Many women find a TENS unit during labor to calm and take the sharpness out of their contractions, as well as to be a good distraction from them.
How does it work? The message your brain receives during a contraction is pain. However, using the” Gate Theory”, if you are able to confuse the message being sent, by stimulating the surrounding nerve endings running up along the spine with tingling sensation from the electrical pulses of the TENS unit; it can diffuse the pain signals that your brain in creating, helping to make labor more bearable
Another way the TENS can work is, if it is turned up to one of its highest levels. The discomfort created, increases the body’s own pain relieving hormones, which can contribute to some relief of the intensity of the contractions, otherwise felt.
I started using a TENS in my doula work a year ago. Since using it, it has completely changed the way my clients have been able to handle the discomfort of their labors. The number of clients able to go all the way through their labors without an epidural has increased. Many have been able to go longer and progress further into their labors, before getting one; which decreases the likelihood of labor slowing from epidural.
One mother of four, (having had all her children without the use of pain medication) was able to use it during her fourth labor and birth. She explained to me that it doesn’t completely take away the pain; but you are well into a contraction before noticing it come on. The peak of the contraction is dulled or not as sharp; and then it kind of just fizzles out.
I had another mother feel like her back was breaking during an induction. She was still in very early labor, when she called me to come to her. After about 45 minutes of having the TENS unit placed, she wasn’t able to feel her contractions at all anymore until well into the active phase of labor.
Most recent research shows that a TENS can decrease pain levels during labor and increase maternal satisfaction around birth. There do not currently appear to be any negative side effects of using TENS during labor. Ask your birth attendant if they carry one in their birth tool kit.
*This is a summary of: Positively Birthing, “Do I Really Need a TENS Machine”, written by Megan Rossiter; with added commentary by Maggie Watkins, Doula
Should you hire a birth doula if you plan to have an epidural, need a cesarean or have the support of family and friends?
Whether you have an un-medicated home birth, birth in water at a birth center, plan to ask for an epidural the minute you walk into the hospital doors or have a planned cesarean; a doula is invaluable in providing you and your partner personalized, evidence based information and resources, emotional and physical support and advocacy from before your pregnancy begins to as many as 3 months or more in postpartum.
Mirriam-Webster's Dictionary defines a doula as: "a person trained to provide advice, information, emotional support, and physical comfort to a mother before, during, and just after childbirth."
DO I STILL NEED A DOULA IF MY HUSBAND IS ATTENDING?
Doula's do not take the place of your husband or chosen birth partner. We are their doula, too. How many births have they participated in? Will they know when and how to use all the head knowledge they gained when they read the book or took the birth class? We are a knowledgeable tool bag to pull from while they are supporting you in your labor and birth. We offer ideas and suggestions for them to use at the moment it makes sense to use it. We offer encouragement that things are going as they should. We switch out with your partner so their arms can have a break from giving hip squeezes. We help them to advocate for you when you are unable. When things get a little scary, we are right next to them explaining what is happening and what to expect, as we are able. We offer a hand to hold, hugs and prayers.
A doula is a completely different type of support than a loved one
HOW DOES A DOULA HELP IN A BELLY BIRTH (CESAREAN) SITUATION?
A doula can help you the same way for a planned cesarean as a planned vaginal birth. The differences would be, that the day of your "belly birth" your doula will join you in pre-op (if allowed) to help set a calming atmosphere and ease anxieties before you are escorted to the OR; help you to get answers to your questions and take pictures of you and your partner before the birth. After the birth, she will join you in recovery or your postpartum room to help you get settled, take more photos, and help with breastfeeding or pump set-up depending on her training.
EVIDENCE BASED BENEFITS OF HAVING A DOULA
WHAT DOES A DOULA DO?
Personalized education and support
Evidence based answers to questions as they come up
Resources and referrals to other helpful providers
Help with questions to ask during your provider office visit
Learn About: positional changes, comfort measures, right-to-know, right-to-refuse, decision making, advocating for yourself and your baby
Create a birth plan
What to expect in general
Labor & Birth
24/7 Support (physical, emotional and informational)
Help in Advocating
Suggesting position changes to keep labor moving
Suggesting Comfort Measures (massage, encouragement, soothing, ...)
