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

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Labor and Birth

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Doula Myth: I Don’t Need A Doula, My Nurse Will Help Me!

 

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Today we are excited to share a guest post from an incredibly experienced doula and one of the driving forces behind our very own Birth Boot Camp DOULA program, Maria Pokluda. Maria’s words of wisdom on the importance of and difference between both a doula and a labor and delivery nurse are so important.  Enjoy reading, and share with your pregnant friends!

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I attended a birth recently at a local hospital. When we arrived at the hospital the nurse greeted us and did all the right things: she asked for the couple’s birth plan, she told them that everything on their birth plan looked acceptable and she smiled as they talked about their plans. She was a great nurse and this couple (who took a Birth Boot Camp class) did go on to have a pretty amazing natural birth many hours later. As the nurse was leaving at shift change, she mentioned that she was excited to have seen a natural delivery because she had only seen ONE other natural birth in the SIX years she had been working as a labor and delivery nurse. I am still stunned by her comment and I think (and hope) that her experience is not reflective of all nurses who work in labor and delivery rooms. However, the fact is that it is neither a nurse’s primary job nor the focus of her training to help couples have a natural birth.

All couples birthing at a hospital will have a labor nurse, and I frequently get asked why a couple would need a doula since they will have this nurse to help them while they are at the hospital. Labor and Delivery nurses are a wonderful resource, however they have the clinical duties of monitoring baby and mom, the charting that is part of today’s medical care and they also have other patients – how many depends on the time of day and how a particular hospital staffs the floor. All of these other roles can limit the amount of time a nurse has to spend taking care of mom’s physical and emotional needs, but perhaps more importantly, most are simply not trained in helping women who are planning a natural birth and many don’t see natural births all that often.  If one sees medicated births day in and day out, that becomes the norm and a couple planning a natural birth will seem unusual.

In a study examining pregnant women’s expectations, first time mothers anticipated that their nurse would spend 53% of her time offering physical comfort, emotional support, information, and advocacy. However studies have shown that the actual amount of time an obstetrical nurse spends doing these things is closer to 6%*. With hospital interventions at an all-time high, nurses may want to do these things for women, but the reality is that they have to spend a lot of time just managing medical concerns and hospital policies. In fact until a women starts to push, nurses do not usually spend time in the labor room but rather monitor remotely at the nurses’ station. In my own experience as a doula, it is not unusual to attend a whole labor and never see the nurse touch mom in a non-clinical manner. She may move fetal monitors, take a woman’s temperature or feel her cervix by placing her fingers in mom’s vagina but never touch the mom outside of these tasks.

On the other hand, a doula’s primary focus is on the laboring couple. Her continuous care allows for her to respond quickly, make recommendations based on how labor is unfolding and provide immediate emotional and physical support. A doula sees natural birth all the time. She is familiar with the sights and sounds of normal labor and can often anticipate what a woman will want as she labors. She is trained to suggest position changes, relaxation methods and comfort measures. If a couple has taken a great birth preparation class they will have confidence and information, but that does not replace having someone there to answer questions and provide ongoing encouragement. A doula does not have to analyze a fetal heartbeat, administer antibiotics or enforce hospital policies.

The relationship between an expectant couple and their doula is also different than with their nurse whom they generally meet the day of delivery. The doula has likely been working with the couple prenatally and often has been laboring with a couple in their home prior to arriving at the hospital. The doula will know the couple’s desires, their concerns and even the dynamics of the couple’s relationship.  She knows if a relative is someone that should be in the labor room. She knows that mom wants to have the cute nursing bra on for pictures even if she says she doesn’t care at the time. A doula is there through as many shift changes as it takes which offers stability when other faces may be changing and a doula will stay with a laboring woman so her partner can get coffee, check on older children or get some food. In the weeks after the baby is born, the doula is available to talk, to answer questions, and to process concerns.

