615 Doula Co. // supporting Nashville's growing families //
  • Home
  • Meet Nicki
  • Doula Support
  • Blog
  • Let's Connect

Nashville Birthplace Comparison Guide

1/23/2025

0 Comments

 
Picture

Pregnant in Nashville and Plan to Deliver at One of These Birthplaces?

Is your birthing place Vanderbilt or Williamson? There have been recent changes to some of Vanderbilt's and Williamson's policies. If your birth place is any of the ones below, download our Free Nashville Birthplace Comparison Guide to see the recent changes! 
-Vanderbilt
-Saint Thomas Midtown (Ascension)
-Saint Thomas Birth Center 
-Vanderbilt Birth Center (formerly Baby & Co.)
-Williamson in Franklin
-Tristar Centennial
-Tristar Stonecrest in Smyrna
DOWNLOAD THE GUIDE

Do You Have One of These Middle Tennessee Providers?

We work with providers across Nashville and Middle Tennessee so we see an array of care. Commonly, some of our clients' top favorites are:
  • Common providers at Vanderbilt: Vanderbilt Melrose Midwives and OBGYNs 
  • Common providers at St. Thomas Midtown: Connectus Health Midwives, Women OB and OBGYNs
  • Common providers at St. Thomas Birth Center: Connectus Health Midwives, Women OB and OBGYNs
  • Common providers at Vanderbilt Birth Center: Midwives and Dr. Thigpen, OB
  • Common providers at Williamson: OBGYNs
  • Common providers at Centennial: Connectus Health Midwives, Women OB and OBGYNs
  • Common providers at Stonecrest: Diana Health Midwives and OBGYNs

What's Included in the Birthplace Comparison Guide?

Hospital and Birthplace policies such as:
  • eating/drinking during labor
  • delayed cord clamping
  • birthing tubs and water birth
  • pushing and laboring positions
  • pain management medications
  • family centered c-section
  • and so much more! Click here to download now. 
DOWNLOAD NOW
Picture

Some Qualities to Look for in a Supportive Midwife or OB-GYN:

  • They will provide you with options and not just directives. They will explain the pros and cons of different options and use research to support their recommendations. They will not pressure you into making a decision that you're not comfortable with.
  • They will listen to your questions, concerns, and preferences and respond with kindness and empathy. They will not dismiss your concerns or make you feel unheard.
  • They will ask for your consent before doing anything. They will respect your right to make decisions about your own body.
  • They will help you feel empowered and in control of your own care. They will support you in making informed decisions and will be there to guide you through your pregnancy and birth.

Don't Be Afraid to Switch Providers.

We can’t always get a full feel of the provider and their style of care in an interview.  If you begin to have doubts about your care while pregnant, work to communicate directly with your provider to see if you can work through it.  If not, take the steps to explore other options.  We have had several families do this and they don’t regret it.   We shouldn’t have to sacrifice how we feel with a provider for quality care.  We can have both!  Don’t be afraid to put in a little extra work to switch providers.  This is your birth experience and it is worth it!

Want to know the REAL scoop about Middle Tennessee providers???

The guide is a great starting point, but it doesn't replace the insights from seeing these offerings and policies in practice.  If you want that additional context of our experience in these spaces, book a consult and we can get more nuanced.  
BOOK A FREE CONSULT
0 Comments

Let's Talk About Fetal Monitoring

4/2/2024

0 Comments

 
Fetal monitoring is a birth preference that can have a significant impact on how you labor, so digging into the info to see what aligns with your preferences and needs is worthwhile.  There are so many options when it comes to monitoring baby in utero, from intermittent monitoring to continuous monitoring and all the different machines to do so. Here at 615 Doula Co., education and having information before you need it is one of our top priorities.  This blog post breaks down:​
  • metrics fetal monitoring measures
  • pros and cons of continuous vs. intermittent monitoring
  • type of tools/machines used for monitoring
  • the electronic fetal monitor (most commonly used in hospitals) and what it all means
  • next steps for moving forward

​Let's get to it!

What is Fetal Monitoring?

Fetal Monitoring is the act of using various types of instruments to help monitor baby during labor.  ​

What Does Fetal Monitoring Measure?

There are four different metrics throughout labor.  Not all tools/machines measure each one, but the four possibilities include:

1. Baby’s Heart Rate:
This is the main form of fetal monitoring, regardless of the type of monitor used (we will get into that later). It tells us how baby is handling labor.

