Tongue-tie

Another great resource for tongue-ties http://evolutionaryparenting.com/the-role-of-early-diagnosis-of-tongue-ties-on-breastfeeding-success/

What is a birth plan? And should you have one?

A birth plan is a set of preferences that is written by the expecting parents to let your OB, nurses and staff know what you do and do not want done during labor, delivery and postpartum care for both mom and baby (as well as any other special requests)

Part of my doula services is to sit down and help the expecting parents come up with a birth plan if they haven't already. I highly recommend it. Not only do I recommend it, but its almost sort of required for me to support you. I can't do my job unless you tell me what you want me to do and what you expect out of the labor and birth process. I personally do not give birth without one. It's as essential to me as having my own doula present at my births.

Now before I continue let me tell you what a birth plan is NOT. A birth plan is not:

• A list or rules
• Demands
• Requests are not set in stone
• A legally binding contract

Think of a birth plan as more of a set of wishes and not something that has to be followed point by point. Labor and delivery sometimes has a way of not going to "plan".  For example, on my birth plan I have always wanted to avoid internal monitoring. The fetal monitor looks like it has a little coil or spring at the end and what they do is actually puncture the top of the babies head and place that just under the scalp to get a better reading of the baby's heart rate. I have always disliked the thought of that piercing my child's skin. For my first 3 deliveries I was able to avoid that, however with my last child, a combination of things did not allow us to keep the external monitor on. It was not giving proper readings so I finally agreed on it. It was a good thing too. Not too long after I agreed to it, my baby's heart rate dropped dangerously low into the 30's and I had to deliver ASAP. So you never know what could happen and you may need to deviate from the birth plan at times. 

What do you include in a birth plan?

You can find lots of birth plan examples online to get some ideas but here are some categories I always list on my birth plans and things to consider

Labor

• Is eating and drinking an option during labor? Is that something you want?
• Do you want to be connected to an IV machine upon arrival? This means you won't be able to walk around as freely.
• Do you want to keep the number of vaginal exams to a minimum?
• Does it matter to you who checks you? Nurses? Nurses in training? Students?
• Who do you want to have present? Your partner? Your mother? Your doula?
• Do you want to be coached when its time to push?
• Does the use of forecast or a vacuum matter to you?

Monitoring

• Do you have a preference with internal and external fetal monitoring?
• Do you want to have all procedures explained to you prior to it being done?

Pain Relief

• What kind of birth are you going for? Natural? Medicated?
• Will you have a labor coach or doula present? (if yes its important to name them)

Cesarean

• Would you like to avoid a cesarean unless absolutely necessary?
• If you end up getting a c-section who do you want in the operating room with you?
• Do you want everything to be explained to you? Your partner? Both?
• If your baby is not in distress, would you like to see your baby? 
• If you are not able to hold your baby, do you want your partner to hold your baby?
• Do you want to breastfeed in the recovery room?

Episiotomy

• Are you against getting one? Are you ok with getting one?
• Do you want guidance in when to push and when to stop pushing so the perineum can stretch?
• Do you want local anesthetic to repair any tears?
• Would you rather tear naturally than have an episiotomy?

Immediately After Delivery

• Do you want your partner to cut the cord?
• Do you want to hold your baby while you deliver the placenta and any tissue repairs are made?
• Do you want to keep your placenta?
• Do you want immediate skin to skin contact?
• Do you want to delay newborn procedures so that you can attempt to breastfeed?
• If your baby must be taken from you to receive medical treatment, do you want your partner to go with the baby?
• Do you want to avoid using a catheter?
• Do you want your baby to room with you? Or taken to the nursery?
• Do you want your baby to receive any vaccinations? if so, which ones?
• Will you accept eye drops and the vitamin K shot for your baby?

Postpartum

• If you are having a boy, do you want him circumcised?
• If you were told you were having a girl, but end up having a boy, do you want him circumcised? 
• Do you want to avoid giving your baby bottles? Artificial nipples?
• Do you want to avoid supplementing feedings with formula?