Despite all the things I just listed that doulas do, a nurse’s role is just as important. The way most hospitals operate means that the labor nurse is the primary liaison between a couple and their care provider. She will be the one calling the OB and passing along the details of the labor, she will be the one that makes ongoing analysis of baby’s wellbeing.  In the rare event that something needs immediate medical attention, it may seem as though the OB is swooping in to save the day…but it will be the nurse that calls the OB to come. Part of a nurse’s training is being a patient advocate. The American Nurses Association includes in its definition of nursing  “advocacy in the care of individuals, families, communities, and populations.” Nurses can advocate for a couple’s expressed treatment preferences which is a very distinct and different role from that of a doula who can help couples express preferences, consider options and facilitate communication, but not actually advocate for a couple or act as a liaison.

I remember working with an excellent nurse at one birth where the care provider and the couple were in disagreement of the use of a routine intervention that was part of hospital policy.  The nurse pulled a chair up to the bed and told the laboring couple exactly what their options were, what could be expected to happen with each choice and how to say no in a manner that would be most respected by the care provider.  She also took it one step further and told the couple that she would speak to the care provider on their behalf and that she could be the one that told the care provider that they had declined. While this may not be a common scenario, a nurse can choose to do this as part of her job; a doula cannot.

The roles of the labor nurse and the doula will overlap in some areas which actually works out well as very few couples will complain about extra support, but they also have marked differences. Ideally the roles should complement each other, which is why laboring couples need both. With a great nurse and a great doula a couple can expect to have an empowering birth.

 

Maria Pokluda has been a doula serving the Dallas/Ft. Worth area since 2004.   She has a Masters in Political Science and while she finds that slightly funny, she feels her degree helps her work with all types of people and she can now appreciate those statistics classes as she reads the research about evidenced practices in maternity care.  In the last 10 years, Maria has attended hundreds of births, helped form Dallas Birth Network and in 2013 and 2014,  she was voted Best Doula by North Texas Child Magazine. (Maria has recently co-written the Birth Boot Camp Doula program and can’t wait to start training Birth Boot Camp Doulas.)   Maria has been married to Brian for 18 years and they have 4 children, each with a very different birth story ranging from one with all the bells and whistles in a hospital to a homebirth.  

* Tumblin A, Simkin P. Pregnant women’s perceptions of their nurse’s role during labor and delivery. Birth. 2001;28(1):52–56. [PubMed]

 

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Exercises For A Great Birth Pregnancy (& Birth!)

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We are honored to share a guest post today from one of our newest board members, Katie Dudley.  Katie first became interested in natural birth as she prepared for the birth of her own child and attended our founder, Donna Ryan’s, birth class.  Our newest student manuals include her contributions in both exercise and nutrition.  They are nothing short of incredible and we are so proud and excited to have her on our team.  Today she shares three exercises (there are many, many more in the complete Birth Boot Camp class series!) to get you started in preparing for a great pregnancy and birth.  

One reason we chose Katie as the developer for our pregnancy fitness program is her trust in the female body and its inherent power. We too believe that women are capable of birth and that they are strong! There are many in the fitness industry who believe that pregnancy and birth are very harmful and damaging to women’s bodies and they need to be “put back together” afterwards. With proper exercises before, during and after pregnancy, in addition to phenomenal pregnancy nutrition, we don’t believe this to typically be true. 

As with any fitness program, seek approval from your physician before beginning, especially during pregnancy. These exercises are widely accepted as safe for pregnant women in general, but (as with everything relating to birth) there are exceptions. Be aware of your body and listen to it. Consult with your care provider if you have any questions.

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I always thought it was humorous when people would come up to me during the last couple of months of my pregnancy and say “Aren’t you ready for that baby to come out?” It was my first child! Of course I’m ready. They would then they would follow it up with “I’m sure you are so ready, you must be miserable!”

Being in the health and wellness industry, I find this sentiment is pervasive. In fact, my husband recently had a conversation with a pregnant couple urging us to get pregnant too so “we could be miserable together.”

As a personal trainer and fitness junkie, I don’t just love exercise and nutrition; I also believe that just as our bodies are strong and capable of fitness, women’s bodies are also strong and capable of an enjoyable pregnancy and birth.

