So how lucky are we that one of our own is 9 months pregnant.  She was our model for this super fun photo shoot where we are doing some of our favorite positions for laboring and pushing.  Be sure to check out the whole set to get inspiration for your own labor and delivery.  You can find the whole album with comments on facebook - http://www.facebook.com/media/set/?set=a.449655948404915.90542.100000815403904&type=1

We had one of each in our house: one baby that we let cry for periods of time to self-soothe and one where I simply couldn’t bear to hear the crying in quite the same way. You’d think it would have been just the same for both of our boys, but it wasn’t. Clearly I wasn’t the same parent each time around.

There are many things that go into the equation of how we get our babies to sleep thought the night. And those of us who struggled after our babies after 6 months of age are in good company. Research shows that about 45% of mothers say they struggle with their 6-12 month-old’s sleep.

Solving the sleep solution requires a diverse mix of instinct, patience with personal and baby temperament, timing, mood, advice we get, and good luck.

The reality is that there isn’t one perfect way to help support an infant who’s learning to sleep through the night. But there are few pearls I believe in:

• Start letting your baby learn to fall asleep on their own (not at the breast or with a bottle or always being rocked) at 1 months of age when they are drowsy but content. At least a few times a day, let them fall off to sleep on their back, in a crib without you. This will help them learn the skills of self-soothing. This can serve your entire family…
• Start a bedtime routine during early infancy. Do your best to keep the same bed time with the same routine each and every night.
• Let your baby show you their resilience. Allow them to fuss and crank and re-position themselves at times to learn how to calm themselves and learn how to self-soothe. I sincerely believe infants surprise us with what they can do. This doesn’t mean you have to listen to your baby wail!

Beyond those pearls, I’ve yet to commit to recommending one strict sleep method for patients. I often try to offer up the options. I believe some babies and parents do very well letting their babies “cry-it-out” while others really suffer. The good news is that we’re all doing it right—in the long run, we all can care for our children with equal love and compassion. New data this month sets this straight.

Teaching parents to regulate their children’s sleep behavior is a form of limit setting that, combined with parental warmth, constitutes the optimal, authoritative, parenting style for child outcomes.

A study published recently followed up on infants and moms who had reported challenges with sleep at 7 months of age. The researchers initially (5 years prior) had randomized babies and their moms into groups — one group got no advice about sleep while the another group learned about two sleep training methods from nurses at 3 visits:

1. Controlled comforting: parents let their baby “cry it out” for longer and longer stretches of time. They still return to the babies for comforting but give their babies a chance to learn to self-soothe for periods of time.
2. Camping out: a technique where parents sit or lie with their babies and children until they fall asleep and gradually extract themselves from their children’s sleep space.

In the original study, parents who learned the two techniques found their babies slept better at 10 months of age compared with the parents who didn’t. The mothers who used sleep training had significantly less depression, as well. In the short term, these sleep interventions served both the baby and the mothers.

The researchers then followed up on the infants after they had reached their 6-year birthday. They evaluated the children’s sleep, their levels of stress hormones (cortisol) twice during the day, their mom’s anxiety and depression, and the bonding between children and their moms. What they found should make us all feel pretty good. Didn’t matter if you let your baby cry it out, if you camped out, or if you did none of the above, neither setting seemed to affect mom’s mood, the degree of bonding, or the levels of stress children experienced when they were entering the school years.

The best kind of news of all: maybe we’re all right.

Wendy Sue Swanson is a pediatrician who blogs at Seattle Mama Doc.

So a French study published in AJOG this month shows that planned vaginal breech birth is pretty safe.  With just over 2500 women attempting a vaginal breech delivery, researchers looked at the outcomes, to measure any adverse perinatal outcomes.  Once they controlled for variables, they found that the things that contributed significantly to these adverse outcomes were things like premature baby, small for gestational age baby, geography of mother and experience of hospital.  Being breech alone didn’t affect the outcome of the delivery.

