My Mundane Birth

I have always been amazed at the miracle and mundanity of birth. It is the most normal, universal experience AND the most magical and unbelievable event. And my birth was one of the mundane ones. 

I have been to around 200 births in the last 13 years. I have seen people go through incredible journeys and have heroic births. Mine was not one of those for me. My birth was simple, straight forward and very uneventful. I was at first surprised and sad about this feeling. I thought I would go on a trip and have to overcome and persevere and.. and… have one of the triumphant births I have witnessed so many times before. I thought I would get to the point where I said, “I can’t do this,” and then do it! But I never felt like I couldn’t do it, I knew I could do it.

During my birth, my partner kept wanting to call the midwives because he thought it was time for them to be at our house. But I kept thinking I was in early labor, that I might have to do this for days. I told him the contractions were still short and not that close together. He let me know that indeed they were about 3 min apart and a minute and a half. At that moment, I thought to myself, “This is it, I’m in labor, if this is it, I can do this.” Even while pushing, where a lot of people get to a point where they aren’t sure, even witnessing births, I have thought “how is that going fit?!” I never thought that. I knew that I could birth my baby at home. 

I don’t write this as a show of strength or bravery, I write this to bring to light my unique experience as a midwife giving birth. As a person who has seen birth and wasn't scared of the process, someone who trusted the process deeply and was allowed to surrender to the experience. 

I have seen birth, I know birth. And I was able to carry that knowledge with me through the birth of my daughter. This should be every birthing person’s right. We should all know birth and feel comfortable and confident going into this mystery. I am not saying that I knew birth IN my body. The sensations were like nothing I have ever felt and I was in awe of this. But I knew deep in my heart that I was safe and this was the way to birth a baby. With that knowledge and trust in the process I was able to drop into a space to let my body take over, let my body open and get my baby from the stars. 

I feel like in the past people saw birth more often. I am not an anthropologist who studies birth practices of past cultures. But I can assume that when birth was taking place in the home of people’s sisters, mothers, and aunts, more people saw birth. And seeing birth more normalizes it. Most people giving birth today have not even seen one birth! (again, I am not sure if there are statistics that back this up, but in my experience most people have never witnessed a birth). This has to have an effect on how we go into birth! If we have never seen birth (other than in the media), how could we feel confident and trust the madness that is birth? Can we fully trust the word of our care providers or the machines that we are hooked up to monitoring our well being, or do we need to be witnesses to the process and talk to mothers who have given birth and who have also witnessed birth? 

I was also able to have this mundane birth because of my privilege. I am white in the USA, so this gives me the ability to go into birth without much fear of losing my life, or my baby’s life. Unlike a woman of color in the USA who is up to 4 times more likely to die due to systemic racism. In addition their baby is about 2x as likely to die. I speak the same language as my care providers. On top of that I have more knowledge about birth and my options than most people. I didn’t have to navigate a system that is set up for profit and not for the optimal outcome and experience of the birthing family. I was at home with midwives who are my dear friends and people who care deeply for me and my family. I am healthy and don’t have trauma that I had to work through before or during my birth. I have a partner and family who are supportive of homebirth and physiologic birth. I see this privilege and wish this for every birthing family.

I wish everyone could have a mundane birth. That they didn’t have to dive into the unknown without an internal knowing of what the birth process is as well as countless role models through their lives. I am amazed at the people’s births who I have attended and they have just trusted my word that “everything is normal,” and “yes this is indeed the way,” even when I hadn’t gone through it myself. I am amazed that women continue on even though it feels like it can’t be the right way. I guess that is the feeling of “I can’t do this.” But we keep going and get the sweetest gift at the end. But really that is just the beginning of opening, learning, stretching and overcoming the impossible as parents.

Pelvic Floor Activation- The First Steps

Pelvic Floor Activation- The First Steps 
Guest Blog by: Carolyn Wojtusiak DC, Chiropractor, Women's health and Fitness

One of the most beautiful experiences to go through as a person is the miracle of childbirth- bringing new life to this world. It is the most rewarding and uplifting experience, but it also comes with side effects that we, as parents, are not expecting. Throughout the first few weeks of post-partum, the transformation into parenthood is in full swing and it is a time where one is learning to live their new “normal.” While learning to be the best parent possible for your little one is paramount, adjusting and healing from delivery is a close second. Challenges that people experience throughout healing are often caused by or cause pelvic floor weakness. Finding the connection to our pelvic floor so it can heal can be very challenging and my answer is always to return to the basics. 

The pelvic floor (PF), in and of itself, serves as the hammock to our pelvis. It is composed of muscles which are responsible for two major functions in our body. It’s first job is to support the organs within the pelvis- the bladder, vagina, uterus, and rectum, while its second purpose is to serve as the floor of our core musculature. During pregnancy the PF undergoes a great deal of stress while the baby is growing and the body is preparing for delivery. Throughout labor and delivery, the PF relaxes and opens, allowing the baby to enter our world. If one experiences difficulty while attempting to relax and open, complications can occur. Tearing, hemorrhage, and prolapse are all possibilities throughout this journey and it is important for mom to receive the care necessary to heal appropriately. 

Healing begins with increasing the connection from our mind to this region of our body. The best way to find this connection is to re-introduce the PF’s purpose into our body- to support the reproductive organs and bladder while stabilizing our pelvis in relation to our torso. To engage the pelvic floor, it is important to understand that the pelvic floor is also known as the pelvic diaphragm, which serves as the foundation of our core musculature. The core is the trunk of our entire body and is essential to the stability of the human frame. The breath diaphragm and pelvic diaphragm serve as the top and bottom of our core and our breath cycle ties them together. When the diaphragm drops upon inhale, our pelvic floor relaxes, allowing the belly and pelvis to fill with air. As we exhale our pelvic floor engages, rising into the abdomen and pushing our diaphragm back into our rib cage. 

In the beginning it is often easiest to re-establish this flow while lying on your back with a pillow tucked under your pelvis to give it a gentle lift. This takes the gravitational pull from our pelvic and abdominal organs out of the equation- especially if you are experiencing prolapse! People often think that to engage the pelvic floor, one must simply kegel. There is a little more to it than just this. While the kegel is an important component to the engagement of our pelvic floor, it leaves out other regions that deserve just as much attention. I like to imagine my pelvic floor in halves, an anterior and a posterior. Each half contains openings- the rectum is in the posterior, while the vagina and urethra are in the anterior half. Each one of these openings is surrounded by their own sphincter, which are all part of the pelvic floor. Activation of the PF will also engage these sphincters. 

In the recommended position, place one hand onto your chest and the other on your belly. The goal throughout the first phase of these exercises is to engage our pelvic floor musculature individually, according to our region break down. I personally like to begin with the posterior region, surrounding the 

rectum and work my way forward. The cue that I recommend to patients is to think of it as you are holding in gas. For the anterior half, surrounding the vagina and urethra, I like to encourage women to think they are pulling their pubic bone to their sacrum. Once you find each isolation, begin to incorporate each half into your breath cycle. If you find that you are experiencing difficulty engaging either of these regions, do not feel rushed to master their activation quickly. Everyone is different and each will find their connection at their own pace. It is important to spend as much time as you need with each region to feel comfortable before moving on! 

Once you have identified and found comfort in your breath cycle with each of these regions, bringing them together to contract as a whole during exhalation is the next step. This should be a slow and sustained breath cycle with a full activation of the PF. I want to stress this because it is important to be able to activate the PF in both a quick and slow, rhythmic manner. Our muscles are composed of two types of fibers- slow and fast twitch fibers. Slow twitch fibers are important for sustained activation of a muscle. The breath cycle described above represents a long and steady contraction from slow twitch fibers in our pelvic floor musculature. This is required for supporting all of the structures in our pelvis. Quick activation, fast twitch, is important to mimic for situations that require a fast response of our muscles- similar to jumping, sneezing, coughing, or running. The final phase of this breathing exercise is to challenge the pelvic floor in a way necessary to recruit your fast twitch fibers. While exhaling during your breath cycle, I challenge you to quickly pulsate your pelvic floor up to ten times! Being able to do so increases the pelvic floor's ability to respond quickly to internal and external stresses.

When the pelvic floor is engaged properly with our breath cycle, we promote a balance of support and stability in our body- a very important piece to the puzzle while healing during our first few weeks post-partum. Establishing a well connected core and pelvic floor begins with breathing but many variables can be contributing factors to an individual’s progression. It important to utilize the guidance of a midwife, chiropractor, physical therapist, or any healthcare professional who is well versed in pelvic floor therapy to ensure that your individual symptoms are being addressed appropriately. The journey of parenthood is full of many challenges and blessings; I encourage each of you to take each step with patience and appreciation. Honor your body for all that it has done and continues to do for you and your family. 

To contact Dr. Carolyn Wojtusiak see her website: https://evolvehealthandwellness.com/

"Common ≠ Normal" — A Guest Blog by Carolyn Yates, DPT

All too often I hear things like, “oh ya, I pee my pants when I run but I’ve had kids so it’s totally normal and that’s life.” Or, “I can’t jump on the trampoline with my kids because I pee my pants and I just live with it.” I hear this one less often than the “pee my pants” one but, in my opinion, hearing it once is one too many times, “sex is uncomfortable and less enjoyable after having kids.”

My newest schtick is educating on the saying “common does not mean normal.” Yes, leaking urine after having children is common. Muscles, fascia, ligaments all get stretched out during pregnancy and childbirth. This can cause changes in strength and alter the ability of the muscles of the pelvic floor, core and glutes to function correctly and in unison. These changes will affect your ability to create pressure enough to close off the urethra (where our pee comes out) and possibly your rectum and can lead to unwanted leakage. However, just because these changes and stretching happens during pregnancy and with childbirth, does not mean long standing effects from these are normal and should be lived with.

Along with urinary incontinence, I also hear women stating that their experience sexually is uncomfortable and marginally (sometimes extremely) painful ever since having children but they live with it because “that’s just what happens after experiencing childbirth.” Again, things do get stretched, pulled, irritated, torn, changed, during pregnancy and childbirth and some women experience these more than others. However, living with less-than-satisfactory sexual interactions that are considered to be due to the physical act of childbirth should not be considered normal and do not have to be “lived with”. Pelvic floor physical therapy can conservatively and effectively help to decrease incontinence and dyspareunia linked to childbirth. Whether you are 6 weeks postpartum or 6+ years, pelvic floor PT can help make a difference and improve your quality of life.

Here are a few reasons why you may be having incontinence or dyspareunia:

• You had tearing during childbirth that was stitched. Everything is back together and that is great. However, you may have scar tissue from the tearing. Scar tissue can grow like a spiderweb below the scar and adhere onto other structures. This adhesion pattern will affect the muscles ability to contract and relax appropriately thus decreasing strength. Adhesions can also cause pain. Similar to when you pull a bandaid off of your skin, scar tissue that has adhered down can pull on structures and cause pain.

• You think you are performing kegels correctly but you’ve never been formally taught or checked. I have treated many women who say they are doing their kegels religiously but still leak. When I do an internal examination I find that they are squeezing their glutes and abdominal muscles but have very little activation in the muscles of the pelvic floor; the ones that ultimately keep us from peeing our pants!

• Tightness! Muscles cannot be strong if they are too tight. Imagine that you can only straighten your elbow 50% of the way. Your bicep muscle (the one that bends your elbow) can only be 50% strong. For it to have 100% strength, it must be able to stretch out fully. This concept is the same for the pelvic floor muscles and is actually heightened due to the size of the muscles “down there”. The pelvic floor muscles are small and do not have much excursion (amount of distance a muscle can stretch and then contract) to begin with. Therefore, if they are at all tight, the strength is going to be severely affected.

How can we help these things?

1. Learn how to correctly contract and relax your pelvic floor muscles (also known as doing kegels). The best way to do this? Go see a pelvic floor PT who does internal work!

2. Assess for tightness around the hips, groin and pelvic floor muscles. Again, a pelvic floor PT who does internal work will best be able to assess this for you.

3. Work to decrease scar tissue adhesions through manual internal release.

Remember, common does not have to mean it is your new normal! You can do something about your pelvic floor symptoms and improve your quality of life!