Coaching and Peace of Mind for Birth Partner
Photos as Possible
WHO COULDN'T USE THIS TYPE OF SUPPORT?
There are decisions to be made along the way, no matter the type of birth you opt for, or end up having based on your circumstances. As a birthing woman, you have options before, during and after your birth. In the case of a hospital birth, if you don't know you have options and the right to ask questions or refuse procedures; your birth becomes a process where hospital regulations, protocols and your physicians fear of liability take over the event. Birth becomes a medical procedure rather than a special event. Many times these types of births end with Mama feeling like her birth was "done to her".
DID YOU KNOW...
A postpartum doula’s is an expert at protecting, nurturing, and coaching you through the 4th trimester period after birth; while you and baby are learning how to do life together. She’ll teach you feeding, swaddling, diapering, bathing, baby-wearing techniques and so much more. She helps in your recovery, offering tips for sore nipples, perineum and cesarean after care; making sure you’re getting nourished, hydrated, taking naps and getting some time to yourself.
A postpartum doula helps with tips and tools for managing your new life with baby. She will help you filter through some of the opinions, advice and information you've come across; sharing some of her best resources and trade secrets. She will also help with light housekeeping, as well as demonstrate how to balance the household duties with baby duties. She will help you create routines for days, nights and sleep, along with getting things done and getting out of the house together and on time.
Ultimately, a doula helps you transition into a new lifestyle with a baby or with adding another baby to the home. She helps you to gain confidence in your ability to mother your baby by providing emotional, physical and informational support.
A nanny’s primary responsibility is childcare. She is someone who is knowledgeable about babies and children after most of the above has been figured out. They help parents get a break and get time for themselves away from the kids, in order that parents can focus on and get more of their other things done; whether it is errands or their careers.
When I sometimes tell people that I do placenta encapsulation for clients who desire it; the reactions I receive are usually faces appearing to have just smelled something obnoxious, and less than enthusiastic attitudes. At best, most are intrigued with how it is processed, and for what purposes someone would want to consume their placenta. Below are some interesting facts about the placenta, description of the different processes used for encapsulating the placenta, and the benefits reported by new moms (aka, anecdotal evidence), who have consumed their placentas.
Very basically, the placenta is a temporary organ developed in the uterus during pregnancy. It is shared between Mama and Baby. The umbilical cord connects Baby to the placenta, providing him with oxygen and nutrients from Mama to grow, while also removing waste from his blood. In this way, the placenta acts as both a lung and a filtering system for Baby. The placenta also secretes large amounts of hormones to keep baby from delivering, too early; as well as hormones which pave the way for delivery.
We are one of only a few animals that does not practice placentophagy, or consuming our placentas as part of the normal birth process. There is much debate from just about anyone you ask, as to whether animals do it for safety purposes (hiding evidence from predators), or for physiological purposes (see reported benefits below). Maybe it's both.
Midwives around the globe have known the uses and healing benefits of the placenta for centuries. One practice of midwives includes using the placenta to stop postpartum hemorrhage following delivery. The placenta is believed to hold increased amounts of hormones from pregnancy and delivery, in addition to high levels of iron. Midwives, by cutting off a piece of the raw placenta and giving it to the mother to hold inside her cheek, use the mother's own hormones and nutrients held in the placenta, which are immediately transferred into mama's blood stream, to stop the blood flow. These hormones cause the uterus to clamp and slow the blood flow.
Some cultures make it a regular practice to give mama a piece of the placenta to hold in her cheek as a way of avoiding hemorrhage, altogether. Some homebirth mamas choose as part of their birth plan, to consume a piece of their placenta in a smoothie immediately after giving birth, for the reported benefits of its ability to provide a surge of energy, as well as decrease bleeding.
