The Birth Center Difference

Community Class Success!

We had such a great time last night at our FIRST Community Class at Ellwood Thompson's last night! Thank you to all of our participants, it was actually quite a diverse crowd of couples in different stages of conception and some wonderful doulas wanting to learn more!  We will absolutely be doing another class there, topic to be decided...any suggestions?

Does My Vagina Look Normal?

Even if it has not been your habit throughout your life so far, I recommend that you learn to think positively about your body.”
― Ina May Gaskin, Ina May's Guide to Childbirth

There’s an old joke…men look at their penises 6 times a day…5 times to pee and once just to admire it!  As women, we have to work much harder to see our vaginas, so there is a much larger mystery about them.

Every woman I know is concerned in some way about her vagina.  Well, really, technically, they are worried about their vulvas, which are the exterior lips of the vagina.  As women, we do not really “see” other women’s vaginas or even vulvas…unlike men who are all out there in front, in every locker room in America.  So, that leaves us to compare ourselves (if we chose to) to porn stars and online images.  And unfortunately, like every other public image, those are usually not the most realistic models.

I hate that moment I have a woman cringe at the thought of a vaginal exam, shame and worry in her eyes.  I had one woman who had never let her husband see her undressed…she put on a nightie in the bathroom, and crept to bed.  Intimacy was under the blankets, under the nightie and under the cover of darkness.  Why?  Because she was sure her vulva was abnormal, because her labia minora (the pink, wet inner lips) were too large and uneven.

So, after some gentle talk, and some reassurance, including the option to decline the exam completely, I left the room so she could get ready for the exam.  When I came back in, she was draped well, completely tucked in.  I talked a lot about how all vulvas are different, just like noses and toes.  How some have “innie” lips, and some have “outies” and how often the lips are different sizes.  How we have to learn to be as comfortable with our vaginas and vulvas as we are with our elbows.   And then I asked if she was ready for the exam.

She nodded through tears, and I smiled gently.  I just lifted the drape a bit and peeked.  I dropped the drape, wide-eyed and straight-faced.   “Oh my goodness~ it looked just like a vulva!”  We both started laughing.  I looked again, a bit closer this time, and told her that her labias were perfectly normal, and no larger or smaller than most women’s.   Relief flooded her face.  Tears rolled down her cheeks.  She had spent years thinking she was deformed, believing it for so long she couldn’t even remember when it had become a thought.   I began telling her about her body, explaining the purpose of each part, and continually reassuring her it was perfectly normal.

So, let’s be clear.  Vulvas come large and small, even and uneven, pink and brown, smooth and wrinkly, all of them as unique as the women they grace.  If your vulva doesn’t pinch when you get on a bike or hurt during sex, it’s normal.

Meanwhile, as some homework, go visit http://www.greatwallofvagina.co.uk and enjoy the great variations that nature brings us.

Support Our Community Care Circle with Urban Baby Beginnings!

For those of you who have wondered what kind of program we have cooking for our Community Care Circle, tonight's the night! We welcome all community supporters to meet and mingle with us as we share the vision and mission of quality care for all mothers and babies. We'll all be available at the Embrace Wellness Center, 124 Buford Rd., 6-8 pm.

We will begin our Community Care Circle informational time for mothers every Friday from 5pm - 6pm starting August 5th!

What We Provide

Based on your individual needs, the following services may be available:

Midwifery Services Include:

• 20 - 30 minute prenatal check
• monthly through week 28
• every 2 weeks from week 29 - 36
• weekly from week 36 - delivery
• Routine lab work
• Postpartum visit

Supportive Services Include:

• Birth Doula to support you while you labor
• Postpartum Doula when home
• Breastfeeding education and support
• Home Visiting Program
• Licensed Perinatal Home Health for high risk pregnancies and more
• NICU Graduate Safe Landing Program
• HEAL Program (Help Educate After Loss)
• Transportation to and from your Midwifery appointment at Embrace or help setting up
• Community Referrals as appropriate

Educational Events to Include:

• Childbirth education
• Yoga classes
• Daddy Bootcamp
• Newborn Care Education

How Mothers Can Get Started - Medicaid recipients automatically qualify for services**

1.  Request a referral from your MD office or Social Worker
2. Once a referral is received, an intake Coordinator will contact you to set up an appointment.

