Pregnancy - Getting Siblings Ready for the New Baby

Posted by Carri

It is almost time for this little one to join the family! Unfortunately, my children have been waiting and waiting and waiting for this baby for so long - they kind of think it is not really going to happen. So to help them feel like a part of this event, and that something really is going to happen, we went to Build A Bear. We have done this for all of the boys. We take the big brother(s) to Build A Bear where they get to pick out a bear and put a heart in it and of course have it stuffed. This is the gift the boys will give the baby when it is born - and likewise the baby will have gifts for them too. My youngest will get a newborn cabbage patch kid - so he has a baby to take care of too. The other two will get gifts that they will enjoy and will keep them occupied every so often.

As another way to wake them up to the fact that this baby really will be joining our family, I put the car seat in the car. I put it where the youngest currently sits and put a stuffed animal in the seat to make it more fun for them. Overall, I think it will be a joyous celebration when this little one arrives - but adding fun things, and remembering that kids liked to be included to the mix, only makes it better.

Doula Digest - What to pack in your Birth Bag

Posted by Kim:

What should I pack in my Birth Bag?


Preparing for the birth of your child is one of the most exciting times for every mother, but what do you really need to bring with you? With my experience as a doula and mother of three, along with many experienced moms' opinions, we have the most comprehensive list along with many great tricks and inside tips. We hope this not only prepares you, but also educates and empowers you to create the best birth possible for you!

Labor Soothing Tools:
Massage Oil - not only does massage feel good, it also helps the body relax. If you like scents, massage oils are the best way to experience aromatherapy during your birth. But be aware, just because it smells good to you now, you may not enjoy the smell while you are actually in labor.

Massage Ball - using a massage ball creates pressure like a hand, but without the effort or stress on the massager. You will us it FOREVER!

Spikey Ball - rubbing a spiked ball between your hands (or on your feet) during contractions will relieve pain. The tactile stimulation focuses your pain receptors away from your contractions.

Barley Pack - wonderful to heat in the microwave or cool in the refrigerator to relieve sore spots (especially the neck and lower back).

Moist Heat Heating Pad - cordless microwaveable heating pad can soothe back aching. Be sure it is moist heat though!

Personal Items

Birth Outfit - don't be frustrated and intimidated by the hospital gown and environment. We at BINSI feel that you deserve the most practical and functional outfit possible on your big day. Check out our complete line of labor and birth apparel!

Robe - a soft, warm and comfortable robe will make a huge difference.

Slippers - slippers that slide on, are soft and cushioning and have a tread bottom are important. You want to be able to get in and out of them quickly and easily, all while feeling cozy and warm.

Personal Pillow - bringing your own pillow can be important, it is nice to have something soft and comfortable (not plastic) to rest your head on. Make sure you use a colorful cover, so it isn't mistaken for a hospital pillow. One mom even told us she brought a pillow with a red pillowcase to use as a backdrop for her pictures. Hey, its ok to want to look as good as you can!! You deserve it!

Music - bring all the genres of music you like. You may be surprised what you're in the mood for or need during your labor.

Flash Light or Night Light - turn off those horrible overhead lights (especially while you're in the bath) and relax with soft lighting instead of the harsh overhead lights.

Chap stick - the effort you exert, not to mention the breathing techniques you might use, will surely dry your lips.

Ponytail Holders - obviously very important during one of the most physically taxing events of your life. No one wants their hair in their face.

Sour Candy - labor can often create nausea. Having sour candy can help alleviate these symptoms.
Doula– be supported, encouraged and understood during your labor. A doula provides physical and emotional assistance for both you and your partner.

Baby Powder– labor can make you hot and sweaty. Baby powder can be an easy solution to helping you feel dry and fresh.

Bath Pillow – if you are able to labor in the tub, it is nice to have something soft to cradle your head as you relax.

Prenatal Vitamins – the amount of energy you exert during labor and birth is enormous. Remember to give yourself and your baby the best start by staying healthy and nourished.

Toiletries – all the basics (toothbrush, toothpaste, deodorant, shampoo and conditioner, hairdryer, makeup, etc.)

For Birth Partners:

Change of clothes –

Comfortable Shoes –

Toiletries –

Food – bring lots of non-fragrant snacks, granola bars and protein bars are great. Even though she won’t be able to eat, you need to stay nourished and in top shape to be there for her as best you can.

