Choosing Home Birth: A Guide to Safe and Personalized Care

Choosing Home Birth with a midwife

The decision to bring a child into the world is a deeply personal and transformative journey. With the evolving landscape of maternity care, many expectant parents are choosing midwives who specialize in home birth to guide them through this sacred experience. Home birth midwives offer a unique blend of medical expertise and personalized care, ensuring a safe and empowering birth experience.

Types of Midwives

Certified Nurse Midwives (CNMs): These midwives are registered nurses with specialized training in midwifery. They have completed advanced education and hold a master's or doctoral degree in nursing. CNMs are licensed to provide care across various settings, including hospitals, birth centers, and homes.

Certified Midwives (CMs): These midwives earn a graduate degree in midwifery from a program accredited by the Accreditation Commission for Midwifery Education (ACME). CMs differ from Certified Nurse-Midwives (CNMs) only in that they are not also licensed as nurses. Only a few states recognize the CM credential.

Certified Professional Midwives (CPMs): CPMs are trained specifically in out-of-hospital settings, making them a popular choice for home births. They acquire education through accredited midwifery programs and gain hands-on experience through apprenticeships. CPMs focus on providing holistic and family-centered care.

Direct-Entry Midwives (DEMs): Direct-entry midwives have typically not undergone nursing training. They receive education and training directly in midwifery. Regulations and requirements for DEMs vary by region, which can affect their scope of practice and legality.

Traditional Midwives: Traditional Midwives may have studied midwifery through an apprenticeship, but they often do not have additional formal schooling. They have not gone through any skills testing and are often unregulated and/or practice illegally.

Checking Credentials and Qualifications

Certification: Regardless of the type of midwife, it's crucial to ensure they hold a valid certification from a reputable organization. CNMs are certified by the American Midwifery Certification Board (AMCB), CPMs are certified by the North American Registry of Midwives (NARM), and DEMs may have certification from other organizations. CMs are certified through the American Midwifery Certification Board (AMCB).

Licensing and Regulation: Research the licensing and regulatory requirements for midwives in your state or region.
In SC, CNMs can practice under the supervision of a physician. CPMs are able to obtain a license to become a LM and practice independently.
In GA, CNMs can practice independently. GA does not offer licensure for non-nurse midwives.

Experience: Inquire about the midwife's experience; this may include asking about the number of births attended and the specific settings they have worked in.

Continuing Education: A commitment to staying up-to-date with the latest advancements in midwifery and childbirth care is essential. Ask about the midwife's participation in continuing education programs and workshops. All credentialed midwives are required to attend a minimum amount of continuing education each certification/licensure cycle.

Choosing the Right Midwife

Interview Midwives: Many midwives offer free or low-cost consultation appointments to help you find the one who aligns with your values, preferences, and birthing goals. Ask about their approach to childbirth, emergency protocols, and postpartum care.

Collaboration with Healthcare Providers: A midwife should have a network of collaborative relationships with medical professionals and/or hospitals. This ensures a smooth transition in case of emergencies or the need for a higher level of medical intervention.

Open Communication: Choose a midwife who actively listens to your concerns, answers your questions, and involves you in the decision-making process. A strong sense of trust and communication is vital throughout your journey.

Choosing a midwife is a significant decision that directly impacts your birth experience and the well-being of both you and your baby. By understanding the different types of midwives, checking their credentials, and carefully evaluating their qualifications, you can confidently select a midwife who will provide safe, personalized, and empowering care. Remember, your midwife is not just a healthcare provider but a partner in your journey to welcoming a new life into the world.

Group B Strep in Pregnancy

Group B Strep (GBS) in Pregnancy

Pregnancy is a time of anticipation and preparation, but it's also a period when healthcare considerations are of utmost importance. Group B Streptococcus (GBS) is a common bacterium that can affect pregnant individuals and their newborns. In this blog post, we'll delve into the significance of GBS testing during pregnancy, the standard treatments available, potential complications for newborns, and the implications of GBS disease.

The Importance of Testing

Group B Streptococcus is a naturally occurring bacterium that can be present in the genital or gastrointestinal tracts of adults. While it doesn't usually cause problems in healthy adults, it can pose a risk to newborns during childbirth. GBS testing during pregnancy, typically conducted between weeks 35 and 37, helps identify whether the bacterium is present in the mother's body. This information is crucial in determining the best course of action to prevent its transmission to the newborn.

Standard Treatments and Interventions

Intravenous Antibiotics During Labor: If GBS is detected, the standard approach is to administer intravenous antibiotics to the pregnant individual during labor. This treatment helps prevent the transmission of GBS to the baby during birth.

Risk Factors and Considerations: The decision to administer antibiotics also takes into account risk factors, such as preterm labor, prolonged rupture of membranes, and fever during labor.

Possible Complications for the Newborn

GBS infection in newborns can lead to serious health complications, including:

Early-Onset GBS Disease: This occurs within the first week of life and can lead to sepsis, pneumonia, and other life-threatening conditions.

Late-Onset GBS Disease: This occurs between the first week and the third month of life and might result in sepsis, meningitis, and related complications.

Signs and Symptoms: Newborns with GBS disease might exhibit symptoms such as fever, difficulty feeding, breathing problems, and lethargy.

GBS Disease and its Implications

While GBS disease in newborns is relatively rare thanks to effective testing and preventive measures, it underscores the importance of early detection and treatment. Left untreated, GBS infection can lead to severe health consequences, making timely testing and administration of antibiotics during labor vital.