**Clients with no insurance will be accepted for supportive services on a sliding scale basis.

Contact:

Stephanie Spencer, RN, BA, CBE, LD

Director of Health Services

Urban Baby Beginnings

1704 W. Laburnum Ave

Richmond, VA 23227

804-519-5526

facebook.com/urbanbabybeginnings

Birth Affirmations for Pregnancy & Labor

Your mind is powerful, put it to good use with reassuring affirmations for you and your baby.

The Power of Birth Affirmations
By Rebecca Gruber


Hypnobirthing isn't for everyone, but for moms-to-be who are planning a natural childbirth, classes can provide them with tools in their tool belts to help them learn techniques to relax and cope with the intensity of labor and delivery. Instructors tend to hand out CDs remind laboring moms to focus on breathing and positive thoughts, and though it sounds a little weird, it can honestly be really helpful. One of the CDs is often filled with birth affirmations, which you've probably heard about in prenatal yoga classes. You basically say a positive statement either in your mind or out loud, and it helps dissipate fears and manifest the feelings you want to experience. Based on advice from moms who've been through it, we wanted to share some birth affirmations that have built their confidence and made them feel more prepared for childbirth.

• Our baby's birth will occur at just the right time and just the right way.
• I trust my body to grow my baby, and I trust my body to birth my baby.
• My body is strong enough to birth this baby.
• I enjoy experiencing the power of my body as my birthing muscles bring my baby to me.
• With each amazing wave, I am letting go more easily.
• I am releasing to these sensations.
• I let these waves wash through me as I go deeper into relaxation.
• I am connected to myself. I am connected to my partner. We are connected to our baby.
• I welcome strong waves that are bringing my baby closer.
• Every contraction brings me closer to our baby.
• The stronger my contractions become, the sooner I meet my baby.
• I breathe slowly and easily, and it helps my body to let go.
• I breathe to my baby, and let my breath flow down and out my baby's birth path to show my baby the way.
• My body is so open that my baby just slides right out and into my arms.
• I am calm, I am safe, I am relaxed.

Hearing these for the first time is a little odd (or reminds you of SNL's Jack Handey), but if you can get passed feeling weird and say them to yourself, they will help replace your fears with positive feelings.

If you have any affirmations to share, we'd love to hear them as well.

To read the original article, click here.

Intro to Cloth Diapering from Green Baby Planet

Are you interested in cloth diapering but not really sure where to start?  Green Baby Planet at the Embrace Wellness Collective is offering a class, Intro to Cloth Diapering Saturday, July 23rd at 1 pm! Here's a little 101 info on the subject to give you some insight into the benefits of cloth diapering!

Cloth Diapers 101
By Allison Pennell from Parents Magazine

Think cloth diapers are impractical? Think again. They've changed a lot since Grandma's day. Here are the facts.

Cloth Diapers: The Basics
For disposable users out there who wince when contemplating your family's personal contribution to the local landfill but even more so at the thought of the alternative, cloth diapers are an option you may want to consider again. They're not what they once were.

Say goodbye to your notions of the pins, the big square pieces of cotton, leaky kids, and the daunting task of cleaning up. Easily laundered all-in-one diapers are the order of the day. With snaps or Velcro closures, waterproof banding around the waist and legs, and natural, breathable fibers that require no soaking, cloth diapers can be a more palatable choice than you may imagine.

For the fashion conscious, there are all the cool patterns to consider. For those concerned with keeping little bottoms pristine, you won't have to worry about blowouts and suspicious chemicals used in making disposables so absorbent. Add to this the potential savings and you may want to give cloth-diapering a try.

The Bottom Line
If you go cloth and launder them yourselves, the cost over three years will be between $800 and $1100, half as much as disposables. And diapering a second child will only cost you the laundering (about $400 for three years).

