Vaginal Exams. Are They Necessary?

 The months leading up to those final few weeks of pregnancy can seem like they are fooooorever. The first few months fly by and then suddenly you are in your final few weeks that just seem to drag by. The emotions are high, you are so excited to meet your baby, and you are probably wondering when you will go into labor. Your provider might bring up checking your cervix for dilation around 36-37 weeks. During this time, your provider will check to see if your cervix has dilated, effaced, and they also can get a better gauge of what station baby is (how high or low baby is in the pelvis). This can be exciting, but it can also be disappointing. Imagine feeling all the contractions and pains towards the end of your pregnancy and you are feeling like possibly there is some changes going on down there. Your provider comes in the room and asks if you want your cervix checked. You get excited and say “Yes!”. All those contractions and pains should have done some changes to your cervix by now, right? The excitement is everything BUT- your provider tells you that you are only 1cm dilated. This is where disappointment can set in. It can be very discouraging to have someone tell you that you are ONLY 1cm dilated or maybe not even dilated at all. That disappointment can also hinder your body’s natural ability to labor. 

What happens if you don’t do anything and deny any cervical checks? Absolutely nothing. Cervical dilation is NOT an indication of when labor will begin. You can be 40 weeks with zero cervical change and go into labor the very next day. OR you can be sitting at 4-5cm dilated for weeks with labor not beginning. There really is no telling when you will go into labor. Cervical checks can also be invasive on yourself and sometimes baby, especially during labor. There really is no need to continuously check the cervix, unless you want it checked of course. 

Basically, wrapping it up, cervical checks are NOT super necessary. They can be declined at any time, even during labor. If you feel like you are unsure of the decision to decline or even consent to a cervical check, talk to your provider, or reach out to a birth professional! And lastly, always remember to be patient with yourself, your body, and your baby. Your body and baby know how and when to be born and I promise the uncomfortable doesn’t last forever! 

Written by: Natalie Story

Fact About Sleep

There is a lot of misinformation circulated by well-meaning friends and sources about infant sleep. Who are you supposed to trust when it comes to getting your baby to rest? There are aunties, experienced parents, blogs, and pediatricians who all have THE tools to get your baby to sleep reliably.

Still, when you try to implement what they say, it ends up being a mish-mash of a little bit of one thing, and some of what you remembered reading, and the all-too-real stuff of what actually worked to get your baby to dreamland.

We love helping families learn strategies to use with their children, and learn how they can best meet their kids where they are at in their sleep journey. One of the most important factors in getting to the roots of their information, and give a foundation of facts. From there, we get to layer your baby's personality, needs, and lifestyle on top of it. Here are some facts about sleep every parent should know

Sleep is essential, and if your baby is overtired, your priority is to get them sleep of any kind.

An overtired baby may not be easily soothed, but getting your baby sleep has to happen before you can use trusted tools to help them going forward. So if going for a walk, using a babywearing device, going for a drive, or holding your baby is the only way you know to get them sleep, we start there.

Having help for this part is usually a game-changer, and a trusted friend, tagging out with a partner, or hiring a postpartum doula is an excellent option for helping you to stem the seemingly endless need for your baby to be attached to you.

Advice from your pediatrician does not always follow safe sleep guidelines - and it can be a problem.

Many pediatricians advise having an elevated sleep surface or using rolled towels or blankets to prop or move your baby into a position that helps them sleep, especially if your baby has any sort of reflux. This is not recommended by the AAP and does not follow safe sleep recommendations.

Having conflicted professionals giving you advice is part of the struggle parents have to navigate. Educating yourself on why those recommendations are offered is as important as getting the information.

Your baby does not sleep the same way you do - so you can't expect them to sleep the way you do.

Your baby is not physically or mentally wired to go to sleep like you are. Your baby has seldom been in the positions we place them to sleep as newborns, and they have sleep reflexes that have helped keep our species alive until they are better able to care for themselves. These reflexes make it hard for babies to have long stretches of sleep.

Learning about your baby's sleep cycles and how your baby's brain works are some ways you can quiet expectations of your wee babe.