The average fetal heart rate during labor is in the range between 110-160 beats per minute. Baby’s heart rate may vary by 5 to 25 beats per minute as baby responds to labor.


2. Variability Pattern:
When monitoring the heart rate pattern, some accels (peaks) and some decels (valleys) are normal and this variability is a good sign. These accels and decels show baby is responding to contractions. However, persistently low dips can call for some changes during labor (i.e. positions changes, hydration like IV fluids, and further intervention if those don’t work).

3. Contractions:

Some forms of monitoring also track pressure, i.e. contractions. When evaluating baby’s heart rate, knowing when the accels and decels are happening before/during/after contractions gives additional information to how baby is doing.
​

If utilizing an epidural, some epidurals cover the contraction sensation, so tracking contractions can be helpful in navigating your labor.

4. Maternal Heart Rate:
Some forms of monitoring also track your heart rate. This can be useful, especially if the fetal monitor begins picking up on your heart rate (we don’t want that confusion because our heart rates are much lower than a baby’s). A persistently high heart rate might be a sign of a developing infection.
​

The Two Main Types of Monitoring: Continuous vs. Intermittent

When thinking about how you want to labor, one important choice to consider is what type of fetal monitor you prefer.  Before choosing what type or tool you want used for monitoring, you first want to decide your preferences and needs for intermittent vs. continuous monitoring.  As the words suggest, continuous monitoring is continuous, without breaks during labor.  Intermittent monitoring checks in on baby at set intervals during labor (commonly every 30 or 15 minutes depending on the stage of labor).  Continuous types of monitors (i.e. the Electronic Fetal Monitor, the Bluetooth Monica, etc.) and Intermittent types of monitors (a handheld doppler) both have pros and cons in their usage.  Below, we lay out some pros and cons. Huge shoutout to Evidence Based Birth for being the brains behind these pros and cons. Check out their website here; they have amazing resources for all things birth. ​

Continuous Monitoring

Pros: 
  • Lower rate of infant seizures
  • Some monitors are wireless and water-resistant
  • Can depict how baby is handling labor
  • Advised in higher risk labors
  • Advised if using epidural or Pitocin

Cons:
  • Higher rates of cesareans, and assisted (vacuum or forceps) deliveries
  • Restricts mobility of mom
  • Might restrict shower or tub use
  • Distracting or uncomfortable for mom (cords, straps, beeping, tethered)
  • Hospital personnel may be more focused on the monitor instead of mom​
​

Intermittent Monitoring

Pros: 
-Lower rate of cesareans, vacuum, and forceps
-Supports mobility and position changes (key for coping through unmedicated labor)
-Can be used in shower or tub
-Leads to more continuous, hands-on support from providers during birth

Cons:
-Higher rates of newborn seizures, though still rare regardless at .2%
-May not be appropriate for some high-risk pregnancies or those with complications
-Staff must be trained on how to log data instead of relying on machine that does it for them
-Requires 1:1 nurse to patient ratio to provide this hands-on care

​Note:  If your risk level changes during labor, your type of monitoring preferences may need to pivot.

Types of Fetal Monitors

PictureImage Credit: @emanating_kate on Instagram
1. Intermittent Doppler with Handheld Ausculation
​Pros: 
  • Intermittent Auscultation is evidence-based option for low-risk birth
  • Allows most mobility as the device runs on a battery and can go anywhere
  • Waterproof - can be used in the shower and underwater in the tub
  • More hands-on attention from nursing staff
Cons:
  • Staff have to know how to use it and how to chart the data
  • Requires frequent (commonly for the length of a contraction every 15-30 min) contact with medical staff and some patients prefer less or the hospital does not have a staff ratio to support this
  • Not recommended once some interventions begin (epidural, pitocin, etc.)