Home Laundering 101
Don't worry that your house will become a toxic waste dump. There's no longer any need to soak, rinse, or flush a diaper. Simply shake solids into the toilet and drop the diaper into a plastic-lined pail after a change. When the pail is full, tip into your washer. Wash once with a detergent like Tide or Cheer Free, reset washer, add more detergent, and wash again. Don't use bleach. Rinse twice to be sure all residue detergent is completely rinsed away and dry on hot. Not as bad as you thought! And it won't leave your washer stinky. It will be exactly as clean as the diaper and drains to the same place your toilet does.

Stocking the Changing Table
Experts estimate that you'll need about 2-3 dozen diapers if you get to the wash every third day, about 75-80 if you use a weekly diaper service. Many diaper services include diaper rentals in their price but you sacrifice choice.

Eco-Friendly Diaper Services
If your motivation to use cloth isn't based on finances, and the prospect of home laundering is an intimidating one, you may want to opt for a local diaper service. As a rule, services now use biodegradable detergents in their cleaning process rather than the harmful phosphates of old. Like disposables, the costs of using a diaper service plus diaper covers will fall in the range of $2000-$2500 over a three year period.

To Push or Not To Push? Only you can answer that question!

The more research that goes into birth, the more we find out how instincts and natural intuition plays a role in successful birthing.  As a western culture we have grown accustom to doctors telling us how to care for our bodies as if it were separate from ourselves.  Ultimately, if we are in tune with our bodies, we can decide the right steps to take as long as we have access to good information!  That is our ultimate goal at Embrace Midwifery & Birth Center, to equip you with good information for you to make the best decision for yourself!  We believe all birth is beautiful and agree with Dr. Rachel Reed, the author of this wonderful article that, "a powerful, primal, loud and ‘out of control’ birth is just as amazing and valid as a gentle, quiet ‘in control’ birth."

Pushing: leave it to the experts
By Dr. Rachel Reed

A birthing woman is the expert regarding when and how she pushes. Providing directions implies she needs our guidance and we are the experts. Of course each woman and birth situation is different and in some circumstances guidance may be helpful for a woman. This post will examine the implications of telling women when to push, how to push and not to push during birth.

This post is based on part of a literature review I carried out for my PhD. You can find more information and the reference list in my Phd thesis (p.19 to 24) or on a research poster you can download here.

Telling women to push

There is overwhelming evidence that directed pushing results in increased morbidity for both mother and baby, and amongst other things is associated with: Mother – altering body fluid pH resulting in inefficient uterine contractions; maternal fatigue; and metabolic acidosis. Baby – interferes with the gradual descent and rotation and increases risk of hypoxia.

In addition directed pushing does not reduce the duration of the ‘second stage’. However it does result in the common scenario of: Woman is directed to push = baby becomes hypoxic and fetal heart rate abnormalities are heard… woman is shouted at to push harder to get her stressed baby out quickly… woman pushes harder… baby becomes more hypoxic and stressed… obstetrician is called in to rescue the baby and pull it out.

Telling women not to push

The cervical lip

The most common reason for telling a women not to push is that her cervix is not fully dilated. Often when a baby is in an occipito posterior position the woman will feel the urge to push before the cervix is completely open. She is then told not to push because the lip will swell up (and/or tear) and prevent the baby from descending. Not pushing is an almost impossible task and many women in this situation opt for, or are encouraged to have an epidural so they can stop pushing. The baby is then less likely to rotate into an anterior position because the pelvic floor tone is reduced and the woman is unable to move.

There is no evidence to support his notion of a swelling cervix and I am yet to encounter the situation as a result of  ‘premature pushing’. In some cultures it is tradition for the woman to push with each and every contraction from the beginning of labour. Surely these cultures would have died out if the outcome had been swollen/torn cervices and stuck babies. Studies (Borrelli, Locatelli & Nespoli 2013; Downe et al. 2008) have found that the incidence of ‘early pushing urge’ EPU (as it is referred to in the literature) is between 20% to 40% and is not associated with complications.