Babies show sleepiness in varying stages.

Like there are hunger cues to learn, there are sleep cues you can learn. Both have early, mid, and late signals.

Here are some early, mid, and late cues your baby is tired and ready for sleep:

Early:

Spacing, or gazing for periods of time
Red-rimmed eyes
Jerking head or arm movements

Mid:

Trying to pull or grab their face
Yawning
"Settling sounds" like grunts or squeaks, or long sighs

Late:

Crying
Being hard to soothe
Back is arched, or very tight muscles and rigid body

Sleep begets sleep, and putting off a nap will not make a baby sleep longer or later.

Depending on your child's age, it may seem like all you are doing after they wake up is getting ready for their next nap - and after getting a diaper change, and more food, it very well may be the case! But your baby needs to sleep A LOT, which means their awake times seem to move pretty quickly.

One thing that is not true is that prolonging awake time will make babies sleep "better" or "longer." When sleep is stalled, babies need extra help to calm and be soothed. Their naps most likely will remain the same length because of the way they cycle through sleep, meaning they only get less sleep overall.

The sleep cycles for babies mean they are designed to have more periods where they can be woken up by hunger, wetness, or other basic needs as a survival mechanism. Their ability to "rationalize" through light sleeping times and self soothe back to sleep depends on age, overall weight gain, and having developmental milestones met.

Sleep needs to be evaluated in a 24-hour period, not just overnight.

Some of the confusion about helping babies sleep in longer stretches, is that their daytime routine needs to be considered as well. If your baby is not able to have restorative sleep during the day, it is harder for them to have restorative sleep at night. They may be exerting too much energy and need to have more calories. They may need help to nap with the use of a sound machine or reducing noise or light. Or, It may be early cues are missed, and the window for sleep gets missed until the next cycle for sleep is next available.

How Do Doulas Help Parents Delivering By Cesarean?

Labor doulas are typically hired by people planning to have a vaginal birth. A doula's knowledge of normal physiological birth, the constant support through labor, and the skilled hands-on care are all reasons doulas are growing in popularity.

But what if you suddenly need a surgical birth or are planning a cesarean delivery from the onset? Are labor doulas helpful then?

Yes.

When it becomes necessary to decide to have a non-emergency cesarean, after long hours of hard labor, the flood of emotions is intense and overwhelming for many. The medical team will be focused on getting you prepared physically for unexpected surgery.

Your doula will be focused on your mental and emotional preparedness.

Having all your questions answered, understanding the risks, helping you wade through the options all happen before the choice is made. And once made, your doula can help you to prepare for what will happen next.

• Your doula will outline what you can expect to see, smell, and experience in the operating room.

• Your doula will outline what the next few hours will look like, and when you see her next (if doulas are not allowed in the operating room), and keeping you and your partner tuned into each other while getting ready to meet your baby.

• Your doula can help your partner know how they can support you through surgery if she is not able to attend.

Help During Recovery

After surgery, you are going to need immediate help from both the medical team and support team for the first hours after you deliver. Having a cesarean birth is major abdominal surgery, and nurses will monitor your vital signs and postpartum bleeding.

Usually, in those first hours, parents are eager to have skin-to-skin or start breastfeeding. Families now have time together that may have felt stolen because of the limitations a surgery places on movement and autonomy. All of these activities require more care and attention because of the strain they apply to the new surgical wound on the lower abdomen, and a doula is a skilled set of extra hands and knowledge to help families reconnect.

A doula can help with positioning, answer questions about breastfeeding, and be available to keep baby in a safe position. At the same time, the birthing parent continues to come fully aware after the anesthesia wears off.

Planned Cesarean Delivery

For those people who know they are going to deliver by cesarean, having doula support through pregnancy can offer some unique advantages. Having a doula can lead to better home planning for your post-operative abilities, combined with the needs of your new baby. A doula's experience can help you understand what will and won't be possible after surgery and help you identify any ways you may need to adapt.

It's a complicated world post-surgery of understanding your body's new abilities, caring for your baby, and the intense emotions that come with being a new parent. Having a doula helps make all of the big questions seem smaller, and the unknowns easier to adjust.