You will also want to include any special instructions like people who are NOT allowed at your birth. Or perhaps any religious views on medical procedures like avoiding blood transfusions and whatnot.

As you can see, there is A LOT to consider. I suggest you research all these topics and see what is best for you and your child. Your doula or midwife can also assist you in providing information and going over topics. Once you have come up with a birth plan, you will want to go over it with your OB and make sure you are both on the same page and that all requests can be met... or at least to the best of their ability.

My Tip To You:

When the big day arrives and you are heading to labor and delivery, take at very least 10 copies of your birth plan with you. This is why:

• You will want to take a copy for you OB even if you gave them one previously
• Your labor coach/ doula will need a copy
• Have a copy for your partner
• Have copies for the nurses who will be assisting you
• Keep in mind there may be one or more shift changes so bring enough for them too
• Have copies for when you get moved to recovery/ postpartum care, those will be new nurses as well and you will definitely have a few shift changes

Side note: If you want to avoid artificial nipples you may want to print and bring with you a sign that states baby is breastfed or no artificial nipples please. I take the second sign with me always and always bring extras. I have seen nurses throw them away after I have taped it up in the baby's basinet. You can find those signs here and here.

Now, sometimes not always, but sometimes the nurses have a mama who comes in waving their birth plan acting like its a list of demands. And is unwilling to steer from it even in the least. And come on, lets be honest, who likes a difficult patient? Its not someone they take seriously, not someone they want to help, and definitely not someone that they will really listen to to honor wishes. So depending on the experiences your specific birthing location has dealt with, they may see mom arrive with a birth plan in hand and think "oh no... one of those". Because of that I have a very important trick to share with you. One that has worked every single time for me.

While I am in early labor and still at home, I like to bake chocolate chip cookies for the nurses and hospital staff. And I bake a few dozen to make sure I have enough for all nurses (delivery and postpartum) and for all shift changes. I usually fill a few baskets full of baggies filled with individual servings for each nurse. I attache a little note to each thanking them for being there for us on this exciting day. Now here is the kicker. It also states to "Grab some cookies and feel free to get a copy of our birth plan." And I conveniently have a stack of birth plans right in the basket with the cookies. Im telling you, works like a charm! And the plus side is you usually have extras so mama can have some late on too!

So all in all, there really are no cons to having a birth plan as long as you know you may have to compromise on some things during delivery. If you can deal with that, then you won't be disappointed.

Herbs in pregnancy

There are some herbs you should avoid in pregnancy. According to the American Pregnancy Association those herbs are as follows:

•  Saw Palmetto – when used orally, has hormonal activity
• Goldenseal – when used orally, may cross the placenta
• Dong Quai – when used orally, due to uterine stimulant and relaxant effects
• Ephedra – when used orally
• Yohimbe – when used orally
• Pay D’ Arco – when used orally in large doses; contraindicated
• Passion Flower – when used orally
• Black Cohosh – when used orally in pregnant women who are not at term
• Blue Cohosh – when used orally; uterine stimulant and can induce labor
• Roman Chamomile – when used orally in medicinal amounts
• Pennyroyal – when used orally or topically

But there are quite a few that can help you during your pregnancy and labor/delivery. I will be writing about the ones that I personally found helpful.

I like to make tinctures out of nettle, oatstraw and red raspberry leaf. I  have read that its safe to start taking in the last trimester. I usually wait until the 8th month. This tonic has been known to help tone the uterus and encourage a strong milk supply. Here are the befits:

