Pregnancy "Support" 101

Image by Krista Evans Photography

Support bras, support socks, support tops, support belts…

Once you become pregnant it’s like you get sucked into this huge market of support goods that everyone is telling you you’ll need, and it can get almost as overwhelming and pricey as planning a wedding, ALMOST. Yet, here I am advocating for pregnancy + labor support.

What exactly does that even mean and why do you need it? Let’s start with the top 3 very basics that are MOST important.

1. I worked in facility that I felt was very supportive to the birth I envisioned. I trusted my coworkers and above all felt safe. When I delivered my second, my husband worked there, I researched the hospital and (again) felt SAFE. Can you say the same about your hospital? Will you be delivering at a facility with a low primary cesarean rate, a place that will support your wishes and put you first? If you answered “no” to this, maybe you can take the time to reconsider.

   As evidence becomes more available to the public, it is no wonder more women are wanting to have more laboring and birthing options.

   But unfortunately it takes 15-20 years for evidence to come into practice in a hospital.

   If your hoping to labor in a birthing tub, but the labor and delivery unit does not even have one, or maybe the hospital you are delivering at has a high primary cesarean rate and low breastfeeding rate… that may be something to reconsider. Spend that extra time and do research. If you are in California, check out calhospitalcampare.org, or leapfroggroup.org. If you find your hospital isn’t what you thought it would be, call your insurance and switch! If you can’t switch, for whatever reason, know that you can still get an awesome birthing experience by having other “support” systems in place, for example, a great provider.

2. As a woman, a mama, and a nurse, finding the “perfect” provider is a solid must. As a labor and delivery nurse I was able to indirectly audit, interview, and precisely choose a provider that I knew, trusted, loved, and who felt the same about me.

   How do you feel about YOUR provider?

   Do you find yourself completely comfortable with him/her? Are you able to ask questions without them shutting you down or making you feel silly? Do you completely trust them? If you answered “yes”, AWESOME- that is one of the biggest components of labor support. If you answered “no”… sistah, lets chat.

   In every profession, you will have those people (providers) that just blow you away with their amazingness, and how they put their heart into everything. If you find them, hold them tight, DON’T EVER GO!!

   BUT, there are also those who… well, those who don’t. There were moments I wanted to tell my laboring patients that the provider they chose was not one to honor the birth plan they spent hours preparing, would routinely perform an episiotomy, scoffed at doulas, or that they probably had the highest primary cesarean rate around… but couldn’t or I’d lose my job, the only thing I could do was involve the expecting parents in their care and encourage that family to use their voice and advocate for themselves.

   If you find yourself in a position where you don’t like your provider, you can call your insurance company and get a list of providers, ask other mamas for recommendations, or even look on yelp. Then meet with them until you find THE one.

   You have every right to change providers if you don’t trust or feel comfortable in their care.

   “OK, but Jessica, what if you think you like your physician at first but the closer you get to your due date you find that you are just not happy?” SWITCH.

3. Have you considered who will be at the hospital or in your room while you are in labor?

   True Story, us Labor and Delivery nurses are never afraid to be the “mean nurse” to guests in the interest of our patients. Labor is an exciting thing, BUT, it doesn’t warrant a party with 15 people sitting around you as you labor, passing a box of pizza back and forth, speaking above each other, and shows like Maury (THE WORST) playing in the background. It is  amazing how much resetting the environment, asking everyone to leave, cleaning the room, turning off the TV and bright lights, actually helps contractions to get back on track and resume labor progression.

   Another question I get asked a lot is about having a birth doulas for labor or having another person available to provide continuous labor support in addition to your partner. A doula’s role is to provide physical support, emotional support, informational support, and advocacy to his/her clients. Evidence shows that women who have had some sort of continuous support show: (Evidence Based Birth®)

   • 25% decrease in the risk of Cesarean; the largest effect was seen with a doula (39% decrease)*

   • 8% increase in the likelihood of a spontaneous vaginal birth; the largest effect was seen with a doula (15% increase)*

   • 10% decrease in the use of any medications for pain relief; the type of person providing continuous support did not make a difference

   • Shorter labors by 41 minutes on average; there is no data on if the type of person providing continuous support makes a difference

   • 38% decrease in the baby’s risk of a low five minute Apgar score; there is no data on if the type of person providing continuous support makes a difference

   • 31% decrease in the risk of being dissatisfied with the birth experience; mothers’ risk of being dissatisfied with the birth experience was reduced with continuous support provided by a doula or someone in their social network (family or friend), but not hospital staff

While you don’t have complete control of how your pregnancy and childbirth unfold, you can control how you nest your mind and your heart for this momentous day. As a nurse and a wife to a pediatrician, we feel most comfortable delivering in a hospital setting. Knowing our options, asking questions, advocating for ourselves, and choosing a provider and a hospital that we know will support us gives us that certainty and that trust. Take the time you need and don’t be afraid to ask questions. You’ve got this!!