PictureImage Credit: @midwifeco.dfw on Instagram
2. Monica Novi Bluetooth Monitor
​Pros:
  • Helpful for higher risk labors that require continuous monitoring
  • Wireless, no uncomfortable straps
  • Wireless, allows for more movement, within range of wifi
  • Usable in shower
  • Better reliability for higher BMI patients
Cons:
  • Continuous monitoring, associated with higher c-section rates in low-risk labors
  • To get the sticker patch to stick, skin is often roughed up with sandpaper
  • Sometimes there are connection issues with the wifi
  • Though many hospitals have, they are often limited
  • Bath usually not an option as signal doesn’t transmit through water well

PictureImage Credit: gehealthcare.com
3. Portable Mini Telemetry Unit
​Pros:
  • Allows for mobility as it is powered by a battery pack
  • Allows for bath and shower as the pack is waterproof
  • Helpful for higher risk labors that require continuous monitoring (ex: on pitocin, but no epidural and still wants mobility and hydrotherapy)
Cons:
  • Continuous monitoring, so associated with higher c-section rates in low-risk labors
  • Not commonly available
  • Uses the traditional fetal monitoring straps so can be uncomfortable
  • Must carry the battery pack around on shoulder strap

PictureImage Credit: @heartsandarrowphotography on Instagram
4. Electronic Fetal Monitor
​This is the most commonly used monitor in the US.  It is often the default option.  Keep reading until the end to learn more about how to read the data this puts out.  
Pros:
  • Readily available in all hospitals; logs data for staff and doesn’t require staff to be in room as often, staff most familiar with this technology
  • Continuous monitorings, so for higher-risk labors or labors with interventions like epidural, pitocin, etc.
Cons:
  • Restricts mobility by the length of the cord attached to the machine (in and around the bed)
  • Associated with higher c-section rates in low-risk labors
  • Straps are often uncomfortable
  • Often requires frequent adjustments by nursing staff

PictureImage Credit: Google Images
5. Fetal Scalp Electrode for Internal Monitoring
​Pros:
  • Most accurate data on baby heart rate as it is connected to baby - should be reserved for very difficult to track situations that are showing concern
Cons:
  • Uncomfortable to place - inserted internally through cervix to baby
  • Electrode is a tiny corkscrew that punctures the baby’s skin; typically placed in scalp, but if baby is presenting a different body part this can be missed and puncture face or other part of body

You Get to Choose

Fetal Monitoring is a birth preference. Of course, your preference may need to change or be shifted if your risk level changes during labor. However, always remember you do have a choice and knowing your options before birth helps to ease the mental load if you have any turns in the road during labor. 
  • between continuous vs. intermittent monitoring
  • ​what type of monitor you prefer

Demystifying the Electronic Fetal Monitor

If you are planning to give birth in a hospital, this info on the electronic fetal monitor is important for you to understand what is going on in the labor room.   The Electronic Fetal Monitor is most hospital’s default option and is therefore used in most hospital births.  If you are planning for an unmedicated birth, you will likely want to choose another monitoring option, but having this basic knowledge in case of any pivots in labor, can be helpful.  This monitor is also often used in triage, regardless of your preferences for medicated/unmedicated.  If you are planning for an epidural or induction your chances of using this machine are much higher.   Here is some basic info to demystify it.
​
Picture
Image by Bundle Birth Nurses
Picture
Image by Bundle Birth Nurses

If you are planning on using the Electronic Fetal Monitor

  • share this info with your birth team (partner and anyone you plan to have in the labor room)
  • and are without an epidural, know that you can still stand and move around as far as the cord will reach.  Often the cart that the monitor is on can move too.  Ask for a yoga ball to sit on or stand and sway, etc.  
  • with an epidural, you can still move!  There are lots of positional options for being in a bed, with the electronic fetal monitor, with an epidural.  
  • ask questions about what things mean on this machine or the screen
  • request the beeping and heart tones to be muted
  • turn down lights or monitor / cover them if you are resting
  • the machine and data is interesting, but don’t allow it to become the focus of your experience. Remember to focus on how you are feeling, connecting with your baby and family, and communicating with your team.

​Don’t forget, continuous monitoring is not evidence-based for low-risk labors that are unmedicated.  If you do want/need continuous monitoring, you have other tool options.  


A special thanks to Bundle Birth Nurses for these labeled images.  You can check them out at https://bundlebirthnurses.com/ or on Instagram @bundlebirthnurses. 
​

Next Steps

  • Know what options are available at your birth place.  In Nashville? download the Nashville Birth Place Comparison Guide. 
  • Add your preferences to your birth preferences document
  • Talk about your preferences with your OB or midwife
  • Want help with any of this?  If you are local to the Nashville and Middle Tennessee area, schedule a time to chat.  If you are outside of the area, we would also love to chat about our virtual support options including birth preferences planning and education as well as virtual doula support for your labor.  ​
0 Comments

All About the Cervix

2/6/2024

0 Comments

 
What do you know about your cervix? We find that many of us aren’t well informed about our cervixes, but it is such a dynamic and interesting part of our body and does so much during our fertility, pregnancy, and birth journeys. So, we have compiled a blog post to give you the 411 on your cervix!  This comes after our Instagram series on the cervix in honor of January’s Cervical Health Month.