Group B Streptococcus is a prime example of the critical role that prenatal testing plays in ensuring the well-being of both pregnant individuals and their newborns. Testing for GBS during pregnancy, along with standard antibiotic treatments during labor when necessary, can significantly reduce the risk of GBS transmission and associated complications in newborns. By staying informed, seeking regular prenatal care, and discussing GBS testing with your healthcare provider, you're taking proactive steps to ensure a healthy start for both you and your baby.

Safe and Supported: The Role of Midwives in Modern Maternity Care

Safe and Supported: The Role of Midwives in Modern Maternity Care

The landscape of maternity care is evolving, with an increasing number of expectant parents seeking alternative options that align with their desires for a personalized and empowering birth experience. In this context, the role of midwives has gained increasing recognition as a choice that provides both safety and emotional support.

Ensuring Safety Through Expertise

Comprehensive Prenatal Care: Midwives are trained healthcare professionals who provide thorough prenatal care to monitor the health and progress of both the mother and the baby. Through regular check-ups, we identify potential risks and complications early on, ensuring appropriate interventions are taken when needed.

Continuous Monitoring: During labor, midwives closely monitor the progress of labor and the well-being of the mother and baby. We are skilled at recognizing signs of complications and are equipped to handle emergencies or to make the decision to transfer to a hospital if necessary.

Emergency Preparedness: Home birth midwives undergo rigorous training to handle emergencies that might arise during childbirth. We carry medical supplies and equipment to manage common complications, and we will communicate directly with the hospital if a transfer becomes necessary. We renew our Neonatal Resuscitation certifications at least every two years.

Risk Assessment and Transparency: Midwives conduct thorough risk assessments to determine if a home birth is a safe option for each individual. We maintain open and honest communication with each client, discussing potential risks and benefits and ensuring that everyone is well-informed before making decisions.

Providing Unwavering Emotional Support

Creating a Trusting Relationship: Home birth midwives focus on building strong relationships with expectant parents. We invest time in getting to know our clients, understanding their values, fears, and aspirations for childbirth. This relationship of trust fosters a sense of emotional security during the birth process.

Empowerment Through Education: Midwives are educators as well as caregivers. We provide comprehensive information about the birthing process, available options, and potential interventions. This empowers parents to actively participate in decision-making, contributing to a more positive and confident birth experience.

Holistic and Family-Centered Approach: Midwives consider the emotional and psychological aspects of childbirth. They create a supportive environment that includes partners, family members, and even older siblings, fostering a sense of unity and comfort during labor and delivery.

Emotional Well-being: We are attuned to the emotional needs of expectant parents. We offer reassurance, encouragement, and personalized comfort measures, helping to alleviate anxiety and promoting a more relaxed birthing atmosphere.

The resurgence of interest in home birth with midwives reflects a growing desire for a birth experience that values both safety and emotional support. These skilled professionals bridge the gap between medical expertise and compassionate care, ensuring that expectant parents are well-prepared for the transformative journey of childbirth and the first several weeks postpartum. By embracing the holistic approach of certified and licensed midwives, modern maternity care melds with the importance of personalized care, informed decision-making, and the emotional well-being of both parents and newborns. As the trend of pursuing a home birth continues to gain momentum, more families are discovering the profound impact that the partnership with a midwife can have on their birthing experience.

Empowering Your Birth Experience: How Home Birth Midwives Can Make a Difference

Empowering Your Birth Experience: How Midwives Can Make a Difference

Bringing a new life into the world is a transformative journey that holds immense significance for expectant parents. As the birthing landscape evolves, more individuals are seeking ways to take control of their birth experiences, embracing options that align with their values and desires. Midwives have emerged as key figures in this movement, offering a unique approach to childbirth that empowers parents and celebrates the natural process of bringing a child into the world. Let’s explore how home birth midwives can make a profound difference in empowering your birth experience.

Personalized Care and Relationship Building

Home birth midwives prioritize building strong relationships with their clients, cultivating an environment of trust, comfort, and respect. Unlike the often impersonal setting of a hospital, midwives take the time to understand your personal preferences, concerns, and aspirations for your birth journey. This personalized approach ensures that you are an active participant in every decision, fostering a deep sense of empowerment.

Education and Informed Choices

One of the remarkable aspects of home birth midwives is their commitment to education. Throughout your prenatal care, midwives provide comprehensive information about various birthing options, potential interventions, and the natural progression of labor. Armed with this knowledge, you are empowered to make informed choices that resonate with your values and wishes. This educational aspect of midwifery care enables you to approach childbirth with confidence and a clear understanding of what to expect.

Honoring the Natural Process

Home birth midwives have a profound respect for the natural process of childbirth. They believe that birth is not just a medical event but a deeply transformative and emotional experience. Midwives work with your body's innate wisdom, allowing labor to unfold naturally whenever possible. This approach minimizes unnecessary interventions and medical procedures, allowing you to embrace the innate strength and capability of your body.

Creating a Supportive Environment

The familiar surroundings of your own home can significantly contribute to a positive birth experience. Home birth midwives curate a calming and supportive environment that promotes relaxation and confidence. You have the freedom to move, eat, and labor in ways that feel most comfortable to you, enhancing the natural progression of labor. Additionally, having your loved ones close by can provide invaluable emotional support, further enriching the experience.

