Birth Boot Camp® Natural Childbirth Education Classes – Online and Instructor-

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April 2013

4 Simple Ways to Prepare for Natural Birth

Congratulations on your pregnancy!  Many women desire a natural birth but preparing for one can seem overwhelming.  Here are some wonderful tips for preparing yourself for the best natural birth possible.  There is so much you can do to ready yourself and your family for birth.  With these four simple things: education, nutrition, birth place, and birth team, you will be more able to make your goal a reality.  

#1-Education-  Probably the most important step in preparing for natural birth is to educate yourself as much as possible.  Just as with breastfeeding, the more you know about the benefits of natural birth for you and your baby, the more motivated you will be to follow through and prepare accordingly.

Of course there is a plethora of information out there on birth.  How do you trudge through it and find the diamonds among the coal?  First, a comprehensive childbirth education program is a must.  Look for one that is longer rather than shorter.  A weekend “crash course” cannot possibly give you all the information that you need to navigate policies, stay low risk and prepare properly for the birth you want. 

Look for natural childbirth classes that cover staying low risk, nutrition and exercise, relaxation techniques, choosing a care provider and birth place, the stages of labor, preparing your partner, common policies and procedures, breastfeeding and newborn care, and possible complications and how to avoid them. 

Not only will a good birth class help prepare you, it should prepare your partner as well.  In all honesty, your partner’s preparation is tantamount.  If they are frightened or simply unaware of normality, it will inevitably impact the birth negatively. 

In addition to preparing your partner, your natural birth instructor will be able to guide you to find the best books, websites, even care providers and doulas in your area.  Think of a childbirth instructor as somebody on the “inside.”  They have been there and done that and now they can help you accomplish the same thing.  (Our instructors are well trained women who have had natural births, themselves.  You can see a list of their requirements here.)

#2-Nutrition-  As you will quickly learn, preparing your body for a natural birth is just as important as preparing your mind.  Your body will go through some drastic changes as it grows first a placenta, then a baby, adds fluid, almost doubles its blood volume and prepares for future breastfeeding. 

Eating properly means not just avoiding refined foods such as sugars, white flours, packaged foods and chemical sweeteners, it also means adding the right foods into your diet.  Daily nutrition should include several servings of greens (broccoli, spinach, kale, asparagus, etc), citrus foods (oranges, tomatoes, kiwis, bell peppers), vegetables and fruits (celery, cucumbers, bananas and apples), whole grains (spelt, quinoa, oatmeal), eggs, complete protein sources (meats or other combined proteins such as beans and rice) and dairy (milk, Greek yogurt, keifer). 

Women are amazed at how much better they feel when eating properly during pregnancy. Many common pregnancy ailments disappear. Great nutrition and adequate protein can even help eliminate morning sickness.  Your childbirth instructor can provide you with a complete system to chart your nutritional intake and make corrections, if needed.  You can also find many phone apps with which you can keep track of your daily nutrition throughout pregnancy. 

Great nutrition will help your body and your baby be ready for a natural birth.  Many care providers believe that common ailments that surface at the end of pregnancy and often lead to induction or C-section can actually be avoided with optimal nutrition.

#3-Choose Your Birth Place Carefully-   One of the most important choices, as you prepare for a natural birth, is your choice of birth place.  Many factors play into this decision from insurance coverage to proximity.  Women often have three main choices available to them when it comes to birth place:  hospital, birth center or home.  The birth place that works best for you and your family will be influenced by many things, from cost to your own health to where you feel most emotionally comfortable. 

Wherever you choose to birth, be sure that the policies are not so prohibitive that they make natural birth nearly impossible.  Some important policies to look for are:

  • Women are encouraged to eat and drink in early labor.
  • Vaginal exams are kept to a minimum.
  • Women are encouraged to move about in labor.
  • IV’s are only given when necessary.
  • Breastfeeding is supported.
  • They have a low C-section rate. 

In a birth center, you may want a hospital nearby in case of transfer and an environment in which you feel comfortable and supported.  If choosing a home birth (as with any other birth place), you will want to carefully choose your midwife. Look specifically for someone with experience, skills or certification that you feel comfortable with. 

While it may be tempting to choose a birth place simply because it is close, doing things because they seem “easy” is an often regretted decision for birthing women.  A nearby hospital with a sky high induction and C-section rate will greatly increase your chances for the same.  In the case of an unwanted and/or unneeded cesarean section, a shorter drive for a birth place can yield a much longer recovery.  Choose your birth place carefully. 