Let's start with the basics...What is a cervix?

The cervix is a canal that connects your uterus to your vagina. It comes from the Latin word ‘neck’ and is sometimes called the "neck of the uterus". In the below image, you can see that the cervix in a non-pregnant woman, tilts more towards the back. 
Picture

Some Interesting Facts about the Cervix:

  1. It’s dynamic! It changes length, position, & opens/closes. During the height of ovulation, the cervix becomes shorter, more moist, and soft. The cervix rises up to the top of the vagina which allows for better conditions for the sperm to fertilize the egg.
  2. From the start of pregnancy, your cervix develops a thick and sticky layer. This forms the mucus plug that you have during pregnancy. Which protects your baby and bag of waters from microorganisms, bacteria, and viruses. ​
  3. Your cervix might be hard to find. In non-pregnant people you will sometimes hear this called a tilted uterus. When pregnant, most cervixes are pointed more towards your back until the end of pregnancy or even during labor when it begins to rotate around and line up with the birth canal.
Now that we have labeled, and chatted about the non-pregnant cervix, let’s move into talking about the cervix during pregnancy. We will discuss: what a cervical exam is and what it is not, what cervical checks measure, pros and cons of cervical checks, and how to advocate regarding cervical checks during pregnancy and labor. ​

What is a Cervical Exam (or cervical check)?

Cervical exams check the cervix for common changes that occur throughout pregnancy and labor!
You may think that measuring a cervix is a precise business that includes a special tool.  It's not!  It is literally someone spacing out their fingers to determine how many centimeters open the cervix is.  As you can imagine, this is highly subjective.  Many labor care teams work to norm their measurements, but we commonly see one provider like an OB saying one dilation and then a nurse or another care provider saying another.  It can really throw you for a loop, but as long as you know, you can temper your expectations of its precision.  ​
Picture
Picture

What Does a Cervical Check Measure?

Well first, they measure more than just dilation! They actually measure 5 different metrics:
  1. Consistency is how the cervix feels. It is often hard for most of pregnancy and then begins to soften in the weeks leading up to labor.​
  2. Position During pregnancy, the cervix usually points toward your back (posterior). As your body prepares for labor, the position shifts more forward (anterior) so that it is better aligned with the vagina for the baby to be born. 
  3. Effacement is the shortening and thinning of the cervix. You will likely hear this in terms of a percent, ex: you are 60% effaced means that the cervix is 60% shorter than before. 
  4. Dilation is how open the cervix is. Some pregnant people are dilated at 3 cm for a few weeks before labor and others dilate once labor starts. The cervix dilates to 10 cm (size of a bagel) for baby to emerge. 
  5. Station is how far the baby has descended into the pelvis, as labor progresses, the baby moves down. Negative numbers mean the baby is still above the mid pelvis.  At -5, the baby is "floating" above the pelvis.  At -3, the baby is just entering the pelvis.  When the baby's station is at 0, they are considered "engaged" and in the midpelvis. As the baby descends the number increases until the baby is at the perineum at +4 and born at +5. 
  6. BONUS Direction Baby's Head is Facing- Though not always needed, some nurses and providers are able to tell based on the sutures on the top of the baby's head, which direction the baby is facing. This can be helpful in telling us doulas which positions or movements (like spinning babies) might be helpful to get baby in the best position possible. 
Picture
Image by @beforethebirth on Instagram

Pros and Cons of Cervical Checks During Labor

As with many things during birth, there are pros and cons. We believe it is very important to be informed and to know both the positives and negatives of birth options. This stands true for cervical checks as well. Below are *some* of the positives and negatives of cervical checks during labor. Once you know some of these positives and negatives, you can make an informed decision about them for your birth plan and then advocate for your preferences during labor.
Pros: 
- gives data that can be helpful, such as whether to be admitted to your birth place. As a doula trained in spinning babies, it gives me some additional data points to recommend specific positions or movements to ensure baby is in the best position for a smooth birth. 
​- can encourage you if you like the way you are progressing 
- can give you the go-ahead to push with the urge after 10 cm (we don't want to push before 10 - the cervix can swell) 