VERITY PHYSICAL THERAPY & WELLNESS

Vitamin D and Activated Shiitake and Dulse Almonds Recipe

Activated Shiitake and Dulse Almonds

recipe below…

Vitamin D is an fat soluble vitamin that we need throughout our lives, especially in pregnancy. One of our main sources of Vitamin D is the sun. So as the days get shorter and we are outside less, its important to increase our supplementation and Vitamin D rich foods. We also get Vitamin D naturally from fish oils, or from fortified foods like milk, and OJ.

Another great source of Vitamin D is mushrooms, especially if they are dried in the sun!

Vitamin D allows for calcium absorption and enables normal bone mineralization and growth for the pregnant person and the developing fetus. Additionally, more and more is coming out about the benefits of Vitamin D especially the role it has in pregnancy, such as promoting insulin action and secretion, immune modulation and lung development. Not only having effects on the pregnant person, but the baby as well.

Effects of low levels of Vitamin D have been linked to pre-eclampsia, preterm labor, low birth weight, gestational diabetes, primary cesarean sections, and bacterial vaginosis. But there are no randomized studies (yet) showing that Vitamin D supplementation decreases these risks. Vitamin D deficiency doesn’t just affect the mother, the fetus will also be deficient and has an increased risk of skeletal issues, hypocalcemic seizures, and low cord blood concentrations of Vitamin D have been associated with respiratory viruses and respiratory infections as well as asthma later in life.

There is still a lot to be learned about the levels of Vitamin D supplementation and what the levels should be in our bodies for optimal health. There is no data to support routine testing in pregnancy, but providers should test those who are higher risk (people with darker pigmentation, people who don’t go outside often, or at latitudes that have decreased sunlight). There is also controversy about what routine supplementation in pregnancy should be. But most expert agree 1,000-2,000 IUs is safe for someone who is deficient and although data is lacking, 4,000 IUs is even considered safe during pregnancy and breastfeeding. Most prenatal vitamins are nowhere near this and pregnant individuals may need to add in more when appropriate. Toxic levels of Vitamin D are thought to be extremely hard to reach.

The following recipe packs some serious nutrients into a quick and easy snack:

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Shiitake Mushrooms: These mushrooms have been used for thousands of years for medicine and food. They slow tumor growth, support health cholesterol levels, and are immune boosting.

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Dulse- Dulse is a red seaweed harvested in the cool waters along Atlantic coast of North America and also along the shores of Ireland and Norway. Its fronds grow in tidal areas on rocks, and shells. As most seaweeds, it contains iodine, which if you are eating sea salt, or himalayan salt, you may be missing out on this important nutrient that support your thyroid. Dulse also contains a variety of minerals, especially magnesium, potassium, iron, vitamin A, vitamin C, and traces of others.
*DO NOT EAT IF YOU HAVE A SHELLFISH ALLERGY*

Sunny Mushroom Powder:

Ingredients:

½ LB Shiitake Mushrooms (you could also use your favorite mushroom here, but a study was done by Fungi Perfecti with shiitake specifically, with amazing results: by drying the mushrooms in the sun, their Vitamin D2 content went from 100 IU/100 grams to nearly 46,000 IU/100 grams!)

*Important to note, testing for Vitamin D is usually looking at D3. So you may also have to supplement with D3 to get the full variety of D vitamins.

Instructions:

Loosely cut up mushrooms.

Place the mushrooms, GILLS UP as much as possible in the sun until dry. This may take a couple days. Remember to bring them in at night, and keep an eye on the weather.

When the mushrooms are completely dry, use a mortar and pestle or coffee grinder to make into a powder.

Store in a cool dark place in a jar or use right away with the following recipe. You could also add this powder to soups, or other savory treats!

Activated Shiitake and Dulse Almonds:

This is a “loose” recipe, so please adjust to how much you want to make, or what ingredients you want to add/ take away.

Ingredients:

Organic Almonds (Use as many almonds are you will eat over the next few months.)
Sunny Mushroom Powder (see above)
Dulse Powder (you can buy powdered, or powder flakes using a coffee grinder)
Apple Cider Vinegar
Aminos (I use coconut aminos which are a bit sweet, but Braggs Aminos would also be delicious)
Salt

Instructions:

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24 hours before mixing everything together, soak the almonds in filtered water.

Place the almonds in a jar twice the volume. Fill with filtered water. Let them soak on the counter for 24 hours. After the 24 hours, rinse and let drain.

Mix together Apple Cider Vinegar and Aminos to your liking. I did about 1:1 parts.

Add in the almonds and let them soak for about 15 minutes, stirring occasionally.

In a separate bowl combine Sunny Mushroom Powder and Dulse powder.

Add the wet almonds to the powders and coat well.

Place an even single layer of almonds on the dehydrator sheets, or a baking sheet. Sprinkle with salt.

Dehydrate at 125℉ for about 24 hours. If using the oven, set to the lowest temperature your oven allows and cook until the almonds are completely dry. This may take the full 24 hours as well.

Store the almonds in a jar and enjoy!

Citations:
https://fungi.com/blogs/articles/place-mushrooms-in-sunlight-to-get-your-vitamin-d

https://www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/vitamin_d_sip43_june14.pdf

https://www.mountainroseherbs.com/products/dulse-flakes/profile

https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Vitamin-D-Screening-and-Supplementation-During-Pregnancy

Blissful Family Birth: A Love Note

Dear Baby Daughter,

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The story of your birth begins in the week leading up to your birth. I’d been having contractions on and off all week, most often during the night. However, the week before your birth was also a very challenging and difficult week where my mind and heart were occupied with a very serious and stressful family matter, and I knew that you wouldn’t be able to come until I was able to set everything else aside and focus on preparing for birth, getting ready to welcome you, and relaxing my body. The Friday before you were born I went on a long walk in the neighborhood while your brother and sister went to the park with Grandpa. As I walked I kept repeating to myself, “I will birth this baby full of joy.”

At the end of the day, I had an acupuncture appointment, and she treated me both to help encourage you to roll over (you were still in a posterior position) and to help me process the difficult events of the week and prepare for your birth. It was raining outside and she encouraged me by reminding me that even though the room we were in was quiet, if you really listened, you could hear the sound of car tires on the street outside and all kinds of other noises all around us that we naturally tuned out. So I was able to remember that you, the story of your birth that had begun unfolding, and the joyful anticipation of finally meeting you were all the melody, and everything else was just in the background, at least for the time being.

We went to bed Friday evening with our plans for Saturday still somewhat in the air.  I woke up at 1:45 am and stayed awake until 3:30 with contractions on and off, but then finally went back to sleep on the downstairs couch until about 5:45 am. Then I got up and made a pitcher of red raspberry leaf and nettles tea, and spent the early morning hours tidying up the kitchen and even folded laundry. I took a picture of the morning sky from the front porch, as the colors were incredible.  I knew that birthing time was getting close and I really wanted to have the house clean and in order, but I also knew that labor wouldn't start until I was home, relaxed, and settled, so it made sense to just go about our day like we planned.

We all left the house together at about 8:00 am and stopped for coffee and bagels at Moe's Bagels. I had a granola bagel with butter, and I remember it just not tasting all that good- probably because I was in early labor and probably because the bagel needed more butter. A few hours later that morning, I called the midwives and spoke to Nichole, one of the three midwives we had been seeing all pregnancy and who was on call that day, just to give her a head's up that we were probably getting closer. But I told her I didn't expect that anything would happen until maybe tonight or tomorrow, after our plans for the day, but we would stay in touch as things changed. We spent the morning visiting two nearby farms and then afterwards had lunch at Garbanzos. I didn't have a great appetite, but remember feeling sentimental and happy as I looked across the table at your brother and sister and held Papa's hand as he sat next to me.  I knew you would be coming very soon, and I enjoyed spending the day making sweet final memories together as a family of four.

Papa was making bratwursts for dinner, and I knew I absolutely couldn't eat that, so I politely said that I would make some of my own food, and made a tortilla with melted farmer's cheese. I poured myself a generous glass of white wine to help me relax that evening, but couldn't drink more than about two tiny sips. I remember feeling very tired and wanting to lay down. I also saw that my Aunt and another friend had texted to check in with me, and I responded to them both that I really needed to unplug from my phone. The whole dinner experience that evening was surreal, like I was having an out-of-body experience, watching myself and my family together and knowing that our family was about to change and grow. I was having contractions but they still seemed too sporadic to even really time them, and definitely too early to call Nichole, though Papa had asked. We did have a chance to review as a family everyone being really quiet and letting mama focus when I was having a contraction. I kissed the kids goodnight and headed to bed myself, and thanked Papa for taking care of everything else that evening.

Earlier that morning, I'd brought the last of my things I'd need for after the birth downstairs to the room where we'd be staying for a few weeks. I brushed my teeth, washed my face and climbed into bed around 7:30 or so, wanting to get as much rest as I possibly could as I expected to be up during the night fairly soon. I had a few contractions here and there, but was able to sleep pretty well and finally woke up about 11:45 pm when Papa came upstairs. We spent a few minutes talking and then went to bed, both in the downstairs birth room. I told him that there was something special about this early part of pre-labor, and that I was thankful that I had a whole few days of very easy contractions. They were a reminder that helped me transition into focusing towards labor and birth, but they were also pretty easy- contractions were so easy and mild that they were just a reminder of what was to come, and the whole experience was actually restful. After the difficult week, it just felt enjoyable to have a little bit of space together as a family to prepare for labor too. At some point, I wrote the following in my notebook: "Went to bed around midnight- want to sleep as long as possible and conserve my energy. I feel good and at peace and excited for the journey beginning."

I rested and dozed off between contractions, but they were a little too intense to just keep still, and I wanted Papa to be able to get as much rest as he could as well. For the past few days, whenever I'd had contractions at night, I felt best lying on my side, and rocking and swaying my pelvis slightly, and ideally also pushing my back against the couch for some counterpressure. Looking back, my body knew just how to move to help you get into the best position to be born. I spent a few minutes on the couch in the living room, but eventually went back upstairs to sweep the floor in the playroom (Papa had brought the upstairs rug downstairs to the living room earlier that evening while I was resting). I also wanted to give your brother and sister a big kiss and tuck them in again. The house was quiet and still. Somewhere around 1:00 am, I started timing contractions, and realized that they were between 4-8 minutes apart, some 30 seconds long and some 90 seconds long.

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Somewhere approaching 1:45 am, I started drawing a bath in the upstairs tub. Grandma C and I had been texting- I know she had been too excited to sleep at, and I texted her to ask if she could come over, and that I was handing over the communication to Papa. I woke Papa up and told him it was time to call Nichole and check in with her. Part of me was hesitant to call her too early, but I knew contractions were getting longer, stronger, and closer together. I have often heard it said that third births can be a wild card in terms of what to expect, so the midwives had all emphasized to call when things started picking up or changing. I think I was mentally preparing for a relatively long labor.

I think Papa called Nichole somewhere around 1:45 am, and called Grandma C to check in as well. I got into the tub, which was warm, and Papa stayed next to me. Or rather, he kept returning to be because I constantly sent him out of the room to fetch things- a rolled up towel to put behind my head, water with a straw, coconut water, and a bowl of ice water to dip a washcloth. I felt hot and remember from P's birth the refreshing sensation of an ice cold washcloth on my forehead. I remember thinking that even though we weren't timing contractions, they were definitely closer than 5 minutes apart, and it wasn't premature to have called Nichole. I also knew that it was just about time to shut off my thinking brain and really zone out into labor, but also that I still had a few more emotions and experiences to process.

I remembered my walk on Friday morning and repeated to myself that this baby would be born in peace and joy, and I was giving birth full of joy. Papa held my hand and I softly sang a song that went, "The joy of the Lord will be my strength... I will not waiver walking by faith... I am surrounded by beauty and grace... the joy of the Lord is my strength." I changed a word to say "beauty" instead of "mercy" though, because this was my labor song and "beauty" sounded right in the moment. I felt really overwhelmed with happy emotions; love for my family, joy that labor had started and excitement about what would be on the other end (that was you!). I choked up and cried some happy tears and just allowed myself to experience the flood of emotions.

The rest of the timeline of the birth is more vague to me as things got more intense and I entered labor land, but Nichole shared her birth notes with me so I can piece together the rest. I remember Papa telling me that Grandma C and Nichole had both arrived right at the same time, at about 2:30 am. I was still in the tub on my side, breathing through contractions, and pushing my back against the side of the tub. The water was deep enough to fully cover my belly when I was on my side. Between contractions, I also marched my legs up and down, slowly, stepping on the bottom wall of the tub. Again, my body knew how to help encourage you into the best position to be born.