In US hospitals and hospital based birth centers, synthetics are given immediately after birth to control maternal, postpartum bleeding.
Some Reported Benefits of Placenta Consumption Include:
increase in milk production
increased energy levels
decrease in stress levels
decrease in postpartum baby blues/depression
decreased postpartum bleeding
Some Methods of Consumption
as an ingredient to other recipes
The Encapsulation Process
Traditional Chinese Medicine Method (TCM)
This method has been used for generations upon generations. This process is based on the idea of Yin (cold) and Yang (warm). Steaming the placenta, along with the healing properties of lemon (grounding), ginger (circulation) and jalapeno (warmth) are believed to restore the warmth to a woman's body, and provide balance to her after birth, which is thought to leave a woman's body in a cold state.
The process involved includes: First, steaming the placenta with lemon, ginger and jalapeno. Then, it is cut into thin slices and placed in a dehydrator. After dehydration is complete, the pieces are ground into a fine powder and put into capsules for consumption.
Benefits of this process are reported by women to have a more calming effect and reduction in postpartum depression. However, this process produces fewer capsules, since during the steaming process the placenta shrinks (see pics above).
Raw (Simple) Method
Believing that some of the healing properties and nutrients are destroyed in the heating process of the TCM method; this process skips this step. Raw slices of the placenta are dehydrated on a lower setting, ground into fine powder and put into capsules for consumption. This process yields more capsules than the TCM method, which allows for longer consumption. The benefits reported are an increase of energy. Some believe the raw method of preparation provides more medicinal value.
It is relevant to note that despite warnings from the CDC, that placenta consumption poses no health risks to the newborn, as reported by a new study conducted by UNLV, which found no harm to newborns of women who practice placentophagy.
None of the studies conducted on placentophagy, so far have supported the benefits reported by mamas practicing it. However, most admit in discussion to limitations in the method as possible factors. Studies are continuing to be conducted by universities such as, UNLV, who previously concluded no hormonal benefits or otherwise from placenta consumption. However, they in their Placenta vs. Placebo study suggested, "... it doesn’t necessarily mean that between-group differences do not exist, just that we did not have a large enough sample size for differences to appear."
Other resources used for this article include:
Three Keys to Avoiding Postpartum Hemorrhage
What is the difference between raw (simple) and steamed (TCM) Placenta Encapsulation?
UNLV Study: Placenta Consumption Offers Few Benefits for New Mom
Study: Maternal Placenta Consumption Causes No Harm to Newborn
Newborns will sleep anywhere from 17-22 hours in a 24-hour period. However, it is very interrupted sleep with all the diaper changes and required around-the-clock feedings; sometimes taking up to an hour or more at a time, while getting the hang of it all. Somewhere around 3 weeks postpartum, things change. Baby will have longer awake times between naps (30-45 min), and they will begin to cry more (3-6 hours cumulative); sometimes at certain times of the day, for what seems like no reason at all. However, it is also around this time a healthy newborn will begin to get into a better sleep routine.
On average baby's sleep cycle will start at 10PM-11PM and end between 7AM-8AM (if days and nights are not confused, which is an easy fix). If baby is let be, he* will go longer stretches between late night/early morning feedings, which means longer stretches of sleep. The new parents are grateful to be getting these longer stretches of sleep.
However, sleep is still not undisturbed; because while newborns are sleeping (very often in the parent's room, as recommended), they grunt, groan, squeak and cry in their sleep throughout the night. These noises cause alarm to a new parent, jolting them awake. Now at the ready for another feed or diaper change, the parents either sleep walk over to the baby to start the changing/feeding routine, before it's really needed; OR they lie very still, while silently and often grudgingly praying it's a false alarm, so they can get another 5 minutes of sleep. Add jumping up from a deep sleep to check once again if baby is still breathing; because Baby is, too quiet.
