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Eating & Drinking During Labor

11/24/2020

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Labor is called labor for a reason. It is hard work. Not necessarily work that you have to put in as it happens involuntarily, but your body and the wondrous organ that is the uterus is working really hard during labor to get the baby in the right position and to push it out of your body. Hard work requires energy and that is where food and drink comes in! 

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Have you ever wondered why many hospitals do not allow eating or drinking during labor? This overwhelming trend in hospital “policy” is for fear of aspiration (throwing up and choking on it) if general anesthesia (getting “knocked-out” and intubated) is needed. This started in the 1940’s when the drugs and tools used while providing anesthesia were very different. Luckily the field of anesthesia has drastically improved, making the probability of aspiration extremely rare. Some hospitals are heeding the newer research and changing their policies for low-risk pregnancies.

Many women feel that they could use a little nourishment, especially during long labors. Some women report no desire to eat during labor, especially as it intensifies. In quick labors there may not be time for it. 

Your body. Your taste. Your choice.  

If it is early labor, by all means, eat a well-rounded, nutritious meal until satisfied. Heavy meals are sometimes later regretted. 

Here are some food ideas that I have found laboring people like:
  • Hydrating drinks like water, gatorade, juice, coconut water, or bone broth
  • Peanut butter crackers or other nut butters
  • Bars like nut, fruit, protein, granola, etc. 
  • Fruit like berries, grapes, etc. 
  • Honey stick

If you ate during labor, what were your foods of choice?

When is a pregnancy no longer low-risk and fasting is recommended?
Planned c-section. There are also some other potential factors that might increase your chances of aspiration such as: airway issues, eclampsia, pre-eclampsia, obesity, or opioids in your IV, but they haven’t been thoroughly studied. An epidural does not take you out of the low-risk category, but waiting a while after it is placed to make sure it doesn’t cause nausea is advised.  

Compare the eating policies at the local hospitals by downloading the Nashville Birthplace Comparison Guide.

Sources // Evidence Based Birth

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How Mobility Affects Pain Management

11/4/2020

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PictureContinuous, wired monitoring Image via Instagram: @thefirsthello
Being mobile is key to managing pain during labor. Upright and mobile positions are associated with shorter labors, decreased pain, and higher overall satisfaction for mothers. Women often report that when laboring unmedicated, being confined to a bed is least favorable for coping, though when there is an opportunity to rest or sleep it's usually a good idea to take it!

Pain management is largely affected by mobility, and mobility is affected by the cords around you, such as fetal monitoring of heartbeat and IV fluids. Thankfully, you have options for both!

Monitoring: Continuous vs. Intermittent

First, let’s talk about the two major types of monitoring: continuous (all the time) and intermittent (periodic, in intervals such as every 15-30 min). You may be asking yourself, is continuous monitoring actually needed? Research shows and ACOG agrees that for low-risk pregnancies, continuous monitoring is usually unnecessary and can actually create situations where more interventions are performed when not necessarily needed. Continuous monitoring is recommended for 1) inductions, 2) when an epidural is used, and 3) for some specific health conditions.  So, if you are receiving medication, the risk for complications is higher, and additional monitoring is needed.  

Continuous

In continuous monitoring, electronic fetal heart rate monitors are used to measure two things:  
1) baby’s heart rate
2) contractions

There are two devices that do continuous electronic fetal monitoring, and they both provide a digital display and print out of both the contraction and baby heart rate.

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Image via Instagram: @bundlebirthnurses

The most common option and especially the one used during epidurals, uses two sensors that are wrapped around your abdomen and attached by a cord to a recording machine and monitor.  As you can imagine, this requires you to be in or around the bed and near the machine. 

A newer option that many hospitals are beginning to offer for continuous monitoring measures the same two things, but uses bluetooth to send the signals, instead of cords. The sensors are attached as patches on the abdomen. This obviously allows for more mobility, which is a goal, but keep in mind that it also continuously monitors which is not the research-based recommendation for low-risk pregnancies with unmedicated labor. 

Cons to the bluetooth monitoring device: 
  • Bluetooth receptions can be spotty, everyone in the room is usually advised to turn bluetooth off their phones.  
    • The range is often short and while it is waterproof, when submerged in water (bathtub) the signal can be weak. 
    • The signal can fade in and out and it can sometimes produce false data which can usually be remedied by adjusting or resetting the device.

  • Sometimes they are not available because they are in use or are out for repair.

Intermittent

The handheld doppler is used to listen to the baby’s heartbeat. You have likely used this device during your pregnancy at prenatal appointments with your provider when they listen for the baby’s heartbeat. 