Video and/or Still Camera –

Phone List –

Cell Phone (and charger) – preload your friends’ and families’ email addresses into your phone so you can send pictures right from your phone.

Laptop Computer -

Books and Movies – for big brother’s or big sister’s visit.

Medicine – even though you’re in a hospital, if you get sick they won’t give you anything. Make sure to pack a pain reliever and upset stomach medicine – just in case.

Swimsuit – you may want to join her in the tub – which we highly recommend.

Pillow – pillows can be scarce in a hospital, and you’re the last in the line. Make sure you’re comfortable and bring your own.

For after the birth and the trip home:

Maternity Clothes – even though you are no longer pregnant you will most likely not fit into your pre-pregnancy clothes.

Nursing Bra -

Book and/or magazines -

Baby outfits – your baby does not have to only wear a diaper or t-shirt while in the hospital. Bring some outfits for your little one for your stay in the hospital and for the ride home.

Baby Blanket – a soft, cozy blanket helps everyone to feel more relaxed and ready to brave the new world.

The Late Preterm Infant & Getting to Know Your Baby

Posted by Kim:

I am the Coordinator of a non-profit group called Exceptional Families and we provide parent to parent support to families who have children with special needs. Part of my responsibility as the Coordinator is to attend the Boulder County Health Department's monthly cross-disciplinary meeting for children birth to 3 years old. This month we had a therapist from the Tiny Tim Center present the following information to us. It is shocking and eye opening considering our current birth environment and the prevalence of preterm induction and cesarean birth.

I am making no judgments here because I am all the things that I would now preach against (unfortunately I have learned more about birth since my children were born). My first son was an induced preterm labor due to fetal distress. While there was nothing I could do about this induction the statistics below are still frightening to me and make me cringe that I never once doubted my doctor or sought a second opinion. This being said, I do believe we did right by Connor inducing his birth and providing him with a better chance of survival outside the womb (I will post Connor's birth story soon). Griffin however is a different story. His induction was the typical convenience birth at 40 weeks. It has taken me several years to process his birth and I will always regret the induction (birth story also to follow).

Please read over the following information and consider it carefully. Share it with friends, family and clients. While it is particularly focused on late preterm births (and sometimes this can not be avoided), I think the "Get To Know Your Baby" section can also be applied to full term children in some situations. Every baby is different, but if you can read their signals you can better respond to their needs.

Children need their 40 weeks!

The late preterm infant is:

• born 34 - 37 weeks
• 75% of all preterm births are in this category
• Many are from induced deliveries or C-sections
• Studies have shown an increase in morbidity rate, as well as long term outcomes showing developmental delays, special education for pre-k and behavior problems that persisted to 8 years of more.

Brain Development

• At 34 weeks the brain has fewer sulci
• During the last 4 weeks of gestation there is an increase in the development of axons, dendrites, synapses etc
• The is the most active phase of synaptogensis (40,000 new synapses per second)
• At 34 weeks the brain only weighs 65% of term brain weight
• Frontal lobes are last to develop
• Late preterm babies are more vulnerable for bilirubin induced brain injury and neurological injuries

Medical Issues for Late Preterm Infants

Respiratory Control

• 33-38 weeks there are changes in lung compliance, they are still developing how to
• breathe, they may have apnea and bradycardia
• Increase incidences of SIDS

Thermoregulation

• Less body weight, decreased ability to regulate body temperature

Infection

Jaundice

Motor Challenges

• Mild hypotonia, decreased stamina & endurance
• Difficult feedings secondary to tone issues
• May hear respiratory sounds due to decreased muscle activity in intercostals and upper airway
  

What we might see

State Organizational Challenges

• Decreased arousal and alertness (can affect attachment between baby and parents)
• Sensitivity to environment (light, noise, activity) therefore may have problems getting to deep and active sleep (brain development occurs when in active REM sleep)

Feeding Issues

• Less effective suck and swallow
• Breastfeeding may be difficult because they are sleepier, have difficulty stabilizing their temperatures and they are unable to coordinate suck/swallow/breathe

Interventions

• Education and support for parents
• Scheduling babies activities for when they are in arousal states
• Kangaroo mother care (skin to skin)
• Infant Massage
• Knowing awake/sleep states and stressor signs that baby is communicating to you
• Using environmental modifications keep lights, noise and activity down preserve active REM sleep