• Nettle-  This has a grassy taste to it which isn't the best, but all the benefits outweigh any issues with taste. Its a fantastic source of magnesium and potassium. Its also considered a good source of plant-based protein. High in vitamins A, C, K , calcium, potassium, and iron. Used in many pregnancy teas because it is a great all around pregnancy tonic. The list of vitamins and minerals in this herb includes nearly every one known to be necessary for human health and growth. Aids the kidneys. Increases fertility in men and women. Nourishes not only mother but baby as well. Easing leg gramps and other spasms. Diminishing pain during and after birth. The high calcium content, which is readily assimilated, helps diminish muscle pains in the uterus, in the legs and elsewhere. Prevents hemorrhage after birth. Nettle is such a superb source of vitamin K, and increases available hemoglobin, both of which decrease the likelihood of postpartum hemorrhage. Also assists in reducing hemorrhoids. (Note on the safety of Nettles from the American Pregnancy Association's website: Natural Medicines Database gives Nettles a rating of Likely Unsafe, even though it is used in countless pregnancy teas and recommended by most midwives and herbalists. This may be contingent upon which part of the Nettles plant is used (the root or the leaves) and how much is used. According to other sources, the use of Nettles is encouraged during pregnancy because of its health benefits)
• Oatstraw- Can assist with any digestive problems, improve the overall digestive system, especially in those who experience occasional constipation. It's also a great source of magnesium, calcium, chromium, fiber and a variety of vitamins. Assists to strengthen the nervous system and are considered nerve tonics.  Helps relive anxiety, restlessness and irritated skin. Helps build strong bones and teeth and strengthen capillaries and veins. Provides some support to those troubled by varicose veins and hemorrhoids.
• Red raspberry leaf- Great source of magnesium, potassium and a variety of vitamins including iron. Tones the muscles of the pelvic region, including the uterus itself. Increases fertility in both men and women. Assists in preventing miscarriage and hemorrhage. Also helps prevent postpartum hemorrhage. Some have said to have it assist in morning sickness relief. Reduces pain during labor and after birth. By toning the muscles used during labor and delivery, RRL eliminates many of the reasons for a painful delivery and prolonged recovery. (It does not, however, counter the pain of pelvic dilation) Assists in the production of plentiful breast milk. RRL works to encourage the uterus to let go and function without tension. It does not strengthen contractions, but does allow the contracting uterus to work more effectively and so may make the birth easier and faster. Some studies have even reported that using RRL during pregnancy can reduce complications and the use of interventions during birth.

Recipe:
1/2 cup red raspberry leaf
1/3 cup of oatstraw
1/4 cup of nettle

Place the above herbs in a quart sized mason jar.  Pour boiling water into the jar, filling it to the top. Let it steep for about four hours. After four hours, strain the herbs and pour the infusion into a fresh jar. Add whatever you would like for taste (honey, lemons, peppermint, etc.). I personally like to make a big pitchers worth so I have an already, chilled, and ready made batch whenever I want in the fridge.

Of the 3 herbs mentioned above, Red Raspberry is the most well known herb for pregnancy. And in my opinion is the most important. Now sometimes it has been very hard for me to drink the tea. Even with added ingredients to improve taste, I personally still found it hard to drink as much as I wanted to. And I didn't want all that wonderful RRL to go to waste. So what I ended up doing was taking RRL in pill form. This assured I was definitely taking as much RRL that I wanted directly and not just from the infused tea.

I personally have not tried these but I just found that oatstraw and nettle are also available in capsule form. I might just opt to getting the capsules instead of the tea in the future. If you're interested you can click here for the Nettle leaf capsules. And here for the oatstraw capsules.

But feel free to do your own research and decide which brand of capsules (should you decided to go that route) is best for you.

Don't Throw Out the Old Breastmilk!

So you have built up a stash of frozen breast milk in your freezer. Congrats! That's quite the accomplishment. Building up a stash is very convenient. This means mom can have a night off or even a night out and leave milk for dad to feed baby. Perhaps you can partake in a nice dinner with some adult beverages without the worry of passing any alcohol on to baby through the milk. Or maybe you are going back to work and are preparing to have baby's meals already to go for the baby sitter. Or maybe your just storing it just because you can. All these are amazing and wonderful reasons to build a stash.

But do you know how long breastmilk can last frozen? Just like cows milk it does have an expiration. These guidelines are taken directly from Medela's website:

If you're like me, you probably don't have a deep freezer to have milk last up to 12 months. Regular freezers attached to your fridge can safely store breastmilk for up to 6 months (temp should be kept below 39 degrees).