Big hugs and belly rubs from this mama to you.

Top 10 Items For The Best New Mama Gift Basket

I love baby showers. Mostly because I love pregnancy and babies… alright I’ll say it, and “momosas” that have thankfully become a staple. As a mama myself, I spent so much time nesting by preparing the nursery, registering for baby items, washing baby clothes, and prepping a diaper bag. After I delivered I realized I forgot completely about me… specifically the things I would need at home after delivery. 

Back in the day childbirth was somewhat of community/mom tribe event, women supported women, delivery was not so medicalized or private, and there was not much fear around childbirth because you were very much exposed to it. What I loved about my role in labor and delivery was that I had the privilege to play a part in MANY childbirths, I knew what to expect, and I felt prepared and empowered in watching women give birth. It was such a beautiful experience. BUT, after talking to many millennials around my age, I realize THAT is not the case for everyone. In reality, there is this “unknown” that accompanies childbirth and it can be scary, and you can feel and be quite unprepared for the normal occurrences post-delivery.

Since then, my favorite thing to gift at baby showers are postpartum baskets. These baskets are filled with little things that prepare new mamas for postpartum paired with a card that explains each item… I also throw in a few things for the baby because, c’mon, who could resist. While my mama friends may blush a little when opening them, especially if they are first time moms, they hands down thank me after the baby is born.

** Disclaimer: This post contains affiliate links. This means I may earn a small commission should you chose to purchase using my link. Please note that I only recommend products that I personally use and love and always have fellow mama's (+ baby's) interest at heart.

You can gift a few or all of the below, but the top 10 items are:

1. A cute water bottle: Hydration for a new mom is key for milk production, healing, and because she lost lots of fluids during delivery, it helps with fluid replacement. 

2. Pads: Postpartum bleeding can last days to weeks and having at least a pack of pads WITH WINGS at the ready just helps your new mama to care for herself, prevent infection, and feel good.

3. Fridet the MomWasher: A perineal spray that helps to clean any laceration repair, prevent infection, soothes irritation, and honestly just feels great. If your mama is having a cesarean, a GREAT abdominal binder in leu of this would rock!
4. Witch Hazel Pads: Witch Hazel pads AKA Tucks is used for hemorrhoids, and are cold and soothing. I recommended my patients placed them on top of peri pads for the same effect on the perineum. They are also very gentle for cleaning, and last forever!
5. Stool Softeners: regardless of a vaginal delivery or cesarean, the first time pooping after is going to be quite uncomfortable. If she needs to take anything stronger than Ibuprofen for pain, constipation is inevitable. Stool softeners/Smooth Move tea will help with that discomfort and make that transition smooth... (get it?? ;])
6. Ibuprofen: Postpartum cramping is very normal, but feels like bad period cramps, not to mention possible laceration repair discomfort, and the burning that often accompanies breastfeeding. Ibuprofen really helps to ease that discomfort and is safe for the baby. Having this at the ready literally can save a new mom from tears and stress.
7. Nipple Cream: as I just mentioned, breastfeeding can be quite uncomfortable for the first 1-2 weeks, not only from causing you to contract but throwing nipple sensitivity on top of chapped nipples can bring a new mama to tears. Help prepare her with nipple cream or coconut oil. If that is a liiiittle too intimate for you, a great nursing tank would ROCK her world. Breast accessible clothing is a Game. Changer. Big Time.
8. Bamboobies: Bamboobies are breast pads made from bamboo and are the SOFTEST breast pads ever and truly absorbent... that comes from someone who made enough milk every feeding to feed an entire NICU and leaked through EVERYTHING. They are my absolute favorite! 
9. A nursing cover: I am all about "free the nip" but, I also prefer to use a light nursing cover when I don't want to accidentally spray down anyone who is in the way of my breastmilk. I love the ones that are just an easy strap like an apron with a rigid neckline for easy no-fuss breastfeeding.
10. Prenatal/postnatal vitamins: After delivery a mama's body does not stop working. In fact, more calories are being used for breastmilk, there is more nutritional need for healing and to pass to baby. Encourage a new mama to continue to take vitamins after delivery to help with all of the above and to get back on her feet faster. She very well can get all the vitamins she needs from her diet, but just in case I definitely recommend a whole food vitamin option. 

Mommy-ing ain't easy, and it takes a village. Luckily if you are reading this, you are making that village pretty dang awesome. If you are a momma, no shame in sharing this post to your fam/friends... think of it as part of your registry. You've got this! 