GETTING TO KNOW YOUR BABY

Organized Physiological Behaviors

• Skin is pink and stable throughout
• Breathing is regular and smooth
• Gastrointestinal is stable and there are regular elimination patterns

Disorganized Physiological Behaviors

• Cough, breathing intervals are variable (too fast or too slow)
• Gasp, Startle, Twitch, Sneeze, Tremor

Organized Motor Behaviors

• Tone is balanced
• Posture is flexed and relaxed
• Movements are smooth and close to the body

Disorganized Motor Behaviors

• Tone is hypertonic or hypotonic
• Posture: arms salute, sitting on air, toe or finger splay, fisting, high arm position
• Movements: squirm, jerky, gape face, tongue extension, arching

Organized State Behaviors

• Awake States are calm alert, alert and focused, and may be fussy and crying
• Sleep States are deep sleep, active sleep and drowsy sleep

Disorganized State Behaviors

• Hypoalert, hyperalert, gaze averting, uncontrollable fussing and crying, upward gaze, staring, grimace

Behaviors that help baby become organized/Helpful self regulation behaviors

• Hands to mouth/face
• Hand & Foot clasping
• Leg/foot bracing
• Sucking and suck search
• Tucking
• Grasping and holding
• Looking and attending

Ways to promote Baby's Development at Home

• Light reduction
• Noise reduction
• Positioning
• Comforting
• Look for signs of stressors indicating need for a rest
  

To see this complete presentation please visit
http://www.uchsc.edu/cfii/Documents/Getting%20to%20Know%20Your%20Baby.pdf

Birth Story - Elaine & Greg's Birth

Posted by Kim:

I was lucky enough to be hired as the doula for another wonderful couple and I was honored to be present at the birth of little baby boy Nikolai! It was an amazing experience and has made me even more passionate about being a doula! To be honest it was only the second completely natural birth I have ever seen, the birth of Carri's third son being the first.

It was interesting because Elaine had a few instances of stalled labor as my previous client did. On Monday evening Greg called me to let me know that Elaine had stopped in to see her doctor that afternoon and she was dilated to almost 4 cm and 100% effaced. The doctor said she could check into the hospital then if she wanted to, but they chose to head home and relax to prepare there instead. This was great news seeing as though Elaine mentioned that she had not really had any major contractions, just what felt like some annoying menstrual cramps. Remembering what a marathon Gina's birth was I began to mentally prepare myself for labor and went to bed early anticipating a call from them that night (again, silly new doula). No calls. I ask them to stay in close touch just so I would know how they were feeling. So we talked Tuesday morning and everything was back to normal.

On Tuesday they ended up coming into the hospital again because they were concerned that they really hadn't felt the baby move at all that day. Luckily the nurses monitored the baby and everything was fine. So they went home and Elaine rested, ate and prepared for pending labor.

Around 12:15am on Thursday morning Greg called me again and said that Elaine's contractions were coming on very regular and they were going to head into the hospital and wanted me to meet them there around 1am. So I jumped out of bed, hit the shower (I had some hot water this time) and was in Boulder by 1am. It was a very interesting drive however because the Old Stage fire was raging and literaly lit up the entire sky. I had never been so close to a brush fire like that and actually felt a little guilty that we have had such a dry winter, I guess I better hope for some snow (hard for me to do). In addition to the fire there was also a major accident on the Diagonal Hwy and as I approached I just kept praying that it was not Greg and Elaine, luckily they took 287.

When I reached Elaine's room Greg told me that their contractions were very intense at home, in the car, up the elevator, but as soon as she got into the hospital room they literally ended. Elaine placed the intensity of the contractions at only a 2 on a scale of 10. In addition to the lack kof contractions she also had an elevated temperature so the doctor wanted to monitor Elaine closely and she received an IV of fluids as they were thinking the elevated temperature was possibly due to dehydration. This was hard for Elaine to accept because she felt like she had been drinking tons of water, but as she received the fluid her temperature did go down. Just prior to going into the hospital Elaine had been taking a hot bath so I asked the nurse if that could have effected her body temperature and she said it wouldn't really have effected her overall body temperature, and especially for this length of time. Good to know. So I headed home around 4am and Greg and Elaine were released shortly after. I called Carri later that morning to talk with her about what was going on and her thoughts about the stalled labor again and she said that the contractions Elaine was experiencing could actually have been caused by the dehydration. Again, good to know I will keep that in my knowledge bank.

