Sunday, July 7, 2019

FAQ's About Doulas

What is a Doula?

Doula is an ancient Greek word that roughly translates to "a woman who serves." In modern times, the term doula has become the title of an individual who has training and experience as a labor companion. A doula is someone who supports a mother and her partner before, during and just after childbirth by providing them with continuous emotional support, physical comfort measures and assistance in obtaining up to date and evidence-based information regarding pregnancy, labor and the postpartum periods. 

What is the difference between a birth doula and a postpartum doula?

A Birth Doula is a doula with specific training and focus on labor and delivery. Birth doulas support a mother prior to labor by discussing the mother's (and partner's) ideal birth, help find research and information that supports the mother and her choices, explain the labor and delivery process, educate the mother about comfort measures and coping techniques and help answer any questions she may have prior to delivery. During labor, the doula joins the mother at her home or the hospital and stays with her throughout her labor, delivery and generally stays for a few hours postpartum as well. The doula supports the mother's choices throughout the labor process by providing emotional support and physical comfort measures (like hip compressions and gentle touch) and providing reassurance throughout the labor and delivery process. After delivery, the doula generally stays to help the mother with the baby's first feeding and to ensure the new family has extra support while also allowing them to bond. 
A Postpartum Doula is a doula with specific training and skills to help the mother and her family after delivery. Postpartum doulas provide much needed support to new mother's in those first few days and weeks in many different ways. The doula's services are oftentimes based upon the mother's postpartum needs; the doula may come and help with light housework so the mother and baby can bond or sleep or she may provide emotional support and education with breastfeeding. The doula is mindful of the mother's emotional state and provides an empathetic, supportive place for the mother to talk about any concerns she had with the delivery or problems adjusting to her knew role as a parent. Additionally, the doula can provide the mother and her partner with local area resources, such as a Lactation Consultant, as well as help find information if there are any questions or concerns that may arise during the postpartum period. 

What are the benefits of hiring a birth doula?

There are many benefits to hiring a birth doula.  Here is a brief list and a few links to clinical studies describing them:
  • Women who hire doulas tend to have fewer medical interventions, are more likely to breastfeed and are less likely to have low birth weight babies (click here to read a study published by The Journal of Perinatal Education about the impact of doulas on healthy birth outcomes).
  • Women who hire doulas tend to have fewer unplanned cesarean sections and fewer assisted deliveries with the use of forceps or vacuum extraction (click here for an excerpt of an article outlining the results of two studies regarding the outcomes of women who had continuous emotional support during labor vs women who did not).  
  • Women who hire doulas tend to have more satisfaction in their birth experience, a strengthened mother-infant bond and more success with continuing to breastfeed long-term (click here for an excerpt from an article published in the Journal of Midwifery and Women's Health discussing the benefits of having a doula present during labor and delivery).

What is the difference between a Certified Doula, a Student Doula, and a Senior Doula?

A Certified Doula is a doula who has chosen an organization(s) to complete certification trainings and/or requirements with, and to adhere to the organizations Standards of Practice and Code of Ethics.  Doulas are also likely to be required to pay fees for training as well as certification and membership dues.  Most certifying organizations require that doulas re-certify at specific intervals and usually require continuing education hours and/or client reviews.  Each certifying organization has its own set of guidelines and requirements for certifications, so if hiring a Certified Doula is important to you, it would benefit you greatly to familiarize yourself with the certifying organizations represented in your area as well as understanding what each organization expects from their doulas.  You can expect to Certified Doulas to charge slightly higher rates than Student Doulas, however there is no industry standard or regulation with what a doula may or may not charge for her services. 
A Student Doula is a doula who is working towards certification with a specific organization.  Student Doulas may or may not have previous birth or doula experience, as it is not required for doulas to be certified to provide labor support services.  Student Doulas with little or no birth experience may charge slightly lower rates than the average in your area, however it is very important to understand that studies have proven even doulas with minimal training positively impact birth outcomes.  Experience, training, and dedication to craft are all important traits when searching for doula services, however it is always worth looking at Student Doulas in your area who may be a better fit for your personal needs.  Students are just as dedicated and passionate as Certified Doulas! 
A Senior Doula is a birth or postpartum doula who has either chosen not to certify with an organization, or who has previously obtained certification and has chosen not to pursue re-certification.  Non-certified doulas may have decades of birth and labor support experience and are just as valuable as resources, if not moreso, as Certified Doulas.  Depending on her individual depth and breadth of experience, a Senior Doula may charge as much or more as Certified Doulas in your area.  

Can a doula perform simple medical services (cervical checks etc.)?

