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Bethenny Getting Married Birth Episode: My Thoughts As A Doula, Including Why Rachel Dratch Should Definitely Take Childbirth Education Classes

by Andrea Crossman, RN, BS, BA on July 27, 2010

in Best of the Blog,Birth Stories,HDNYC,Labor & Birth,Must Know Info,NYC Local Resources,Preparing for Baby

Comedian and actor Rachel Dratch said she's going to use Bethenny Frankel's reality TV birth episode as her childbirth education class. Read below for why I hope she's just being funny. Photo from Bravotv.com.

Guilty pleasure admission: I am a big Bethenny Frankel fan. I fell for her sass on the Real Housewives of New York, and am falling for her vulnerability and cuteness in her new show, Bethenny Getting Married. So last week when the Bethenny Getting Married birth episode was about to air, I wanted the best for her and new hubby Jason Hoppy, of course, but also for the vast and impressionable viewing public. In addition to working as a birth support doula, I teach private childbirth education classes, and hear week after week from parents saying that what they know about birth has come mostly from TV and movies. Unfortunately it’s also mostly wrong. If you are a regular reader of this blog you probably remember last spring when Pam and Jim on The Office had their baby, that I “live blogged” the fictional event offering my 2 cents as a former labor and delivery nurse here in New York City about what the writers got right, and what could have been better (my full analysis is here). All in all, The Office did a pretty good job, and I was hopeful for Bethenny’s birth as Bethenny is a natural foods chef, a yogini, and someone who I thought might very well have a great holistically minded birth team on board.

I have to say that from what I saw on TV, Bethenny could have benefitted from a little more help, particularly in the form of a quality childbirth education class and a skilled labor support doula. There were so many things I watched in that episode that just looked so much harder than they needed to be. I wanted to crawl through the screen and offer my services, but alas, it doesn’t work that way. I was going to keep my commentary to myself because unlike the birth on The Office, Bethenny is a real person and this is her real story–albeit packaged and edited for television entertainment. My decision to stay mum on the matter changed tonight when Bethenny and Rachel Dratch (who is expecting baby #1) were on Bravo TV’s Watch What Happens Live with Andy Cohen, and Rachel said that she was just going to use the Bethenny Getting Married birth episode in lieu of a childbirth education class.

Oh, nooooooooooo. No, no, no, no, no Rachel.

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Emily’s Rock Star Mama Birth Story | aka The Real Scoop From A Holistic Doula NYC Childbirth Education and Doula Client

by Andrea Crossman, RN, BS, BA on July 19, 2010

in Best of the Blog,Birth Stories,Childbirth Education Classes,HDNYC,Labor & Birth,Must Know Info,Preparing for Baby

I am very thankful to have been chosen by Emily and her husband Alex to support them in their childbirth education preparation and during the birth of their son Logan as their labor support doula. Emily knew from the beginning that she wanted a natural delivery and she did all the work necessary to make that a reality. She was amazing, as was her whole team of supporters–Alex and her sister Meggie. More and more clients are hiring Holistic Doula NYC for both childbirth education and labor doula services and the pairing works really well. Emily recently blogged about her experience and was gracious enough to grant permission for me to share it here. If you are looking for childbirth education, doula services, or both like Emily was, feel free to send me an email at hello@holisticdoulanyc.com. Here’s Emily’s birth story, thank you Emily, you were AMAZING!

Logan is here! Here is how he got here:

First off Alex was amazingly supportive throughout my pregnancy. He listened over and over again while I talked about my cervix and my uterus and used words like cervical mucous and bloody show and hemorrhoids and all sorts of other unpleasant things. He learned just about as much about childbirth as I did and was committed to being an incredible birth partner. I could not have asked for more from him.

Second, I had an amazing doula named Andrea Crossman. Here’s her website: http://www.holisticdoulanyc.com

Alex and I opted to do childbirth education classes with her because 1) she came to our apt, 2) she tailored the class towards the unmedicated birth I was aiming for and 3) we got to know her better during the classes. I think every tidbit of information Andrea gave us during the classes was useful in labor. She told me about some of the gorier things TV and other women don’t tell you to expect (bloody show, vomiting) so that when they happened I wasn’t scared. She also taught us about how fear inhibits labor. Knowing that helped me to get into a mindset of accepting the various stages of labor and all the things that come with it instead of allowing fear to creep in.

I also read just about every book there is about childbirth.

Here’s a taste of my pregnancy library:

Ina Mae’s Guide to Childbirth

The Mayo Clinic Guide to a Healthy Pregnancy

The Pregnancy Bible

Your Best Birth

Don’t forget the DVDs:

Orgasmic Birth

The Business of Being Born

None of these books or DVDs are perfect, and as with everything there is some work in sorting out opinion from fact, but all of them were useful in satisfying my unquenchable need to understand all the crazy things going on with my pregnant body.

