former Mexican partera, her mother Eufracia (pic) who taught my mother the importance of the Cuarentena care was also a Mexican partera, and me (left), currently training as a nurse-midwife at UCSF. — Cristina Urista

Sarah Miranda had discussed the special postpartum care she received from her mother with her Imeinu doula Wendy Kenin after her third pregnancy. They had hoped to document it, to share the important traditions in supporting maternal health. Cristina Urista encountered Wendy the next year.

Cristina herself was beginning her journey into birth work at the time she interviewed the Miranda – Moreno family about the Cuarantena. Doing this research gave her an opportunity to begin to approach her own mother for a deeper understanding of her background as a midwife (partera) in Mexico.

“I am grateful that Imeinu encouraged me to further connect with my mother’s past as a Mexican partera, allowing me to discover that my maternal grandmother was also a partera,” Cristina says. “Imeinu opened a space where I could explore and reclaim my traditional and intergenerational Mexican birthing customs.”

Sarah Miranda (left) and her mother Martha (right.) Martha cared for Sarah according to the traditional cuarantena customs of their heritage after the birth of Sarah's third child, as was documented by Cristina Urista.

Sarah Miranda (left) and her mother Martha Moreno (right.) Martha cared for Sarah according to the traditional cuarantena customs of their heritage after the birth of Sarah’s third child, as was documented by Cristina Urista.

Cristina did an awesome job applying her ethnic studies background to document the postpartum care that Sarah’s mother Martha Moreno provided beginning immediately after delivery of her third child. We were thrilled that Squat Journal published Cristina’s concise and rich article to help share the wisdom of these special traditions for women’s and babies’ health.

After, Cristina joined Imeinu at a home birth and several hospital births. She wrote the story of her own birth, published by instructor Samsarah Morgan, founder of Bay Area Birthkeeper, where Cristina dove deeper into birth work, and you can read it here.

“Imeinu opened a space where I could explore and reclaim my traditional and intergenerational Mexican birthing customs.”

Cristina has been accepted this year into the nurse-midwifery program at UCSF after working for three years as a doula, which followed after the publication of this article in 2011.

It was very special to have Cristina document this practice that a grandmother brought with her from Mexico to Napa Valley in caring for her daughter, our beloved Imeinu client. Imeinu thanks Cristina for her tremendous contributions and looks forward to continued collaboration as she embarks on her midwifery studies.

Mazel tov!

What is Naturopathic Medicine, how can it help with infertility, and is it really different from acupuncture?

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by Dr. Aumatma Naturopathic

Medicine has a few basic tenets that seem almost common sense. Use of natural substances (such as herbal medicine, nutrition, and homeopathy) to help rebalance the body and allow for the healing force to heal itself, is the ideal. Naturopathic Doctors (NDs) are trained in 4-6 year medical programs that integrate eastern and western medicine. While Western Medicine is primarily focused on diagnosis, followed by “fixing” the problem, Naturopathic Medicine is focused on discovering the root cause. Many people consider Western Medicine to be a proficient band-aid. Western Medicine does have many advantages such as the advance of technology that allows doctors to help with things that even a hundred years ago may have appeared miraculous.

Acupuncture and Chinese Medicine, on the other hand, have gotten good results for helping women rebalance their bodies from stress, reverse the damage to ovaries and eggs, as well as tonify the body overall to be able to conceive. I know lots of women get great results withAcupuncture.

Naturopathic Doctors fulfill a very different need, however. NDs consider it fundamentally important to understand the functions and pathways of the body and intimately understand hormones that can affect health and wellness. In addition to this foundation, however, Naturopathic Medicine also includes training in natural modalities for supporting the vital force of the body to heal. These therapies vary from Naturopathic doctor to doctor, as different practitioners may focus on different therapies. A majority of NDs do practice herbal medicine, functional medicine, nutrition, homeopathy, energy healing, and more.

Infertility is a complex diagnosis with many potential underlying causes. Naturopathic Doctors are particularly proficient in helping uncover a deep underlying cause that may not be obvious. Because Naturopathic Medicine views the body in a holistic way with a myriad of connections (that could be deemed otherwise unrelated), it is easy for NDs to recognize the deeper issues that may be contributing to a couple’s inability to conceive.