Empowerment Through Active Participation

Home birth midwives encourage active participation in the birthing process. They guide you through the stages of labor, offering encouragement, comfort measures, and various positions that can facilitate labor progression. This hands-on approach empowers you to be an integral part of your birth story, creating a lasting sense of accomplishment and pride.

The role of home birth midwives goes far beyond providing medical care; they are champions of empowerment, education, and holistic experiences. By choosing a home birth attended by a skilled midwife, you are embracing an approach that values your unique needs and desires, while celebrating the beauty of childbirth. The empowerment you gain from actively participating in your birth journey, supported by the expertise of a midwife, can set the tone for your parenting journey ahead. As this trend continues to grow, more individuals are discovering the transformative impact that home birth midwives can have on the sacred journey of bringing new life into the world.

Bringing Birth Back Home: The Rising Trend of Home Birth Midwives

Bringing Birth Back Home: The Rising Trend of Home Birth

In recent years, there has been a noticeable shift in the way many individuals approach childbirth. With a desire for a more personalized and holistic birthing experience, the trend of home births attended by midwives has been steadily gaining momentum. This movement signifies a departure from the traditional hospital setting, highlighting a return to the roots of childbirth.

The Role of Midwives

Home birth midwives play a crucial role in ensuring a safe and supportive environment for expecting mothers who choose to give birth at home. These skilled professionals bring a wealth of knowledge and experience in providing prenatal care, assisting with labor and delivery, and offering postpartum support. Their primary goal is to empower and educate mothers, promoting a sense of ownership and confidence in the birth process.

Benefits of Home Birth with Midwives

1. Personalized Care: One of the standout advantages of home birth midwives is the individualized attention they offer. Unlike the often fast-paced hospital environment, midwives take the time to build strong relationships with their clients, tailoring their care to the specific needs and preferences of each mother.

2. Comfort and Familiarity: Giving birth at home provides a comfortable and familiar setting for the mother, reducing anxiety and stress. This can contribute positively to the progression of labor and the overall birth experience.

3. Reduced Medical Interventions: Home births with midwives tend to have lower rates of medical interventions such as cesarean sections, epidurals, and induced labor. Midwives emphasize natural birthing processes and intervene only when medically necessary, promoting a more holistic approach.

4. Family Inclusion: Home births allow for greater involvement of family members, partners, and even older children in the birthing process. This can foster a stronger family bond and a more inclusive experience for everyone involved.

Challenges and Considerations

While the trend of home birth midwives is on the rise, there are certain challenges and considerations to keep in mind:

1. Safety Concerns: Critics argue that home births might carry increased risks in cases of emergencies or complications. However, trained midwives are well-prepared to identify potential issues and take appropriate actions. If medical concerns arise, the midwife will facilitate transfer to the hospital for continued care.

2. Legal and Regulatory Factors: The legality and regulation of home births vary from region to region. Some areas have well-defined guidelines and support for home birth midwives, while others have stricter regulations or even outright bans. In SC, midwives are eligible for licensure after earning the Certified Professional Midwife (CPM) credential. On the other hand, GA does not license midwives unless they are Certified Nurse Midwives (CNMs), who are nurses with additional training in pregnancy and birth.

3. Access to Resources: Availability of resources such as emergency services can be a concern in remote or rural areas, affecting the feasibility of home births.

4. Client Choice: It's essential to remember that home birth is a personal choice. Not all individuals are suitable candidates for home births, and some might prefer the controlled environment of a hospital setting.

The rising trend of home birth reflects a growing desire for a more personalized, natural, and family-centered approach to childbirth. These skilled professionals offer individualized care, emphasizing the importance of empowering mothers and promoting a sense of agency during the birthing process. While challenges exist, the increasing popularity of home birth midwives underscores the need for a diverse range of options that cater to the diverse preferences and needs of expectant parents. As this trend continues to gain traction, it will be interesting to observe how healthcare systems and policies adapt to accommodate and support this evolving approach to childbirth.

Setting Boundaries with Visitors

Having a new baby is exciting for the whole family! Everyone wants to meet the new baby as soon as they possibly can. This excitement is absolutely understandable, but this time can also be quite stressful for the parents. Whether this is a first baby, or if baby was welcomed by several siblings, a new baby always bring a change from previous routines and a need for rest and recuperation.

Setting boundaries with well-intentioned through the first few days or weeks can be a healthy way to ensure the family is able to recover and bond as needed. It can feel difficult to set new boundaries, especially with family members. It’s important to remember that boundaries are not placed to harm your relationship or to cause feelings of harm to your family and friends. The intention is to help ensure that your new family has time to bond and recover from the overwhelm that birth often brings.

Parents may choose to share their chosen guidelines ahead of time, whether directly or through social media posts. I’ve attached a free, printable door sign and social media graphic of guidelines below; feel free to share!

What boundaries or guidelines did you set postpartum? Let us know in the comments; your ideas may help other new families choose their own!

Do WHAT With My Placenta??

So you're expecting a baby, and everyone is giving you advice. 
"You need this stroller; it's a lifesaver!" 
"Make sure baby eats every 2 hours!"
"Don't use that brand of diaper! You'll have poop explosions; they leak!"
"You have to encapsulate your placenta! I did, and it was wonderful!"

Wait, what was that about a placenta? 

Placenta Encapsulation is a way of ingesting the placenta, and it's a decision that's gaining popularity. It may sound bizarre, but the placenta is filled with hormones that many people believe may benefit new mothers. 

