Informed Decision Making

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by Sarah Abigail Ejigu

abby logoAre you pregnant?  Chances are your OB or Midwife will have forms for you to fill out and papers to sign.  Imagine you are in labor, arriving at your hospital triage and you still have papers to sign, even if you preregistered!  What are you putting your name on? What are you agreeing to?  Did anyone go over this with you in a way you can actually understand?

It is the responsibility of our care providers to afford their patients what is call Informed Consent. In the medical field, Doctors, Midwives, Nurses and Nurse Practitioners, and various Clinicians are familiar with Informed Consent and can be held accountable to include this in their practices. https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Ethics/Informed-Consent

In pregnancy, we mothers are most open and sensitive to receiving information.  Even the usage of the term Informed Consent implies that we will *agree* to move forward with whatever proposed measure that may be mentioned by our trusted care provider.  Some may not necessarily be so trusting and would rather approach this process with the mindset of Informed Refusal.  Both are valid, and to be neutral, nonjudgmental and unbiased, this Doula prefers the term Informed Decision Making.

When navigating our way through choices regarding our health, it helps to gather our thoughts in an organized way so that we clearly understand our priorities.  As your Doula, I use a simple acronym to guide this thought process.  BRAIN

Benefits: what are the benefits of any proposed measure or intervention?

Risks: tell me the drawbacks and potential risks also.

Alternatives: what other options do we have in this situation?

Intuition: given the above information, my gut is telling me…

Need more time? or do Nothing: take your time!  it may not be necessary to decide now.

We are definitely conditioned to sign consent forms and liability waivers when interacting with care providers, and we often do this without question… but inquiring minds want to know what exactly is expected of us when we put our signature on those papers, and how we and our babies may be affected by our decisions.  Using our BRAIN gives us power in this decision making.  And it’s no inconvenience to engage with your OB or Midwife in this way.  By exercising Informed Decision Making, you’re taking control of your choices and building a trusting relationship with your birth team.  Tell me more!  NO guessing, NO assumptions, YES please and NO thank you.  It’s YOUR birth & YOUR baby, the power is YOURS.

Learn more from Doula Abby at her website Abyssinia Birth Services.

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.

(Yes, that’s CHOCOLATE!) When #Pregnant, We’re Just Different: How To Maintain Sanity

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Pregnancy brain? Hormonal, x35,000? Feel like a complete MENTAL CASE?

All things pretty common when we’re pregnant.

Thoughts like:

“If I JUST had a big hunk of extra sharp cheddar cheese RIGHT NOW, everything, and I mean EVERYTHING, would be fine!” (And add to that, a few (?) pieces of chocolate, and we’re set!)

“If anyone else calls me on the phone,  I WILL HUNT THEM DOWN, STEAL THEIR PHONE, BREAK IT, AND THROW THE PIECES IN THEIR FACE!”

“I AM NO LONGER HAPPY THAT YOU WILL BE THE FATHER OF THIS CHILD!”

Woh, Nelly.   What happened? I was fine (well, most of the month, anyway) a month ago, six months ago, nine months ago.

What happened, is, for sure, hormonal changes. What exactly, and why exactly? Not clear. But we need to give ourselves a break.

The whole truth is this: When we are pregnant, we are, in many ways, simply a DIFFERENT PERSON. We have a different makeup.

We could theorize that we are in need of more protection ourselves, as we’re protecting a most fragile being, increasingly growing inside of US.

And modern day culture, which does not encourage a woman to rest for anything,  fuels us an uphill battle.

We feel like we should do it all. Be pregnant, and run a marathon, while keeping a full time job, fully managing the house, and of course, taking care of any children we already have. Not to mention keeping up a good marriage. It’s a lot. Guess what? It’s too much.

Ladies, our priority is to take it easy, however we need to, in our own pregnancies. For some women, this means energy levels aren’t much different (at least perhaps until the end of pregnancy;), and others feel a huge energy drop just after conception.