But What Do You Do With Expired Milk?
First, DONT THROW IT AWAY! Even though its not safe for consumption, it is still liquid gold with valuable usages! I still have frozen milk from my now 5 year old and 1 1/2 year old. The following are few ways to use that milk:

• Eye drops for pink eye
• Ear drops for ear infections
• Diaper rash
• Sore/Cracked nipples
• Facewash 

If you're crafty you can even make your own soap, lip balm, lotion and tons more.

Free Breastfeeding Support!

If you're like me, you worry about the cost of things. Starting from the cost of the delivery. Then the cost of what you will need to get ready for baby. The cost of daycare. The cost of raising a child... the list goes on. And all of it adds up. 

So if I can help you save some money here and there AND get some essential support, why not? Part of why some women do not succeed in breastfeeding is lack of support. It is so important to have that. Support includes not only from family members and your doctor... but also those that can help should you need assistance. Those people include your OB, lactation consultants, support groups and organizations like La Leche League, and community centers like WIC... just to name a few. 

Should you find that breastfeeding isn't going the way you planned, or you need some help do not feel ashamed. Do not hesitate to ask. The sooner you get help the sooner you can get back on the right path. Even I who has successfully breastfed 2 children have my list of backup support in case I should need it. And I got to tell you, those first 4-6 and sometimes up to 8 weeks is what it takes for me to find my groove and to build up my supply enough. It definitely is a process. 

Anyway, here is a few resources that are free of charge for breastfeeding support:

• If you are a WIC participant, they have lactation consultants onsite to assist you with breastfeeding. Keep in mind they usually have specific days and hours that they are there. So you will want to check with your local WIC to check their availability. And remember as a participant you can also obtain a free breast pump!
• WIC also has phone support available if their office is closed or if there isn't a lactation consultant onsite. They can be reached at 1-888-278-6455.
• La Leche League International is a wonderful resource. Not only do they have valuable information on their website (along with forums to ask questions), but they also have local groups that meet for support. You can even begin these before you give birth to be prepared, and meetings are FREE. To find local support simply click the drop down in the upper left hand corner to choose your country. Then select your city. By doing this you will get the contact information for your local group. You will also get group leader information that can either assist you (or assist you in getting help) for FREE over the phone support. I have used this a few times and it has been a lifesaver.
• La Leche League can also help answer any questions free of charge regarding what is safe to take during pregnancy. I remember I had to have my wisdom teeth pulled and the dentist wanted me to take Vicodin for pain and I was able to find out if it was safe or not for breastfeeding. Of course I asked my dentist previously but they are really not knowledgable in regards to breastfeeding. He told me no and to pump and dump or give formula which of course would have affected my supply. LLL was able to confirm the safe dosage for me.

So there you have it. I hope some or all of these are helpful to you should you need support.

You can get a FREE breast pump!

Did you know that here in the US through the affordable healthcare act women can get one free breast pump per pregnancy? Yes its true! FREE! PER PREGNANCY! Ive done some research and most insurance companies will cover the cost of one for you. Now keep in mind some insurance companies have fine print (as always) and Ive found that some grandfathered plans are not eligible for this coverage.  But a simple call to your insurance provider can let you know if this is available or not.

First what I have found is that in order for insurance to cover this, it needs to be a medical need. According to a representative I spoke to from Anthem Blue Cross, a medical need would be low milk production/ supply or latch issues. If you have these things, then there are two ways of going about getting your free breast pump. (Keep in mind that this is just what insurance companies say. Im sure that no one will have a problem giving you a prescription even if you're not having major issues)

First, you will need a prescription from either your physician, OB or lactation consultant. Once you have that prescription, they will give you an 800 number to contact a medical supply vendor they use nationwide. Make sure you get the extension for breast pumps. And they would then tell you the steps on how to get the prescription to them.

The second way is that you can purchase your pump on your own and then ask your insurance provider for reimbursement. You will have to contact your specific insurance provider to see what their steps for reimbursement are.