But the real fun was just about to start because Friday morning around 4:30am Greg called and said that they had been laboring since about 9:00pm Thursday night and they were ready to have me come over. Remembering Gina's labor I didn't freak out, I took a quick shower, gathered my doula bag and personal items and headed out ready for a long day (again, silly new doula). When I arrived at the house Elaine's car was running in the driveway so I figured we would soon be heading to the hospital. Elaine was in her bed and Greg was being an amazing coach. While I could tell the contractions were intense for Elaine she seemed to be handling then amazing. SHe breathed through them as Greg was reminding her to take deep belly breaths and I tried to help her relaxed her hands and face. It was interesting because Greg told me that she was also experiencing significant discomfort in her back but when I tried to apply the same massage and pain relief that I used on Gina this was of no comfort to Elaine. Again, I had to remind myself that this was a completely different person so what works on one may not work on the other. Greg and I began talking about when to go to the hospital and seeing as though she had been laboring for quite a while and the intensity of the contractions were so strong we decided that it was time to go. However, getting Elaine to the car was my biggest fear because she was obviously feeling so much intensity and handling them seemingly so well in the bed that I hated to move her, get her to the hospital and have the contractions slow, but I knew we had to go. So step by step and in between each contraction we headed to the car we eventually reached the Boulder Foothills Hospital around 6:15am.

Greg said that one of his funniest memories of this experience was our trip from the car into the hospital. He had gotten a wheelchair for Elaine and I had made myself in charge of carrying all of our gear. So he said as we were walking down the hall he looked over at me and couldn't help but laugh because all he saw was me carrying 18 bags and a pillow. I told him not to worry that it was my job to take care of the things that he should not occupy his mind with. He should be worrying only about Elaine. So we then named me the Doula Sherpa! : D

When we got to our room Elaine settled in bed and the intensity remained and I think we were all thankful for that. The nurse was wonderful and asked Elaine if she would like to get up and walk, take a bath or try some different positions. She said as soon as she checks her she could do whatever she wanted. Much to all of our surprise, when the nurse checked Elaine she was 10cm dilated and the nurse said she would be able to push whenever soon. The only thing standing in the way of her and the baby was the bulging bag of water. Because Elaine had been experiencing a lot of discomfort in her back I suggested she get on her knees and lean on the birth ball. I told her that this would relieve some of the discomfort and would also be a great position to start pushing once her water broke. It seemed to help for while, but the doctor came in and we all discussed if she should break the bag of water for Elaine or if she should wait for it to happen naturally. It was decided that the doctor would break the water so Elaine could start the pushing phase of labor. By 7:00am her bag of water was broken and the urge to push was rushing over her and by 8:05am little baby Nikolai was born. Elaine was a wonderful pusher and having the nurse use her fingers to help Elaine feel where to push really seemed to help! It was beautiful and amazing, again I felt blessed to be there.

After Nikolai was born the placenta would not expel itself naturally, even after several minutes of nursing (Nikolai was a natural). So they finally decided Elaine needed to receive some pitocin to encourage the placenta to come out. Unfortunately when it did there were pieces of the placenta left behind and the doctor tried a manual extraction to remove the remaining pieces before Elaine bled too much. This however was ineffective and Elaine eventually had to have a spinal epidural and a D & C. Not the ending we anticipated after a healthy pregnancy and beautiful natural childbirth, but medically necessary.

This was another learning experience for me (although I can't think of a birth that won't be a learning experience). I was impressed with the nurses and doctor at Boulder Community Hospital and I was thankful we were there, but I was most impressed and awed by how Elaine breathed through her contractions and how great a coach Greg was. This may sound a little corny, but I could truly see how deep their love is for one another and what an amazing family Nikolai was being born into. It was truly a blessings. Elaine's recover has been more difficult than we would have hoped, but ultimately the most important thing is that there is a very healthy baby and a healthy recovering Mom and ecstatic Dad!

Birth Story - Kim's First Birth as a Doula!