The most practical tips are simple:

1. EAT.

Eat well. (Whole grains, fruits, veggies, PROTEIN. Did I mention that extra sharp cheddar cheese? I seem to have needed that for weeks one pregnancy.)

EAT FREQUENTLY – you might prefer smaller meals, 6-7 x/s day, including middle of the night. (My husband LOVES to joke about my 3am escapades. Where’d those last two, three, four pieces of gourmet pizza go?)

2. DRINK.

DRINK WELL. (Tea, whole fruit juices, not sugary ones, and water.)

DRINK FREQUENTLY.

3. If you feel up to it, EXERCISE.

Break a sweat, work the muscles. Doesn’t have to be what you did pre-pregnancy, not even close – depends on how you feel. Just follow your body, and you’ll know what feels good during, and afterward. YOU, AND ONLY YOU, KNOW.

4. BLOOD TESTS.

Your prenatal care provider should be sending you for regular blood tests to monitor you. Iron levels, for example, can affect energy levels.

5. HOMEOPATHY/HERBALIST/DOCTOR.

If you feel like you’re drinking & eating well, exercising to your beat, and you still feel depressed, or overly low on energy, consider a good homeopath and/or herbalist. They will screen you well and determine some good supplements for you, which often do the trick. If you have a history of needing antidepressants, and/or feel that none of the above solutions are working for you, consider speaking with a doctor about medication suitable for pregnancy.

Overall, know that you know yourself. Give yourself your time to yourself. Baths, reading, napping all over the place, hire a maid (the money will come back to you), whatever you need.  (Wanna laugh? Read “The Girlfriend’s Guide to Pregnancy” by Vicki Iovine. A must.)

Relax. Drop your shoulders.

And above all, there’s no need to explain nor apologize. Just do your thing, and those around you will get it. And they’ll ultimately be happier for you, and with you. And hey, you can always remind yourself it’s for your baby.

Feel great, feel healthy,

Chaya

This article first appeared on Easier Birth.

chaya doula

Chaya Valier – Israel

Chaya is a doula with 9 years experience as well as over a year of informal midwifery studies with local homebirth mentors; considering going to nursing school and then midwifery school in Israel. Specialize in assisting women who prefer to birth without drugs, and at the same time happily support whatever the situation might be. Main focus is on relaxing the body in order to facilitate the easiest, quickest births, all the while trusting in the mother’s instincts as the central, pivotal, and overall best guiding force. www.easierbirth.com @valierbirth

The Placenta: Alive & Golden

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The placenta is an organ designed to leave the body. Fully, and in tact. Can you imagine if your kidneys, on their own, just left the body? Once given the signals, the placenta, or after-birth, releases itself from the woman’s uterus, literally to be born. If someone gives birth to her child, she also gives birth to her placenta.

Besides camels, we are the only land mammals that do not regularly eat our placenta. In a mainstream culture where the sanitized is favored over the raw, and where 98% of women birth within a system that considers it medical waste, our re-membering of who we are is really at hand.

Placenta is gold! This recipe is jam-packed with nutrients: iron, vitamins including B-12, minerals, and various hormones such as oxytocin, the ‘love hormone’. Ingesting placenta also supports milk supply and breastfeeding.

Mystically, the veins on the baby side are shaped as a tree. Many spiritual traditions reference a tree, or the Tree of Life, as part of their cosmology. Placenta can be read, like tea leaves, or Tarot. That which is most wild, most “out there”, is actually what is innate to us, common, and natural: most “in here”. None of us could be here without it. Without placenta, we would not grow in the mother’s womb. In Hebrew, one of our ancient languages, the word for placenta is שִׁלְיָה, shilya, which is spelled the same as shelya, meaning Of God.

There are many traditions around the placenta. Some cultures historically have made ceremony with placenta, or medicine. Others have eaten it raw, or made a stew. Some have included a burial ceremony. Other options American women currently use are smoothies, tincture, homeopathic, or requesting encapsulation. Women have reported that eating placenta has supported them immensely with post-partum in terms of energy level, mood, and internal support for an extremely transitional time.