Grandma C came upstairs and sat with me a few minutes, holding my hand between contractions and sitting quietly while I focused and breathed through contractions. I told her how much I loved her and how glad I was that she was there. After a few more minutes, she asked if I minded if she went to sleep for a while, and I encouraged her to go rest. I didn't need her help right then, the kids were also both asleep, but I was really glad she was close by at our house and could sleep here, even though she lived just a few houses away from us. Papa also went to sleep in our bedroom, with the bed stripped of all the pillows I'd taken downstairs. Nichole sat in the grey chair in the playroom and silently monitored me, but let me just be in my space without interfering. She helped me get water or coconut water during contractions, and helped me pee and then back into the tub, and occasionally listened to your heartbeat with the Doppler. Eventually I heard the bird clock in the playroom chirp to mark the top of the hour, realizing it must be the 3:00 am bird- only because I knew it had to be past 2am, and I could recognize the woodpecker call of the 4:00 bird.

A few minutes later I asked Nichole to help me put more hot water into the tub. I was cooling off and being in the tub just wasn't working as well anymore. The last few contractions slowed down to about 10 minutes apart, and I just wasn't enjoying the tub anymore and wanted to be downstairs. I got out of the tub at about 3:30 am. Nichole helped me dry off and dress in my swimsuit top, terry cloth skirt, and zip up hoodie sweater and head back downstairs. I got into bed, wanting to see if I could sleep a little more. I told Nichole that I figured baby wasn't going to come while I was asleep, so I might as well try to sleep some more if I could. I laid on my side, but for contractions had to move to hands-and-knees. At this point, contractions were more intense, and I wasn't able to stay silent and had to move and vocalize. I was able to doze and rest for a few minutes, maybe even like 10 minutes at a time, but after I had a contraction, I would get up to pee and right away have two more contractions. This happened a few times, but soon I felt like I didn't want to be alone anymore and needed Papa to be with me.

At 4:40 I went upstairs to wake him up. This was actually the only point during labor where things felt so intense that they almost seemed a bit scary. After the birth, Nichole later told me that she would have guessed that I moved into active labor at that point, as the intensity increased and I probably also experienced a hormonal surge. Papa was in our bed upstairs with the lamp on next to him, and maybe even asleep with his glasses still on. I told him I needed him, and he woke up and held me in his arms, like we were slow dancing. I had a few contractions upstairs together before he got ready to come downstairs, and then we found ourselves in the kitchen.

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We stood hugging and holding each other for a moment, and I remember walking around the kitchen island and dining room table. I had a few contractions leaning over the kitchen counter, with Papa putting counter-pressure against my lower back with either his hands or a rolling pin. Papa or Nichole gathered a few pillows for me to rest my head on the counter, and even a few LED candles. We moved over the booster chair and placemat so that Papa could stand behind me far away from the stairs, because I didn't want him to accidentally get distracted and step backwards too far without thinking.

But we didn't stay in the kitchen very long; we just kind of gravitated towards the living room a few minutes later. I took the big blue birth ball and pressed it against the wall with my lower back, as hard as I could. I was against the wall in a small nook between the play kitchen and the kid's bookshelf. I was having a lot of pressure and sensation in my lower back during contractions and it felt so good to press into the contraction. Papa brought me coconut water and plain water for me to drink between contractions, and asked if I wanted to listen to any music. I told him I yes, something instrumental like classical or jazz, and then change my mind, definitely jazz. He put Ahmad Jamal, a favorite album that Papa grew up listening to and often played for us. I’m sure by the time you are old enough to read this letter, you will have listened to this album thousands of times, especially now that this music I already loved is so beautifully connected to your birth. I was so glad to hear this music. I remember almost dancing in place to the music between contractions and really enjoying it, especially to my favorite song, Poinciana. The living room wasn't bright but there were lamps on, and all of it, especially the music, just contributed to the joyful mood and happy experience of getting ready for your arrival.

At some point I told Nichole that I was feeling a lot of downward pressure, especially during a contraction, and she realized it was a good time to call Lauri, the assistant midwife.

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Around this time I asked Papa to start moving some blankets to the rug on the living room floor so that I could have a soft place to rest on hands and knees, and plus, I wanted those blankets off of the bed. When I left my position on the ball to go pee, I told him to please remind me of standing against the wall and pressing into the ball again because I really enjoyed it. I dashed back to the living room right away to have a contraction on the floor, and Nichole stepped right in with counter-pressure against my lower back. Though Papa had been doing a wonderful job supporting me physically, he'd supported far fewer laboring women than Nichole had, and when she pressed against my back it was so effective that it changed the way I experienced the contraction. At first I thought that they just hadn't been very strong contractions, but now I believe that the right kind of pressure pushing into my back in the right place made the contraction dramatically easier- certainly I could tell this by the noise I was making. I asked Nichole to show Papa how he was doing that, and at another point either before or after asking Papa to ask Nichole to show him. Also, I whispered to Papa to please go brush his teeth too.

Around 5:20 am, I asked if Nichole could tell your position inside me, as you had been facing my belly button rather than my spine for the past few weeks and as we moved into labor. I hadn't been sure whether you had turned or not. I knew that I really liked counter-pressure on my back during contractions, and I didn't think I was experiencing back labor, but how did I really know for sure if I had never actually experienced it before? Fortunately, I had absolutely no sensations between contractions at all though. I laid down on the floor, but my belly was too firm for Nichole to be able to tell anything at all, although a few minutes later while standing on my knees she felt again and realized that you were ROA. Mentally, I think something shifted for me at that point, and any of the last bits of anxiety I'd had about labor floated away. Both other kids were born in an ROA position (which means you were all head down, your back was facing outwards towards my belly, and more towards my right side), so I knew that was my ideal birthing position and you were in just the right position to come. I spent a few more contractions on hands and knees in the living room floor.

A few days after your were born, Papa, Nichole and I were talking and reminiscing together about your birth story at a postpartum visit. From her experience, Nichole imagined that you likely turned in labor at the point when I was in the tub and Papa had called Nichole, so around 1:45 am. Contractions were very close together then, definitely closer than every five minutes although we didn't time them, and this was very likely because that was what my body needed to do to help you roll over into a better labor position by squeezing and shifting you a little bit at a time. That makes sense because I was on my side, marching and bicycling my legs to help. After you turned, contractions spaced out again, to about every ten minutes, which is a typical early labor pattern.

Most of your labor I had been burping and belching away. Once I joked about not even needing to say "excuse me," and Nichole said I was just burping you right down. I had experienced such intense heartburn and reflux for the last trimester of pregnancy that I was just relieved not to experience it in labor too. I had only a few anxieties about labor and birth, but top of the list was having intense heartburn in labor. So I happily burped away.

At 5:37 according to Nichole's notes, Lauri arrived. I told Nichole I could feel you moving down. At 5:43 I was on hands and knees again with Nichole, and then papa applying counter-pressure, and contractions were 5 minutes apart and a minute long. Sometimes I found myself shaking and trembling during a contraction, and sometimes after the contraction I still wanted to continue shaking and vibrating my body because it felt good. I was hot and then cold- but finally took off my hoodie sweater and had a blanket nearby to cover my shoulders between contractions. At 5:54 I was standing back up against the wall again pressing against the ball, and this time leaning forward and pressing into the arm of the couch too. Once I accidentally slid the couch at least a foot I was pushing it so hard.

Who knows exactly when, but Papa brought up another silver exercise ball and inflated that one, switched it out with the blue one I'd been using so he could pump that one up some more too, and then replaced it for me between contractions, noticing that I was really pressing into the ball. I was vocalizing loudly during contractions, and probably also grunting a little bit. Nichole placed a chux pad below me on the floor just in case.

At 6:01 am, right during or at the end of a contraction, my water broke with a spectacular sound and gush. Papa said it sounded like glass shattering. I recall thinking that it seemed just like a pregnant woman's water breaking in movies and TV shows- overly dramatic but never the way it actually happens in real life, except this time it did and we all were there to witness it. Anyway, I was caught off guard by the amount of liquid, and all of us by the incredibly loud pop and gush, and since our floor is all tile, I actually slipped trying to move. Nichole saw both my heels go up and was right there to catch me from falling and helped me to the bathroom. My water breaking probably dilated the last bit of remaining cervix, and as I was about to flick some of the remaining materials and membranes I'd caught with my hands into the sink, I am pretty sure that I yelled at Papa to come move his toothbrush, which he left on the bathroom sink when I asked him to go brush his teeth. Nichole kindly rescued it for him just in time.

Still in the bathroom, Nichole asked me something about catching the baby, and I mis-heard her and replied something about yes, I did think that the baby probably would be born today. She said something about her thinking that things were pretty close... She later told me that in her mind she was thinking just a matter of minutes. I was surprised, still mentally anticipating a few more hours of labor because the whole thing so far hadn't felt very long or hard at all. I had a contraction again in the bathroom where my body was pushing on its own, and I told Nichole that it wasn't me doing that, it was happening without me thinking or doing anything.

Lauri meanwhile had told Papa that now would be a good time to wake up Grandma C and the kids as they both thought that things were quite close. After the bathroom, I moved back to the living room and laid down on the floor to completely rest, my head on a wedge pillow. Actually, neither Nicole, Papa, nor I accurately remember at what point I came back to the living room for my nap (whether it was before or after my water broke for certain), but someone took a picture of me so we know it must have happened. I don't remember if I fell asleep or not, and it was probably only about 5 minutes that I rested, but I was covered in a blanket and completely relaxed with my eyes shut. Papa thought I slept through a contraction, but with the next one I got up and my body was pushing, or at least I was grunting and bearing down and couldn't really do much about it.

At 6:12 Grandma C and the kids came downstairs. Both Palesa and Ikechi were groggy from having just woken up. They were in their pajamas with both their hair sweet and a little wild. They walked in the room, smiling and waving and blowing kisses at me, but knowing they needed to be quiet because Mama was working hard. They silently marched like they were in a special little parade coming close to me yet giving me space. I cried as soon as I saw them, saying over and over again, "I'm so happy, I'm so happy." Palesa was here when Ikechi was born, and it was important to our family that Palesa and Ikechi also be here if possible when you were born too. I smiled at them as they walked by and out of my mouth just came babbling words of love and happiness for our family- for Papa, and your big sister and brother and our family so far. They walked around the rug where I was on my hands and knees or kneeling, and sat on cushions against the wall and underneath the living room window, on Grandma Cyndi's lap with her arms around both of them. Looking at the birth notes, they were not there for very long before you were born!

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With the next contraction, my body began pushing again, and this time I think I joined in and pushed along with the sensations. I almost couldn't help it, and I certainly couldn't stop any of the grunting or noises I was making. After the contraction, I made a choice to smile. Certainly, now and throughout the rest of labor up until this point, contractions themselves had been hard work. I don’t think I can describe them as painful, but rather, intense. But honestly, the other parts, between all the contractions, hadn't been the least bit hard at all. In fact, they had been restful, joyful, and actually really pleasurable. Very truthfully I really was enjoying myself during the whole labor. But I also made the choice to smile because I felt like it was important that the Palesa and Ikechi also know for sure that this was all happy work, and that I was not in pain or suffering, but rather working hard with a purpose, and that this purpose (you!) was good. They were prepared for what to expect, but I wanted my face on the outside to match how I felt on the inside too. We'd also watched a lot of birth videos and talked pretty extensively about what it would be like when the baby was being born and how Mama would be working hard and making lots of strange noise.

And strange noises I definitely made! After another contraction where I made noises so loud and unfamiliar that I surprised myself, I then burped and belched loudly. I turned to the kids and smiling, told them, "When Mama is having a baby, you get to make all kinds of funny noises!" Palesa and Ikechi smiled at me and seemed to really enjoy watching and being there.