Generally, Placenta Encapsulation involves processing the placenta into a dry, fine powder. The powder is then put into empty capsules so that the client can take the capsules just like a vitamin. There are also other ingestion options which may include taking the placenta as a tincture or in raw smoothies. 

Why would someone eat their placenta? 
Many new moms report benefits from ingesting their placentas. Benefits can vary person to person, but some of the most common reported include an increase in energy levels, balanced mood, increased milk supply, and lower incidents of postpartum depression. It is important to note that there have been little to no scientific studies into these benefits; most of the information available is anecdotal. One of the main theories is that since the placenta is partially the mother's hormones, these can help balance her hormone levels after the sudden drop that occurs after the birth. Again, results may vary, and the FDA has not researched or approved placenta encapsulation as a way to treat or prevent anything. 

Are there any negatives or side effects?
The majority of our clients never have any issues. In the general population of people who try placenta encapsulation, a small percentage do report that they have a decrease in milk supply. It is also possible that one may experience a burst of shaky energy (similar to caffeine jitters) if they are taking too much placenta at once. Again, this is not common and can normally be eliminated by taking fewer capsules at once. 

Raw Prep, Heated Capsules, Traditional Chinese Method...What's the difference?
There are multiple ways to prepare the placenta prior to making it into capsules. Each has their own pros and cons, and preparation methods may vary encapsulator to encapsulator. 
Raw preparation means dehydrating the placenta at temperatures between 115-118F. Heating at these lower temps is thought to preserve more of the nutrients since heat can denature some of the beneficial nutrients, but these temperatures are not high enough to kill off potentially harmful bacteria. Because of the bacteria risk, Little Orchids does not offer raw preparation. 
The Traditional Chinese Method (TCM) involves steaming the placenta prior to dehydration. Adding more heat by steaming is thought to add hot "yang energy" to help balance the cold "Yin energy" thought to be prevalent postpartum. Depending on the practitioner, some will add herbs to the steaming placenta thought to help promote postpartum healing. The placenta is then dehydrated at temperatures that vary by practitioner. Steaming can help kill more of the surface bacteria on the placenta. Steaming the placenta may produce fewer capsules since the processing loses additional mass. At Little Orchids, we do not add anything to your placenta, and we dehydrate at 160F to maintain food safety guidelines. 
Heated preparation means that the placenta is dehydrated at temperatures high enough to kill off any bacteria. This is normally done for a longer period of time than other preparations - usually 12-24hours. This can produce a safer product, but the additional heat can very slightly lower the nutritional benefits. This is the default preparation method at Little Orchids unless TCM is requested. 

How do I plan to encapsulate my placenta? 
The first step would be to locate a local placenta encapsulator. It is beneficial to do your research; placenta encapsulation is completely unregulated, so training and processing standards vary wildly. At Little Orchids, our encapsulator is a Certified Postpartum Placenta Encapsulation Specialist who maintains ServSafe Foodhandler certifications as well as Bloodbourne Pathogens certification. Safety is our number one consideration, and we want to ensure a safe product for our clients. 
Once you've chosen your encapsulator and confirmed they're available for your due date, you can start their booking process. At Little Orchids we offer the options of meeting for a consultation or just directly booking online through our website. 
After you've booked, your encapsulator will follow their specific procedures for pick up and processing of your placenta. At Little Orchids, we give clients a handout of instructions for safely storing the placenta until pickup as well as how and when to contact us for pickup. Placenta products are completed promptly and are returned directly to you.

Placenta Encapsulation can be beneficial for many mothers, and it can be a great thing to consider. If you do choose to ingest your placenta, it is important to find an encapsulator you're comfortable with who provides the processing options you want, so begin your search in advance whenever possible. Have any questions for our encapsulator? Contact us today! 

BRAINED: Decision Making for Labor (and Life)

Labor can be an intense, stressful time. Many people go into the birth process with a "birth plan," or a list of ideals they wish to stick to. These are often well researched ideas the family is comfortable with. But what happens when suddenly your doctor comes in and says those ideas need to change? Whether the doctor suggests additional interventions or even talks about changing the type of delivery, sometimes births do not go as planned. How can you make such a potentially huge decision during a high-stress, vulnerable time? 

We like to use the BRAINED pneumonic to talk through these situations. It can be helpful to have a neutral third party (like a doula) to help walk through these steps, but it can be a handy tool for anyone to use for any decision.

So what is BRAINED?

B: Benefits

What are the benefits of the suggested choice? Are there more benefits than there would be with the current plan? Are the potential benefits worth changing plans?

R: Risks

What are the risks of the suggested choice? Does the risk level increase or decrease with the new choice? Do the benefits outweigh the risks? How severe are the potential risks?

A: Alternatives

Are there any other alternatives to consider? What are the alternatives? How do the alternatives compare to the current options?

I: Intuition

What does your gut feeling say? Intuition can be a powerful thing, and it is there for a reason.

N: Nothing

What happens if we decide to do nothing or stick with the original plan?

E: Evaluate

Evaluate these considerations as well as any other questions you have.

D: Decide

Decide what is the best option for you.

The BRAINED tool is most often used for labor decisions, but it's also great for really any life choice. Using this tool helps prevent making quick, emotional decisions by breaking down different considerations logically. 