The handheld doppler provides the opportunity for the most mobility during labor and can therefore, indirectly, be a great way to increase comfort level and manage pain. The device is portable, so it can go anywhere your nurse can go and you can be in nearly any position for them to get a reading.This device is waterproof and can even be used in the tub. It does require some additional training on part of the nurse, so be sure to ask your provider and hospital if nurses are trained and ready to use the handheld doppler for intermittent monitoring.

IV During Labor

IV's can largely affect your mobility during labor. When you have an IV, the pole must trail behind you which can be an annoyance during labor. Many laboring women report that they feel restricted by it, while others don’t notice it as much. The choice is yours! Typically, IV fluids are not needed in an unmedicated, low-risk pregnancy, BUT hydration and urinating are very important. 

Another Option To Consider
Some hospitals also offer the option of a hep-lock or saline. This is a port where the IV catheter is inserted into one of your veins. It serves as an easy access port to your body for IV fluids or medications. When not in use, it can be taped off! Some families choose this option as a comforting precaution in case of an emergency since it is one less thing a nurse might have to do urgently. Other low risk women choose to forgo this option all together.


Do you know which monitoring options are available at your chosen birth place? Download my Nashville Birthplace Comparison Guide to see your options. This guide compares each of these providers: Vanderbilt, St. Thomas Midtown, St. Thomas Birth Center, Baby + Company, Williamson, and Centennial. 

Here are some ways to be mobile and upright during labor:  
  • Slow dance with a partner
  • Sitting on a exercise ball, bouncing or doing figure 8’s
  • Sitting on a birth stool
  • Standing and swaying
  • Walking, especially in the early stages (balance this with a need for rest and sleep in early labor)
The 615 Doula Co Approach
When I am supporting families in this decision, we will discuss your risk level along with any other determining factors such as if you are planning for a medicated or unmedicated labor. Regardless, hydration (and urinating) is key! I will be right beside you offering water continuously… One less thing you have to worry about!

Sources // Evidence Based Birth

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Managing Pain During Birth

9/26/2020

6 Comments

 
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The fear of pain is the most common concern for pregnant people, especially if it is their first birth and they are unsure of what to expect. “How bad is the pain?” or “I don’t know if I will be able to go unmedicated, but I would like to...”, are both common thoughts that I hear from expecting clients who are interested in an unmedicated birth or know that they will experience some labor before an epidural.


First things first, it all starts with knowledge. Let’s talk about the sensation or pain you might experience in labor. It helps to memorize this acronym:
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P: It is not like a charley horse or breaking a bone. It is purposeful. The contraction is doing something very purposeful and productive by opening the cervix, and the uterus muscle is spinning the baby into position, pushing the baby down and out. It is bringing you your baby!
A: The sensation is anticipated. Contractions or waves are patterned and they continue to build, so it is not like a scary surprise, but you can sense it building.
I: The pain is intermittent, not constant. Unless there is something else going on, you do not feel the sensation of pain in between contractions. These moments in between are nice breaks where you can rest, change positions, communicate, etc. 

N: The discomfort of labor is normal. The discomfort felt during labor is not cause for alarm, unlike an emergency situation where you break a bone, rupture an appendix, etc.  We can normalize the feeling of contractions in labor. 

Once you have some knowledge around birth, your perception can begin to shift. Many like to re-frame the word “pain” or “contractions”, and prefer to use a word like “waves” or “surges”. I personally call them contractions, but feel that “waves” is a great descriptor because you can feel the contraction building up, peaking, and then falling... like a wave. It then washes away until the next one rolls in. Your only job is to ride the wave, not fight it. I also like to describe it as pure power. It is the kind of power you don’t have to will into existence, instead you have to let it be. It is pretty awe inspiring, and really opens your eyes to what your body can do.

The Evidence on Doulas
Laboring women report lower pain levels and lower anxiety levels when they are supported by a doula. There is also a decrease in requests for pain medication, and labors are on average shorter with the support of a doula.

Pain is a physical reaction. Suffering is an emotional reaction, and can be better understood by education and learning what to expect. Here is a great, short clip from Doula and Childbirth Educator, Penny Simkin, on pain versus suffering.