In Texas there is only one doctor who will perform a vaginal breech delivery of a singleton.  That’s Frederick Cummings in Denton.  He’s highly experienced in this area, and women from all over Texas will drive to him to have the opportunity to attempt vaginal birth instead of being relegated automatically to a c-section.  As doulas we’ve even had the opportunity to support women making the journey, and it’s awesome.   So just remember, you always have options.

http://www.ajog.org/article/S0002-9378(12)00906-4/abstract

Factors associated with adverse perinatal outcomes for term breech fetuses with planned vaginal delivery

Objective

We sought to identify factors associated with adverse perinatal outcomes (APO) among term breech neonates with planned vaginal deliveries.

Study Design

We conducted univariable and multilevel multivariable analysis of the data collected in the multicenter prospective observational study PREsentation et MODe d’Accouchement (PREMODA) in women with planned vaginal delivery giving birth to singleton term breech babies. The end point was a composite set of APO.

Results

Of 2502 women with planned vaginal delivery recruited in the 174 participating centers, 1772 (71%) delivered vaginally. Adverse outcomes were observed in 165 cases (6.59%). After adjustment, the factors associated with them were geographic origin, gestational age <39 weeks at birth, birthweight <10th percentile, and annual number of maternity unit births <1500.

Conclusion

When strict conditions governed the selection of delivery route and management of labor was rigorous, APO were not associated with any prenatal or peripartum obstetric factors.

If you’re headed for an induction, and your cervix isn’t “ripe” you have two main choices to make it more favorable for induction. The traditional method is a topical postaglandin (Cervidil usually). You report to the hospital the night before your induction and have this gel on your cervix for 12 hours before starting other induction drugs.

Or, you could opt for the foley balloon. In this option, your OB would insert a balloon next to your cervix, and would pump it up with saline so it’s putting pressure, also stimulating natural prostaglandins to promote opening and softening. There are two clear advantages of going this route. The first is that you can go home! How nice to be able to sleep at home the night before you have your baby, laboring when you’re not well rested is a real bummer. And sleeping in the hospital is tough, because you have to be monitored, blood pressured, poked, prodded, bugged, it’s not a great sleep. Another advantage is that sinces it’s mechanical in nature, it’s “natural”. No drug has entered your body, and you can continue to labor using other natural methods.

There are only two doctors that I work with in Austin that do the foley routinely as their preferred method of ripening, probably because of my two points above, becuase they support a more mother friendly apporoach (Nurture and OBGYN-North). Why don’t the rest of doctors do it? I have my doula clients request this option many times, and there is always some excuse as to why the balloon is inferior to the drugs.

But low and behold the study in the American Journal of Obstetrics and Gynecology this month. The foley balloon actually does better by having more women delivering babies within 24 hours of its use than of traditional prostaglandins. Now science favors mother-friendly care too. Ladies – ask your doctors about your options!

A randomized trial of preinduction cervical ripening: dinoprostone vaginal insert versus double-balloon catheter

Objective

Alternate Nostril Breathing or (Nadhi Sodhana) is a good way to provide balance for the right/left hemispheres of the brain and to increase oxygen to the cerebral tissues. Shirley Telles, PhD (a leading researcher in the field of Yoga) shows that right nostril breathing has a stimulating effect on the body and the mind, while left nostril nostril breathing has a calming effect. It makes sense, then, that if someone who experiences major depressive episodes, her energy might be expanded with right nostril dominance breathing, in which you inhale through the right nostril and exhale through the left. On the other hand, if you are feeling anxiety, a few extra rounds of left nostril dominance breathing will help.

Labor can be vary intense, we know this to be true. Employing left nostril breathing can help bring about a calming effect. And I think it probably helps us slow our breathing, and provides a distraction for our minds – now we have a task to focus on, we no longer have to worry about the pain of the next contraction, or how to cope with the pain, or when it will be over. All we need to do is focus on our breath, and find a natural rhythm in changing nostrils with each inhale and exhale.