But as I said before, it wasn't very long that the kids got to sit and watch before you arrived. At 6:16, your head came out, according to the birth notes. All I remember was all of a sudden being overwhelmed by the sensation of a head. I was on my knees, with Nichole sitting behind me and Papa right next to me, also taking a few pictures. My body was pushing on its own, but I was pushing myself too and the power behind my pushes felt so strong. I could feel you coming out, and probably something else as well... I warned Nichole, "That's poop!" but a midwife is pretty used to that sort of stuff during labor and didn't even blink an eye. But then I revised my previous statement and exclaimed, "That's also a head!" I remember Nichole saying something about head being out to the nose. I reached down to feel, and felt your hair and the hard shape of the back of your head.

Nichole asked me to pause for just a second and then your whole head was out. She told me later that as your head came out, you looked right into her eyes and she into yours. For me it all happened so fast. But I do remember her asking me if I was ready to catch you, as I had intended. I said yes, but seconds later said, "No, you do it!" because it just felt too intense and I needed both of my hands. With the next contraction just moments later, your body slid out, and Nichole's loving hands caught you and eased you gently to the ground and forward, just below me, where I immediately swooped down and picked you up and brought you to my chest, already crying. That is, both of us. I heard your sweet cat-like cry before I picked you up, and I was already crying for joy as well.

You were born at 6:17 am on Sunday, November 19, 2017. You arrived right on your expected due date. Just as I had envisioned your birth, I labored at night, and you were born at dawn, just as the sun was coming up. I later heard that the sunrise that morning had been absolutely stunning, and though we had missed it, I knew that of course it had been a perfect sunrise.

Papa and Nichole soon helped me turn over and sit up against the wedge pillow from where I still stood on my knees. I was bawling and spewing out words of happiness and emotion- "Baby, you are here," again and again, as well as "I'm so happy, I love you so much." Everyone else in the room was silent but I couldn't stop myself from exclaiming through words the rush of emotion I was experiencing in my heart during those first moments.

I looked at Papa, and I looked at Palesa and Ikechi, and at Grandma Cyndi, who was also crying as she held your brother and sister. I told each of them how much I loved them, and just soaked in the flood of exuberance. Lauri handed me a blanket as soon as I rolled over, or probably before, and I covered you to help keep you warm. You were covered by a nice layer of thick white vernix, and you came out pretty immediately pink. I vaguely recall briefly seeing your two eyes open, but you actually didn't really open your eyes again until that evening. I took a dab of your vernix and spread it underneath my eyes like an eye cream (for wrinkle prevention, of course!). Your hair was thick, black and straight. You looked very similar to both Palesa and Ikechi when they were born, but also very different and perfectly you. I gazed at your long fingers (perhaps another musician or piano player?) and counted each of them out loud, 1-2-3-4-5, absolutely amazed that one of your tiny hands could have five perfect fingers.

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After maybe two minutes, I encouraged Palesa and Ikechi to come closer and take a look at you. They had both been beaming and thrilled, also experiencing the love and emotion now shared by our entire family, though very eagerly they came over to get a closer look at you. Palesa came first, and hesitantly, Ikechi followed. We moved the blanket aside and I asked them what they saw. Palesa exclaimed, "A vagina!" and Ikechi exclaimed with just as much enthusiasm, "Penis!" The entire pregnancy, Palesa had wanted and hoped and expected you to be a girl. Most of the time, Ikechi had thought that you were a little brother (who he also initially suggested naming "Baby Sister"), though recently he had been thinking you would be a girl too But we all confirmed and shouted, "It's a girl!"

We spent almost 20 minutes sitting on the floor like that, together as a family of 5 for the first time before eventually moving to the bed in the downstairs bedroom. That first 20 minutes after you came into the world was surreal and incredible. I couldn't believe that you were here, and that this was now you I was holding in my arms. I remember every detail of those moments, and yet I remember almost nothing at all, only at most the raw feelings and emotions and intense sensations of memories. I was both totally present and floating away in another universe of ecstasy and joy.

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Right away Palesa asked to hold you, and someone gently broke it to her that she would get a chance to hold you a later on, but for about the next two hours, you would stay just in my arms. (Plus, logistically, the placenta hadn't yet come out, so you and I were still attached). Ikechi suggested quite earnestly, "I know, we can name the baby Unicorn!" Palesa also chimed in with several name suggestions, inspired by objects or events around the room at that moment. Ikechi also started singing, "This little piggy of mine, I'm going to let it shine," and we all laughed at the way he conflated two different songs so perfectly. Regardless of all of the other precious details I have now forgotten, every moment of those first few minutes we spent on the living room floor together were absolutely blissful and perfect.

At 6:35 am we moved into the bedroom and I was settled onto the bed. The placenta came out 3 minutes later. We put you on my stomach and you began crawling up my torso to latch on and begin nursing. While you were growing in my uterus, we talked extensively with Palesa and Ikechi about what it was like inside my uterus (Ikechi was actually quite sad that he couldn't remember what it was like).  We talked about how it was warm and dark, and you were floating in warm water and could hear the sounds of my heart and body as well as my voice and the voices of those around me. We talked about how you didn't eat food, but rather got everything you need from your umbilical cord and were nourished by the placenta. When we watched you crawling up my body looking for food, even though we had seen this happen before- even watched your brother Ikechi do this- we were absolutely amazed... somehow you knew that there was something important you were looking for, and you knew this was the way to go. You didn't know what it looked like, because you had never seen it before, and anyways, your eyes were still completely closed.  You didn't really know what it was for either, because you never ate food inside my uterus. But, somehow, by instinct, by smell, by God's perfect design, you knew exactly what you were looking for and eventually latched yourself on and started nursing.

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A few hours after your birth, we were ready to cut the cord and begin the newborn exam. We had promised Palesa she could help, and first we set up a special box with a candle to burn the cord. We had burned Ikechi's cord all the way through, but this time decided to just burn it for a few seconds. Palesa held the lit candle to the cord, and Ikechi held the corner of the cord, his little fingers safely away from the flames. Papa took pictures while I held you in my arms and watched. Then Palesa cut the rest of your cord with Nichole's help. After, we watched Nichole do the newborn exam, where she confirmed what we already knew about you- everything about you was simply perfect! She first took your measurements- 13-3/4" head, 20" long and 14" chest, and then checked your reflexes and each and every part of your body. Lauri asked me to guess what you weighed, and I estimated 7lbs 8 oz, just between the birth weights of Palesa and Ikechi. However, you are our biggest baby yet- as Palesa calls you, a prize-winning baby, weighing in at 7lbs 13 oz! In case you ever should wonder, your Apgar scores at birth were 8 and 9 at one and five minutes.

Before the midwives left, Nichole sang a little song to you. She warned us that she was not a good singer, but her voice and the song she sang about all of us being here to welcome you into the world was the most beautiful thing I could imagine hearing.

Recently I heard an interesting fact that a certain kind of horse can pull up to 8,000 lbs. However, instead of two of these horses being able to pull 16,000 lbs, they can actually pull something like 24,000 lbs. I've thought about that a lot in terms of how much more love has been added to our family now that you are here. Before Ikechi was born I wondered how it was going to be possible to love this new baby as much as we already loved his big sister Palesa, but the moment he arrived, Papa and I instantly understood how our love had grown so much bigger.

Before you were born, our beautiful double rainbow baby daughter, conceived after the loss of two early pregnancies, I couldn't wait to experience all the new love that we would share with you. But it is so much bigger than simply adding another baby's love to our family- all of the rest of the love we already had exploded in size and then multiplied in amount. We have just started getting to know you, as we've only just met you, but the love that I have for you, as well as Papa, Palesa, and Ikechi all have for you, and the love we all have for each other, is as big as anything in the universe.

Baby Sikia, welcome to earth (on the outside) and welcome to our family. We are so glad you are here!

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Love,

Mama

P.S. Here is the short story of your name: Sikia Aletheias May. Sikia, pronounced Se-KEY-ah, is a Swahili name meaning "Harmony." We understand this in the classical sense of balance and concordance, but also recognize the harmony in the universe signified by the Trinity. Harmony is a consistent, orderly, or pleasing arrangement of parts, and in music harmony is a simultaneous combination of tones blended into chords and pleasing to the ear. Your middle name Aletheias (ah-LAY-thee-us) is a Greek word derived from "aletheia" or truth, literally translating to the state of not being hidden. However, as you will soon learn, you are the child of two nerdy parents, so we chose for your middle name the genitive form of the root word, meaning "of truth." Put together, your name means something closer to "Harmony of Truth."

The Dangers of Phthalates

What are phthalates?

Phthalates, or plasticizers, are used in plastics to to make them more flexible and harder to break, or as solvents. This group of chemicals are creeping their way into many products that we use everyday. Similar to BPA, a phthalate is a stealth chemical that is classified as an endocrine disrupting compound (EDC). EDCs interfere with healthy hormone regulation.  

The jury is still out on what effects phthalates can have on our health. The CDC has found that people who are exposed to phthalates have a higher concentration in their urine, but are unsure what health effects occur from low level exposure. Phthalates are on their list of potentially harmful but need more research to determine how. Further, the FDA doesn’t have enough scientific evidence to take action against products with phthalates in them. As we know from history, the FDA and CDC are often slow acting in cases like this (DES, BPA, tobacco, etc). They have also concluded that women of childbearing age have the most exposure and concentration in their bodies, which may then be passed to their baby in utero.

As consumers, we need to take our health into our own hands and make the decision to be conscious about what we are putting in and on our bodies, in our homes and how we are caring for our families. We need to consume responsibly and safely by choosing products without plastic, phthalates, PVC, DBP, and DEP (“fragrance”).

In pregnancy:

Studies have shown that fetal exposure happens in utero. Two studies from Harvard T.H. Chan School of Public Health have shown the effects in pregnancy to be:

• Increased risk of pregnancy loss - 60% higher in women who had high levels of di- phthalate at the time of conception

• Increased risk of gestational diabetes - 7 times risk with higher levels of phthalates

• Higher weight gain in pregnancy - 2 times the risk with higher levels of phthalates

• Lower IQ in child exposed during pregnancy - 6.7 points lower on average

• Shortened anogenital distance, or hypospadia in newborn boys

Outside of Pregnancy:

• Lower sex hormones

• Lower thyroid hormones

• Reduced sperm count

How phthalates affect our planet:

Phthalates are getting into our environment by way of industrial releases, the disposal of manufacturing, processing and industrial wastes, municipal solid waste, land application of sewage sludge, and release from products containing phthalates. The land, air, water, plants and animals are all being exposed to phthalates, which then often results in human exposure. Similar effects are seen in animal studies, where their reproductive and hormonal systems are harmed.

Phthalates and economy:

Phthalates have become a main part of our economics, as they are an inexpensive ingredient in many mass produced products. We are producing phthalates at an alarming rate, almost 6 million tonnes (1,000 kg) per/year globally!

Exposure to phthalates:

We are being exposed to phthalates through earth, air, water, food, intravenous fluids, or skin contact with DEHP-containing plastics. In biomonitoring surveys, the CDC has found phathales in human tissue, pointing to high, widespread human exposure.

Here are some common products containing high levels of phthalates:

• PVC-shower curtains, blinds, inflatable toys/mattresses, changing tables/diaper mats and other similar soft plastic products

• Vinyl flooring

• Clothing- Rain gear, jewelry

• Some food packaging and processing

• Some medication and medical devices

• Some air fresheners and scented candles

• Cosmetics: The ingredient most commonly seen in cosmetics: DEP, nail polish, hairspray, body products with “fragrance” or “perfume”, baby powder, lotions and soaps *even sometimes “natural” products

• Electronics

• Soft Plastic Toys

How to Reduce Your Exposure:

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At this point it is impossible to completely avoid phthalates, but we can do a lot to shift our lifestyles and limit our exposure in simple ways. The EPA, FDA, and Consumer Products Safety Commission (CPSC) are looking into the toxicity of the 8 different types of phthalates so they can better categorize potential risks. Until there are regulations or warnings available in every state, we have to be smart consumers and pay attention to where we are getting exposure to phthalates and how we can limit this.

• Check  cosmetic, hair and body products’ ingredient list. Do not use anything that has DEP, “fragrance” or “perfume” listed.

• Limit exposure to PVC (here is a great list of products that contain PVC: http://mommyfootprint.com/pvc-items-in-your-every-day-life/) Often there are reasonable replacements to PVC products.

• Avoid plastic #s 3, 6 and 7, they may contain phthalates or other harmful chemical plastics.

• Use glass, wood, ceramic or stainless steel instead of plastic to store and reheat food and drinks.