No.  A doula is there for the emotional and physical comfort support of the mother.  The mother's caregiver(s) - nurse/birth assistant and doctor/midwife - are responsible for the health and well-being of the mother and baby throughout her pregnancy and her delivery and are the ones who will be handling all medical tests, exams and procedures.

I am planning on getting an epidural during the birth of my child.  Can I still benefit from hiring a birth doula?

YES.  Birth doulas have training to assist and support mothers and their partners regardless of whether or not you are planning on an  unmedicated birth, plan to use narcotics and/or an epidural for pain relief, will be having an induction, are having a planned cesarean section or anything in between!  Doulas are there to support you and your decisions for your birth, whatever those may be.  
For those of you considering an epidural, having a birth doula to support you can be an invaluable asset in the delivery room.  Most caregivers require that a mother be in her active stage of labor (4-5cm dilated) before receiving an epidural or a spinal.  
Your doula will meet with you before your delivery to discuss and practice coping techniques to help manage your pain during this first part of labor and will join you at home or in the hospital to help and support you until you are able to receive the drugs.  They also may suggest and help support you in different positions to try while in the bed to help move the baby down through the birth canal.  They can also help provide much needed emotional support or answer questions if the mother or their partner experiences any anxieties or fears during the delivery process as well as remain by your side when your partner needs to take a break to eat or use the restroom.  Additionally, they will also be there to help support the mother during the first few hours postpartum and can help with the baby's first feeding or perhaps take those first few family pictures. 

I am having a planned cesarean section.  Can I still benefit from hiring a doula?

YES.  Whether your cesarean is planned or you have to have an unplanned one due to complications during your delivery hiring a doula can be immensely beneficial.  Remember, a doula is there solely for the emotional and physical comfort support of the mother so the manner of delivery does not impact their role in your birth plan.  
Prior to your cesarian, your doula will meet with you just like they would with any other mother and discuss your wishes for the birth of your child.  They may help provide resources and information about different "gentle" cesarean practices that you can then discuss with your obstetrician, or help you organize a birth plan highlighting your wishes for what should happen to the baby after delivery (do you want the baby placed immediately on your chest skin-to-skin or handed to your partner as soon as possible?).  Once you are in the recovery room, your doula can stay by your side while your partner stays with your baby in the nursery or they can assist with holding the baby while you nurse or bottle feed them for the first time.  

Thursday, April 25, 2019

Chemical Pregnancies: The Silent Loss

An African American woman in obvious emotional pain with tears streaming down her face.
Home pregnancy tests have come a long way since they became available to the public in the 1970's.  Some brands are now so sensitive that they are able to detect hCG levels as low as 5-10mIU, meaning you may only be one to two days past implantation when you get a positive result.  For women who are trying to conceive or who have been struggling with infertility, these highly sensitive home tests provide answers faster and shortens the dreaded "Two Week Wait" in between ovulation and awaiting their cycle in hopes for a pregnancy.  Unfortunately this also can cause a lot of confusion and heartbreak for women.  Imagine seeing a faint positive line form on your test - your long awaited pregnancy is now a reality! - only to have your cycle start a few days later.  Or worse, having a negative result at the doctor's office when you go in to confirm the pregnancy.  This is what is known as a chemical pregnancy and is the earliest type of miscarriage that can occur. 

Approximately 50% of all pregnancies end in a miscarriage, with 80% of those occurring in the first trimester.  It is speculated that these numbers may be even higher but prior to the high sensitivity levels available with home pregnancy tests on the market today, most of these losses went undetected.  

Chemical pregnancies are defined as a miscarriage that occurs within the first 5 weeks of pregnancy.   With a chemical pregnancy, a woman may have no or very few pregnancy symptoms.  Often times with a chemical pregnancy, any pregnancy symptoms are attributed to PMS.  Her menstrual cycle may be on time but unusually heavy, or perhaps a day or two late with more intense cramping than usual, or she may have no noticeable difference than any other menstrual cycle.  Unless she was purposefully testing early, as is the case for many women who are trying to conceive, she may never have even suspected that she was pregnant for that brief time. 

Chemical pregnancies can be a very isolating and profoundly life-altering experience for women, especially those who have been trying to conceive for many cycles or who are struggling with infertility.  Since this type of loss occurs before many women even have a chance to announce their pregnancies to friends and family, it can be very difficult to find the support one would usually receive during a miscarriage.  This means that the majority of women who experience a chemical pregnancy often suffer alone and in silence.  