#4-Choose Your Team Well-  You won’t win the Super Bowl with a football team made up of expert karaoke singers and you won’t get a natural birth with a team of care providers who specialize in surgical birth.  Choosing your birth team carefully is one of the best ways to ensure you get a natural birth.  Sometimes, even when a mother is knowledgeable and physically prepared, things can fall apart for her in labor if her team doesn’t support her decisions. 

So how do you find this pro-natural birth team of supporters?  Asking your childbirth instructor is a great way to start.  As a woman experienced in birth and engaged in the local birth community, she should have a list of resources to provide you with. 

There are many people who will make up your birth team. All of these people will influence your birth experience.

A great doula (a woman trained to support a birthing mother) can be a fabulous resource for both the laboring woman and her partner.  She can provide emotional and physical support, an experts view on supportive care providers, and may act as a sounding board for advice. 

Another good person to have on your team is a Webster Certified chiropractor.  Chiropractic care during pregnancy (and even birth) can help ensure the pelvis is well aligned so that it can move for a faster and more comfortable birthing experience with a better positioned baby.  This alone can help avoid many problems that prevent natural birth. 

Probably most important of all is your choice of care provider.  Your doctor or midwife will make decisions when you can’t and will be there for the final moments of birth.  It is vitally important that this person be both trustworthy and skilled.  If you are a low risk woman, you may want to consider midwifery care.  Midwives often work in hospitals (thought many can be found working in a home birth or birth center environment) and their approach to birth tends to be more supportive of  natural choices. 

You CAN Have an Amazing Birth!  Choosing a natural birth is a wonderful decision. With the right choices and preparation, we believe that most women can achieve this goal.  (Check out our stats from our students!)  Proper education, excellent nutrition, and careful choice of your birth team and your birth place are all things that can make your choice of a natural birth more attainable.  When all is said and done, sometimes things don’t go exactly as planned.  But, when we have done our best and chosen a care provider that we trust, we can rest assured that we did everything possible to accomplish our goal.

I’m pregnant! What’s happening here?

Photo credit: super-structure / Foter.com / CC BY-NC-SA

What Should I Expect During the First Trimester of Pregnancy?

You are pregnant!  Congratulations!

Now you might be wondering, what happens next?  If this is your first baby then you are in for some wonderful and amazing changes as your body starts to grow a new human being.  Every moment might not be wonderful, but every change does inspire wonder.

Here is a list of some of the many changes that take place in your body during the first trimester of pregnancy.  The symptoms you experience will vary, since every woman and every pregnancy are different. Consult your care provider with any questions you may have.

Nausea or Morning Sickness-

Morning sickness is probably the most talked about pregnancy symptom of all.  For many women there are symptoms of nausea that start somewhere around five or six weeks into pregnancy.  The length of time this lasts varies, from a few weeks to the entire pregnancy.  Typically, nausea subsides after the first trimester, or around 12 weeks gestation.  While it is called “morning sickness”, this pregnancy nausea can last all day, but is often worse in the morning or after going without food for a long stretch.  For some women, they will experience no nausea whatsoever.

Morning sickness is thought to be caused by changing hormones and the slowing down of digestion that often occurs during pregnancy.  Various things can help control pregnancy nausea so that it isn’t overwhelming.  Eating protein rich foods frequently throughout the day is often the most helpful thing that can be done.  Trying to consume about 80 grams of protein each day may provide relief, and starting each morning with a protein rich breakfast (eggs, oatmeal with fruit and nuts) can start the day off right and curb nausea.

Ginger is well known for it’s ability to help with nausea and can usually be safely consumed during pregnancy.

Breast tenderness-

While not as talked about as nausea, breast tenderness is often the first thing that tells a woman that she may be pregnant.  Suddenly your breasts are tender to the touch, which may be especially noticeable while exercising.  Usually a minor irritant, breast tenderness is one of the first signs that your body is growing a baby, your hormones are changing, and you will in a few short months be nursing your little one!  Our bodies are amazing.

There is no known “cure” for this aspect of pregnancy and it will usually pass with time.

Headaches-

Some women experience headaches during pregnancy, often in the first trimester.  While they can be disconcerting, especially to someone not used to them, there is often a simple solution.  Often pregnancy headaches are simply caused by low blood sugar and the increased need for nourishment as the placenta is being formed.  Pregnancy is not a pathology, but it is hard work for the body and requires healthy, whole foods, frequently throughout the day.  (Sign up for our e-mail list to get a FREE download about optimal pregnancy nutrition with bonus recipes.)