This routine happens several times a night, and doesn’t allow for a nice, long, deep, refreshing sleep cycle. One day blends into the next, and the new parents never really feel refreshed and rejuvenated to take on the next round of feedings, diaper changes, fussy moments or the 8 to 5 workdays. Sleep deprivation depletes a parent’s mental and emotional capacity, shortens patience with themselves, with baby and other household members, heightens frustration levels, and has been significantly linked to symptoms of postpartum depression, (Dennis & Ross, 2005).
“Mothers exhibiting major depressive symptomatology (EPDS > 12) at 4 and 8 weeks were significantly more likely to report that their baby cried often, be woken up 3 times or more between 10 pm and 6 am, have received less than 6 hours of sleep in a 24-hour period over the past week, indicate that their baby did not sleep well, and think that their baby's sleep pattern did not allow them to get a reasonable amount of sleep” (Dennis & Ross, 2005, 187).
In addition to coaching, educating and providing encouragement and resources on various relevant topics, an overnight postpartum doula helps to support healing and recovery in the 4th trimester (first three months following birth); and helps to renew and strengthen the parent’s depleted mental and emotional capacity, allowing them to better adapt to their new role and new lifestyle.
HOW DO THEY DO THAT???
What responsibilities does an overnight doula actually have?
An overnight doula will often show up at the house around 10PM (or agreed upon time) and takes over the night-time duties of the baby for 8-10 hours. She* stays in a separate room with baby, allowing parents uninterrupted sleep. She will bring the baby to Mama when it is time for a feeding (if she is breastfeeding), and immediately takes the baby away again to the other room to continue attending and caring for his needs. Examples of overnight doula support services include:
This type of overnight support keeps parents: from being woken up from anxieties, knowing baby is being cared for by an experienced professional; as well as from every noise baby makes in the night. This type of care also, often leads to baby sleeping longer, too; and helps him to develop better night-time sleep habits and patterns.
There are many changes to lifestyle and challenges encountered while adapting to the newborn during the 4th trimester. Studies have shown that having the support of a postpartum doula increases the parent’s confidence in their parenting skills and instincts, increases breastfeeding success, and decreases the likelihood a mother will experience symptoms of postpartum depression, (McComish & Viscer, 2009).
Dennis, C-L. & Ross, L. (2005). Relationships among infant sleep patterns, maternal fatigue, and development of depressive symptomatology. Birth, 32. 3, 187-193. doi: 10.1111/j.0730-7659.2005.00368.x
McComish, JF. & Viscer, JM, (2009). Domains of postpartum doula care and maternal responsiveness and competence. J Obstet Gynecol Neonatal Nurs, 38(2):148-156. doi: 10.1111/j.1552-6909.2009.01002.x
**This article will use the term "woman" instead of "mother" in recognition that some women will experience childbirth for an intended parent.**
There are several options for preparing yourself for the labor and delivery of the baby you carry. Knowing the differences of each and when it is recommended to take is important to how birth is experienced and coped with.
Some of the more popular options include: Lamaze, Bradley Method, Hypnobirth, and Birthing from Within. Below are some simple descriptions of each, what they will teach; as well as at what point in pregnancy they are recommended to be taken..
Lamaze is probably the most well-known of methods, since it has become a generic term for childbirth classes in general. The philosophy of Lamaze is not to push having a natural, medication free birth; but to inform on all the options, to teach confidence, as well as how to keep birth simple and safe. Natural strategies like rhythmic breathing, hydrotherapy, massage, position changes and walking to deal with labor are taught and include partner participation.
Class content will include:
Bradley is a 12-week course, where natural childbirth is the end goal. Its focus is on self-awareness, and emphasizes relaxation. It encourages the partner to play an active part in helping the woman to deal with the pain and stress of her labor. Therefore, a person able to act as a continuous coach (partner/doula/midwife) is required, since they will be the main support of the laboring woman.
This course is 12 weeks long. Therefore, it is required to start no later than the second trimester.