In my experience, Acupuncture is a great adjunct to Naturopathic Medicine & IVF/IUI. My recommendation is to go all out, with multiple approaches, because the complexity of infertility needs to be addressed on many levels. All of the different approaches fill very unique needs for the client, but there’s no one right answer. When we, as practitioners, collaborate fully, our clients get results faster. And, that’s what I am all about! When couples are ready to start a family and they are getting older and don’t have a lot of time, I think it’s ideal to use a multi-disciplinary approach. It breaks my heart when clients come to me after having tried acupuncture for 5 years… I wonder why they waited 5 years before trying something else or adding something else? Often, they come from referrals from their acupuncturist, but it’s only after they have fully exhausted their time with the acupuncturist. And, I have been able to help most of these couples– however, I just wonder if they wouldn’t have been saved anguish and disappointment if their work with me was started sooner, in collaboration with acupuncture.

So, overall, what I can offer clients is very different from acupuncture. Acupuncture can strengthen the body, help with stress, and re-balance the energetic body. I really like to work on the physical-mental-emotional from a different perspective. On the physical level, we want to detoxify and clear the channels of the body. Then, we are testing and rebalancing hormones (often undiagnosed abnormalities that Western Medicine missed). And lastly, we work on the mental – energetic layers. In short, using a mind-body approach to conceiving and birthing a healthy child is essential — and can happen easily when you have a team of practitioners caring for you and your partner’s health and well-being.

Remember they say, “it takes a village to raise a child?”…. these days, I say, it takes a village to conceive and birth a child.

Find more from Dr. Aumatma on her website at  www.draumatma.com.

How Dilated Am I? Assessing Dilation in Labor WITHOUT an Internal Exam

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by Sarah Vine

It’s the magic question weighing on most laboring mothers’ minds: (as well as the minds of her partner or birth attendants!) How much longer? Is there any way to tell how far along I am in the birthing process? I’ve seen mothers beg for an internal exam and then be gutted about the answer (What? ONLY 4cm STILL!?) and suddenly *poof* she looses her resolve. It’s akin to having a test and finding out you’ve failed it, in front of your loved ones as well as complete strangers. Everyone knows this feeling is not conducive to labor – suddenly doubt and fear slide in and the laboring mother feels tense. Her oxytocin levels (our body’s natural pain-killer and labor inducer) take a nose dive and immediately she feels much more pain and she starts to run away from the contractions.

Happily, there are a number of external cues that can help you and birth partners get clued in to how much labor is advancing. Some are more subtle than others, but if you are ignoring the clock and keeping focused on staying in tune with your body, you will see them. Listen, embrace, wait.  Enjoy the way it responds! It is amazing what it can do, this body that God gave you.

1. Sound. The way you talk changes from stage to stage in labor. With the first contractions, you can speak during them if you try, or if something surprises you, or if someone says something you strongly disagree with. You may be getting into breathing and moving and ignoring people – but if you really want to you can raise your head and speak in a normal voice. When the contraction disappears you can chat and laugh at people’s jokes and move about getting preparations done. During established labor, There is very little you can do to speak during a contraction. You feel like resting in between, you are not bothered what people are doing around you. As you near transition and birth, you seem to go to ‘another’ level of awareness – it’s almost like a spiritual hideaway. You may share this with someone else, staring into their eyes with each surge, or you may close them and go into yourself. In between surges you stay in this place. It is imperative for birth assistants and partners to stay quiet and support the sanctity of this space: there are no more jokes, and should be as little small talk as possible. Suddenly, the sounds start to change involuntarily: you may have been vocalizing before (moaning, talking and expressing your discomfort, singing, etc) or you may have been silent. Listen – there are deep gutteral sounds along with everything you have heard before, just slipping in there. You are about to start pushing.

2. Smell. There is a smell to birth, that hits towards the end of dilation, during intense labor, just before birth. It is a cross between mown hay and semen and dampness. It has a fresh, yet enclosed quality, and is pervasive. The Navelgazing Midwife has also observed this scent and writes about it here.

3. IrrationalityI love this clue – it often is a sign of transition. It always makes me smile, and I always warn women about this phenomenon so that when we hit it during labor I can remind them that what they’ve just said is irrational, and that I told her this would happen, and here it is! Relax, it means we’re nearing the end. Sometimes a mother will say she wants to go home, she is done now she’ll come back and do this later, she wants to put on her trousers and coat and go out the door. A mother who wants a natural birth and has been coping brilliantly will suddenly say she was crazy and needs pain killers right now, or that she didn’t want another baby anyways, who said they wanted a baby? Some will just curl up and say they’re going to sleep now. If she does this, that’s okay. The contractions may die down, get farther apart, and maybe she (and the baby) will get a few minutes of sleep. This slowed down transition sometimes freaks out doctors or hospital midwives and pitocin is offered – try to see if you can put them off for half an hour. Send every one out, lie on your left side propped up by pillows and have a little nap before pushing; it is such a wonderful gift.