Whether you decide on a medicated or unmedicated birth, it’s important to understand the choices and effects of BOTH options. Below, I have included some popular medications to ease the pain during labor and birth:
  • Epidural (see previous post breaking down the pros and cons of epidurals here)
  • Nitrous Oxide or “laughing gas” - doesn’t pass the barrier to the baby, dissipates quickly, often described as anxiety relieving or calming and sort of a distraction from painful sensations
  • IV or inject-able medications - narcotics that do reach the baby, can cause reactions common in opioids like nausea, itching, or drowsiness, least safe for baby of the medicated routes, but for some that cannot have an epidural this can be helpful
The 615 Doula Co Approach
As a doula, here are some strategies that I use to reduce pain during labor:
  • Knowledge - demystify the birth process and develop an understanding of what your body is doing
  • Perception - affirmations are a favorite (see previous post on affirmations here)
  • Encouragement and assurance of what is normal and acknowledging progress
  • Breathing - 
    • Slowing your breath to bring a calming response
    • Lengthening your breath to provide your body and baby with the oxygen it needs to power forward
    • Syncing your breath with contractions
    • Panting or using short, shallow breaths when baby is crowning to reduce tearing 
  • Water -
    • The shower is a great place for early labor or even transition. Bathrooms often offer a more private space where lights can be dimmed and the environment more controlled. Some birth places have additional sprayers that can be nice for targeting certain areas of the body like lower back or abdomen. The birth ball and stools can provide other opportunities for positioning whether it is a restful sit, bouncing, on hands and knees, or using it to prop one leg up.  
    • The bathtub can help to soothe your body and many mamas comment that the floating feeling is helpful. In the tub you can float on your stomach or back, squat, kneel, or get on hands and knees.  Some of the birthing tools can also go into the bathtub, such as knee pads or towels to soften the edge as you lean over.  
  • Massage - The lower back is a common request, but your neck, hands, or legs can also feel nice. This is another great way to feel the presence and support of your partner.  
  • Counter Pressure - Oh the glorious hip squeeze! This perfect spot really varies by woman and by labor.  Some love the squeeze on the sides, others directly on the sacrum and some even like it on the sides of the lower abdomen as contractions come. We try a few to see which works best for what you are experiencing.  
  • Acupressure - There are two main points, one in the hand and one on the leg. There are other lesser known points such as on the bottom of the foot and at the sacrum on your lower back.  
  • Heat - Heating pad or warm, moist towels.  I actually tote in a sterilized crockpot, which feels a little nutty, but hey, my clients rave (and laugh) about it.    
  • Position changes - Most positions last about a half hour and then it is usually a good idea to switch to another one to make sure that the body is staying mobile, you are staying comfortable, and the time flows more quickly. The possibilities for positions are endless from standing and swaying to hands and knees or squatting on a labor bar with a rebozo.  
  • Movement Techniques - During labor I am attuned and collecting data in my mind about where your baby is in the process and how you are responding to each stage and position. If you are coping well, then I follow your flow and support you. If you are struggling to find your rhythm or cope, then I step in with some suggestions. I often assist you in performing some balancing exercises like sifting with a rebozo while you are on hands and knees. I might support you in bouncing on an exercise ball with hip swirls, doing what Spinning Babies calls “shake the apples”, or to simply rest smartly.


Sources // Evidence Based Birth, National Library of Medicine

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Your Birth Space Vibe

9/17/2020

2 Comments

 
PictureImage via Instagram: @mintandcocoaphoto
The environment of your birth space truly sets the tone for your birthing experience. First, you should ask yourself, how do I want to feel during birth? Do you want the vibe to be spa-like or a more energetic celebration? There is not a wrong answer to this question. It is totally dependent on your personal preference!

Research shows that “Creating an environment that helps women to feel safe and secure during birth can improve women's experiences and likelihood of normal birth.” (Royal College of Midwives, 2014). A “private, undisturbed and dark environment, where women feel calm and safe can promote the release of oxytocin, the hormone responsible for uterine contractions and thought to promote the release of the pain relieving hormones endorphins” (Uvnas Moberg, 2003). When this environment is “not achieved, women can experience fear-tension-pain syndrome, impending labour progress and causing increased levels of pain” (Dick-Read, 2013).

Here are some tips for creating a calm, spa-like environment in a hospital:

During labor and birth, focus and composure are both very important. You may not think of things like beeping, talking, or a subtle hum of a machine as distracting until you are trying to coax a tiny human out of your body 🙂
The 615 Doula Co Approach
Little things such as the vibe of your birthing environment might seem tiny in the overall birth plan, but trust me, these details are so significant in the moment. As your doula, I help walk you and/or your family through your birth space desires. We create a step-by-step plan on how we are going to achieve the vibe you want and uphold it in the actual labor space.

Sources // Royal College of Midwives, Uvnas Moberg, Dick-Read, National Library of Medicine

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    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.

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