So, labor begins!

I had been having Braxton-Hicks contractions on and off for a few days, but by Sunday evening on May 23rd they started picking up, getting stronger and more regular. I was very eager to get this baby out so instead of taking Andrea’s evening advice and taking a bath and getting some rest I went for almost a 2 mile walk, which really got the contractions going. By around 11pm we were pretty much sure this was the real thing. I called Andrea who advised that I try to get some rest, especially because labor for first time moms can be very long, and early labor is a time of manageable pain. I did my best but I couldn’t sleep. At least the Lost series finale was on so I was distracted for a good while. Around 2am Andrea came over and she did her best to get me to sleep but it just wasn’t happening. I was too excited and I couldn’t calm down to sleep between contractions. She sat up with me talking while Alex got some rest. At 5am my equally restless sister came over and we continued chatting and hanging out until 6:30 when, with a particularly strong contraction, my water popped. I know the term is broke, but really this was a strong pop. When it happened I imagined a little leprecon popping a balloon inside me. I have no idea where that image came from.

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What Does A Doula Do?*

by Andrea Crossman, RN, BS, BA on April 14, 2010

in Best of the Blog,HDNYC,Labor & Birth,Must Know Info,Pregnancy,Preparing for Baby

This is a variation on a post written for Kris Carr's Crazy Sexy Life,"a supercharged health hub filled with compassion, knowledge, and an anything-is-possible spirit." If you want to get it on the discussion there (and you should—what a great community!) click the pic!

As a doula and a nurse I am concerned with the birth of the baby, and with the birth of the mother. Indian mystic Osho says: “The moment a child is born, the mother is also born. She never existed before. The woman existed, but the mother, never. A mother is something absolutely new.” I totally agree. So how do I support the birth of the mother? Or said another way, what exactly does a doula do? Well, a whole bunch of things, and many of them happen long before anyone is breathing through a contraction. Here is how I typically work with a doula client:

COMPLIMENTARY MEET AND GREET

Main goals: Meet and understand how you would work together

Most important about this meeting is to simply check out the “vibe.” Second to that is to make sure you feel good about the experience and energy your potential doula can bring to your birth.

UNLIMITED PHONE AND EMAIL SUPPORT

Main goals: Continue building a relationship, have a go-to for your questions, keep your doula up-to-date on your pregnancy

I offer unlimited email and phone support to help my clients better navigate their pregnancy and birth. I also ask my clients to contact me within 24 hours of each midwife or ob/gyn appointment with an update. I can help translate medical-speak and am often able to also see potential issues before they arise and then offer suggestions for how to stay on track with your birth goals.

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The Office Birth: Thoughts from a Labor and Delivery RN & Doula

by Andrea Crossman, RN, BS, BA on March 4, 2010

in Best of the Blog,Birth Stories,Labor & Birth,Midwifery,Must Know Info,Random Goodness

All photos from NBC.com

Note: If you missed The Office birth episode (The Delivery Parts 1 and 2) you can watch the whole thing on NBC by clicking here.

I’m a huge fan of The Office, and have always been enamored with the Pam and Jim love story. I was, nonetheless, trepidatious of tonight’s hour-long episode, “The Delivery Part 1 and 2.” Television and film portrayals of labor and delivery are notoriously inaccurate and often play into our society’s fear of birth. Every pregnant mama I work with has mentioned the need to get media images of birth out of her psyche to trust in the process. I do understand that the goal of TV and film is to entertain, but I also know that accurate portrayals of the birth process can be just as entertaining, and probably even more so. With all of that in mind, as I sat down to tonight’s very-special-episode of The Office I decided to blog and watch, providing my doula/L and D RN two cents in terms of what they’re getting right, and what is for fictional portrayals only. Here we go…

#1) Pam and Jim need a doula! They would be able to call her up and get reassurance that with contractions that are irregular and even 7 minutes apart, there is still plenty of time to labor at home (or at the office in this case) before heading to the hospital. Early labor is best done where a mama can move around free from IVs and monitors, and eat and drink as she pleases.

#2) Pam: “I’m not really in labor, I’m near labor.” Excellent description of early labor! When contractions are irregular they can come and go. A+

Pam "contrapting."

#3) Michael: “Contraptions! She’s contrapting!” No. But really funny.

#4) This get-to-the-hospital-at-midnight-for-the-extra-day-in-the-hospital plan is not necessarily a great idea. Hospitals are best for acute injury and life-threatening illness. For most other situations being in the hospital increases risk of infection and illness or injury caused by being in the hospital in the first place. I say get out of there as soon as you are safely able.