4. Feel. Here come some of the more fun tools that you might not have heard of before! Think about the shape of the uterus. Before labor, the muscle of the uterus is thick evenly around all sides, above, below, behind. As the cervix starts thinning and dilating, all that muscle has to go somewhere – it bunches up at that top. The top of the uterus thickens dramatically the more the cervix opens. During a contraction, at the beginning of labor, check how many fingers you can fit between the fundus (top of your bump) and the bra line – you will be able to fit 5 fingers. As the top of the fundus rises higher during labor, you will fit fewer and fewer fingers. When you can fit 3 fingers, I usually tell mothers they can think about going into hospital as they will find they are around 5cm dilated. At 1 finger, you are fully dilated. (Awesome, huh! Here is a blog post by a woman who describes in great detail checking her own cervix just before she went into labor.)

5. Look. There is something called the ‘bottom line’, which is shadow that extends from the anus up towards the back along the crease of the buttocks. It begins as 1cm and lengthens to 10cm, and it’s length correlates with cervical dilation. Why not look down there before inviting a stranger to put their fingers up inside you? It makes sense to me. Here is current research verifying the existence of the bottom line, and in their trial it was measurable and had acceptable accuracy for 76% of women checked.

6. Gooey Stuff. Also known as bloody show; there is usually one at around 2-3 cm dilation, and it can happen during the beginning of labor or a few days before hand. Sometimes it’s hard to know what is or isn’t a show, since during the days before labor the amount of vaginal mucus increases in preparation and this can be confusing. A show is up to a couple of tablespoons in quantity, so quite a lot. It can be clear, but is usually streaked with pink, brown, or bright blood. If there is more than a couple of tablespoons of blood then you do need to go straight into hospital to make sure the placenta is not detaching, but if there is just a bit and then it stops, then it is just show. There is a SECOND show at around 8cm dilation. This second show means that birth is near.

7. Opening of the Back. This is just at the spot where your birth partner has been doing lower back massage, at the area above the tailbone. It is a little smaller than palm sized, rather kite-shaped area that bulges out during pushing. At this point you’ve waited too long to go into hospital, and you need to refer to my last post, 4 rules of what to do when delivering a baby!

8. Check yourself. Okay, so technically this one is an internal check, but it done by YOU. You don’t have to announce the results or write them down: it is not an exam. To me it’s obvious that as the owner of your body, you have more of a right than anyone else to feel comfortable with it and understand how it works. It is best to get to know what your own cervix feels like from early on in your pregnancy, if not before, and then to keep a regular check on what feels normal. If you do this through out your pregnancy you will keep your flexibility into the 9th month. This is also an excellent time to remind you to not neglect perineal massage since you’re already down there! Check out the website My Beautiful Cervix to see photos and descriptions of what a cervix should feel like. At 1 cm you can fit the tip of one finger inside. Use a ruler to practice discerning how many centimeters dilation feels like, measuring with your pointer and middle finger. This visual aid is also a cute way to imagine dilation. NOTE: Always, always, always wash your hands thoroughly beforehand, up to the elbows, for 4 minutes at least. Do not assess your own dilation after your waters have gone.

For more labor tips and information about external assessment of dilation, I recommend finding a copy of Anada Lowe’s book, The Doula Guide to Birth, Secrets Every Pregnant Woman Should Know.  This is one book packed with practical and useful information!

This post first appeared at Helping Mothers Give Birth Joyfully Without Fear: A doula in California blog by Sarah Vine.

Sitz Bath Herbs

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from Lauren Samuel

A sitz bath is basically a small hip bath that you sit in to ease the swollen, stretched muscles and tissues around your vagina after giving birth.

Sitz baths will also help heal perineal tears. You can either use a small basin or plastic tub placed in the bathtub that you squat into, or you can buy an inexpensive, and much more comfortable basin that fits right onto your toilet seat.

Calendula Flowers (Calendula Officinalis) – (calendula officials) – calendula is a great antiseptic, as well as being anti fungal and antiviral. It lessens inflammation and cleanses the body via the lymph system. It is often used for painful scars and thus may be helpful for cesarean scars as well as perineal tears or episiotomy.
Plantain Leaf – (plantago spp) – plantain is cooling and has the effect of drawing out impurities. It coats and soothes mucous membranes and lessens inflammation in  tissues.
Comfrey Leaf – (symphytum officials) -Comfrey is soothing, constrictive and healing for wounds, cuts and tears. It is a cell proliferant – it promotes speedy wound healing both inside and outside the body. NOTE: If there is infection present, do not use Comfrey as it will heal the outside so quickly that it may heal over infected tissues inside. Make sure wound is clean before using Comfrey.
Yarrow Leaf and Flowers – (alchillea millefolium) – Yarrow is useful for stopping excessive bleeding and acts as an anti-inflammatory as well as being anti bacterial and antimicrobial, and helps to relieve pain. It can also be used for varicose veins.