Cons: 
- introduces bacteria and therefore increases risk of infection
- it can hurt and feel foreign
- can disrupt your labor flow, including getting in an uncomfortable position 
- can discourage you if you haven't yet made the progress you were hoping for 
- some may pressure you to begin pushing as soon as you reach 10cm, instead of honoring "laboring down" and spontaneous pushing (see previous posts re: pushing)

A Note About Cervical Exams During Pregnancy

Increasingly, routine cervical exams during pregnancy (without specific evidence of need) are going to the wayside, and for good reason.  Sometimes you still hear that OB's are requiring cervical exams during pregnancy, sometimes early on, and for all of their patients.  We also hear of OB's beginning/restarting cervical exams weekly at 36 weeks.  Some offer it and others expect it.  We find that there is a fairly reliable overlap with the doctors that do routine cervical checks during pregnancy and those that favor old-school hospital style birthing where they know better and intervene often (inductions, pushing on your back, limiting food and drink, etc.).  We find that many of the most consent and evidence-based providers that honor the safest low-intervention path, don't usually have routine cervical exams as part of their pregnancy care protocol.

It might not be the full picture of a provider, but it is a clue. 

As always, there are exceptions.  For example: if you have a history or there are signs for preterm labor, a cervical exam could be helpful in mapping out your care plan.  You, do you.   ​​
Picture

You Get to Choose

  1. Whether you want cervical checks during pregnancy and/or labor
  2. How often or how many you want
  3. Who performs them (midwife/OBGYN or nurse)

Here are our best tips:
  • Talk to your provider beforehand! Find a provider that aligns with your wishes regarding cervical checks throughout pregnancy and labor. If you are finding that you and your provider are not aligned on many topics, change providers.​
  • Put it on your birth preferences! Want minimal or no cervical checks during labor? Only want one when you are admitted into the hospital/birth center? Add it to your birth preferences document! It’s another communication point with your birth team.
  • Advocate during labor! Loop in your partner and doula to help advocate when you are focused on coping and moving through your labor rhythm!​
  • As always, please remember to remain flexible if your body and your baby need something different, both prenatally and during birth.
Picture
0 Comments

Breastfeeding 101

12/6/2023

0 Comments

 
This blog is a collection of breastfeeding‑related posts that @615doulaco put together in honor of National Breastfeeding Month. What once used to live in Instagram Guides, now lives on the blog! Breastfeeding can be hard work, but with education and support, you and your baby can find your groove!

Conversation Starter

Picture

Breastfeeding Myths Busted

Picture

Ways Your Partner/Support People Can Help You

Picture

The Benefits for Both You and Baby

Picture

How to Know When Baby is Hungry

Picture

What is Colostrum and How is it Good for Baby

Picture

How Much Colostrum or Milk Does a Baby Need?

Picture

Save Your Sanity and Focus on the Facts

Picture

How Do I Know My Baby is Getting Enough Food?

Picture

Breastfeeding Positions to Try

Picture

Breastfeeding Positions Continued

Picture

Common Breast Holds

Picture

Understand How Baby Latches

Picture

Quick visual reminder for getting a strong latch

Picture

Latch Checklist

Picture

Get a Deep Latch with the “Flipple” Technique

Picture

“Flipple” IRL Example

Picture

Learn How to Hand Express

Picture

Some Thoughts on How Long to Breastfeed

Picture

How to Properly Store Breastmilk

Picture

Paced Bottle Feeding Explained

Picture

Alternative Feeding Methods

Picture

You're Doing Great Mama!

Picture

Local Breastfeeding Support

Picture

Wake Windows

Picture

Waking Baby to Feed

Picture
0 Comments
<<Previous
    Picture

    Meet Nicki

    Hi, I'm Nicki! I am a Nashville based Doula and founder of 615 Doula Co! My favorite part of working as a Doula is supporting families through the life transitions of pregnancy, birth, and postpartum life.

    Explore Blog

    All
    Birth Options
    Birth Tips

HOME
MEET NICKI
DOULA SUPPORT
BLOG
CONTACT
Copyright 2019 - 615 Doula Co.

Website by samanthagagnon.com
  • Home
  • Meet Nicki
  • Doula Support
  • Blog
  • Let's Connect