As a biochemistry graduate and crazy hippy all in one this alternating nostril breathing intrigues me further. The ancient Kundalini Yogis have always honored the pituitary gland as the master gland of the body, the internal thermostat and regulator for emotion. It’s an ancient wisdom that might contain relevance in modern endocrinology. When we slow our breath, our hippocampus signals to our pituitary gland to release more beta-endorphins (anti-stress hormones). Slow breathing, and alternate nostril breathing actually change the biochemistry of our bodies to promote relaxation. The pituitary gland is of course the main focal point of labor. This is the gland that releases oxytocin, the hormone of labor, while also being involved involved in releasing beta-endorphins, our own natural opiates. Kundalini breathing may help us to labor faster and more efficiently by stimulating release of our own endogenous oxytocin (making us labor more efficiently), while at the same time encouraging increased levels of endogenous opiod release to help us cope with that same increased pain and intensity of labor.

Shorter labors with less pain? Yes please. Who’s wants to be my next guinea pig for alternate nostril breathing in labor?

Thank you to these smart folks for intriguing my interest in combining yoga and chemistry:

Yoga for Depression by Amy Weintraub
Kundalini Yoga by Shakta Kaur Khalsa.
Corticotrophin-releasing hormone and beta-endorphin in labour.
McLean M, Thompson D, Zhang HP, Brinsmead M, Smith R.
Eur J Endocrinol. 1994 Aug;131(2):167-72.

Brittany, our newest shadow doula at Get Babied, shares some of her tips on the emotional side of breech presentation (have had a breech baby herself).

With a breech baby, there are two distinct approaches that you can take.

The first is to investigate ways to turn the baby into the cephalic, or head-down, position. I have attached an article that lists different ideas to help with this. It’s a good starting point, and many of the suggestions can be done at home.  For those that requires outside assistance, I have included below the names and contact information of two practitioners in Austin.  I highly recommend both women, having been a client of theirs during my pregnancy.

There is also a website called Spinning Babies, which focuses on getting babies into the optimal position for childbirth.  There is a section on the website reserved for breech birth that might be helpful.

I find that the above approach can be empowering because it allows women to participate in turning the baby.  It has its downsides, namely the time and money spent and the possible frustration if the baby doesn’t turn.  The second approach is to wait and see if the baby moves spontaneously. For some women, relinquishing control can be liberating and lower their stress.

Whatever you choose, I think it’s important to make decisions that will benefit you mentally and emotionally.  One of the best things that you can do is talk to individuals who will listen and support your decisions. (The doulas at Get Babied are great at this!)  It’s also important to engage in activities that calm your mind and relax your body. If you’re having trouble with this, a great book is Stress Solutions for Pregnant Moms by Susan Andrews.

Local Resources for Breech Presentation

Acupuncture and Moxibustion

Light Family Acupuncture

http://lightfamilyacupuncture.com

Mayan Abdominal Massage

Hannah Ford – Mint Massage Therapy and member of Get Babied! Co-op

www.mintmassage.net

Web-Based Resources for Breech Presentation

Spinning Babies

www.spinningbabies.com

The best defense is a good offense, and that’s especially true when it comes to avoiding PPD. There’s no guarantee that you won’t get PPD if you follow the steps below, but being proactive will reduce your chances of ending up a victim of PPD, and you’ll have more of a safety net to help you out if you do develop it.

Preventing PPD starts while you’re still pregnant, and continues until your baby is off to college. (Just kidding. Sort of.) If this list of things to do seems overwhelming, just try one or two things. IF YOU THINK YOU HAVE PPD ALREADY, tell your partner, provider, and best friend so they can help you get help. PPD is an illness, it’s easily treatable, and it’s not your fault. You will feel normal again, and you won’t even have to stop breastfeeding if you don’t want to.

1. Pick a provider you feel comfortable with. The labor and delivery will almost certainly not happen the way you imagine it. That means you need to trust your provider absolutely to make decisions that are right for you and your baby. Find a provider that takes you and your concerns seriously, and seems comfortable with the preferences and situation you’re bringing to the experience. Don’t be afraid to switch if you think the fit isn’t right.

2. Find support for feeding problems while you’re still pregnant. Many women attempt to breastfeed, and most of those women discover that it’s not as easy as they thought it would be! While you’re still pregnant, find an International Board Certified Lactation Consultant in your area. Put her number on your refrigerator, so when you’re crying on the first day home from the hospital you have someone to call for knowledgeable help.