Are there “uncomfortable” aspects to pregnancy at times? Yes. The possible months of nausea are not great, the swelling is pretty interesting, we all know about the weight gain aspects, the going to the bathroom throughout the night, being physically out of sorts and many other common pregnancy “symptoms”. Pregnancy is a multifaceted experience both wonderful and filled with unique challenges for each of us. A woman’s body goes through a lot of changes, but does it really have to be as physically uncomfortable as many women experience, let alone miserable? I say for many women, “No”.

I believe we can be proactive in combating many of these discomforts through proper exercise. That was my personal experience, but also, and perhaps more importantly, the experience of countless pregnant women I have worked with over the years. While I did experience months of nausea (not fun), other than that I felt great. I didn’t experience the aches and pains that other women talk about in their backs, hips and joints that I had anticipated before becoming pregnant. Pregnancy can be a joy! I felt good and I felt strong. I had a physical confidence with the extra 45 pounds I was carrying on my body and I really attribute that to being physically active before and during my pregnancy and eating nutrient dense foods.

I was on my feet 8-10 hours a day with clients and I focused most of my exercise on my postural health. Making sure my spine and my hips were supported by a strong core can be life changing.Many women complain of lower back pain during pregnancy. There are things we can do about this!

Most of that pain is caused by lordosis (rotated pelvis). Many other women also have SI Joint dysfunction, leg cramps, numbness and aching in the hips and legs. The majority of these ailments can be alleviated with appropriate physical activity, massage/myofascial release, chiropractic and stretching. By doing so, individuals create strength and balance in their alignment relieving a lot of unnecessary pressure on their frame. I’ve seen this myself through my own pregnancy and the many women I’ve had the opportunity to work with over the years as well as others my colleagues have trained.

It’s a new physical world that we live in. Many of us spend our days sitting behind a desk or at a computer. Others are in the car for work or with their families. These positions can weaken and put strain on our bodies. We just do not have the physical demands as those generations that came before us. Our days are generally not spent foraging food, washing clothes by hand, and carrying water on our shoulders. Most of us have to make a point to get physical activity to strengthen our bodies. And that’s ok! We can do it!

Don’t know where to begin? Here’s a great place to start. These are a few of my favorite specific strengthening exercises for preparing the body for a comfortable pregnancy and a great birth.

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One of my favorite core exercises for everyone is bridging. Bridging is utilized to strengthen the glutes, hips, pelvic floor, and core. It is especially beneficial for individuals who spend a significant amount of time sitting. This particular exercise helps to lengthen those muscles that are contracted during sitting and help strengthen the muscles that are relaxed in that position. Women and men that sit often have weak glute muscles and have a difficult time activating them which can affect the knees and lower back.

Bridging is also advantageous for those that have an anterior rotated pelvis, by strengthening the hips to stay in a more neutral position.

~Simple directions~

1. Lie on back or stability ball with knees and feet straight and in line.

2. Tuck pelvis to neutral position, keeping shoulders relaxed and spine straight.

3. Squeeze glutes and pelvis up off floor keeping core tight and knees straight. Pause.

4. Slowly lower down to starting position and repeat.

*Try 2-3 sets of 12-15 repetitions 3 times a week.

squatting

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Squatting is one of the most functional exercises people can do. Individuals use it almost every day whether bending down to grab something out of a cabinet or to sit on the floor. It not only supports movements in everyday life, but can also help women achieve an easier birth physically and support their bodies throughout the pregnancy. A squat strengthens the glutes, hips, core, feet, back, pelvic floor and the stabilizing muscles around knees. People with previous injuries are often afraid to squat, but when executed and practiced with proper form, squatting can actually help prevent an injury from recurring.