All known pregnancy losses take an emotional, physical, and mental toll on the mother and the length of the pregnancy does not correlate with the amount of grief they mother may experience.  As mentioned before, one of the biggest issues for mothers experiencing a chemical pregnancy is lack of support and understanding from friends and family.  Most people do not understand what exactly happened, are misinformed about early losses and either assume that the mother couldn't possibly be attached to the pregnancy that quickly, or feel that a chemical pregnancy doesn't "count" as a miscarriage.  Partners may also struggle with supporting the mother, or may not understand why she may be experiencing such profound grief and confusion.  

Care providers and well-meaning friends and family members my try to downplay the depth of grief and the sense of loss that can accompany this type of pregnancy loss.  You may hear that things are "better this way" as it is speculated that these types of miscarriages are due to chromosomal anomalies, like Down Syndrome or Trisomy, and that by miscarrying you are being "spared" a child with severe learning or physical disabilities.  These statements, however, do not lessen the pain or provide any sort of relief for a woman navigating the emotions and thoughts of a miscarriage. 

Women who experience a chemical pregnancy may worry that it means there is something wrong with her and that she may not be able to carry a pregnancy to term.  Most chemical pregnancies, however, do not indicate any underlying fertility issue with the mother or the father and many women who have had a chemical pregnancy go on to have healthy, full-term pregnancies within the next year.  If you have had multiple chemical pregnancies or first trimester losses, it is important to be seen by a provider who can assess if there are any health or hormonal issues that are preventing you from carrying a pregnancy past this point of development.  Usually in these cases it is discovered that the mother has a hormonal imbalance that prevents her from producing enough progesterone to sustain the pregnancy in the early weeks of gestation.  This issue can sometimes be resolved by using a progesterone cream for the first few weeks of pregnancy, or through dietary and life-style changes if the mother has a form of insulin-resistance known as Polycystic Ovarian Syndrome (PCOS).

It is important to remember that everyone handles loss and grief differently and there is no right or wrong way when dealing with a pregnancy loss.  It is normal for a mother to feel anger, confusion, and sorrow with this type of loss just as it can be normal for her to feel nothing more than a mild sense of disappointment before moving on.  There is no time-line for grief, just as there is no measurement for the depth of pain she may or may not experience.  Acceptance, empathy, and support are the best ways to help a mother as she deals with her loss in her own way.  It is appropriate and should be encouraged for a mother to seek counseling or therapy if she is really struggling with her emotions after a chemical pregnancy. 

Monday, April 22, 2019

All About: Birth Doulas

The term "doula" refers to a birth or life-stage professional who provides four key things to their clients: physical support, emotional support, informational support, and advocacy support.  There are many types of doulas.  Over the next several weeks, I will be talking about the types of doulas specific to pregnancy, labor & delivery, postpartum, and pregnancy loss.  Each week I will focus on a specific type of doula, her role, and the benefits she provides to her clients.

Birth & Labor Doulas: What They Are

A birth or labor doula is a person, generally a woman who has given birth before herself, who has specialized training and experience with supporting women during their birth process.  Birth doulas typically meet with their clients a few times before delivery so that they may get to know the mother and her partner better and to understand what their ideal birth experience would be, however studies have shown that simply having a birth doula present in the delivery room improves outcomes - whether or not the doula and the client have met before.  Birth doulas provide their clients with the three major tiers of doula support during labor: emotional, physical, and informational.  Some even provide advocacy support, depending on their personal views and/or certifying organization.  

What They Do:

Emotional Support

Pregnancy can be a stressful time in a woman's life.  There are so many differing opinions on what is "safe" and "healthy" while growing a person in your womb.  Add hormones, routine tests, conflicting medical advice, and sifting through all of your birth options and its enough to give anyone heartburn.  Birth doulas provide a safe, empathetic space for expecting mothers to vent all of their anxieties and concerns with.  They also give mothers reassurance, letting them know that their feelings are valid and their choices are supported.  During labor, women need a LOT of emotional support - especially if an unmedicated vaginal birth is the goal.  Birth doulas soothe and comfort the mother, letting her know that what she is going through and feeling is normal and that she is doing an amazing job with her labor.  They also support the partner!  Partners need the steady reassurance and guidance of someone who knows that what is happening to the mother, that she is not dying or in imminent danger, and who can calm them so that they are better able to offer their own unique (and much needed!) support to the mother.  Lastly, a woman remembers the emotional experience of every birth she has for the entirety of her life.  A woman who feels supported in her choices and nurtured through her birth experience will likely have positive emotions and memories, regardless of outcome.  A woman who has the "perfect" birth but who felt unsupported will probably have negative thoughts and feelings about her delivery.  Having a doula present increases the likelihood of having an emotionally satisfying birth.  