Big hugs and belly rubs from this mama to you

The Natural Nipple: Guest Blogger

Many people talk about the magical parts about becoming a mother. But so often we forget about, or avoid talking about the difficult, maybe embarrassing parts about being a mom for fear that we are abnormal or that we’re a failure.

One of those difficult parts is the challenges faced with breastfeeding. A significant part of being a mother with a newborn.

If you’re a new mom or expecting you’re probably no stranger to the studies that have been published on the incredible benefits of breastfeeding your children. Just to list a few, there is a greater resistance to developing things such as systemic autoimmune diseases, allergies, and neurodevelopmental disorders (Weng & Walker, 2013). Other findings from a recent study suggest that breast milk provides babies with diverse gut microbiome that helps protect them from harmful diseases (Stewart et al., 2016). These are just a few of the incredible things breast milk can provide.

But breastfeeding isn’t easy - with so many moms experiencing difficulties with latching, nipple confusion(after the baby is introduced to a bottle), nipple pain and discomfort, anxiety about whether or not they are producing enough milk, and so on. These are such common issues experienced among moms...but what solutions have really been offered?

That’s what we are trying to do with The Natural Nipple. Our goal is to pioneer the first study that explores women’s natural flow rate at different stages post-birth and differences in nipple shape and structure to develop a better breast to bottle solution.

We want to design a bottle and nipple that doesn’t disrupt your breastfeeding by providing you with a bottle and bottle nipple that mimics your natural shape and flow rate so you’re able to more easily go between breast and bottle.

What you’re doing is important, but life and other things can make it difficult. So for any mom who is trying to breastfeed but needs to get back to work, any mom who is experiencing extreme pain and needs to take a break from direct feeding, or struggling with breastfeeding in any other way we want to offer a solution.

We would greatly appreciate your input as well because we can’t do this without your help!

If you can, please fill out the survey below or donate a small amount to help us get this project off to a running start! 

Stewart, C. J., Embleton, N. D., Marrs, E. C. L., Smith, D. P., Nelson, A., Abdulkadir, B., . . . Cummings, S. P. (2016). Temporal bacterial and metabolic development of the preterm gut reveals specific signatures in health and disease. Microbiome(1). doi:10.1186/s40168-016-0216-8    
Weng, M., & Walker, W. A. (2013). The role of gut microbiota in programming the immune phenotype.Journal of Developmental Origins of Health & Disease, 4(3), 203. 

team of clinicians, scientists, and mothers pioneering advancements to empower breastfeeding, promote bonding, and optimize wellness for mothers and babies worldwide

Your Perineum & Childbirth... my what?

So what IS a perineum? The female perineum is the region between the vagina and the rectum. It consists of layers of skin, mucosa and muscle.  This is the area, during childbirth that is most talked about when it comes to labor trauma/lacerations.

It seems like perineal trauma may be a big concern for many women, for good reason. I mean, no one wants vaginal trauma, EVER. 

One of the most common questions I get asked is, “does every woman ‘tear’ down there?”

The answer, no, not every woman will have lacerations from birth. Spontaneous lacerations that occur during birth are not always controllable, but there are certain techniques that can help slow down the birth of the baby’s head, and allow the stretching of the perineum to prevent injury, including “perineal massage, warm compresses and a “hands on” guarding of the perineum.” (World Health Organization, 2018)

The next question is almost always, “is it true everyone gets an episiotomy?”

The answer again, NO.

Lets take a step back... What IS an episiotomy? An episiotomy is a “surgical incision” of the perineum and vaginal wall done by an obstetrician during the last part of the second stage of labor (*translation: as the head of your baby is crowning). The purpose of this incision is to create more room for a safe delivery of your baby. Like any surgical incision, episiotomies should be performed under local anesthesia... like the shots the dentist gives to numb your mouth, only its your OB and your perineum.

While there are many reasons to have an episiotomy, not every woman needs one and not every woman will have one. 

It used to be common practice for obstetricians to perform episiotomies routinely because they thought it would help control spontaneous perineal lacerations from extending to the rectum (third and 4th degree lacerations), new evidence has shown that episiotomies should be performed only when deemed absolutely necessary and should be decided by the obstetrician.

In July of 2016, The American College of Obstetricians and Gynecologists (a professional organization that advocates for the highest standards of care, continuing education, and awareness of women’s health care issues) released a practice bulletin that strongly recommends certain prophylactic practices to reduce dramatic lacerations that extend to the rectum and prevent anal sphincter lacerations. These practices include NOT performing episiotomies routinely, applying warm packs to the perineum during pushing, and performing perineal massage in the second stage of labor to reduce 3rd and 4th degree lacerations.