#5) Along those lines, a lot of people make critical decisions based on insurance. If you are able to avoid this please do. You will be happiest if you deliver with whomever’s practice and philosophy best matches yours, and in the venue (home or hospital) that will support the birth experience you seek.

#6) Kelly: “Did you know that labor can last weeks, and then they take your insides out and just plop them on a table, and sometimes epidurals don’t work and you can poop yourself?” My response in order: Not exactly but kind of (early labor warm up contractions can be felt for weeks by some), the uterus is placed on mamas belly during a c-section–but not plopped on a table, and true, and true. All of which would be well supported by a doula who would do her best to provide you with the informational, emotional, and physical support to help you feel a-ok about whatever your labor may bring. (Even the pooping, which sounds horrible but I promise you, it isn’t. Your excellent nurse will whisk it away and you won’t even know it happened.)

#7) To pick up with the point of when to leave for the hospital if you choose a hospital birth, leaving when contractions are every 5 minutes is generally better than when they are every 7, and many practitioners even recommend 3 minutes. The general recommendations go something like this: “Leave when the contractions are 4 minutes apart, and last for one minute, for one hour.” They call this “411″ and some midwives and docs recommend 511, some 411, and others 311. As a doula, I support my client in leaving whenever she wants, however, for my mamas who want to stay home as long as possible, I work with them to stay home until we see signs that mama’s entering transition territory.

#8) Jim: “Why don’t I just run you down to the hospital and we’ll get you a quick check.” I totally understand Jim’s reaction here as this is all unknown to him. At this risk of sounding like a broken record, this is where a trained birth professional can really help keep everything calm, cool, and collected. And although this may be different around the country, in most NYC hospitals there is little to no chance of a “quick check.” Priority is given to women in active labor or in emergent situations, and Pam would likely spend a lot of time in the waiting room in triage, where she would be less comfortable and perhaps progress more slowly. Also, in many situations once you’re in the hospital they will try to keep you there and then begin “active management” of labor, which means interventions to try to speed it along. Staying home as long as possible (or having a homebirth) is your best shot at being on the time table that is best for you and your baby, not the time table preferred by the hospital.

Curious about the Early Labor Baking Project? Click the pic for the scoop.

#9) In her early labor Jim is trying to give Pam room to “listen to her body’s signals,” which is right on (good job Jim!), but just not quite yet. In early labor, distraction is the name of the game just like Pam says. If Pam and Jim were my doula clients I would have helped them create an appropriate Early Labor Plan which helps with the distraction factor early on. I may even recommend they consider an Early Labor Baking Project which can be both distracting and delicious. Of course, none of that would make for Must See TV…

#10) Kelly: “Oh my god Pam, you are a warrior.” Yep, all laboring mamas are. More impressive than Olympic athletes and marathon runners. Hands. Down.

#11) Michael’s labor induction tips:

  • Stimulate the nipples: True–releases oxytocin, causing uterine contractions.
  • Walk around: Yes! I recommend a good 3 – 4 mile walk to my mamas who want to get things going.
  • Eat spicy food: Maybe, can’t hurt. Some say eggplant parmesan is a good food for labor too (I’ve heard it’s actually the basil and oregano that do the trick).

#12) Jim: “Let’s go to the hospital…let’s go now.” Oh Jim…I will say that I’m not sure who I am of more use to in early labor, the mamas or the papas. 99.9% of men have never seen a woman give birth before, let alone witnessed a number of births with myriad variations on normal. It is totally natural that they would feel better being someplace with people around who did know about birth. The thing is, that is not what is best for mama most of the time. The cervix needs an environment of safety, privacy, and calm to properly dilate, and hospitals rarely offer much of that particular combo. A doula and/or a midwife who will join the couple in their home during this time allows papa to be a wonderful supportive partner, and know that there are other people with the experience to judge if everything is as it should be.

#13) Pam held her ground even though Jim wanted to leave. Not all mamas are able to do this, and in part because they’re scared too. This is an important thing to discuss as a couple ahead of time. Birth should be about supporting mama in what she needs, and anything that may get in the way of that (including a birth partner’s own nerves or fear) needs to be figured out in advance.

Jim and Pam before baby made three.

#14) Pam: “There’s no rush to get to the hospital. I’m fine. I’ll get there. And if I don’t get there, I don’t get there.” Wow. Pam’s composure is amazing, but rare in a first time mama, so don’t feel bad if you’re not quite so confident. I love this portrayal though, it is so different than the typical terrified and frantic mother-in-labor image. I hope the tone stays like this!