I have great reverence for this organ that continues to pulse and live even after it is released from the body. My experience with her is that she is alive. By beginning to see the power and potency in placenta, we can begin to feel the power and potency in ourselves.

Batya Friedland, MA, is an ordained chaplain, Jewish ritual artist, doula, and midwifery student. She offers placenta preparation, as well as workshops and retreats on Jewish Meditation, Direct Torah study, and Hebrew prayer.

Batya lives in Oakland, and can be reached at batyamidwifery@gmail.com.

Building Health in the Postpartum Period

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by Hilah Zohar, Holistic Practitioner

Most cultures around the world have the tradition and understand the importance of the postpartum 4th trimester. In the Chinese tradition this is called the Sitting Moon period which lasts from 30-40 days. In the Jewish tradition it is known as Kimpetorin and lasts from 30-60 days. This is the time to heal and restore. We know if the new mother is cared for in the first month, even if she was not healthy before, her health will be rebuilt.

In this special window of time the mother has healing restorative treatments preformed. This also helps prevent postpartum depression that is so prevalent in our present day culture.

I will explain some of these treatments and what I offer.

Mother Roasting

After giving birth it is essential that the new mom is kept warm for the first 6 weeks. She has lost blood, energy and heat and is depleted. To aid in her recovery and restore energy I do what is called “Mother Roasting”. It is keeping the mother warm specifically using moxa. Moxa is the herb mugwort, it is rolled in a stick and lit. It is held over the skin at certain points on the lower abdomen, lower back and on legs till the area is warmed. The treatment should be repeated often and is experienced as very comfortable, relaxing and revitalizing.

Moxa’s warmth penetrates deeply and is an effective treatment to warm the uterus and softens lumps. It has been shown to help dry up lochia, prevent or treat hemorrhage, shrink the uterus back to normal size and stimulate milk production, it replenishes the mother’s energy and encourages healing.

Chinese Medicinal Herbal Teas

Chinese medicinal teas are used in assisting women in their post partum recovery. For the first week after delivery the mother is given a formula to support milk production and help remove old blood from the uterus, this shortens the length of time that the mother bleeds. Then for the following three weeks the formula is changed to strengthen, build and fortify her
system.

Post Partum Massage

Massage is an important healing tool in post partum care. It helps realign the pelvis, spine, neck and shoulders to relieve soreness, stiffness and pain after birth and from nursing.

Visceral Manipulation

Pregnancy, childbirth and your growing uterus creates extra pressure and displaces vital organs. Visceral Manipulation is a gentle non invasive touch that encourages normal mobility, tone and motion of organs and connective tissue, improving functioning of individual organs and organ systems. Visceral Manipulation has been used in many traditional cultures to facilitate the new mothers healing.

Sitz Baths

Sitz Baths sooth, reduce swelling and heal the micro tears and burning sensation upon urinating that happens after childbirth. Heat increases circulation, which allows the fluids sitting in the tissues to be carried away, while fresh oxygenated blood brings nutrients and speeds healing. A blend of herbs is used in creating the sitz brew.

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 Herbs in the Doula’s Birth Bag; One Midwife’s Perspective

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by Deborah Simone, Midwife

All of us have been taught that after the birth of a baby we should put an ice pack on the Mama’s bottom. But truth be told, this is a fairly new Western medical practice, that once closely examined, turns out to be lacking in value & is actually somewhat harmful.

In Chinese medicine, the teaching is to heat the mothers after the birth. Many indigenous cultures also have some form of Mother Roasting- keeping the mother & baby very warm, feeding them hot soups or gruels and keeping the Mother/Baby dyad secluded for some weeks after the birth. When we look at these practices from an anthropological perscpective, we recognize that they must impart some benefit to the individuals, as well as the community, or they would not have become codified into the culture.