Eating frequent small snacks or meals (about every two hours) always containing a protein source is probably the best way to not only curb pregnancy headaches and also feed your body the nourishment it so needs during the early days of pregnancy.  The practice of eating healthy has the added bonus of helping with a variety of pregnancy symptoms considered unavoidable, from nausea to swelling.  You and your baby are worth the effort.

Feeling emotional-

Though seldom talked about, feeling a variety of strong emotions during pregnancy (especially during the first trimester) is very common.  Some women find they cry more easily, others find that they are glowing and deliriously happy.  Even when a pregnancy was planned and much looked forward to, feelings of ambivalence are normal.  The occurrence is so common it is documented in midwifery textbooks as a normal pregnancy symptom.

While the change in hormones may cause this emotional manifestation of the physical changes in the body, there are things that can help.  Some women find that careful attention to their diet, paying especial attention to healthy B vitamin sources is beneficial.  Brewers yeast, seafood (in moderation, according to your care provider’s recommendations), beef, cheese and eggs are all ways to increase B vitamin consumption through diet.

It is also important that the new mother be gentle with herself, accept that pregnancy can be emotional, and surround herself with supportive people like her partner, her birth doula, family and friends, and a knowledgeable childbirth educator.  Pregnancy is a time where each women deserves extra care and support.

Exhaustion-

You are pregnant!  Do you feel sleepy yet?!

It is very common for pregnant women to feel tired in both the first and the third trimester.  During the first trimester of pregnancy (from conception to about 12 weeks gestation) it is perfectly normal to be tired.  Your body is working hard to form a placenta and the very beginnings of your baby.  Give your body time to rest and feed it well during this time when so much is developing.

Good diet, paying special attention to greens (you can supplement with a liquid chlorophyll if needed) and iron intake (meats are high in this and chlorophyl supplements will help your iron to absorb well as will vitamin C) can help with tiredness.   Women get a renewed energy when the second trimester starts, around 13 weeks.

Frequent urination-

Even though the baby is very tiny during the first trimester, it is not uncommon to have a frequent urge to urinate. Hormonal changes cause the blood to flow through your kidneys more quickly thus causing more frequent urination.  In addition, your blood volume increases dramatically during pregnancy (by about 50%) and this is a further stress on the kidneys and increases the need to urinate.  Of course, as the baby grows, because it rests just above the bladder, the increased weight adds pressure causing frequent urges.

Though this is a normal and healthy part of pregnancy, avoiding things that are diuretic (like coffee, tea, caffeine, and alcohol) can ease the burden on your hard working body.

Birth Boot Camp encourages a proper Kegel program to strengthen the pelvic floor.  The muscles in the pelvic floor support the bladder and other organs and having them strong and flexible allows for more control of elimination.

Growing a human is hard work – 

Sometimes it is tempting to focus on the “symptoms” of pregnancy.  We prefer however to focus on what a miracle it is.  A human being (you) is able to grow another human being.  It is truly amazing (and yes, hard) work.  You will find that there are many nutritional and lifestyle changes that can improve overall health and happiness throughout pregnancy.

Enjoy!  The best is yet to come.

Should You Kegel?

 

Introduced in 1948 to strengthen the pelvic floor, Kegel exercises have recently experienced a surge of controversy. The discussion on how and when Kegels (an exercise designed to improve core strength and support the internal organs) are appropriate for women requires examining how the pelvic floor functions and what keeps it in shape.

This article discusses the function of the pelvic floor, how to properly incorporate Kegels into your lifestyle and alternatives if Kegels are inappropriate for you.

The function and purpose of the pelvic floor.

The pelvic floor consists of a group of muscles that sit between your pubic bone in front and your coccyx, tailbone, in the back.  Ideally, the pelvic floor acts like a trampoline – flexible to weight when needed, but strong enough to hold up what is placed on it.  The pelvic floor has four main functions:

  1. It acts as a sphincter, which means it closes the openings of the urethra and the vagina.
  2. It is supportive. In particular, it supports the pelvic organs (uterus, bladder, etc.).
  3. It has a sexual function.  An orgasm is a rhythmic contraction of the pelvic floor muscles.
  4. It is a stabilizer.  The muscles of the pelvic floor stabilize the pelvis during movement.  When functioning properly, the pelvic floor can help prevent or decrease pain in the low back, pelvic region, hip, and even the knees.  Think of the pelvis as the foundation of a house and your spine as the house.  If the foundation is weak, then the house won’t stand properly.  Your pelvic strength is important to your spinal health and thus the health of the entire body.