#15) Not being able to walk or talk through a contraction is indeed a sign that Pam has moved from early labor to active labor.

#16) Ummm…oops. To go directly from active labor (can’t talk during contraction) into signs of transition (Pam’s expression that she can’t do it) is not particularly realistic. Though the timing is off, a woman’s sense of overwhelm is virtually universal, and I believe that emotional state gives way to the surrender necessary to fully open up and eventually push the baby out. The best thing to say to a mama in this moment? “You are doing it! You’re doing so good!” (Because she is!)

#17) Contractions are now 2 minutes apart, keep breathing everyone. A lot of my clients like to keep track of their contractions with this iPhone app called Contraption Contraction Master.

#18) You should not attempt to measure dilation with a metal tape measure. Just so you know.

#19) Jim: “Pam’s ten inches dilated now. Sorry, sorry meters. Centimeters. And she’s fully effaced. Which, ah, I don’t know what that is.” Perhaps Jim and Pam didn’t take childbirth education classes, because those are certainly terms that we cover. Taking childbirth education classes with your partner is incredibly important in terms of gaining the knowledge needed to be empowered in a the brand new situation. You will learn cool things like this: Cervix Lingo: Effacement What? Dilation Who?

#20) RN: “Daddy, she’s ready to push.” How do you know you ask? Rectal pressure. It feels like you have to have a bowel movement, but in fact what you’re feeling is the baby’s head. If you have an epidural you may not feel this, although you very well may. With an unmedicated birth you will absolutely know when you’re ready to push.

Babies come in their own time Michael!

#21) Michael during Pam’s pushing, “Can we have an ETA?” Not really. The average is from a few minutes to 3 hours of pushing. First time mamas like Pam usually take on the longer side. This is a-ok as it is important that mama and baby have time to work together for optimal fetal positioning and so that mama has time to open up and stretch.

#22) And finally, a beautiful baby girl was born and Pam looks fresh and pretty in a gown and robe. The fresh and pretty part is absolutely true. Every woman I have seen give birth looks unbelievably beautiful right after, it is amazing. None of them have a robe on however. A gown maybe, or a tank, or a belly band worn as a tube top. This is all preferable as you want lots of skin-to-skin contact for bonding and breast feeding.

****Postpartum

#23) When Pam is unsure if the baby is latching or getting anything (what she would be getting is colostrum by the way) and the nurse offers to take her away to the nursery that was just not very helpful. A doula or RN would ideally help ensure that the baby is latching correctly. When mom and baby need a break, it is best to stay close and enjoy skin-to-skin contact and just getting used to each other, and then try again in a bit. Here’s a good video about getting started with breastfeeding, and here’s one specifically about latching.

My conclusions? Not bad! I am pleasantly surprised by how well the writers finessed this episode. Pam was quite empowered, and there were no “emergency” twists and turns. There was also no hint that she couldn’t handle the intensity, or scenes of her screaming for an epidural, which TV shows often portray. All in all I have to say nicely done NBC and The Office, and congratulations fictional Pam and Jim!

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Aubrey’s Holistic Mama Birth Story & Choices in Childbirth Inspiring Birth Stories Events in NYC

by Andrea Crossman, RN, BS, BA on February 9, 2010

in Best of the Blog,Birth Stories,HDNYC,Labor & Birth,Must Know Info

Choices in Childbirth Mission: Choices in Childbirth is a non-profit organization that strives to improve maternity care and birth experiences by providing access to information about the range of choices available regarding where and with whom to birth. So often we hear from the women we work with that the decisions they made about their birth environment and the people that they invited to share in their birth experience all fundamentally affected the outcome of their birth and their level of satisfaction.

Update: Tonight’s (February 10th) Choices in Childbirth Inspiring Birth Stories Event has been cancelled due to the blizzard in NYC, but they will be back in March.

I just found out from one of my doula clients that she posted a review of my doula services on the BoCoCa Parent’s Listserv (BoCoCa = Boerum Hll, Cobble Hill, and Carroll Gardens Brooklyn), and that as a result, she was asked to share her whole birth story at an upcoming Choices in Childbirth Inspiring Birth Stories Event. I’m so happy for her, and believe that telling her birth story is a wonderful and important ritual for mothers. The Inspiring Birth Stories Events are free and I highly recommend them for any mama-to-be. From the Choices in Childbirth Site:

