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.

Acupressure to Reduce Labor Pains

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I found this research on acupressure to reduce labor pain interesting. I use more points than what was used in this study, and the results are truly incredible, it works like magic. Acupressure to reduce labor pain, Hjelmstedt A, Shenoy ST, Stener-Victorin E, Lekander M, Bhat M, Balakumaran L, Waldenström U. Acupressure to reduce labor pain. Acta Obstet Gynecol Scand. 2010 Nov;89(11):1453-9. A randomized controlled trial within an Indian public hospital to evaluate the effect of acupressure on pain levels when administered during the active phase of labor with women having their first baby Summary 213 women having their first baby were randomized to receive either

  1. Acupressure at SP6 (Sanyinjiao) on both legs during contractions over a 30-minute period
  2. Light touch at SP6 (Sanyinjiao) on both legs during the same period of time
  3. Standard care

Their experience of labor pain was assessed by visual analog scale at baseline before treatment, immediately after treatment, and at 30, 60 and 120 minutes after treatment. Treatment Methods The study was conducted in a large public hospital in India where epidural analgesia is not an option in normal labor and where women cannot bring a companion. All women in the study had uncomplicated pregnancies and been transferred to the labor room with a cervical dilatation between 3 and 7 cm. The women in the acupuncture group were treated with acupressure at SP6 (Sanyinjiao) on both legs simultaneously during each contraction over a period of 30 minutes. Conclusion A reduction of in-labor pain was found in the acupressure group and was most noticeable immediately after treatment. Retrospectively (2–24 hours after birth), the women in the acupuncture group remembered having had less pain during labor and said they coped better with their labor pain compared with the standard care Compared to the women in the touch group, those in the acupuncture group remembered having coped better with the pain. The authors concluded that acupressure seems to reduce pain during the active phase of labor in women having their first baby and that that acupressure may be most effective during the initial phase of labor. Clinical Perspective This study reinforces a previous study that also found the use of acupressure on SP 6 (Sanyinjiao) reduced pain for women during active labour. While it is positive that these studies are exploring the use of acupressure as pain relief for women, it is very disheartening that they focus only on the use of a specific point. Clinical experience suggests that there are a variety of acupressure points that a woman may find useful. The reality of following up hundreds of women from clinical practice, after having taught them nine acupressure to use, has been that very few that found SP6 (Sanyinjiao) the most useful point for pain relief. It may be that there are greater benefits than those found in the study through letting women and their support people select the acupuncture points they find most suitable for the different stages of labour.

The Amazing Benefits of Prenatal, Labor and Postpartum Massage

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by Hilah Zohar

Benefits

To read more about each individual benefit listed (including references to the studies) you can read my Guide to the Benefits of Massage.

During pregnancy:

  • Decreases rates of complications during labor
  • Decreased rates of postnatal complications for the baby
  • Decreases rates of premature birth
  • Decreases stress hormone levels in mother
  • Increases oxygen and nutrients to the cells of mother and baby
  • Promotes easier breathing
  • Reduces swelling (edema) in the hands and feet
  • Decreases pain in low back, shoulders, neck, and hips due to shift in posture
  • Alleviates stress on weight-bearing joints due to additional weight of the baby
  • Alleviates leg cramps
  • Alleviates sciatic pain
  • Decreased insomnia
  • Helps prepare the muscles used during childbirth

Postpartum: Lymphatic, Visceral Manipulation (Gentle Repositioning of Organs)

  • Better milk production and easier breastfeeding
  • Helps to realign the pelvis after birth
  • Relieves soreness after birth
  • Faster recovery from a cesarean
  • Relieves stiffness, tension, and aches and pains associated with caring for a newborn
  • Realigns and lifts organs in their proper positions

Most of my prenatal clients purchase a prenatal massage package ($15 off 3 massages, $50 off 6 massages, or $100 off 9 massages) and see me throughout their pregnancy and postpartum period. Studies show the greatest benefit for those who receive regular massage during their pregnancy (although even one or two sessions can be hugely beneficial). These benefits are described below.

During prenatal massage, you will be able to lie comfortably on your side with the support of pillows and bolsters (except during the first trimester when you may lie face down). I will focus on your specific needs depending on your stage of pregnancy and your individual experience.

My postpartum massage focuses on physical recovery and rejuvenation after childbirth,through Lymphatic drainage massage, and organ repositioning.i will  gently reposition organs to their proper position, releasing any adhesion’s  that may have formed during pregnancy. Giving you some space to focus on how your own body is feeling, and to relieve stiffness, tension, and pain associated with caring for a newborn.