The pelvic floor muscles do not exist alone.  They work together with your transverse abdominals and multifidus (deep back) muscles to support your pelvis and spine.  Your glutes are also very important to the stability of your body- specifically your gluteus medius.

In addition to the everyday necessity of a strong pelvic floor for prevention of problems like urine leakage, a strong pelvic floor is specifically important during pregnancy and childbirth.  Most every pregnant woman has noticed increased pressure and, sometimes, trouble with leaking urine as the baby gets bigger and presses down more and more on the bladder.  A strong pelvic floor can help with this and is important to proper positioning of the baby at the time of birth.

The ideal position for a baby to be born is with the face towards the mother’s tailbone with the chin tucked to the chest.  This ensures that the smallest presenting part (that “cone head” sometimes noticeable in the hours after birth) is presenting.  A strong pelvic floor applies appropriate pressure to the top of the baby’s head, causing the chin to tuck and encouraging this birthing position for the baby.  A face or military presentation (where the face of the baby is the presenting part) is much bigger, can cause more pain, and can, in fact, be impossible to deliver vaginally.

A properly functioning pelvic floor will help prevent embarrassment, discomfort, and even difficult labors.

What are Kegels? 

Arnold Kegel was a gynecologist in the 1940s who worked with women suffering from “genital relaxation” or a weak pelvic floor.  He used an instrument that could measure the strength of the pelvic floor muscles to determine the severity of the condition.  Dr. Kegel saw women of all ages who struggled with various problems (incontinence, sexual dysfunction, etc.) due to a weak pelvic floor.  His intention was to find a way to help people who struggled with urinary incontinence without resorting to surgery.  (You can read Arnold Kegel’s published paper on the pelvic floor here.)  He sought to help women learn to identify and strengthen the pelvic floor through resistance exercise, ie, muscle contraction.  His findings indicated that in all but the most severe cases of pelvic floor damage, women could return to a normal, functional lifestyle through these exercises.  The strengthening of the pelvic floor muscles, pioneered by Dr. Arnold Kegel, are known today as Kegel exercises.

Researchers are still finding great benefits to women who are doing proper pelvic floor exercises.  Today, rather than using the instrument used by Dr Kegel, physical therapists and others specializing in female pelvic floor health use biofeedback machines to measure the strength of the pelvic floor and to help women learn how to properly contract and relax these muscles.

Proper Kegeling

While Kegel exercises for the pelvic floor are currently very accepted and widely done, it is apparent that just doing Kegels, without proper instruction, is simply not enough.  A Kegel exercise program should be done properly and should be individually geared for each woman and her needs.  The Kegel program taught in Birth Boot Camp classes is based on the work of Pamela Jones, PT.  This individualized program helps each woman assess her pelvic floor needs and adjust her exercise program.

It is important that women struggling with severe or specific problems or pelvic pain consult with their care provider or seek out a physical therapist specializing in women’s health.  The following are general tips for properly strengthening the pelvic floor.

A proper Kegel requires FULL relaxation and then FULL contraction and then back to FULL relaxation.  Remember, proper Kegels don’t just involve contractions.  Relaxation is a very important component to your pelvic floor health.  If a woman cannot achieve full pelvic floor relaxation then stretching and relaxation techniques should be used first.

To begin Kegeling, you must first recognize the muscle that you will be strengthening.  This is often done by stopping the flow of urine mid-stream.  The muscle that you tighten in order to do this will be the same one you strengthen doing Kegels.  (Don’t do this frequently, only to initially identify the correct muscle.)  Noting how easy this is for you and how quickly it can be done can give you some indication of your pelvic floor strength.  Another way to identify strength of the pelvic floor is by tightening your pelvic floor during intercourse and getting feedback from your partner.  Note how long you can hold this contraction and how many times you can repeat it.  As you begin a pelvic floor strengthening program, continually ask for feedback from your partner.

Once your pelvic floor strength has been determined, you can tailor your Kegel program to fit your needs.  A weaker pelvic floor will require just three to five repetitions five times per day in a position where gravity can assist you.  For example, with your hips propped up with pillows.  A woman with a stronger pelvic floor will be able to Kegel in an upright position, even while walking or running and will be capable of doing more contractions.