Inspiring Birth Stories

Our highly popular Inspiring Birth Stories evenings offer expectant parents a night out in which to draw strength and inspiration from women and men who have recent experiences of birth in New York. The evening features inspiring ? not necessarily easy! – stories from three to four new parent storytellers and expert commentary from mother-friendly birth professionals. The stories tell of a range of births (stunningly short, impressively long, unexpectedly challenging, remarkably straightforward, twisty-turney, painless, orgasmic, painful, cesarean. VBAC, twins, etc.) and reflect a range of choices (home, birth center, hospital, midwife, Obstetrician, family practitioner, doula, family support, etc.). We hope you can join us for an upcoming night inspiring birth stories.
The Inspiring Birth Stories events are monthly, and February’s is set for tomorrow (double check on their website given the blizzard that may be hitting NYC). I’m so appreciative of this great resource for our local mamas. Aubrey will be presenting her story in a few months, but in the meantime, she has agreed to let me share with you the review she posted to the BoCoCa Parents site. I know that many of you want to know what it’s really like to work with a doula, and Aubrey’s story provides some great insight. A big thank you and congratulations to Aubrey! She was a rockstar, as are all laboring mamas!

Aubrey & Hendrix

Aubrey’s Story

I enthusiastically recommend Andrea Crossman (Holistic Doula NYC).  She has worked as a Labor & Delivery nurse at St. Luke’s/Roosevelt, and has tremendous experience with all manner of births. She lives in Carroll Gardens and is on call at all times from week 38 on.

Andrea became my doula when my original doula, the also fantastic Laurel Axen Carroll (acupuncturist) had a death in the family. As soon as the doula swap happened, Andrea came over, armed with coconut water and questions to get an assessment of what coping mechanisms might be best to help me through labor. I found her to be warm, sincere, and incredibly knowledgeable.

When I went into labor, I had “risked” out of the Birthing Center by being one day over 41 weeks, and was afraid that laboring on the regular Labor and Delivery floor would result in a different birth experience than I had planned and hoped for. Andrea’s experience on this very L&D floor combined with her determination to provide a laboring woman with an unnecessary-intervention-free labor relieved me of a lot of stress.

Andrea also helped my husband by soothing him and communicating to him the range of choices that we had so we could make informed decisions. She was instrumental in making sure we were stocked with a variety of beverages and snacks to keep me hydrated and nourished. She also provided aromatherapy and other forms of relief. Most impressive was how she kept me focused on my goals when I was going through the most intense contractions and whimpering that I couldn’t take it any more! She was a rock for my husband and I, helping to make the birth of our son, Hendrix, the kind of story you want to be able to tell!

After Hendrix’s birth, Andrea went out and got me a terrific meal. She has been checking in on us by email and is coming for a follow up visit sometime this week.

-Aubrey, mom of Hendrix, 1 week old

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Bishop Score: Induction math mamas-to-be need to know

by Andrea Crossman, RN, BS, BA on February 4, 2010

in Best of the Blog,Labor & Birth,Must Know Info

Fun fact, the slit shape of the cervical opening tells us that this is a parous cervix, meaning this woman has had a vaginal birth. A nulliparous cervix (no history of vaginal birth) has a round opening.

In a previous post I provided definitions for terms related to the cervix. Understanding cervix related lingo is especially important if you find yourself discussing an induction of labor with your provider (which is becoming increasingly common, check out this short video for more info). Induction of labor is a huge topic (and has been discussed previously here), so in this post I want to focus on the concept of the Bishop Score. The Bishop Score is a way of rating “cervical favorability” to estimate the likelihood of a successful induction of labor. Knowledge of the Bishop Score and its implications can help you make an informed decision should you find yourself weighing the option of an elective induction of labor. I support the Lamaze Healthy Birth Practice Guideline which is to Let Labor Begin On It’s Own, with a few very specific exceptions. You can print out a Lamaze handout related to this principle here, or watch their short video here. Now for some basics…

What is considered a successful induction of labor? What is a failed induction?

A successful induction of labor results in a vaginal birth. The opposite of a successful induction is a failed induction. A failed induction is one that was not able to induce a labor that resulted in a vaginal delivery. When an induction fails, a cesarean birth is the result. Induction of labor carries a higher risk of cesarean section than a normal spontaneous vaginal delivery. And cesarean delivery puts both mom and baby at higher risk of illness, injury, and death. For this reason, many providers, institutions, and professional organizations do not recommend elective inductions of labor. Here is a post by another blogger that describes good and not so good reasons to consider an induction of labor.

Quote from the ACOG (American College of Obstetricians & Gynecologists)

Induction of Labor Practice Bulletin 2009

Nulliparous women undergoing induction of labor with unfavorable cervixes should be counseled about a two-fold increased risk of cesarean delivery.

*In plain English? If this is your first baby and you consent to an induction of labor with an unfavorable cervix you are twice as likely to end up with a cesarean delivery.

