One question that comes up for a lot of people at the end of pregnancy is the efficacy and safety of natural induction methods. Always remember, before attempting any induction method (natural or otherwise), you should have a conversation with your care provider about its safety and benefits/risks/alternatives for your specific situation!
This week, Evidence Based Birth hosted a webinar on three of the most popular natural induction techniques: acupressure/shiatzu/acupuncture, breast stimulation, and consuming castor oil. They reviewed the most up-to-date research about these methods and whether they're safe and effective. After watching the webinar, I created this summary for you.
A summary always leaves out important details, so I encourage you to check out this link as well for more information about these and other natural induction techniques
(NOTE: some have been found to be unsafe and are not recommended, so make sure you read each entry!)
And always remember to check with your care provider before attempting any induction technique!
Studies indicate that care from a licensed acupressurist or acupuncturist or may help promote cervical ripening.
Shiatzu treatment has been linked to less Pitocin use for labor induction.
Studies show that these techniques are NOT linked to adverse effects.
More high-quality studies that investigate a wider range of pressure points and other uses of these techniques would be helpful!
Breast stimulation was found to be effective for inducing women at term with a favorable cervix. For those without a favorable cervix, it may help with cervical ripening
Breast stimulation has been found to reduce postpartum hemorrhage.
Not recommended for those categorized as "high risk." Should only be done with the guidance of your care provider!
Studies indicate that castor oil is an effective natural induction method, especially for subsequent pregnancies.
No evidence linking castor oil use to adverse effects for baby.
Possible side effects of castor oil use: nausea, vomiting, diarrhea
More higher-quality studies are needed!
I hope you enjoyed this quick summary of the evidence on these induction methods! Don't forget the best induction method: PATIENCE!
“This is our first pregnancy... I don’t even know what to ask.”
“How do I even prepare for something like birth? It’s so different from anything I’ve ever done before!”
“I just feel nervous about the whole thing.”
Do you hear yourself in any of these questions?
Many first-time parents are excited, nervous, anxious, or not even sure what questions to ask or how to prepare for the journey of birth and early parenthood.
So how do you prepare? Let’s take a look at some ways to move past uncertainty and find confidence as you prepare for this life-changing adventure.
You know yourself and your learning styles and preferences best, so you’ll be able to determine the best way to educate yourself about pregnancy, birth, and the postpartum period. Find an in-person class, an online class, or lose yourself in some great books (I have several I’d recommend—check out the titles in my Lending Library!). As you choose your educational path, make sure your choice honors you as a birthgiver—a whole individual with unique preferences, perspectives, and incredible life-giving power. (Hint: you’ll probably need to look beyond a hospital birth class to find this.)
Ask questions...so many questions
You may not even be aware of all the questions you have. Write down the ones that come to mind. (Yes, even the "dumb questions." Because really, there are no dumb questions!) Did you have a fleeting thought about, "I wonder why doctors recommend ________________ during birth?" Write it down! Did you have a strange dream about giving birth to a monkey, and you wonder what it could possibly mean? Write it down! Did you read something in a birth book that doesn't jibe with the stories you've heard from family members? Write it down!
Once you've got your list of questions, go out looking for the answers. Ask your care provider. Consider whether their answers fit with your preferences and perspective, and whether you felt respected in asking your question. (If not, find a new care provider, and keep asking questions until you feel heard and supported!) Ask trusted mentors: your friends, sisters, care provider, aunts, mom, neighbors, doula, birth class teacher...
Find support you can trust
You may have an older sister or mother who has navigated the journey of birth and early parenthood in a way that you want to emulate. If so, reach out to her, and ask for her mentorship. Involve your husband or partner every step of the way. A doula can also be a great support person to have on your team. Doulas are specially trained to help you prepare and to support you and your family during labor and birth. If you’d like to see if I’d be a good fit to add to your support team, reach out and schedule a complimentary consultation!
Having a supportive birth team will ensure that you’re cared for as a whole person as you begin the journey of parenthood. Your care provider will attend to your and your baby’s medical needs. But birth is also a very emotional and physical process—build a support network that reflects that reality!