Doulas are not only for an unmedicated vaginal birth. Doulas are for any person who wants one-on-one personal support through an experience that can be intense and overwhelming.

The Benefits of Sleep Training

When a family starts thinking about how to get their child to sleep better, it can be for many reasons.

what we see commonly is:

• Overwhelm from the entire adjustment to parenthood, and there has never been a chance to "catch up" from the first weeks

• A family with expectations for how a baby should behave, but little understanding of how babies realistically behave

• Families who have tried to change habits, but their baby "just won't go to sleep." 

Working with a sleep trainer is more than turning off the lights and leaving your child to cry until they are exhausted. We do not support that behavior or advice.

Working with a sleep trainer is taking an assessment of how your family's day is currently structured, in an entire 24-hour period, and making a plan that uniquely fits the needs and philosophy for your family. 

Working with a sleep trainer means being in tune with where your child is at developmentally and emotionally, and seeing what their current behavior says about their night parenting needs. 

Working with a sleep trainer means readjusting expectations to be in line with what is possible for your baby, and what will be possible as time progresses. And sometimes, it means adjusting daytime behavior along with the nighttime routine. 

Here are a few things every parent should expect from a reputable sleep trainer 

1. Your sleep trainer should be able to describe the sleep needs of your baby regardless of when you are asking for help. The way a newborn sleeps is different than the way a five-month-old sleeps. There is no one-size-fits-all plan, and a sleep trainer will ask thoughtful questions that help outline a full picture of what is going on with your child. 
   

2. Your sleep trainer should be able to tell you what the plan will be before getting started with changing rituals and habits and help you understand why some small adjustments may make a huge difference. 
   

3. Your sleep trainer should be able to help your family determine when the right bedtime is for your baby. Is it 6 pm, 7 pm, 9 pm? Each family has a different rhythm, and babies are susceptible to the energy in the house. 
   

4. Your sleep trainer should be able to make a reasonable impact after the first visit, but also help you understand that your baby is not a robot, and sleep training isn't about making your child do something they don't want to do. Sleep training is about helping your child learn how to find security in ways they don't yet identify and feel safe sleeping in their space. 
   

5. You should not feel like your sleep trainer is making you do things that feel unsafe or neglectful. If at any point, you need to be with your child, your sleep trainer should support that and reiterate the ways everyone can feel comfortable with the plan. 
   

Sleep training is a profession that gets a nasty reputation. We know. We've heard it. We want to share that babies who have been able to learn safe self-soothing techniques are well attached, and have all their physical, emotional, and mental needs met.

When you work with sleep trainer with a wholistic family sleep plan in mind you can expect:

• Sleep! 

• Less anxiety about the health and well-being of their child

• Happier kids and parents

• Tools to understand how your child communicates

• Less guilt 

We want families to have the help and support they need, be it with extra hands-on care from skilled doulas, or with additional education and support of sleep coaching. Caring for an entire family means having everyone's needs met, and we're here to help make that happen. 

Are You Scared To Give Your Baby A Pacifier?

Soothies, binkie, paci...whatever you call it in your family, pacifiers have been used for generations.

Before polymers were used from the discovery of rubber trees, cultures around the world used things like beads made of wood, or other things like ivory, mother-of-pearl, bone, or coral, were used on the opposite end of a rattle, or the "gum stick" to help soothe a baby.

Modern pacifiers in the United States undergo an immense amount of regulation. Early models proved two-piece pacifiers and hard plastic pacifiers posed too much risk and required oversight. Today, the worry isn't so much in the material that is used, but IF pacifiers should be used! Concerns like "nipple confusion" or of orthodontic damage done if they are used too long into adolescence.

The concern about “nipple confusion” stems from trouble breast- and chest-feeding families may have if a pacifier is introduced too soon after birth. The thought is that a baby will be soothed by sucking and waive their natural cues to eat.

The other concern is that a baby will become used to sucking on the pacifier, and "forget" how to feed from the breast, making it harder for families to sustain that form of nutrition. We want to dispel the notion of "nipple confusion" for all those families who feel afraid to introduce a pacifier or bottle for fear of sabotaging a breastfeeding relationship.