When we tell a woman not to push the message is ‘your body is not working correctly and is sending you the wrong messages – you need to fight against it’. Fighting her body until she is ‘allowed’ to push may result in difficulty switching into trusting and following her body once given the ‘go ahead’ (Bergstrom 1997). For more information about pushing and cervical lips see this post.

Breathe don’t push***

I need to breathe before I write this next bit as I am sure it will offend many – some of them my friends. So please feel free to comment and share your alternative views. Here goes… there seems to be a growing trend of telling women to resist their instinctive urge to push. The idea is to ‘breathe’ the baby down gently, and it does sound lovely. However, I have spoken to a number of women whose birth stories conveyed a sense of failure because they were unable to achieve this gentle ‘birth breathing’. I have also seen women attempting this during birth – struggling to breath upwards lightly to avoid the guttural downward pull of their body.

Hypnobirthing – the Mongan method seems to be one of the key advocates of this no-push technique and I recently read the book in an attempt to understand the approach. Overall the book has many positive messages for women about their innate ability to birth. However, I have concerns regarding some of the concepts (which I will blog about in the future) in particular ‘birth breathing’ . I agree that staff directed pushing is not good (see above) but I disagree with the following quote: “Often women speak of an overwhelming urge to push taking over. If this is felt it is also because of conditioning… our animal sisters elect to gently expel their babies” (Mongan 2005, p.129)

Pushing is physiological and instinctive, and a feature of all mammalian births. To tell a woman that if she pushes she has given in to external programming and her baby will not enjoy a gentle birth is disempowering – especially for those who fail to override their ‘conditioning’. A powerful, primal, loud and ‘out of control’ birth is just as amazing and valid as a gentle, quiet ‘in control’ birth.

***We strongly believe in choice, and while we are strong advocates of Hypnobirthing, we don't believe in edited or convenient information.  We have had an amazing success rate with our Hypno-mamas, and while we don't practice telling mothers when to push, we have too many amazing births and testimonies to reject its effectiveness and find that it does facilitate calmer births.

Suggestions for Midwives

Antenatally

• Find out what the woman’s expectations are about this part of labour.
• Reinforce her belief in her own innate ability to birth and explain that this is the reason you will not be telling her how and when to push. This is important as some women will interpret a lack of instructions as a lack of support if they are expecting to be told what to do (Anderson 2010; Parnell et al. 1993).
• Encourage first time mothers to talk to other women and read birth stories written by birthing women. This will give her some idea about what it may feel like, and how different it is for each woman.
• Show her ways to connect with her body and relax her pelvic tissues so that she can use this in labour if needed. 
• If the woman is planning a hospital birth she will need to be prepared for hospital practices including directed pushing – a Doula and a birth plan can help. The Maternity Coalition have a good info sheet aimed at parents.

During birth

• Avoid interfering with the physiological process ie. only do or say something if it is really necessary.
• If the woman tells you she feels the urge to push, reassure her that this is good. Don’t tell her to push. There will come a point when she is pushing rather than feeling an urge to. Gloria Lemay has recorded an audio ‘pushing for first time mothers’ explaining why this is so important, especially for first time mothers.
• If she is extremely tense and the baby is not descending encourage her to use the techniques she learned antenatally to relax her pelvic tissues and open.

In essence – telling women when to push, how to push or not to push contradicts the notion that women are the experts in their own births.

Pushing with an epidural

The information above is about physiological birth i.e. a woman birthing without intervention. An epidural can alter the ‘urge to push’ and prolong the descent of the baby once the cervix is open. An evidence based approach to pushing with an epidural is to wait until the baby’s head is visible i.e. is almost birthed. Then, if required, actively push to birth the baby… it should only take a few pushes. This approach reduces the chance of an instrumental delivery and decreases pushing time (Brancato et al. 2008). I have worked in a hospital where this was the standard approach and there was a lot less fetal distress and perineal trauma for women with epidurals.

It is also beneficial to help women with epidurals to get off their sacrum to increase pelvic space. So, semi-supine is perhaps the worst possible position. Many women can move and kneel or squat with an epidural – if not a side lying position allows the sacrum and coccyx to shift backwards.


For more great information and to read this article, visit MidwifeThinking.com