I believe that the way we birth matters—it’s the beginning of our experience as parents, and can be the beginning of a strong bond forged with baby that can lay the foundation for an empowered start to parenthood. I wish you the best on your journey!
For clients due in 2020, I've got great news!
Mary Caplin and I are teaming up to bring you the support and expertise of TWO doulas! Mary and I have been collaborating for several months, and we both feel like we're ready to synergize and work together for the coming year. Mary is an incredible support to the families she serves. She has a wide range of experience in the clients she's served, and she's especially good at helping learn how to work together as a couple during the transformative time of birth.
So, what will it look like?
You--the client--will reach out to one of us, and meet with us during a complimentary consultation. That gives you a chance to ask your questions and decide if the fit feels right. After the consultation, you can connect with the other doula before deciding to move forward.
Then, when you book, you'll have two doulas working together to make your birth journey positive! We'll work together to direct you towards helpful resources, answer your questions, and help you and your partner prepare for birth. During your two birth preparation visits, you'll get to know and be comfortable with each of us one-on-one.
When labor begins, the doula you originally reached out to will be your primary on-call doula to join you when you need extra support. Sometimes, though, labor is long. If that happens, you'll want a fresh, well-rested doula to join you so you can continue to focus on the incredible and unique work you're doing. Mary and I will switch each other out to make sure you're getting the support you need.
In the days following baby's birth, you can continue to reach out to both of us via text, phone, or email. One of us will also visit you in your home to discuss your birth and connect you with postpartum support resources.
The services unique to each of our businesses will now be available to you throughout the experience. We'll continue to offer grants for lower-income families, and you can borrow books (about fertility, breastfeeding, pregnancy, birth, and infancy!) from the lending library. Plus, Mary's unique touches of a birth memory letter and a loaf of homemade bread will help you settle in with your new addition.
I'm thrilled to offer this service to our clients! Do you have questions about the partnership? Ask them below!
I've blogged before about how, when I heard about doulas, we just weren't in a position to hire one. I'm passionate about making doula care accessible, and so today I'm so excited to announce that I know offer grant applications for lower income families. Find out all the details and submit an application here.
But here's the low down:
If your annual household income is at or below the guidelines in the chart at the end of this post or are otherwise financially constrained, you can apply for a grant to help pay for doula services.
Just head on over to the Grant Application tab and fill in the required info, including your self-reported annual gross household income. You'll get an email response within 48 hours letting you know if you could receive a grant and the value of the grant. If you decide to hire me as your doula, that grant will go directly towards the total fee.
I'm happy to answer any questions you have! Email me at firstname.lastname@example.org or comment below.
*Calculated as 2X the 2019 federal poverty guidelines, as reported at https://aspe.hhs.gov/2019-poverty-guidelines#guideline
The other day, I was talking with my daughter, telling her about the research I've been doing at the intersection of doula work and linguistics. I explained to her that linguistics is all about words: what we say, how we say it, why we say things certain ways, etc. And I told her that I was writing about words and why they're important in doula work: what are good, helpful things that we can say to "mommies having babies," and what things aren't helpful or good. I asked her if she had any ideas about that, and her response gave me lots to think about!
She said, "well, it wouldn't be good to say, 'I don't think this baby is going to come out. It's not going to come out. You better just stay here until it comes out.'" I then asked her about what would be good things to say, and she said she could only think of silly ideas. I pressed her, asking what ideas seemed silly that she had thought of. She said, "Well, you could say, 'Are you hungry?'" I assured her that this was not a silly idea, but rather a really important question to ask! A laboring woman may very well be hungry (especially in early labor), and it would be very helpful to check in about that need. I thanked her for her great idea and asked her if she had any other ideas about good things to say. "You could say, 'Are you feeling okay right now?'" When I asked why that was a good thing to say, she explained, "because you want to make sure she feels safe." I again thanked her for her very thoughtful and important idea and asked if she had any more. She told me she had one last idea: "Are you comfortable?" Again, I told her this was an excellent idea and that she would be a great doula! She told me she'd consider adding it to her future plans. :)
As I thought back on our conversation, I really was struck by the simple dichotomy in what she labeled as helpful versus unhelpful things to say to a birthing woman. Few people would actually say to a woman in labor, "I don't think this baby's going to come out; you better just stay here until it comes out," but what's the underlying message here? It's a lack of confidence in the woman and her body and an assumption that birth is something that just happens to a woman while she "stays there" and waits, without confidence that she can actually do this. Are there times when words uttered in the birth space have these unhelpful dubious underpinnings? Instead, let's aim for our words to share Ina May Gaskin's message:
“Birth is something that women do—not something that happens to them. The birth-giving woman is the central agent in the ancient drama of life bringing forth new life.”