Labor Inductions: What to Expect

Your doctor may recommend scheduling an induction of labor for many reasons. For some this can be a welcome suggestion; you get to know more definitively when you will meet your new baby! For others, induction can be a scary or unwanted option. No matter how you come to the decision to induce, there are a few things to consider.

1. Methods of induction

There is no one-size-fits-all approach to induction. Multiple different methods may be used based on your personal history, any medical concerns, and your doctor's preference. There can be pros and cons for each method, so it can be helpful to talk through your options in advance with your doctor. Here are some of the most common methods:

Pitocin
Pitocin is the synthetic form of the hormone Oxytocin, which helps trigger contractions during spontaneous labor. Pitocin is given through an IV line in labor, and the hospital staff may adjust the dose as needed throughout the induction. Sometimes Pitocin can cause contractions longer and stronger than spontaneous contractions would be, but it is often an effective method of induction. 

Cervidil
Cervidil is a medication that helps soften the cervix. This preparatory softening can help stronger induction medications be more productive, so many doctors will recommend Cervidil overnight the night before an induction is officially set to start. Cervidil is applied right by the cervix on a cloth tape and can be left in for many hours. Many people find this no more uncomfortable than a regular cervical check. One of the good things about Cervidil is that if the contractions are too strong or if there is a problem, the tape can be removed, limiting further effects. 

Cytotec/Misoprostil
Cytotec is a brand name of the drug Misoprostil. This medication can help soften the cervix and bring contractions, so it is often used during labor inductions. Use for inductions is actually an off-label use not recommended by the FDA, but it is often very effective. Cytotec is packaged in tablets that can be given multiple ways, but it is most often placed internally by the cervix for induction. Although it is effective, Cytotec can be a bit controversial when used for labor induction since it can produce contractions so long and strong that baby becomes distressed. Unlike Cervedil or Pitocin, Cytotec cannot just be removed or turned off if there are complications; once it has dissolved, it's gone. 

Foley Bulb/Cook Catheter
Foley Bulb Catheters and Cook Catheters are very similar options that both function the same way. Both of these options can be used to manually dilate the cervix without the use of medications. These work like balloons; a long balloon-like tube is inserted into the tip of the cervix. Saline is then used to inflate the end, which begins to wedge open the cervix. You do need to be at least 1cm. dilated for this to work, and it may not work for everyone if your cervix isn't ready. The level of discomfort this procedure causes varies person to person, but it may not be comfortable to have the cervix physically stretched. Some providers will require the patient to remain in hospital once a bulb is placed. Others will place the bulb and ask the patient to come back when it falls out, which would mean they should be 3-5cm dilated. If there are problems, the bulb can be deflated and removed quickly and easily. 

Homeopathy and Natural Induction Methods
Homeopathic remedies and herbs are not frequently recommended by OB/GYNs, but they may be a good option for some. There are multiple homeopathic remedies that may be effective to nudge someone into labor. As with any other intervention, we always recommend you speak with your doctor or midwife about what options may be best for you. 

Acupuncture is a centuries-old practice that may be used to start labor. There are specific pressure points a knowledgeable acupuncturist may use if the goal is induction, although it may not work for everyone. Sometimes multiple treatments are needed, but acupuncture can be a good option to try if one wishes to avoid a more medicalized induction. 

Chiropractic care from a Webster-certified provider does not directly start labor, but it can help align the pelvis properly so that baby can find the best position. Sometimes labor doesn't start because a misalignment doesn't allow baby to drop or sit properly; a good adjustment may help with that. 

Breast pump and/or nipple stimulation can be used to naturally produce oxytocin that may trigger contractions. It can be possible to overstimulate the uterus if this is done too frequently, so it is often recommended to stop the stimulation once contractions are established. As with anything else, it's best to check with your provider if there are concerns. 

2. What are the chances an induction will be successful?

The Bishop score is a test that looks at multiple aspects of your history to estimate if an induction would be successful. This scoring system looks at cervical position, cervical consistency (softness), cervical dilation, cervical effacement (thinning), and fetal station (how high baby is in the pelvis). These aspects are rated on a scale of 0-3, and a score of 8 or above is believed to mean that either the body will begin labor spontaneously or that an induction would be successful. Low scores often correlate with unsuccessful inductions, and the doctor may move to recommending a Cesarean birth. 

3. We've started an induction; now what?

There is no hard and fast rule about how an induction will proceed. A lot depends on how ready your body was at the beginning. For some people, a little nudge is all that's needed to push them into full blown labor. For others, the body needs a bit more coaxing, and the induction may take a bit more time. Sometimes an induction can be a lengthy process; some inductions may actually take multiple days. 

It's normal to not feel much at the beginning; depending on your personal tolerance, it can take hours for the medications used to produce uncomfortable contractions. If this is true for you, that can be a good time to rest while you can. Inductions can become very intense suddenly, so taking every chance you have to just rest and take it easy can pay off in the long run. 

Once contractions are strongly established, some providers will lower or disconnect the medications. Often the body will take over and continue contractions. Others may leave the meds running throughout to make sure contractions stay strong. If you would wish to cut the medications as soon as contractions are established, we recommend you discuss this possibility with your provider in advance. 

4. Can a doula help in an induced birth?

Yes! Doulas can be wonderful support for any type of birth, including inductions. Our support in an induction changes very little and is tailored to each client. Often, we accompany you as you get settled in to start the induction. Some clients then choose to send us home until things ramp up, but that is totally up to the client. We can stay with you, or we can return whenever you're ready. From there the support is the same as any other birth; we can help with comfort measures, talking through upcoming options, and whatever else you most need. 