Physical Support

Mothers need a great deal of physical support during birth, regardless of the method of delivery.  Undisturbed birth, or birth that has no medical interventions whatsoever, requires a great deal of physical support by the use of comfort measures and positional changes.  Women who choose to have pain medication, such as a narcotic or an epidural, need positional changes and support to help gravity continue to play it's role in the delivery process.  Inductions can be extremely physically challenging as the synthetic hormone, Pitocin, can cause intense and unrelenting contractions - the skilled hands of a doula can help provide much needed pain relief!  Lastly, women who deliver via cesarean section are often over-looked when it comes to delivery support and yet they too are giving birth and have all the same needs as any other mother!  Doulas can be with a mother in the OR if the partner is unable to be there for some reason, and then can provide a huge amount of physical support as the mother recovers in the hospital after delivery.  

Informational Support 

Informed consent is the name of the game when it comes to having an empowering birth experience.  Yet how can you possibly be expected to make an informed choice without knowing all of your options?  Doulas bridge the gap between the medical providers and the clients by providing non-biased information about all of the options available to expecting and new parents in the delivery room and immediately postpartum.  During the delivery, if an intervention is suggested the mother and her partner can ask for a minute to talk it over.  In that time, they can ask the doula about the benefits and the risks of the intervention and provide alternative options that could be discussed with the care provider.  A doula will never choose an option for a client or suggest one option is "better" than another.  Their role is to provide the information the client needs to make their own informed choice.  


The birth doula's role in advocacy can vary greatly based on a doula's certifying organization, training, and business practices so it is important when interviewing doulas to discuss their role and what they can or cannot do for you in terms of advocacy.  Generally speaking a doula cannot speak to a care provider on behalf of their client, especially in a hospital or medicalized setting.  What she can do is remind you of your choices and support you in your decisions, regardless of hospital policies or care giver preferences.  

How To Find A Birth Doula

There are several ways to go about finding the perfect doula for you. is a free searchable database for doulas that allows women to browse doulas serving their zip code.  Doulas post profile information such as number of births attended, specialty trainings, certifications, and client testimonials.  The doulas are also able to update their availability for Estimated Due Dates on their Doulamatch profiles, allowing mothers to narrow down their searches a little faster.  

Most certifying organizations also have online databases available with listings of their doulas by state or zip code. is a great place to start your search!  

Lastly, word of mouth is a fantastic way to find wonderful doulas and other birthworkers in your area.  Natural birth groups, yoga studios, midwives, lactation consultants, and mom groups usually all have a list of doulas that they know and love.  

It is highly recommended that you interview several doulas before making your decision on who you would like to support your labor.  You want a doula that you feel is a good fit for you and that you have a connection with.  Doulas do not take it personally knowing that you are "shopping around".  Great doulas really want their potential clients to interview with other doulas in the area to ensure that the mother is getting the best person for them and their birth.  

Here is a list of questions you may want to ask during your interviews:

1.  How many births have you attended?  
2.  Have you supported a cesarean section delivery?  Were these planned or unplanned?
3.  What trainings and/or certifications do you hold?  
4.  Do you have a back-up doula?  Is it possible to get their website and business information so that we can familiarize ourselves with them prior to my due date?  
5.  How many prenatal appointments will we have together before my delivery?  How many postpartum visits after the baby arrives?  
6.  What is your on-call window for my birth?  
7.  Are you available by text, phone, or e-mail to answer questions prior to my delivery and during my postpartum period?  
8.  What is included with your services?  Are there limits on hours for labor support?  Do you charge an hourly fee after a certain amount of support hours are provided?  
9.  Do you support women who wish to use epidural or narcotic pain relief?

Friday, October 19, 2018

All About: Antepartum Doulas

The term "doula" refers to a birth or life-stage professional who provides four key things to their clients: physical support, emotional support, informational support, and advocacy support.  There are many types of doulas.  Over the next several weeks, I will be talking about the types of doulas specific to pregnancy, labor & delivery, postpartum, and pregnancy loss.  Each week I will focus on a specific type of doula, her role, and the benefits she provides to her clients.

Antepartum Doulas: What They Are

A pregnant woman in a white tank top sits on the edge of her bed, holding her hand up to her head with a tired and concerned expression.  Her other hand rests on her pregnant belly.
Antepartum means "before birth" and as such antepartum doulas have specific training to care for clients during their pregnancies.  This type of doula specifically aids women with high risk pregnancies who may have been put on bed rest, have a severe medical condition that impacts her pregnancy, be a teen or single mother, be an at-risk mother, be a rape survivor, or have some other risk factor that may impact their pregnancy.  