Class content will include:
Hypno-Birth focuses primarily on relaxation and self-hypnosis; requiring the laboring woman to rely on the power of suggestion, to help her relax and let her muscles work as they were intended. Affirmations and visualizations are paired with special breathing and meditative techniques to help guide her thoughts in a positive direction, and naturally decrease stress and fear. The goal is to achieve a feeling similar to daydreaming, while remaining in control and happy during labor and birth. Classes do not teach the “what if” scenarios of complications in pregnancy, cesarean sections or medications to keep the fear of birth out.
Hypno-Birth should be started in the second trimester, so that it can be practiced well before baby’s guess date. A support person is encouraged, but is not required for success.
More great information about this approach and its different techniques can be found at: http://www.webmd.com/baby/features/hypnobirthing-calmer-natural-childbirth - 2
Birthing from Within is a series preparing women to give “birth-in-awareness” and as a “rite of passage”. Its goal is not to achieve a specific birth outcome, but to feel good about telling the story later, no matter how baby’s birth was achieved. Instructors use a multi-sensory approach, which includes art and writing assignments designed to help mothers discover the process. These classes can be started as late as the third trimester.
More great information about this approach can be found at: https://birthingfromwithin.com/
Hospital Childbirth Preparation classes will teach the biology of labor and birth; pain management options offered at the hospital; include some breathing techniques; teach potential labor and delivery interventions, such as labor augmentation, vacuum assisted and cesarean deliveries; hospital policies with regard to such things as visiting hours; and includes a tour of the hospital’s labor, delivery, postpartum rooms and baby nursery.
Hospitals offer classes lasting as long as 6 weeks and as little as 1 day. They can be started in the third trimester.
What questions should I ask before I choose a class?
LINKS TO RELATED PEER REVIEWED STUDIES
Comparison of the Bradley Method and HypnoBirthing Childbirth Education Classes
Evidence Based Patient Education to Promote Natural Childbirth Experiences: Educating your Patients to know the Right Questions to ask to meet their Own Personal Birthing Need
"Healthcare professionals need to advocate for evidence-based policy change within a hospital system to revise practices to include more complimentary modalities to support an un-medicated natural labor  and promote community awareness on available options or programs. Allowing a more customer-made labor experience will increase the autonomy of the individual, support women seeking an un-medicated labor, decrease complications/interventions, and increase satisfaction of the labor experience. (Sisiam, 2015).”
It is important to work with practitioners who have a lot of experience with prenatal practices.
1. Prenatal Yoga – Improves posture and tones muscles in preparation for birthing process. The deep and mindful breathing in Yoga helps with stress, provides grounding through hormonal changes and better focus. It also helps with relaxing the mind and muscles for better sleep..
2. Acupuncture/Acupressure helps to remove blockages which interfere with the body’s energy flow. Many women swear by its effectiveness in helping with pregnancy back pain relief.
3. Prenatal Massage – In addition to helping to relieve muscular clenching, which irritates nerves in the back, research has shown regular prenatal massage can help with depression and anxiety in pregnancy.
4. Chiropractic Care – Relief from muscular tightness, nerve compression and joint misalignment are found through joint manipulation, soft tissue work and prescribed exercise.
5. Physical Therapy – In addition to body work, PT’s can teach their clients how to walk, sit, stand, bend, lie down and exercise in healthy ways which support the back; as well as teach a pregnant woman how to limit range of motion since their joints become lax as a result of the pregnancy hormone Relaxin (a hormone produced by the ovary and the placenta with important effects in the female reproductive system and during pregnancy. In preparation for childbirth, it relaxes the ligaments in the pelvis and softens and widens the cervix), being released. Pregnancy women can over extend their joints, which can exacerbate their pain.
6. Meditation – elicits a biological relaxation response and stimulates the brain to control its release of stress hormones. Meditation can also increase one’s pain tolerance level, which can help with both managing back pain and coping with labor and delivery pain.
7. Swimming – takes the pressure off the spine. Paddling back and forth in the lanes helps to decompress the spine, tone the legs, arms, back and core muscles. Deep breathing while floating help with both physical and emotional relaxation. A breaststroke can strengthen both chest and back muscles.