Throughout the whole process of induction, communication with your provider is important. A birth plan can be a great way to go over your thoughts with your provider, but it is always important to remember that nothing with labor is ever set in stone. 

If you would like to meet to discuss how we can support you through your upcoming birth, please let us know! We'd be happy to schedule a consultation or a phone call to answer all of your questions. 

What is a Postpartum Doula?

You've built a strong support team for your birth. Wonderful! But what happens when you return home with a brand new baby?

New families often need support in the days and weeks after they return home more than ever. Whether this is the first or the fifth baby, parents can often benefit from an extra set of hands. Did you know that there are doulas that specialize in postpartum care? Postpartum doulas are specifically trained to provide education as well as direct support through the postpartum period.

Why not just have family come help? They don't charge! 
It's wonderful if you have family close by that can come visit. In many cases, family and friends can be very helpful! But sometimes, new babies can be very distracting for visitors. Who wants to chip in washing dishes when there's an adorable baby to snuggle? 
Families often don't live as close to one another as they used to; for many people, having family come by isn't even an option. 

Hiring a trained and certified postpartum doula ensures that you have a capable, professional support person available to help, whether that means running an errand, caring for baby so you can get a nap, or prepping dinners for the next week. Your doula doesn't come over to see baby; we come to help meet your needs for the day. You focus on bonding with your baby; we'll handle the rest! 

Another benefit of having this professional support is that these doulas are trained to recognize the signs of postpartum depression. Doulas are not medical providers, but we can start that discussion and provide resources when needed. The postpartum time can be a hormonally-charged period of emotions; postpartum doulas are trained to help notice when things are no longer quite normal and can point out these changes so that additional help can be sought. 

While many families feel the greatest need for support during those first few weeks, there is no time limit for finding a postpartum doula. Need a couple nights of sleep while your child hits a sleep regression? There's a doula for that! Need help prepping meals and setting a pump routine for when you return to work? There's a doula for that! Our doulas tailor their assistance to whatever you need; there is not just one plan to fit everyone. 

So what all does a postpartum doula do?
Postpartum doulas can fill in many different capacities depending on what is needed. The support they provide can include:
Running errands
Meal planning and preparation
Teaching and demonstrating infant care tasks
Basic infant care
Basic housework tasks
Educational support
Caring for baby so parents can nap or shower
Overnight care

There is a postpartum doula for every situation. Whether you are a first time parent who just needs a confidence boost or you've adopted a toddler and need help adjusting, we can support you through your parenting journey.

The Little Orchids Difference
There are many postpartum doulas, so how do you choose? When you hire the doulas of Little Orchids, you have the benefit of working with the only local group of doulas. What if your regular doula gets sick? We can send a backup so that your schedule is uninterrupted. What if you need an emergency last-minute shift worked in? Between all of us, we can usually accommodate late scheduling. What if you feel you would better connect with a different doula? That's fine! We can change assignments until you find someone you are most comfortable with. 

Interested in our postpartum doula services? Check out our website or contact us to schedule a consultation. 

Affording a Doula

Having personal, in-person doula support through your labor is an investment, and people may be surprised at cost of hiring a doula. The prices doulas charge varies widely, often anywhere from $350 to $1,200 or more. With such a wide range of prices, many families may feel that they cannot afford a doula. While the total cost might seem daunting, there is a variety of creative options you may be able to draw from to cover the fee. 

We rarely hear anyone say they regret hiring a doula, but so often we hear from many who regret not hiring one. Your baby will only have one birth; while costs are eventually forgotten you will always remember if you felt supported through that experience.

Before we talk about how to pay for a doula, I think it is also important to think about what that fee really covers. Every doula should be able to clearly lay out how many meetings and what labor support is included in their cost. Beyond that, there are still multiple other commitments a doula makes to support you. 

1. Accepting a client means that your doula is willing to be on-call 24/7 in the weeks around your due date. This means that your doula will drop everything, day or night, at your call. This means that the doula will not go too far away and will keep their cell phone handy and audible at all times. If the doula has children, this also means that they will have a solid plan for childcare for any time you go into labor. This can mean that the doula may have to cancel their own appointments last minute or miss holidays and birthdays. 
2. Doulas are unregulated, so their training may vary. At Little Orchids, our standard is that every one of our doulas is certified or trained and working towards certification as a doula with their choice of professional doula organizations. These trainings, certification, and continuing education to maintain certification and remain up-to-date can all add costs for the doula. 
3. Your doula is agreeing to support you during your labor- no matter how long that takes. Whether your birth takes 2 hours or 30 hours, your doula is there. At Little Orchids, this is one reason we work in doula teams. If you do have a longer labor, your doula can bring in their doula partner when needed to make sure you have a fresh doula to continue supporting you.
4. In many (if not most) cases, your doula is self employed. This means that your doula pays taxes and fees associated with owning a business. 
5. The cost of fuel and car maintenance can be expensive, and doulas often have to travel frequently. Although driving to and from consultations, prenatal visits, births, and postpartum visits are  the travel time associated with initial consultations, prenatal and postpartum home visits are all included in the cost of doing business, these expenses do add up.
6. Being a doula can be a physically demanding profession. Your doula may miss nights of sleep and skip meals during births. Your doula may get physically exhausted from massaging, providing counter pressure, or otherwise supporting you for hours on end in whatever position is most comfortable for you. 
7. Your doula gains experience with each birth they attend. Working with different doctors and nurses and in different hospitals and birth locations gives your doula a unique perspective that allows her to understand current policies and options. 