While many of us birth workers are aware of these practices and may even incorporate them into our postpartum protocols, most of us still continue to put ice packs on Mamas’ bottoms, without applying our critical analysis to this one small piece of the process.

While applying ice to cool a hot nerve, or for use as a numbing agent has some value, it has no business on woman’s yoni after birth. Instead, following the Chinese way of applying a hot tea of soothing herbs is much more beneficial & effective. Heat increases circulation, which allows the fluids sitting in the tissues to be carried away, while fresh oxygenated blood brings nutrients and speeds healing. If we accept that blood placed in a freezer will solidify, what do we think happens to tissues full of fluids when we keep icing them? Far from being beneficial or even benign, this procedure keeps Mama bottoms from healing as well or quickly as they might otherwise.

At a homebirth, we delay assessing the perineum in the two hours post birth. (This assumes no excessive bleeding that needs to be dealt with). During that time we are placing fresh hot compresses on the Mama’s bottom every 10 to 15 minutes. What we have discovered since implementing this procedure is, that by two hours, much of the swelling is gone and often a tear that looked like it would require stitches will lie together so nicely, it is hard to see, even when the Mama’s legs are splayed open during the exam.

Obviously incorporating the use of these herbs is well within the Doula scope of practice, but will require a bit of adaptation, especially for hospital births. It would be very easy to put together a postpartum packet for a small fee for the clients: 1.5 cups of the herbs, 1 muslin tea bag and 1 dozen wash-clothes (to be cut up).

I can see a couple of possibilities for the preparation of the herbs. Doulas who meet their laboring clients at hospital could prep the herbs at their own home, cut up the wash-clothes and bring the herb tea already hot, in a thermos to the hospital. A second batch would be made for the client once she returned home and kept hot in a crock pot.

If the Doula is with her client at home prior to birth, herbs could be prepped there, as well as setting up everything for the client’s return home.

It is understood that at hospital, the assessment of tissues after birth is not going to be delayed for two hours, and in fact, probably not at all. We can barely get them to wait 3 minutes to cut the cord! But this does not mean the tea would be any less effective. Once the doctor or Midwife has finished suturing, the Doula would simply remind the nurse that, in her birth plan, the Mother declined to use ice pacs in favor of hot compresses and begin applying them, while the Mama is helping her baby find the breast. This is also a great way for the Doula to be close to Mother/Baby, able to unobtrusively observe, offer suggestions and assist with promoting latch.

Supplies & Instructions

The herbs: Uva Ursi, Yarrow, Plantain leaf, Sage leaf, Witch hazel leaf, Comfrey leaf & root

Sea salt

1 dozen wash-clothes: 4 cut in 1/2, the remainder cut into quarters.

1 muslin tea bag with draw string

16-20 oz Thermos

Client’s home set up:

Crock pot

1 clean long-neck bottle w/a funnel (like a Martinelli’s bottle)

Peri Bottle (Mama brings home from hospital)

Container with lid for discarding used rags

Place 1/2 herbs into muslin tea bag, tie w/a bow (you will need to undo it to make the 2nd batch)

Bring 1qt water to boil, turn heat to lowest possible setting, add tea bag. Cover and allow to steep for several hours. Fill thermos, and bring it with the eight 1/2 wash-clothes to hospital. After repairs are done, fold the clothes in thirds length-wise and pour tea long-ways down the center. Make it wet, but not dripping. Test on Mama’s thigh as tolerance is individual. Lay over her yoni, discard and change every 10-15 mins. This will take you thru the first two hours postpartum, after which the Mother/Baby will be ready to go to sleep.

Before going to hospital, empty the tea bag, rinse and hang somewhere to dry. When meeting the Mother/Baby at home for your 1st postpartum visit, refill the tea bag with the rest of the herbs, place it in her crock pot, cover with boiling water. Set the crock on Keep Warm. Instruct client to leave tea bag in pot and simply add water as level drops. The crock and the rest of the cut wash-clothes go in the bathroom.