What They Do

Emotional Support
Perhaps the most important role of the antepartum doula is to provide her client with empathy, reassurance, and a sympathetic ear.  Antepartum doulas have special training and experiences that allow them to empathize with mothers in these unique situations and can provide a much needed and impartial ear for women who are going through less than perfect pregnancies.  There is a lot of guilt associated with "not enjoying" being pregnant - an antepartum doula accepts and respects this as part of the variations of normal when dealing with a pregnancy that may be unwanted, cause the mother extreme physical distress, or that may be the product of rape and she can help the mother as she navigates her way emotionally through her pregnancy.

Physical Support
Many high-risk pregnancies require a lot of extra physical support.  For example if the mother is on bed-rest she may need someone to prepare meals, do light house work, take her to and from appointments, or perhaps watch older children.  Whatever the need, the doula is there to make sure the mother is well-supported physically during her pregnancy. 

Informational Support
Moms with health concerns for themselves or their babies tend to have a lot of questions, or may be unaware of their options for care.  Their antepartum doula is there to help fill in the gaps that may be missed during her appointments with care providers or who can offer unbiased information about the pros and cons of different treatments or interventions the mother may be considering.  The doula may also have information specific to the issue her client faces, providing insights or tips for the mother to discuss with her care provider that may help make her more comfortable or manage her pregnancy symptoms better. 

How To Find An Antepartum Doula

Finding an antepartum doula can sometimes be a little bit of a challenge.  Since antepartum care is not as wide-spread or well-known as other the types of doula specialties there are not as many resources available to search from, especially in smaller or rural areas.  The best place to start is probably an internet search, followed by asking for references from local high-risk pregnancy groups you can find either through your care provider or online.  Keep in mind that many birth or postpartum doulas may offer antepartum services, so if you are stuck or having a hard time finding someone in your area it is worth sending a few inquiries to doulas asking if they may provide antepartum services.  Lastly local area birthworkers like Certified Practicing Midwives, Certified Nurse Midwives, midwife assistants, and doulas can also be a great referral resource for expecting mothers and their families.  

Wednesday, October 3, 2018

Postpartum Stories: Nevertheless She Persisted (Lindsay's Story)

Like most mothers, Lindsay spent her pregnancy envisioning the beautiful experience she was about to have welcoming her son Greyson into the world.  Mothers are told how beneficial and easy it is to breastfeed, and Lindsay was told nothing different.  So when things did not come as naturally or easily as she was led to believe, Lindsay found herself faltering.  This is Lindsay's story.

"When I was pregnant, I pictured a wonderfully natural nursing relationship with Greyson. Greyson, however, had other plans for us. He was a hard latch from the start. The LCs at the hospital, while meaning well, told me to just keep trying. Getting home was terrifying because I wanted to make sure he was getting enough to eat, but he cried a lot when trying to latch which would stress us both out, and created a vicious cycle. By our first pediatrician’s appointment, Greyson had lost 9% of his body weight, putting him dangerously close to “failure to thrive” territory. 
Meanwhile, I was a wreck. I had just brought home this beautiful boy and I was stressing and crying beyond control trying to feed him. I didn’t want to “give up” and go for formula (side note—I have always believed in Fed is Best, and I believe formula is perfectly healthy—but my hormones and mom instincts to nurse were insane...and I do NOT believe that giving formula is “giving up,” it’s just how I was feeling at the time). I decided I wanted to fight to breastfeed. I brought an IBCLC out to my house the same day of his first pediatricians appointment, who held me and told me that it was OKAY if I gave him some formula and OKAY if I pumped. For some reason, despite hearing it from many others, hearing it from her felt freeing. Here was this expert, and she couldn’t get him to latch. She saw how stressed he got, and in turn how stressed I got. She even let me know that the reason she became an IBCLC was because she’d had a completely similar experience with her own kids. She showed me how to pump and told me I’d have to pump every 2 hours for a month to get a supply going. I started right away.
For the first two to three weeks we supplemented what I pumped with formula. The mom guilt was REAL. The jealousy was REAL. People would check in with me and ask “How’s your breastfeeding relationship going?” meaning well, but it was like a knife in the chest. It hurt my heart to see latched mamas. I longed for that relationship too.
Eventually, I started making enough so that I didn’t touch the formula in the pantry. Then I made more. And more. I didn’t stick to a two hour schedule for long because it drove me insane. I found 3 hours to be much more doable, with a longer stretch at night. Life became less insane. Less stressful. More about enjoying my boy. I became less afraid. I began pumping in the car to save time when I could. I bought three pumps so I wouldn’t have to lug them around everywhere. I put s fridge in my room to store milk. I did all that I could to make it easier on myself, because it’s HARD! 
Today I made my first donation to the CHKD Milk Bank. 154 ounces. My supply is not fantastic at the moment because I’m sick, but I’m confident I’ll get it back up. Still, even if I don’t, my kid has had almost 20 weeks of milk because I. Didn’t. Give. Up. Of course, I was also blessed to be able to respond to a pump and to have a supply. Some mamas are not as lucky, and therefore I am thankful.
We still continued to practice latching, so that my body could respond and make the type of milk Greyson needed. We were doing really great, latching about once per day when I went back to work, but now it stresses him out again, so I don’t push it. I know either way, my kid is going to be fed. If I dry up tomorrow, he still went 20 amazing weeks with mom’s milk. Also, my kid is HAPPY. Seriously, this kid smiles ALL THE TIME! That’s what truly matters to me. He’s happy, and with either formula or milk, he’s healthy.
I wish I could talk to all brand new moms struggling with the same thing and tell them that everything is going to be okay. I also wish I could go back and give May 2018 Lindsay a hug. To tell her not to be so hard on herself. To show her a glimpse of the future just four short months down the road. Still, I’m so proud of her. She was the embodiment of #NeverthelessShePersisted."