So, how do you pay for these services?

For some families, payment is not an issue. That’s great! For others, it can be more difficult. If you do need a bit of a boost, here are a few ideas:

1. Payment Plans
   Many doulas accept payment plans, so ask if this is an option. Generally, the fee for your doula is not due all at once, and payments can be made over time. 
2. Baby Registry
   Did you know that many doulas offer gift cards or gift certificates? Add these to your shower registry to see if family and friends would like to help chip away the cost. 
3. Health Savings Accounts and Insurance
   While many health insurance companies do not directly cover doulas, it never hurts to ask. Your doula may be able to provide a superbill for support and any classes taken with which you can request at least partial reimbursement. 
   Some doulas are able to accept payment through HSA cards. If you already have funds set aside in one of these accounts, that may be a good option for some. 

In the end, doulas are human. If you have questions or concerns about the cost of services, please ask! Many doulas are able to work with customized payment plans, and some doulas may offer occasional discounts. While we do need to make doula-ing a sustainable way to support our families, most doulas are not in it purely for the money. We truly love what we do, and we want every family to be totally supported through their birth experiences. 

Fear and Birth

There are many fears associated with pregnancy and birth. One of the most common fears is the fear of pain. Will birth hurt? What happens if I can’t deal with the contractions? For some people this fear impacts their decision of where to give birth.

     To some, home birth sounds like a nice, peaceful plan. But there is no medical pain management available at home. Another common fear is the fear of messing up. There is a lot of responsibility needed to bring a new life into this world and raise him to adulthood. This can be a scary realization, and many parents initially feel self-doubt that they are worthy of this responsibility. It can take time for the parents to finally understand that they are exactly the parents this baby needs. The fear of changing plans is also a common fear. Mothers and partners can do everything in their power to plan and prepare for their birth. They can find the best provider, the best support, the most informative childbirth classes, and the safest car seat. They can have a birth plan describing in detail how exactly they expect labor to proceed. What happens when the baby becomes distressed and a Cesarean birth is necessary? What happens when the mother fatigues and is unable to continue with her plan? Sometimes plans need to change, and this can introduce some fear. Hopefully having the understanding that births cannot be completely planned out in advance can help ease some fear.

       Fear can have detrimental effects in labor. In some ways, labor requires the mother to let go, both mentally and physically. The mother must allow the body to take over and do what is needed to dilate and help get the baby out. Fear can block this necessary and instinctual action. Fear can cause the mother to experience “psychological dystocia” which is a term used when labor slows or is inhibited by a non-physical issue. Fear can cause the mother to clench and fight contractions, which can affect the speed and ease of dilation. Many mothers have reported that contractions are more painful if the mother tries to clench or fight them. Thankfully, women have multiple ways to deal with this fear response. Women can try meditation, breathing exercises, or having an Epidural as means to aid in relaxation.

          Fear does not only impact labor psychologically, but it can also affect the hormones of labor. Oxytocin, known as the love hormone, is the hormone that is needed for labor to progress. Oxytocin stimulates the uterus to contract. These contractions cause dilation, and they eventually help push the baby down and out. After the birth, these contractions help clamp the uterus and prevent hemorrhage. Oxytocin also helps initiate a type of natural pain relief as it blocks some of the pain signals during labor. Another hormone, Adrenaline, has more negative effects. Adrenaline is the stress hormone involved with the fight-or-flight response. Fear can trigger Adrenaline to be released during labor. Adrenaline does not help labor; Adrenaline inhibits the release of Oxytocin. This effect can slow or completely stop labor, which can necessitate the use of augmentation measures. This can also lead to longer labor.

         To some people, fear is a motivator to get an unpleasant task over with. But fear can impede and negatively impact labor. Babies are born every day, so try to push the nagging fears away!

Postpartum Realities

Experiences and expectations of the postpartum period can be completely different from one person to another. Because of this, new mothers can become confused when their experiences do not align with what their friends or family members described. The postpartum period vary greatly from the beginning, especially depending on the type of birth there was.     

The physical recovery needed can be a shock if you does not know what to expect. There are so many false ideas portrayed in movies, television shows, and social media today! Most of what is portrayed makes everything look easy. The new mother on Facebook looks gorgeous with her flawless hair and makeup, smiling with her new tiny babe. Or in a movie a woman walks proudly out of the hospital the next day, walking easily and with no sign of a residual baby bump. In reality, most mothers are exhausted after delivery. Just think, either they have just spent hours laboring and pushing out a small human, or they have just gone through major abdominal surgery. In either case, the body needs rest! Most new mothers probably won’t feel like sitting through a photo op right after the birth. So how do women feel when they wake up still looking six months pregnant the day after birth? For many women, the physical recovery is not all unicorns and flowers. What then should a new mother expect postpartum?