3. Line up help for the first few weeks after the baby arrives. Caring for a new baby is hard, tiring work, but it’s also lonely. Even if your partner is going to be home from work for the first week or two, you’ll still do much better if you have another adult around the house for a few hours each day to help you with laundry, feeding yourself, holding the baby while you nap, and providing some adult conversation.

Choose your help wisely, though—pick someone you can stand to be around for long hours under stressful conditions. Surrounding yourself with people who are happy and kind will make the first few weeks better.

4. Drink lots of water. The more water you drink, the faster your body will flush out the toxins, reduce swelling, and start to heal itself. Try to drink a glass of water every time you sit down to feed the baby.

5. Take your vitamins. Especially the B-complex vitamins, which have been shown to help elevate mood. Consider adding a B-complex supplement to your regular multi-vitamin/prenatal.

6. Take Omega 3 fatty acids. Fish oil or flax seed oil in capsule form is the easiest to take. In addition to regulating your moods and serotonin levels, Omega 3s will help prevent plugged milk ducts, lower your cholesterol, and make your hair shiny.

7. Exercise for at least 20 minutes a day. Things that strengthen your core and help regulate your hormones (like T-Tapp, yoga, and Pilates) are good choices, as are cardio exercises that will get your heart rate up (like walking, swimming, and climbing stairs). Even dancing around the living room with your baby for 20 minutes will help.

8. Ask someone to give you a massage every day. Seriously. Evidence is showing that as little as 15 minutes of massage a day is as effective as anti-depressants in preventing PPD. Your partner and friends love you and want you to feel good, so they’ll be happy to take turns giving you backrubs every day.

9. Get as much sleep as you can within the limits of your situation. It’s going to be a loooooong time before you get eight hours in a row again, but the consensus among tired parents seems to be that if you can get one four-hour stretch and a few other stretches each day you’ll be able to function decently. See if you and your partner can take turns so that each of you gets a four-hour stretch each night.

If you can, keep the baby in the room with you so no one has to make the long trudge down the hall whenever the baby wakes up. This is no time for heroic sacrifices on the altar of How Your Baby Should Be Sleeping, so do whatever you have to do to get everyone as much sleep as possible.

10. Turn your face to the sun. Getting 5-10 minutes of sunshine a day can really help your body feel better. As an added bonus, if you take your baby into daylight first thing each morning it will help her start to regulate days and nights better.

11. Go out every day at the same time. Whether it’s for a walk around the block, to run an errand, or even just to walk around at the mall, setting a time to go out of your house and into the outer world will give your day some structure and help you feel like a normal person again.

12. Force yourself to make new friends. You’re feeling insecure and puffy and tired and shocked, but so is everyone else with a new baby. You’re all in the same situation, so it’s an excellent time to make new friends. Force yourself to get out to breastfeeding support groups, new mom drop-in groups, the library and bookstores, and the places in your neighborhood where the new parents hang out. Then start talking to people. (Commiseration about lack of sleep is always a good topic.) Eventually you’ll start to find people to hang out with and share the experience with.

13. Keep your baby as close as you want to. There are tons of wives’ tales about not picking up your baby too much, but babies and mothers are built to be a close unit at the beginning. Carrying and holding your baby will help him regulate his movements, digestion, and sleep, and make him cry less. Staying close to your baby is good for you, too, as it helps regulate your moods and milk production (if you’re nursing), and pumps up your biceps. Your baby will be running away from you soon enough, so enjoy the snuggle time as much as you can right now.

14. Be gentle with yourself. You’re doing the best you can, and that’s all anyone can do. You’re the perfect mother for your child.

May is here, and Mother’s Day is just around the corner!  At Get Babied, we’re big fans of moms and moms-to-be, and we’re devoting the month of May to pampering moms and future moms.  If you are expecting and interested in having a blissful birth and pampered pregnancy, please stop by one of our Meet the Doulas Nights this month!  This is also perfect for moms with little ones looking for postpartum support to come find out more about what our postpartum doula team has to offer and how they can spoil you a bit this month.  Our Meet the Doulas Nights are always a lot of fun, and they are a great opportunity to meet all of us face to face, take a load off, have some yummy food and soothing tea, and find out more about our services.