- written by Lindsay Paiz 
October 3, 2018

Shared with express permission in the hopes that another mother who is struggling will read Lindsay's journey and find strength & comfort.  

Sunday, September 9, 2018

The Big Cut: Circumcision Information

What Is Circumcision?

Circumcision is the surgical removal of the foreskin from the penis.  In the United States, this procedure is routinely performed on males within the first few days of life for various religious, cultural, and aesthetic reasons. 

At birth, the foreskin is firmly adhered to the glans of the penis, like a fingernail is attached to its nail-bed.  The procedure requires that the foreskin be forcibly broken away from the glans.  After all of the adhesions are broken away, the foreskin is then surgically removed or a circumcision device is placed to cut off blood flow to the foreskin, causing it to become necrotic and to fall off in a few days.  If the procedure is done as an adult, the patient will be placed under general anesthesia and the foreskin will be surgically removed.  There is no need to break away any adhesions since most males have fully retractable foreskins by the time they reach sexual maturity.  

Risks VS Benefits

There are many risks to circumcision, the greatest of which are infection of the circumcision site, accidental damage to the penis, and post-operative hemorrhaging.  

Other side effects of circumcision include adhesions to the surgical site (which can cause irritation, discomfort, and pain) and urethral stenosis (a narrowing of the urethra causing urinary tract health issues and pain).  These types of issues typically require additional surgeries to be corrected.  

While there have been studies showing that circumcised males are at less risk for UTIs, phimosis, and for certain cancers none of these studies have shown significant improved outcomes.  The American Academy Of Pediatrics issued a statement that while the benefits of circumcision may outweigh the risks of the procedure, they do not recommend the routine circumcision of all infants as a preventative measure, while the American College of Obstetricians and Gynecologists published a statement that circumcision is an elective procedure and that parents should weigh the risks and benefits before making an informed decision about circumcising their sons.***
***American Academy Of Pediatrics Task Force On CircumcisionACOG Newborn Male Circumcision FAQ


It is very important that you keep your son's surgical site clean after his circumcision to prevent complications from infection.  The glans will appear to be very red, irritated, and is likely painful to the touch due to the forceable removal of the foreskin from the glans prior to the surgical removal of the tissue.  Any urine or stool will burn the skin of the glans until it has properly healed.  Using warm soapy water, wash the penis gently (do not use wipes or a washcloth).  Pat the area dry.  Apply vaseline liberally  all over the surgical site and penis.  It is important to make sure the skin on the shaft of the penis is not adhering to the surgical site.  Gently (but firmly) break away any forming adhesions at each diaper change.  

Other Considerations

Most insurance companies view routine circumcision as an elective and aesthetic procedure and as such do not cover the cost.  Depending on the area you live in and where you deliver, the cost of the procedure can run anywhere from $200 to $500.  

Intact Information

Intact Myths

Intact penises are dirty.

An intact penis is no dirtier than one that has been circumcised.  Proper cleaning of an intact penis is as simple as gentle SELF retraction in the shower and rinsing the glans with clean water (no soap needed).  After putting the foreskin back over the glans, wash the penis with mild soap and water - just like you would a circumcised one.  

It is harder to care for a newborn if they are intact.