So let's turn to the second set of suggestions my daughter gave, of helpful things to say. The obvious similarity among all three suggestions is that they are questions. Rather than projecting a certain sentiment about the birth experience onto the laboring woman, these questions value the woman's role as an important individual with unique needs. The questions seek to discover those needs, with the intent of helping to meet them. I was especially struck with the explanation she gave regarding her second question, "Are you okay right now?" about how it's important that she feel safe. This is so true for a laboring woman! Her physical progress in labor can be impeded if she feels unsafe: physically, emotionally, or otherwise. This is a basic need that all in the birth space should be sensitive to! And attending to her other physical needs of hunger and comfort are helpful ways of showing support for her in the valuable work she's doing. As participants in a birth experience, let's always be mindful about the underlying messages our words send and thoughtful about sharing confidence and support.
I'm grateful for the wise words my daughter shared with me! What wisdom have the young people in your life shared with you?
When I first heard about what a doula was, my husband was in grad school, and our main source of income was his research stipend. I used most of my time taking care of my twin daughters, and I worked a variety of side jobs to (minimally) supplement our income: babysitting, tutoring, teaching voice lessons, cutting hair, and a couple of other random gigs. Money was tight, but we recognized that the sacrifices we were making as a family would pay off long-term and that education is invaluable. When I was pregnant with my son, my neighbor, who was pregnant with her third baby, told me about doulas and sang their praises. Then she mentioned the cost of hiring a doula, and the subject became completely irrelevant to me. It simply wasn't in the budget!
Fortunately, I took a comprehensive childbirth class, and my husband was a fabulous support. My obstetrician was respectful of my desire for an unmedicated VBAC, and I lucked out with a phenomenal nurse who stepped in and gave some awesome counter-pressure and words of encouragement. I ultimately had a very empowering, amazing labor and birth.
Three years earlier, when I was pregnant with my twins, I didn't even know what a doula was. If I had know then, though, my reaction would have been the same as it was during my pregnancy with my son, "that sounds nice, but it's not relevant to me. It's just not in the budget." But in the case of their birth story, I sincerely believe that having a doula by my side would have made a world of a difference. I strongly believe that, with the help of a doula, my husband and I would have realized that we had the opportunity to make choices throughout my labor. We could have declined or delayed interventions, and I have a hunch I could have avoided the emergency cesarean that brought my twins into the world. Of course I'll never know, but I know for sure that additional knowledge and support during that pregnancy and birth would have been helpful. But it wouldn't have been in the budget.
So, if you figuratively find yourself in my old shoes, saying, "a doula sounds nice, but it's just not in the budget," please reach out to me. I offer a significantly reduced (40% off) student rate, and I'm willing to work with anyone (students or not) to make my services affordable to you. Everyone deserves a supported birth!
Here are some other ideas to help make hiring a doula a financial possibility:
*Consider this: A doula provides physical and emotional support that can help you avoid the use of pain relief medications during labor, such as epidurals. Not having an epidural on your hospital bill will significantly reduce your hospital costs!
*Ask for funds for a doula on your baby shower wish list.
*Some insurance companies will give partial or full reimbursements for doula services. Reach out to your insurance company to see if they'll offer that for you--it can't hurt to ask! To boost your argument, share this article from Evidence Based Birth. Your insurance company will see that when their clients have doulas, they are likely to save money! This blog post takes you through the step-by-step process of asking your health insurance company to reimburse doula costs.