We will hold our Meet the Doulas Tea on Tuesday, May 8, from 7-9 pm.  This is a casual Meet the Doulas Night with tea and light snacks.  We won’t have a guest speaker, but we will have a birth testimonial from previous clients, Christine and Jay, and then we’ll break up and do a speed-dating session so that you can meet all of the doulas, and we can all meet you!

Our second Meet the Doulas Night this month will be on Saturday, May 19, from 7-9 pm.  Please note that we are moving it up a week this month in order to avoid Memorial Day conflicts.  Sleep consultant, Bruce W. Meleski, Ph.D., will be speaking about the importance of sleep and suggesting ways to help new parents get some much-needed rest.  And, as always, we will have a birth testimonial from a previous client.  It will be a fun and informative evening!  You won’t want to miss it!

All of our Meet the Doulas Nights are held in our office at 1825 38 ½ Street.  You don’t need to RSVP.  Just show up!  We look forward to seeing you!

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And in honor of Mother’s Day, let us pamper you at the Get Babied! Spa Fest at Baby Earth in Round Rock on May 12!  Admission is free, and there will be tons of giveaways, free massages, speakers, lots of awesome vendors, and all kinds of goodies.  If you came to our Baby Expo this past January, then you know that the Get Babied! doulas know how to throw a party.  Mark your calendars, and join us Mother’s Day weekend for some extreme pampering!

Many moms put all their energy into getting through pregnancy and preparing for the birth with no real plan for the early post-partum weeks. They expect to care for their baby. But who will help care for the new mom?

Post-partum doulas, family and friends can help.

Making a Plan
New moms should start planning for their post-partum period before baby arrives. Women spend lots of time preparing for the birth, but not much time preparing for life with a new baby.

New mothers need rest, breastfeeding support, help for older siblings and a way to maintain a sense of self. That’s a tall order for many moms, and a post-partum plan can help organize those details so Mom can focus on the baby.

That’s where a post-partum doula comes in.

Post-partum doulas provide non-medical support and are trained consultants and educators who specialize in the care of new moms, babies and families in the first 12 weeks following birth.

It’s important that moms get help for themselves so they can feel more rested and confident taking care of their child.

Plus, 10 to 20 percent of new moms experience some kind of mood or anxiety disorder following birth, placing unrealistic demands upon yourself can lead to physical, emotional and even mental breakdowns.

Changes in a woman’s body contribute to a new mom’s stress. Immediately following the birth of a baby, a woman experiences a dramatic change in hormone levels, and her body makes a sudden adjustment from pregnancy to post-partum.

Feeling in control of your environment can help. It’s important to gather helpful supplies beforehand, such as pantry staples, healthy snacks, household items, toilet paper and laundry detergent. Even having a spot ready to feed the baby can be helpful in the early days. Get that area set up and stocked with burp cloths, bottled water to stay hydrated, snacks you can eat with one hand and a stack of books.

Don’t forget about your time in the hospital. Having a plan for dealing with visitors can help new moms feel more in control of their situation.

Asking for Help
A mother’s job during the first few weeks post-partum is to rest, eat, hydrate and feed her baby. New moms almost always try to do too much in the first few weeks following birth. Oftentimes, a mom might feel physically well, but if she tries to do too much, she’ll get tired easily.

The first few weeks are very critical for families to bond together,” she says. “Let the housework go, stay home and just hold that baby.

Even if families don’t have a post-partum doula, family and friends can make a big difference in easing the transition for the new mom.

Friends can also help by setting up a meal calendar for the first few weeks. A simple cooler on the porch to place the meals will give the mom some peace, but also nutrition. When friends and family do visit, they should stay for only a short period of time, and see if they can vacuum, fold laundry or empty and fill the dishwasher.

Something as simple as holding the baby while Mom naps or takes a shower is helpful. A new mom, though, might just want extra household help while she holds her baby. It is far better for the new mom to hold her baby while someone else helps around the house. The primary needs of a post-partum woman are plenty of rest, good nutrition and emotional support.

You can’t be superwoman. Take it easy on yourself. If help is offered to you, grab it.

Her postpartum doula probably helped her into that breastfeeding position.