Now my specific insurance won't let me claim this until the baby is born. However I have heard of some insurance companies allowing you to get your breast pump 30 days prior to your due date. Again, to get the information that pertains to your specific insurance, call your provider for details. The number is on the back of your insurance card.



What If I Don't Qualify For A Free Breast Pump?
There are other resources out there for you to get free pumps. Some hospitals give pumps out to moms. Check with your hospitals maternity ward to see if they provide this for you. Ive heard some will give electric pumps and some will give manual pumps. Hey, free is free.  Also if you are a participant of WIC they also provide a free pump to moms. Again, I think it may be a manual pump but ask your local office for details.

Can I Buy A Used Breast Pump?
You can find people selling breast pumps pretty much anywhere online. They are everywhere from Facebook, Craigslist, Ebay.... list goes on.

Breast pumps were made to be a single-user product. Breast pump manufacturers will tell you this right on their website. The reason for this is that breast milk is a bodily fluid. That means there is a risk of contamination should you use another persons breast pump. Risks include (but are not limited to):

• HIV
• Hepatitis
• Human T-cell leukemia virus type 1 (HTLV-1)
• Cytomegalovirus (CMV)

Not only that but if the previous use experienced cracked or bleeding nipples then the pump may have been contaminated with blood, which increases health risks. Additionally, if the previous user had a fungal infection such as thrush, it may be possible to be transmitted through the pump.

Many people reason that they can buy new accessories and it should be in the clear for contamination. That is not the case. Although all accessories can be replaced, the original pump cannot. (I would also add that no matter how old a breast pump is, if it has been used my more than one user it voids the warranty)

The Medela website states that the difference between personal use pumps and rental pumps is as follows:

Personal Use Breastpumps Personal use pumps that you buy at the store are personal care items, much like a toothbrush. Personal use pumps should never be resold or shared among mothers. The Medela Pump In Style Advanced has an internal diaphragm that cannot be removed, replaced, or fully sterilized. Therefore, the risk of cross-contamination associated with re-using a previously owned pump such as the Pump In Style cannot be dismissed, even when using a new kit or tubing. Another consideration when deciding to borrow or even lend a previously owned electric pump is the pump’s motor life. A high quality electric double pump might last through the breastfeeding of your second child, or even several children. However, like computers or other electronic products, an electric breastpump has a limited lifetime. Medela guarantees its pump motors with a one year warranty. If you use an electronic pump that has been used for more than one year, there is no guarantee that it will generate as much speed and vacuum as it did earlier in it’s life. By using your own pump, you can compare the pump’s performance with each child. However if you borrow a pump, you cannot gauge its performance to ensure it is operating at full capacity.

Rental Pumps
Rental pumps such as Medela’s Symphony, and Lactina are designed for multiple users. These pumps have special barriers and filters to prohibit milk from entering the pump motor, which prevent cross-contamination. In addition, each renter uses her own personal set of breastshields, containers and tubing, to ensure the safe use of these pumps.

I will tell you this though. I personally have tried many breast pumps over the years. Everything from renting a hospital grade pump, to buying the cheaper priced pumps like Avent or Platex, and buying a legit high functioning breast pump like the Medela Pump In Style. You get what you pay for. The hospital grade of course worked but it got expensive renting and I was better off buying. But like many of you, I was concerned about the price. I started with the cheaper pumps and it was such a waste of time and money. They were a joke to say the least. I learned the hard way not to skimp on something so important.

Sciatic Nerve Pain

Im currently in the midst of my 6th pregnancy. Through the years and with each pregnancy I have learned a lot. My goal in being a doula and in having this blog is to pass on the gems of knowledge I have acquired through the years to anyone who is open to suggestions to possibly help them out. If even one thing I pass on to you all helps you out or makes your life easier, or in more awesome cases, helps you avoid the mistakes I made, then AWESOME.