Your baby is smart. Your baby is not confused!

Your baby understands that eating from a bottle is easier than latching and suckling. It isn't nipple confusion - it's nipple preference! So let's celebrate your smart baby! And we can support their need to suckle, and your desire to feed at the breast. Both can happen! To counter the smooth flow of milk from a bottle, we suggest you introduce Paced Bottle-Feeding.

If you want to use a pacifier, we recommend using it only when you know the pacifier is not delaying a feed. The need to suck is a real comfort, and some babies need to suck more than others. Pacifiers are a great way to help those babies find comfort in between feedings.

As for the type of pacifier to use, you may be feeling overwhelmed with the options!

Some brands you may consider:

• Natural rubber pacifier: natursutten

• Soothie Pacifier: One piece and easy to find in stores

• Soothie Pacifier: With detachable, and easy to clean toy

• Best for newborns: Mam Brand

One last note on pacifier use and when to introduce them:

Just like breastfeeding is a skill that your baby has to develop, learning how to suckle a pacifier and have the ability to hold it in one’s mouth is a skill that has to be developed! Many families wait to introduce a pacifier for fear it can damage a breastfeeding relationship, and inadvertently miss the window of opportunity to introduce its use.

So! We recommend introducing pacifiers (and bottles if you plan to use them AT ANY TIME in your feeding plan) between 6-10 weeks of age. They don’t have to be used all the time, but without at least some sporadic use, you will never get the benefits of these tools.

What Should You Bring To Your Hospital Birth?

There are so many ways to pack for your hospital birth.

Do you like to have options?
Do you feel best being prepared for any possible need?
Do you need fewer options, so you feel less overwhelmed?

Only you know how you operate best in stressful situations. 

Your hospital bag can serve so many other functions, too, besides holding all your stuff!
Is planning your bag something that helps you relax in the days leading up to labor? Does it make you happy to put it together? Do you like a challenge to start with ALL the things and then whittle it down to what will fit in your ideal case?

OR

Do you see birth as a short overnight trip away from home and pack economically?

Packing your hospital bag can be a “labor project” or something that helps you take your mind off some of the stress the end of pregnancy can place on you.

Here is the part where we reassure you and offer the reminder that people often have babies at inopportune times. And the hospital has things to help everyone - not just people with their overnight bag. Things like toothpaste and toothbrushes, towels and wash rags, and those lovely hospital gowns to keep your clothes as fresh as possible. 

But let's hope you won't need to walk into a hospital off the street, and you'll have time to go to the hospital in the way and manner of your dreams. With that as the plan, what would you bring? 

The items below are listed as a building set. Based on our experiences, we have seen families use the following items and appreciate their being with them from "Essential" to "All The Things." Have fun reading through, and if you think of something that would be perfect for you and it isn't here - pack that too!

What To Pack For Your Hospital Birth

Essential:

• Wallet: medical card, ID, Debit or Credit card

• Cell phone & charger

• 2 Shirts

• 2 Pants with elastic waist

• Slip-on shoes

• Dop Kit: toothbrush & toothpaste, chapstick, any medication & glasses

• Carseat

Added comfort: 

• Robe

• Slippers

• Book/magazine

• 2 Nursing bras

• Dop Kit: lotion, facial cleansing cloths, brush, hairbands, shampoo & conditioner

• Hand fan

• Water bottle

• Snacks

• Headphones

• Baby: going home outfit, muslin blanket

• Underwear for going home

A bit more for the unknown:

• A printed copy of your birth plan

• Pillow

• Preferred nipple cream

• Breast pads

• Tissues

• Extra outfit for baby

• Essential oils

• Belly Band

• Hand cream

• Battery-powered fan

• Towel

• Bluetooth speaker

• Flipflops

Details for all the things you want: 

• Any tools you imagine for pain management: birth ball & pump, tennis balls and/or massage tools

• TENS Unit

• Rebozo or woven scarf

• Heating pad

• Meditations and/or affirmations

• Eye mask & earplugs

• Props/outfit for newborn photos