To prepare your sitz bath…

• Pour boiling water over four ounces of your herbal sitz bath blend.

• Let it sit and steep for at least four hours.

• Strain it into a bowl, or directly into your basin and then sit with your vaginal area in the tea for about 15 minutes.

• Repeat several times a day if you do not have stitches, and enjoy the powerful healing of a simple herbal sitz bath!

Buy a sitz bath herbal package prepared by Lauren! Order Now >>

Preparing for Homebirth

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by Lauren Samuel Following is information I have gathered from various sources over the years. Aside from the obvious homebirth supplies, this list can be equally valid for hospital births as well.

You and the physical, emotional and spiritual environment you prepare for welcoming your child are most important! You create the clean, beautiful, peaceful environment to give birth. Flowers and candles add a lovely touch. Buds have been known to open during labour, mirroring the way you will open. Essential oils or aromatherapy candles can be soothing, especially rose geranium, rose and lavender.
The following items are useful:
  • Sterile gauze pads (4″ x 4″)
  • Disposable under pads (walgreens)
  • Large bottle of hydrogen peroxide (cleans blood off everything)
  • Bacitracin or neosporin -small tube (topical antibiotics), Witch Hazel – small bottle (hemorrhoids).
  • Arnica tablets 200c, for birth swelling, bruising or aching
  • Optional: Belladonna and Phytolacca for breast infections or blocked milk ducts
  • Frozen cabbage leaves for breast inflammations
  • Arnica massage oil for back pain (optional)
  • Garbage bags (2, one for waste; one for dirty laundry)
  • Protective covering for mattress, chair, floor, etc.. flannel backed vinyl tablecloths work well
  • Large bowl for placenta
  • Thermometer for baby
  • Flashlight with batteries
  • Sanitary napkins (hospital size), or extra absorbent pads for urinary incontinence
  • Prewashed clothes and diapers and two soft cotton newborn hats
  • Receiving blankets 6-8 and /or old soft towels, 2.
  • Face cloths or old towel cut up for compresses (6)
  • Old bath towels for large compresses
  • Crock pot or large pot for hot water
  • Have plenty of juices, tea and nutritious food around
  • Recharge/electrolytes for a long labour
  • Comfort items:
    • hot water bottle
    • extra pillows
    • heating pad if you have one
  • Camera
  • Lip balm
  • Herbal bath ingredients for after birth
  • Food prepared for after birth or arrangements for food to be brought in
  • Evening Primrose Oil – 500mg, 3x daily after 37 weeks. Preprostaglandin for ripening cervix
Choose a family physician or pediatrician prior to the birth whom you have met and spoken with. While newborn exams and follow up care are done by your midwife, if there were a problem you would want to know the physician who would provide care for your baby. Have your infant car seat inspected and in the car. Register your birth with relevant county to receive birth certificate.
Emergency Phone Numbers – post near phone:
Ambulance – 911
Hospitals – closest and preferred
Consulting Physician
Pediatrician or Family physician
Midwife
One place you can purchase many of these items online is at Midwife Supplies.

#Birthing in a #HighTech Civilization: For the Expectant #Mother & Anyone Who’s Ever Known One

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by Wendy Kenin @greendoula

In the United States’ high tech birthing industry, a pregnant woman must do research and be ready to advocate for herself. Important safeguards for a fulfilling rite of passage are a birth plan and a solid birth team.

If a mother-to-be doesn’t have the time to research all of the regional hospitals, birth centers, or homebirth practices, she may want to check with local friends who’ve had babies or find a doula who has experience with multiple providers and methods. Even if the birth does not go as planned, a mother may carry with her a positive memory of her milestone day if she is surrounded by an attentive and caring team.

Believe it or not, it has only been one century since almost all births in the United States took place at home. Natural childbirth occurs when a woman gives birth with little or no medical intervention (depending on the varying definitions of the term). The process of choosing a natural childbirth imparts power and strengthens a woman’s autonomy.

Planning a natural birth in the United States today requires stern commitment. The ACLU reports violations of pregnant women’s right to make their own medical decisions and pregnant women have even been jailed for refusing advice from their doctors. Expecting families must thoroughly interview caregivers about practices in order to find the professionals whose ideas match their own.