So how do you know if your cervix is favorable or not?

By knowing your Bishop Score! Below is a table that explains how the Bishop Score is calculated, and in this post all of the relevent terms (effacement, dilation, etc…) are defined.

  • A Bishop Score of >8 describes a woman who is most likely to have a successful induction of labor
  • A score >9 means that labor is eminent anyway
  • A score < 6 typically requires a cervical ripening agent (typically Cervadil) prior to beginning a pitocin induction

When researching the Bishop Score I found an interesting post on Intermountain Healthcare’s website. Between 2001 – 2006 they tracked average hours in labor and delivery as well as cesarean delivery rates based on Bishop Score. The data helps illustrate the correlation between cervical favorability and outcome. You can view it here.

A final note on informed consent and choice

The reality is that many providers do recommend elective inductions of labor, and patients often do not feel that they are receiving a recommendation, but rather that they are being told that they must have an induction by such and such a date. Almost all of the mothers I have worked with were told by their ob/gyns well before they even hit their 40th week, and in the absence of appropriate medical indications for induction, when they would be induced. The conversation seems to go like this, ob/gyn: “So, if you haven’t had the baby by the 20th, I’ll induce you on the 21st.” I really have a problem with this way of communicating, and it is completely embedded in doctor/patient culture.

It is my belief that in the absence of a medical indication, the induction conversation should not even come up. For many women this conversation creates a ton of stress as they panic about not going into labor on their own and try to research and do everything they can to naturally bring on labor. Every time I see this it saddens me. I really wonder if practitioners realize how their words effect their patients. It is a scientific fact that excess adrenaline inhibits the release of oxytocin, which is necessary to bring about the contractions of labor. The last thing mamas need in their final weeks of pregnancy is a heightened state of anxiety.

It is important for women to know that induction of labor should only be recommended when there are medical indications and also that their ob/gyn or midwife, just like every other healthcare provider, has an obligation to communicate the benefits, risks, and alternatives of each and every treatment plan or procedure they recommend. Barring imminent harm, it is inappropriate for a provider to simply tell you that they will be performing a medical procedure on you. It happens all the time, so people think it must be ok. But it is not. So here are the take away messages, #1) if you’re considering an induction make sure you know your Bishop Score and if you are even a good candidate, and #2) even if your options and rights are not acknowledged by your provider, you still have them.

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Cervix Lingo: Effacement what? Dilation who?

by Andrea Crossman, RN, BS, BA on February 4, 2010

in Best of the Blog,Must Know Info,Pregnancy

Image from A.D.A.M.

As a pregnant woman gets closer to the birth of her little one, she will typically have more exams and may be introduced to a whole new vocabulary. When attention shifts from keeping the baby thriving inside to getting the baby safely outside, the cervix becomes a focus of attention.

First things first, the cervix is the lower “neck” of the uterus, and sits at the top of the vaginal canal–which is also referred to as the birth canal. Just as sperm travelled through the cervix and into the uterus for conception, the baby will eventually travel out of the uterus through the cervix during birth. Throughout pregnancy the cervix has been tightly closed and fortified with a mucous plug to keep the baby safe and sound. This all begins to change toward the end of pregnancy and throughout labor. The end result of cervical change is a cervix that is dilated to 10 centimeters and is ready for the second stage of labor: pushing.  There are 5 different cervical changes that occur to get to this point, and each comes with its own lingo.

#1: Position: Posterior, mid-position, anterior

This is a way to describe the position of the cervix in the birth canal (aka the vagina). The cervix starts out in the posterior position, which means it is oriented toward the backside. In early labor the cervix transitions from the posterior position, to the anterior position. Anterior means front of the body and this alignment is necessary for the baby to move through the birth canal.

See how cervix points to the back? This is called "posterior." The cervix will change to an anterior position to align with the birth canal. Image from http://www.methodisthealth.com

#2: Consistency: Firm, medium, soft

Some say a soft cervix feels like an overripe pear

These sound like descriptions for how to choose fruit, and you know what? That’s not a bad way to make sense of what we’re talking about here. Matter of fact, a soft cervix is often referred to as “ripe,” and prostaglandins, which can aid in the softening of the cervix (for example semen, a natural source of prostaglandins, or cervadil, an artificial source of prastaglandins used in some labor inductions) are sometimes called “ripening agents.” At its most firm, the cervix will feel like the tip of a nose (or perhaps unripe fruit), at it’s most soft, it will feel like lips (or perhaps very ripe fruit).