While healthcare is continuously evolving to make childbirth a pleasant experience, and physicians should always strive to administer the highest standard of care, I highly encourage you as a patient, the significant other, or the support person to talk with your obstetrician about episiotomies, their practices, express your concerns, and have an open conversation to create a plan for your delivery.

Big Hugs & Belly rubs. 

references

“WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience.” World Health,              World Health Organization, 2018, www.who.int/reproductivehealth/publications/                            intrapartum-care-guidelines/en/.

“Women's Health Care Physicians.” Ob-Gyns Can Prevent and Manage Obstetric Lacerations                     During Vaginal Delivery, Says New ACOG Practice Bulletin - ACOG, June 2016,                                 www.acog.org/About-ACOG/News-Room/News-Releases/2016/Ob-Gyns-Can-Prevent-                   and-Manage-Obstetric-Lacerations.

Pregnancy & Skin Care

Pregnancy can often throw curve balls when it comes to your skin. You can either have that glowing beautiful blemish free skin ORRR you can have those breakouts that throw you back to your high school years, dark spots/darkening on various parts of your body, eczema flare ups, and/or red blotchy skin.

I was lucky/unlucky to experience all of the above. First trimester of my second pregnancy, I definitely broke out as much as I did when I was 15. I had a linea negra with ONLY my first pregnancy that extended from my navel to my pubic bone. I had an eczema patch on the inner corner of my eyelid that drove me nuts. The increase in blood volume + the mix of progesterone caused this increase in volume to my lips (which was pretty great), my face (not that great), and caused his weird blood vessel to enlarge on my face which is actually still there 4 years later (not great at all).

So, what is a girl to do when pregnancy gives you lemons?... you ask a legit source for some advice on how to make some strong, non-alcoholic, lemonade. 

I reached out to my friend, Jenn Rawson PA-C, who works in an obstetrics office affiliated with Hoag Hospital, and asked if she could lend some professional advice about skincare & pregnancy for all my radiant mama-friends, and she did NOT dissapoint!

The thing to remember is, while it can be unpleasant, it’s actually normal.

There are many things that you can do for your skin, but the thing to remember when it comes to pregnancy and skin care is that most of these changes are hormone related and it is important to be aware of ingredients in the products you use, and check with your provider if there is any question.

When it comes to breakouts, Jenn explains, “the majority of acne is hormonal and doesn’t always respond to over the counter treatments, however there are pregnancy sage acne medications. Benzoyl peroxide wash, salicylic acid face wash (max 2%) and prescription azelaic acid.Pregnancy safe facials are allowed in the second trimester, however, I always advise to get it done by a licensed esthetician since they are more knowledgeable about pregnancy safe products.”

In addressing eczema flare ups, Jenn says that it is common, and that over the counter hydrocortisone is safe in pregnancy and for severe flares, a moderate level steroid under the supervision of a dermatologist usually for no more than a week is okay if necessary.

I mentioned earlier that dark spots are common during pregnancy due to hormones, and can be on various parts of your body. That includes dark spots on your face, upper lip, Melasma aka the pregnancy mask, darkened nipples, a darkened line that extends down your abdomen, and sometimes darkened labia. While there is not much you can do about Melasma, linea negra, and darkening of your “lady parts”, Jenn recommends to be proactive about decreasing facial spots by wearing wide brim hats and SPF 50 while in the sun.

With that being said, its also important to completely AVOID the use of retinol and hydroquinone. Hydroquinone is actually a category C medication, which means it is extremely harmful to your baby. These ingredients can be found in many “lightening” products, and one of the main ones Jenn counsels about is the very popular R+F’s REVERSE line.

Other things to avoid while pregnant are injectable blocks and fillers- although the increase in blood supply and progesterone should take care of all that plumping, laser treatments, and eyelash treatments. One of the main reasons for this is because there are currently not enough studies to deem these treatments as safe for your pregnancy.

Aside from her “secret weapon” aka coconut oil, the BEST thing to do for your skin during pregnancy is to make sure you are eating a clean diet, drinking 1-2 liters of water daily, taking prenatal vitamins, use over the counter face wash and creams, and last, but not least, “SUNSCREEN SUNSCREEN SUNSCREEN”.

Take a deep breath and smile, mama. These things, along with the many other unpleasantries of pregnancy, go away after delivery… you can do this!!

Big hugs & belly rubs from this mama (and Jenn)to you.

 

Jenn Rawson PA-C

Jenn is a momma to two, a physicians assistant with a specialty in obstetrics, and such a wealth of information. She is one of those genuine people who truly cares, works to provide excellent and evidence based care to her patients, and continuously strives to increase her knowledge to better maternity care in her community. Send her lots of love as she embarks on her educational journey for lactation consultation.