For reproductive health as well as for personal sovereignty, it is critical for a woman to trust that her body knows how to birth, just as her body knows how to breathe. Nurses and doctors I have encountered in the hospital have all told me that they rarely see, or have never seen a natural birth. In today’s climate, a pregnant woman who relies on these professionals becomes subject to modern medicine’s latest trends.

Hospitals
With a range of monitoring and protocols, the process of birthing in a hospital becomes the subject of analysis that regularly leads to successive medical interventions. Many women who intend to have a natural birth find themselves being guided by their caregiver to use pain medications, hormones, and more. Sadly, most pain medications reach the baby, who may be born intoxicated.
Often the nurses who are on shift during labor have the greatest impact on labor decisions. Nurses are oriented toward measuring labor progress and administering pain medications. Doctors or midwives are also present during delivery. Depending on the people and the institution, hospital midwives may have an approach that is more conducive to a natural delivery.

As a doula with a background in various birth settings, I strive to create a homebirth experience in the hospital. My attention is on providing the mother informational, emotional and physical support. Just like at home, the mother in the hospital may choose to walk around, turn out lights, and go through contractions in multiple positions for many hours to help the baby move down and to manage her pain.

Often mothers are kept on an active schedule to resemble a textbook delivery, discounting that every woman, labor, and delivery is different. Nurses offer simulated hormones to bring on stronger contractions and move the labor along. When a woman in labor complains about pain, the nurse informs her of available medications. With every medical intervention comes more risk factors and typically one medical intervention leads to the next.

“Failure to progress,” also called dystocia, is the leading cause of Cesarean delivery—major surgery of the abdomen and uterus—in the United States, not fetal or maternal distress. USA Today reporter Rita Rubin aptly calls dsytocia “failure to wait.” Cesareans entail many more risks to baby and mother than do vaginal births. A natural vaginal birth ensures the best possible entry into the world for baby, and the optimal emotional, spiritual, and physical experience for mother.

Technology imparts the pregnant mother with new choices. We may be measuring our nutrition intake, or choosing in vitro fertilization or prenatal testing. Unfortunately, the power of technology can also work against a woman’s basic rights and her intuitive knowledge.

Birth Plans
Some women include in their birth plans that they do not want pain medication offered unless they request it. Some specify to not be coached to use arguably hazardous yet standardized precautionary techniques, such as bearing down and pushing the baby before the urge to push arises, or having her bag of waters artificially ruptured. Some birth plans instruct to wait until clamping and cutting the cord, to wait for the placenta to birth naturally, or to wait until after mother and baby have bonded before performing routine medical procedures with the newborn. To allow for maximum inclusion and respect of your birth plan in a hospital, bring five to 15 copies to share with the various nurses and medical personnel who will be involved in your care.

Whatever your circumstances, a doula can help navigate your birth through the high tech system. Usually the doula stays with you after the birth until you begin your next natural stage of mothering: breastfeeding. Simply having someone who understands the experience to be your ally assures a positive element to the birth experience.

Ceremony
The life cycle events of birthing and being born have been Hallmarked, mechanized, corporatized, politicized, and institutionalized, along with many other naturally occurring life forms and processes. One way to retain your humanity during birth planning is to have your beloveds organize a Blessingway, a spiritually-focused gathering in honor of the mother.
In her book Blessingways: A Guide to Mother-Centered Baby Showers, author Shari Maser, CCE, explains, “The common thread among Blessingways is the use of ritual to celebrate the mother-to-be, to acknowledge the momentous impact of bringing a new baby into her family, and to support her through this transition.”

The term “Blessingway” comes from a traditional Navajo ceremony. In popular culture, mothers receive gifts at fanciful celebratory baby showers. Many traditional peoples still adhere to taboos that prohibit gathering baby items, setting up a baby room, or naming a baby before birth. Drawing from your personal ancestral cultural heritage to hold a spiritually-centered baby shower concentrates your attention on the spiritual journey of your birth and has the potential to bring together your community’s strength around your birth and the welcoming of your child.

Birthing can be healing and restorative. Always transformative, birthing is when a woman’s body acts as a vessel to form a passage from the spirit realms to the physical world. Empowered we embody the life-giver, and when we birth with intention, the worlds can come together.

Wendy Kenin is a doula and mother of four in Berkeley, California. She is Vice Chair of the Berkeley Peace and Justice Commission, and serves on the Editorial Board of the Green Party of the United States. Contact her at green.doula@gmail.com.

The original version of this article first appeared in Vision Magazine, September 2009.