Actually, it's easier.  There is no post operative care and no need to break adhesions to the surgical site routinely during diaper changes.  Remember two simple steps:  DO NOT RETRACT (not even a little) and wipe what you can see from base to tip, just like a finger.  

You need to retract your son to make sure he doesn't have issues as an adult.

This is very important:  IF INTACT, DON'T RETRACT.  Misinformed healthcare providers and outdated information still suggest that you should start retracting during diaper changes or when your child turns three years of age to prevent an issue called phimosis.  Phimosis is when the opening of the foreskin becomes to tight to allow for full or partial self-retraction to occur.  This can be very painful for adult males and can impact sexual pleasure and function.  We have now learned that most cases of phimosis are actually caused by forced retraction from care givers and health care providers.****  At birth, the foreskin is actually fused to the glans of the penis.  As your child grows, these adhesions gently break away on their own, allowing the foreskin to become retractable between the age of 6 through to the late teens.  Forced retraction causes damage and leads to the build up of scar tissue, which greatly reduces the natural stretch of the skin and tissues and can lead to phimosis.  
****It is important to note that even "a little" retraction from a care provider or parent is still considered forced retraction and can cause irritation, pain, and/or damage to the glans or foreskin.

Your son needs to look like his dad.

This is a common concern amongst circumcised men who are considering leaving their sons intact.  They worry that their son will question why their penises look different, or that it may somehow impact their son's body image or self-confidence.  However, these concerns are needless.  It is a simple enough thing to explain to your son that you chose to keep him intact while his father's parents chose to circumcise him and the difference in appearance will not impact potty training, self-confidence, or your son's body image.  

Your son will be bullied for having an intact penis.

This is known as the Locker Room Myth.  A study in 2015** showed that out of the 10% of boys who were teased about their penises in middle or high school (90% of boys were not teased about their penises at all), 83% were teased about penis size while only 17% were teased in relation to being intact or circumcised.  Finally, 97% of the boys polled who were intact reported that they were happy with their penis and would not change it's appearance.  
**Alexander, Cooper, Storm.  2015.  "Teasing In School Locker Rooms Regarding Penile Appearance" Journal Of Urology, 193:3, 983-988 

Intact Care

Intact care is SIMPLE!  Wipe any stool or urine off the exterior of the penis from base to tip, just as you would a finger.  Never retract, not even a little.  

If you are interested in more information about circumcision, why circumcision rates are so high in the United States, information about intact care, and functions of the foreskin I recommend watching the YouTube video Child Circumcision: An Elephant In The Hospital.

Monday, September 3, 2018

Cesarean Sections: You Don't Have To Miss Out On A Natural Birth Experience

New mother smiling after a cesarean section as a nurse lays her newborn across her chest
Whether having a medically elective cesarean section for the first time or having a repeat cesarean for medical reasons or personal choice, many mothers feel that they must give up on having a natural birthing and immediate postpartum period with their newborns.  Due to the clinical nature of a cesarean it may be shocking for you to learn that you don't have to miss out on as much as you may think, even within the surgical setting.  Just like mothers who labor and deliver vaginally, you have choices that you can discuss with your obstetrician and your surgical team to get the birth you want to experience.

Traditional Cesarean Practices

Before we discuss how you can achieve a more natural experience during a cesarean section, also known as a c-section, we should review a traditional cesarean procedure.  Unless you are having a "crash" c-section, meaning a true obstetrical emergency has occurred and they must deliver the baby immediately, the mother will be prepped in the operating room prior to surgery by having an IV and a spinal or epidural block put in place.  During a crash c-section, general anesthesia may be used since that is much faster than placing the spinal.  

While your surgical team is waiting for your spinal to take effect, you'll be further prepped for surgery while lying on the operating table.  A nurse will scrub your belly and may even clip your pubic hair if need be, and a surgical drape will be hung up above your belly to keep the surgical site sterile and keep you and your partner from becoming light-headed from watching the procedure.  Your arms may be strapped to the table to ensure you don't accidentally bump someone holding a scalpel and you will have electrodes placed on your chest so that the anesthesiologist can keep a close eye on your heartrate.  After you are prepped and numbed, your partner, who will be in a surgical gown and mask, will be invited into the surgical suite to join you.  

Your surgeon will ensure you are properly numb before beginning the procedure - keep in mind numb means no sharp pain, you will still be able to feel tugging and pulling.  After checking to make sure you are numb, your surgeon will make a horizontal incision very low across your abdomen and will cut through the skin, fat and other tissues layered over the uterine wall.   After moving the muscles of the abdomen aside, your surgeon will make another horizontal incision into the uterine wall, simultaneously breaking the amniotic sac.  At this point, they will deliver the baby's head by pushing on the top of the uterus while manipulating the incision and the head.  After the head is delivered, the rest of the baby is pulled through.  The umbilical cord is then clamped and cut and the baby is handed to the partner, nurse, or pediatrician.  