#3 & #4: Effacement & Dilation: Effacement is measured from 0 % – 100%, dilation is measured from 0 centimeters (closed) – 10 centimeters (complete dilation)

Image from Relay Health, as displayed on http://www.med.umich.edu/

These two definitely require visual aids.

Effacement speaks to the “thinning” of the cervix, while dilation speaks to the opening of the cervix. In the non-pregnant state, the cervix is typically 3 – 5 centimeters long. As labor approaches, the cervix starts to draw up and over the baby’s head thus becoming shorter and thinner. Imagine your baby pulling a turtleneck over his or her head. (Very funny visual, no? And not too dissimilar!)

Dilation is the opening of the cervix from completely closed, 0 centimeters, to completely dilated, 10 centimeters.

#5: Station: -3, -2, -1, 0, +1, +2, +3

Station refers to how high the baby’s head (or other presenting part–for example, the bottom in most breech presentations) is in the pelvis. At 0 station the baby is in the pelvis and considered “engaged.” The lower the baby is in the pelvis, the less distance he or she needs to travel to eventually be born. Starting to push when the baby is too high in the pelvis can lead to maternal exhaustion. There is something called “laboring down,” in which mama sits tight at 10 centimeters allowing the uterine contractions (vs her active pushing) to do the work of bringing the baby further down into the birth canal. This can be a great way to be efficient with both mama and baby energy, and to save up all that pushing power for when it’s really needed.

Image from Nucleus Medical Media

How to use your newfound cervix lingo

Why is this knowledge useful? First of all, it is just nice to feel like you know what the heck your practitioner is talking about, right? Second of all, you may want to write down whether you are soft or firm, closed or a little dilated, and all the rest to share with your doula. This information is useful to us so that we can remind you of the progress you have made toward birth. Thirdly, if your practitioner starts talking with you about an induction, and it is something you are considering, this information takes on a special importance. There is something called the Bishop Score which assesses cervical favorability based on the 5 cervical qualities you have just learned. Want to know more? It’s all right here.

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Marci’s Holistic Mama Birth Story

by Andrea Crossman, RN, BS, BA on December 22, 2009

in Best of the Blog,Birth Stories

Last week I shared some tips for a holistic pregnancy and birth in this post. I introduced the post by talking about a birth I had attended the night before—the mama was my doula client Marci. This evening was my postpartum visit with Marci, her husband Matt, and their gorgeous baby William.

During our visit I held the baby (is there anything better?), and we talked about the birth, including some of Marci and Matt’s birth memories. Marci shared that she wrote her birth story to share with her prenatal yoga class. Knowing that her story would be interesting and inspiring to other mamas, I asked Marci if I could share it with you. She generously said yes, so a copy of the letter she wrote her Monday night yoga class is below. I know you’ll enjoy her story as much as I did, and I hope you’ll consider writing your own birth story when the time comes. It can be a healing practice for the new mama, and creates a memento for your child like no other.

By the way, Marci took her prenatal yoga classes at the Prenatal Yoga Center with yoga teacher Lisa, and absolutely loved them. I think any mama-to-be can benefit from a prenatal yoga practice. In addition to strengthening the core, and increasing flexibility, prenatal yoga can help build confidence, nurture community with other mamas-to-be, and provide an opportunity to practice finding the breath. All of this helps contribute to a happy, healthy, holistic pregnancy and birth.

Matt, Marci, and baby William

Marci’s Story, as emailed to her Monday night prenatal yoga class

Dear Monday night yoga class,

On Monday, 12/14/09, I was t-minus two days to my due date and still feeling good, albeit experiencing the discomforts of being ginormously preggers. And more importantly I was so ready to meet my bundle of joy, I was full of anticipation as to everything that I was about to experience. Was I going to have the holistic childbirth I planned and wanted for my peanut and me?

Throughout the day I experienced menstrual type cramps, but nothing crazy. At 3:30 pm I decided to indulge in a nap. An hour later I woke up really hungry and ate a big bowl of turkey chili. I spoke with Elyssa about attending yoga at 6:30 and to be honest I had some hesitation throughout the day about going, but I knew it would feel good to get out of the house and focus on my breath and relaxing. I was in.

At 6pm, Elyssa and I walk from Brooklyn Heights, and I’m experiencing heavier menstrual like cramps. I was in contraction denial, but it felt good to walk.

From 6:30-8pm, I practice with all of the Monday night mamas-to-be. Throughout class, I begin to notice that my “menstrual like cramp” contractions are taking shape. I actually have to rest during some poses because the obvious contractions are uncomfortable. I laughed when Lisa asked if I was in active labor and she mentioned Deb having to turn some ladies away from class. Little did I know!