Posted by Kim:

Well bringing in the new year was VERY exciting this year. I was not with my family when the clock struck twelve, instead I was helping a family be born! Since Friday night I had been in touch with Gina and Steve as their contractions began. The first call from Steve was received on Friday night at 10:30pm just as my husband Paul and I were sitting down to see the new 007 movie! Things were pretty much under control at that time, however I expected to hear from them later that night, but no news (silly new doula). Saturday morning I called at 9am to see how things were going and Gina's contractions had slowed throughout the night, but things kicked in again a little early Saturday morning, but were light. On Sunday morning I heard from Gina and Steve again and contractions started early and they wanted me to come over. I headed over around 9am (after picking up a heating pad) and worked with Gina as her contractions remained 5 minutes apart. Unfortunately they started to fade again so we walked the stairs, I encourage them to be together and kiss, we took a walk together, but nothing seemed to help. So after a while I went home and Gina enjoyed her mother and sister's company for the rest of the day.

On Monday Steve and Gina went to see their doctor and found out that she was 3cm dilated and 80% effaced. Good news that her contractions were actually doing something for her.

On Tuesday morning around 4:15 am Steve called again and asked if I would be willing to come over and help Gina as her contractions were back, but Steve was going to go into work. When I arrived Gina was laboring hard and we worked through the contractions. She sat on the fit ball and once the sun came up we went for a walk. Today however she wasn't able to walk through the contractions as on Sunday. We had to stop, I rubbed her back and she was cool and calm through each one. I was so impressed with how she was able to close her eyes, go into herself as each wave passed through her. Steve returned home from work around 10am, just as Gina's contractions were slowing in time and intensity AGAIN. Poor thing, how many days of labor can one person take? So I suggested she rest as much as possible and call me if she needs me. So once again I headed home expecting to hear from them again soon.

And I did..... It wasn't as soon as I thought, but after a fun evening of taking the boys Dave and Busters, Steve called me around 12:15 am Wednesday morning and said that Gina had been laboring and the intensity of the contractions seems like it had changed. After getting up and getting dressed (couldn't shower because the pilot on the hot water heater was out NICE...) I headed over to their house once again. I arrived around 1am and Steve immediately went to bed to rest. Gina and I spent some time together talked through the waves of contractions and I spent a lot of time rubbing her back, this seemed to be a continuous ache for her. While trying to remain completely confident and in control for Gina, on the inside I was worried that she could be progressing and we were close to birth and I didn't want to catch a baby. Gina kept asking me when we should go to the hospital and I reassured her that we could go any time, and we should especially go when she no longer instinctively felt safe at home. So around 3am and after a call to the hospital confirming that we could come home after being checked if we chose to, we decided to head out.

We arrived at the hospital about 20 minutes later and by 4am they checked Gina and confirmed that she had progressed to 5 cm and was about 100% effaced. This was good news so we decided to stay. Gina continued to labor and we all hoped that the contractions were making her progress, but again by 10am ish her contractions started to slow and become less intense. After talking with the doctor (she wanted to start pitocin right away) Gina and Steve agreed that we would wait until noon and see if she has progressed. At noon they checked her and she was only 6cm. So the doctor broke her water and this definitely brought on active labor. Gina continued to labor and was my hero because she was really handling it well considering the new level of intensity.

Around 6pm Gina decided to have another check and she was only 7cm. This was very discouraging for Gina and frankly after 5 days of labor she was really starting to get exhausted. So she and Steve decided it was time to consider the epidural. We all hoped the epidural would help her relax enough to dilate quicker. Once the epidural was placed there was instant relief and Gina felt much better and could even get a little rest. Unfortunately it did not help her dilate faster however. At 9pm she was 8cm, 11pm 9cm, 1am 9 1/2cm and by 1:40am she was fully dilated and ready to push. This was an exciting moment, but I tried not to get too excited because I knew from experience that there was still a lot of work to be done. I just didn't know how true this was, because it wasn't for 5 more hours before little baby girl Jordyn joined the world at 9 lbs 1 oz and 22 inches. As always it was amazing wonderful and euphoric. Looking at Gina's face it was like the last 28 hours (or 6 days for that matter) hadn't even happened! What a honor to be there. I can't wait for my next birth! I learned so much and it even allowed me to let go of some of the figurative pain I have been going through since Griffin's birth. Its like anything with parenting, you just can't make plans or if you do they have to be written in pencil because they are sure to change!