The squat pictured above is a deep birthing squat. Not all women will be able to perform this easily or with proper form the first time. Pay attention to your body and listen to it! Consult with your care provider if you have questions. More specific thoughts are also found in your student “Field Manual” and the videos in your class. The deep squat was once a natural and everyday movement for women, now we often need to “re-learn” it to prepare for birth. But be assured: squatting is an incredibly important position for pushing with the ability to shorten and speed the second stage of labor. You don’t want to learn it in the heat of birth.

Squatting isn’t a competition! Go to a comfortable depth for you. Keep your spine and pelvis neutral. Don’t push beyond what you are able.

~Simple directions~

1. Stand with feet shoulder width apart, toes following knees.

2. Keep core and glutes tight, sit back straight and lower as if sitting in a chair with a neutral spine

3. Pause at bottom, keeping feet flat on floor.

4. Sitting up tall, keeping glutes contracted, press through heels and return slowly to starting

*Try 2-3 sets of 15-20 repetitions.

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A perfect asymmetrical exercise for pregnancy, the quadruped helps to strengthen our core through an unstable position. By executing exercises in this manner, it allows for better control over the body by strengthening the stabilizing muscles. To keep the body in a neutral position when practicing an asymmetrical exercise requires better muscle recruitment. Over time this provides more support for the spine and more control over the body. This is an especially beneficial exercise for those combating sciatica or Diastasis Recti. (If your Diastasis Recti is known and severe this may not be the best position for you. This will often feel wrong for these particular women. We encourage all women to pay attention to their bodies.)

In addition, “all-fours” positions are fabulous for birthing and women left to their intuition often birth in this position. Many care providers notice that hands and knees positions can help in properly positioning a baby when done during pregnancy and even during the birth. They can also make labor more comfortable, particularly back labor. Practicing things like the quadruped or pelvic rocking can help prepare you in many ways. Exercises like this help strengthen your body so that you can function better in pregnancy and during your birth.

~Simple directions~

1. Start on all fours with hands directly under shoulders and knees directly under hips.

2. Activate core and glutes.

3. Keeping back and hips level, raise arm and opposite leg straight out. Relax shoulder.

5. Take your time, move slowly keeping core tight (draw belly button to spine) and glutes

6. Return to starting position and alternate sides.

*Important to keep spine straight and not twist or shift hips.

Pregnancy and birth are miraculous and under-appreciated times in our life. Opinions are pervasively negative regarding the functioning of our bodies during pregnancy. But knowledge, effort, and some labor can help prepare our bodies, ease the burdens placed on them, and help us enjoy the amazing moments of pregnancy and birth a little bit more.

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Katie Dudley is responsible for the new and improved exercise and nutrition program in the Birth Boot Camp 10 week educational series.  This article is just a tiny taste of what she has created for our students. Her amazing program appears in our new online classes and our new work book for students (the “Field Guide) and includes myofascial release, stretching, exercises, postural support, nutritional awareness and charting and much more. You can find her at Cornerstone Integrative Fitness and Wellness in the Atlanta, GA area and weekly in your online classes!

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New and Updated Online Childbirth Classes

Yes, you heard that right: we have completely updated our online classes! We loved the original birth classes featuring Donna Ryan, but felt it was time to mix things up. Our online childbirth classes are not just a few handouts that you print off yourself with some articles to read, they are literally HOURS of streaming video with a beautiful workbook included. By the time you are done, you will feel as though you know your instructors! Read more

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The Birth of Hannah- A Birth Boot Camp Natural Hospital Birth Story!

We are honored today to share a birth story from one of our recent online birth class graduates. As you read you will find that the end of pregnancy and the labor were not without some unexpected surprises, but because this mom and her partner had worked so hard preparing for their birth, they were still able to have a fabulous experience.

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Black Women and VBAC- A Guest Post By Melek Oz Speros

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Tasha after her vaginal birth after four c-sections. It can be done. You can read her story here.

Melek Oz Speros, founder of Black Women DO VBAC!, has made it her mission to bring research, birth stories, and inspiration to Black women giving birth.  We are excited to share her and her knowledge with you today and help spread the word that black women CAN and DO have vaginal births after cesarean.

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