• Avoid soft plastic toys, especially those manufactured before 2008.

• Eat organic food and wear organic clothing.

• Avoid packaged or fast food.

• Look for “phthalate free” on products. Even better, make some of your own “clean” household and body products.

• Wash hands frequently (with phthalate free soap of course!).

• Minimize handling of receipts.

• Remove shoes at home to avoid tracking in dust that may contain these chemicals.

Resources where to buy phthalate free:

• This local soap company uses glass jars for products and is transparent about all ingredients, using all natural, organic when possible as well as essential oils to scent their products. All products are phthalate free, as well as free of other concerning common toxins. They make household and body products: https://keepitcleansoaps.co/

• Another local company that has amazing body products that are plant based: https://thelittleherbalapothecary.com/

• This website has about a million DIY home and body products. https://wellnessmama.com/

• Food storage and baby bottles: https://www.lifefactory.com/, or good ol’ fashioned mason jars

Nuchal Cords

Nuchal Cords:

We have all heard the story of “the baby could have died, the cord was around its neck!” or “we had to have a c-section because the cord was around the baby’s neck.”  At CRMC we often get this question: “what happens if the cord is around the baby’s neck!?” in regards to the safety of homebirth and the safety of birth in general. 

It sounds like a scary situation but here is the truth: it happens all the time! The medical term for a cord around the neck is nuchal cord. Nuchal cords happen in about ⅓ of labors and very rarely causes any problems or concerns. “In the largest available data set, in which a tight nuchal cord was documented in 6.6 percent of 219,337 live births, there was no association with adverts neonatal outcome” (Neonatal outcomes following a tight nuchal cord. Jenny E, Andres RL, Christensen RD. J Perinatology.2013; 33(3):231.) We are trained to deal with a cord around the neck, shoulders, belly or any combination of the above. We simply unwrap the cord from around the baby as the head is birthed, as the baby comes out, or even after the baby is born and handed to the parents.

Monet Nicole

Babies are active participants in labor and the birth. They spiral through the birth canal to maneuver through the tight spots and do the movements they need, to get through the pelvis. This can sometimes result in them getting tangled in their cord. Thankfully, humans have wise bodies and know that the cord needs some protection! Wharton's Jelly protects and covers the umbilical cord, so there can be some compression; the Wharton’s Jelly cushions the vein (1) and arteries (2) within the umbilical cord.

Date Fruit & Effective Labor - What’s the Connection?

Dates & Effective Labor - What’s the Connection?

Are you looking for ways to help you get through an unmedicated birth? Most likely if you are reading this, you have already made some important choices to aid in this goal. Mainly, choosing midwifery care and homebirth! You may have also chosen to hire a doula or someone who can help provide emotional and physical support through labor, attended a childbirth education class, and practiced prenatal yoga. You may have read natural pregnancy and birthing books and taught your partner exactly how to be the best support person. There are endless ways to improve individual birthing experiences.

One more way to help with your labor and birth can be found in your diet! Beyond eating nourishing food and staying hydrated, new studies have found that dates can help during this transition from pregnancy to your baby being born.

This study was of people eating 6 dates per day, for 4 weeks before their estimated due date.
Here are the findings: https://www.ncbi.nlm.nih.gov/pubmed/21280989

• “The women who consumed date fruit had significantly higher cervical dilatation upon admission compared with the non-date fruit consumers- 3.5 cm vs 2cm.

• The date eaters had significantly higher proportion of intact membranes upon admission (83% vs 60%).

• Spontaneous labour occurred in 96% of those who consumed dates, compared with 79% women in the non-date fruit consumers.

• The first stage of labour was shorter in women who consumed date fruit compared with the non-date fruit consumers- 8.5 hours vs 15 hours.”

This study “concluded that the consumption of date fruit in the last 4 weeks before labour significantly reduced the need for induction and augmentation of labour, and produced a more favorable, but non-significant, delivery outcome.”

This study: http://jmrh.mums.ac.ir/article_2772.html evaluated 1st time parents only.

Starting at 37 weeks, the date-eating group ate 70-75 grams/day (3-4 dates) until the onset of labor. In this study, they used the Bishop Score to measure the results. The Bishop Score uses 5 measurements to determine how likely a vaginal delivery is, especially if an induction is attempted. These include: cervical dilation, effacement (how thin the cervix is), how soft the cervix is, where the cervix is in the vagina, and the station (how far down the baby’s head is).

The results in the group that ate dates had a higher, more favorable Bishop Score, and a higher cervical dilation at admission, and even though the rates of induction were lower, the group that ate dates were more successful with inductions at 41 weeks.

So why are dates effective?

• “Date fruit contains 13 vital substances and 5 kinds of vitamins, fatty acids, and sugars.” Dates contain: calcium, zinc, iron, copper, magnesium, manganese, calcium, potassium, A, K, and vitamin B6 (pyridoxine), niacin, pantothenic acid, and riboflavin which provide their own unique preventive and healing functions.

• “Date fruit also influences estrogen and progesterone hormones, which are effective in preparing the uterus and cervical ripening.”

• Dates are high in fiber.

• They also contain Tannins and  antioxidants which fight infection, and are anti- hemorrhagic.

• Date palm fruits possess high nutritional and therapeutic value with significant antioxidant, antibacterial, anti-fungal, and anti-proliferative properties.

**Dates are also pretty high in sugar, so if you are struggling with yeast, bacterial vaginosis, another infection, or maintaining your blood sugar it may be better to skip the dates.

Dates have a rich and long (8,000 year) history, including Ancient Egyptian Hieroglyphs depicting the date tree. Dates have been an important ritual aspect in religions across the world. According to the Qur'an, dates have always been considered beneficial to mothers. In Islamic history, it is believed that Maryam (also known as Mary in Christian faith), the mother of Eesa (Jesus in Christian faith) was provided with dates during her labor and after delivery. When Maryam gave birth to the Eesa under a palm tree, she heard a voice telling her, "Do not grieve. Your Lord has placed a small stream at your feet. Shake the trunk of the palm toward you, and fresh, ripe dates will drop down to you. Eat and drink, and delight your eyes." These sweet treats hold a deep wisdom and health benefits worth exploring.

Here is a recipe for a delicious way to get some dates in your diet during the last weeks of pregnancy, from Oh, Holy Basil:

(http://www.ohholybasil.com/raw-goji-cardamom-rose-truffles/)

Joyful Heart Balls:

This is Rachel’s name for these. This comes from my favorite additions, Sassafras and Maca (save these additions for when you are NOT pregnant)  

INGREDIENTS (makes about 48 small balls) 

• 2 cups/12 oz ( about 16 large) medjool dates, pitted

• 1 teaspoon vanilla extract

• 1 teaspoon rose water

• ¾ teaspoon fine grain pink salt or sea salt

• ½ cup almond butter (Get that protein boost!)

• ½ cup + 2 tablespoons raw cacao powder

• ½ cup shredded coconut

• ½ teaspoon cardamom

• 1 tablespoon rosehip powder, optional (BONUS for a Vitamin C boost)

• ⅓ cup goji berries (BONUS for a Vitamin C boost)

• cacao powder, shredded coconut or rosehip powder for coating the truffles

** I add other nutrient rich and medicinal herbs to these balls to get an extra kick of whatever I am needing in the moment**

Here are some ideas:

• 1 Tablespoon of powdered Nettles- blood building, immune boosting, nutritive tonic, helps milk supply
• 1 Tablespoon powdered Ashwagandha- antioxidant, immune boosting, calming
• 1 Tablespoon Oat Straw powder- nervine, nutritive tonic, anti spasmodic, sedative  
• 1 Tablespoon  Burdock Root powder- digestive aid, liver tonic, hormonal balance, immune boosting
• 1 Tablespoon powdered Raspberry Leaf- Uterine tonic,
• 1 Tablespoon powdered Lemon Balm- calming
• 1 T Lavender- calming
• 1 Tablespoon Spirulina- blood building, detoxifying, helps fight candida, lowers blood pressure, energy boost
• 1 Tablespoon Chaga Mushroom powder- immune boost
• 1 Tablespoon Astragalus Root Powder- immune boost, antiviral, adaptogen  

*As always, check with your healthcare provider before adding any of these herbs to your diet**

INSTRUCTIONS

1. Place the dates, vanilla, rose water and salt into the bowl of a food processor and blend until a chunky paste forms. Add the almond butter and pulse until incorporated.

2. Add the cacao, coconut, cardamom, rosehip powder, herbs (if using) and goji berries. Pulse until combined.

3. Roll the truffles into scant tablespoon balls and place on a parchment-lined tray. Chill for ½ hour in the refrigerator.

4. Remove the truffles from the refrigerator. Fill a small bowl with your desired coating and roll each truffle until well coated. Cover and refrigerate until ready to serve.

Citations:

• http://foodfacts.mercola.com/dates.html
• http://www.ohholybasil.com/raw-goji-cardamom-rose-truffles 
• https://www.ncbi.nlm.nih.gov/pubmed/21280989
• http://jmrh.mums.ac.ir/article_2772.html

MYTH: Homebirth is messy!

MYTH:  Home Birth is Messy

There is a common misconception that having your baby at home means your house will become a “disaster area” during labor and birth. We often hear folks comment that they would consider a home birth, but are concerned about the clean up. We’re here to tell you that one of the best things about having the support of Community Roots Midwife Collective is that you won’t have to worry about the mess!

Here are some things to contemplate when considering the clean up of a home birth:
-Birth is not as messy as people think. Sure, there are some exciting fluids involved, but for the most part, it’s easy to contain them.
-You and your Midwives are well-equipped for the mess. We have you order a birth kit which comes with either reusable or disposable absorbent pads. These come in handy for protecting bedding and flooring. You will also gather extra towels, tarps, and protective plastic for bedding and carpet, and have a bowl nearby to catch fluids if needed.
-Did you know that hydrogen peroxide works miraculously to remove blood from carpet, clothes, towels, and bedding? We’ll be sure you have a few bottles on hand in case it’s needed.
-While you’re resting and bonding with your baby after the birth, we’ll be quietly tending to the clean up. This includes breaking down the birth tub, cleaning surfaces, starting laundry, and taking out the trash. We make sure that your home is a tidy as we found it so that you can focus on healing and your little one.
-In the case of a transport to the hospital, one of your midwives will stay behind to clean up if needed. We want to be sure that your return home feels warm and welcoming.

So, if you’re worried about having your baby at home due to the burden of the clean up, fear not! Often our clients or their family/support members comment that there are no traceable signs that a birth just took place in the home, apart from the new baby being cuddled in arms. Thus, we invite you to relax, and trust that your space will be well care for.

Here are some before and after pictures just for fun :)

Before... 

After!

Postpartum Care with CRMC: The First 6 Weeks

The postpartum period is often a time of immense joy, healing, growth, and challenge. As midwives, we acknowledge that the postpartum period is a time of great transition, in which supportive and evidence-based care can be of tremendous service.

Community Roots Midwife Collective (CRMC) is proud to offer comprehensive care for the parent/baby unit through 6 weeks postpartum. Rest and healing are central to postpartum health; thus, we offer our one, three, seven day and 2 week visits in-home, so that parents don’t have to travel to receive care. Our final 4 and 6 week visits happen at our office. Appointments last one to two hours and include full physical and emotional assessments of mom/baby, lactation support, healing therapies such as postpartum baths and/or vaginal steams, and any newborn screenings that have been chosen such as: Critical Congenital Heart Disease (CCHD) screen, Newborn Metabolic Screening and Newborn Hearing Screen.

Throughout the postpartum time, we offer a vast array of holistic care and advice focused on the body’s innate ability to heal. Our recommendations are often nutritionally or herbally based, gently supporting people through the significant changes experienced in this remarkable time.

We also invite our clients to join us in community when they are ready to venture from home. CRMC hosts a FREE, weekly “Milk Circle”, facilitated by our midwives who are all Certified Lactation Counselors®. We also hold monthly community gatherings for our clients, with the intention of holding space for connection amongst new parents and families.