Fill the Martinelli’s bottle with the tea. Explain to the Mama that she should use this to fill her peri bottle 1/3, then add hot water, to make a warm wash for cleansing after pee or poo. After she goes to toilet, she should take a rag, fold it into thirds length-wise, dip into the crock, using the lid to press out excess tea. She places this on her bottom for 2+/- minutes, discards & repeats the process one or two more times. The rags can be washed as often as necessary, but must not be re-dipped. The Mama will do this for between 3 and 10 days, depending on her tear & individual constitution with regards to healing time.

Rebozo Workshop with Gena Kirby Aug 25, 2013 Berkeley

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Register: http:/bit.ly/rebozoworkshop

Facebook Event: https://www.facebook.com/events/395057493932677

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Contacts:
Wendy Kenin, Founder, Imeinu Doulas 510-504-4937
Samsarah Morgan, Founder, Birth Professionals of the Bay Area 510-496-3491

Video Testimonials of the Workshop from Berkeley Participants

Photos in Imeinu’s  Flickr Set:

Berkeley Ca Rebozo Workshop with Gena Kirby

Social image set on Imeinu’s facebook page:

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Post Partum Nutrition and Herbs

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by Lauren Samuel
Mothering the Mother after birth is vital to her continued strength and future health, from the physical to the emotional and spiritual. The post partum period is considered the ‘fourth trimester’ by conscious and discerning health care practitioners. It is a period of reintegration and recuperation.

“Preparation for the fourth trimester should begin prenatally. There is nothing more important than connecting pregnant women with one another, or better still, with those who have recently given birth. Prenatal classes or support groups may serve to accomplish this, but however it happens, it is not optional.” – Elizabeth Davis – Hearts and Hands.

During pregnancy, labour and birth, and afterwards with breastfeeding, a woman is giving continuously of her life force. It is vital that she is replenished afterwards to ensure her complete recovery. Elder women’s wisdom speaks of proper care during the childbearing years easing the discomforts of menopause. More immediate still;

“The better she feels, the more easily she will integrate her new role and learn to distinguish the needs of her child from her own. Care of new mothers assures survival of the species, but more than that, it positively affects the quality of life for us all,” – Elizabeth Davis – Hearts and Hands.

Ain’t that the truth!

Many cultures around the world stress the importance of keeping the mother warm – literally and metaphorically not leaving her out in the cold!

Women are incredibly opened by birth and susceptible to chill and energy loss. During the moon that follows birth, a woman is given only warming foods with warming spices, healing teas and tonics. She is attended by the entire family and community to ensure she has enough rest, comfort, food and herbs and assistance with household responsibilities.

The range of time spent indoors and resting ranges from culture to culture as well as needs, but the aim is restore balance through total care. Cold foods, hair washing and being in cold weather are discouraged due to the heat lost through childbirth.

Often fires were built in the rooms near the mother, or steam baths were used to bring warmth as well as healing to the perineum and pelvic area.

Pelvic Steam Baths relax spasms, bring warmth and increase circulation, nourish the internal membranes, cleanse and promote healing.

Most herbs used for the steam baths are aromatics, combined with antispasmodic, antiseptic and soothing herbs.  They can be used fresh or dried. These include;

Calendula – anti microbial with wound and skin healing properties.

Lavender – antiseptic, antispasmodic, sedative, relaxing nervine.

Red Roses – astringent, relaxing, uplifting for emotional stress, sadness and depression, nervine.

Rosemary – antibacterial, stimulating, aids circulation

Basil – antispasmodic, sedative, nervine.

Lemon Balm – antispasmodic, antiseptic, nervine.

Other herbs include red raspberry leaf, myrrh, yarrow, comfrey leaf, nettles, oregano, witch hazel.

How to have a Vaginal Steam

Add two large handfuls fresh/one handful dry herbs to about a gallon of boiling water. Boil for 10 minutes and remove from heat. Let steep for 10 minutes.