I read an interesting article yesterday with some important implications for labor and birth. It was aimed at an audience of anesthesiologists, but it raises some important questions about how laboring women frame their own experience and how they're cared for.
The authors had conducted a study to determine the effect of language when checking in with post-cesarean patients. The assessors came into the room of the recovering patients in the first day after their cesarean. To half of the patients, the assessors asked the patients, "Do you have any pain at the moment?" 63 of the 116 patients (54.3%) responded that they did. To the other group, the assessors used more positive language, asking, "How are you feeling?" and "Are you comfortable at the moment?" In this group, only 28 of the 116 women (24.1%) reported that they were in pain. And these women were recovering from a major surgery!
For the most part, this study was well-conducted, although it did have a few limitations, which were acknowledged by the authors (like the fact that study's design meant that only the patients, and not the assessors, were blinded; and the difficult-to-define spectrum of pain and comfort affected the results). However, I think it offers important food for thought in the care of laboring women.
Imagine how a similar phenomenon might happen with a woman in labor. If asked how she's feeling and if she's comfortable, the laboring woman and her friends and care providers can work to help her find optimally comfort and find a rhythm with the work her body is doing. If confronted with the question of her pain, she may pause, get out of her body's natural rhythm, and focus more on the pain she's feeling. The authors of this article point out that, during pregnancy and the postpartum period, women are increasingly susceptible to the power of suggestion. This is acutely true during labor. We need to carefully consider how our language frames the mother's birth experience.
I certainly don't want to discredit women who have felt pain during childbirth. Although I believe there are ways to manage pain and increase comfort in labor, I feel that it would be more beneficial to reframe our perception of pain in labor. As the authors of this study pointed out, pain is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." This definition, and the common perception of pain, is that it indicates that something is wrong. Sometimes this is the meaning of pain in labor, as when the baby is malpositioned, or the mother is in an unfavorable position. This pain can alert the mother and her care providers to take action to correct this.
Often, though, the "pain" of contractions is a sign that everything is right, that the body is doing just what it needs to in order to birth this baby. For this reason, hypnobirthers have chosen to linguistically reframe many of the sensations of labor. Rather than "contractions," they refer to "waves" or "surges." These words are inspired by images of nature running its right and proper course, and help a laboring mother realize that her body, too, is doing what it naturally should. Many hypnobirthers speak of intense pressure, rather than pain, as they experience the sensation of the uterus working to open and thin the cervix.
Many women feel that hypnobirthing isn't for them. I still believe that these women benefit from linguistically reframing the sensation of labor and birth! If a mother says she's in pain, we should believe her and work with her to manage it! But if she hasn't said anything of pain, then let's not introduce the word into the vocabulary of the experience. Let's talk about optimizing comfort; let's compliment her for beautifully handling the intensity of the experience; and let's remind that her body knows what to do, and that she is doing just what she needs to be doing.
What terms or phrases have been helpful for reframing labor sensations for you?
Chooi C. S. L., Nerlekar R., Raju R., Cyna A. M. (2011). The effects of positive or negative words when
assessing postoperative pain. Anaesthesia and Intensive Care 39(1), 101-106.
One of the things that drives my linguistic study of the birth environment is that so little has been done in this area so far. In situating my contribution to the literature, I've had to go back a few decades to find relevant books. So here's this beauty: published in 1984, Birth Stories, edited by Janet Isaacs Ashford, is a collection of birth stories (bet you couldn't have guessed that!).
An interesting feature of this book, though, is that the stories collected range from 1915 to 1983, so it really gives a big picture of a variety of obstetric practices and childbirth tendencies over several decades. You may have heard of some of them: overuse of forceps due to complete unconsciousness of the mother during delivery; "Twilight Sleep;" women being left alone, without friends or family, to labor; routine shaving, enema, and episiotomy... Unfortunately, the list goes on. I'm so grateful to be mothering in an era when most of these have faded into the past. I watched many of them fade as I turned the pages of this book.