Pumpkin Chili

Pumpkin Chili Recipe: 

Ingredients: 

3 Cups Roasted Pie Pumpkin (roast in the oven until soft) 
1 lb Ground Meat (we used Turkey for the party, but I also use beef) 
*Sub 2 15 oz cans of beans for veggie Chili* 
1 cups (or to taste) Green Chilies (if it is Chili season, so get some freshly roasted green chilies. If it is off season, you can usually get Poblanos at the grocery store or canned/ frozen. 
1 Onion
1 T Chili Powder mix (We used a mix from Natural Grocers, it has Chili Pepper, Cumin Seed, Oregano Leaf, and garlic. You can use this or the separate spices) 
1 T Smoked Paprika
4 Cups or more Broth (veggie, store bought or homemade Nutritional Broth) 
Pepper
Salt to taste

Instructions: 

1) Roast Pumpkin, peel, and chop roughly
2) Cook Meat, onions, salt and spices until meat is cooked. Use the pot you will be cooking the chili in. 
3) Add garlic and green chilies, cook until combined. 
4) Add pumpkin, cook until combined. 
5) Add broth. (The amount of broth here can vary, 4 Cups will make this more strew-like, and more broth will make it more soupy.) 
6) Let the soup simmer on low until Pumpkin is soft and become more integrated into soup. 

Nutritional Fall Broth

Nutritional Fall Broth: 

I have been using a pressure cooker to make my bone broth this year and it is amazing! Saves time, and gas/ electricity. I have also been adding nutritional herbs to cook with the bones and veggies. I have mostly used nervines and immune booster, but anything would work. It doesn't affect the taste much, but adds more complexity. 
*if pregnant, be mindful and contact your midwife to know what herbs are safe for pregnancy*

---

Ingredients: 

Organic Bones (Baked at 450 for 20 min) 
2 Carrots (chopped roughly) 
1 Head of Celery (chopped roughly) 
1 onion (chopped roughly) 
1 Leek (chopped roughly) 
4 Garlic Cloves
1 bunch of Parsley
1 T Red Boat Fish Sauce
Splash of Apple Cider Vinegar
Salt to taste

Herbs: 
2 Bay Leaves
1/4 Cup Elderberry
1 TRosemary
1 T Peppercorn
Astragalus (a few slices) 
1/4 Cup Nettles
Reishi (a few mushrooms) 
1/4 Cup Lemon Balm
1/4 Cup Burdock
1 T Turmeric
1/2 Cup Alaria (or other seaweed) 
1 T Codonopsis
Other herbs specific to your needs... 

Put all of the above ingredients into the pressure cooker. Cover the bones and veggies with water, make sure to not fill more than the "fill line." Cook in pressure cooker for 30- 60 minutes. When warm, but not hot, strain broth.  

An Inspiring Celebration and Global Call for More Midwives

An Inspiring Celebration and Global Call for More Midwives

In late June, I had the honor of attending the 31st Triennial Congress of the International Confederation of Midwives (ICM), in Toronto, Canada. The theme was, “Midwives---Making a Difference in the World”. I’d heard rumors that more than a 1000 midwives attended these events, but as I arrived at the Toronto Convention Center on the first day, the numbers didn’t look like they’d add up. Helpful ushers guided the us down escalators to the meeting rooms below......far below, it turned out. There are at least four levels of conference facilities below ground level. As the escalators delivered us 3 levels down, the noise of a crowd became louder and louder. A colorful, diverse, mass of people soon came into view. Midwives from more than 100 countries filled a vast lobby. They held flags from their countries and many dressed in traditional costume, and waited for the Opening Ceremony doors to open. They spoke the languages of Africa, Asia, the Americas, and beyond. The excitement and anticipation was palpable.

The doors soon opened to a massive room, with seats for thousands; more than 4,000 it turned out. Many midwives sat with colleagues from their countries, hundreds from New Zealand, UK, USA, Canada, Japan, Korea, Kenya, Mali, France, Italy, Philippines, Indonesia, and many more. The conference was opened by Ontario Regional Chief, Isadore Day, from Serpent River First Nation, Ontario. Chief Day spoke with eloquence and humor, and deep reverence for his heritage and Mother Earth. A fitting way to kick off a conference focusing on maternal and neonatal health, through the care of midwives.

For the next two hours, we were honored to be entertained by many incredible talents, including Midwife Alison Walker, who beautifully sang the Canadian National Anthem (in French and English!); Tekaronhiáhkhwa Santee Smith, a leader in indigenous performance and dance; Ms. Abelone Melesse a 21(!) year old rapper who is the National UNICEF Ambassador to Ethiopia; two Inuit Throat Singers; Lisa Odjig-Hoop Dancer, who has danced before Queen Elizabeth, using up to 17 hoops at a time; Jade’s Hip Hop Academy dancers (amazing) and fantastic fiddler/step-dancer Stephanie Cadman. Perhaps the most moving part of the afternoon was the parade of nations, where a representative from each country carried their flag in procession, placing them on the stage, creating a colorful backdrop for the week. Optimism filled the room; we know there’s so much work to be done, but the connections and friendships made during this week will turn into positive action, benefitting pregnant people, their families and communities world-wide.

The following four days offered an overwhelming schedule of provocative scientific presentations and skills workshops. Topics ranged from access to ultrasound in developing countries, to leadership development, to preserving vaginal breech skills, to building cultural understanding, to increasing access to VBAC, to LGBTQ & trans people’s health care, to abortion access, and hundreds more. The plenary sessions focused on the promising impact that midwifery care has had, and will have, on the health of refugees, indigenous and aboriginal people, and other vulnerable communities around the world.

A highlight of the week was a presentation by Ms. Kate Gilmore, Deputy High Commissioner for Human Rights of the United Nations. She discussed the role of midwives in increasing humanity & compassion in the world, as well as the connection between human rights and midwifery care. It was one of the most powerful speeches I’ve heard.

Make your plans now for the 32nd ICM, which will be in Bali, Indonesia, in 2020. It promises to be another inspiring, powerful event and there’s so much to learn!

Lauri Hughes, CPM, RM, CLC
August, 2017

Our Story

We are honored to introduce ourselves as the four midwives of Community Roots Midwife Collective (CRMC). We are a group of dedicated, trained midwives providing home birth midwifery services to those in or near Boulder County. Central to our mission is to provide skilled midwifery care to anyone who desires it, regardless of their ability to pay. Our collective holds the values of integrity, human rights, reproductive justice and physiologic birth paramount.

As individuals, our backgrounds and experience are varied, and we come together offering heart-centered, competent care. Together, we come from a line of elders and teachers who span from Montana, Colorado, Utah, New Mexico, Texas, Mexico, Guatemala, Indonesia, and the Philippines. Midwifery is an ancient art form, rich in wisdom and tradition.

We invite everyone to re-member the purpose and power of childbirth. Concepts which come to our minds are: Evolution. Reproduction. Human Nature. Temporality. Connectedness. Humility. Empowerment.

Birth is fundamental to our survival.  When people are able and willing to connect to this mysterious and impactful process in a way that feels authentic to them, they are given the opportunity to understand and model inner strength, courage, deep wisdom, self reliance and self respect. It can be understood then, that the way in which we acknowledge and approach health care during pregnancy and birth, will have a profound effect on our entire society.

In our current culture, Americans generally approach childbearing as a medicalized process in need of expert management, often met with interventions and fear. The US spends more on maternity care and obstetric technology than any other industrialized country, yet we rank last or near the bottom when it comes to outcomes (cesarean rate, maternal mortality/morbidity, preterm labor, premature birth, perinatal and infant mortality/morbidity, and postpartum depression). Important to note, our poor, immigrant, and communities of color are those which experience the highest rates of complications. Statewide data for Colorado looks very similar to the national averages for these outcomes.

In contrast, countries which make space for the natural process of birth, limit interventions, andwhere midwives attend the majority of births have better outcomes (ie Finland, Iceland, Norway, Belgium, Germany, Denmark, Sweden, the Netherlands, and the UK). The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes. The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section (CFM). Here in Boulder county, about 9% of all births are attended by certified nurse midwives (CNMs) and about 3% are attended by certified professional midwives (CPMs)/Registered Midwives, such as our practice.

Why Midwives and Home Birth?

Research from the Midwives Alliance of North America (MANA) statistics program (which we are a part of) has collected and analyzed 17,000 cases in which the pregnant person was planning a home birth from 2004-2009.

The data states:

- 89.1% of planned home births occurred at home

- 93.6% vaginal birth

- 87% vaginal births after cesarean (vbac) were successful

- 97.7% of babies breastfeeding at 6 weeks postpartum

- Fewer than 5% of the births used Pitocin or epidural

- Low intrapartum and neonatal fetal death rate overall:

-2.06 per 1000 intended home births (includes all births) 

-1.61 per 1000 intended home births excluding breech, vbac, twins, gestational diabetes, and preeclampsia.

-Low rate of low APGAR scores

These statistics prove that for low risk people, home birth is a safe and healthy choice to make. It also proves that when people become higher risk, midwives know when to transport in order to access the medical options that the pregnant person or baby needs.

Beyond the statistics here are more reasons for midwife-lead care and home birth:

- You cultivate a meaningful relationship with your care providers

- You have the best chance at breastfeeding (midwives see the new family at least 4 times in   the first week to help with the transition into parenthood)

- You have the best chance at having a vbac

- The family is in the comfort of their home

- You participate in informed choice and shared decision making

- You are in control of who attends your birth and catches your baby

- Water birth is supported

- Birthing in the position you choose

- Moving, eating and drinking are encouraged during your labor and birth. 

- Midwives spend time getting to know the pregnant person and their family

- Compassionate and heart centered care

- Lower risk of intervention

- Gentle newborn care

- Personal empowerment

You may be asking, what does midwifery care look like, and what makes it unique from routine OB care? As inspired by the International Confederation of Midwives: Midwifery care is holistic in nature, grounded in an understanding of the social, emotional, cultural, spiritual, psychological, and physical experiences of all humans. Ethical and competent midwifery care  is informed and guided by formal and continuous education, scientific research, and application of  evidence. Midwifery care is provided to clients on the basis of shared decision making and informed consent to all treatments.

Midwives follow a standard prenatal care schedule, and our appointments are an hour long. We provide continuous hands on support through labor and delivery and then keep a close eye on the new family postpartum by offering in-home visits on days 1, 3, 7, 14, and 2 clinic visits at 4 & 6 weeks. Our extensive postpartum care is one of the most beautiful and impactful aspects of midwifery; our clients are able to be in their own home healing, resting and nesting, with comprehensive lactation, newborn, and parenting support.

As midwives of your community, we see it as our responsibility to increase accessibility to our care, educate the community regarding their birthing options, and promote an attitude of trust and respect for the birthing process. Despite the encouraging statistics of midwife-led care, cost remains a huge barrier for many. Though midwifery services cost a fraction of standard OB care ($4K vs $10-$16K), insurance reimbursement for Registered Midwives is very limited, and coverage by Medicaid is non-existent for Registered Midwives in Colorado. 

As you can imagine, poor, immigrant, and communities of color are those who have the least access to our care. And those are likely the communities which could greatly benefit from the comprehensive care of a midwife.

To increase access and educate our community, here’s what we’re up to at Community Roots. Currently, we are offering care on a sliding scale by providing 2 low-cost births/month to those in need. We hold bi-monthly community presentations regarding midwifery care and are present at community events such as Longmont’s Cinco De Mayo, Boulder/Longmont Pridefest, and Longmont Farmers Markets, spreading the word about midwifery care. We offer free, weekly lactation support groups at our classroom space in Longmont and we also teach low-cost childbirth education and breastfeeding classes quarterly.

We are committed to strengthening our local midwifery community. This past July we hosted a training for birth workers about providing culturally competent care for the LGBTQ community and we hope to continue hosting educational events such as this. Also, we recently hosted a screening of the film, “Why Not Home: The Surprising Birth Choices of Doctors and Nurses." The proceeds of this event were donated to the Colorado Midwives Association.

Our goals for the near future include: 
- training midwives who represent under-served communities
-increasing the depth of our sliding scale
-hosting community clinics in which folks can access both midwifery care as well as reproductive health care and holistic therapies such as acupuncture, massage, and chiropractic care for a minimal fee
-AND deepening the scope of our community education by hosting informational presentations at community centers and health clinics, with a focus on reaching out to our immigrant and teen populations.