The body goes through many changes as it adapts to no longer being pregnant. One of the most obvious changes is in the new mother’s stomach. The uterus does not just disappear immediately after delivery; it took nine months to grow to the current size, and it takes more than a few hours to shrink back! The shrinking does proceed much more quickly than the growing, though, and it is often shrunk back down by six weeks after the birth. The stomach can feel loose or jello-y after delivery since the water and baby are no longer keeping the uterus inflated. It can be a good idea to wear some sort of support after the birth, such as a girdle or even trying Bengkung belly binding. If there was a Cesarean delivery, it is recommended to not use these supports as they can harm or cause infection in the healing incision. Another major change the body goes through after birth is weight change. Many women can lose around ten pounds immediately after birth. This is due to the loss of fluid and the baby born. For many women, they continue to lose some weight in the days and weeks after birth as they lose fluid they have been retaining.

The postpartum period is also full of emotional changes. Your body has been producing and circulating numerous hormones over the past several months in order to grow and support the pregnancy, then deliver the baby. Once the baby is born, the hormone levels suddenly drop as the hormones are no longer needed. Women can respond differently to this sudden drop. Some women notice little or no change. The majority of women may develop some level of the “baby blues.” This is a feeling of sadness or moodiness often seen in new mothers, and it is not as severe as true depression. Mood swings are common. Many women may find themselves feeling overwhelmed or hopeless after the birth of a baby. They may experience a loss of appetite, and they might get to the point where they just feel nothing. These are signs that the mother may be experiencing Postpartum Depression, or PPD. PPD is actually very common, and it is nothing to be ashamed of! This is completely treatable, and it is not at all a sign that the woman will have lasting Depression later. Hormones can have strange or bizarre impacts in the postpartum period. If you do not feel like yourself after birth and are unexplainably sad or have these strong feelings, please do not be afraid to discuss them with your doctor.

Bonding with the new baby after birth can come easy, or it may take some time. If you do not feel an instant connection with the baby, know that that is not uncommon. Different aspects and experiences during the labor and delivery can lead to a disconnected feeling in some cases. This disconnect is not permanent, and there are ways to support bonding with the baby. Birth partners may take longer to develop a bond with the new baby as they did not physically birth the child, but these bonds can and do form.

Skin to skin is a great way to encourage bonding with the baby. This method is also very easy to accomplish; it just means lying topless or mostly topless with the naked (but generally diapered) baby on your chest. Many hospitals now practice skin to skin regularly, and hospital staff are able to check the baby’s vital signs and gather APGAR scores while the baby remains on the mother’s chest. Research supports giving new families at least an hour of uninterrupted skin to skin bonding time. Spending time skin to skin is not only good to promote bonding, but it also helps establish breastfeeding and stabilize the newborn physically. Skin to skin has been shown to help regulate the baby’s temperature, heart rate, respirations, and even blood sugar. It also can comfort the baby as the position puts the baby close enough to hear the mother’s heart beat that he has become so accustomed to hearing. It allows the baby to smell the mother’s milk, and it is amazing to see a newborn scoot himself towards a breast and begin feeding all on his own. The birth partner can do skin to skin as well! Skin to skin has no detrimental effects, only benefits, and it is a great way to begin bonding with a new baby.

Feeding a newborn is another aspect that new parents must adapt for in the postpartum. Even if you’ve heard things like “feed the baby every two hours,” it is a completely different experience to realize just how frequently that is. Some mothers have decided in advance how they want to feed their child, and some decide to figure out what works after birth. The two general food sources for a newborn are breast milk and formula. Breast milk is full of antibodies and nutrients from the mom, and Colostrum (the first milk) is often considered the baby’s first “vaccine.” However, breastfeeding is not desired or possible for some families. Formula is formulated to provide the nutrients and calories that a baby needs as well. There are also specialty formulas that are great for babies with allergies or other specific feeding difficulties. No matter which option you choose, for the majority of women breast milk fully comes in by around three days postpartum. The first day that the milk comes in can be an experience. You may wake up and not recognize your own breasts! The breasts may feel huge, round, and hard. This sensation is partially because the breast tissue becomes inflamed; they are not just full of milk. Thankfully, this inflammation does not last forever, and for many women it is gone or at least greatly lessened by the next day. Feeding a baby can be a stressful experience for new parents. Is the baby gaining enough weight? Is he getting too chunky? Weight gain is stressed by many pediatricians as blood sugars may drop if the baby is not eating enough. First, take a breath; it is okay! Every family adopts their own feeding schedule and practices, and not every suggestion works for every baby and family. If there are specific concerns, your pediatrician can provide advice and recommendations.

For those who choose not to or are not able to breastfeed, breast milk still does come in. There are ways to stop the milk flow, but these take time. Options to help stop milk from continuing include binding the breasts and herbal teas or supplements. Binding and compressing the breasts can help stop triggering the breasts from making more milk, but this can take a few days or weeks. There are herbal teas, but like any other type of supplement, it can be best to consult your doctor before trying them.

The postpartum period and adjusting to life with a new baby can be hard. This adjustment can be made easier by having a good support system in place. This system can take many forms, from having family stay over, to having a friend stop by, to asking your church for help, or hiring professional support. For many mothers, the easiest option might be having their own mother or mother in law stay over and help. This gives the grandmother an often desired chance to bond with the baby, and she can help around the house. There is also the option to hire a Postpartum Doula. A Postpartum Doula is a non-medical support person specifically trained to support families in the postpartum period. They can teach basic infant care, help with infant care, help give the new mother a chance to rest and heal, and many do basic meal preparation and house work. A Postpartum Doula is a great option to have for postpartum support as they are trained in up-to-date practices and care.

Overall, the postpartum period is full of adjustments and changes. It can be difficult, but by preparing and knowing in advance what can be expected, it can be a rewarding time.