Throughout the decades, themes persist. There are women who feel there must be a better way, who seek alternative care. Some of these women find it. They deliver at home or birthing centers with the care of experienced midwives. Some are treated with respect in the hospital and voice their preferences and are listened to. Birth empowers them. Some go without care and face unfortunate consequences. Some feel that they can't find it, and end up being subject to the interventions they were hoping to avoid, even though they vocally protested. These women feel a loss of control, and birth is a severely disempowering experience. Their stories are told in this book.
After reading this book, I believe more strongly that birth is a story we must keep telling. We must tell our experiences, good and bad, and seek to make birth better and better for our birth-giving posterity.
Now to close, I have two questions for you, dear reader: 1) Would you be interested in also reading article reviews of the journal articles I'm reading about language and childbirth? and 2) Do you know of any books I'm missing out on that talk about language and birth? If so, comment below!
In September, I'll be presenting at the Evidence Based Birth Conference in Kentucky. (Can I just pause to say about how thrilled I am to be able to present at this amazing conference!?) I'll be leading a workshop about the critical role that our words play in shaping the birth environment. I can't wait to share how my passion for birth converges with my passion for linguistics and give other birth workers tools to use their language for good!
In preparation for my workshop, I'm familiarizing myself with any other texts that are relevant to this topic. It turns out that there aren't a ton of super-relevant texts, but I'm reading what I can about the overlapping spheres of language usage and childbirth. Enter Women Writing Childbirth: Modern Discourses of Motherhood by Tess Cosslett. It's an older book (published 1994) that synthesizes and analyzes literature of the 20th century that addresses the topic of childbirth. While it's well-done and thorough and has a few good themes, it's not a book I would widely recommend. If you're curious about what (mostly female) writers have written about birth in both fiction and non-fiction works and want to read one critical interpretation of those texts, it's a worthwhile read. It's certainly got its own biases (which the author acknowledges), and I disagreed--either in part of in whole--with several things Cosslett writes. However, she does uncover a few worthwhile themes in her analysis. Here are the ones that stood out to me:
Cosslett teases out these themes as she examines several works of literature, both fiction and non-fiction. This book certainly provided food for thought and insight into potential themes in the language that surrounds birth.
Stay tuned for more reviews of the birthwork/linguistics literature and a preview of my EBB workshop!
I've read more than a few books about pregnancy, birth, and the rest of the journey. But this one, my friends, is my favorite.
I was introduced to this beautiful book by a dear friend when I was struggling with infertility before conceiving my twins. She shared a few essays about patience during infertility with me, and I was touched by them, but didn't read any of the rest of the book.
Then, years later, when I was pregnant with my son, I rediscovered this book and read it cover-to-cover. Reading it was one of the critical parts of my preparations for his birth--an unmedicated VBAC--and the beginning of the path that lead me to becoming a doula. The book is a compilations of essays and birth stories about pregnancy and birth, written by birth workers and many other child-bearing women. The common thread among the authors is that they are all members of my faith (The Church of Jesus Christ of Latter-day Saints). The unique perspectives offered by the authors invited me to reconsider stereotypes and paradigms about pregnancy and birth that I'd inadvertently and unknowingly observed and absorbed. The writings brought to light some beautiful truths that had been hiding in shadows for me and gave words to powerful beliefs that have become personal pillars. It sparked in me the desire to invite other women on this journey. In short, reading these stories and thoughts changed my life.
The Gift of Giving Life is divided into topical sections, including patience, preparation, fear, and many others. Among my favorites is the opening section, "Our Legacy," which begins with an essay titled, "We Are Each Eve," and continues with the faith/birth/motherhood journeys of many women who have faithfully and wisely chosen to bear and mother their children, following in the footsteps of Mother Eve and Mother in Heaven. From this potent beginning, the book carries the reader through women's thoughts and experiences about the importance of giving life, personal revelation, the spirit-mind-body connection, the atonement, and others. The book ends with a section on the fourth trimester, or the newborn/postpartum phase, inviting new mothers to go forward with a sense of divine purpose as they continue on the path of motherhood.
I feel it's not possible to do justice to the beauty and power of this book. So I encourage you to read it for yourself! If you're looking for a copy, I have one you can borrow. :)