After the delivery of the baby, the surgeon will administer a shot of pitocin, which is a synthesized version of the naturally occurring hormone oxytocin, to help deliver the placenta as well as to encourage the uterus to start contracting back down to it's pre-pregnancy size.  Once the placenta has been delivered, the surgeon will begin sewing up the incisions to the uterus, abdominal muscles, tissues and skin.  Prior to suturing, an IUD or other means of birth control may be placed if so requested.  

The baby is typically taken to the warming bed for newborn screenings while the surgeon is suturing and will be handed back over to your partner once the pediatrician and their team are satisfied that your baby is in good health.  After you are completely closed up from the surgery, you will be moved to a recovery room.  If you are alert and not shaking too much, uncontrollable shakes are a common side-effect of the anesthesia used for surgery, you can try to initiate some skin-to-skin time with your new baby or even nurse. 

Gentle Cesarean Practices

Provided that the mom and baby are both in good health and a "crash" c-section is not being preformed, there are simple changes to the routine procedures normally followed in the Operating Room (OR) to make your delivery a more natural experience.  Talking with your provider prior to your scheduled procedure will help ensure that you both are on the same page regarding care during delivery and immediately postpartum and will allow you to have realistic expectations for your birth.  It may also help to talk with your anesthesiologist as well, to see what they are or are not willing to do to help you achieve your ideal birth. 

  • Ask that your IV line and blood pressure cuff be placed on your non-dominant arm/hand.  This way your dominant arm is free to hold and touch your baby.
  • Ask that the electrodes be placed along your back and shoulders vs your chest so that you can facilitate immediate skin-to-skin and/or breastfeeding with your baby.
  • Ask if a clear surgical drape can be used and request that the table be elevated once your baby's head has been delivered so that you may watch your baby being born.  
  • Request that the baby be placed on your belly/chest for immediate skin-to-skin time.
  • Request delayed cord clamping.   
  • Request that the baby be left on your chest while the doctor sutures you.  You can also request that all newborn screenings be done on your chest as well. 
  • Delay newborn bath for a minimum of 12hrs postpartum.  Your amniotic fluid smells and tastes like your colostrum.  This scent encourages your baby to latch and suckle at the breast.  
  • Discuss the possibility of vaginal seeding with your provider.  This procedure simply uses a swab of your vaginal secretions that is then swabbed in your baby's nose and mouth, simulating the exposure they would have had during a vaginal delivery.  Studies indicate that this exposure to the mother's vaginal flora and fauna help establish the newborn's gut health and microbiome.  Vaginal seeding is NOT currently recommended by ACOG as most planned cesarean mothers have not had the routine STD and GBS screenings as mothers who were planning on a vaginal delivery.  This risk is mitigated if you a) take the screenings and have negative results and/or b) understand the risks associated with exposure.  

Other Considerations

Many women decide that since they are having a cesarean delivery that they do not need the traditional labor support of a doula or from their partners.  While it is true that you will not experience labor, you ARE going to experience birth - and as such you deserve just as much physical and emotional support as any other mother out there.  A doula can help you consider and become educated about your delivery options, help support you as you advocate for the delivery experience you want, can provide "in the wings" support during your surgery so if an emergency happens with your baby your partner can stay with your newborn and your doula can come and stay with you in the OR and the PACU, can help you hold and care for the baby in the first few hours postpartum while you recover, can aid in initiating breastfeeding if you are too incapacitated from the drugs to do it yourself, and will provide reassurance as well as physical and emotional support for both you and your partner as you recover.  

If you are planning on breastfeeding, consider making a prenatal appointment with a Lactation Consultant or and IBCLC a few weeks prior to delivery.  They can help set you up for the best chance at breastfeeding success after your surgery.  This also establishes a relationship with them in case you need more support after delivery.  

Set yourself up for your postpartum period in the weeks before you deliver.  Your recovery is going to take a little longer than if you had a vaginal delivery.  Ask friends and family to help stock your freezer with meals that can be thawed and thrown in the oven.  Have your partner help you set up nursing and changing stations by comfortable chairs throughout the house, complete with water bottles and snacks for you.  Consider hiring a postpartum doula for the first few weeks postpartum for extra support - not only will she be a welcome extra set of hands to help with the baby, she will also provide you with much needed physical support as you recover as well as encouragement and reassurance as you settle in to your new role as a mother.  

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