At 8pm, Elyssa and I head back to Brooklyn Heights. As we walk, I have to stop a few times along the way during the contractions to get my breath. At this point I decide to call my husband, it was time to fully come out of the denial that I’m in labor!

Around 8:30 pm, Elyssa helps me get home, God bless her! We say our goodbyes and I take to the bathroom.  It felt comfortable to sit on the toilet during contractions, find my breath and remain as calm and relaxed as possible. I bathe, I vomit.

At 9:00 pm, I tell my husband to call our amazing doula, Andrea Crossman. I’m now at a point where I’m struggling with the contractions and we need extra support. My contractions were about 3 minutes apart, lasting for a minute. Go birth team!

Andrea arrives around 9:45, and for the next hour or so I practice different positions. By 10:45, using my voice and breath are trumped. It’s go time, and we get a car service. God bless the driver Utah, because I was in full on transition while that man got us all to the hospital like a champ.

Baby William, Sleeping Buddha

Around 11pm, we arrive at NYU delivery triage 9 cm dilated, 100% effaced, and +2 station. I am admitted to a labor and delivery room and feel the urge to urinate, with everyone telling me whatever I do, do not bear down. As soon as I sit on the toilet a contraction comes on and I have to stand.  As I stand up, my bag of waters break, or burst with a gush more like it. I feel ready to push, but my OB hasn’t yet arrived so I’m holding off. Minutes later she comes in ready to go, and I was able to begin to push through the contractions.  Our OB allowed me to labor and push at my own pace, and at 12:15 a.m. on December 15, 2009 my son, William was born! It was amazing, I did it! Open throat, open vagina.

Will, Mama and Daddy are now comfortably at home and I look forward to Mommy-and-Me classes in a few weeks.

Thanks Monday night yoga!

Marci

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Tips for a Holistic Pregnancy and Birth

by Andrea Crossman, RN, BS, BA on December 19, 2009

in Best of the Blog,Childbirth Education Classes,Holistic Health,NYC Local Resources

for Holistic Mamas-To-Be (and mama-wanna-bes too!)


Holistic Doula NYC client Marci

Holistic Mama Marci & her little one, born 12.15.09

Last night I supported my doula client Marci* and her husband through a natural birth and I’m still buzzing with post-birth energy.  Marci took an evening prenatal yoga class from 6:30 – 8:00, and was apparently in labor the whole time without fully realizing it. Four hours and fifteen minutes after rolling out of Savasana, she gave birth to her first baby. During her pregnancy, she was a regular at her yoga class, received acupuncture treatments, and took the right supplements. During her labor, she sipped on coconut water and used hydrotherapy, multiple positions, and focused breathing to manage her pain. All of these holistic practices played a role in her healthy transition into motherhood.

In an effort to share the tips and resources I give my doula clients with even more holistic mamas-to-be, I’m teaching a unique childbirth education course at the New York Open Center in February. The class is called HDNYC’S Truly Holistic Pregnancy and Childbirth Series and in addition to all of the traditional childbirth education material, it will incorporate some of my best and perhaps less well known tips for a holistic pregnancy and birth. Because everyone already knows to lay off the bad habits, get enough sleep, and take prenatal vitamins with folic acid, right? Below is a sneak peek at some of the information that will be shared.

CHOOSE YOUR TEAM WISELY

Find a provider who shares your philosophy about health, wellness, pregnancy, and birth. In New York City, it is typical to choose a homebirth midwife, a midwife practicing in a hospital, or an obstetrician (Ob/Gyn) to provide your prenatal care and attend your birth. My perspective from working with hundreds of laboring women is that your choice for Team Birth is far and away the most important factor in having an experience you feel good about. You also need to know that if your midwife or obstetrician is part of a group practice, it may be one of her/his partners who is actually on call when you deliver. So make sure you research, meet, and feel good about everyone in your chosen provider’s practice.

GET A DOULA

Doulas decrease the incidence of cesarean deliveries, epidural anesthesia, and failed inductions

And I’m not just saying that because I am one. When I was a labor and delivery nurse I was awfully doula-ish, but with all of my responsibilities-other patients, charting, sometimes setting up the OR-it was impossible for me to offer the continuous emotional, physical, and informational support a doula does. Also, as a doula I meet women and their partners in their homes for weeks before the birth. I help them pack their labor bags (or prepare for home birth), make sure the ice pack is chilling in the freezer, and may even fire up the blender and teach them how to make a glow-getting green smoothie. This kind of relationship is totally different than one with someone you meet in the midst of transition and hee-hee-who breathing. Studies show that women who have the continuous support of a labor doula have significant reduction in the rates of cesarean deliveries, epidurals, and failed inductions, and a significant increase in feelings of satisfaction with their births.

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