8. Sleep Support – Side sleeping optimizes blood flow to the baby. However, it also causes a strain on the back when the belly hangs to the bed. Body pillows or a heavy blanket folded lengthwise are helpful for supporting chest, hips and lower back. Put either between the knees so that top knee is at hip level, and under the belly to keep it from pulling on back muscles and ligaments.
9. Wear a maternity Belt – helps to hold up the belly and keep it from causing strain on the pelvic girdle and lower back.
10. Wear Proper Shoes – Heels increase the curvature of your back and creates pressure on your lower spine and hip joints. Weight shifts, causing a change in the center of gravity, and heels cause less stability. Flats can cause lack of support; cause your foot to spread and cause pain up the legs. A shoe with a low-heel and built-in arch support helps distribute the weight that is in your legs in a more stable way, which helps with better back support.
*This is a summary of an article found on Parents.com, written by Holly Lebowitz Rossi, and can be found at: Pregnancy Back Pain Remedies
1. What is a birth or labor doula?
A birth or labor doula is a non-medical professional trained to attend a woman during her labor and birth. She* offers physical, emotional, informational and advocacy support to her clients during pregnancy, labor and delivery.
2. What are the benefits of having a doula at my birth?
Several studies have shown that having a trained doula benefits all involved in the birth of a baby; including the mother, the partner, attending family members, as well as hospital staff. These studies have been consistent in their results finding shorter labors, less use of pain medications, lower episiotomy rates, and as much as 50% reduction in cesarean rates. Increased rates of breastfeeding, better family bonding, fewer admissions to the NICU, and a more positive over-all birth experience are also shown in study results.
3. How is a doula different from a nurse or midwife?
A doula is a non-medical professional, mostly privately hired by the family to be a constant support (emotional, physical, informational and advocacy) during pregnancy, labor and until a baby is born. The doula does not make decisions or give advice regarding medical care, and does not perform any medical procedures. She is trained to help her client through labor by suggesting positional changes to encourage the progression of labor, and help keep the laboring mama as comfortable as possible. She also offers encouragement and emotional support; as well as to help her client to advocate for herself (informed consent), when interventions are being suggested by medical staff.
The main concern of the provider (OB or midwife) and medical staff is the health and safety of the mother and baby. In hospitals they change shifts and have other patients to attend. They are not usually able to dedicate their time to the comfort measures and positional techniques a doula is trained in. The doula's only focus is on the one family she is serving, and stays to provide her support, until the baby's arrival.
4. Does the doula take the place of the father or partner at the birth?
No. The doula is there as another member of the birth team; providing support, ideas and techniques for positions and comfort measures, as well as information and education along the way. She is also there to support partners and family members by providing breaks at appropriate opportunities, and to stand in for any procedures, which they may not feel comfortable being part of.
5. What if I want an epidural?
Doulas are for every birth, no matter the birth plan. Epidurals do not always take care of all the pain sensations during labor. They take away sharp, cramping type pain, not pressure. Sometimes, the pressure of baby is so intense, counter pressure techniques are still necessary, even with an epidural. In addition, epidurals have been shown to increase the likelihood of more interventions. A doula can provide several position recommendations via a Rebozo and/or peanut ball, leg supports; which have proven to help in avoiding a C-section, and which may help baby to keep descending. She still provides informational and emotional support, along with helping to ask additional questions to obtain informed consent. She also provides assistance during delivery, since movement is oftentimes difficult with an epidural.
6. What if you have a C-section?
Doulas are for every birth, no matter the birth plan. Whether planned or unplanned, a doula can help support the family with information and emotional support prior to the procedure, and wait meet the family in the postpartum room following the procedure. A doula is also able to attend the procedure if a family member is unavailable.
*Doulas can be any gender.
Maggie Watkins is the mother of 2 adult children. She has over 20 years experience working with pregnant and postpartum families as a private hire doula and prenatal educator. She has a passion for birth and postpartum, along with a strong belief that parents become more confident in their roles the more they are supported and encouraged, without judgement of birth choices; and through the first several days at home with their new baby.