You will need to set up a way for you to sit over the pot of steaming herbs. One way is to use an open slatted chair and place the pot on the floor below you. Another is to pour the herbs into a large rimmed stainless steel bowl that can fit inside your toilet, resting on the edge underneath the seat.

Remove clothing from waist down, leave on warm socks. Sit on chair or toilet over steaming herbs and wrap yourself with a blanket from waist down. Keep upper body warm too.

Relax over steam for 20 mins, reading, journaling or meditating.

Be careful not to burn yourself.. Test the steam before sitting down!

Keep warm after the pelvic steam. It is ideal to do before bed. If you are doing it at another time, make sure to warp yourself warmly up in bed for an hour afterwards. Avoid any chills or drafts for 24 hours afterwards.

Possible side effects; May include a temporary increase in flow including more debris and dark fluids. This is seen as an effect of cleansing.

Contraindication; Do not do if pregnant, menstruating, have an acute uterine infection, vaginal sores or blisters. Never add aromatherapy essential oils to the steam as these can burn your sensitive genital tissue.

Sitz Baths

Sitz Baths are another, more commonly practiced way of using herbs to heal the perineum and vagina after birth.. The principle is essentially the same, except that the area is placed directly in the water with the herbs, and often is combined with sea salt to aid any healing of tears and soreness.

Often women were wrapped with a special cloth or band to help the uterus and internal organs and tissues back into place. This is a valuable practice that can be combined with regular massage post partum to help ease pains and bring comfort from pregnancy, labour and the after pains of the uterus contracting back into place.

Benefit of Herbs and Nutrition Postpartum

Blood building and nourishment are essential after birth; Often this has been traditionally done by the use of soups and stews and bone broths – often using herbs that clear the afterbirth and uterus and prevent infection as well as toning and nourishing the tissues and blood. There are many recipes for nutrition after birth, that vary with culture and taste as well as availability. I am going to focus more on Herbs that are useful for tonifying, nourishing and fortifying, which include;

Nutritive Herbs:

These are tonic herbs akin to foods, often containing vitamins and minerals in abundance. They are building and nourishing and can be taken over long periods of time.

Milky Oats – Avena Sativa.. contains Vitamin B complex which sustains our energy and soothes our nervous system. It is great for convalescence, depression, debility, exhaustion, anxiety, insomnia and is generally an excellent tonic for the overworked or overstressed, those who live on too much caffeine or nervous energy.

Alfalfa -Medicago Sativa – cooling, sweet, astringent herb that gently cleanses, controls bleeding and is rich in minerals such as potassium, magnesium and calcium as well as vitamins A,D, E and K as well as chlorophyll and carotene.

Nettles – Urtica Dioca – Urtica is one of the finest nourishing tonics. It is reputed to have more chlorophyll than other herbs and contains vitamins A,C, D and K, and minerals calcium, magnesium, potassium, phosphorus, Silica and Iron. It is a nourishing tonic for weakness, debility and anaemia. Nourishing to mother and baby during and post pregnancy. Aids kidney and bladder function and gently cleanses wastes. Nettle seeds are an adrenal tonic and restorative. Astringency can help check bleeding and contains vitamin K – can be used in sitz baths after birth. Useful in stimulating and nourishing breast milk.

Gotu Kola – Hydrocolyte asiatica – good combined with other nervines, reduces nervous exhaustion whilst promoting mental clarity. A connective tissue tonic, helps restore tone to ligament and uterine tissues, as well as useful for varicose veins as a circulatory tonic.

Red Raspberry Leaf – Rubus Ideaus – Increases fertility in both men and women, especially when combined with red clover.

Raspberry leaf is astringent and tonic – strengthens and tones and relaxes uterus, and entire pelvic area.  Contains fragarine – an alkaloid that gives tone to uterine muscles and indeed tones and nourishes the whole body. It is the famous herb of pregnancy and great to use before during and after birth. Contains Vitamins A, C, E, B complex and easily assimilated calcium and iron as well as phosphorus and potassium among other minerals.