Since my second pregnancy, my first pregnancy going to full term, I have had to suffer through Symphysis Pubic Dysfunction (SPD). Let me tell you, this is not fun at all. Add to it some sciatic nerve pain and the fact that at least for me, all these issues have progressively gotten worse with each pregnancy, I am at the end of my rope in terms of back/hip/pelvic pain. And I have a pretty high pain tolerance. I mean hello, I did have 4 unmedicated natural births. It seems that these pains not only intensify with each pregnancy, but the pain begins sooner and sooner with each one. Currently as it is, I find myself gasping when I feel that shooting pain. Just turning in bed or moving my leg is excruciating. Walking is almost impossible. I limp as if I was an 80 year old woman missing her cane. So with that, Id like to share a few things that have personally helped me with pain management.

First and foremost being able to stretch and crack my back has been my first method of coping with pain. Those things in itself help relive so much tension and pain. But if you know true sciatic pain, then you know you will need much more.

I have been very successful with using a hot rice pack. These are just little cloth packs (or big) they sell at the pharmacy, or you could make your own, usually filled with rice and you heat them up in the microwave. I find 2 minutes is the magic number for me. Once the heat hits my lower back and my tail bone, I get immediate relief. Now the only downfall of this is that the hot pack eventually cools off. Hopefully by that time you have gotten enough relief to have either fallen asleep (as my pain tends to intensify as the day progresses) or at least enough to be able to move more comfortably.

My next method of attack that I have been using for quite some time now, almost 2 years, is Doterra's PastTense essential oil. This has got to be my favorite oil blend that they sell. It smells amazing and when massaged into the area of pain, you will feel an instant tingling. Similar to that of Vic's vapor rub, only better. Im telling you when this is applied this is the only thing that will pretty much take the pain 100% away. It lasts a few hours too. And this particular oil is great not only for aches and pains but fantastic for headaches and migraines as well.

Now a little more about Doterra. I am a member with them and pay an annual membership and they require a monthly order (no minimum purchase amount). Also by being a member you get discounted prices instead of the full retail price. So for those of you interested in getting this oil without having to sign up for an account there are a few ways going about getting it. First off, you can find someone who has an account (like I do) to add it to their order. This is the cheapest way to get it. Otherwise, you can search Amazon.com or Ebay.com and see who is selling online. Prices will vary since the price is set by the seller. But I can tell you that almost always you will be paying more this way. You can also see if there is a Doterra brand rep that is willing to send you a sample of this oil before you commit to buying.

Now because these wonderful essential oils are a little on the pricey range I wanted to have another method of treating my pain without using a whole bottle of oil a week. I recently purchased pure magnesium oil as I had read great things about it. Although they call it an oil, its not actually an oil. It has a consistency similar to oil, but non greasy, so thats why they categorize it as that. Its completely natural. Its basically made up of water and magnesium chloride flakes (aka epsom salt). This is a great alternative to those like me who don't have a bath tub to soak in an epsom salt bath (but if you do have a tub I highly recommend trying it). It also has many uses as well. Everything from pain management, muscle aches and cramps, insomnia, anxiety, depression, heart palpitations, migraines, headaches, PMS, constipation and much much more. It really is amazing! Now from what I have learned, most people are deficient in magnesium. So when first applied, those who are deficient may feel a slight burning or tingling sensation. The more you use it, the less deficient you are and the less it will sting. I didn't really experience any stinging when using this. I sprayed it all over my lower back and down my legs where I had the shooting pain from my sciatic nerve. Thanks to my husband i was able to have it massaged in. The massage itself was wonderful, but it was this spray that instantly gave me relief. Now this isn't 100% relief, at least for me. It is a new product for me so perhaps the more I use it the better it will work. But so far it has probably taken away about 94% of the pain. Still really amazing! Right before I had it applied, I was limping with shooting pain. Immediately after application I could walk without limping with only slight mild discomfort. Relief in only minutes! I was skeptical before I tried this but I just had to try something that I could use more regularly without draining my bank account. And this is my answer to my sciatic/back/hip/pelvic pain.

I hope my tidbits of info help you out with any pain or discomforts you may be experiencing in pregnancy (these are great for when you're not pregnant too!).