A story from our midwife Lo:

"I’d like to leave you with a personal story of mine in which midwifery care greatly helped an immigrant family. A few years back, I was working as a medical assistant in a community health clinic in Boulder. There, I met a young woman Silvia from El Salvador, who was newly pregnant. Through our check-ins at her PN appointments, Silvia grew to trust me and was drawn to my midwifery insight. She began to confide in me that she was not feeling comfortable with the MD who was in charge of her care. There was a huge language barrier as the MD didn’t speak Spanish (I trained and practiced in many Spanish speaking countries/populations, so I was able to communicate with her clearly). She didn’t feel that she was in charge of her care. She felt uncomfortable that she only had 15 minute appointments and that she didn’t understand much of the information/choices presented to her. She didn’t feel her cultural practices and beliefs were being respected in the clinical setting. She was afraid of having an unnecessary C/S (at that time, the C/S rate at Boulder Community Hospital was 32%, well above the ideal rate of 10-15% as established by the World Health Organization (WHO). Luckily it has lowered to 26%), and her husband was nervous to be in a hospital setting as he didn’t speak any English. I explained more to her about what midwifery care looked like including informed decision making and hour-long prenatals, and what her birthing options could look like at home. The more we chatted, the more Silvia wanted to birth at home. She was healthy, had a low-risk pregnancy, and was a great candidate. There was one major barrier for them, however, in that they were insured by Medicaid and none of my services would be covered. I chose to offer her my services for $250. I knew she wanted to contribute something, but that she had very little to give. We started care at 28 weeks and spent many hours together, along with her husband, learning about what was important for them to feel safe birthing in the home setting. Silvia went on to have a beautiful, uncomplicated birth at home. She was able to move freely and eat in labor, which were very important to her. She and her husband felt heard and supported. They felt comfortable saying traditional prayers to their baby in the intimate first moments, and we followed  traditional postpartum practices that Silvia knew about from her Grandmother. I continue to be in touch with this dear family and have witnessed them grow into proud and courageous parents. The three of us often reflect that the wisdom they gained through the birthing process birthed them into empowered parents."

In the interest of sustainability of midwifery as a profession as well as CRMC, it would be impossible for us to continue attending births for $250. However, it shouldn’t be impossible for healthy, low-risk individuals to access the care of a midwife if they so choose. That is why we’re here today, asking for your support of our collective, so that we can continue educating our community about their birthing options as well as finding a sustainable way to increase access to midwifery care. Many thanks for your attention and for your commitment to improving our community in all the ways you do. We are incredibly grateful! Please take a peek at our website to learn more about us!

How you can help:

- Donate to our fundraiser now to help us care for our community. 

- Educate your community about home birth and midwives.

- Educate yourself about the health disparities that are in our country and your backyard. 

- Refer people to our Meet the Midwife gatherings, our breastfeeding classes, and our other events. 

- Stay informed about local politics regarding midwives and reproductive justice issues. 

Special thanks to Monet Nichole for making our video and providing all of your support.

Racial Issues and Birth

Racial Disparities in Birth Outcomes and Racial Discrimination as an Independent Risk Factor Affecting Maternal, Infant, and Child Health

Despite widespread calls to reduce the infant mortality, preterm birth, and low birthweight rates in the United States, racial disparities in birth outcomes persist, with African-American infants remaining the most vulnerable. In 2013, the rate of preterm birth for African-American infants was nearly double that for white infants.

Known medical, genetic, and/or sociodemographic factors alone do not account for these disparities, leading researchers to examine race and the experience of racial discrimination as independent risk factors for affecting maternal, infant, and child health.

Elephant Circle, in collaboration with the International Center for Traditional Childbearing, the International Cesarean Awareness Network, and the Midwives Alliance of North American has created this Executive Summary of existing research to make this important area of study more accessible to people interested in maternal health.

The Executive Summary includes statistical data to describe the racial disparities in birth outcomes, including preterm birth, low birthweight, and infant mortality; provides a summary of current research to examine the correlations between race, racism, and poor birth outcomes; and provides recommendations to policymakers and researchers so that meaningful strides can be made toward dismantling racism, a necessary strategy to improve birth outcomes and eliminate healthcare disparities in the United States.

The Infographic also provides a useful tool for raising awareness about this important issue. If you have any questions about these tools or the research, don't hesitate to reach out at elephantcircle@gmail.com.

Bring on the Flavor!

by Lo Kawulok, Midwife, CLC

Positive aspects of a varied diet during pregnancy and breastfeeding

One of the best ways we can expose our children to a variety of healthy foods is by eating them during pregnancy as well as while breastfeeding. Julie Mennella, a biopsychologist at Monell Chemical Senses Center in Philidellphia, has been one of the leading researchers investigating the effect of early exposures on the development of taste. Since 1991, she has published a range of studies from the affects of maternal garlic intake on breast milk flavor to prenatal and postnatal exposures of a flavor enhancing an infants’ enjoyment of that flavor in solid foods later on.  

Her work has confirmed what many of us have intuitively known for generations: If we expose our little ones to a balanced diet rich in fruits, vegetables, and complex flavors during pregnancy and breastfeeding, they are more likely to have a taste for these foods later on. And, because we know that a balanced diet is one of the best ways to lower our risks of chronic health conditions such as obesity, diabetes and cancer, the benefits of introducing these flavors to our children while in the womb and during breastfeeding are immense.

It’s really an impressive design: during pregnancy, what you eat is broken down and enters your bloodstream as molecules of protein, carbohydrate, fat, as well as volatiles, which contain the scents from your food. These scents directly affect the taste of food. Amniotic fluid is exclusively influenced by what is in your blood, thus, the flavor of foods you eat are transmitted through the amniotic fluid, which the baby is swallowing throughout pregnancy. The same is true while breastfeeding; the flavors you eat while nursing enter breast milk through the blood vessels that supply the mammary glands that produce milk. Consequently, the more variety in your diet both while growing your baby on the inside and out, the more likely your baby will have a varied palate as they grow.

I love reminding pregnant and nursing folks of this connection because it helps ease one’s mind when trying to figure out what the ideal diet is for both pregnancy and nursing. Because babies are acculturated to flavors in the womb, one can rest assured that they don’t need to limit their diet (unless there is a serious allergy) once they are nursing. I encourage breastfeeding parents to eat the foods that are part of their food culture, be it spicy or highly aromatic, as babies will most likely enjoy these interesting and familiar flavors. Dr. Menella says it well: “A diet of the healthy foods a mother enjoys is modeling at its best. The baby only learns if the mother eats the foods.”

Wishing you all healthful and inspired meals throughout pregnancy, breastfeeding, and family dinnertime!

Longmont midwife collective works to make home births affordable for low-income women

A relatively new midwife collective in Longmont has started a unique pricing model and fundraiser to help women who couldn't usually afford their services access home births.

The Community Roots Midwife Collective comprises four midwives who have been working separately for several years in Boulder County — Rachel Engel, Lauri Hughes, Nichole Didelot and Lo Kawulok.

A year ago, they got together and formed the collective. They took on their first clients in February and, in September, the collective helped welcome five new babies to the world.

In late November, the collective launched their Generosity Campaign, a fundraiser to benefit their Birth Service Fund. The Birth Service Fund allows the collective to fund about two low-cost births per month in order to allow lower-income families to access their services. Anyone can donate to the fund at bit.ly/2idZrAO.

They said they feel that access to midwifery services and home births rather than the modern alternative of a hospital birth is important.

"Some people say midwifery is preventative care in a sense because it is so comprehensive and we spend a lot of time with our clients," Kawulok said. "We take care of every aspect of their health care from their physical needs but their mental, emotional and spiritual needs as well."

A midwife is different from a doula. Midwives are vetted and certified by the state and function as primary care providers throughout a pregnancy. Doulas, on the other hand, function more as birthing coaches and not as medical professionals.

Low-risk pregnancies where the woman feels most comfortable at home are ideal for midwife births, the midwives all agreed. If there are any complications in the birth, the woman's midwife accompanies her to the hospital.

The midwives also check in on their clients several times postpartum to make sure the health of the mother and the infant are on track and answer any question the woman has about lactation or postpartum care.

Kawulok said that checking in with new mothers shortly after they give birth lowers the risk for postpartum depression, making the surrounding community at-large healthier as well.

"Their well-being post-birth and their ability to care for their babies directly affects their children, their families and all of our communities, which is why we believe that every mom, or every birthing person really deserves individual care and the care of a midwife if possible," Kawulok said.

The collective also hosts events such as lactation circles and new mom socials to ward off the isolation that can affect some new mothers.

"If moms are held in those first couple of weeks and they aren't stretched beyond what they can do and they have people checking in on them frequently and caring about them, they have a continuity of care and a lower risk for postpartum depression," Didelot said.

Hughes said it really helps to create a sense of community and support among the new moms.

"People don't feel so isolated because they know they have other parents they can talk to and they're not alone with the experience that they're having at home with their newborn," Hughes said.

Because midwife care is paid for up front and often not covered by health insurance, the collective operates on a sliding pay scale for services.

The sliding scale is unique in that it doesn't require any tax documents or proof of income, but rather functions on the honor system and women's self-evaluation of their resources. It's a much larger version of the "take a penny, leave a penny" bowls on some cashiers' counters, Hughes confirmed.

The sliding scale information sheet asks women to think about their resources. Are they living paycheck to paycheck? Would paying a higher amount mean they aren't able to pay utility bills or that they would have to cut back on eating out and buying coffee?

The lowest end of the sliding scale is $2,500 and the information sheet asks people to exhaust other resources such as friends and family before committing to pay the lowest price. Currently, the collective can only afford to offer two $2,500 births per month on a first-come, first-serve basis.

The midrange on the sliding scale is about $4,000 and is for people who have a steady income and are not worried about meeting basic needs such as food, shelter or medical care.

The high end of the sliding scale ranges from $4,500 to $6,000 and is for people who own property or have savings. Women who pay the higher end of the sliding scale enable the collective to offer the lower end.

Didelot said that the midwives have been amazed that women are perfectly willing to pay the higher end of the scale in order to allow others to pay the lower price.

"We've had two of our current clients pay above the $6,000 rate in order to pay into the fundraiser so other clients can pay at the lower end of the sliding scale and we just think that's really remarkable that those with more resources are willing to do that," Didelot said. "It's mind-boggling. I'm like, 'Oh my God! People are really choosing it!'"

Hughes said that the collective is also passionate about reaching out to traditionally underserved communities, such as people who only speak Spanish or people in the LGBTQ community.

One way to do that is take on apprentice midwives from underserved communities, Hughes said.

Kawulok added that diverse midwives are important because someone with a language barrier or from the LGTBQ community will be most comfortable with someone who can represent them.

"We want people to feel comfortable with who is providing their care and also really be able to educate from the ground up in those communities about their options," Kawulok said.

Karen Antonacci: 303-684-5226, antonaccik@times-call.com or twitter.com/ktonacci

See Full Article Here:
http://www.denverpost.com/2017/01/03/longmont-colorado-midwife-collective/

Depression in Pregnancy: 10 Things You Can Try Instead of Medication

Updated January 20, 2016 (article by Aviva Romm MD)

You’re full of new life! Overjoyed, right?

Actually, if you’re among the 1 in 10 – or even more – pregnant women who struggle with the symptoms of depression, then you might not be feeling overjoyed at all. While you may be happy to be pregnant, this may be overshadowed by cloudy feelings…

I know it can be really tough to admit we’re depressed when everyone else thinks we should be ecstatic. Many women have told me they fear they will be judged by others as “bad moms” for admitting they feel miserable.  And it can be terrifying to imagine taking care of a baby when you feel you can barely get a smile on for the day.

You may also feel very alone with your concerns.

Your midwife or doctor, and even your friends and family, might not recognize that you’re depressed. Your symptoms may be mistaken as simply normal changes of pregnancy due to hormonal shifts and other physiologic changes. After all, fatigue, changes in eating habits, sleep problems, general aches and pains, changes in mood, irritability, and tearfulness – all of these are normal during pregnancy, right?

The answer is sometimes, but not always. When mild and infrequent, these symptoms may be normal, but they are also classic signs of depression! 

Why Do I Feel So Blue? Causes of Pregnancy Depression

The root causes of depression are often complex – but they can be tackled! 