Rosehips – Excellent source of vitamin C as well as astringent and diuretic, benefitting kidneys and easing constipation. Aids the absorption of iron. Contains Vit A which is useful in nourishing immune system.

Nervines:

Catnip – Nepeta Cataria – Gentle, relaxing, antispasmodic, great for mama and baby for both after pains as well as colic symptoms.. Can be used in gripe water with slippery elm, fennel and chamomile.

Chamomile – relaxing, anti- inflammatory, antispasmodic, good for nervous tummies.  Aids relaxation and well being inside and out.

Passionflower, – relaxing sedative, night time tea, aids insomnia.

Lavender – Gentle, relaxing, soothing, good for insomnia and aids let down reflex where due to tension and stress.

Lemon Balm – Calming, aids digestion, antispasmodic, antiviral, relaxing nervine – passes through to babe.

Skullcap – On edge, excited, much on mind, new changes, overstimulation, blues, exhaustion from lack of rest.

Vervain – Helps when irritable, on edge, angry, had enough, might lose it, great combined with milky oats and skullcap in tincture.  Also good for PMS, mood swings when your moon cycle starts again soon after birth.

Galactagogues to help increase the flow of breastmilk

There are many herbs that increase the flow of breast milk.. Here i will focus on a few that I personally know and have used.

Vitex – Agnus castus.. a merits berry for women if ever there was one!

Vitex is a reproductive tonic that rebalances our hormones by stimulating and normalizing the pituitary gland function. It is therefore useful for PMS, menstrual cramps, menopause, and after using birth control pills, as well as a long term fertility aid. It helps with irritability, depression, headaches, anger,pms as well as menopausal symptoms – and can raise the level of progesterone in cases where women are estrogen dominant.. thus useful for shrinking fibroids, regulating cycles and aiding fertility. Improvements of various conditions can be felt in as little as two months, although more lasting results take from 6 months to a year or longer. Vitex nourishes the supply of breast milk.

Blessed Thistle – Great in the first few weeks after birth as it helps with uterine bleeding and milk irritability. Helps aid milk production by stimulating blood supply to the mammary glands and good for sluggish digestion too.. It is bitter and best taken as tincture.

Fennel Seeds – great taste, improve milk production as well as digestion.

Fenugreek Seeds – Strong maple like taste that exudes from your pores. Increases milk production fast.

Best used with alfalfa, raspberry leaf, nettles, and marshmallow root.

After Birth pains

Motherwort is great for fatigue, cramps and to aid relaxation. It is a bitter nervine, moves stuck heart and womb energy ( it is an emmenagogue, therefore not to be taken during pregnancy), great for palpitations, temperature and mood irregularities.

Calcium/Magnesium is great for after pains as is chamomile, lemon balm, oat straw, nettle, wild yam, red raspberry and partridge berry.

Stronger herbs include cramp bark and black haw and blue cohosh – relaxes smooth muscles in uterus and whole pelvic area. Relieves and reduces after pains.

IronTea

Dandelion Root, Yellow dock root, Nettles, Rosehips.

Yellow Dock root helps the body retain Iron, rose hips contain Vitamin C. which increases Iron absorption.

After Birth Tea

Oranges, lemons, Ginger, Cardamon, Cinnamon sticks, Lemongrass, Raspberry, Borage, Star Anise and Honey.

Grate ginger, add cinnamon sticks and star anise to a large pot of water, bring to boil and simmer for 25 mins. Add oranges and lemons for ten minutes. Add rest of the ingredients and let steep. Strain and add honey. If you prefer this can be made with red wine instead of as a tea.

For Shakes, chills, sweats after birth , grate fresh ginger root and steep for 10-15 mins with 2tsp panax ginseng and dried licorice root.

Also Cinnamon tea – 1/2 tsp powder to 1 cup water or milk. Sweeten with honey if desired.