Remember to tighten and then FULLY relax the muscle.  A proper Kegel will develop both strength and awareness of the muscle.  We don’t just want a “tight” pelvic floor; we want a strong pelvic floor which we are able to fully relax.  Also, be aware of the surrounding muscles.  The point of a Kegel is not to tighten the gluts or bottom.  Those should stay relaxed.  Focus on muscles in the front.  It will feel like you are tightening the vaginal opening rather than the rectum.

No more Kegels?

It seems clear that the scientific literature and popular opinion recognize the importance of both the strength of the pelvic floor and the importance of Kegels in this strength.  Despite this, Kegels have fallen out of favor in some circles and this sentiment has made its way into the birthing world.

Often those who believe Kegels should not be done recommend squatting instead.  Any comprehensive birthing class will encourage and focus on squats.  They are a very important exercise for many reasons – flexibility, strength, and opening up the pelvic outlet.  They are also effective in strengthening the pelvic floor without the use of Kegels.  Our instructors encourage their students to appropriately squat AND Kegel as part of their comprehensive physical preparation for childbirth.  Many other exercises are also encouraged which help strengthen the body for birth.  Ideally, these two exercises (squats and Kegels) will both be employed by women for a fully functional, flexible, and strong pelvic floor.

Is there a time when Kegels are not appropriate?  Some women will find that their pelvic floor is excessively tight.  Tight is different than strong.  In fact, a woman can have a weak pelvic floor that is very tight.  This is usually accompanied by pelvic floor pain.  Women describe this pain as feeling like a headache in the pelvis.  For those women whose pelvic floor is very tight, doing excessive Kegels would not be appropriate and could make the problem worse.  Diagnosis and treatment from a physical therapist specializing in pelvic floor problems may be appropriate.  Your physical therapist would be able to prescribe an individualized program that could help.

In addition to exercise, we recommend that pregnant women seek chiropractic care from a Webster certified chiropractor.  Chiropractic care during pregnancy can also help with some of the pain associated with pregnancy and, like a strong pelvic floor, can help ensure proper positioning of the baby.  As mentioned earlier, the pelvic floor, spine and pelvis all work together for a functioning, healthy, and pain free body.  If the pelvis is badly misaligned causing torque on the pelvic floor muscles and thus excessive tightness and an inability to fully relax, it can not only cause pain but make it nearly impossible to properly Kegel and strengthen the pelvic floor muscles.  A chiropractic adjustment by a Webster certified chiropractor can remove the misalignment in the pelvic bones allowing full relaxation of the pelvic floor and relieving pain.  Once the bones are properly positioned and the muscles are allowed to fully relax, a complete Kegel exercise program may be implemented to strengthen the muscles that were once weak and hypertonic (tight), allowing it to be both supple and strong.

In conclusion

Without a doubt, a strong and healthy pelvic floor is important to every pregnant woman.  A comprehensive childbirth class should include various ways to strengthen the pelvic floor, including Kegels, squats, and other core strengthening exercises.  It is important for women to evaluate their own individual needs and adapt, as necessary.  Your childbirth educator will also go over many of the ways you can protect both the pelvic floor and the perineum (tissues between the rectum and the vagina) during birth.

Additional information and resources-

Dr Kegel’s Research:
http://journals.lww.com/greenjournal/Citation/1956/11000/Early_Genital_Relaxation__New_technic_of_diagnosis.4.aspx
 
Study finds Kegel exercises more effective than cone or electric treatment:
http://www.bmj.com/content/318/7182/487.abstract
 
Cochrane Library meta analysis finds that doing Kegel exercises improves lifestyle and in particular, stress incontinence:
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005654.pub2/abstract;jsessionid=ECFB884EB2A0D1D252E134351F9B8AA4.d03t01
 
Website for Pamela Jones, Physical Therapist specializing in women’s issues:
http://physicaltherapy-northtexas.com/
 
To find a chiropractor certified to work work with pregnant women, check out:
http://icpa4kids.org/Find-a-Chiropractor/
 
Thanks to Sara Bogner, Physical Therapist and Nathan Clark, DC for lending their professional opinions on this subject.
 
 
 
Sarah Clark has been a birth instructor since 2008 and now helps train future birthing instructors for Birth Boot Camp.  A mother of four, she also blogs about natural birth and motherhood at www.mamabirthblog.com.
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