As you can see from the diagram below, depression has many possible causes and sometimes even more than one. These can include:

• Medical problems (for example, hypothyroidism, severe nausea and vomiting in pregnancy, or a pregnancy-related medical problem)
• A previously complicated pregnancy or pregnancy loss
• Nutritional deficiencies (protein, omega-3 fats, iron, vitamin D, to name a few)
• Fatigue from poor sleep
• Blood sugar problems, including both hypoglycemia and elevated blood sugar
• Lack of support or relationship problems
• Family history of depression
• Inadequate or ineffective coping skills
• Stressful life problems (money, living situation, job stress)
• Unhappiness or ambivalence about being pregnant
• Food sensitivities  or  gut dysbiosis (unhealthy changes in the gut flora or microbiome)
• Lack of exercise/movement
• Lack of sunlight or time in nature
• Environmental toxins, for example, heavy metal toxicity, usually from eating too much high mercury fish such as tuna, or hormone mimicking chemicals such as plastics from food packaging and water bottles, to name a few sources

Does Depression Pose Increased Risks to My Baby?

Untreated, severe depression can increase some risks to you and your baby – that’s why it’s so important to promptly get the support and the treatments that work best for you.

Even moderate depression can impair your quality of life.

Problems can arise because when we’re depressed, we don’t tend to take optimal care of ourselves. If this happens during pregnancy women are more likely to:

• Skimp on nutrition
• Not gain enough weight
• Have sleep problems
• Skip prenatal visits
• Use harmful substances (i.e., tobacco, alcohol, or drugs)

This can increase the risk of premature birth, having a low birth weight baby, medical problems in the pregnancy, and problems at birth.

Increasing numbers of studies are also showing that depression, stress, and anxiety in the pregnant mom influences and alters the expression of the baby’s genes, increasing the child’s lifetime risk of mental health problems.

Prenatal depression also increases the risk of postpartum depression, which, if untreated, can lead to developmental, behavioral, and mental health problems in the baby, as well as problems that arise from neglect if mom is unable to fully care for the baby.

On top of it, all of this can also have an impact on your self-esteem and confidence as a new mom, and this can also negatively affect your parenting.

But not to worry – there is help!

Should I Take an Antidepressant?

Whether to take an antidepressant is a complex and often tough decision. The evidence on the safety of these medications in pregnancy does show some risk of potential birth defects, and also withdrawal symptoms in baby after birth. You have to weight the potential benefit to you and the baby against medical risks of  taking antidepressants in pregnancy. I address this thoroughly in Depression in Pregnancy: Should You Take Medications?.

For mild to moderate depression, natural approaches can be tried first, and are often all that is needed, but women should also consider being under the care of a midwife or obstetrician and a mental health provider simultaneously.

Women with moderate to severe depression, in addition to trying these 10 tips, should be under the care of a physician who specializes in prenatal depression. Medications are an option that should be considered in severe cases, or in moderate-severe cases where your health is at risk because you aren’t able to take care of yourself; but in moderate-severe cases one can often try natural treatment for a few weeks first .

“The new medicine for women” as I call my whole women approach to Functional Medicine, includes the best combination of available strategies for individual women, used with wisdom and common sense.

 

So What Can I Do? 10 Strategies for Beating Depression Naturally

Here are 10 pregnancy-safe, positive steps you can take toward optimizing your mood and your wellness.

1. Get Real About How You Feel

The first step toward feeling better is to get real about how you feel. If you’re not happy, if you’re feeling sad, or worse than this – feeling desperate – don’t pretend otherwise. The consequences of ignoring depression in pregnancy are serious for you and baby. Admit how you’re feeling to yourself, let your partner, a close relative, or BFF know, tell your care provider and get the ball rolling on feeling better. You’re not alone, there is help, and you deserve wellness!

2. Get a Medical AOK
A number of medical conditions, including thyroid problems, diabetes, hypoglycemia, and anemia can cause symptoms of depression. Have your doctor or midwife run some simple blood tests to check for these and start appropriate treatment as necessary.

Many women who experienced severe nausea and vomiting in pregnancy also report depression – sometimes just because they felt so awful and thought it would never end, other times likely because underlying nutritional issues led to or resulted from the vomiting. Get with your midwife, doctor, or a functional medicine physician who specializes in prenatal care to help you get your nutrition on track.

3. Seek Support, Stay Connected, and Pay for Help if Needed
This is not a time to be shy asking your partner, other adult family members, your BFF, or other moms you know for support, particularly if you already have young children and are experiencing depression. If you are single or if everyone else is too busy to help when you need it, hire some extra help – whether for getting shopping and chores done, or taking care of the house or older kids. This will give you time to take care of yourself – and it’s so important!

Find a therapist. Cognitive Behavioral Therapy is one form of therapy that is especially helpful in developing coping skills for depression, and changing old, ineffective thinking patterns into new and successful skills for coping with challenging emotions, behaviors, and thoughts.

Get educated and clear out the fears. Interestingly, a recent study showed that fear of birth is associated with the later development of postpartum depression. While this association has not been studied in pregnancy, it does make sense that unresolved fears and worries can lead to prenatal depression. I once had a patient who was terrified that, because she’d had an abortion as a young adult some 15 years earlier, she would be “punished by God in this pregnancy,” and that her baby would be born deformed. This fear was even playing out in her dreams, causing her to be fatigued on top of the worry! When I was able to elicit the story and her fears, we were able to do some emotional healing around the issue and she once again had peace of mind and peaceful sleep.

4. Optimize your Diet

Gluten and dairy, while we might crave them like crazy during pregnancy, can cause mood problems in those who are sensitive. A trial of gluten and dairy free for a month, even, might shed light on whether these are not optimal for you. If symptoms improve, stay clear of them; if you don’t notice a difference, it might not have been a long enough trial, or you might not be intolerant of these substances. If you do go dairy free, make sure to get calcium from other sources.

Hypoglycemia is common during pregnancy, often made worse by nausea in the first trimester. It is important to eat high quality foods, especially a protein source (nuts, nut butters, meat, fish, or poultry, hummus or something with beans or legumes, or a protein shake, for example) and good quality fats (avocado and nut butters, for example) every few hours, and never skip meals. You do not have to eat larger quantities, but keeping your blood sugar steady is especially important if you struggle with mood swings or depression. High blood sugar over time leads to gestational diabetes, but can also lead to generalized inflammation in the body, and the chemicals produced during an inflammatory response also depress the mood. So make sure to avoid simple carbs (white flour products, white rice, pasta) and sugar, and emphasize a pregnancy-smart way of eating.

Also, make sure that you are getting all of the nutrients you need. Iron deficiency anemia, low vitamin D, low vitamin B12, can all increase depression in pregnancy, and are easily to supplement. Talk with your midwife or doctor about testing.

5. Get a Move On: Yoga and Exercise Really Help!
30 minutes per day of exercise has been shown to prevent and help with depression in pregnancy. One 12-week study done at the University of Michigan, found that group yoga classes in pregnancy substantially reduced depression, increased mindfulness, and improved mother-child bonding after the birth!

6. See The Light
Bright light therapy can be helpful in brightening your mood. The usual dose is up to 10,000 lx for 30–60 min/day using a light box. One side effect is a slightly “hyper” mood – use for a shorter duration or every other day if you experience this. Even just sitting with your face toward a sunny window for 30 minutes each morning has been shown to improve mood.

7. Sleep Well … and Embrace the “Cat Nap” 
We don’t need to be rocket scientists to know that lack of sleep increases depression and irritability, makes us grab for quick sugary foods that later lead to a blood sugar crash, and generally rocks our boat. It also increases inflammation so our health takes some hits when sleep is poor. Since pregnancy naturally makes it harder to sleep due to our growing belly size and frequent need to pee in the night, taking cat naps in the day rather than pushing through or grabbing for sweets or caffeine is the healthy way to catch up on rest and nip depression in the bud.

8. Spend Some Time in Nature
It’s so easy to spend most of our time indoors and to forget how uplifting even a little bit of fresh air and sunshine can be. But getting even 15 minutes of fresh air each day can help us overcome the nature deficit disorder most of us suffer from, and with it, brighten our moods. Consider a brisk walk for the double benefit of fresh air and exercise for a better mood and even better sleep, or find a sunny spot for a quick mediation to brighten your day!

9. Use these Pregnancy-Safe Herbs and Supplements to Reduce Inflammation and Support Your Brain and Nervous System

• Omega-3 fatty acids: There is good evidence to show that many pregnant women are deficient in omega-3 fatty acids, and when maternal intake is low, so is the mom’s DHA level which can affects mood. Fish oil capsules (I recommend Nordic Naturals prenatal fish oil products) can be trusted to be mercury-free, and vegetarians can use a product such as Omega Twin by Barleans. I recommend discontinuing use 2 weeks prior to the due date because of a small but possible increased risk of bleeding while supplementing. Though this is likely overly cautious, and most evidence suggests no risk, many herbalists have reported observing bruising in clients taking 2 g or more/day. If you do discontinue it, simply resume a few days after birth to help prevent postpartum depression.

• Sam-E: A natural substance important for methylation, a process involved in making chemicals called neurotransmitters, which control mood, Sam-E has been well-studied and found to be safe in pregnancy. It should not be used in women with bipolar depression. A typical dose is 400 mg/day, but up to 800 mg (400 twice daily) may be needed for an optimal therapeutic effect. Rarely, it has been reported to cause mild gastrointestinal symptoms, sweating, dizziness, and anxiety.

• Folate: Important for preventing neural tube defects in our babies, folate is also important for a healthy nervous system. Taking folate does not in itself seem to improve prenatal depression, but it does appear that women who have adequate folate intake respond better to treatment with antidepressant medications. It may also have protective effects against autism in our babies. I recommend 800 mcg – 2 mg of methylfolate daily, ideally starting 3 month prior to pregnancy, or at any point that you realize are pregnant.

• St. John’s Wort: While the data is limited, and more studies are needed, especially given uncertainty over the safety of conventional antidepressant medications in pregnancy, studies on the effect of prenatal consumption of St. John’s wort on pregnancy in mice and rats were generally associated with normal gestation and offspring development. A limited number of human case reports indicated healthy pregnancies and infants when St. John’s wort was used prenatally. A standard adult dose is 300 mg 2-3 times/day, of a product standardized to 0.3% hypericin.

• Probiotics: Increasing evidence suggests that disrupted flora can contribute to a disrupted mood, including depression and anxiety. Studies have shown that eating live active cultures such as found in yogurt can improve women’s moods! I extend this to fermented foods in general, such as sauerkraut, kimchee, and miso.  A good probiotic can also do the trick!

Check with your midwife or doctor before using if you are already on a medication or if you have any medical problems related to pregnancy).

10. Call on a Pregnancy Natural Medicine Expert
If after a couple of weeks of incorporating a combination of the above strategies you’re not noticing any improvements, this is a good time to consult with a medical provider who specializes specifically in the functional medicine, naturopathic, integrative, or mental health care of pregnant women. While self-care is the cornerstone of health, greater health challenges can be best addressed with a supportive, knowledgeable team.

Now it’s your turn to share! If you suffered from depression in a past pregnancy, what helped you to cope or heal? What do you wish someone had told you while you were pregnant that you can share as inspiration for other women?

Want to learn more about natural care for yourself during your pregnancy and beyond? You’ll love the down-to-earth nature of The Natural Pregnancy Book, and for after baby – Natural Health After Birth. They also make great gifts for other pregnant women in your life!

With love and compassion,

Aviva

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References

Benard, A. et al. The risk of major cardiac malformations associated with paroxetine use during the first trimester of pregnancy: A systematic review and meta-analysis. British Journal of Clinical Pharmacology.doi: 10.1111/bcp.12849.

Freeman, MP. (2009). Complementary and alternative medicine for perinatal depression. Journal of Affective Disorders, 112: 1–10.

Hogg K, Price EM, et al. (2012). Prenatal and perinatal environmental influences on the human fetal and placental epigenome. Clin Pharmacol Ther, 92(6):716-26.

Misri, S and S Lusskin. (2013). Depression in pregnant women: Management. http://www.uptodate.com/contents/depression-in-pregnant-women-management?source=see_link

Muzik, M et al. (2012). Mindfulness yoga during pregnancy for psychiatrically at-risk women: Preliminary results from a pilot feasibility study. Complementary Therapies in Clinical Practice, 18:235-240.

Romm, A. (2014) Uncovering and Treating Depression during Pregnancy. Alternative and Complementary Therapies. In Press.